Key Takeaway
Court ruling shows evolution in acupuncture fee schedule defense standards, moving from procedural comparison requirements to simpler denial efficacy tests.
Karina K. Acupuncture P.C. v State-Wide Ins. Co., 2014 NY Slip Op 51518(U)(App. Term 1st Dept. 2014)
“The affidavits and other documentary evidence submitted by defendant established prima facie that defendant timely denied that portion of plaintiff’s first-party no-fault claim seeking payment of $1,182.53 – stemming from acupuncture services rendered by plaintiff during the period October 1, 2009 through October 21, 2009 – on the ground that the fees plaintiff charged exceeded the amount permitted by the applicable workers’ compensation fee schedule (see Akita Med. Acupuncture, P.C. v Clarendon Ins. Co., 41 Misc 3d 134, 2013 NY Slip Op 51860; Great Wall Acupuncture v Geico Ge. Ins. Co., 16 Misc 3d 23 ). In opposition, plaintiff failed to raise a triable issue as to the efficacy of defendant’s mailing of the denial form issued in connection with this claim or the calculation of the fee.”
Note how in less than one year, this Court moved away from the original language in Akita :”Nor did plaintiff establish or raise a triable issue that the acupuncture work sued for did not constitute a similar procedure than the one defendant chose for comparison in arriving at the reimbursement rate” and has now moved towards the following language: “In opposition, plaintiff failed to raise a triable issue as to the efficacy of defendant’s mailing of the denial form issued in connection with this claim or the calculation of the fee.”
(what a difference a year makes)
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- Fee Schedule Defense Requirements in No-Fault Insurance Cases | Long Island & NYC Legal Analysis
- Fee schedule defense – competent evidence?
- New York No-Fault Insurance Law
Legal Update (February 2026): The no-fault fee schedules and reimbursement methodologies referenced in this 2014 decision may have been subject to regulatory amendments or updates since publication. Practitioners should verify current fee schedule provisions and calculation methods, as the New York State Department of Financial Services periodically revises reimbursement rates and procedural requirements for acupuncture and other healthcare services under no-fault insurance regulations.
