PC ROSSI ALBERT v. State Farm Mutual Automobile Insurance Company, Defendant. (2026)

Recitation, as required by CPLR § 2219(a), of the papers considered in the review of this Motion:

D's Motion & Supporting Docs 8-16

P's Affirmation in Opposition 18

D's Affirmation in Reply 19

Upon the foregoing cited papers, the Decision/Order on Defendant's motion for summary judgment is GRANTED IN PART and DENIED IN PART for the reasons discussed as follows:

The coder affirmation of Mercy Acuna, RN, BSN, CPC (NYSCEF No. 14) indicates that an additional $65.60 is owed to Plaintiff as follows: (1) $26.24 for dates of service 03/18/24-03/27/24 ($186.18 found to be owing pursuant to coder affirmation, but only $159.94 paid per the denial); (2) $26.24 for dates of service 04/01/24-04/11/24 ($81.30 found to be owing pursuant to coder affirmation, but only $55.06 paid per the denial); and (3) $13.12 for dates of service 05/08/24-05/16/24 ($40.65 found to be owing pursuant to coder affirmation, but only $27.53 paid per the denial).¹

While Plaintiff submitted a rebuttal affirmation of its billing and collections specialist (see NYSCEF No. 18), the Court finds that affirmation does not adequately rebut the relevant points made in Ms. Acuna's thorough 27-page discussion of the application of the fee schedule to the bills at issue here.

As such, Plaintiff is granted judgment for $65.60 plus interest, attorney's fees, and filing fees. The Complaint is otherwise dismissed. All trial dates are hereby vacated.

This constitutes the Decision and Order of the Court.

DATED: June 11, 2026

Hon. Javier Ortiz, J.C.C.

Kings County Civil Court

FOOTNOTES

1.   Ms. Acuna also found that Defendant only should have paid $152.26 for dates of service March 1-13, 2024, even though Defendant's denial indicated that it would pay Plaintiff $175.66. Additionally, for dates of service April 16-May 1, 2024, Ms. Acuna found that Defendant only should have paid $73.36 even though the denial indicated a payment of $103.75. The Court nonetheless finds that the total $53.79 of alleged overpayments for March 1-13, 2024 (equaling $23.40) and April 16-May 1, 2024 (equaling $30.39) cannot be used to reduce the overall amounts owed by Defendant here because Defendant did not assert a counterclaim in its answer seeking reimbursement for any alleged overpayments. (Cf Nova Acupuncture, P.C. v Mercury Cas. Co., 48 Misc 3d 127(A), 2015 NY Slip Op 50914(U) [App Term, 2d Dept 2015] [defendant asserted counterclaim to seek reimbursement of overpayments]; Cornell Med., P.C. v Mercury Cas. Co., 24 Misc 3d 58, 2009 NY Slip Op 29228) [App Term, 2d Dept 2009] [defendant sought to amend its answer to include counterclaim to seek reimbursement of overpayments].)

Javier Ortiz, J.