March 30, 2006

Craig Antell, D.O., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50521(U))

https://www.beynensonlaw.com/case-law/craig-antell-d-o-p-c-v-new-york-cent-mut-fire-ins-co-2006-ny-slip-op-50521u/

Court: Appellate Term, First Department
Decided: March 30, 2006
Citation: 2006 NY Slip Op 50521(U) · 11 Misc 3d 137(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Later treatment: Followed in 3 later decisions (see Cited by)
Issues: Fraudulent incorporation (Mallela)

Cite as

Craig Antell, D.O., P.C. v New York Cent. Mut. Fire Ins. Co., 11 Misc 3d 137(A), 2006 NY Slip Op 50521(U) (App Term, 1st Dept 2006)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

A billing provider cannot receive assigned no-fault benefits for services performed by an independent contractor rather than itself or its employees. The Appellate Term, First Department, affirmed summary judgment dismissing the provider's complaint in favor of the insurer. Under 11 NYCRR 65-3.11 (a), direct payment upon assignment is available to providers of health care services. The unrefuted evidence established that an independent physician, rather than the billing provider or its employees, performed the services. The court therefore concluded that the billing entity was not a provider authorized to bill for those services under the no-fault law.

Reported in New York Official Reports at Craig Antell, D.O., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 50521(U))

[*1]

Craig Antell, D.O., P.C. v New York Cent. Mut. Fire Ins. Co.

2006 NY Slip Op 50521(U) [11 Misc 3d 137(A)]

Decided on March 30, 2006

Appellate Term, First Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on March 30, 2006

APPELLATE TERM OF THE SUPREME COURT, FIRST DEPARTMENT

PRESENT: June 2005 Term DAVIS, SCHOENFELD, JJ
.

Craig Antell, D.O., P.C., as Assignee of Jeannette Hanlon, Plaintiff-Appellant, No. 570002/05
against
New York Central Mutual Fire Insurance Company, Defendant-Respondent.

Plaintiff appeals from an order of the Civil Court, New York County (Donna G. Recant, J.), entered January 29, 2004, which granted defendant summary judgment dismissing the complaint.

PER CURIAM:

Order (Donna G. Recant), entered January 29, 2004, affirmed, without costs.

In this action to recover no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that the health care services were not provided by the plaintiff or its employees, but by an independent contractor. Civil Court granted defendant’s motion. We affirm.

Insurance Department regulation 11 NYCRR 65-3.11 (a) (formerly 11 NYCRR 65.15[j][1]) provides, in relevant part, for the payment of no-fault benefits “directly to the applicant . . . or upon assignment by the applicant . . . [to] the providers of health care services . . . .” Where such services are not performed by the billing provider or its employees, but by a treating provider who is an independent contractor, the billing provider is not entitled to direct payment of assigned no-fault benefits under 11 NYCRR 65-3.11(a) (see New York Insurance General Counsel Opinion No. 05-03-21 [2005] and Opinion No. 01-02-13 [2001]; see also A.B. Medical Services PLLC v Liberty Mutual Ins. Co., 9 Misc 3d 36 [2005]).

The unrefuted evidence establishes that the health care services for which plaintiff seeks no-fault benefits were performed by a treating physician who was an independent contractor, not plaintiff’s employee. Accordingly, plaintiff is not properly considered a “provider” authorized to bill under the no-fault law.

This constitutes the decision and order of the court.
Decision Date: March 30, 2006

Cited in this decision

A.B. Med. Servs. PLLC v Liberty Mut. Ins. Co. (2005 NY Slip Op 25277)A billing provider cannot recover assigned no-fault benefits directly for services rendered by an independent contractor.

Cited by

A label shows how the later decision treated this one.

Health & Endurance Med. P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51191(U)) FollowedA billing provider cannot recover assigned no-fault benefits for services rendered by an independent contractor rather than its employees.
Aetna Health Plans v Hanover Ins. Co. (2014 NY Slip Op 02541) FollowedA health insurer cannot recover no-fault benefits as an injured claimant's assignee under 11 NYCRR 65-3.11 (a).
State Farm Mut. Auto. Ins. Co. v Farescal (2009 NY Slip Op 50937(U)) FollowedA medical provider cannot recover assigned no-fault benefits for services rendered by independent contractors rather than by it or its employees.
A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co. (2012 NY Slip Op 06902)An insurer's independent contractor defense is subject to preclusion if not asserted in a timely denial of claim.
Boai Zhong Yi Acupuncture Servs. P.C. v Allstate Ins. Co. (2006 NY Slip Op 51288(U))A billing provider cannot recover direct payment of assigned no-fault benefits for services rendered by an independent contractor.
Health & Endurance Med., P.C. v Liberty Mut. Ins. Co. (2008 NY Slip Op 50864(U))A billing provider cannot recover direct payment of assigned no-fault benefits for services rendered by an independent contractor.
V.S. Med. Servs. P.C. v Allstate Ins. Co. (2007 NY Slip Op 50016(U))A billing provider cannot recover assigned no-fault benefits for services rendered by independent contractors.

Similar decisions

A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co. (2005 NYSlipOp 51111(U))A billing provider cannot recover assigned no-fault benefits for services performed by an independent contractor rather than by it or its employees.
V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52553(U))A billing provider cannot recover direct assigned no-fault payments for services rendered by independent contractors rather than its employees.
A.B. Med. Servs., PLLC v New York Cent. Mut. Fire Ins. Co. (2009 NY Slip Op 50331(U))The insurer's evidence established a founded belief that the assignors' injuries did not arise from an insured incident.
Andrew Carothers, M.D., P.C. v New York Cent. Mut. Fire Ins. Co. (2007 NY Slip Op 51613(U))The insurer's opposition raised a triable issue on lack of medical necessity, defeating the provider's summary judgment motion.
New York Diagnostic Med. Care, P.C. v GEICO Cas. Ins. Co. (2012 NY Slip Op 52409(U))The provider's billing affidavit failed to establish overdue claims or timely denials that were legally deficient.