December 11, 2006

V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52553(U))

https://www.beynensonlaw.com/case-law/v-s-med-servs-p-c-v-new-york-cent-mut-fire-ins-co-2006-ny-slip-op-52553u/

Court: Appellate Term, Second Department
Decided: December 11, 2006
Citation: 2006 NY Slip Op 52553(U) · 14 Misc 3d 134(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Assignments and standing Provider's prima facie case
Legal questions: Claimant's prima facie case on motions (see the maps)

Cite as

V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 134(A), 2006 NY Slip Op 52553(U) (App Term, 2d Dept, 2d & 11th Jud Dists 2006)

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.

A billing provider cannot recover direct assigned no-fault payments for services rendered by independent contractors rather than its employees. Under 11 NYCRR 65-3.11 (a), it is not the provider of those services. Three of the provider's five claim forms identified the treating providers as independent contractors. The remaining forms entered "N/A" for the business relationship, leaving triable issues and failing to establish prima facie entitlement to summary judgment. The Appellate Term, Second Department, affirmed denial of the provider's partial summary judgment motion and passed on no other issue; a separate concurrence agreed only with the result and expressed disagreement with propositions in the cited cases.

Reported in New York Official Reports at V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52553(U))

[*1]

V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co.

2006 NY Slip Op 52553(U) [14 Misc 3d 134(A)]

Decided on December 11, 2006

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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 11, 2006

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT:: PESCE, P.J., GOLIA and BELEN, JJ
2006-31 Q C. NO. 2006-31 Q C

V.S. Medical Services, P.C. A/A/O MIRIAM MALDONADO, Appellant,
against
New York Central Mutual Fire Insurance Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Bernice Daun Siegal, J.), entered September 30, 2005. The order denied plaintiff’s motion for partial summary judgment.

Order affirmed without costs.

In this action to recover first-party no-fault benefits for medical services rendered to its assignor, plaintiff moved for summary judgment. Three of plaintiff’s five claim forms indicate that the treating health care providers were independent contractors. 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 health care 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 insurer (see Boai Zhong Yi Acupuncture Servs. P.C. v Allstate Ins. Co., 12 Misc 3d 137[A], 2006 NY Slip Op 51288[U] [App Term, 2d & 11th Jud Dists]; Rockaway Blvd. Med. P.C. v Progressive Ins., 9 Misc 3d 52 [App Term, 2d & 11th Jud Dists 2005]). The [*2]remaining two claim forms have “N/A” typed in the box in which the business relationship of the treating provider was to be provided. Such lack of specificity does not establish plaintiff’s prima facie entitlement to summary judgment as a matter of law inasmuch as it fails to exclude all triable issues of fact. Accordingly, plaintiff’s motion for partial summary judgment was properly denied.

We pass on no other issue.

Pesce, P.J., and Belen, J., concur.

Golia, J., concurs in a separate memorandum.
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM : 2nd and 11th JUDICIAL DISTRICTS
PRESENT: PESCE, P.J., GOLIA and BELEN, JJ.
V.S. MEDICAL SERVICES, P.C.
A/A/O MIRIAM MALDONADO,
Appellant,

-against-

NEW YORK CENTRAL MUTUAL FIRE INSURANCE CO.,
Respondent.

Golia, J., concurs with the result only, in the following memorandum:

While I agree with the ultimate disposition in the decision reached by the majority, I wish to emphasize that I am constrained to agree with certain propositions of law set forth in cases cited therein which are inconsistent with my prior expressed positions and generally contrary to my views.
Decision Date: December 11, 2006

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.

Claimant's prima facie case on motions

Open the full map

On summary judgment or another pretrial motion, what must a no-fault claimant show to establish its prima facie case?

This decision: Insufficient for another reason (eligibility, timely submission, own papers defeat the claim)

Held the provider did not establish prima facie entitlement because three claim forms showed independent-contractor treating providers and two left the business-relationship box as 'N/A', leaving triable issues about its right to direct payment.

Proof sufficientMailing/receipt not shownOverdue not shownBusiness-record foundation lackingOther element missingThis decisionCites it or cited by itCited or followed

Of the 1,063 decisions on this question in the Second Department courts and the Court of Appeals, 19 (this one included) are in the same category.

Cited in this decision

Boai Zhong Yi Acupuncture Servs. P.C. v Allstate Ins. Co. (2006 NY Slip Op 51288(U))A billing provider cannot recover direct payment of assigned no-fault benefits for services rendered by an independent contractor.
Rockaway Blvd. Med. P.C. v Progressive Ins. (2005 NY Slip Op 25278)A provider's omission of its relationship with the treating physician from claim forms does not defeat its prima facie case.

Cited by

A.M. Med. Servs., P.C. v Progressive Cas. Ins. Co. (2012 NY Slip Op 06902)An insurer's independent contractor defense is subject to preclusion if not asserted in a timely denial of claim.

Similar decisions

V.S. Med. Servs., P.C. v New York Cent. Mut. Ins. (2007 NY Slip Op 51080(U))The provider's summary judgment motion failed because its officer's affidavit did not establish a business-records foundation.
V.S. Med. Servs. P.C. v Allstate Ins. Co. (2007 NY Slip Op 50016(U))A billing provider cannot recover assigned no-fault benefits for services rendered by independent contractors.
A.M. Med. Servs., P.C. v New York Cent. Mut. Ins. (2006 NY Slip Op 51662(U))The insurer proved mailing of one medical necessity denial but failed to prove verification mailing for four other claims.
V.S. Med. Servs., P.C. v Allstate Ins. Co. (2007 NY Slip Op 50400(U))The provider failed to prove claim submission because its corporate officer's affidavit lacked a sufficient business-records foundation.
A.M. Med. Servs., P.C. v Liberty Mut. Ins. Co. (2006 NY Slip Op 51044(U))The provider's W-2 forms did not establish employment when services were rendered by professionals listed as independent contractors.