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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. 2015-1094 K C
Regular Panel Decision
Dec 22, 2017

V.S. Care Acupuncture, P.C. v. NY Cent. Mut. Fire Ins. Co.

This case involves an appeal brought by NY Central Mutual Fire Ins. Co. against V.S. Care Acupuncture, P.C., an assignee, concerning first-party no-fault benefits. The defendant appealed an order from the Civil Court that denied its motion for summary judgment to dismiss claims for services rendered between October 2009 and February 2010. The Appellate Term found that the defendant had properly mailed denial of claim forms and established that the amounts sought by the plaintiff exceeded the applicable workers' compensation fee schedule. Consequently, the Appellate Term reversed the lower court's order and granted the defendant's motion for summary judgment, dismissing the relevant parts of the complaint.

No-Fault BenefitsSummary JudgmentAppellate ReviewFee Schedule DefenseDenial of ClaimWorkers' Compensation Fee ScheduleInsurance LawFirst-Party BenefitsAssignee RightsCivil Court Order
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
May 05, 2000

Pain Resource Center v. Travelers Insurance

This case addresses a dispute regarding the payment of first-party no-fault benefits to a health provider, Pain Resource Center, as the assignee of John Hiotis, who was injured in an auto accident. The defendant, Travelers Ins. Co., challenged the validity of the assignment and the necessity of the medical services provided. The court affirmed the validity of the assignment under New York's Insurance Law and related regulations. However, based on conflicting expert testimonies, the court limited the compensable medical services to six hours and awarded the plaintiff $566.10, along with statutory interest and attorney's fees.

No-Fault InsuranceFirst-Party BenefitsAssignment ValidityMedical ServicesPeer ReviewInsurance LawHealth Provider ClaimAutomobile AccidentDamagesStatutory Interpretation
References
5
Case No. MISSING
Regular Panel Decision

Travelers Insurance v. Nory Construction Co.

Plaintiff Travelers Insurance Company initiated a subrogation action against Nory Construction Co., Inc. to recover over $3.5 million paid to satisfy a judgment against its insured, the State of New York, following a construction accident. Travelers sought common-law indemnification, arguing Nory was entirely at fault, including amounts paid beyond its policy limits. Nory countered that Travelers could not recover voluntary payments, and the claim was barred by the antisubrogation rule and untimely disclaimer. The court denied Travelers' motion for summary judgment due to insufficient evidence regarding Nory's sole fault. Ultimately, the court granted Nory's motion for summary judgment, concluding that Travelers' overpayment, made without legal compulsion or Nory's request, constituted a voluntary payment and was therefore not recoverable under equitable subrogation principles.

SubrogationIndemnificationInsurance Policy LimitsAntisubrogation RuleVoluntary Payment DoctrineSummary Judgment MotionConstruction LawWorkers' Compensation InsuranceCommercial General LiabilityUmbrella Policy
References
48
Case No. 2017-1180 K C
Regular Panel Decision
Aug 02, 2019

Merrick Med., P.C. v. A Cent. Ins. Co.

The case of Merrick Med., P.C. v A Central Ins. Co. concerned a provider's action to recover assigned first-party no-fault benefits from an insurer. The defendant insurer, A Central Insurance Company, moved for summary judgment to dismiss the complaint, asserting that a portion of the claim exceeded the workers' compensation fee schedule and other claims lacked medical necessity. Initially, the Civil Court denied the defendant's motion in part, making CPLR 3212 (g) findings. However, the Appellate Term, Second Department, modified the Civil Court's order. The appellate court concluded that the defendant's motion for summary judgment dismissing the complaint should have been entirely granted, as the specific claim was properly paid under the fee schedule, and the remaining claims were successfully challenged on medical necessity grounds by the defendant, which the plaintiff failed to rebut.

No-fault benefitsSummary judgment motionWorkers' compensation fee scheduleMedical necessity defenseAppellate Term decisionInsurance litigationAssignee claimCivil procedurePeer review reportIndependent medical examination
References
3
Case No. 2014-1942 K C
Regular Panel Decision
Sep 22, 2017

AL Acupuncture, P.C. v. Geico Ins. Co.

This case, AL Acupuncture, P.C. v Geico Ins. Co., concerns an appeal from a Civil Court order regarding assigned first-party no-fault benefits. The plaintiff, AL Acupuncture, P.C., sought summary judgment for services rendered, while defendant Geico Insurance Company cross-moved for dismissal. The Appellate Term modified the lower court's order. It denied the plaintiff's motion for summary judgment on claims from September 8 to September 25, 2008, citing the plaintiff's failure to prove the claim was not timely denied and issues with IME scheduling evidence. Conversely, the court granted the defendant's cross-motion, dismissing claims for services from July 8 to September 5, 2008, as Geico demonstrated timely denial and payment under the workers' compensation fee schedule. The order was affirmed as modified.

No-fault benefitsSummary judgmentIndependent medical examinationsTimely denialWorkers' compensation fee scheduleAcupuncture servicesAppellate TermProvider actionAssigned claimsCivil Court order
References
5
Case No. 2015-455 K C
Regular Panel Decision
Dec 19, 2017

Metro Psychological Servs., P.C. v. Travelers Prop. & Cas. Ins. Co.

This case involves Metro Psychological Services, P.C., as an assignee, seeking first-party no-fault benefits from Travelers Property & Casualty Insurance Company. The defendant moved for summary judgment, arguing the assignor's injuries occurred during employment, which would make workers' compensation benefits applicable. The Civil Court denied the defendant's motion and granted the plaintiff's cross-motion for summary judgment. The Appellate Term reversed this order, concluding there was an unresolved issue as to whether the plaintiff's assignor was acting in the course of employment at the time of the accident. Consequently, the matter was remitted to the Civil Court to be held in abeyance, pending a determination by the Workers' Compensation Board regarding the parties' rights under the Workers' Compensation Law, underscoring the Board's primary jurisdiction in such matters.

No-Fault BenefitsWorkers' Compensation LawPrimary JurisdictionAbeyanceSummary JudgmentAppellate ReviewInsurance DisputeMedical ProviderAssigneeCourse of Employment
References
9
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. 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
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