CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. 2017-407 K C
Regular Panel Decision
Jul 12, 2019

Apple Massage Therapy, P.C. v. 21st Century Ins. Co.

This case concerns an appeal by Apple Massage Therapy, P.C., as an assignee, against 21st Century Ins. Co. The plaintiff sought to recover assigned first-party no-fault benefits. The appeal challenged an order from the Civil Court of the City of New York, Kings County, which had granted the defendant's motion for summary judgment, thereby dismissing the complaint. The appellate court found that the defendant adequately demonstrated the proper mailing of denial of claim forms and the correct application of the workers' compensation fee schedule for determining benefits. Consequently, the appellate court affirmed the Civil Court's order.

No-Fault BenefitsSummary JudgmentAppellate ReviewDenial of ClaimWorkers' Compensation Fee ScheduleInsurance LawCivil ProcedureAssignee ClaimMailing PresumptionMedical Provider
References
1
Case No. 2015-1076 K C
Regular Panel Decision
Dec 19, 2017

Shirom Acupuncture, P.C. v. 21st Century Natl. Ins. Co.

This case involves an appeal by Shirom Acupuncture, P.C., as assignee of Amalia Madera, against 21st Century National Ins. Co. The plaintiff sought to recover assigned first-party no-fault benefits, appealing an order from the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment dismissing the complaint. The defendant argued it had fully paid the plaintiff according to the workers' compensation fee schedule. The Appellate Term affirmed the order, concluding that the defendant provided sufficient proof of mailing the denial of claim forms and finding the plaintiff's other contention without merit.

No-Fault BenefitsWorkers' Compensation Fee ScheduleSummary JudgmentDenial of Claim FormsFirst-Party BenefitsAppellate ReviewCivil CourtInsurance LawKings County
References
1
Case No. 2014-2010 Q C
Regular Panel Decision
Sep 22, 2017

Charles Deng Acupuncture, P.C. v. 21st Century Ins. Co.

The case *Charles Deng Acupuncture, P.C. v 21st Century Ins. Co.*, decided on September 22, 2017, by the Appellate Term, Second Department, involved an appeal concerning first-party no-fault benefits. The plaintiff-appellant, Charles Deng Acupuncture, P.C., challenged an order from the Civil Court that denied its motion for summary judgment and granted the defendant-respondent's cross-motion for summary judgment and to compel disclosure. The Appellate Term affirmed the lower court's decision, finding that the plaintiff failed to establish its prima facie entitlement to summary judgment regarding claim denials. The court also affirmed that insurers may use the workers' compensation fee schedule for acupuncture services by chiropractors to determine payments for licensed acupuncturists and upheld the defendant's right to discovery due to the plaintiff's untimely objections.

no-fault insurancesummary judgmentacupuncture servicesCPT codesworkers' compensation fee schedulediscovery disputeappellate reviewmedical billinginsurance claimstimely denial
References
7
Case No. 2015-232 K C
Regular Panel Decision
Dec 19, 2017

Easy Care Acupuncture, P.C. v. 21 Century Advantage Ins. Co.

In this action, Easy Care Acupuncture, P.C., acting as an assignee, sought to recover first-party no-fault benefits from 21 Century Advantage Ins. Co. The plaintiff appealed an order from the Civil Court of the City of New York, Kings County, which granted the defendant's motion for summary judgment, dismissing the complaint. The defendant successfully argued that it had fully paid the plaintiff for the services according to the workers' compensation fee schedule. The Appellate Term affirmed the order, finding that the defendant's proof was sufficient to establish proper mailing of the denial of claim form and the correct application of the workers' compensation fee schedule.

No-Fault BenefitsSummary JudgmentWorkers' Compensation Fee ScheduleAppellate TermFirst-Party BenefitsDenial of Claim FormInsurance DisputeAssigned BenefitsCivil CourtAcupuncture Services
References
1
Case No. 2015-1088 K C
Regular Panel Decision
Feb 08, 2017

Healthy Way Acupuncture, P.C. v. 21st Century Indem. Ins. Co.

In this no-fault benefits case, Healthy Way Acupuncture, P.C., as assignee of Erole Isma, appealed an order granting summary judgment to 21st Century Indemnity Ins. Co. The Appellate Term affirmed the Civil Court's decision, which dismissed the complaint. The plaintiff argued that the defendant's motion for summary judgment was untimely and that the defendant's submitted automobile insurance policy lacked a proper certificate of conformity. The Appellate Term found the motion timely, noting that the initial service was within the statutory period, and determined that the absence of a certificate of conformity was a non-fatal defect, as the plaintiff demonstrated no prejudice. Consequently, the court upheld the defendant's right to deduct a $200 personal injury protection deductible from the payments to the plaintiff.

Summary JudgmentNo-Fault BenefitsInsurance DeductibleTimeliness of MotionCertificate of ConformityAppellate ReviewCivil ProcedureKings County Civil CourtAssigned BenefitsAutomobile Insurance
References
9
Case No. 2015-608 Q C
Regular Panel Decision
Dec 19, 2017

Adelaida Physical Therapy, P.C. v. 21st Century Ins. Co.

In this case, Adelaida Physical Therapy, P.C., acting as an assignee, appealed an order from the Civil Court of the City of New York, Queens County. The original order had granted 21st Century Insurance Company's motion for summary judgment, dismissing parts of a complaint seeking first-party no-fault benefits for services billed under specific CPT codes (97010, 97110, and 97124). The Appellate Term, Second Department, reversed the lower court's decision. The appellate court found that 21st Century Insurance Company failed to demonstrate that it had used the correct conversion factor to calculate the reimbursement rate, thus not establishing its defense that the charged fees exceeded the workers' compensation fee schedule. As a result, the branches of the defendant's motion for summary judgment related to those CPT codes were denied.

No-Fault BenefitsCPT CodesSummary JudgmentWorkers' Compensation Fee ScheduleReimbursement RateAppellate ReviewInsurance DisputeCivil ProcedureConversion FactorMedical Billing
References
2
Case No. 2016-2075 K C
Regular Panel Decision
Nov 16, 2018

UGP Acupuncture, P.C. v. 21st Century Ins. Co.

UGP Acupuncture, P.C., as the assignee of Santana, Nicole, appealed an order from the Civil Court that granted summary judgment to 21st Century Insurance Company. The action sought to recover first-party no-fault benefits. The defendant had dismissed the complaint, arguing that the amounts claimed for acupuncture services after April 1, 2013, exceeded the workers' compensation fee schedule. The Appellate Term affirmed the Civil Court's decision, reiterating its prior holding that insurers may lawfully use the workers' compensation fee schedule for acupuncture services, even if performed by a licensed acupuncturist rather than a chiropractor. Therefore, the order granting summary judgment to the insurer was affirmed.

No-fault benefitsacupuncture servicesworkers' compensation fee schedulesummary judgmentappellate reviewinsurance lawmedical billingfee reduction
References
1
Case No. 2014-827 Q C
Regular Panel Decision
Sep 22, 2017

Compas Med., P.C. v. 21st Century Ins. Co.

This case involves an appeal from an order of the Civil Court regarding a provider's action to recover assigned first-party no-fault benefits. Plaintiff, Compas Medical, P.C., sought summary judgment, while defendant, 21st Century Insurance Company, cross-moved for summary judgment to dismiss several causes of action. The Appellate Term modified the Civil Court's order by denying the defendant's cross-motion to dismiss the fourth cause of action, noting the defendant's failure to establish a timely denial. However, the plaintiff also failed to prove entitlement to summary judgment on this claim. The court affirmed the dismissal of the first and fifth causes of action, finding that the defendant had adequately paid for services according to the workers' compensation fee schedule. A triable issue of fact was identified concerning whether the defendant received the claims for the remaining causes of action.

No-fault benefitsSummary judgmentTimely denialFee schedule defenseWorkers' compensationAppellate reviewCivil Court orderCauses of actionInsurance claimsProcedural appeal
References
5
Case No. 2016-334 S C
Regular Panel Decision
Apr 27, 2017

2 & 9 Acupuncture, P.C. v. 21st Century Advantage Ins. Co.

This case concerns an appeal by 2 & 9 Acupuncture, P.C. from an amended order that granted summary judgment to 21st Century Advantage Insurance Company, dismissing a complaint to recover assigned first-party no-fault benefits. The defendant argued it had paid the plaintiff in accordance with the workers' compensation fee schedule. The Appellate Term, Second Department, reversed the lower court's decision, finding that the defendant failed to prima facie demonstrate proper denial of payment for services billed under CPT codes 97026 and 97016. Consequently, the defendant's motion for summary judgment regarding these specific CPT codes was denied.

No-Fault BenefitsSummary JudgmentCPT CodesWorkers' CompensationAppellate ReviewInsurance LawMedical BillingAcupunctureSuffolk CountyPayment Dispute
References
3
Case No. 2016-1722 K C
Regular Panel Decision
Mar 08, 2019

Parisien v. 21st Century Ins. Co.

In this case, Jules Francois Parisien, M.D., as assignee of Elvis Gregoine, appealed an order from the Civil Court concerning first-party no-fault benefits against 21st Century Insurance Company. The Civil Court had denied plaintiff's motion for summary judgment and granted defendant's cross-motion, dismissing several causes of action. The Appellate Term modified the Civil Court's order, denying the branches of defendant's cross-motion that sought summary judgment dismissing the second and fifth causes of action. The court found a triable issue of fact regarding the timely mailing of the claim form for the second cause of action and deemed a follow-up EUO scheduling letter for the fifth cause of action untimely. Consequently, the original order was affirmed as modified, without costs.

No-Fault BenefitsSummary JudgmentAppellate ReviewTimely MailingExamination Under OathInsurance CoverageProcedural ComplianceAssignee RightsClaim DenialCivil Court Appeal
References
8
Showing 1-10 of 449 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational