Fee schedule vendor properly substituted for a claims rep. affidavit

Amica’s fee-schedule vendor supplied competent proof of the payment calculation in this case. A separate claims-representative affidavit established timely mailing of the denials. The decision did not eliminate the need for that mailing evidence, and it did not say that Healing Art’s patients were treated by chiropractors.

Legal Update (September 2026): Healing Art’s 2015 payment decision used the older acupuncture framework; the schedule amendments effective for no-fault services from October 1, 2020 mean its historical rate reference is not a current billing instruction, as distinguished in the fee-schedule hub.

Last reviewed: September 2026.

What Healing Art actually established

Healing Art Acupuncture, P.C. v Amica Mutual Insurance Co., 2015 NY Slip Op 50078(U), was decided January 15, 2015, by the Appellate Term, Second Department. The provider challenged the judgment dismissing its complaint after the Civil Court granted Amica summary judgment and denied the provider’s cross motion.

The appellate court affirmed. Amica established timely denial mailing and full payment under the fee schedule it had used. The provider’s opposition did not raise a triable issue.

For the payment issue, Amica relied on an affidavit from a fee-schedule adjuster employed by Managed Care Network, its vendor. The court held that this affidavit established proper use of the workers’ compensation schedule for acupuncture services performed by chiropractors to determine the amount payable on the disputed services.

That wording identifies the schedule applied. It does not establish that the practice employed chiropractors or that chiropractors actually performed these treatments. The earlier explanatory copy supplied those facts without support in the published opinion.

The vendor did not replace every witness

The headline concerns the fee-schedule calculation. The insurer also submitted a claims-representative affidavit establishing timely mailing of the denial forms. Those were separate evidentiary tasks.

The published decision therefore does not support a statement that the vendor’s affidavit replaced all claims-representative evidence in the case. It supports the narrower point that the vendor adjuster could establish the merits of this fee defense on the record submitted.

Nor does the decision describe an earlier universal rule requiring an insurer’s own employee to testify about every reduction. The vendor affidavit was accepted; that is not proof that the court announced a wholesale departure from a previously mandatory employee-only rule.

Jason’s original observation

Jason’s February 2015 note focused on who supplied the fee evidence:

So here, you have a vendor’s affidavit establishing the merits of the fee schedule defense. Generally, this type of issue can be handled through claims representative affidavit.

Read “this type of issue” as the fee calculation discussed in the preceding excerpt. The opinion’s mailing analysis remains separate. Preserving that distinction keeps the historical observation useful without expanding it into a rule about every function a vendor might perform.

The certificate-of-conformity objection

The provider also challenged the claims representative’s out-of-state affidavit because it lacked the certificate of conformity addressed by CPLR 2309(c) and Real Property Law § 299-a. The court held that the omission was not fatal on this record.

Its reasoning relied on the absence of prejudice and the treatment of the defect under CPLR 2001. The provider had not shown that a substantial right was prejudiced. That is more precise than saying certificates never matter or that any out-of-state affidavit is automatically acceptable.

The current text of CPLR 2309(c) still addresses an oath or affirmation taken outside the state and the accompanying authentication. Healing Art concerns how the court handled the omission presented to it; it does not repeal the statute.

For a comparable record, identify whether the objection concerns the form of the oath, the witness’s knowledge, the document’s authenticity or the substance of the calculation. An answer to one issue does not supply proof of the others.

Compare successful and unsuccessful payment explanations

MIA Acupuncture v Integon also resulted in an insurer victory after proof of timely denial and full scheduled payment. Its mailing-company evidence had a different role from the fee-schedule adjuster’s evidence in Healing Art.

Tyorkin v Garrison supplies the contrasting result. There, the court found that the coder’s explanation left a factual issue over the fee reduction. The surviving defense did not entitle the insurer to dismissal merely because a certified coder had participated.

The comparison is useful for both sides. A vendor’s employment status is not, standing alone, a reason to disregard a supported calculation. But the vendor’s involvement is not a substitute for the factual explanation needed to connect the schedule with the billed services and payment.

Saddle Brook adds the question of denial preclusion under the post-2013 excessive-fee amendment. Healing Art expressly included timely mailing proof, so its result should not be cited as though the court had excused a late denial.

The service date controls the historical rate comparison

The 35th Amendment to Regulation 83 made the specified schedule amendments applicable to no-fault services performed on or after October 1, 2020. A later claim requires the applicable schedule and ground rules, not an assumption that the older chiropractor-rate reference governs every acupuncture service.

Similarly, an opinion’s publication date does not establish the treatment dates in a different file. A reader comparing older bills should keep the date of service, version of the schedule and date of the court decision in separate fields.

For a current dispute, the practical review starts with the bill, the schedule used, the insurer’s calculation, any payment and the denial. Identify what the affiant says was personally performed or reviewed and which documents support the conclusion. The case does not prescribe a vendor contract or a particular job title as a universal condition of admissibility.

What belongs in the library entry

Healing Art contributes two concrete points: accepted vendor proof of the fee calculation and a nonfatal certificate defect where prejudice was not shown. It does not establish the treating practitioner’s profession, create a general agency-law rule for outsourced claims administration or guarantee that another vendor affidavit will be sufficient.

The Natural Acupuncture Health note illustrates why a caption and a rate assumption need similar care. Together, these notes help readers follow the evidence that actually produced the result rather than repeat an unsupported account of what supposedly happened behind the short opinion.

Connect to the Encyclopedia

Start with the fee-schedule defense hub. Follow the closest case comparisons:

• MIA Acupuncture: denial-mailing and full-payment proof.
• Tyorkin: a coder’s unexplained reductions did not earn dismissal.
• Saddle Brook: a different question about a late fee denial.
• Natural Acupuncture Health: do not infer a rate from the caption.
• Shara: proof for treatment codes did not address the evaluation.

For review of a particular no-fault billing dispute, contact the Law Office of Jason Tenenbaum. Bring the service dates, bills, payment records, denials and the insurer’s fee calculation. A review can identify the disputed issue; these historical decisions do not guarantee a recovery.