Key Takeaway
Forrest Chen's 2008 acupuncture fee ruling: the evidence GEICO supplied, the argument not preserved and the later change to acupuncture schedules.
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.
Forrest Chen concerns acupuncture payments under the rules for the 2001 claims. It does not set a fixed reimbursement rate for today’s services.
Historical note: Forrest Chen concerns the pre-adoption acupuncture schedule regime; DFS identifies the later October 2020 service-date rules, so this decision does not fix today’s reimbursement rate.
Last reviewed: September 2026. Original publication date retained.
What the court decided
In Forrest Chen Acupuncture Services v GEICO, 54 AD3d 996 (2008), the provider’s motion failed and the insurer obtained dismissal. GEICO had shown that no acupuncture schedule existed for the relevant period and that its comparison with scheduled procedures supported the payment.
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The provider’s later attack on the proof supporting the chosen comparison was not considered because it had not been raised in Civil Court. That preservation problem matters: the decision cannot be read as a ruling that every comparison method is sufficiently supported.
The court cited the Department of Insurance’s 2004 opinion, which allowed comparison with similar scheduled services. It did not prescribe the archive’s expanded checklist of exhibits. Nor does a reduction authorize an excess patient charge: Insurance Law § 5108(c) separately limits what providers may demand.
Historical commentary from the archive
The first-person observation retained from the existing archive proposed a proof checklist. It is not a checklist imposed by Forrest Chen; the ensuing source-based explanation above replaces the expanded list:
Based on my analysis of this case and years of experience handling no-fault disputes, I would opine that “competent evidence” to support a prima facie fee schedule defense would include (besides a timely denial) the following:
Connect to the Encyclopedia
- Fee-schedule defense hub: cases, proof and later developments
- Acupuncture Approach: 97039 survived, other claims did not
- 2 & 9 Acupuncture: the unresolved 97026 and 97016 claims
- Flushing Traditional: an unresolved initial-evaluation claim
- Bronx Acupuncture: by-report verification and the motion result
- W.H.O. Acupuncture: the rate ruling and judgment procedure
For review of a particular no-fault billing dispute, contact our office.
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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Oct 2, 2017Frequently 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: Can my insurance company refuse to pay for acupuncture after a car accident?
Medical necessity and the allowable charge are separate questions. Forrest Chen upheld the rate proof for the old claims before it; it did not authorize arbitrary refusal of acupuncture benefits.
Q: What should I do if my no-fault carrier denies treatment citing fee schedule issues?
Obtain the denial, the billing explanation and the service dates. The disputed schedule provision and the evidence supporting the calculation matter more than a general reference to fee schedules.
Q: How can I protect myself from fee schedule disputes?
Keep the treatment and billing records. A fee reduction alone does not establish that care was unnecessary or authorize a provider to demand an excess charge from the patient; see Insurance Law § 5108(c).
Q: What happens if there’s no fee schedule for my specific treatment?
Forrest Chen applied the older similar-procedure framework. First determine whether a schedule now covers the provider and service; the absence of a schedule for licensed acupuncturists in 2001 is not today's rule.
Q: Can I appeal a fee schedule-based denial?
A disputed denial may be challenged through an available court or arbitration procedure. Which route and deadline apply depends on the claimant, assignment and procedural history; this opinion does not supply a universal appeal process.
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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.
