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 NY Slip Op 51149(U)
Regular Panel Decision
Sep 08, 2017

Charles Deng Acupuncture, P.C. v. ELRAC, Inc.

This case concerns an appeal regarding first-party no-fault benefits. The plaintiff, Charles Deng Acupuncture, P.C., sought to recover for acupuncture services provided to Sarae Gomez, which were billed under CPT codes 97810 and 97811. The defendant, ELRAC, Inc., had reduced the payments based on the workers' compensation fee schedule applicable to acupuncture services performed by chiropractors. The Appellate Term affirmed the Civil Court's decision, holding that an insurer is permitted to use the workers' compensation fee schedule for chiropractic acupuncture services to determine the reimbursement amount for licensed acupuncturists, thereby upholding the dismissal of the plaintiff's claim for the disputed services.

No-fault benefitsAcupuncture servicesCPT codes 97810CPT codes 97811Workers' compensation fee scheduleSummary judgmentAppellate reviewFee reductionLicensed acupuncturistChiropractic services
References
1
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. 2017-905 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. 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. 2015-432 K C
Regular Panel Decision
Dec 22, 2017

Oleg's Acupuncture, P.C. v. GEICO Gen. Ins. Co.

This case involves an appeal by GEICO General Insurance Company against Oleg's Acupuncture, P.C., concerning first-party no-fault benefits. The Appellate Term reversed an order from the Civil Court that had denied GEICO's cross-motion for summary judgment. The court found that GEICO had timely mailed denial of claim forms and had fully compensated Oleg's Acupuncture for services billed under CPT codes 97813 and 97814, in accordance with the workers' compensation fee schedule for acupuncture services. The plaintiff failed to present a triable issue of fact in opposition to GEICO's evidence.

no-fault benefitsacupuncture servicesworkers' compensation fee schedulesummary judgmentCPT codestimely mailinginsurance claimassigneeAppellate TermCivil Court
References
4
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. 2014-1947 K C
Regular Panel Decision
Sep 08, 2017

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

This case involves an appeal by Acupuncture Now, P.C., as assignee, against State Farm Mutual Automobile Insurance Co. from an order of the Civil Court. The order granted State Farm's motion for summary judgment to dismiss certain causes of action and to compel plaintiff's deposition. Acupuncture Now, P.C. contested State Farm's fee reductions for acupuncture services, which were based on the workers' compensation fee schedule for chiropractors. The Appellate Term affirmed the lower court's decision, upholding that insurers may use this fee schedule for licensed acupuncturists. Furthermore, the court found the order compelling plaintiff's deposition proper, as State Farm was defending the remaining cause of action on grounds of lack of medical necessity.

No-fault benefitsAcupuncture servicesFee scheduleWorkers' compensationSummary judgmentDepositionMedical necessityInsurance disputeAppellate TermChiropractic services
References
2
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
Case No. 2014-1535 Q C
Regular Panel Decision
Sep 22, 2017

GBI Acupuncture, P.C. v. GEICO Ins. Co.

The Appellate Term, Second Department, affirmed an order from the Civil Court of the City of New York, Queens County, in a case involving GBI Acupuncture, P.C. and GEICO Ins. Co. GBI Acupuncture, as assignee, sought to recover first-party no-fault benefits, but the Civil Court had denied its motion for summary judgment and partially granted GEICO's cross-motion. The Appellate Term concurred with the Civil Court's findings, holding that GEICO had properly mailed its denial of claim forms. Furthermore, the court found no merit in the plaintiff's arguments concerning the application of the workers' compensation fee schedule in this no-fault benefits dispute.

No-fault benefitsSummary judgmentClaims denialWorkers' compensation fee scheduleAppellate reviewProper mailingCivil courtFirst-party benefitsAssignee claimInsurance dispute
References
2
Case No. 2017-303 K C
Regular Panel Decision
Apr 12, 2019

GL Acupuncture, P.C. v. Progressive Ins. Co.

This case involves an appeal by GL Acupuncture, P.C. from a judgment of the Civil Court of the City of New York, Kings County. The plaintiff sought to recover assigned first-party no-fault benefits for acupuncture services. The Civil Court, after a nonjury trial, awarded the plaintiff only $54.74, finding that the defendant had properly paid the claims based on the workers' compensation chiropractic fee schedule. The Appellate Term, Second Department, affirmed the judgment, concurring that the Civil Court correctly determined that the defendant had fully paid for the services billed under CPT codes 97810 and 97811 in accordance with the fee schedule, and that the plaintiff failed to rebut this showing.

Acupuncture servicesNo-fault benefitsChiropractic fee scheduleCPT codesAssigned claimsInsurance disputePrima facie caseCredibilityAppellate reviewCivil Court judgment
References
1
Showing 1-10 of 79 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