Key Takeaway
New York court upholds insurance company's denial of acupuncture claims exceeding workers' compensation fee schedule limits in Raz Acupuncture v New S. Ins. Co.
This article is part of our ongoing mr. five boro award coverage, with 7 published articles analyzing mr. five boro award 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.
Court Upholds Fee Schedule Limits in Acupuncture Billing Dispute
No-fault insurance billing disputes often center on whether healthcare providers can charge beyond established fee schedules. In Raz Acupuncture, P.C. v New S. Ins. Co., a New York court addressed this fundamental issue when an acupuncture practice challenged an insurance company’s denial of claims that exceeded workers’ compensation fee schedule amounts.
The case highlights the ongoing tension between healthcare providers seeking full compensation for their services and insurance companies applying statutory fee limitations. For practitioners in the no-fault insurance system, understanding these fee schedule restrictions is crucial for proper billing and avoiding claim denials. This decision reinforces that insurance carriers can successfully defend against claims that exceed established fee schedules when they follow proper denial procedures.
Jason Tenenbaum’s Analysis:
Raz Acupuncture, P.C. v New S. Ins. Co., 2012 NY Slip Op 50865(U)
“The affidavits submitted by defendant in support of its cross motion for summary judgment established that defendant had timely denied (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ; Delta Diagnostic Radiology, P.C. v Chubb Group of Ins., 17 Misc 3d 16 ) plaintiff’s claims on the ground that the unpaid portion exceeded the amount permitted by the workers’ compensation fee schedule. Moreover, defendant demonstrated that it had fully paid plaintiff for the services in accordance with the workers’ compensation fee schedule.”
Another great appeal. Mr. Five Boro would be proud.
Key Takeaway
This ruling demonstrates that insurance companies can successfully defend fee schedule challenges when they properly deny claims and pay the permitted amounts. The court’s decision reinforces the importance of adhering to established fee schedules in workers’ compensation cases. Healthcare providers should be aware that claims exceeding these statutory limits face significant legal hurdles, as shown in this recent Mr. Five Boro victory.
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Legal Update (February 2026): Since this 2012 decision, New York’s no-fault fee schedules and reimbursement regulations have undergone multiple revisions, including updates to both the no-fault fee schedule and workers’ compensation fee schedules referenced in acupuncture billing disputes. Additionally, procedural requirements for claim denials and the intersection between different statutory fee schedule frameworks may have been modified through regulatory amendments. Practitioners should verify current fee schedule provisions and denial procedures under the applicable regulations.
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.
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Feb 3, 2012Common Questions
Frequently Asked Questions
What is the significance of notable legal decisions highlighted by attorneys?
Experienced attorneys frequently analyze notable court decisions to identify legal principles, procedural strategies, and emerging trends. These analyses help other practitioners and clients understand how courts apply the law in real-world disputes.
How do court decisions in one case affect future litigation?
Under the doctrines of stare decisis and precedent, court decisions — particularly from appellate courts — guide how similar cases will be decided. In New York no-fault and personal injury law, key decisions shape how insurers, providers, and claimants approach their disputes.
Why is case analysis important for understanding New York law?
New York's legal landscape is shaped by thousands of court decisions interpreting statutes and regulations. Detailed case analysis reveals how judges apply the law to specific facts, what evidence they find persuasive, and what procedural steps are critical for success.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
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 mr. five boro award 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.