June 3, 2016

Renelique v Tri State Consumers Ins. Co. (2016 NY Slip Op 50866(U))

https://www.beynensonlaw.com/case-law/renelique-v-tri-state-consumers-ins-co-2016-ny-slip-op50866u/

Court: Appellate Term, Second Department
Decided: June 3, 2016
Citation: 2016 NY Slip Op 50866(U) · 51 Misc 3d 151(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Fee schedule

Cite as

Renelique v Tri State Consumers Ins. Co., 51 Misc 3d 151(A), 2016 NY Slip Op 50866(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016)

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.

The provider's challenge to the specificity of the insurer's fee schedule denial failed, and its calculation argument was unpreserved. The insurer obtained summary judgment dismissing assigned no-fault claims on the ground that it had fully paid the provider under the workers' compensation fee schedule. Following A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co., the Appellate Term, Second Department, rejected the contention that insufficient particularity in the denial precluded the fee schedule defense. It declined to consider the challenge to the insurer's reimbursement calculation because the provider first raised it on appeal, and affirmed the Civil Court's order.

Reported in New York Official Reports at Renelique v Tri State Consumers Ins. Co. (2016 NY Slip Op 50866(U))

[*1]

Renelique v Tri State Consumers Ins. Co.

2016 NY Slip Op 50866(U) [51 Misc 3d 151(A)]

Decided on June 3, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 3, 2016

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-1709 Q C

Pierre Jean Jacques Renelique, as Assignee of YVON DELGADO, Appellant,
against
Tri State Consumers Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered June 28, 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 in accordance with the workers’ compensation fee schedule. The Civil Court granted defendant’s motion.

Plaintiff’s argument—that defendant is precluded from raising its defense that the fees charged exceeded the amount allowed by the workers’ compensation fee schedule because defendant’s denial of claim form did not set forth this defense with sufficient particularity—lacks merit (see A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co., 39 AD3d 779 [2007]). To the extent plaintiff seeks to challenge defendant’s calculation of the amount plaintiff was entitled to recover pursuant to the workers’ compensation fee schedule, this argument is not properly before this court as it is being raised for the first time on appeal, and we decline to consider it (see Joe v Upper Room Ministries, Inc., 88 AD3d 963 [2011]; Gulf Ins. Co. v Kanen, 13 AD3d 579 [2004]). Consequently, plaintiff has demonstrated no basis to disturb the order.

Accordingly, the order is affirmed.

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

Decision Date: June 03, 2016

Cited in this decision

A label shows how this decision treated the case it cites.

A.B. Med. Servs., PLLC v Liberty Mut. Ins. Co. (2007 NY Slip Op 03636) FollowedAn insurer denying no-fault benefits for lack of medical justification need not include a medical rationale in the prescribed denial form.

Similar decisions

Renelique v Allstate Ins. Co. (2017 NY Slip Op 51141(U))The insurer established proper application of the workers' compensation fee schedule to CPT code 20553, and the provider did not rebut its showing.
Renelique v American Tr. Ins. Co. (2016 NY Slip Op 51526(U))The insurer established fee-schedule reimbursement using assigned relative values, and the provider failed to rebut its calculation.
Harvard Med., P.C. v Tri State Consumers Ins. Co. (2016 NY Slip Op 50860(U))The insurer's summary judgment dismissing the provider's claims on a full-payment fee schedule defense was affirmed.
Renelique v New York Cent. Mut. Fire Ins. Co. (2016 NY Slip Op 50868(U))The insurer's affidavit established timely and proper mailing of the denial based on the assignor's IME nonappearance.
Renelique v State-Wide Ins. Co. (2016 NY Slip Op 50095(U))A default declaratory judgment precludes a no-fault recovery that would impair the rights established by that judgment.