Precious Acupuncture Care, P.C. v. Hereford Ins. Co.
This case concerns an action by Precious Acupuncture Care, P.C., as assignee of James Hough, against Hereford Insurance Company to recover assigned first-party no-fault benefits. Plaintiff sought the unpaid balance of five claims for services rendered between December 2013 and April 2014. Defendant cross-moved for summary judgment, asserting that the amounts claimed exceeded the workers' compensation fee schedule. The Civil Court initially granted plaintiff's motion, ruling that defendant was precluded from the defense due to untimely denial. However, the Appellate Term reversed this decision, clarifying that under 11 NYCRR 65-3.8 (g) (1) (ii); (2), for services rendered after April 1, 2013, payment is not due for fees exceeding permissible charges, irrespective of timely denial. Consequently, the Appellate Term vacated the prior order, denied plaintiff's motion, and granted defendant's cross-motion for summary judgment dismissing the complaint.