November 9, 2018

Parisien v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51602(U))

https://www.beynensonlaw.com/case-law/parisien-v-state-farm-mut-auto-ins-co-2018-ny-slip-op-51602u/

Court: Appellate Term, Second Department
Decided: November 9, 2018
Citation: 2018 NY Slip Op 51602(U) · 61 Misc 3d 140(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Fee schedule

Cite as

Parisien v State Farm Mut. Auto. Ins. Co., 61 Misc 3d 140(A), 2018 NY Slip Op 51602(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification.

Summary

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

No payment is due for medical service fees exceeding permissible fee-schedule charges under 11 NYCRR 65-3.8 (g) (1) (ii). The provider sought assigned no-fault benefits for services rendered after April 1, 2013, the regulation's effective date under 11 NYCRR 65-3.8 (g) (2). The insurer obtained summary judgment because the amounts sought exceeded the workers' compensation fee schedule. Applying the regulation and Insurance Law § 5108 (a) and (b), the Appellate Term, Second Department, rejected the provider's sole appellate issue concerning the denial form and affirmed the order granting the insurer's motion and denying the provider's cross motion.

Reported in New York Official Reports at Parisien v State Farm Mut. Auto. Ins. Co. (2018 NY Slip Op 51602(U))

[*1]

Parisien v State Farm Mut. Auto. Ins. Co.

2018 NY Slip Op 51602(U) [61 Misc 3d 140(A)]

Decided on November 9, 2018

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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 9, 2018

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

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2016-1242 K C

Jules Francois Parisien, M.D., as Assignee of Ferary Masani, Appellant,
against
State Farm Mutual Automobile Ins. Co., Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Richard T. Lau & Associates (Arthur T. Kontaxis of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Harriet L. Thompson, J.), entered March 30, 2016. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.

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 the amounts plaintiff sought to recover, for services rendered after April 1, 2013, were in excess of the workers’ compensation fee schedule, and denied plaintiff’s cross motion for summary judgment.

Since 11 NYCRR 65-3.8 (g) (1) (ii), effective April 1, 2013 (see 11 NYCRR 65-3.8 [g] [2]), provides that “no payment shall be due for . . . claimed medical services under any circumstances . . . for those claimed medical service fees that exceed the charges permissible pursuant to Insurance Law sections 5108 (a) and (b) and the regulations promulgated thereunder for services rendered by medical providers” (see also Oleg’s Acupuncture, P.C. v Hereford Ins. Co., 58 Misc 3d 151[A], 2018 NY Slip Op 50095[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018]), plaintiff’s sole issue on appeal, regarding defendant’s denial of claim form, is without merit.

Accordingly, the order is affirmed.

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

ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 09, 2018

Cited in this decision

Oleg’s Acupuncture, P.C. v Hereford Ins. Co. (2018 NY Slip Op 50095(U))An insurer need not issue a timely denial to preserve a fee-schedule defense for services rendered on or after April 1, 2013.

Similar decisions

Parisien v 21st Century Ins. Co. (2018 NY Slip Op 51652(U))The insurer established timely mailing of the denial forms asserting lack of medical necessity, defeating the provider's appellate challenge.
Parisien v Tri State Consumers Ins. Co. (2021 NY Slip Op 50728(U))The insurer's unrebutted IME report established a lack of medical necessity for the provider's subsequent services.
Parisien v Allstate Ins. Co. (2019 NY Slip Op 51154(U))The insurer failed to establish timely mailing of its denials, but the provider also failed to establish entitlement to summary judgment.
Parisien v American Ind. Ins. Co. (2019 NY Slip Op 51751(U))The insurer's motion to dismiss the provider's complaint for lack of personal jurisdiction was granted on appeal.
Parisien v Nationwide Ins. (2019 NY Slip Op 51980(U))The insurer's proof raised a presumption that its denial-of-claim forms had been properly mailed.