August 6, 2015

Neomy Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51237(U))

Headnote

The main issue in this case was whether the denial of claim forms had been timely and properly mailed, and whether the fees charged by the medical providers exceeded the amount set forth in the workers' compensation fee schedule. The court considered the lack of evidence provided by the defendant to demonstrate that the denial of claim forms had been timely and properly mailed, as well as the failure to establish as a matter of law that the fees charged exceeded the amount set forth in the workers' compensation fee schedule. The court held that with respect to the bills sued upon by Neomy Medical, P.C., the defendant failed to demonstrate that the denial of claim forms had been timely and properly mailed, while with respect to the bills sued upon by Perfect Point Acupuncture, P.C., the defendant failed to establish as a matter of law that the fees charged exceeded the amount set forth in the workers' compensation fee schedule. Therefore, the Civil Court properly denied the defendant's motion for summary judgment dismissing the complaint.

Reported in New York Official Reports at Neomy Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51237(U))

Neomy Med., P.C. v Praetorian Ins. Co. (2015 NY Slip Op 51237(U)) [*1]

Neomy Med., P.C. v Praetorian Ins. Co.

2015 NY Slip Op 51237(U) [48 Misc 3d 140(A)]

Decided on August 6, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 August 6, 2015

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

PRESENT: : PESCE, P.J., ALIOTTA and SOLOMON, JJ.
2013-509 K C

Neomy Medical, P.C. and PERFECT POINT ACUPUNCTURE, P.C. as Assignees of MICHAL WILLIAMS, Respondents,
against
Praetorian Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Ingrid Joseph, J.), entered April 1, 2010. The order denied defendant’s motion for summary judgment dismissing the complaint.

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

In this action by providers to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court which denied defendant’s motion for summary judgment dismissing the complaint.

With respect to the bills sued upon by Neomy Medical, P.C., defendant failed to demonstrate that the denial of claim forms had been timely and properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 [App Term, 2d & 11th Jud Dists 2007]). With respect to the bills sued upon by Perfect Point Acupuncture, P.C., defendant failed to establish as a matter of law that the fees charged exceeded the amount set forth in the workers’ compensation fee schedule (see Rogy Med., P.C. v Mercury Cas. Co., 23 Misc 3d 132[A], 2009 NY Slip Op 50732[U] [App Term, 2d, 11th & 13th Jud Dists 2009]). In view of the foregoing, the Civil Court properly denied defendant’s motion for summary judgment dismissing the complaint. Accordingly, the order is affirmed.

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

Decision Date: August 06, 2015