November 9, 2018

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

Headnote

The court considered a case in which a provider was seeking to recover assigned first-party no-fault benefits. The main issue was whether the amounts the provider sought to recover for services rendered after April 1, 2013 exceeded the workers' compensation fee schedule. The court decided that since 11 NYCRR 65-3.8 (g) (1) (ii), effective April 1, 2013, provides that no payment shall be due for services that exceed the charges permissible under Insurance Law sections 5108 (a) and (b) and the regulations promulgated thereunder, the provider's claim was without merit. Therefore, the court affirmed the order that granted the defendant's motion for summary judgment dismissing the complaint and denied the plaintiff's cross motion for summary judgment.

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

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This opinion is uncorrected and will not be published in the printed Official Reports.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