April 25, 2012

W.H.O. Acupuncture, P.C. v AIG Auto Ins. (2012 NY Slip Op 50755(U))

Headnote

The relevant facts considered by the court were that W.H.O. Acupuncture, P.C. was seeking to recover assigned first-party no-fault benefits, but their claim was partially denied by AIG Auto Insurance on the grounds that the unpaid portion exceeded the amount permitted by the workers' compensation fee schedule. The main issue decided was whether AIG's denial of claim forms and explanation of benefit forms were sufficient to apprise the plaintiff of the reasons for the denial. The court held that the denial forms were indeed sufficient, and affirmed the order granting AIG's motion for summary judgment and dismissing the complaint by W.H.O. Acupuncture, P.C. The judgment was subsequently entered, and the court deemed the appeal to have been taken from that judgment.

Reported in New York Official Reports at W.H.O. Acupuncture, P.C. v AIG Auto Ins. (2012 NY Slip Op 50755(U))

W.H.O. Acupuncture, P.C. v AIG Auto Ins. (2012 NY Slip Op 50755(U)) [*1]

W.H.O. Acupuncture, P.C. v AIG Auto Ins.

2012 NY Slip Op 50755(U) [35 Misc 3d 133(A)]

Decided on April 25, 2012

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This opinion is uncorrected and will not be published in the printed Official Reports.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 25, 2012

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

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
.

W.H.O. Acupuncture, P.C. as Assignee of IAN WILLIAMS, Appellant, —
against
AIG Auto Insurance, Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Maureen A. Healy, J.), entered August 20, 2010, deemed from a judgment of the same court entered September 14, 2010 (see CPLR 5501 [c]). The judgment, entered pursuant to the August 20, 2010 order granting defendant’s motion for summary judgment and denying plaintiff’s cross motion for summary judgment, dismissed the complaint.

ORDERED that the judgment is affirmed, with $10 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint and denied its cross motion for summary judgment. A judgment was subsequently entered, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).

Contrary to plaintiff’s sole contention, defendant’s denial of claim forms and the accompanying explanation of benefit forms were sufficient to apprise plaintiff that defendant was partially paying and partially denying its bills on the ground that the unpaid portion exceeded the amount permitted by the workers’ compensation fee schedule. Accordingly, the order is affirmed (see generally Great Wall Acupuncture v GEICO Gen. Ins. Co., 16 Misc 3d 23 [App Term, 2d & 11th Jud Dists 2007]).

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: April 25, 2012