563 Grand Med., P.C. v Allstate Ins. Co.
Annotate this CaseDecided on February 8, 2005
Civil Court, Kings County
563 Grand Medical, P.C., a/a/o Miriam Polonia, Petitioner,
against
Allstate Insurance Company, Respondent.
91337/04
Eileen N. Nadelson, J.
Petitioner, a medical provider, brought this action to vacate a Master Arbitration award rendered in favor of Respondent insurer. The initial arbitration award was affirmed by the Master, both arbitrators concluding that Petitioner lacked standing to institute this claim for first party benefits under New York's No-Fault Insurance Law.
At the initial hearing, the arbitrator sua sponte raised the issue of Petitioner's standing to receive no-fault benefits. Petitioner, at the time in question, was a professional corporation authorized under New York law. The sole owner of the corporation was a medical doctor, and the services for which this action was commenced were acupuncture treatments performed by a licensed acupuncturist under the auspices of the professional corporation. The physician who owned the corporation was neither licensed nor certified to perform acupuncture, and no evidenced was adduced to indicate whether the acupuncturist was an employee of the corporation or an independent contractor.
11 NYCRR sec. 63-3.16(a)(12) states that:
A provider of health care services is not eligible for reimbursement under
section 5102(a)(1) of the Insurance Law if the provider fails to meet any [*2]
applicable New York State or local licensing requirement necessary to
perform such services in New York or meet any applicable licensing
requirement necessary to perform such service in any other state in which
such service is performed.
Under New York law, an acupuncturist may only be employed by or contracted to provide licensed services to the public through certain entities, including a licensed or certified acupuncturist or partnership of licensed (or certified) acupuncturists; a professional corporation authorized to practice acupuncture; a limited liability company or partnership lawfully authorized to practice acupuncture; a hospital, nursing home, clinic or HMO. See Advisory Letter from the State Education Department, October 8, 2002.
In order to provide acupuncture services, a professional corporation must be owned, organized and operated by persons who are licensed or certified to practice acupuncture. See generally, New York Business Corporation Law sec. 1503. In the case at bar, although Petitioner's owner was a licensed physician, he was neither licensed nor certified to practice acupuncture.
Cases in New York have held that proper licensing of a medical provider is a condition precedent to payment of benefits under the No-Fault Law. Valley Physical Medicine and Rehabilitation, P.C. v. New York Central Mutual Insurance Comany, 193 Misc 2d 675, 753 N.Y.S.2d 289 (2d Dept. 2002). Consequently, if Petitioner was not licensed to perform acupuncture, it may not recover first party No Fault benefits for such services.
In affirming the initial arbitration award, the Master stated that the award was based on the fact that Petitioner, although a licensed physician, presented no proof that such license encompassed acupuncture services. Such evidence was also not presented in the current petition. Therefore, because Petitioner was not licensed nor certified to perform acupuncture, it cannot bill for such services. 11 NYCRR sec. 65-3.16(a)(12).
In its papers, Petitioner focused on the circumstances that permit a court to vacate an arbitration award and specified the minium requirements that a health care provider must supply in order to prevail on a claim for No-Fault benefits. Petitioner completely failed to address the standing issue upon which the arbitration award was based. However, a health care provider's standing based on licensing requirements is always an appropriate field of inquiry. See generally CKC Chiropractic v. Republic Western Insurance Co., 5 Misc 3d 492, 784 N.Y.S.2d 350 (Kings County 2004).
Based on the foregoing, the court affirms the award of the arbitrator and Master Arbitrator. The court finds it unnecessary, based on this decision, to address the grounds that may be used to vacate such awards.
This constitutes the decision and order of the court.
[*3]Dated: February 8, 2005
__________________________
EILEEN N. NADELSON, J.C.C.
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