November 19, 2015

GL Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51698(U))

Headnote

The relevant facts the court considered were that GL Acupuncture, P.C. had moved for summary judgment to recover assigned first-party no-fault benefits, but Praetorian Ins. Co. had cross-moved for summary judgment dismissing the complaint, arguing that they had properly paid GL Acupuncture, P.C. for the services at issue in accordance with the workers' compensation fee schedule. The main issue decided was whether Praetorian Ins. Co. had properly paid GL Acupuncture, P.C. for the services at issue in accordance with the fee schedule. The court held that Praetorian Ins. Co. had established that they had timely mailed the denial of claim form and had fully paid GL Acupuncture, P.C. for the services at issue in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors, therefore affirming the order.

Reported in New York Official Reports at GL Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51698(U))

GL Acupuncture, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51698(U)) [*1]

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

2015 NY Slip Op 51698(U) [49 Misc 3d 147(A)]

Decided on November 19, 2015

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This opinion is uncorrected and will not be published in the printed Official Reports.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 19, 2015

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-753 K C

GL Acupuncture, P.C. as Assignee of CLIVE ELCOCK, Appellant,
against
Praetorian Ins. Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dawn Jimenez Salta, J.), entered January 18, 2013. The order denied plaintiff’s motion for summary judgment and granted defendant’s cross 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 moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint, arguing that it had properly paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule. The Civil Court denied plaintiff’s motion and granted defendant’s cross motion.

Contrary to plaintiff’s contention, defendant established that the denial of claim form at issue had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant further demonstrated that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 [App Term, 2d, 11th & 13th Jud Dists 2009]).

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: November 19, 2015