July 25, 2011
W.H.O. Acupuncture, P.C. v Geico Gen. Ins. Co. (2011 NY Slip Op 51408(U))
https://www.beynensonlaw.com/case-law/w-h-o-acupuncture-p-c-v-geico-gen-ins-co-2011-ny-slip-op51408u/
- Decided
- July 25, 2011
- Citation
- 2011 NY Slip Op 51408(U) · 32 Misc 3d 132(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Issues
- Fee schedule
- Legal questions
- Proving a fee schedule defense (see the maps)
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.
Reported in New York Official Reports at W.H.O. Acupuncture, P.C. v Geico Gen. Ins. Co. (2011 NY Slip Op 51408(U))
| W.H.O. Acupuncture, P.C. v Geico Gen. Ins. Co. |
| 2011 NY Slip Op 51408(U) [32 Misc 3d 132(A)] |
| Decided on July 25, 2011 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports. |
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM: 2nd, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : PESCE, P.J., WESTON and STEINHARDT, JJ
2010-512 Q C.
against
Geico General Ins. Co., Appellant.
Appeal from an order of the Civil Court of the City of New York, Queens County (Cheree A. Buggs, J.), entered December 18, 2009, deemed from a judgment of the same court entered February 18, 2010 (see CPLR 5501 [c]). The judgment, entered pursuant to the December 18, 2009 order granting plaintiff’s motion for summary judgment and denying defendant’s cross motion for summary judgment dismissing the complaint, awarded plaintiff the principal sum of $568.10.
ORDERED that the judgment is reversed, without costs, the order entered December 18, 2009 is vacated, plaintiff’s motion for summary judgment is denied and defendant’s cross motion for summary judgment dismissing the complaint is granted.
In this action to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that defendant had properly reimbursed plaintiff for services rendered by plaintiff’s licensed acupuncturist to plaintiff’s assignor. By order dated December 18, 2009, the Civil Court granted plaintiff’s motion for summary judgment, awarding plaintiff the principal sum of $568.10, and denied defendant’s cross motion for summary judgment dismissing the complaint. Defendant filed a notice of appeal from the order. A judgment awarding plaintiff the principal sum of $568.10 was subsequently entered on February 18, 2010, from which the appeal is deemed to have been taken (see CPLR 5501 [c]).
Subsequent to the entry of the judgment, plaintiff, upon discovering a mathematical error, plaintiff moved to reduce the sum awarded in the December 18, 2009 order to $169.24. By order entered April 28, 2010, the Civil Court (Carmen R. Velasquez, J.) granted that motion. Contrary to plaintiff’s contention on appeal, the entry of the April 28, 2010 order did not affect the appeal from the judgment, which was entered pursuant to the December 18, 2009 order, and has not been amended. We note that the April 28, 2010 order modified the December 18, 2009 order only to the extent of changing the sum awarded. It did not affect the Civil Court’s findings of liability as a matter of law, which are the subject of defendant’s appeal. [*2]
We find that defendant’s cross motion for summary judgment dismissing the complaint should have been granted, as it was proper for defendant to use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which plaintiff was entitled to receive for services rendered by a licensed acupuncturist (see AVA Acupuncture, P.C. v GEICO Gen. Ins. Co., 17 Misc 3d 41 [App Term, 2d & 11th Jud Dists 2007]; Great Wall Acupuncture v GEICO Gen. Ins. Co., 16 Misc 3d 23 [App Term, 2d & 11th Jud Dists 2007]).
We incidentally note that the judgment in this case was improperly prepared and entered by the clerk on his own initiative and that no notice of the entry of the judgment was provided to the parties. Pursuant to CCA 1401, a judgment shall be prepared by a party’s attorney and should be prepared by the clerk only upon the request of an unrepresented party, except in the case of a summary proceeding to recover possession of real property.
Accordingly, the judgment is reversed, the order entered December 18, 2009 is vacated, plaintiff’s motion for summary judgment is denied and defendant’s cross motion for summary judgment dismissing the complaint is granted.
Pesce, P.J., Weston and Steinhardt, JJ., concur.
Decision Date: July 25, 2011
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.
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
Held the insurer properly used the chiropractor acupuncture fee schedule to pay the licensed acupuncturist, so its cross motion dismissing the complaint should have been granted.
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.
Cited in this decision
A label shows how this decision treated the case it cites.
- AVA Acupuncture, P.C. v GEICO Gen. Ins. Co. (2007 NY Slip Op 27371) FollowedAn insurer may use the workers' compensation fee schedule for chiropractors to reimburse acupuncture performed by a licensed acupuncturist.
- Great Wall Acupuncture v GEICO Gen. Ins. Co. (2007 NY Slip Op 27164) FollowedThe insurer properly reimbursed the licensed acupuncturist at chiropractor rates because similar services and licensing requirements supported them.
Similar decisions
- W.H.O. Acupuncture, P.C. v Geico Indem. Co. (2011 NY Slip Op 51530(U))An insurer may reimburse a licensed acupuncturist under the workers' compensation fee schedule for acupuncture performed by chiropractors.
- WJJ Acupuncture, P.C. v Geico Ins. Co. (2011 NY Slip Op 52377(U))The insurer established full payment under the chiropractic acupuncture fee schedule except for the initial visit claim.
- MIA Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 51731(U))The insurer proved full payment of fee schedule claims and raised a medical necessity issue on the remaining acupuncture claims.
- Amercure Acupuncture, P.C. v GEICO Ins. Co. (2010 NY Slip Op 50068(U))An insurer may use the chiropractic acupuncture fee schedule to reimburse services rendered by a licensed acupuncturist.
- Great Wall Acupuncture, P.C. v GEICO Ins. Co. (2009 NY Slip Op 52308(U))The insurer's fee-schedule defense was precluded for one claim because it failed to establish a timely denial of the unpaid balance.