October 24, 2023
Matter of New Millennium Pain & Spine Medicine, P.C. v Progressive Cas. Ins. Co. (2023 NY Slip Op 05369)
https://www.beynensonlaw.com/case-law/matter-of-new-millennium-pain-spine-medicine-p-c-v-progressive-cas-ins-co-2023-ny-slip-op-05369/
- Decided
- October 24, 2023
- Citation
- 2023 NY Slip Op 05369
- Posture
- Article 75 petition
- Outcome
- Insurer prevailed
- Legal questions
- Court review of arbitration awards · Exhaustion of policy limits (see the maps)
Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.
Summary
Editorial summary by Beynenson Law, not part of the court’s decision.
Reported in New York Official Reports at Matter of New Millennium Pain & Spine Medicine, P.C. v Progressive Cas. Ins. Co. (2023 NY Slip Op 05369)
| Matter of New Millennium Pain & Spine Medicine, P.C. v Progressive Cas. Ins. Co. |
| 2023 NY Slip Op 05369 |
| Decided on October 24, 2023 |
| Appellate Division, First Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and subject to revision before publication in the Official Reports. |
Decided and Entered: October 24, 2023
Before: Manzanet-Daniels, J.P., Rodriguez, Pitt-Burke, Higgitt, Rosado, JJ.
Index No. 654892/22 Appeal No. 879 Case No. 2023-03262
v
Progressive Casualty Insurance Company, Respondent-Respondent.
Roman Kravchenko, Melville (Jason Tenenbaum of counsel), for appellant.
McCormack & Mattei, P.C., Garden City (Jamila Shukry of counsel), for respondent.
Order, Supreme Court, New York County (John J. Kelley, J.), entered June 28, 2023, which denied petitioner’s application pursuant to CPLR article 75 to vacate a master arbitration award, dated December 1, 2022, affirming an arbitrator’s award denying petitioner’s claim for no-fault benefits for medical services rendered to the insured, unanimously affirmed, without costs.
The court correctly denied the petition to vacate the master arbitration award. “Generally, a court will not set aside an arbitrator’s award for errors of law or fact unless the award is so irrational as to require vacatur” (Matter of Carty v Nationwide Ins. Co., 212 AD2d 462 [1st Dept 1995]). Here, petitioner does not dispute that the subject policy was exhausted prior to the underlying arbitration, but argues that its claim for no-fault compensation, which was submitted and denied prior to the exhaustion of the policy, should retain priority of payment. The fact that the arbitrator followed First Department precedent in Harmonic Physical Therapy, P.C. v Praetorian Ins. Co. (47 Misc 3d 137[A], 2015 NY Slip Op 50525[U] [App Term, 1st Dept 2015]) rather than Second Department precedent in Alleviation Med. Servs., P.C. v Allstate Ins. Co. (55 Misc 3d 44 [App Term, 2d Dept 2017], affd on other grounds 191 AD3d 934 [2d Dept 2021]) does not warrant reversal. To the contrary, this Court has held that, in awarding a claim after a policy has been exhausted, an arbitrator exceeded his or her power since an insurer’s duties cease upon the insurer’s payment of the contractual limit on its no-fault policy (see Matter of DTR Country-Wide Ins. Co. v Refill Rx Pharm., Inc., 212 AD3d 481 [1st Dept 2023], lv denied 40 NY3d 904 [2023]).
THIS CONSTITUTES THE DECISION AND ORDER OF THE SUPREME COURT, APPELLATE DIVISION, FIRST DEPARTMENT.
ENTERED: October 24, 2023
Legal questions (2)
Questions of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.
When does a court vacate, modify or confirm a no-fault arbitrator’s or master arbitrator’s award under CPLR article 75?
This decision: No ground for vacatur or modification shown: the award is confirmed or left in place
Affirmed denial of the petition to vacate, holding that the arbitrator's choice to follow Harmonic rather than Alleviation on a conceded exhaustion was not irrational, since an award after exhaustion would exceed the arbitrator's power.
Of the 55 decisions on this question in the First Department courts and the Court of Appeals, 34 (this one included) are in the same category.
Did the insurer prove the policy’s no-fault limits were properly exhausted before it became obligated to pay the claim?
This decision: Insurer proved the limits were used up before it had to pay this claim; claim fails or is reduced
Upheld the award denying the claim where the policy was conceded exhausted, rejecting the argument that a claim denied before exhaustion keeps priority, because an insurer's duties cease once it pays the policy limit.
Of the 16 decisions on this question in the First Department courts and the Court of Appeals, 7 (this one included) are in the same category. 2 decisions in other departments that cite or are cited by this one are on the full map.
Cited in this decision
A label shows how this decision treated the case it cites.
- Harmonic Physical Therapy, P.C. v Praetorian Ins. Co. (2015 NY Slip Op 50525(U))An insurer need not defer payment of other legitimate claims pending resolution of a claim it timely denied for lack of medical necessity.
- Alleviation Med. Servs., P.C. v Allstate Ins. Co. (2017 NY Slip Op 27097)An insurer cannot establish policy exhaustion through payments made after it denied a fully verified claim.
- Alleviation Med. Servs., P.C. v Allstate Ins. Co. (2021 NY Slip Op 08159)The insurer failed to support its policy-exhaustion defense with admissible evidence concerning the provider's claim.
- Matter of DTR Country-Wide Ins. Co. v Refill Rx Pharm., Inc. (2023 NY Slip Op 00179) FollowedA no-fault award directing payment beyond the policy's monetary limit exceeds the arbitrator's power.
Similar decisions
- Matter of New Millennium Pain & Spine Medicine, P.C. v Garrison Prop. & Cas. Ins. Co. (2024 NY Slip Op 00599)The provider's petitions failed because policy-exhaustion awards were rational and its wage-offset argument was unavailing.
- Allstate Fire & Cas. Ins. Co. v Branch Med., P.C. (2022 NY Slip Op 50277(U))An arbitration award directing payment beyond exhausted no-fault policy limits exceeds the arbitrator's power.
- Allstate Prop. & Cas. Ins. Co. v Northeast Anesthesia & Pain Mgt. (2016 NY Slip Op 50828(U))An arbitration award directing payment beyond a no-fault policy's monetary limit exceeds the arbitrator's power.
- Ameriprise Ins. Co. v Kensington Radiology Group, P.C. (2017 NY Slip Op 51911(U))The insurer's policy declarations and payment ledger raised a triable issue of exhaustion before its obligation to pay the claims arose.
- 563 Grand Med., P.C. v Progressive Northeastern Ins. Co. (2008 NY Slip Op 50090(U))A no-fault arbitrator may raise any issue the arbitrator deems relevant under 11 NYCRR 65-4.4 (e) and 65-4.5 (o).