Key Takeaway
OS Tigris v Liberty: the 2008 fee-defense evidence failure, the limited medical report and the difference between Jason's inference and the ruling.
This article is part of our ongoing fee schedule coverage, with 118 published articles analyzing fee schedule issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
What was missing in OS Tigris Acupuncture v Liberty, 2008 NY Slip Op 51996(U) was competent proof. The court did not prescribe a checklist of mandatory exhibits. On October 7, 2008, the Appellate Term, First Department, reversed and granted the provider summary judgment.
Historical note: OS Tigris predates the post-April-2013 excessive-fee rule applied in Oleg’s Acupuncture v Hereford (2018); preserving a fee defense without a timely denial is different from proving it.
Last reviewed: September 2026.
Why the provider won
The provider established that its claim forms had been mailed, received and left overdue. The insurer’s unsworn chiropractor’s report was inadmissible under the affirmation rules applied in 2008. There was a second problem: the report addressed whether further acupuncture was necessary, not whether the earlier treatment in dispute had been necessary.
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The court separately found no competent evidence that the charges exceeded the fee schedule. It did not identify the missing document. That distinction keeps Jason’s suggested explanation below from turning into a factual finding.
Applying the evidentiary lesson
Separate the medical opinion from the fee calculation. A report about future treatment does not answer the necessity of earlier services; an assertion about excessive charges does not demonstrate which schedule and calculation establish the allowed payment. The later Precious Acupuncture coder decision illustrates proof the court did accept.
The 2008 treatment of an unsworn chiropractor’s report is historical, not a statement that today’s affirmation statute excludes chiropractors. Current CPLR 2106 permits an affirmation by any person when its statutory requirements are met.
Jason’s original observation
Jason’s retained comment expressly offered an assumption. The opinion does not identify those missing exhibits or prescribe that checklist:
I am going to assume that the movant did not provide a copy of the applicable portions of the fee schedule and annex the Department of Insurance Letter allowing the carrier to pay the chiropractor or physician fee schedule for acupuncture or a geographical rate it deemed proper.
Connect to the Encyclopedia
Start with the fee-schedule defense hub. Related case notes:
- Urban Well: coding corrections and separate necessity proof.
- Great Wall: the November 2009 trial record.
- Great Wall: the split result in the August 2009 appeal.
- New Age: the denied motion on CPT 97026.
- Precious Acupuncture: coder proof and post-2013 preclusion.
- Quality Comprehensive: fee proof supported only partial dismissal.
- Acuhealth: the missing by-report verification request.
For review of a particular no-fault billing dispute, contact the Law Office of Jason Tenenbaum. Bring the bill, service dates, denial and payment calculation.
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Fee Schedule Issues in No-Fault Insurance
The New York no-fault fee schedule establishes the maximum reimbursement rates for medical treatment provided to injured motorists. Disputes over fee schedule calculations, coding, usual and customary charges, and the applicability of workers compensation fee schedules to no-fault claims are common. These articles analyze fee schedule regulations, court decisions on reimbursement disputes, and the practical challenges providers face in obtaining appropriate payment under the no-fault system.
118 published articles in Fee Schedule
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Jan 26, 2018Frequently Asked Questions
Common Questions About This Topic
5 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
Q: What should I do if my insurance company denies treatment but won’t provide detailed fee schedule information?
Request the denial and the calculation supporting it. OS Tigris concerns the evidence required on a court motion, not a ruling that every incomplete payment explanation automatically invalidates a denial.
Q: Can insurance companies just point to general fee schedule violations without specific evidence?
An unsupported assertion did not defeat the provider's motion in OS Tigris. The court required competent evidence of the alleged excess, without identifying a mandatory set of exhibits.
Q: How can I verify that my healthcare provider is billing correctly according to fee schedules?
Ask which schedule, service date, provider category and codes were used. The billed amount alone does not establish the charge authorized under the applicable no-fault rules.
Q: What happens if an insurance company’s evidence doesn’t meet the competent evidence standard?
In OS Tigris the provider received summary judgment because its own proof was sufficient and the insurer failed to raise a triable issue. Failure of one side's proof does not always establish the other side's entitlement.
Q: Can I appeal a fee schedule denial even if the insurance company provides some documentation?
The existence of documents does not establish their sufficiency. Review what they actually prove, the procedural posture and the available challenge with counsel.
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a fee schedule matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
