June 3, 2016

Renelique v Tri State Consumers Ins. Co. (2016 NY Slip Op 50867(U))

https://www.beynensonlaw.com/case-law/renelique-v-tri-state-consumers-ins-co-2016-ny-slip-op50867u/

Court: Appellate Term, Second Department
Decided: June 3, 2016
Citation: 2016 NY Slip Op 50867(U) · 51 Misc 3d 151(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Fee schedule
Legal questions: Proving a fee schedule defense (see the maps)

Cite as

Renelique v Tri State Consumers Ins. Co., 51 Misc 3d 151(A), 2016 NY Slip Op 50867(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 insurer's summary judgment dismissing the provider's claims on a full-payment fee schedule defense was affirmed. The Appellate Term, Second Department, upheld the Civil Court's order for the reasons stated in the companion appeal decided the same day, No. 2013-1709 Q C, after the insurer asserted full payment under the workers' compensation fee schedule.

Reported in New York Official Reports at Renelique v Tri State Consumers Ins. Co. (2016 NY Slip Op 50867(U))

[*1]

Renelique v Tri State Consumers Ins. Co.

2016 NY Slip Op 50867(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This opinion is uncorrected and will not be published in the printed Official Reports.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.
2013-1714 Q C

Pierre Jean Jacques Renelique, as Assignee of MANENDRA BHAGWANDIN, 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.

For the reasons stated in Renelique, as Assignee of Yvon Delgado v Tri State Consumers Ins. Co. (___ Misc 3d ___, 2016 NY Slip Op ___ [appeal No. 2013-1709 Q C], decided herewith), the order is affirmed.

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

Decision Date: June 03, 2016

Legal questions

A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Proving a fee schedule defense

Open the full map

Did the insurer prove that the amount billed exceeded the applicable workers’ compensation fee schedule?

This decision: Insurer proved the billed amount exceeded the applicable fee schedule

Upheld summary judgment for the insurer on its showing that it had fully paid the provider under the workers' compensation fee schedule, for the reasons given in the companion appeal.

Excess shownNot established; openDefense rejectedSplit by chargeThis decision

Of the 284 decisions on this question in the Second Department courts and the Court of Appeals, 146 (this one included) are in the same category.

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.
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 American Tr. Ins. Co. (2016 NY Slip Op 51546(U))The insurer's motion for summary judgment dismissing the provider's claims as premature for outstanding verification was denied on appeal.
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 National Liab. & Fire Ins. Co. (2016 NY Slip Op 51528(U))The insurer's cross motion for summary judgment based on the assignor's failure to attend scheduled IMEs was granted and affirmed.