Careplus Med. Supply Inc. v Allstate Indem. Co.

[*1] Careplus Med. Supply Inc. v Allstate Indem. Co. 2004 NY Slip Op 51148(U) Decided on September 24, 2004 Civil Court, Kings County Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on September 24, 2004
Civil Court, Kings County

CAREPLUS MEDICAL SUPPLY INC., a/a/o Moises Aguirre-Zamudio and Luz Arteaga, Plaintiff,

against

ALLSTATE INDEMNITY COMPANY, Defendant.



44388/04

Loren Baily-Schiffman, J.

Plaintiff moves this Court for summary judgment to recover assigned first party no-fault insurance benefits. Specifically, the instant action involves claims for medical equipment allegedly provided to the assignors. Plaintiff asserts that it provided certain medical equipment to its assignors that had been prescribed by the assignors' doctors. In each instance, defendant timely made partial payment and has refused to make any further payment. Defendant asserts that plaintiff's submitted charges were not documented as required by Insurance Regulation No. 83, 11 NYCRR 68. In opposition to plaintiff's motion, defendant contends that summary judgment is inappropriate because the plaintiff has "failed to identify the actual items supplied and has failed to establish the 'documented' cost of the items at issue." Affirmation of Allison B. Lindsey. The claim for $581.41 concerning assignor Luz Arteaga has been resolved and is not the subject of this motion.

A party moving for summary judgment must show by admissible proof that there are no material issues of fact in controversy and that they are entitled to judgment as a matter of law. [*2]Alvarez v. Prospect Hospital, 68 NY2d 320 (1986); Winegrad v. New York Univ. Medical Center, 64 NY2d 851 (1985). Once that showing is made, the burden shifts to the opponent of summary judgment to come forward with proof in admissible form that there are material issues of fact in controversy that require a trial. Id.

In support of its motion plaintiff submits the following documents concerning a claim for equipment provided to Moises Aguirre-Zamudio for $1323 of which $1020.98 is in dispute:

1.A claim, dated May 14, 2003, in the amount of $1323,for medical equipment provided to Moises Aguirre;

2.The NF-10 form which disputes $1020.98 of the submitted claim;

3.An "Explanation of Medical Bill Payment" indicating that payment for the claimed equipment has been "adjusted to reflect reasonable and customary fees of providers in the geographic area";

4.An Assignment of Benefits signed by Moises Aguirre and acknowledging receipt of the medical equipment in question;

5.A medical referral for the equipment in question;

6.Two (2) Invoices from Atlas Medical Equipment indicating medical equipment and supplies, including the equipment in question in this action, sold to the plaintiff;

7.Cancelled checks from plaintiff to Atlas Medical Equipment in the full amount of the aforementioned Invoices.

The same types of documentation have been provided with reference to the claim for equipment provided to Luz Arteaga in the amount of $565 of which $259.07 is in dispute.

At oral argument, the parties agreed that the leading cases in this area of law are Kings Medical Supply Inc. v. Allstate Insurance Company, NYLJ, Jan. 6, 2004, p.26, col. 6 (App Term 9th & 10th Jud. Dists, 2004) and Kings Medical Supply Inc. v. Travelers Property Casualty Corp., 194 Misc2d 667 (Civil Ct, Kings Co, 2003). In this Court's view, the holdings of these two decisions are not in conflict. In fact, the decision of the Appellate Term in Kings Medical v. Allstate, supra cites the Civil Court decision in Kings' Medical v. Travelers, supra with approval: The regulations, however, explicitly limit a provider's medical equipment claims to 150 percent of cost (11 NYCRR App. 17-C, Part E[b][1] which clearly is an applicable fee schedule within the [*3]contemplation of 11 NYCRR 69.5(b) (see King's Med. Supply v. Travelers Prop Cas. Corp., 194 Misc.2d 667, 673 [2003]).

Kings Medical v. Allstate, supra.

Accordingly, this Court holds that in order to make out a prima facie case for payment of assigned first party no-fault benefits for medical supplies or equipment, the party seeking such payment must document the cost of the supplies or equipment to the provider and must show that this cost was paid for the specific supplies or equipment provided to the assignor.

Here, plaintiff/movant has met its burden by submitting a claim for benefits which states the specific equipment provided to the assignor; an assignment of benefits by the assignor/patient to the assignee/provider; a medical referral to the assignor/patient for the specific equipment at issue in this motion; invoices from a supplier showing the cost of the subject equipment to the provider; and cancelled checks showing that the invoices were paid by the provider. Defendant's argument that plaintiff has failed to establish the amounts charged by the supplier is without merit. Defendant's argument that in order to make out its prima facie case, plaintiff must provide "identifying information for the medical equipment and supplies at issue such as the make an model number of the items" is rejected by this Court to the extent that any more information than that provided by plaintiff in support of this motion is required. Defendant's Memorandum of Law at p. 3.

Defendant submits that plaintiff must submit proof that it was actually charged the amounts it claims it was charged. An invoice and a cancelled check in the amount of the invoice are sufficient proof in this Court's view. The decision in King's Medical Supply v. Travelers, supra does not require a different holding. In King's Medical the plaintiff merely submitted copies of invoices. Here, plaintiff has established the entire chain of information from the assignment of benefits to the medical referral to the patient's receipt for the equipment to the invoice to the cancelled check in addition to the claim, denial and NF-10 form. Nothing more than what has been provided to this Court is required to establish the "documented cost" and that the "documented cost" has been paid.

Plaintiff's motion for summary judgment is granted in all respects. Accordingly, judgment is granted to plaintiff in the total sum of $1,280.05 plus statutory attorneys fees, interest and costs to be computed by the Clerk of the Court.

This constitutes the decision and Order of this Court.

Dated:September 24, 2004 __________________________

LOREN BAILY-SCHIFFMAN, J.C.C.