Key Takeaway
New York court ruling on fee schedule defense failures in no-fault insurance summary judgment motions, highlighting judicial notice requirements for claims examiners.
MIA Acupuncture, P.C. v Praetorian Ins. Co., 2011 NY Slip Op 21480 (App. Term 2d Dept. 2012)
“With respect to the claims for acupuncture services rendered from May 31, 2007 through August 27, 2007, the affidavit of defendant’s claims examiner stated that these claims underwent a “fee schedule review” resulting in a reduction of the amount due therefor. This allegation alone was insufficient to establish defendant’s contention that the amounts charged by plaintiff for these acupuncture services exceeded the relevant rates set forth in the workers’ compensation fee schedule (see Megacure Acupuncture, P.C. v Clarendon Natl. Ins. Co., 33 Misc 3d 141, 2011 NY Slip Op 52199 ) and, thus, defendant was not entitled to summary judgment with respect to these claims.”
The dissent. I think we saw this in a prior dissent from Golia, J., but I think it probably makes sense.
“An advocate before any court need not supply it with physical copies of the laws upon which an argument is based to ensure that those particular laws are taken under consideration by this court. An advocate need only recite an argument involving a certain law; an attorney need only bring the relevant law to the attention of a court. Indeed, here it is enough that defendant alleged that the fee charged by plaintiff exceeded the relevant rates set forth in the fee schedule as prescribed by law. As such, I would remit this specific issue back to the lower court for a determination of the motion as to whether the proper fees were charged under the workers’ compensation fee schedule for the services rendered from May 31, 2007 through August 27, 2007, and whether appropriate payment was made thereon. I would also advise the motion court that it is obligated to take notice of the workers’ compensation fee schedule and all New York laws and regulations pertaining thereto.”
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Legal Update (February 2026): Since this 2012 decision, New York’s no-fault fee schedules have undergone multiple revisions and the procedural requirements for establishing fee schedule defenses in summary judgment motions may have evolved through subsequent case law and regulatory amendments. Practitioners should verify current fee schedule provisions and judicial notice requirements under the most recent Insurance Department regulations and court decisions.
