September 13, 2012

Ying E. Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51805(U))

Headnote

The relevant facts considered in this case were that defendant, GEICO Ins. Co., denied the plaintiff's claims for no-fault benefits on the grounds that the claims exceeded the amount permitted by the workers' compensation fee schedule. The main issue decided in this case was whether or not the denial of the claims by the defendant was proper. The Court held that the denial of the claims by the defendant was proper, as they had sufficiently established the timely mailing of the denial of claim forms and had used the workers' compensation fee schedule to determine the amount the plaintiff was entitled to receive. Therefore, the Court reversed the order granting the plaintiff's motion for summary judgment and denied the motion.

Reported in New York Official Reports at Ying E. Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51805(U))

Ying E. Acupuncture, P.C. v GEICO Ins. Co. (2012 NY Slip Op 51805(U)) [*1]

Ying E. Acupuncture, P.C. v GEICO Ins. Co.

2012 NY Slip Op 51805(U) [36 Misc 3d 158(A)]

Decided on September 13, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 September 13, 2012

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

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
2007-1156 K C.

Ying Eastern Acupuncture, P.C. as Assignee of LATOYA WYCHE-IRABOR, Respondent, —
against
GEICO Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Sylvia G. Ash, J.), dated April 25, 2007. The order granted plaintiff’s motion for summary judgment.

ORDERED that the order is reversed, without costs, and plaintiff’s motion for summary judgment is denied.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court which granted plaintiff’s motion for summary judgment. In opposition to plaintiff’s motion, defendant submitted an affidavit by its claims division employee which sufficiently established the timely mailing of the denial of claim forms (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). The claims were denied on the ground that the claims exceeded the amount permitted by the workers’ compensation fee schedule, and that defendant had fully paid plaintiff for the services billed for in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors. An affidavit by another of defendant’s claims division employees established that defendant had properly used the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which [*2]plaintiff was entitled to receive for the services at issue (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d, 11th & 13th Jud Dists 2009]). Accordingly, the order is reversed and plaintiff’s motion for summary judgment is denied.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: September 13, 2012