Matter of American Tr. Ins. Co. v Heyligers (2026 NY Slip Op 04363)

Reported in New York Official Reports at Matter of American Tr. Ins. Co. v Heyligers (2026 NY Slip Op 04363)

(July 9, 2026)

Order, Supreme Court, New York County (Jeffrey H. Pearlman, J.), entered October 8, 2025, which denied the petition brought pursuant to CPLR article 75 to vacate a master arbitration award, dated April 3, 2025, affirming an arbitrator’s award, dated January 6, 2025, awarding respondent Mark Heyligers, DC $3,568.50 for no-fault benefits for medical services he rendered to the insured, and to vacate the January 6th arbitration award, unanimously affirmed, with costs.

Initially, and contrary to Supreme Court’s finding, the petition was timely. The petition was filed July 1, 2025, and sought review of an arbitration award issued on January 6, 2025. However, before instituting this proceeding, petitioner appealed from the award to a master arbitrator, as was required before bringing this petition (see American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 239 AD3d 1, 11-12 [2d Dept 2025]; 11 NYCRR 65-4.10 [a]). The master arbitrator mailed his decision on April 7, 2025. Petitioner thus brought this action within the CPLR 7511 (a) 90-day window (see Matter of New York City Tr. Auth. v Heights Med. Care P.C., 52 Misc 3d 1214[A], 2016 NY Slip Op 51153[U], *3 [Sup Ct, NY County 2016]).

The court nevertheless properly denied the petition, as the arbitrators’ decisions were neither arbitrary, capricious, without rational basis, nor contrary to settled law. Petitioner contends that the no fault benefits owed to Heyligers, a chiropractor, were terminated on March 12, 2023, based on an independent medical examination (IME) report that nonparty Dr. Neil M. Ganz, D.C. issued on February 21, 2023. That report stated that the covered individual whom Heyligers was treating needed no further chiropractic care. However, the treatment cut-off date was not the date on which petitioner terminated the benefits (cf. Dayan v Allstate Ins. Co., 49 Misc 3d 151[A], 2015 NY Slip Op 51751[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2015]), but the date on which Heyligers received notice of the termination, which was May 1, 2023. Petitioner did not address Heyliger’s argument, adopted by the initial arbitrator, regarding the May 1, 2023 cut-off date. Nor did petitioner address the finding of the master arbitrator that the arbitrator was entitled to rely on an opinion letter from the New York State Insurance Department Office of General Counsel, which provided that the IME would not take effect until the insurer sent the provider a timely denial based on that IME. Because petitioner has not undermined the basis for the arbitrators’ conclusions, it has not shown how either arbitration decision lacked a rational basis or was arbitrary and capricious or contrary to settled law (see Matter of State Farm Mut. Auto. Ins. Co. v Lumbermens Mut. Cas. Co., 18 AD3d 762, 763 [2d Dept 2005]).

Petitioner also contends that its verification requests, which were sent from July 2022 to July 2023, tolled the time within which petitioner needed to pay or deny Heyligers’ bills. However, with the exception of a July 17, 2023 verification request that Heyligers did not answer, petitioner does not contest that Heyligers furnished the requested verifications, thus requiring petitioner to pay or deny Heyligers’ bills within 30 days of the verifications (see New York Hosp. Med. Ctr. of Queens v Country-Wide Ins. Co., 295 AD2d 583, 584 [2d Dept 2002]; 11 NYCRR 65-3.8 [a] [1]). As to the July 17, 2023 verification request, although Heyligers submitted his last verification in May 2023, petitioner does not address Heyligers’ argument, and the arbitrator’s finding, to the effect that the July 2023 request sought information that Heyligers had previously furnished. Accordingly, the arbitrator could reasonably find that Heyligers’ claims were no longer tolled (see 11 NYCRR 65-3.8 [a] [1]), rendering the master arbitrator’s affirmance of that award reasonable (see Lumbermens, 18 AD3d at 763). Concur—Renwick, P.J., Kapnick, Pitt-Burke, Rosado, Hagler, JJ.