The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Law Office of Goldstein, Flecker & Hopkins (Lawrence J. Chanice of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), dated March 22, 2021. The order, insofar as appealed from, granted the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover on plaintiff’s claims for services billed using CPT codes 97810 and 97811, and for services performed on or after August 10, 2016, and denied the branch of plaintiff’s cross motion seeking summary judgment.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from so much of an order of the Civil Court as granted the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover on plaintiff’s claims for services billed using CPT codes 97810 and 97811 on the ground that defendant had paid these claims in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors, and so much of the complaint as sought to recover on plaintiff’s claims for services performed on or after August 10, 2016 on the ground of lack of medical necessity, and denied the branch of plaintiff’s cross motion seeking summary judgment.

Contrary to plaintiff’s contention, the affidavit plaintiff submitted in opposition to the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover on plaintiff’s claims for services rendered on or after August 10, 2016 failed to raise a triable issue of fact as it did not meaningfully refer to, let alone rebut, defendant’s prima facie showing of lack of medical necessity (see Pan Chiropractic, P.C. v Mercury Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51495[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists [*2]2009]).

To the extent plaintiff appeals from so much of the order as granted the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover on plaintiff’s claims for acupuncture services billed using CPT codes 97810 and 97811, for the reasons stated in Mind & Body Acupuncture, P.C., as Assignee of Wilson, Bernadette v State Farm Mut. Auto. Ins. Co. (— Misc 3d —, 2022 NY Slip Op — [appeal No. 2019-1418 K C], decided herewith), plaintiff’s contention lacks merit.

Accordingly, the order, insofar as appealed from, is affirmed.

ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.

Decided on June 17, 2022

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

The Rybak Firm, PLLC (Damin J. Toell of counsel), for appellant. Rubin, Fiorella, Friedman & Mercante, LLP (Daniel Passer and Kyeko Stewart of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Matthew P. Blum, J.), dated September 10, 2020. The order granted defendant’s motion for summary judgment dismissing the complaint and denied plaintiff’s cross motion for summary judgment.

ORDERED that the order is modified by providing that defendant’s motion for summary judgment dismissing the complaint is denied; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which granted defendant’s motion for summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled examinations under oath (EUOs), and denied plaintiff’s cross motion for summary judgment.

Although defendant established that the EUO scheduling letters had been timely mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]), defendant failed to submit proof by someone with personal knowledge of the nonappearance of plaintiff’s assignor for the EUOs. In addition, defendant’s motion failed to establish, as a matter of law, that defendant had timely denied plaintiff’s claim after plaintiff’s assignor had allegedly failed to appear at two duly scheduled EUOs. Therefore, defendant failed to establish its entitlement to summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for EUOs (see Westchester Med. Ctr. v Lincoln Gen. Ins. Co., 60 AD3d 1045 [2009]; Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]).

Finally, plaintiff failed to demonstrate its prima facie entitlement to judgment as a matter of law, as the proof submitted in support of its cross motion failed to establish that defendant failed to deny the claim within the 30-day period (see Viviane Etienne Med. Care, P.C. v [*2]Country-Wide Ins. Co., 25 NY3d 498 [2015]) or that defendant had issued denials that were conclusory, vague or without merit as a matter of law (see Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).

Accordingly, the order is modified by providing that defendant’s motion for summary judgment dismissing the complaint is denied.

ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.

Decided on June 17, 2022

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

Law Offices of Buratti, Rothenberg & Burns (Rachel L. Hollander of counsel), for appellant. Zara Javakov, P.C. (Victoria Tarasova and Zara Javakov of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Jill R. Epstein, J.), entered November 1, 2019. The order, insofar as appealed from, denied the branch of defendant’s motion seeking summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branch of defendant’s motion seeking summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from so much of an order of the Civil Court as denied the branch of defendant’s motion which had sought summary judgment dismissing the complaint on the ground that plaintiff’s assignor had failed to appear for duly scheduled independent medical examinations (IMEs).

Insofar as relevant to this appeal, in support of its motion, defendant submitted an affidavit by the Director of Operations for Exam Coordinators Network, which had been retained by defendant to schedule IMEs of plaintiff’s assignor, which affidavit sufficiently demonstrated that the IME scheduling letters had been timely mailed to plaintiff’s assignor (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Defendant also demonstrated that the assignor failed to appear for the duly scheduled IMEs (see Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720 [2006]). Thus, defendant demonstrated that plaintiff failed to comply with a condition precedent to coverage (id. at 722). As defendant’s motion further demonstrated that defendant timely denied (see St. Vincent’s Hosp. of Richmond, 50 AD3d 1123) the claim on that ground, defendant demonstrated, prima facie, its entitlement to summary judgment and plaintiff failed to raise a triable issue of fact in opposition. [*2]Contrary to the determination of the Civil Court, as the IMEs were scheduled before defendant received the claim at issue, defendant was not required to comply with the obligations of 11 NYCRR 65-3.6 (b) (see City Anesthesia Healthcare, P.C. v Erie Ins. Co. of NY, 70 Misc 3d 141[A], 2021 NY Slip Op 50135[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2021]; Vitality Chiropractic, P.C. v Kemper Ins. Co., 14 Misc 3d 94, 96 [App Term, 2d Dept, 2d & 11th Jud Dists 2006]; see also PV Holding Corp. v AB Quality Health Supply Corp., 189 AD3d 645 [2020]).

Accordingly, the order, insofar as appealed from, is reversed and the branch of defendant’s motion seeking summary judgment dismissing the complaint is granted.

ALIOTTA, P.J., GOLIA and BUGGS, JJ., concur.

Law Offices of Buratti, Rothenberg & Burns (Bianca Maynard Francois of counsel), for appellant. Law Office of Damin J. Toell, P.C. (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Consuelo Mallafre Melendez, J.), entered January 8, 2020. The order denied defendant’s motion for summary judgment dismissing the complaint and granted plaintiff’s cross motion for summary judgment.

ORDERED that the order is reversed, with $30 costs, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court entered January 8, 2020 denying defendant’s motion for summary judgment dismissing the complaint and granting plaintiff’s cross motion for summary judgment.

Plaintiff was required to submit its claim form to defendant within 45 days after the services were rendered (see 11 NYCRR 65-1.1; Synergy First Med., PLLC v MVAIC, 44 Misc 3d 127[A], 2014 NY Slip Op 50964[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]) and it is undisputed that plaintiff failed to do so. Defendant timely denied plaintiff’s claim seeking to recover for those services, based upon plaintiff’s untimely submission, and informed plaintiff that defendant would excuse the delay if plaintiff provided a “reasonable justification” therefor (see 11 NYCRR 65-3.3 [e]; see also Matter of Medical Socy. of State of NY v Serio, 100 NY2d 854, 862-863 [2003]; Synergy First Med., PLLC, 2014 NY Slip Op 50964[U]). In opposition to defendant’s motion, plaintiff demonstrated that it had initially sent the claim form at issue to a different insurance company, and that, after plaintiff learned, approximately one year later, that [*2]the information it had regarding the insurance company covering the accident was incorrect, it sent the claim form to defendant. However, plaintiff did not establish a reasonable justification for initially submitting the claim form to the wrong insurance company, given that the claim form which plaintiff alleged it submitted to the wrong insurance company bore defendant’s name and address. As a result, plaintiff did not establish that it had provided defendant with a reasonable justification for its untimely submission of the claim form to defendant.

Accordingly, the order is reversed, defendant’s motion for summary judgment dismissing the complaint is granted and plaintiff’s cross motion for summary judgment is denied.

ALIOTTA, P.J., GOLIA and BUGGS, JJ., concur.

The Rybak Firm, PLLC (Damin J. Toell and Richard Rozhik of counsel), for appellant. Abrams, Cohen & Associates, P.C. (Frank Piccininni of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Rosemarie Montalbano, J.), entered August 27, 2019. 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 appeals from an order of the Civil Court denying plaintiff’s motion for summary judgment and granting defendant’s cross motion for summary judgment dismissing the complaint.

Contrary to plaintiff’s contention, the record reflects that defendant demonstrated, prima facie, that the examination under oath (EUO) scheduling letters had been timely and properly mailed (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 [2008]). Contrary to plaintiff’s further contention, an “appearance at an [EUO] is required whether the insurance company demands the [EUO] before the claim form is submitted or after the claim form is submitted” (Stephen Fogel Psychological, P.C. v Progressive Cas. Ins. Co., 35 AD3d 720, 721 [2006]; see Longevity Med. Supply, Inc. v Nationwide Ins., 69 Misc 3d 128, 2020 NY Slip Op 51133[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]; see also PV Holding Corp. v AB Quality Health Supply Corp., 189 AD3d 645 [2020]; LDE Med. Servs., P.C. v Interboro Ins. Co., 31 Misc 3d 146[A], 2011 NY Slip Op 50946[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2011]).

Plaintiff’s remaining arguments are either not properly before this court, as they are being raised for the first time on appeal, and we decline to consider them (see Joe v Upper Room Ministries, Inc., 88 AD3d 963 [2011]; Gulf Ins. Co. v Kanen, 13 AD3d 579 [2004]), or are moot.

Accordingly, the order is affirmed.

ALIOTTA, P.J., GOLIA and BUGGS, JJ., concur.

James F. Butler & Associates (Mohammad Rubbani of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), dated April 4, 2019. The order, insofar as appealed from, upon reargument, adhered to that court’s prior determination in so much of an order entered March 19, 2019 as denied defendant’s motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and, upon reargument, defendant’s motion for summary judgment dismissing the complaint is granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from so much of an order of the Civil Court as, upon reargument, adhered to that court’s prior determination in so much of an order entered March 19, 2019 as denied defendant’s motion for summary judgment dismissing the complaint.

In support of its motion, defendant made a prima facie showing of its entitlement to summary judgment dismissing the complaint by demonstrating that it had fully paid plaintiff for the acupuncture services at issue in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see S.O.V. Acupuncture, P.C. v Global Liberty Ins. Co. of NY, 68 Misc 3d 132[A], 2020 NY Slip Op 51004[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]) and that the subject claims sought the difference between the amount plaintiff charged for the services rendered and the payments made. In opposition, plaintiff failed to demonstrate the existence of a triable issue of fact (see Master Cheng Acupuncture, P.C. v Global Liberty Ins. of NY, 69 Misc 3d 143[A], 2020 NY Slip Op 51371[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2020]; S.O.V. Acupuncture, P.C. v Global Liberty Ins. Co. of NY, 2020 NY Slip Op 51004[U]; cf. Global Liberty Ins. Co. of NY v Acupuncture Now, P.C., 178 AD3d 512 [2019]).

Accordingly, the order, insofar as appealed from, is reversed and, upon reargument, [*2]defendant’s motion for summary judgment dismissing the complaint is granted.

ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.

Decided on June 17, 2022

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

Decided on June 17, 2022

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