March 24, 2017

Healthy Way Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2017 NY Slip Op 50345(U))

Headnote

The court considered the plaintiff's claim for first-party no-fault benefits and the defendant's motion for summary judgment. The main issue decided was whether the defendant's proof was sufficient to establish that the amounts charged by the plaintiff for services rendered exceeded the rates set forth in the workers' compensation fee schedule. The court held that the action was not ripe for summary disposition, as the defendant's proof was insufficient to establish this. Additionally, the court found that the plaintiff's bill for services in the amount of $1,495 was timely denied as the 30-day statutory period was tolled by the defendant's timely verification and follow-up requests. Therefore, the court affirmed the order of the Civil Court, denying the defendant's motion for summary judgment.

Reported in New York Official Reports at Healthy Way Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2017 NY Slip Op 50345(U))

Healthy Way Acupuncture, P.C. v Clarendon Natl. Ins. Co. (2017 NY Slip Op 50345(U)) [*1]

Healthy Way Acupuncture, P.C. v Clarendon Natl. Ins. Co.

2017 NY Slip Op 50345(U) [55 Misc 3d 127(A)]

Decided on March 24, 2017

Appellate Term, First 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This opinion is uncorrected and will not be published in the printed Official Reports.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 March 24, 2017

SUPREME COURT, APPELLATE TERM, FIRST DEPARTMENT
PRESENT: Schoenfeld, J.P., Shulman, Ling-Cohan, JJ.
570521/16

Healthy Way Acupuncture, P.C., a/a/o Leonar Sierra, Plaintiff-Respondent,
against
Clarendon National Ins. Co., Defendant-Appellant.

Defendant, as limited by its briefs, appeals from that portion of an order of the Civil Court of the City of New York, New York County (Debra Rose Samuels, J.), entered February 27, 2015, which denied its motion for summary judgment.

Per Curiam.

Order (Debra Rose Samuels, J.), entered February 27, 2015, insofar as appealed from, affirmed, with $10 costs.

This action, seeking recovery of assigned first-party no-fault benefits, is not ripe for summary disposition. The proof submitted by defendant was insufficient to establish, prima facie, that the amounts charged by plaintiff for the services rendered exceeded the rates set forth in the workers’ compensation fee schedule (see Devonshire Surgical Facility, LLC v Allstate Ins. Co., 38 Misc 3d 127[A], 2012 NY Slip Op 52351[U] [App Term, 1st Dept 2012]; Doctor Richard Med., P.C. v Praetorian Ins. Co., 37 Misc 3d 128[A], 2012 NY Slip Op 51909[U] [App Term, 1st Dept 2012]; MIA Acupuncture, P.C. v Praetorian Ins. Co., 35 Misc 3d 69 [2011]).

Contrary to plaintiff’s contention, the proof submitted establishes that plaintiff’s bill for services in the amount of $1,495 was timely denied, inasmuch as the 30-day statutory period was tolled by defendant’s timely verification and follow-up requests (see 11 NYCRR 65-3.8[a][1]; Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498 [2015]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.

I concur I concur I concur
Decision Date: March 24, 2017