PT Fee schedule denial not substantiatedMarch 17, 2021

NL Quality Med., P.C. v GEICO Ins. Co., 2020 NY Slip Op 51340(U)(App. Term 2d Dept. 2020)

“With respect to the second cause of action, defendant failed to establish, as a matter of law, its defense that the fees charged exceeded the amounts 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 Dept, 2d, 11th & 13th Jud Dists 2009]), because, among other things, defendant attempted to rely on certain documents which were attached to defendant’s motion papers without authentication, foundation or even discussion (see Liberty Chiropractic, P.C. v 21st Century Ins. Co., 53 Misc 3d 133[A], 2016 NY Slip Op 51409[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]).”

This is the line the court uses when it is an 8 unit (now 12 unit) denial based upon exhaustion of per diem units. The court expects the carrier to authenticate someone else’s records.

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