Merrick Med., P.C. v A Cent. Ins. Co. (2019 NY Slip Op 51264(U))

Reported in New York Official Reports at Merrick Med., P.C. v A Cent. Ins. Co. (2019 NY Slip Op 51264(U))

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

Merrick Medical, P.C., as Assignee of Glenda Chin, Respondent,

against

A Central Insurance Company, Appellant.

Gullo & Associates, LLP (Cristina Carollo of counsel), for appellant. Petre and Zabokritsky, P.C., for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Joy F. Campanelli, J.), entered February 15, 2017. The order, insofar as appealed from, denied defendant’s motion for summary judgment dismissing the complaint and, upon denying plaintiff’s cross motion for summary judgment, made, in effect, CPLR 3212 (g) findings in plaintiff’s favor.

ORDERED that the order, insofar as appealed from, is modified by providing that defendant’s motion for summary judgment dismissing the complaint is granted; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint on the ground that the claim seeking to recover the unpaid portion of the bill which had sought to recover the sum of $267.93 was denied on the ground that the fees exceeded the amount permitted by the workers’ compensation fee schedule and that the remaining claims lacked medical necessity. Insofar as is relevant to this appeal, the Civil Court denied defendant’s motion but held, in effect pursuant to CPLR 3212 (g), that the only remaining issues for trial were the reduction of plaintiff’s claims in accordance with the workers’ compensation fee schedule and medical necessity.

As to the claim seeking to recover the unpaid portion of the $267.93 bill, the affidavit of defendant’s litigation examiner was sufficient to demonstrate prima facie that defendant had properly paid that claim pursuant to the workers’ compensation fee schedule. As plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of the $267.93 [*2]claim, the branch of defendant’s motion for summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of this claim should have been granted.

As to the remaining claims, which were denied on the ground of lack of medical necessity, defendant submitted an affirmed peer review report and an affirmed independent medical examination report, each of which set forth a factual basis and medical rationale for the doctors’ determinations that there was a lack of medical necessity for the services at issue. Plaintiff did not rebut defendant’s prima facie showing (see Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2007]; A. Khodadadi Radiology, P.C. v NY Cent. Mut. Fire Ins. Co., 16 Misc 3d 131[A], 2007 NY Slip Op 51342[U] [App Term, 2d Dept, 2d & 11th Jud Dists 2007]). As plaintiff has not challenged the Civil Court’s finding, in effect, that defendant is otherwise entitled to judgment dismissing the complaint insofar as it sought to recover upon these claims, the branches of defendant’s motion seeking summary judgment dismissing these claims should have been granted.

In light of the foregoing, we reach no other issue.

Accordingly, the order, insofar as appealed from, is modified by providing that defendant’s motion for summary judgment dismissing the complaint is granted.

PESCE, P.J., WESTON and ALIOTTA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019
Zen Acupuncture, P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 51262(U))

Reported in New York Official Reports at Zen Acupuncture, P.C. v Ameriprise Ins. Co. (2019 NY Slip Op 51262(U))

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

Zen Acupuncture, P.C., as Assignee of Figueroa Lizzette, Respondent,

against

Ameriprise Insurance Company, Appellant.

Bruno, Gerbino & Soriano, LLP (Nathan M. Shapiro of counsel), for appellant. Law Office of Melissa Betancourt, P.C. (Melissa Betancourt of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Theresa M. Ciccotto, J.), entered March 28, 2017. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.

ORDERED that the order is modified by providing that plaintiff’s cross motion for summary judgment is denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court denying defendant’s motion which had sought summary judgment dismissing the complaint on the ground that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs) and granting plaintiff’s cross motion for summary judgment.

Contrary to defendant’s contention, defendant failed to demonstrate that it was entitled to summary judgment dismissing the complaint based on the failure to appear for EUOs, since the initial EUO request to plaintiff had been sent more than 30 days after defendant had received the claims at issue and, therefore, the requests were nullities as to those claims (see Neptune Med. Care, P.C. v Ameriprise Auto & Home Ins., 48 Misc 3d 139[A], 2015 NY Slip Op 51220[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]; O & M Med., P.C. v Travelers Indem. Co., 47 Misc 3d 134[A], 2015 NY Slip Op 50476[U] [App Term, 2d Dept, 2d, 11th & 13th Jud [*2]Dists 2015]).

Plaintiff’s cross motion for summary judgment should have been denied as the proof submitted by plaintiff failed to establish that the claims had not been timely denied (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).

Accordingly, the order is modified by providing that plaintiff’s cross motion for summary judgment is denied.

PESCE, P.J., WESTON and ALIOTTA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019
Oriental Health Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51261(U))

Reported in New York Official Reports at Oriental Health Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51261(U))

Oriental Health Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51261(U)) [*1]
Oriental Health Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co.
2019 NY Slip Op 51261(U) [64 Misc 3d 141(A)]
Decided on August 2, 2019
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 August 2, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., MICHELLE WESTON, THOMAS P. ALIOTTA, JJ
2017-913 K C
Oriental Health Acupuncture, P.C., as Assignee of Carrington, Earnel, Appellant,

against

State Farm Mutual Automobile Ins. Co., Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Picciano & Scahill, P.C. (David J. Tetlak of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Joy F. Campanelli, J.), entered March 1, 2017. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.

ORDERED that the order is affirmed, with $25 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 on the ground that the amounts plaintiff sought to recover were in excess of the workers’ compensation fee schedule and denied plaintiff’s cross motion for summary judgment.

For the reasons stated in BQE Acupuncture, P.C., as Assignee of Carrington, Earnel v State Farm Mut. Auto. Ins. Co. (___ Misc 3d ___, 2019 NY Slip Op _____ [appeal No. 2017-905 K C], decided herewith), the order is affirmed.

PESCE, P.J., WESTON and ALIOTTA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019
BQE Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51260(U))

Reported in New York Official Reports at BQE Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51260(U))

BQE Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51260(U)) [*1]
BQE Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co.
2019 NY Slip Op 51260(U) [64 Misc 3d 141(A)]
Decided on August 2, 2019
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 August 2, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., MICHELLE WESTON, THOMAS P. ALIOTTA, JJ
2017-905 K C
BQE Acupuncture, P.C., as Assignee of Carrington, Earnel, Appellant,

against

State Farm Mutual Automobile Ins. Co., Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Picciano & Scahill, P.C. (David J. Tetlak of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Richard J. Montelione, J.), entered February 24, 2017. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.

ORDERED that the order is affirmed, with $25 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 on the ground that the amounts plaintiff sought to recover were in excess of the workers’ compensation fee schedule and denied plaintiff’s cross motion for summary judgment.

The proof submitted by defendant in support of its motion was sufficient to give rise to a presumption that the denial of claim forms at issue had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Plaintiff argues that defendant failed to establish that defendant’s fee reductions, which had been done in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors, were proper. However, this court has held, “as a matter of law, that an insurer may use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services” (Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23, 24 [App [*2]Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]).

Accordingly, the order is affirmed.

PESCE, P.J., WESTON and ALIOTTA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51259(U))

Reported in New York Official Reports at Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51259(U))

Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51259(U)) [*1]
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co.
2019 NY Slip Op 51259(U) [64 Misc 3d 141(A)]
Decided on August 2, 2019
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 August 2, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2017-876 K C
Natural Therapy Acupuncture, P.C., as Assignee of Lively, Paul, Respondent,

against

GEICO Ins. Co., Appellant.

Law Office of Goldstein & Flecker (Lawrence J. Chanice of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered December 15, 2016. The order, insofar as appealed from, and as limited by the brief, denied the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims is granted.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. By order entered December 15, 2016, insofar as appealed from as limited by the brief, the Civil Court denied the branch of defendant’s cross motion seeking dismissal of so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims.

For the reasons stated in Natural Therapy Acupuncture, P.C., as Assignee of Boodoo, Anselm Kevin v GEICO Ins. Co. (__ Misc 3d ___, 2019 NY Slip Op _____ [appeal No. 2017-635 K C], decided herewith), the order, insofar as appealed from, is reversed and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims is granted.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51258(U))

Reported in New York Official Reports at Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51258(U))

Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51258(U)) [*1]
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co.
2019 NY Slip Op 51258(U) [64 Misc 3d 141(A)]
Decided on August 2, 2019
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 August 2, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2017-859 K C
Natural Therapy Acupuncture, P.C., as Assignee of Lamarre, Kens, Respondent,

against

GEICO Ins. Co., Appellant.

Law Office of Goldstein & Flecker (Lawrence J. Chanice of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered December 14, 2016. The order, insofar as appealed from and as limited by the brief, denied the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims is granted.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. By order entered December 14, 2016, insofar as appealed from as limited by the brief, the Civil Court denied the branch of defendant’s cross motion seeking dismissal of so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims.

For the reasons stated in Natural Therapy Acupuncture, P.C., as Assignee of Boodoo, Anselm Kevin v GEICO Ins. Co. (__ Misc 3d ___, 2019 NY Slip Op _____ [appeal No. 2017-635 K C], decided herewith), the order, insofar as appealed from, is reversed and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims is granted.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019
Compas Med., P.C. v American Tr. Ins. Co. (2019 NY Slip Op 51257(U))

Reported in New York Official Reports at Compas Med., P.C. v American Tr. Ins. Co. (2019 NY Slip Op 51257(U))

Compas Med., P.C. v American Tr. Ins. Co. (2019 NY Slip Op 51257(U)) [*1]
Compas Med., P.C. v American Tr. Ins. Co.
2019 NY Slip Op 51257(U) [64 Misc 3d 141(A)]
Decided on August 2, 2019
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 August 2, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., MICHELLE WESTON, THOMAS P. ALIOTTA, JJ
2017-847 K C
Compas Medical, P.C., as Assignee of McGarrell, Curtis, Appellant,

against

American Transit Ins. Co., Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Law Office of Daniel J. Tucker, for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Theresa M. Ciccotto, J.), entered January 31, 2017. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 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 denied plaintiff’s motion for summary judgment and granted defendant’s cross motion for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs).

Contrary to plaintiff’s contentions on appeal, defendant established that the EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and that plaintiff’s assignor had failed to appear for the duly scheduled EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). To the extent plaintiff challenges the address to which the EUO scheduling letters were mailed, a review of the record shows that defendant mailed the EUO scheduling letters to the address provided by plaintiff in the bills it sent to defendant.

Accordingly, the order is affirmed.

PESCE, P.J., WESTON and ALIOTTA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51256(U))

Reported in New York Official Reports at Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51256(U))

Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51256(U)) [*1]
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co.
2019 NY Slip Op 51256(U) [64 Misc 3d 141(A)]
Decided on August 2, 2019
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 August 2, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2017-821 K C
Natural Therapy Acupuncture, P.C., as Assignee of Richmord, Jasmaine, Respondent,

against

GEICO Ins. Co., Appellant.

Law Office of Goldstein & Flecker (Lawrence J. Chanice of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered December 15, 2016. The order, insofar as appealed from and as limited by the brief, denied the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims is granted.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. By order entered December 15, 2016, insofar as appealed from as limited by the brief, the Civil Court denied the branch of defendant’s cross motion seeking dismissal of so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims.

For the reasons stated in Natural Therapy Acupuncture, P.C., as Assignee of Boodoo, Anselm Kevin v GEICO Ins. Co. (__ Misc 3d ___, 2019 NY Slip Op _____ [appeal No. 2017-635 K C], decided herewith), the order, insofar as appealed from, is reversed and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims is granted.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019
Acupuncture Now, P.C. v Travelers Ins. Co. (2019 NY Slip Op 51255(U))

Reported in New York Official Reports at Acupuncture Now, P.C. v Travelers Ins. Co. (2019 NY Slip Op 51255(U))

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

Acupuncture Now, P.C., as Assignee of England Andre, Respondent,

against

Travelers Insurance Company, Appellant.

Law Office of Aloy O. Ibuzor (Gini Spiteri of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (John J. Kelley, J.), dated November 18, 2016, deemed from a judgment of that court entered January 3, 2017 (see CPLR 5501 [c]). The judgment, entered pursuant to the November 18, 2016 order denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment, awarded plaintiff the principal sum of $2,626.86.

ORDERED that the judgment is reversed, without costs, so much of the order dated November 18, 2016 as denied the branch of defendant’s motion seeking summary judgment dismissing the third cause of action and granted plaintiff’s cross motion for summary judgment is vacated, that branch of defendant’s motion is granted, and plaintiff’s cross motion 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 denying defendant’s motion which had sought summary judgment dismissing the complaint on the ground that plaintiff had failed to appear for duly scheduled examinations under oath (EUOs) and granting plaintiff’s cross motion for summary judgment.

Contrary to defendant’s contention, to the extent its follow-up requests for verification upon the claims underlying the first and second causes of action also stated that an EUO of plaintiff was needed, the letters were actually delay letters because the letters do not specify the time and place the EUOs would take place (see e.g. A.B. Med. Servs. PLLC v Utica Mut. Ins. Co., 10 Misc 3d 50 [*2][App Term, 2d Dept, 2d & 11th Jud Dists 2005]). As a result, defendant failed to establish that it had issued timely EUO notices with respect to the claims underlying the first and second causes of action.

As to the third cause of action, however, defendant established that proper EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), that defendant’s time to pay or deny this claim was tolled (see ARCO Med. NY, P.C. v Lancer Ins. Co., 34 Misc 3d 134[A], 2011 NY Slip Op 52382[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]), that plaintiff’s assignor had failed to appear for the scheduled EUOs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]) and that the claim was timely denied on that ground (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123). Consequently, the branch of defendant’s motion seeking summary judgment dismissing the third cause of action should have been granted.

Plaintiff’s cross motion for summary judgment should have been denied as the proof submitted by plaintiff failed to establish that the claims underlying the first and second causes of action had not been timely denied (see Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]), or that defendant had issued timely denial of claim forms that were conclusory, vague or without merit as a matter of law (see Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).

Accordingly, the judgment is reversed, so much of the order dated November 18, 2016 as denied the branch of defendant’s motion seeking summary judgment dismissing the third cause of action and granted plaintiff’s cross motion for summary judgment is vacated, that branch of defendant’s motion is granted, and plaintiff’s cross motion is denied.

PESCE, P.J., WESTON and ALIOTTA, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51254(U))

Reported in New York Official Reports at Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51254(U))

Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51254(U)) [*1]
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co.
2019 NY Slip Op 51254(U) [64 Misc 3d 141(A)]
Decided on August 2, 2019
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 August 2, 2019

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


PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2017-635 K C
Natural Therapy Acupuncture, P.C., as Assignee of Boodoo, Anselm Kevin, Respondent,

against

GEICO Ins. Co., Appellant.

The Law Office of Printz & Goldstein (Lawrence J. Chanice of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Devin P. Cohen, J.), entered December 15, 2016. The order, insofar as appealed from and as limited by the brief, denied the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims is granted.

In this action by a provider 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 it had fully paid plaintiff for the services at issue, which had been rendered prior to April 1, 2013. By order entered December 15, 2016, insofar as appealed from as limited by the brief, the Civil Court denied the branch of defendant’s cross motion seeking dismissal of so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims.

Defendant demonstrated that it had timely denied the claims at issue (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]) and that it had properly used the workers’ compensation fee schedule to determine the amount which plaintiff was entitled to receive for the services in question (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App [*2]Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]). As plaintiff failed to rebut defendant’s showing,


the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims should have been granted.

Accordingly, the order, insofar as appealed from, is reversed and the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon the unpaid portion of plaintiff’s claims is granted.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: August 02, 2019