December 19, 2017

Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co. (2017 NY Slip Op 51792(U))

Headnote

The court considered the fact that the defendant had fully paid the plaintiff for the services at issue in accordance with the workers' compensation fee schedule. The main issue decided was whether the proof submitted by the defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim form had been properly mailed and to demonstrate that it had properly used the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive for the services at issue. The holding of the case was that the order granting the defendant's motion for summary judgment dismissing the complaint was affirmed, with the court stating that the proof submitted by the defendant was sufficient to demonstrate that it had properly used the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive for the services at issue.

Reported in New York Official Reports at Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co. (2017 NY Slip Op 51792(U))

Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co. (2017 NY Slip Op 51792(U)) [*1]

Easy Care Acupuncture, P.C. v 21 Century Advantage Ins. Co.

2017 NY Slip Op 51792(U) [58 Misc 3d 134(A)]

Decided on December 19, 2017

Appellate Term, Second 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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 19, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2015-232 K C

Easy Care Acupuncture, P.C., as Assignee of Gary Patterson, Appellant,
against
21 Century Advantage Ins. Co., Respondent.

Gary Tsirelman, P.C. (Joseph Padrucco, Esq.), for appellant. Law Offices of Buratti, Rothenberg & Burns (Leslie A. Eyma, Jr., Esq.), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered October 27, 2014. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule.

Contrary to plaintiff’s contention, the proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim form had been properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and to demonstrate that it had properly used the workers’ compensation fee schedule to determine the amount which plaintiff was entitled to receive for the services at issue.

Accordingly, the order is affirmed.

PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 19, 2017