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October 14, 2014

Matter of Emerald Claims Mgt. for Ullico Cas. Ins. Co. v A. Cent. Ins. Co. (2014 NYSlipOp 06892)

https://www.beynensonlaw.com/case-law/matter-of-emerald-claims-mgt-for-ullico-cas-ins-co-v-a-cent-ins-co-2014-nyslipop-06892/

Court
Appellate Division, First Department
Decided
October 14, 2014
Citation
2014 NY Slip Op 06892 · 121 AD3d 481
Posture
Article 75 petition
Issues
Priority, other coverage CPLR article 75 (arbitration awards) Policy issues
Cite as
Matter of Emerald Claims Mgt. for Ullico Cas. Ins. Co. v A. Cent. Ins. Co., 121 AD3d 481 (1st Dept 2014)

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.

The loss-transfer awards rationally allowed recovery despite the adverse insurer's noncooperation disclaimer. The petitioning workers' compensation carrier paid benefits in lieu of no-fault benefits and sought reimbursement through compulsory arbitration under Insurance Law § 5105. The Appellate Division, First Department, affirmed the judgment confirming two awards in its favor. The arbitrators rationally construed Insurance Law § 5105 (a), with § 5102 (j), to confer a direct recovery right against a tortfeasor's insurer whose policy was in effect at the accident, separate from the insured's rights to defense and indemnification. The adverse insurer waived an arbitral-jurisdiction challenge by participating without seeking a stay or raising it below. Its policy-limits argument was not raised before the arbitrators and was also unavailing.

Reported in New York Official Reports at Matter of Emerald Claims Mgt. for Ullico Cas. Ins. Co. v A. Cent. Ins. Co. (2014 NYSlipOp 06892)

Matter of Emerald Claims Mgt. for Ullico Cas. Ins. Co. v A. Cent. Ins. Co.
2014 NYSlipOp 06892 [121 AD3d 481]
October 14, 2014
Appellate Division, First Department
Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
As corrected through Wednesday, December 3, 2014

[*1]

 In the Matter of Emerald Claims Management for Ullico Casualty Insurance Company, as Subrogee of Randolph Meyers, Respondent,
v
A. Central Insurance Company, Appellant.

Mischel & Horn, P.C., New York (Naomi M. Taub of counsel), for appellant.

Jones Jones LLC, New York (Jacqueline R. Mancino of counsel), for respondent.

Judgment, Supreme Court, New York County (Cynthia S. Kern, J.), entered June 10, 2013, for petitioner in the total amount of $39,935.19, and bringing up for review an order, same court and Justice, entered on or about December 12, 2012, which granted the petition to confirm two arbitration awards against respondent, unanimously affirmed, with costs. Appeal from order, unanimously dismissed, without costs, as subsumed in the appeal from the judgment.

Petitioner’s insured, while driving a van during the course of his employment, was involved in a motor vehicle accident with another vehicle, driven by a nonparty who was insured under a policy issued by respondent. Petitioner paid workers’ compensation benefits to its insured in lieu of no-fault benefits, and then sought “loss transfer” reimbursement from respondent pursuant to Insurance Law § 5105, under the mandatory arbitration procedure. Respondent asserted, as an affirmative defense to petitioner’s claim, that it had disclaimed coverage to its insured on the ground of noncooperation.

As this matter involves compulsory arbitration, the awards will be upheld so long as there is evidentiary support, and they are not arbitrary and capricious (see Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d 214, 223 [1996]). Here, the arbitrators rationally construed Insurance Law § 5105 (a) as providing petitioner insurer a direct right to recover loss transfer reimbursement from respondent, an adverse insurer of a tortfeasor who had a policy in effect at the time of the accident, regardless of respondent’s disclaimer of coverage on noncooperation grounds (see Matter of State Farm Mut. Auto. Ins. Co. v City of Yonkers, 21 AD3d 1110, 1110-1112 [2d Dept 2005]; see also Insurance Law § 5102 [j] [defining “(c)overed person” as having an insurance policy “in effect”]). The loss transfer recovery right of petitioner under Insurance Law § 5105 (a) is separate from the personal right of the insured tortfeasor (and his heirs, assignees, or subrogees) to receive a defense and indemnification from respondent (see Aetna Life & Cas. Co. v Nelson, 67 NY2d 169, 175 [1986]; Matter of Liberty Mut. Ins. Co. [Hanover Ins. Co.], 307 AD2d 40, 42 [4th Dept 2003]; State Farm Mut. Auto. Ins. Co., 21 AD3d at 1110-1112).

[*2] Respondent waived any argument that the arbitrators lacked jurisdiction, since it participated fully in the arbitration proceedings, never sought a stay of the arbitration, and did not raise the argument before the arbitrators or before the Supreme Court (see Rochester City School Dist. v Rochester Teachers Assn., 41 NY2d 578, 583 [1977]; Matter of Philadelphia Ins. Co. [Utica Natl. Ins. Group], 97 AD3d 1153, 1153 [4th Dept 2012], appeal dismissed 20 NY3d 984 [2012]). Nor did respondent assert any argument before the arbitrators that the combined awards exceeded the policy limits. In any event, the argument is unavailing.

We have considered respondent’s remaining arguments and find them unavailing. Concur—Friedman, J.P., Moskowitz, Feinman, Gische and Kapnick, JJ.

Cited in this decision

A label shows how this decision treated the case it cites.

  • Matter of State Farm Mut. Auto. Ins. Co. v City of Yonkers (2005 NY Slip Op 06935) FollowedA personal injury settlement does not extinguish a carrier's loss-transfer rights absent an express waiver.
  • Matter of Philadelphia Ins. Co. (Utica Natl. Ins. Group) (2012 NY Slip Op 05470)The petitioning insurer waived its loss-transfer arbitrability objection by failing to seek a stay before arbitration.

Cited by

  • Matter of Fiduciary Ins. Co. v American Bankers Ins. Co. of Florida (2015 NY Slip Op 06343)An arbitrator may decide whether a carrier is an insurer subject to mandatory loss-transfer arbitration despite its nonappearance.
  • Matter of DTG Operations, Inc. v Travelers Indem. Co. (2016 NY Slip Op 08967)A compulsory loss-transfer arbitration award is upheld if it comports with CPLR 7511 and is not arbitrary and capricious.
  • Country-Wide Ins. Co. v GEICO Gen. Ins. Co. (2017 NY Slip Op 50460(U))The respondent insurer's loss-transfer award was supported by the evidence and was not arbitrary and capricious.

Similar decisions

  • Matter of Progressive Advanced Ins. Co. v New York City Tr. Auth. (2018 NY Slip Op 07432)A loss-transfer award declining an additional 20% wage offset had a reasonable basis and was not arbitrary or capricious.
  • Matter of Global Liberty Ins. Co. of N.Y. v Avangard Supply, Inc. (2020 NY Slip Op 06855)An insurer's vague IME-based denial supported a rational arbitration award of no-fault benefits to the providers.
  • Matter of Infinity Indem. Ins. Co. v Hereford Ins. Co. (2017 NY Slip Op 03177)The petitioning insurer waived its loss-transfer arbitrability objection by failing to seek a stay before participating in arbitration.
  • Matter of O’Neill v GEICO Ins. Co. (2018 NY Slip Op 04328)The SUM award denying benefits for lack of accident-related causation was rational, supported by evidence, and not arbitrary or capricious.
  • Matter of Hereford Ins. Co. v American Tr. Ins. Co. (2019 NY Slip Op 05778)The loss-transfer award was upheld because its legal interpretation had a reasonable basis and did not contradict settled law.
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