December 22, 2017
Ameriprise Ins. Co. v Kensington Radiology Group, P.C. (2017 NY Slip Op 51911(U))
https://www.beynensonlaw.com/case-law/ameriprise-ins-co-v-kensington-radiology-group-p-c-2017-ny-slip-op51911u/
- Decided
- December 22, 2017
- Citation
- 2017 NY Slip Op 51911(U)
- Posture
- Article 75 petition
- Later history
- Affirmed by Matter of Ameriprise Ins. Co. v Kensington Radiology Group, P.C. (2020 NY Slip Op 00500)
- 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 Ameriprise Ins. Co. v Kensington Radiology Group, P.C. (2017 NY Slip Op 51911(U))
against
Kensington Radiology Group, P.C. a/a/o Zoila McBean, Respondent-Respondent.
Petitioner appeals from an order and judgment of the Civil Court of the City of New York, New York County (Erika M. Edwards, J.), entered on or about November 30, 2016, which denied its petition to vacate an arbitration award in favor of respondent, awarding it unpaid no-fault benefits in the principal sum of $3,548.01, and confirmed the arbitration award.
Per Curiam.
Order and judgment (Erika M. Edwards, J.), entered November 30, 2016, reversed, without costs, and matter remanded to Civil Court for a framed issue hearing regarding whether the $50,000 policy limit of the subject insurance policy was exhausted before petitioner became obligated to pay respondent’s claim.
When an insurer “has paid the full monetary limits set forth in the policy, its duties under the contract of insurance cease” (Countrywide Ins. Co. v Sawh, 272 AD2d 245 [2000]). A defense that the coverage limits of the policy have been exhausted may be asserted by an insurer despite its failure to issue a denial of the claim within the 30—day period (New York & Presbyt. Hosp. v Allstate Ins. Co., 12 AD3d 579, 580 [2004]), and an arbitrator’s award directing payment in excess of the $50,000 limit of a no-fault insurance policy exceeds the arbitrator’s power and constitutes grounds for vacatur of the award (see Matter of Brijmohan v State Farm Ins. Co., 92 NY2d 821, 822-823 [1998]; Countrywide Ins. Co. v Sawh, 272 AD2d at 245; 11 NYCRR 65—1.1).
Here, petitioner-insurer’s submissions in support of its petition to vacate the arbitration award – including an attorney’s affirmation, the policy declaration page showing the $50,000 limit and a payment ledger listing in chronological order the dates the claims by various providers were received and paid – raised triable issues as to whether the $50,000 policy limit had been exhausted by payments of no fault benefits to respondent and other providers before petitioner became obligated to pay the claims at issue here (see Allstate Prop. & Cas. Ins. Co. v Northeast Anesthesia & Pain Mgt., 51 Misc 3d 149[A], 2016 NY Slip Op 50828[U] [App Term, 1st Dept 2016]; Allstate Ins. Co. v DeMoura, 30 Misc 3d 145[A], 2011 NY Slip Op 50430[U] [App Term, [*2]1st Dept 2011]). Therefore, we remand the matter to Civil Court for a framed issue hearing on that issue.
THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.
I concurI concur I concur
Decision Date: December 22, 2017
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: The court cannot decide on the record whether a ground for vacatur exists and orders a hearing or a determination below
Reversed confirmation and remanded for a framed-issue hearing because the insurer's declaration page and chronological payment ledger raised triable issues whether the $50,000 limit was exhausted, which would make the award exceed the arbitrator's power.
Of the 55 decisions on this question in the First Department courts and the Court of Appeals, 4 (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: Exhaustion cannot be decided on this record: issue of fact, framed-issue hearing, or remittal to decide the defense
Held the insurer's attorney affirmation, declaration page and chronological payment ledger raised triable issues whether the $50,000 limit was exhausted before it became obligated to pay the claims, noting the defense survives a missing timely denial; framed-issue hearing ordered.
Of the 16 decisions on this question in the First Department courts and the Court of Appeals, 8 (this one included) are in the same category. One decision in other departments that cites or is cited by this one is on the full map.
Cited in this decision
A label shows how this decision treated the case it cites.
- New York & Presbyt. Hosp. v Allstate Ins. Co. (2004 NY Slip Op 08669) FollowedAn untimely denial does not preclude an exhaustion defense or establish entitlement to judgment on a previously denied duplicate claim.
- Allstate Prop. & Cas. Ins. Co. v Northeast Anesthesia & Pain Mgt. (2016 NY Slip Op 50828(U)) FollowedAn arbitration award directing payment beyond a no-fault policy's monetary limit exceeds the arbitrator's power.
- Allstate Ins. Co. v DeMoura (2011 NY Slip Op 50430(U)) FollowedAn arbitrator exceeds the arbitrator's power by directing payment beyond a no-fault policy's $50,000 limit.
Cited by
A label shows how the later decision treated this one.
- Matter of Ameriprise Ins. Co. v Kensington Radiology Group, P.C. (2020 NY Slip Op 00500) AffirmedAn arbitration award exceeding policy limits may be challenged with evidence first submitted when confirmation is sought.
Similar decisions
- Matter of New Millennium Pain & Spine Medicine, P.C. v Progressive Cas. Ins. Co. (2023 NY Slip Op 05369)An insurer's duties cease upon payment of the contractual limit of its no-fault policy.
- 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.
- 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.
- Kanter Physical Medicine & Rehab, P.C., GEICO Ins. Co. (2019 NY Slip Op 51175(U))Denial of a petition to vacate a master arbitrator's award requires confirmation of the award under CPLR 7511 (e).
- First Am. Alliance, Inc. v Ameriprise Ins. Co. (2018 NY Slip Op 51765(U))An insurer's payments of other claims after denying the claims sued upon do not warrant summary judgment for exhausted coverage.