June 22, 2006

Health & Endurance Med. P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51191(U))

Headnote

The relevant facts the court considered in this case were that the plaintiff, a medical provider, sought to recover no-fault benefits for services rendered to its assignor. The plaintiff moved for summary judgment, but the defendant insurer argued that the plaintiff was not entitled to recover direct payment of assigned no-fault benefits because the services were not rendered by the plaintiff or its employees, but by a treating provider who was an independent contractor. The main issue decided by the court was whether the plaintiff, as a billing provider, was entitled to recover no-fault benefits for services rendered by an independent contractor treating provider. The court held that the plaintiff was not entitled to recover direct payment of assigned no-fault benefits from the defendant insurer, and therefore the plaintiff's motion for summary judgment was denied, while the defendant was awarded summary judgment and the complaint was dismissed.

Reported in New York Official Reports at Health & Endurance Med. P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51191(U))

Health & Endurance Med. P.C. v State Farm Mut. Auto. Ins. Co. (2006 NY Slip Op 51191(U)) [*1]

Health & Endurance Med. P.C. v State Farm Mut. Auto. Ins. Co.

2006 NY Slip Op 51191(U) [12 Misc 3d 134(A)]

Decided on June 22, 2006

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 22, 2006

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., WESTON PATTERSON and RIOS, JJ
2005-365 K C.

Health and Endurance Medical P.C., a/a/o Miah Shahin, Respondent,
against
State Farm Mutual Automobile Ins. Co., Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Arlene Bluth, J.), entered February 8, 2005. The order granted plaintiff’s motion for summary judgment in the principal sum of $1,644.74.

Order reversed without costs, plaintiff’s motion for summary judgment denied and, upon searching the record, defendant is awarded summary judgment and complaint dismissed.

In this action to recover first-party no-fault benefits for health care services rendered to its assignor, plaintiff moved for summary judgment. Where a billing provider seeks to recover no-fault benefits for services which were not rendered by it or its employees, but rather by a treating provider who is an independent contractor, it is not a “provider” of the medical services rendered within the meaning of 11 NYCRR 65-3.11 [a] and is therefore not entitled to recover “direct payment” of assigned no-fault benefits from the defendant insurer (see Craig Antell, D.O., P.C. v New York Cent. Mut. Fire Ins. Co., 11 Misc 3d 137[A], 2006 NY Slip Op 50521[U] [App Term, 1st Dept]; A.B. Med. Servs. PLLC v Liberty Mut. Ins. Co., 9 Misc 3d 36 [App Term, 2d & 11th Jud Dists 2005]; A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co., 8 Misc 3d 132[A], 2005 NY Slip Op 51111[U] [App Term, 2d & 11th Jud Dists.]).

In the case at bar, the plaintiff’s claim form states that the treating professional was an independent contractor. Under the circumstances, plaintiff’s motion for summary judgment should be denied and, upon searching the record, summary judgment should be awarded to defendant dismissing the action (see A.B. Med. Servs. PLLC v New York Cent. Mut. Fire Ins. Co., 8 Misc 3d 132, supra; see generally Dunham v Hilco Constr. Co., 89 NY2d 425, 429 [1996]; Murray v Murray, AD3d , 2006 NY Slip Op 02861).

Pesce, P.J., Weston Patterson and Rios, JJ., concur.
Decision Date: June 22, 2006