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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. 2013-2706 Q C
Regular Panel Decision
Sep 19, 2016

NYS Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case, NYS Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., concerned an appeal from an order of the Civil Court of the City of New York, Queens County. The plaintiff, NYS Acupuncture, P.C., sought assigned first-party no-fault benefits from State Farm, which had moved for summary judgment arguing full payment according to the workers' compensation fee schedule. The Civil Court initially granted State Farm's motion. On appeal, NYS Acupuncture, P.C. contended that the fee schedule reductions were improper. The Appellate Term, Second Department, affirmed the prior ruling, finding that State Farm adequately demonstrated it had fully compensated the plaintiff for acupuncture services based on the applicable workers' compensation fee schedule for services performed by chiropractors, referencing Great Wall Acupuncture, P.C. v Geico Ins. Co.

Workers' Compensation Fee ScheduleNo-Fault BenefitsAcupuncture ServicesChiropractorsSummary JudgmentAppellate ReviewInsurance DisputeFee Schedule ReductionAssigned BenefitsMedical Billing
References
1
Case No. 2017-913 K C
Regular Panel Decision
Aug 02, 2019

Oriental Health Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case concerns an appeal initiated by Oriental Health Acupuncture, P.C., acting as the assignee of Carrington, Earnel, against State Farm Mutual Automobile Ins. Co. The appeal originated from an order by the Civil Court of the City of New York, Kings County, which had granted State Farm's motion for summary judgment and dismissed the plaintiff's complaint seeking first-party no-fault benefits. The Civil Court's decision was predicated on the finding that the amounts claimed by the plaintiff exceeded the limits established by the workers' compensation fee schedule. The Appellate Term, Second Department, affirmed the lower court's order. This decision was made in conjunction with a related case, BQE Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., decided concurrently.

No-fault benefitsSummary judgmentAppellate reviewWorkers' compensation fee scheduleAutomobile insuranceFirst-party benefitsMedical provider claimAssigned benefitsCivil Court appealAppellate Term decision
References
1
Case No. MISSING
Regular Panel Decision

United States v. State of New York

The United States sued the State of New York and several state entities, including SBOE, SUNY, and CUNY, alleging violations of the National Voter Registration Act of 1993 (NVRA). The core issue was whether state-funded Disabled Student Services (DSS) offices at public colleges and universities, including SUNY and CUNY campuses and community colleges, must be designated as mandatory voter registration agencies (VRAs) under 42 U.S.C. § 1973gg-5(a)(2)(B). The State defendants argued these offices were not 'primarily engaged' in serving persons with disabilities, and that the NVRA did not apply to them. The Court rejected the defendants' arguments regarding subject matter jurisdiction and the interpretation of the NVRA, citing legislative intent and prior circuit court decisions. The Court concluded that DSS offices at all SUNY and CUNY campuses and their respective community colleges are indeed state-funded programs primarily engaged in providing services to persons with disabilities, and therefore must be designated as mandatory VRAs. The plaintiff's motion for summary judgment was granted.

National Voter Registration Act (NVRA)Voter Registration Agencies (VRAs)Disabled Student Services (DSS)State-funded programsPublic universitiesCommunity collegesFederalismSummary judgmentDeclaratory reliefInjunctive relief
References
24
Case No. 2013-1427 K C
Regular Panel Decision
Jun 03, 2016

Harvard Med., P.C. v. Tri State Consumers Ins. Co.

This is an appeal by Harvard Medical, P.C., as assignee of Lenford Carty, against Tri State Consumers Ins. Co. The appeal is from an order of the Civil Court of the City of New York, Kings County, entered April 12, 2013, which granted the defendant's motion for summary judgment. The defendant argued that it had fully paid the plaintiff in accordance with the workers' compensation fee schedule for first-party no-fault benefits. The Appellate Term, Second Department, affirmed the Civil Court's order, citing a related case, Renelique, as Assignee of Yvon Delgado v Tri State Consumers Ins. Co.

No-fault benefitsSummary JudgmentAppellate ReviewWorkers' Compensation Fee ScheduleAssignee
References
1
Case No. 2011-192 K C
Regular Panel Decision
Dec 19, 2017

Jamaica Dedicated Med. Care, P.C. v. Tri State Consumer Ins. Co.

This case concerns an appeal from an order of the Civil Court of the City of New York, Kings County, which denied defendant Tri State Consumer Ins. Co.'s cross motion for summary judgment. Jamaica Dedicated Medical Care, P.C., as assignee, sought first-party no-fault benefits. Tri State Consumer Ins. Co. contended that it had either properly reimbursed services according to the workers' compensation fee schedule or timely denied others due to lack of medical necessity. The Appellate Term found a triable issue of fact regarding medical necessity and that the defendant failed to establish its workers' compensation fee schedule defense as a matter of law. Consequently, the order denying summary judgment was affirmed.

No-fault benefitsSummary judgmentMedical necessityWorkers' compensation fee scheduleAppellate reviewAssigneeInsurance claimCivil CourtAppellate TermKings County
References
2
Case No. 2017-905 K C
Regular Panel Decision
Aug 02, 2019

BQE Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case involves an appeal by BQE Acupuncture, P.C. against State Farm Mutual Automobile Ins. Co. after the Civil Court granted State Farm's motion for summary judgment and denied BQE Acupuncture's cross-motion. BQE Acupuncture sought to recover assigned first-party no-fault benefits, but State Farm asserted that the amounts claimed exceeded the workers' compensation fee schedule. The Appellate Term, Second Department, affirmed the Civil Court's order. The court reiterated its prior holding that insurers may properly utilize the workers' compensation fee schedule for acupuncture services performed by chiropractors when determining reimbursement for licensed acupuncturists.

No-Fault BenefitsAcupuncture ServicesWorkers' Compensation Fee ScheduleSummary JudgmentAppellate ReviewInsurance DisputeFee ReductionChiropractic ServicesAssigned BenefitsCivil Court Decision
References
2
Case No. 2015-1339 K C
Regular Panel Decision
Dec 19, 2017

GBI Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case concerns an appeal by GBI Acupuncture, P.C. from a Civil Court order granting State Farm Mutual Automobile Ins. Co.'s motion for summary judgment. The Appellate Term found that State Farm's denial of claim forms for the first four causes of action were untimely, thus reversing that portion of the lower court's decision. However, with respect to the fifth through eighth causes of action, the court affirmed State Farm's practice of using the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine payment for licensed acupuncturists. The order was therefore modified by denying summary judgment for the first four causes of action, and otherwise affirmed. The case cites previous rulings on timely verification requests and the application of workers' compensation fee schedules.

No-fault benefitsSummary judgmentTimely denialVerification requestsFee scheduleAcupuncture servicesChiropractorsWorkers' compensation fee scheduleAppellate reviewCivil Court order
References
2
Case No. 2013-1419 K C
Regular Panel Decision
Jun 03, 2016

GBI Acupuncture, P.C. v. Tri State Consumers Ins. Co.

In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint, arguing that it had fully paid plaintiff in accordance with the workers' compensation fee schedule. The Civil Court granted defendant's motion. For the reasons stated in Renelique, as Assignee of Yvon Delgado v Tri State Consumers Ins. Co. (___ Misc 3d ___, 2016 NY Slip Op _____ [appeal No. 2013-1709 Q C], decided herewith), the order is affirmed.

No-fault benefitsSummary judgmentWorkers' compensation fee scheduleAssigneeAppellate TermFirst-party benefitsInsurance disputeCivil CourtKings County
References
1
Case No. 98-CV-1117 (LEK/RWS)
Regular Panel Decision
Oct 09, 1998

Galusha v. NEW YORK STATE DEPT. ENVIRON. CONSERV.

Plaintiffs, individuals with physical disabilities, sued the New York State Department of Environmental Conservation, Adirondack Park Agency, and the State of New York, alleging that their policies in managing the Adirondack Park unfairly limit their access to certain areas in violation of the Americans with Disabilities Act (ADA). They sought a preliminary injunction to allow them to use motorized vehicles on restricted trails. The Court found that the defendants' policy had a disparate impact on disabled persons and that allowing limited, necessary motorized access on roads already used by non-disabled personnel would not fundamentally alter the Park program. Therefore, the Court granted the plaintiffs' motion for a preliminary injunction, mandating access to specific roads for persons with certified mobility impairment disabilities.

Americans with Disabilities ActADAAdirondack ParkEnvironmental ConservationMotorized Vehicle AccessMobility ImpairmentPreliminary InjunctionDisparate ImpactPublic AccommodationsState Government Action
References
27
Case No. 2014-2497 Q C
Regular Panel Decision
Oct 27, 2017

Charles Deng Acupuncture, P.C. v. State Farm Mut. Auto. Ins. Co.

This case involves an appeal by Charles Deng Acupuncture, P.C., as assignee of Blake, Christopher, against State Farm Mutual Automobile Ins. Co. The plaintiff sought summary judgment for unpaid first-party no-fault benefits related to acupuncture services, specifically claims billed under CPT codes 97810, 97811, and 99203. The Civil Court partially granted the plaintiff's motion for a reduced amount on one claim and dismissed the rest, also granting the defendant's cross-motion for dismissal. On appeal, the Appellate Term, Second Department, affirmed the Civil Court's order. The court found that State Farm had timely mailed denial of claim forms and had properly paid the services according to the workers' compensation fee schedule for acupuncture services performed by chiropractors.

no-fault benefitsacupuncture servicesworkers' compensation fee schedulesummary judgmentCPT codesmedical billinginsurance disputeappellate reviewtimely mailingdenial of claim
References
2
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