Key Takeaway
NY court rules simple addition insufficient to prove proper fee schedule calculations in no-fault insurance case, requiring detailed evidence of code utilization.
Jodi Jacobs, D.C., PLLC v Global Liberty Ins. Co. of NY, 2021 NY Slip Op 50445(U)(App. Term 2d Dept. 2021)
Since when was taking out the abacus insufficient to prove that you properly added and multiplied?
“Contrary to defendant’s contention, defendant was not entitled to the dismissal of so much of the complaint as sought to recover upon the unpaid portion of the $380.73 claim for services rendered June 1, 2016 through June 13, 2016 because defendant failed to conclusively establish its defense that the fees charged exceeded the amounts set forth in the workers’ compensation fee schedule (see Rogy Med., P.C. v Mercury Cas. Co., 23 Misc 3d 132, 2009 NY Slip Op 50732 ). Indeed, “the fee schedule does not, in and of itself, establish that defendant properly utilized the codes set forth within the workers’ compensation fee schedule to calculate the amount which plaintiff was entitled to recover for each service rendered (see Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co., 61 AD3d 13 ; Rogy Med., P.C. v Mercury Cas. Co., 23 Misc 3d 132, 2009 NY Slip Op 50732 )” (Acupuncture Healthcare Plaza I, P.C. v Metlife Auto & Home, 54 Misc 3d 142, 2017 NY Slip Op 50207, *1-2 ).”
The one good think about no-fault is the stakes are relatively low, so I can give attorneys who want the experience an opportunity to draft an appeal or to try a case.
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