September 19, 2016

NYS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51362(U))

Headnote

The relevant facts of this case involve a dispute between NYS Acupuncture, P.C. as the assignee of Barbara Greene and State Farm Mutual Automobile Insurance Co. The issue in question was whether State Farm had fully paid NYS Acupuncture, P.C. for the services provided in accordance with the workers' compensation fee schedule. The Civil Court granted State Farm's motion for summary judgment dismissing the complaint. The main issue in this case was whether State Farm had demonstrated that it had fully paid NYS Acupuncture, P.C. for the services at issue in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The holding of the court was that an insurer may use the workers' compensation fee schedule for acupuncture services to determine the amount which a licensed acupuncturist is entitled to receive, and that State Farm had indeed fully paid for the services.

Reported in New York Official Reports at NYS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51362(U))

NYS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2016 NY Slip Op 51362(U)) [*1]

NYS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co.

2016 NY Slip Op 51362(U) [53 Misc 3d 130(A)]

Decided on September 19, 2016

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This opinion is uncorrected and will not be published in the printed Official Reports.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 September 19, 2016

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-2706 Q C

NYS Acupuncture, P.C., as Assignee of BARBARA GREENE, Appellant,
against
State Farm Mutual Automobile Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered November 20, 2013. 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, defendant moved for summary judgment dismissing the complaint, arguing that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule. The Civil Court granted defendant’s motion.

Plaintiff argues on appeal, as it did in the Civil Court, that defendant failed to establish that its fee schedule reductions were proper. We disagree and find that defendant demonstrated that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23, 24 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009] [“we hold, as a matter of law, that an insurer may use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services”]).

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: September 19, 2016