High Quality Med. Supplies, Inc. v. Mercury Ins. Group

Appellate Terms of the Supreme Court of New York

High Quality Med. Supplies, Inc. v. Mercury Ins. Group

CourtAppellate Terms of the Supreme Court of New York

DecidedOctober 5, 2016

Docket2016 NYSlipOp 51444(U)

StatusPublished

This text of High Quality Med. Supplies, Inc. v. Mercury Ins. Group (High Quality Med. Supplies, Inc. v. Mercury Ins. Group) is published on Counsel Stack Legal Research, covering Appellate Terms of the Supreme Court of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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High Quality Med. Supplies, Inc. v. Mercury Ins. Group, (N.Y. Ct. App. 2016).

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Opinion

High Quality Medical Supplies, Inc., as Assignee of CHARLES BOTWEE, Respondent,

against

Mercury Ins. Group, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered July 31, 2013. The order denied defendant's motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court which denied defendant's motion for summary judgment dismissing the complaint.

In SK Prime Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co. (43 Misc 3d 133[A], 2014 NY Slip Op 50630[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]), this court noted that the "NYS Medicaid DME Services Fee Schedule" has been adopted as the Durable Medical Goods Fee Schedule for Workers' Compensation (12 NYCRR 442.2 [a]). However, contrary to defendant's argument on appeal, that is not a basis to hold that "the billing for durable medical equipment that is not included within the fee schedule is not compensable." Indeed, 11 NYCRR 68.5 specifically addresses reimbursement for healthcare services not set forth in fee schedules.^[FN1]

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: October 05, 2016

Footnotes

Footnote 1:11 NYCRR 65-3.16 (a) provides for payment of "medical expenses," which shall be in accordance with fee schedules contained in 11 NYCRR 68, entitled "Charges for Professional Health Services." Reimbursement for durable medical equipment is regularly treated as interchangeable with reimbursement for healthcare services under the No-Fault Regulations (see e.g. Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556 [2008]; see generally Amaze Med. Supply v Allstate Ins. Co., 3 Misc 3d 43, 44 [App Term, 2d Dept, 2d & 11th Jud Dists 2004]).

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High Quality Medical Supplies, Inc., as Assignee of CHARLES BOTWEE, Respondent,

against

Mercury Ins. Group, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered July 31, 2013. The order denied defendant's motion for summary judgment dismissing the complaint.

ORDERED that the order is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals from an order of the Civil Court which denied defendant's motion for summary judgment dismissing the complaint.

In SK Prime Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co. (43 Misc 3d 133[A], 2014 NY Slip Op 50630[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2014]), this court noted that the "NYS Medicaid DME Services Fee Schedule" has been adopted as the Durable Medical Goods Fee Schedule for Workers' Compensation (12 NYCRR 442.2 [a]). However, contrary to defendant's argument on appeal, that is not a basis to hold that "the billing for durable medical equipment that is not included within the fee schedule is not compensable." Indeed, 11 NYCRR 68.5 specifically addresses reimbursement for healthcare services not set forth in fee schedules.^[FN1]

Accordingly, the order is affirmed.

Pesce, P.J., Aliotta and Solomon, JJ., concur.

Decision Date: October 05, 2016

Footnotes

Footnote 1:11 NYCRR 65-3.16 (a) provides for payment of "medical expenses," which shall be in accordance with fee schedules contained in 11 NYCRR 68, entitled "Charges for Professional Health Services." Reimbursement for durable medical equipment is regularly treated as interchangeable with reimbursement for healthcare services under the No-Fault Regulations (see e.g. Fair Price Med. Supply Corp. v Travelers Indem. Co., 10 NY3d 556 [2008]; see generally Amaze Med. Supply v Allstate Ins. Co., 3 Misc 3d 43, 44 [App Term, 2d Dept, 2d & 11th Jud Dists 2004]).

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