Key Takeaway
Appellate Term ruling demonstrates how no-fault insurers lose defenses when they fail to timely deny claims, particularly for acupuncture services under New York's fee schedule.
No-fault insurance disputes often hinge on timing and procedural compliance. When insurers fail to follow New York’s strict 30-day payment or denial requirements, they risk waiving valuable defenses, including challenges to excessive fees and treatment scope. This principle becomes particularly important in acupuncture cases, where fee schedule disputes frequently arise and proper claim handling procedures are essential.
The Easy Care Acupuncture case perfectly illustrates how procedural missteps can doom an insurer’s defense strategy. When ELRAC failed to timely process the provider’s no-fault claims, they lost multiple defensive positions that might otherwise have been viable under New York no-fault insurance law.
Jason Tenenbaum’s Analysis:
Easy Care Acupuncture, P.C. v ELRAC, Inc., 2017 NY Slip Op 50234(U)(App. Term 1st Dept. 2017)
(1) “Plaintiff-provider established prima facie that its no-fault claims in the amount of $2,958.13 were overdue, since they were not “denied or paid” within the prescribed 30—day period (see Viviane Etienne Med. Care, P.C. v Country—Wide Ins. Co., 25 NY3d 498, 507 ).”
(2) “Nor may defendant assert the defense of excessive fees for the acupuncture services rendered in 2010, inasmuch as it failed to timely and properly mail the denial of claim form to plaintiff assignee”
(3) “In addition, the conclusory assertions in the adjuster’s affidavit were insufficient to raise a triable issue as to whether certain services provided were outside the scope of acupuncture treatment”
Gary Tsirelman: the expert in acupuncture. What else do you want me to say here? Elrac got badly shut out on this appeal.
Key Takeaway
The Appellate Term’s decision reinforces that no-fault insurers cannot raise excessive fee defenses or challenge treatment scope when they fail to properly deny claims within 30 days. Conclusory adjuster affidavits are insufficient to create factual disputes, making timely and specific claim denials crucial for preserving defensive positions in acupuncture-related disputes.
Legal Update (February 2026): Since this post’s 2017 publication, New York’s no-fault fee schedules and reimbursement rates have undergone multiple regulatory updates and amendments. Additionally, procedural requirements for claim processing, denial timelines, and fee dispute procedures may have been modified through regulatory changes or statutory amendments. Practitioners should verify current fee schedule provisions, payment timelines, and procedural compliance requirements under the most recent Insurance Department regulations.
