November 16, 2018

UGP Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51657(U))

Headnote

The court considered the fact that UGP Acupuncture, P.C., as the assignee of Nicole Santana, was seeking to recover first-party no-fault benefits from 21st Century Insurance Company, but their amounts were in excess of the workers' compensation fee schedule. The main issue decided was whether the fee reductions made by the defendant were proper, as they were done in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The holding of the case was that the insurer may use the workers' compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services. The court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at UGP Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51657(U))

UGP Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51657(U)) [*1]

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

2018 NY Slip Op 51657(U) [61 Misc 3d 144(A)]

Decided on November 16, 2018

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 16, 2018

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2016-2075 K C

UGP Acupuncture, P.C., as Assignee of Santana, Nicole, Appellant,
against
21st Century Insurance Company, Respondent.

The Rybak Firm, PLLC (Damin J. Toell of counsel ), for appellant. Law Offices of Bryan M. Rothenberg (Deepak D. Sohi of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Richard J. Montelione, J.), entered May 23, 2016. The order granted defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that the amounts plaintiff sought to recover, for services rendered after April 1, 2013, were in excess of the workers’ compensation fee schedule.

Plaintiff argues that defendant failed to establish that defendant’s fee reductions, which had been done in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors, were proper. However, this court has held, “as a matter of law, that an insurer may use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services” (Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23, 24 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]).

Accordingly, the order is affirmed.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 16, 2018