April 27, 2017

Spineisland for Chiropractic, P.C. v 21st Century Advantage Ins. Co. (2017 NY Slip Op 50598(U))

Headnote

The court considered a motion for summary judgment in a case where a provider was seeking to recover assigned first-party no-fault benefits from an insurance company. The insurance company argued that it had paid the provider for the services at issue in accordance with the workers' compensation fee schedule. The provider contested this, specifically disputing the application of a certain CPT code to the services billed. The main issue was whether the insurance company had properly applied the CPT code to the services billed by the provider, and whether there was a triable issue of fact in relation to this. The court held that the insurance company had sufficiently demonstrated, prima facie, that it had properly applied the CPT code to the services billed by the provider, and that the provider failed to raise a triable issue of fact in this regard. As a result, the court affirmed the order granting the insurance company's motion for summary judgment.

Reported in New York Official Reports at Spineisland for Chiropractic, P.C. v 21st Century Advantage Ins. Co. (2017 NY Slip Op 50598(U))

Spineisland for Chiropractic, P.C. v 21st Century Advantage Ins. Co. (2017 NY Slip Op 50598(U)) [*1]

Spineisland for Chiropractic, P.C. v 21st Century Advantage Ins. Co.

2017 NY Slip Op 50598(U) [55 Misc 3d 141(A)]

Decided on April 27, 2017

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This opinion is uncorrected and will not be published in the printed Official Reports.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 April 27, 2017

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS

PRESENT: : ANTHONY MARANO, P.J., JERRY GARGUILO, JAMES V. BRANDS, JJ.
2016-329 S C

Spineisland For Chiropractic, P.C., as Assignee of Naudia Tiwari, Appellant,
against
21st Century Advantage Insurance Company, Respondent.

Law Office of Gabriel & Shapiro, LLC (Steven F. Palumbo, Esq.), for appellant. Law Office of Bryan M. Rothenberg (Deepak D. Sohi, Esq.), for respondent.

Appeal from an order of the District Court of Suffolk County, Third District (C. Stephen Hackeling, J.), dated December 23, 2015. The order, insofar as appealed from as limited by the brief, granted the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under CPT code 95831.

ORDERED that the order, insofar as appealed from, is affirmed, without 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 paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule. In an order dated December 23, 2015, the District Court granted defendant’s motion in its entirety. On appeal, plaintiff argues that the District Court should have denied the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under CPT code 95831.

Contrary to plaintiff’s argument, defendant sufficiently demonstrated, prima facie, that it had properly applied CPT code 95833 to the services that had been billed by plaintiff under CPT code 95831, and plaintiff failed to raise a triable issue of fact with respect thereto (see Sama Physical Therapy, P.C. v American Tr. Ins. Co., 53 Misc 3d 129[A], 2016 NY Slip Op 51359[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]).

Accordingly the order, insofar as appealed from, is affirmed.

Marano, P.J., Garguilo and Brands, JJ., concur.

Decision Date: April 27, 2017