Key Takeaway
Oriental World reversed a provider's summary judgment in 2012. What Great Wall decided, who appealed, and why the Aloi sanctions comparison needs care.
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.
GEICO won the appeal in Oriental World Acupuncture v GEICO (2012). The Appellate Term reversed the provider’s summary judgment and granted the insurer’s dismissal motion. The case did not involve a provider unsuccessfully appealing a fee-schedule loss.
Legal Update (September 2026): Acupuncture Now (2026) confines the older comparison-rate discussion to pre-October-2020 services; Oriental World’s 2012 result is not a current rate table.
Last reviewed: September 2026
The Great Wall ruling
The insurer’s employee established that the claims had been paid under the applicable fee schedule. Relying on the earlier Great Wall decision, the court accepted that proof and dismissed the complaint. The short opinion does not identify particular CPT codes or make a finding about abusive litigation.
Free Consultation · No Fee Unless We Win
Does this apply to your situation?
Every case is different. Get a free, confidential case review from an experienced attorney who can tell you exactly where you stand.
Its significance is the result in this record, not a claim about how often providers lost similar appeals. The older comparison-rate decisions also remain tied to the dates of treatment; a 2026 decision applying an old schedule does not turn that schedule into today’s rate.
The Aloi comparison needs a qualification
Jason mentioned Aloi in his original reaction below. In Aloi v Ellis (2012), however, the Fourth Department vacated sanctions because the comparative-negligence defense was not frivolous. It was a different personal injury case.
Neither opinion imposed sanctions for pressing the acupuncture position. The original comparison is preserved as commentary, with the two reported outcomes distinguished.
Jason’s historical commentary
Jason’s original reaction is preserved here. His Aloi comparison is commentary, not a statement that either opinion imposed sanctions:
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.
Connect to the Encyclopedia
Fee-schedule defense topic hub
- Raz: treatment claims and the separate initial visit
- Okslen: physician-rate calculation in the First Department
- Sung Bok Lee: what the reported decision actually says
- S.O.V.: the old schedule near the 2020 change
For review of a particular bill or denial, contact the firm. The decision and commentary above concern the stated record; they do not determine a new claim.
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
Keep Reading
More Fee Schedule Analysis
Acupuncture Reimbursements and Insurance Legalities Explained
Explore the Forrest Chen v. GEICO case and its impact on acupuncture insurance reimbursements in NY. Key insights for providers and patients.
Dec 11, 2024
Simple addition is insufficient
Jodi Jacobs's 2021 mixed appeal: four claims dismissed, one fee balance unresolved, and why the schedule alone did not prove correct code use.
May 22, 2021
The By-Report
Bronx Acupuncture v Hereford: By Report codes 97039 and 99199, missing documentation, and why the insurer’s summary judgment motion failed.
Feb 2, 2017
Another Civil Kings Judge gets reversed for deciding that Great Wall does not apply
Kings County judge reversed again for rejecting Great Wall acupuncture fee schedule ruling.
Mar 25, 2014
Prior rulings on acupuncture fee schedule and proof needed to oppose a medical necessity motion stand
New York appellate court clarifies acupuncture billing rates, medical necessity proof standards, and scope of practice in no-fault insurance disputes.
Dec 27, 2010
Understanding Medical Billing and Down-Coding in New York No-Fault Insurance Claims
Urban Well v Global Liberty: what the 2018 no-fault ruling actually decided about coding corrections, medical necessity and the unpaid balance.
Dec 18, 2018Frequently Asked Questions
Common Questions About This Topic
3 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
What is the Great Wall rule for acupuncture billing in New York no-fault cases?
Oriental World applied the older Great Wall comparison-rate rule for licensed-acupuncturist services. Acupuncture Now (2026) expressly discusses that rule for services before October 1, 2020; it is not an undated rule for every acupuncture bill.
Why did so many acupuncture fee schedule cases get reversed on appeal?
In Oriental World, GEICO established that it had paid the claims under the applicable schedule, and the court granted its dismissal motion. This one opinion does not establish how frequently other judgments were reversed or why each appeal was taken.
Do the fee schedule amounts from these older cases still apply?
An old rate can still matter to an old service date. Acupuncture Now (2026) applied the older schedule to 2017–2018 treatment. A later decision date does not make that schedule the rate for current services.
Was this article helpful?
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.
