Key Takeaway
New York appellate court reverses lower court decision in Oriental World Acupuncture v GEICO, highlighting the importance of strategic appellate arguments in no-fault cases.
Court Reversal in No-Fault Insurance Fee Schedule Dispute
In New York’s no-fault insurance system, disputes over medical fee schedules frequently make their way through the court system. These cases often involve healthcare providers challenging insurance carriers’ payment denials or reductions, with outcomes that can significantly impact both parties’ understanding of reimbursement requirements.
The case of Oriental World Acupuncture, P.C. v GEICO represents another chapter in the ongoing litigation between medical providers and insurance companies over proper compensation under New York No-Fault Insurance Law. Such disputes typically center on whether specific treatments fall within approved fee schedules and whether carriers have properly applied regulatory requirements when processing claims.
Fee schedule disputes often involve complex regulatory interpretations, particularly regarding CPT Code 97813 and 97814 for acupuncture services. These cases require careful attention to procedural requirements and the 120-day rule and fee schedule compliance issues that frequently arise in no-fault litigation.
Jason Tenenbaum’s Analysis:
Oriental World Acupuncture, P.C. v GEICO, 2012 NY Slip Op 51062(U)(App. Term 2d Dept. 2012)
When one asks to be reversed, you have to figure someone will take you up. I think pure Great Wall reversals should earn the treatment that Defendants in Aloi v. Ellis, 2012 N.Y. Slip Op. 04864 (4th Dept. 2012) received.
Key Takeaway
This appellate reversal demonstrates the unpredictable nature of no-fault insurance litigation. When parties request appellate review, they must be prepared for unfavorable outcomes. The reference to “Great Wall reversals” suggests a pattern of appellate courts overturning lower court decisions in similar cases, emphasizing the importance of thorough case preparation at all levels of litigation.
Legal Update (February 2026): Fee schedules referenced in this 2012 post have undergone multiple revisions since publication, including amendments to 11 NYCRR 65-3.8 and related reimbursement provisions under Insurance Law § 5106. Practitioners should verify current fee schedule amounts, CPT code classifications, and procedural requirements, as regulatory changes may have affected both reimbursement rates and claim processing timelines discussed in the original post.
