Physical Performance Testing of NY v New York Cent. Mut. Fire Ins. Co., 2013 NY Slip Op 50581(U)(App. Term 1st Dept. 2013)
The Court was clear: “It is well-settled that a provider of healthcare services is not eligible for reimbursement of assigned first-party no-fault benefits “under section 5102(a)(1) of the Insurance Law if the provider fails to meet any applicable New York State or local licensing requirement necessary to perform such service in New York”
…
“Applying these principles to the matter at bar, Mutual has made a prima facie showing of entitlement to summary judgment dismissing the complaints by demonstrating that the services rendered by Physical are not reimbursable expenses under the No-Fault Law. In opposition, Physical failed to raise a triable issue of fact with respect to its claims because they were not performed by a medical professional corporation, or a licensed health provider.”
12 Responses
Without seeing the papers can’t make a determination on this case. What was the Mutual proof and I bet Physicals atty dropped the ball unless they weren’t licensed at all.
I think the company was not licensed How do you think atty “dropped the ball.”
Why did plaintiff appeal if company was not licensed? There must have been an issue there. A good firm appealed this case.
You dropped the ball by taking the client in the first place.
Like I said if not licensed than thats it and I said that abt the atty bc these cases are very hard to win for the carriers if the Providers atty is prepared.
Good seeing you too Kurt. They really spruced up the Jay Dietz EBT center in Brooklyn since I was there last…
Easy Captain, easy …. if there were only Mother Teresas out there lawyers would not have work.
Same here Jason, and good job beating up my client. No wonder the court report said he looked like Sly Stalone.
Sorry Kurt I am not an attorney so I would not know. I am a Marvel Super Hero along with lesser heroes such as Thor and Iron Man.
But if I may chime in as a layperson Super Hero. If the client is paying cash its easier to lose a case — I would think.
Was the underlying case handled by the Law Offices of Lana Sukhmen. She usually does good work.
The Captain America I know is faster than an adjuster denying a NF-3, can clear IME doctors in a single bound, and is more powerful than any mere mortal attorney.
So I rephrase my last comment. Without super villains where would you be??
Anonymous we have one slight disagreement. No one in the universe is faster then an adjuster denying an NF-3. Adjusters deny them before they are even sent. Adjusters are so fast that they exceed light speed and travel back in time to deny claims.
The Appellate Term actually stated such in a case were the provider argued that the claim was improperly denied because the denial pre-dated the treatment. See, Segfried and Roy Chiropractic PC v. Mug An Old Lady Mutual Insurance Company, 69 NYS.5d 69, 69 (App Term 2nd July 2013)
For the record, anonymous was me Cap. I don’t post anonymously but must have failed to put in my name on reply.
I stand corrected about the adjuster issue. And, I do know your secret identity. It can now be revealed to the world that you are ….. Oprah.