Matter of Progressive Direct Ins. Co. v Vargas (2026 NY Slip Op 06393)

Reported in New York Official Reports at Matter of Progressive Direct Ins. Co. v Vargas (2026 NY Slip Op 06393)

Matter of Progressive Direct Ins. Co. v Vargas

2026 NY Slip Op 06393

Decided on October 29, 2026

Appellate Division, First Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This decision is uncorrected and subject to revision before publication in the Official Reports.

Decided and Entered: October 29, 2026

Index No. 820821/24|Appeal No. 7405|Case No. 2026-00167|

Before: Renwick, P.J., Kennedy, Friedman, González, Chan, JJ.

[*1]

Order, Supreme Court, Bronx County (Raymond P. Fernandez, J.), entered on or about December 17, 2025, which granted the petition to permanently stay respondent’s supplemental uninsured motorist arbitration demand, unanimously reversed, on the law, without costs, the permanent stay vacated, the matter remanded to Supreme Court and the arbitration stayed pending a hearing to determine whether there was physical contact between respondent’s motorcycle and another vehicle, and whether respondent complied with the requirement to report the accident within 24 hours.

“Physical contact is a condition precedent to an arbitration based on a ‘hit and run’ accident and the burden of proof to demonstrate physical contact is upon the insured” (Matter of Country-Wide Ins. Co. v Colon, 279 AD2d 427, 427 [1st Dept 2001]). Here the EMS Report provided conflicting accounts of whether there was physical contact between respondent and another vehicle. On the one hand it said that respondent “almost collided with a car, causing him to panic and fall of his bike,” while on the other it listed the “Dispatch Reason” as “Pedestrian Struck.” Respondent maintained in his affirmation that an “unknown vehicle” “struck [his] motorcycle,” supporting the notion that there was actual contact. A framed issue hearing is necessary to resolve these discrepancies (see Matter of Universal Underwriters [Zeitlin], 157 AD2d 544, 546 [1st Dept 1990]).

A framed issue hearing is also necessary to determine if respondent complied with the 24-hour reporting requirement in the policy. Applying “a very liberal interpretation to the notice requirement, accepting police contacts that fall far short of the operator’s obtaining a written report” (Country Wide Ins. Co. v Russo, 201 AD2d 368, 370 [1st Dept 1994]), we find that Supreme Court erred in finding that no questions exist as to whether respondent complied. The EMS Report stated that “[u]pon arrival, [respondent] was found sitting on the sidewalk with NYPD present.” Respondent’s affirmation supports this view as he stated that he provided identifying information “to the police at the scene and [he was] unsure why an NYPD report was never made.”

THIS CONSTITUTES THE DECISION AND ORDER OF THE SUPREME COURT, APPELLATE DIVISION, FIRST DEPARTMENT.

ENTERED: October 29, 2026

Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2026 NY Slip Op 51806(U))

Reported in New York Official Reports at Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2026 NY Slip Op 51806(U))

Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims

2026 NY Slip Op 51806(U)

Decided on October 26, 2026

Civil Court of the City of New York, Kings County

Sandra Elena Roper, J.

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Civil Court of the City of New York, Kings County

Decided on October 26, 2026

Index No. CV- 735106/19

Sandra Elena Roper, J.

[*1]

Upon the foregoing cited papers and after oral argument, Defendant’s Motion for Summary Judgment, Plaintiff’s Cross-Motion for Summary Judgment, Plaintiff’s Amended Cross-Motion and Plaintiff’s Motion to Dismiss Affirmative Defenses are determined as follows:

Defendant’s Motion is GRANTED and Plaintiff’s Cross-Motion and Motion to Dismiss Affirmative Defenses are DENIED as moot. Plaintiff’s Amended Cross-Moton was served 18 months after Defendant served its Opposition and Reply, therefore, is not being considered. Arguendo, even where Plaintiff’s Amended Cross-Motion and amended affidavits were to be considered, they would be found insufficient to raise a triable issue of fact to defeat Defendant’s Motion for Summary Judgment. This Court finds that Defendant demonstrated Plaintiff failed to comply with the timely verification requests issued pursuant to 11 NYCRR § 65-3.5 (o) within 120 days, thus satisfying its prima facie burden for judgment as a matter of law in the first instance. Upon the shifting of the burden to rebut to Plaintiff, it failed to demonstrate that it provided the requested verification or set forth a reasonable justification for the failure to respond to Defendant’s verification requests, as required pursuant to 11 NYCRR § 65-3.5 (o). Thus, Plaintiff failed to meet its burden to rebut Defendants prima facie judgment as a matter of law.

Defendant submitted admissible evidence that it had not received the requested documentary verification from Plaintiff. In Plaintiff’s affidavit in opposition submitted, document number 22 on NYSCEF, the affidavit of Plaintiff’s owner merely states he mailed the requested verification to the address designated by Defendant on the verification requests “to the extent such response was proper and, in [his] possession,” and without appending documentary proof of responsive compliance with the verification requests the affidavit is insufficient to meet Plaintiff’s shifted burden to rebut (see NY St Cts Elec Filing [NYSCEF] Doc No. 22, plaintiff’s owner aff at 5, 7). This affidavit is insufficient to raise a triable issue of fact as it failed to demonstrate that it had provided the requested verification nor did it set forth a reasonable justification for the failure to comply with Defendant’s verification requests (see Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 75 Misc 3d 143[A], 2022 NY Slip Op 50623[U] [App Term 2022]). Further, Plaintiff’s owner affidavit contradictorily states that he mailed the requested verification “to the address designated by the defendant on the verification requests” then in paragraph 7 states “to Defendant, State Farm Claims, at P.O. Box 52257, Phoenix, AZ 85072-2257” (NY St Cts Elec Filing [NYSCEF] Doc No. 22, ¶ 5 & 7). Whereas Defendant’s verification letters state that all requested documentation should be sent to “claims specialist, Doug Babin at State Farm Insurance 1 State Farm Drive Concordville, PA 19339-9300,” such internal factual inconsistency within Plaintiff’s affidavit without unimpeachable corroborating documentary proof of mailing vitiates its probative value to establish a finding of a triable issue of fact (see Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 85 Misc 3d 132[A], 2025 NY Slip Op 50306[U] [App Term 2025] [Second Department decision on this exact address issue was decided]). In further internal contradictions, Plaintiff also proffered 197 pages of correspondence submitted to Defendant objecting to the verification requested information and unilaterally on its own volition deeming Defendant’s verification request a nullity to the very same verification requests it contradictorily simultaneously contends were indeed responded to in its affidavit. Further, it has been held, “[c]ontrary to plaintiff’s further contention, it was not improper for defendant to seek, during the claim verification stage, information – such as management agreements, W-2 forms, business-related bank records and lease agreements — for the purpose of determining whether plaintiff was ineligible to collect no-fault benefits due to a failure to meet licensing requirements” (Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 85 Misc 3d 130[A], 2025 NY Slip Op 50195[U] [App Term 2025], citing 11 NYCRR § 65-3.16 [2] [12]; see also State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]). Moreover, the Court further held, “[a]s plaintiff objected to the verification requests claiming they were nullities, the record establishes that plaintiff did not ‘provide within 120 calendar days from the date of the initial request either all such verification under [plaintiff’s] control or possession or written proof providing reasonable justification for the failure to comply’. Consequently, the arguments raised on appeal lack merit” (id. at [*3] [*4], citing 11 NYCRR 65-3.5 [o]).

Plaintiff errs in its reliance on the recent Court of Appeals case in Government Employees Ins. Co. Mayzenberg (45 NY3d 397 [2025]). This case clearly does not apply during the discovery/investigatory phase in the seeking of verification requests pursuant to 11 NYCRR 65-3.5 (o). In Mayzenberg, the Court of Appeals specifically answered the Second Circuit’s certified question: “If an insurer determines a healthcare provider has improperly paid others for patient referrals, in violation of [Education Law § 6350 (18)] and [8 NYCRR 29.1 (b) (3)], can [*2]the insurer deny payment for no-fault benefits on the ground that the provider ‘fail[ed] to meet’ a ‘necessary’ State or local licensing requirement under [11 NYCRR 65-3.16 (a) (12)]?” (id.). The Court of Appeals answered in the negative, holding that an insurer may not deny a provider’s claim for reimbursement based on alleged professional misconduct that falls short of ceding control of a professional services corporation to an unlicensed party (id.). However, The Court of Appeals reaffirmed that DFS regulation does authorize an insurer to deny no-fault benefit claims when a provider fails to fulfill a foundational licensing requirement necessary to perform healthcare services in any instance, and when they are effectively abdicating or ceding control to an unlicensed party (State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]; see Andrew Carothers, M.D., P.C. v Progressive Ins. Co., 33 NY3d 389, 406 [2019]). Whereas “the Education Law vests the Board of Regents with ‘final authority’ concerning matters of professional discipline (Mayzenberg at 405, citing David v Biondo, 92 NY2d 318 [1998]). “The Court further explained that when a professional services corporation violates a foundational statutory requirement for licensure, that violation voids the corporation’s license regardless of when the violation is discovered or committed. By contrast, Mayzenberg’s alleged professional misconduct would not affect his license until State regulators choose, in their discretion, to impose such a penalty” (Mayzenberg at 407). Such delay is antithetical to the No-Fault law’s legislative intent of “prompt payment for basic economic loss to injured persons regardless of fault, in exchange for a limitation on litigation to cases involving serious injury” (id.).

As the Court has previously decided in Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (___Misc 3d___, 2026 NY Slip Op 26164 [2026]):

“Mayzenberg is triggered upon an insurer’s conclusive determination of a provider’s professional misconduct, which cannot be had until the conclusion of the investigatory phase. Insurer’s verification requests are part of the investigatory phase. Where provider fails to respond to the insurer’s verification requests, as herein, it cuts off the processing of the claim at the investigatory phase depriving insurer from ever reaching any substantive conclusive determination on the merits of alleged professional misconduct. Rather, insurer’s denial is premised upon procedural grounds of provider failing to respond to verification request within 120 days, as herein.

“Investigatory verification requests determine whether there is determination of professional misconduct:

1st- Plaintiff provider failed to meet a necessary New York State or local licensing requirement;

2nd-Plaintiff provider’s offending licensing failure of professional misconduct ceded, abdicated or surrendered its control of its licensed professional services corporation to an unlicensed party or entity; Thus, where:

3rd- Defendant insurer’s finding to the second prong is in the affirmative at the conclusion of the investigatory phase of Defendant insurer’s verification requests and Plaintiff provider’s responses thereto prove professional misconduct that rises to the level of ceding, abdicating, or surrendering Plaintiff provider’s control of its licensed professional healthcare services corporation to an unlicensed party or entity, then the Defendant insurer maintains its authority to deny the claimed services as reaffirmed by The Court of [*3]Appeals in Mayzenberg (Mayzenberg at 403, citing State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]; see Andrew Carothers, M.D., P.C. v Progressive Ins. Co., 33 NY3d 389, 406 [2019]).

4th- Where the finding to the second prong is in the negative at the conclusion of the investigatory phase of Defendant insurer’s verification requests and Plaintiff provider’s responses thereto prove alleged professional misconduct of some kind, i.e. unethical referral agreements or kickbacks in violation of Education Law § 6530 (18) and attendant regulation, 8 NYCRR 29.1 (b) (3) which does not rise to the level of ceding, abdicating, or surrendering Plaintiff provider’s control of its licensed professional healthcare services corporation to an unlicensed party or entity, then the Defendant insurer cannot deny the claimed services and shall pay Plaintiff provider for those claimed services billed accordingly.^FN1 The Court of Appeals definitively vests that authority solely with the Board of Regents and divests such authority from No-Fault insurers to deny on that faction or branch of professional misconduct.^FN2

“It is reiterated; there must be a final conclusive determination of the investigatory phase in compliance with Defendant insurer’s verification requests upon Plaintiff provider’s responses thereto. Plaintiff errs in its argument that Mayzenberg’s holding is to be applied to the underlying materiality of the verification requests as circumscribed by the SIU’s investigatory reports. The SIU reports are of no moment to trigger Mayzenberg at the investigatory phase. Mayzenberg is not triggered until Defendant insurer conclusively makes a finding of professional misconduct upon which will be the basis of the denial. There can only be such a finding upon the conclusion of the investigatory phase. Even upon such a finding, the inquiry doesn’t end there. There must be further inquiry into what type or faction of professional misconduct. Whether it rises to Mallella/Caruthers’ professional misconduct which maintains authority vested in Defendant insurer to deny Plaintiff’s claims. Or, whether some other professional misconduct such as “[d]irectly or indirectly offering [and] giving . . . any fee . . . to . . . a third party for the referral of a patient or in connection with the performance of professional services” or paying kickbacks pursuant to Education Law § 6530 (18) and attendant regulation, 8 NYCRR 29.1 (b) (3), which divests authority from Defendant insurer (id.). Nevertheless, this instant matter has failed to reach the trigger point for the application of Mayzenberg. There has been no conclusive finding or determination of any professional misconduct by Defendant insurer for which Plaintiff’s claims may be denied pursuant to the Eligibility Regulation 11 NYCRR 65-3.16 (a) (12), since Plaintiff failed to respond to the verification requests which essentially cut off the investigatory phase, upon which the denial is premised. The instant claim was not denied pursuant to professional misconduct of which Mayzenberg would be controlling. Rather, the instant claim is denied for Plaintiff’s failure to respond to verification requests within 120 days pursuant to 11 NYCRR §65-3.5 (o).”

In this instant case there has been nor could there have been any conclusive finding or determination of any professional misconduct since Plaintiff failed to respond to verification requests within 120 days thereby thwarting the investigatory phase to its detriment, depriving it of a potential Mayzenberg challenge.

Therefore, Plaintiff’s Complaint is hereby DISMISSED with PREJUDICE.

This constitutes the Decision and Order of This Court.

Date: October 26, 2026

Brooklyn, New York

Judge Sandra Elena Roper, JCC

Matter of American Tr. Ins. Co. v Midland Pharm. Yonkers Corp. (2026 NY Slip Op 06193)

Reported in New York Official Reports at Matter of American Tr. Ins. Co. v Midland Pharm. Yonkers Corp. (2026 NY Slip Op 06193)

Matter of American Tr. Ins. Co. v Midland Pharm. Yonkers Corp.

2026 NY Slip Op 06193

Decided on October 22, 2026

Appellate Division, First Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This decision is uncorrected and subject to revision before publication in the Official Reports.

Decided and Entered: October 22, 2026

Index No. 650702/25|Appeal No. 7307|Case No. 2025-07981|

Before: Manzanet-Daniels, J.P., Mendez, Kapnick, Pitt-Burke, Parker-Raso, JJ.

[*1]

Order, Supreme Court, New York County (Verna L. Saunders, J.), entered September 24, 2025, which, to the extent appealed from, denied respondent’s cross-petition for attorneys’ fees pursuant to Insurance Law § 5106(a) and 11 NYCRR 65-4.10(j), and confirmation of a master arbitration award dated December 2, 2024, pursuant to CPLR 7511(e), unanimously modified, on the law, the award confirmed, and the matter remanded to fix the amount of attorneys’ fees owed to respondent, without costs.

The court denied petitioner’s article 75 petition to vacate the master arbitration award, therefore it was required to affirmatively confirm the award (CPLR 7511[e]; see Blumenkopf v Proskauer Rose LLP, 95 AD3d 647, 648 [1st Dept 2012]). Furthermore, respondent was entitled to an award of attorneys’ fees (see Insurance Law § 5106[a]; 11 NYCRR 65-4.10(j)).

The determination of what constitutes a reasonable fee is within the sound discretion of the trial court (see Matter of American Tr. Ins. Co. v SCOB, LLC, 243 AD3d 564, 565 [2d Dept 2025]). Respondent submitted some evidence concerning whether the fee requested was reasonable. Accordingly, upon remand, the court should review the evidence presented, and set a reasonable fee, as well as set forth the evidentiary basis for the award (see Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d 703, 706 [2d Dept 2017]). If the court finds that the evidence submitted was insufficient to determine what a reasonable fee would be, the trial court may determine a reasonable fee in its discretion (see Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC, 243 AD3d 558, 560 [2d Dept 2025]).

The court should also consider the amount of fees incurred by respondent in prosecuting this appeal (see 11 NYCRR 65-4.10[j][4]; Matter of American Tr. Ins. Co. v Rutland Med. PC, 224 AD3d 531, 532 [1st Dept 2024]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE SUPREME COURT, APPELLATE DIVISION, FIRST DEPARTMENT.

ENTERED: October 22, 2026

American Tr. Ins. Co. v Bliss Acupuncture, P.C. (2026 NY Slip Op 06081)

Reported in New York Official Reports at American Tr. Ins. Co. v Bliss Acupuncture, P.C. (2026 NY Slip Op 06081)

American Tr. Ins. Co. v Bliss Acupuncture, P.C.

2026 NY Slip Op 06081

Decided on October 21, 2026

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This decision is uncorrected and subject to revision before publication in the Official Reports.

Supreme Court of the State of New York, Appellate Division, Second Judicial Department

Decided on October 21, 2026

2024-09243, (Index No. 516656/22)

Angela G. Iannacci, J.P.

Valerie Brathwaite Nelson

Carl J. Landicino

Elena Goldberg Velazquez, JJ.

[*1]

DECISION & ORDER

In an action pursuant to Insurance Law § 5106(c) for a de novo determination of claims for no-fault insurance benefits, the defendant appeals from an order of the Supreme Court, Kings County (Anne J. Swern, J.), dated June 20, 2024. The order, insofar as appealed from, denied those branches of the defendant’s motion which were to confirm a master arbitration award dated April 20, 2022, and pursuant to 11 NYCRR 65-4.10(j)(4) for an award of attorneys’ fees.

ORDERED that the order is reversed insofar as appealed from, on the law, with costs, those branches of the defendant’s motion which were to confirm a master arbitration award dated April 20, 2022, and pursuant to 11 NYCRR 65-4.10(j)(4) for an award of attorneys’ fees are granted, and the matter is remitted to the Supreme Court, Kings County, for a determination of the amount of reasonable attorneys’ fees pursuant to 11 NYCRR 65-4.10(j)(4) to be awarded to the defendant in accordance herewith.

After a master arbitrator affirmed an arbitration award in favor of the defendant on its claims for no-fault insurance benefits (hereinafter the master arbitration award), the plaintiff commenced this action pursuant to Insurance Law § 5106(c) for a de novo determination of the defendant’s claims. The defendant answered and, in the “WHEREFORE” clause, requested, inter alia, that the master arbitration award be confirmed and reasonable attorneys’ fees be awarded pursuant to 11 NYCRR 65-4.10(j)(4).

Thereafter, the complaint was stricken due to the plaintiff’s failure to comply with a conditional order arising from its noncompliance with discovery demands. Subsequently, the defendant moved, among other things, to confirm the master arbitration award and pursuant to 11 NYCRR 65-4.10(j)(4) for an award of attorneys’ fees. In an order dated June 20, 2024, the Supreme Court denied those branches of the motion. The defendant appeals.

Contrary to the plaintiff’s contention, the commencement of the de novo action did not eliminate the master arbitration award but only placed it in a dormant state. An award by an arbitrator shall be binding, except for the grounds for review set forth in CPLR article 75, and except where a de novo review is sought (see Insurance Law § 5106[c]). Under certain circumstances, an arbitration award is presumed to be dormant while the de novo action is pending (see Matter of Abadinsky v Aetna Cas. & Sur. Co., 250 AD2d 673, 673-674; Matter of Gersten v American Tr. Ins. Co., 161 Misc 2d 57, 63 [Sup Ct, NY County]). An arbitration award is revived when that action is dismissed for failure to prosecute or other similar basis not on the merits (see Matter of Gersten v American Tr. Ins. Co., 161 Misc 2d at 63). Here, the dismissal of the complaint in the instant [*2]action due to the plaintiff’s failure to comply with discovery demands revived the master arbitration award and made it binding on the parties. Thus, under the circumstances, the Supreme Court should have granted that branch of the defendant’s motion which was to confirm the master arbitration award (see Insurance Law § 5106[c]; Murzik Taxi, Inc. v Lutheran Med. Ctr., 193 AD3d 866, 869; Matter of Slater v Eagle Ins. Co., 294 AD2d 368, 369).

Further, the Supreme Court should have granted that branch of the defendant’s motion which was for an award of attorneys’ fees. Pursuant to Insurance Law § 5106(a), if a valid claim or a portion of a claim for no-fault benefits is overdue, “the claimant shall also be entitled to recover his [or her] attorney’s reasonable fee, for services necessarily performed in connection with securing payment of the overdue claim, subject to limitations promulgated by the superintendent in regulations.” The attorneys’ fees for services rendered in connection with a court adjudication of dispute de novo, as provided in section 5106(c) of the Insurance Law, or in a “court appeal from a master arbitration award and any further appeals, shall be fixed by the court adjudicating the matter” (11 NYCRR 65-4.10[j][4]; see Matter of American Tr. Ins. Co. v Baltic Supply Corp., 247 AD3d 873, 874; American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 239 AD3d 1, 15-16).

Here, as the defendant sought payment of the overdue claims for no-fault insurance benefits, it was entitled to an award of attorneys’ fees for the services necessarily performed in connection with the de novo action and its request to confirm the master arbitration award as well as on the instant appeal (see Matter of Lam Quan MD, P.C. v LM Gen. Ins. Co., 239 AD3d 654, 656; Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co., 170 AD3d 1168, 1168).

The plaintiff’s remaining contention is without merit.

Accordingly, the matter must be remitted to the Supreme Court, Kings County, for a determination of the amount of reasonable attorneys’ fees to which the defendant is entitled.

IANNACCI, J.P., BRATHWAITE NELSON, LANDICINO and GOLDBERG VELAZQUEZ, JJ., concur.

ENTER:

Darrell M. Joseph

Clerk of the Court

Matter of American Tr. Ins. Co. v Pfeffer (2026 NY Slip Op 06113)

Reported in New York Official Reports at Matter of American Tr. Ins. Co. v Pfeffer (2026 NY Slip Op 06113)

Matter of American Tr. Ins. Co. v Pfeffer

2026 NY Slip Op 06113

Decided on October 21, 2026

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This decision is uncorrected and subject to revision before publication in the Official Reports.

Supreme Court of the State of New York, Appellate Division, Second Judicial Department

Decided on October 21, 2026

2024-11510, (Index No. 530675/22)

Angela G. Iannacci, J.P.

Valerie Brathwaite Nelson

Carl J. Landicino

Elena Goldberg Velazquez, JJ.

[*1]

DECISION & ORDER

In a proceeding pursuant to CPLR article 75 to vacate a master arbitration award dated July 21, 2022, Michelle Pfeffer appeals from a judgment of the Supreme Court, Kings County (Richard Velasquez, J.), entered October 1, 2024. The judgment, insofar as appealed from, upon an order of the same court dated June 16, 2023, inter alia, in effect, granting that branch of the cross-petition of Michelle Pfeffer which was pursuant to 11 NYCRR 65-4.10(j)(4) for an award of attorneys’ fees, awarded Michelle Pfeffer attorneys’ fees pursuant to 11 NYCRR 65-4.10(j)(4) in the sum of only $1,000.

ORDERED that the judgment is reversed insofar as appealed from, on the law, with costs, and the matter is remitted to the Supreme Court, Kings County, for a new determination of the amount of attorneys’ fees to be awarded pursuant to 11 NYCRR 65-4.10(j)(4) in accordance herewith.

The petitioner, an insurer, commenced this proceeding pursuant to CPLR article 75 to vacate a master arbitration award confirming an arbitration award in favor of Michelle Pfeffer, a medical provider. Pfeffer filed a cross-petition to confirm the master arbitration award and for an award of attorneys’ fees pursuant to 11 NYCRR 65-4.10(j)(4). In an order dated June 16, 2023, the Supreme Court, in effect, denied the petition and granted the cross-petition.

Thereafter, Pfeffer submitted an attorney’s affirmation describing the nature of the work performed and the amount of time expended on the matter and seeking an award of attorneys’ fees in connection with the proceeding in the sum of $4,300. In a judgment entered October 1, 2024, the Supreme Court, inter alia, awarded Pfeffer attorneys’ fees pursuant to 11 NYCRR 65-4.10(j)(4) in the sum of $1,000. Pfeffer appeals, contending that the award was inadequate.

Pursuant to Insurance Law § 5106(a), if a valid claim or portion of a claim for no-fault benefits is overdue, “the claimant shall also be entitled to recover his [or her] attorney’s reasonable fee, for services necessarily performed in connection with securing payment of the overdue claim, subject to limitations promulgated by the superintendent in regulations” (id.; [*2]see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d 724, 724-725). “The recoverable attorney’s fees include those related to representation in a CPLR article 75 proceeding to vacate or confirm a master arbitration award, and, in such instances, ‘shall be fixed by the court adjudicating the matter'” (Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d at 725, quoting 11 NYCRR 65-4.10[j][4]; see Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 236 AD3d 782, 783).

“The determination of what constitutes a reasonable attorney’s fee is a matter within the sound discretion of the Supreme Court” (Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d at 725 [internal quotation marks omitted]; see Matter of American Tr. Ins. Co. v YD Med. Servs., P.C., 244 AD3d 726, 727). “The attorney bears the burden of establishing the reasonable value of the services rendered, based upon a showing of the hours reasonably expended and the prevailing hourly rate for similar legal work in the community” (Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d at 725 [internal quotation marks omitted]; see Matter of American Tr. Ins. Co. v YD Med. Servs., P.C., 244 AD3d at 727). “In determining the reasonable value of the services rendered, ‘the court may consider a number of factors, including . . . the time and labor required, the difficulty of the questions involved, and the skill required to handle the problems presented, the lawyer’s experience, ability, and reputation, the customary fee charged for similar services, and the results obtained'” (Matter of American Tr. Ins. Co. v Community Med. Imaging, P.C., 247 AD3d 877, 878, quoting Diggs v Oscar De La Renta, LLC, 169 AD3d 1003, 1005).

Here, while the Supreme Court “was not obligated to accept [Pfeffer’s] representation as to [her] attorney’s fee, and the court could rely upon its ‘familiarity with the nature and complexity of the litigation, the time, effort and skill required for its resolution and the fees customarily charged for similar matters’ to determine a reasonable attorney’s fee” (Matter of American Tr. Ins. Co. v SCOB, LLC, 247 AD3d 879, 881 [citation omitted], quoting Ricciuti v Lombardi, 256 AD2d 892, 893), the court awarded Pfeffer attorneys’ fees pursuant to 11 NYCRR 65-4.10(j)(4) in the sum of only $1,000 without stating the basis for that determination. Nor is the basis for that determination evident from the record. Accordingly, the matter must be remitted to the Supreme Court, Kings County, for a new determination of the amount of the award of attorneys’ fees pursuant to 11 NYCRR 65-4.10(j)(4), stating the evidentiary basis for the award.

The parties’ remaining contentions need not be reached in light of our determination.

IANNACCI, J.P., BRATHWAITE NELSON, LANDICINO and GOLDBERG VELAZQUEZ, JJ., concur.

ENTER:

Darrell M. Joseph

Clerk of the Court

Matter of Erie Ins. Co. v Rodriguez (2026 NY Slip Op 06115)

Reported in New York Official Reports at Matter of Erie Ins. Co. v Rodriguez (2026 NY Slip Op 06115)

Matter of Erie Ins. Co. v Rodriguez

2026 NY Slip Op 06115

Decided on October 21, 2026

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This decision is uncorrected and subject to revision before publication in the Official Reports.

Supreme Court of the State of New York, Appellate Division, Second Judicial Department

Decided on October 21, 2026

2025-07173, (Index No. 614856/24)

Francesca E. Connolly, J.P.

Valerie Brathwaite Nelson

Barry E. Warhit

James P. McCormack, JJ.

[*1]

DECISION & ORDER

In a proceeding pursuant to CPLR article 75 to permanently stay arbitration of a claim for supplemental underinsured motorist benefits, Hector Rodriguez appeals from an order of the Supreme Court, Suffolk County (David T. Reilly, J.), dated June 3, 2025. The order, insofar as appealed from, upon reargument, adhered to a determination in an order of the same court dated May 13, 2025, granting the amended petition to permanently stay arbitration of the claim for supplemental underinsured motorist benefits.

ORDERED that the order dated June 3, 2025, is affirmed insofar as appealed from, with costs.

In October 2021, Hector Rodriguez was involved in an automobile accident with a motor vehicle insured by State Farm Mutual Automobile Insurance Company (hereinafter State Farm), with liability limits for bodily injury in the amounts of $250,000 per person/$500,000 per accident under a primary automobile insurance policy and an additional $1,000,000 per occurrence under a personal liability umbrella policy. It is not disputed that State Farm tendered its coverage limits, paying $1,000,000 to Rodriguez and the rest to another person injured in the accident.

At the time of the accident, Rodriguez was operating a motor vehicle insured by the petitioner, Erie Insurance Company (hereinafter Erie), with bodily injury liability limits of $1,000,000 and supplementary underinsured motorist coverage (hereinafter SUM) limits of $500,000. Rodriguez made a claim for SUM coverage under Erie’s policy. Erie denied coverage on the ground that the bodily injury limits provided in the State Farm policies were equal to or greater than those provided in the Erie policy. Rodriguez made a demand for arbitration of his claim. Erie then commenced this proceeding pursuant to CPLR article 75 to permanently stay arbitration of Rodriguez’s claim for SUM benefits. In an order dated May 13, 2025, the Supreme Court granted the amended petition. Rodriguez moved for leave to reargue his opposition to the amended petition. In an order dated June 3, 2025, the court, upon reargument, adhered to its prior determination in the order dated May 13, 2025, granting the amended petition. Rodriguez appeals.

Insurance Law § 3420(f)(2), which requires an insurer to offer SUM coverage in an automobile insurance policy, “was enacted to allow policyholders to acquire the same level of protection for themselves and their passengers as they purchased to protect themselves against [*2]liability to others” (Matter of Metropolitan Prop. & Cas. Ins. Co. v Mancuso, 93 NY2d 487, 492). “SUM coverage is only triggered where the bodily injury liability insurance limits of the policy covering the tortfeasor’s vehicle are less than the third-party liability limits of the policy under which a party is seeking SUM benefits” (Matter of Allstate Ins. Co. v Rivera, 12 NY3d 602, 607-608). In ascertaining the limits of the policy covering the tortfeasor’s vehicle, the statute considers “the limits of liability under all bodily injury . . . insurance policies” (Insurance Law § 3420[f][2][A] [emphasis added]).

Here, the bodily injury liability insurance coverage limits provided under the State Farm policies were greater than that provided under the Erie policy. Thus, the Supreme Court properly determined that SUM coverage was not triggered (see Matter of Allstate Ins. Co. v Rivera, 12 NY3d at 607-608; Matter of State Farm Mut. Auto. Ins. Co. v Diaz, 223 AD3d 674, 675).

In light of our determination, we do not reach Rodriguez’s remaining contention.

CONNOLLY, J.P., BRATHWAITE NELSON, WARHIT and MCCORMACK, JJ., concur.

ENTER:

Darrell M. Joseph

Clerk of the Court

Medical Imaging of Bronx, P.C., Inc. v MVAIC (2026 NY Slip Op 26160)

Reported in New York Official Reports at Medical Imaging of Bronx, P.C., Inc. v MVAIC (2026 NY Slip Op 26160)

Medical Imaging of Bronx, P.C., Inc. v MVAIC

2026 NY Slip Op 26160

Decided on October 1, 2026

Appellate Term, First Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This decision is uncorrected and subject to revision before publication in the Official Reports.

Supreme Court, Appellate Term, First Department

Decided on October 1, 2026

570613/26

Present: James, P.J., Brigantti, Alpert, JJ.

Defendant appeals from a judgment of the Civil Court of the City of New York, Bronx County (Brenda Rivera, J.), entered on or about August 11, 2025, after a nonjury trial, in favor of plaintiff and awarding it damages in the principal amount of $967.70.

[*1]

Per Curiam.

Judgment (Brenda Rivera, J.), entered on or about August 11, 2025, reversed, with $30 costs, and judgment directed in favor of defendant dismissing the complaint.

In this action by a provider to recover assigned first-party no-fault benefits, the parties stipulated that: (1) plaintiff provided medical services to its assignor in May and June of 2021; (2) the claims were timely submitted to American Transit Insurance Company [ATIT], but were denied in July and August of 2021 on the ground that the underlying policy expired; (3) plaintiff then submitted the claims to MVAIC, with a copy of the ATIT denial and cover letter; and (4) MVAIC received the claims on December 15, 2021 and timely denied the claim based upon the 45-day rule. The parties’ stipulation further limited the issues to be tried to whether plaintiff had a “reasonable justification” for the delay in submitting the claims to MVAIC (see 11 NYCRR 65-3.3 [e]).

At trial, plaintiff’s witness testified that upon receiving the ATIT denial, he reached out to the referring physician to determine if another carrier should be billed. However, the witness had no independent knowledge or records of when this contact was made. He only indicated that the physician responded on November 15, 2021, indicating that MVAIC was the new insurance.

Following the trial, the court determined that “plaintiff has proffered a reasonable excuse for the delay” in submitting the claim to MVAIC. This determination was not based upon the evidence, but upon what the court characterized as “strong policy considerations,” including the size of the population, the “overburdened” medical service providers, and the “reasonableness” of the time to submit claims.

We reverse. The court had no authority to disregard the strict time frames and criteria on the filing of no-fault claims, which were intended to combat an escalating fraud problem, were consistent with the policy underlying the No—Fault Law to provide prompt compensation to legitimate claimants (see Raffellini v State Farm Mut. Auto. Ins. Co., 9 NY3d 196, 201 [2007]). [*2]Indeed, no party requested that the court consider public policy considerations in making its determination.

Based upon our authority to render judgment warranted by the facts (see Northern Westchester Professional Park Assoc. v Town of Bedford, 60 NY2d 492, 499 [1983]), we direct judgment in favor of defendant dismissing the complaint. Plaintiff failed to establish a reasonable justification for the delay in submitting the claims to MVAIC. Even assuming that plaintiff’s submission of the claims to ATIT justified the initial delay, the evidence was insufficient to establish a “reasonable justification” for the additional four-month delay between the July/August denial of claims by ATIT and the submission of the claims to MVAIC in or about December 2021 (see Bronx Expert Radiology, P.C. v Motor Veh. Acc. Indem. Corp., 23 Misc 3d 129[A], 2009 NY Slip Op 50621[U] [App Term, 1st Dept 2009]; Bronx Expert Radiology, P.C. v Motor Veh. Acc. Indem. Corp., 20 Misc 3d 140[A], 2008 NY Slip Op 51612[U] [App Term, 1st Dept 2008]; NY Arthroscopy & Sports Medicine PLLC v Motor Veh. Acc. Indem. Corp., 15 Misc 3d 89 [App Term, 1st Dept 2007]). Plaintiff’s evidence, including the testimony of its witness, was insufficient. Although the witness testified that plaintiff reached out to the referring physician to determine whether plaintiff should bill another carrier, the witness was unable to recall or otherwise determine when plaintiff contacted the physician.

Furthermore, MVAIC’s denials informed plaintiff that the delay could be excused if plaintiff provided reasonable justification. However, plaintiff did not respond to the denials, and, instead chose to rely upon the cover letters submitted with its claims stating that the claims had previously been submitted to another carrier. However, this was insufficient because the cover letters did not explain the several months delay between ATIT’s denial and the submission to MVAIC (see Carniol v MVAIC, 62 Misc 3d 148[A], 2019 NY Slip Op 50232[U] [App Term, 1st Dept 2019]).

THIS CONSTITUTES THE DECISION AND ORDER OF THE COURT.

I concur I concur I concur

Decision Date: October 1, 2026

Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2026 NY Slip Op 26164)

Reported in New York Official Reports at Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims (2026 NY Slip Op 26164)

Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co. PIP/BI Claims

2026 NY Slip Op 26164

Decided on September 24, 2026

Civil Court of the City of New York, Kings County

Sandra Elena Roper, J.

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This decision is uncorrected and subject to revision before publication in the Official Reports.

Civil Court of the City of New York, Kings County

Decided on September 24, 2026

Index No. CV-733610

Sandra Elena Roper, J.

[*1]

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

Papers

Notice of Motion and Affidavits 1-2

Answering Affidavits 3

Reply Affirmations

Upon the foregoing cited papers and after oral argument, Defendant’s Motion for Summary Judgment, Plaintiff’s Cross-Motion for Summary Judgment, and Plaintiff’s Amended Cross-Motion are determined as follows:

Defendant’s Motion is GRANTED and Plaintiff’s Cross-Motion is DENIED as moot. Plaintiff’s Amended Cross-Moton was served 18 months after Defendant served its Opposition and Reply, therefore, is not being considered. Arguendo, even where Plaintiff’s Amended Cross-Motion and amended affidavits were to be considered, they would be found insufficient to raise a triable issue of fact to defeat Defendant’s Motion for Summary Judgment. This Court finds that Defendant demonstrated Plaintiff failed to comply with the timely verification requests issued pursuant to 11 NYCRR 65-3.5 (o) within 120 days, thus satisfying its prima facie burden for judgment as a matter of law in the first instance. Upon the shifting of the burden to rebut to Plaintiff, it failed to demonstrate that it provided the requested verification or set forth a reasonable justification for the failure to respond to Defendant’s verification requests, as required pursuant to 11 NYCRR 65-3.5 (o). Thus, Plaintiff failed to meet its burden to rebut Defendants prima facie judgment as a matter of law.

Defendant submitted admissible evidence that it had not received the requested [*2]documentary verification from Plaintiff. In Plaintiff’s affidavit in opposition submitted, document number 34 on NYSCEF, the affidavit of Plaintiff’s owner merely states he mailed the requested verification to the address designated by Defendant on the verification requests “to the extent such response was proper and, in [his] possession,” and without appending documentary proof of responsive compliance with the verification requests the affidavit is insufficient to meet Plaintiff’s shifted burden to rebut (see NY St Cts Elec Filing [NYSCEF] Doc No. 34, plaintiff’s owner aff at 2, 3). This affidavit is insufficient to raise a triable issue of fact as it failed to demonstrate that it had provided the requested verification nor did it set forth a reasonable justification for the failure to comply with Defendant’s verification requests (see Burke Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 75 Misc 3d 143[A], 2022 NY Slip Op 50623[U] [App Term 2022]). Further, Plaintiff’s owner affidavit contradictorily states that he mailed the requested verification “to the address designated by the defendant on the verification requests” then in paragraph 7 states “to Defendant, State Farm Claims, at P.O. Box 52257, Phoenix, AZ 85072-2257” (NYSCEF Doc No. 34, ¶ 5 & 7). Whereas Defendant’s verification letters state that all requested documentation should be sent to “claims specialist, Doug Babin at State Farm Insurance 1 State Farm Drive Concordville, PA 19339-9300,” such internal factual inconsistency within Plaintiff’s affidavit without unimpeachable corroborating documentary proof of mailing vitiates its probative value to establish a finding of a triable issue of fact (see Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 85 Misc 3d 132[A], 2025 NY Slip Op 50306[U] [App Term 2025] [Second Department decision on this exact address issue was decided]). In further internal contradictions, Plaintiff also proffered 197 pages of correspondence submitted to Defendant objecting to the verification requested information and unilaterally on its own volition deeming Defendant’s verification request a nullity to the very same verification requests it contradictorily simultaneously contends were indeed responded to in its affidavit (see NY St Cts Elec Filing [NYSCEF] Doc No. 52). Further, it has been held, “[c]ontrary to plaintiff’s further contention, it was not improper for defendant to seek, during the claim verification stage, information – such as management agreements, W-2 forms, business-related bank records and lease agreements — for the purpose of determining whether plaintiff was ineligible to collect no-fault benefits due to a failure to meet licensing requirements” (Burke 2 Physical Therapy, P.C. v State Farm Mut. Auto. Ins. Co., 85 Misc 3d 130[A], 2025 NY Slip Op 50195[U] [App Term 2025], citing 11 NYCRR § 65-3.16 [2] [12]; see also State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]). Moreover, the Court further held, “[a]s plaintiff objected to the verification requests claiming they were nullities, the record establishes that plaintiff did not “provide within 120 calendar days from the date of the initial request either all such verification under [plaintiff’s] control or possession or written proof providing reasonable justification for the failure to comply’ (11 NYCRR 65-3.5 [o]). Consequently, the arguments raised on appeal lack merit” (id. at [*3] [*4]).Plaintiff errs in its reliance on the recent Court of Appeals case in Government Employees Ins. Co. v Mayzenberg (45 NY3d 397 [2025]). This case clearly does not apply during the discovery/investigatory phase in the seeking of verification requests pursuant to 11 NYCRR 65-3.5 (o). In Mayzenberg, the Court of Appeals specifically answered the Second Circuit’s certified question: “If an insurer determines a healthcare provider has improperly paid others for patient referrals, in violation of [Education Law § 6350 (18)] and [8 NYCRR 29.1 (b) (3)], can the insurer deny payment for no-fault benefits on the ground that the provider ‘fail[ed] to meet’ a ‘necessary’ State or local licensing requirement under [11 NYCRR 65-3.16 (a) (12)]?” (id.). The Court of Appeals answered in the negative, holding that an insurer may not deny a [*3]provider’s claim for reimbursement based on alleged professional misconduct that falls short of ceding control of a professional services corporation to an unlicensed party (id.). However, The Court of Appeals reaffirmed that DFS regulation does authorize an insurer to deny no-fault benefit claims when a provider fails to fulfill a foundational licensing requirement necessary to perform healthcare services in any instance, and when they are effectively abdicating or ceding control to an unlicensed party (State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]; see Andrew Carothers, M.D., P.C. v Progressive Ins. Co., 33 NY3d 389, 406 [2019]). Whereas “the Education Law vests the Board of Regents with ‘final authority’ concerning matters of professional discipline (Mayzenberg at 405, citing David v Biondo, 92 NY2d 318 [1998]). “The Court further explained that when a professional services corporation violates a foundational statutory requirement for licensure, that violation voids the corporation’s license regardless of when the violation is discovered or committed. By contrast, Mayzenberg’s alleged professional misconduct would not affect his license until State regulators choose, in their discretion, to impose such a penalty” (Mayzenberg at 407). Such delay is antithetical to the No-Fault law’s legislative intent of “prompt payment for basic economic loss to injured persons regardless of fault, in exchange for a limitation on litigation to cases involving serious injury” (id.).

Mayzenberg is triggered upon an insurer’s conclusive determination of a provider’s professional misconduct, which cannot be had until the conclusion of the investigatory phase. Insurer’s verification requests are part of the investigatory phase. Where provider fails to respond to the insurer’s verification requests, as herein, it cuts off the processing of the claim at the investigatory phase depriving insurer from ever reaching any substantive conclusive determination on the merits of alleged professional misconduct. Rather, insurer’s denial is premised upon procedural grounds of provider failing to respond to verification request within 120 days, as herein.

Investigatory verification requests determine whether there is determination of professional misconduct:

1st- Plaintiff provider failed to meet a necessary New York State or local licensing requirement;

2nd-Plaintiff provider’s offending licensing failure of professional misconduct ceded, abdicated or surrendered its control of its licensed professional services corporation to an unlicensed party or entity; Thus, where:

3rd- Defendant insurer’s finding to the second prong is in the affirmative at the conclusion of the investigatory phase of Defendant insurer’s verification requests and Plaintiff provider’s responses thereto prove professional misconduct that rises to the level of ceding, abdicating, or surrendering Plaintiff provider’s control of its licensed professional healthcare services corporation to an unlicensed party or entity, then the Defendant insurer maintains its authority to deny the claimed services as reaffirmed by The Court of Appeals in Mayzenberg (Mayzenberg at 403, citing State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 [2005]; see Andrew Carothers, M.D., P.C. v Progressive Ins. Co., 33 NY3d 389, 406 [2019]).

4th- Where the finding to the second prong is in the negative at the conclusion of the investigatory phase of Defendant insurer’s verification requests and Plaintiff provider’s responses thereto prove alleged professional misconduct of some kind, i.e. unethical referral agreements or kickbacks in violation of Education Law § 6530 (18) and attendant regulation, 8 NYCRR 29.1 (b) (3) which does not rise to the level of ceding, [*4]abdicating, or surrendering Plaintiff provider’s control of its licensed professional healthcare services corporation to an unlicensed party or entity, then the Defendant insurer cannot deny the claimed services and shall pay Plaintiff provider for those claimed services billed accordingly.^FN1 The Court of Appeals definitively vests that authority solely with the Board of Regents and divests such authority from No-Fault insurers to deny on that faction or branch of professional misconduct.^FN2

It is reiterated; there must be a final conclusive determination of the investigatory phase in compliance with Defendant insurer’s verification requests upon Plaintiff provider’s responses thereto. Plaintiff errs in its argument that Mayzenberg’s holding is to be applied to the underlying materiality of the verification requests as circumscribed by the SIU’s investigatory reports. The SIU reports are of no moment to trigger Mayzenberg at the investigatory phase. Mayzenberg is not triggered until Defendant insurer conclusively makes a finding of professional misconduct upon which will be the basis of the denial. There can only be such a finding upon the conclusion of the investigatory phase. Even upon such a finding, the inquiry doesn’t end there. There must be further inquiry into what type or faction of professional misconduct. Whether it rises to Mallella/Caruthers‘ professional misconduct which maintains authority vested in Defendant insurer to deny Plaintiff’s claims. Or, whether some other professional misconduct such as “[d]irectly or indirectly offering [and] giving . . . any fee . . . to . . . a third party for the referral of a patient or in connection with the performance of professional services” or paying kickbacks pursuant to Education Law § 6530 (18) and attendant regulation, 8 NYCRR 29.1 (b) (3), which divests authority from Defendant insurer (id.). Nevertheless, this instant matter has failed to reach the trigger point for the application of Mayzenberg. There has been no conclusive finding or determination of any professional misconduct by Defendant insurer for which Plaintiff’s claims may be denied pursuant to the Eligibility Regulation 11 NYCRR 65-3.16 (a) (12), since Plaintiff failed to respond to the verification requests which essentially cut off the investigatory phase, upon which the denial is premised. The instant claim was not denied pursuant to professional misconduct of which Mayzenberg would be controlling. Rather, the instant claim is denied for Plaintiff’s failure to respond to verification requests within 120 days pursuant to 11 NYCRR 65-3.5 (o).

In this instant case, there has been nor could there have been any conclusive finding or determination of any professional misconduct since Plaintiff failed to respond to verification requests within 120 days thereby thwarting the investigatory phase to its detriment, depriving it of a potential Mayzenberg challenge.

Therefore, Plaintiff’s Complaint is hereby DISMISSED with PREJUDICE.

This constitutes the Decision and Order of This Court.

Date: September 24, 2026

Brooklyn, New York

Judge Sandra Elena Roper, JCC

Matter of Hartford Fire Ins. Co. v Villanueva (2026 NY Slip Op 05393)

Reported in New York Official Reports at Matter of Hartford Fire Ins. Co. v Villanueva (2026 NY Slip Op 05393)

Matter of Hartford Fire Ins. Co. v Villanueva

2026 NY Slip Op 05393

Decided on September 23, 2026

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This decision is uncorrected and subject to revision before publication in the Official Reports.

Supreme Court of the State of New York, Appellate Division, Second Judicial Department

Decided on September 23, 2026

2024-09821, (Index No. 503370/23)

Colleen D. Duffy, J.P.

Barry E. Warhit

Lourdes M. Ventura

Lisa S. Ottley, JJ.

[*1]

DECISION & ORDER

In a proceeding pursuant to CPLR article 75, inter alia, to permanently stay arbitration of a claim for uninsured motorist benefits, Devorah Villanueva appeals from an order of the Supreme Court, Kings County (Anne J. Swern, J.), dated June 20, 2024. The order, insofar as appealed from, denied that branch of the motion of Devorah Villanueva which was pursuant to CPLR 5015(a)(1) to vacate an order of the same court (Robin S. Garson, J.) dated June 22, 2023, which upon Villanueva’s default, in effect, in opposing the petition, granted that branch of the petition which was to permanently stay arbitration.

ORDERED that the order dated June 20, 2024, is affirmed insofar as appealed from, with costs.

The petitioner, Hartford Fire Insurance Company (hereinafter Hartford), commenced this proceeding pursuant to CPLR article 75, inter alia, to permanently stay arbitration of a claim by Devorah Villanueva for uninsured motorist benefits arising out of an alleged hit-and-run collision in February 2022 involving Villanueva, who was riding a motorized scooter, and an unidentified motorcyclist. In an order dated June 1, 2023, the Supreme Court directed Villanueva to serve written opposition to the petition by June 15, 2023, and adjourned the petition to June 22, 2023. Villanueva failed to submit written opposition to the petition. Thereafter, in an order dated June 22, 2023 (hereinafter the June 2023 order), the court granted that branch of the petition which was to permanently stay arbitration upon Villanueva’s default, in effect, in opposing the petition.

In August 2023, Villanueva moved, among other things, pursuant to CPLR 5015(a)(1) to vacate the June 2023 order. Hartford opposed the motion. In an order dated June 20, 2024, the Supreme Court, inter alia, denied that branch of Villanueva’s motion. Villanueva appeals.

To obtain relief pursuant to CPLR 5015(a)(1), Villanueva was required to show both a reasonable excuse for the default and a potentially meritorious defense to the petition (see Matter of Maya Assur. Co. v Long Sheng Zheng, 207 AD3d 632, 632; Matter of Liberty Mut. Ins. Co. v Fiduciary Ins. Co. of Am., 111 AD3d 731, 732). “The determination of whether an excuse is reasonable lies within the sound discretion of the trial court” (126 Henry St., Inc. v Cater, 197 AD3d 598, 600; see Beach 28 RE, LLC v Somra, 216 AD3d 610, 611). Here, Villanueva failed to proffer [*2]a reasonable excuse for the default. Villanueva’s conclusory and unsubstantiated assertions that she was hampered in opposing the petition by the lack of production of certain medical records and a purported police report did not constitute a reasonable excuse, as she provided no explanation as to efforts made to obtain those documents. Since Villanueva failed to demonstrate a reasonable excuse for the default, it is unnecessary to consider whether she demonstrated a potentially meritorious defense to the petition (see Matter of Maya Assur. Co. v Long Sheng Zheng, 207 AD3d at 633; Matter of Government Empls. Ins. Co. v Dae-Hee Lee, 78 AD3d 944, 945).

The parties’ remaining contentions either are without merit, need not be reached in light of our determination, or are improperly raised for the first time on appeal.

DUFFY, J.P., WARHIT, VENTURA and OTTLEY, JJ., concur.

ENTER:

Darrell M. Joseph

Clerk of the Court

Matter of Nostrand Drugs Rx, Inc. v Church Mut. Ins. Co. (2026 NY Slip Op 05400)

Reported in New York Official Reports at Matter of Nostrand Drugs Rx, Inc. v Church Mut. Ins. Co. (2026 NY Slip Op 05400)

Matter of Nostrand Drugs Rx, Inc. v Church Mut. Ins. Co.

2026 NY Slip Op 05400

Decided on September 23, 2026

Appellate Division, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This decision is uncorrected and subject to revision before publication in the Official Reports.

Supreme Court of the State of New York, Appellate Division, Second Judicial Department

Decided on September 23, 2026

2025-00470, (Index No. 511903/23)

Francesca E. Connolly, J.P.

Linda Christopher

Barry E. Warhit

Donna-Marie E. Golia, JJ.

[*1]

DECISION & ORDER

In a proceeding pursuant to CPLR article 75 to vacate an award of a master arbitrator dated February 24, 2023, which confirmed an award of an arbitrator dated December 11, 2022, the petitioner appeals from an order of the Supreme Court, Kings County (Carolyn E. Wade, J.), dated December 4, 2024. The order denied the petition to vacate the master arbitrator’s award.

ORDERED that the order is affirmed, with costs.

In September 2020, Ahsan Ali was involved in a motor vehicle accident. Ali received prescription medications from the petitioner Nostrand Drugs Rx, Inc. (hereinafter Nostrand), for injuries he sustained in the accident. Nostrand submitted an insurance claim to Church Mutual Ins. Co. (hereinafter Church Mutual) for reimbursement of the cost of the medication dispensed, in the total sum of $2,343.20. Nostrand never received payment. Thereafter, Nostrand submitted the insurance claim to arbitration. In an award dated December 11, 2022, after a hearing, an arbitrator denied Nostrand’s claim. Nostrand then requested that the matter be reviewed by a master arbitrator. In an award of a master arbitrator dated February 24, 2023, the master arbitrator confirmed the arbitration award dated December 11, 2022, in its entirety.

In April 2023, Nostrand commenced this proceeding pursuant to CPLR article 75 to vacate the master arbtirator’s award. In an order dated December 4, 2024, the Supreme Court denied the petition to vacate the master arbitrator’s award. Nostrand appeals.

“‘Consistent with the public policy in favor of arbitration, the grounds specified in CPLR 7511 for vacating or modifying a no-fault arbitration award are few in number and narrowly applied'” (Matter of Allstate Ins. Co. v Westchester Med. Group, M.D., 125 AD3d 649, 650, quoting Matter of Mercury Cas. Co. v Healthmakers Med. Group, P.C., 67 AD3d 1017, 1017). “Arbitrators exceed their power only when they issue an award that ‘violates a strong public policy, is irrational or clearly exceeds a specifically enumerated limitation on the arbitrator’s power'” (Matter of County of Nassau v Nassau County Investigators Police Benevolent Assn., Inc., 203 AD3d 824, 826, quoting American Intl. Specialty Lines Ins. Co. v Allied Capital Corp., 35 NY3d 64, 70). “The master arbitrator’s determination of the law need not be correct: mere errors of law are insufficient to set aside the award of a master arbitrator” (Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co., 170 [*2]AD3d 1168, 1168, quoting Matter of Liberty Mut. Ins. Co. v Spine Americare Med., 294 AD2d 574, 577).

Here, Nostrand failed to demonstrate the existence of any statutory grounds for vacating the master arbitrator’s award (see Matter of American Tr. Ins. Co. v Big Apple Pain Mgt., PLLC, 242 AD3d 1198, 1199; Matter of V.S. Care Acupuncture, P.C. v Country-Wide Ins. Co., 176 AD3d 832, 833-834).

Nostrand’s remaining contentions either are improperly raised for the first time on appeal or need not be reached in light of our determination.

Accordingly, the Supreme Court properly denied Nostrand’s petition to vacate the master arbitrator’s award.

CONNOLLY, J.P., CHRISTOPHER, WARHIT and GOLIA, JJ., concur.

ENTER:

Darrell M. Joseph

Clerk of the Court