January 2, 2007

V.S. Med. Servs. P.C. v Allstate Ins. Co. (2007 NY Slip Op 50016(U))

Headnote

The court considered the fact that V.S. Medical Services P.C. was seeking to recover first-party no-fault benefits for medical services rendered to its assignor in the sum of $3,836.20. The main issue decided was whether a billing provider is entitled to recover "direct payment" of assigned no-fault benefits from the defendant insurer when the medical services were not rendered by the billing provider or its employees, but by an independent contractor treating provider. The court held that under the circumstances of the case, where the claim form stated that the treating professionals were independent contractors, the billing provider was not entitled to recover "direct payment" of assigned no-fault benefits, and the denial of plaintiff's motion for summary judgment was affirmed.

Reported in New York Official Reports at V.S. Med. Servs. P.C. v Allstate Ins. Co. (2007 NY Slip Op 50016(U))

V.S. Med. Servs. P.C. v Allstate Ins. Co. (2007 NY Slip Op 50016(U)) [*1]

V.S. Med. Servs. P.C. v Allstate Ins. Co.

2007 NY Slip Op 50016(U) [14 Misc 3d 130(A)]

Decided on January 2, 2007

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This opinion is uncorrected and will not be published in the printed Official Reports.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 January 2, 2007

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT:: PESCE, P.J., WESTON PATTERSON and BELEN, JJ
2006-150 Q C.

V.S. Medical Services P.C. a/a/o Susana Jimenez, Appellant,
against
Allstate Insurance Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Anna Culley, J.), entered June 6, 2005. The order denied plaintiff’s motion for summary judgment.

Order affirmed without costs.

Plaintiff commenced the instant action seeking to recover first-party no-fault benefits for medical services rendered to its assignor in the sum of $3,836.20. Where a billing provider seeks to recover no-fault benefits for services which were not rendered by it or its employees, but rather by a treating provider who is an independent
contractor, it is not a “provider” of the medical services rendered within the meaning of 11 NYCRR 65-3.11 (a) and is therefore not entitled to recover “direct payment” of assigned no-fault benefits from the defendant insurer (Health & Endurance Med. P.C. v State Farm Mut. Auto. Ins. Co., 12 Misc 3d 134[A], 2006 NY Slip Op 51191[U] [App Term, 2d & 11th Jud Dists]; Craig Antell, D.O., P.C. v New York Cent. Mut. Fire Ins. Co., 11 Misc 3d 137[A], 2006 NY Slip Op 50521[U] [App Term, 1st Dept]; A.B. Med. Servs. PLLC v Liberty Mut. Ins. Co., 9 Misc 3d 36 [App Term, 2d & 11th Jud Dists 2005]; A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co., 8 Misc 3d 132[A], 2005 NY Slip Op 51111[U] [App Term, 2d & 11th Jud Dists]). In the case at bar, plaintiff’s claim form states that the treating professionals were independent contractors. Under the circumstances, plaintiff’s motion for summary judgment was properly denied.

Pesce, P.J., Weston Patterson and Belen, JJ., concur.
Decision Date: January 2, 2007