December 11, 2006

V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52553(U))

Headnote

The court considered an appeal from an order of the Civil Court that denied the plaintiff's motion for partial summary judgment in an action to recover first-party no-fault benefits for medical services rendered to its assignor. The main issue decided was whether a billing provider seeking to recover no-fault benefits for services rendered by treating health care providers who are independent contractors is considered a "provider" of the health care services within the meaning of the law. The court held that where a billing provider seeks to recover no-fault benefits for services rendered by independent contractors, it is not considered a "provider" of the health care services within the meaning of the law and is therefore not entitled to recover direct payment of assigned no-fault benefits from the insurer. The court also held that lack of specificity in the business relationship of the treating provider does not establish plaintiff's prima facie entitlement to summary judgment as a matter of law.

Reported in New York Official Reports at V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52553(U))

V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co. (2006 NY Slip Op 52553(U)) [*1]

V.S. Med. Servs., P.C. v New York Cent. Mut. Fire Ins. Co.

2006 NY Slip Op 52553(U) [14 Misc 3d 134(A)]

Decided on December 11, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 11, 2006

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT:: PESCE, P.J., GOLIA and BELEN, JJ
2006-31 Q C. NO. 2006-31 Q C

V.S. Medical Services, P.C. A/A/O MIRIAM MALDONADO, Appellant,
against
New York Central Mutual Fire Insurance Co., Respondent.

Appeal from an order of the Civil Court of the City of New York, Queens County (Bernice Daun Siegal, J.), entered September 30, 2005. The order denied plaintiff’s motion for partial summary judgment.

Order affirmed without costs.

In this action to recover first-party no-fault benefits for medical services rendered to its assignor, plaintiff moved for summary judgment. Three of plaintiff’s five claim forms indicate that the treating health care providers were independent contractors. 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 health care 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 insurer (see Boai Zhong Yi Acupuncture Servs. P.C. v Allstate Ins. Co., 12 Misc 3d 137[A], 2006 NY Slip Op 51288[U] [App Term, 2d & 11th Jud Dists]; Rockaway Blvd. Med. P.C. v Progressive Ins., 9 Misc 3d 52 [App Term, 2d & 11th Jud Dists 2005]). The [*2]remaining two claim forms have “N/A” typed in the box in which the business relationship of the treating provider was to be provided. Such lack of specificity does not establish plaintiff’s prima facie entitlement to summary judgment as a matter of law inasmuch as it fails to exclude all triable issues of fact. Accordingly, plaintiff’s motion for partial summary judgment was properly denied.

We pass on no other issue.

Pesce, P.J., and Belen, J., concur.

Golia, J., concurs in a separate memorandum.
SUPREME COURT OF THE STATE OF NEW YORK
APPELLATE TERM : 2nd and 11th JUDICIAL DISTRICTS
PRESENT: PESCE, P.J., GOLIA and BELEN, JJ.
V.S. MEDICAL SERVICES, P.C.
A/A/O MIRIAM MALDONADO,
Appellant,

-against-

NEW YORK CENTRAL MUTUAL FIRE INSURANCE CO.,
Respondent.

Golia, J., concurs with the result only, in the following memorandum:

While I agree with the ultimate disposition in the decision reached by the majority, I wish to emphasize that I am constrained to agree with certain propositions of law set forth in cases cited therein which are inconsistent with my prior expressed positions and generally contrary to my views.
Decision Date: December 11, 2006