Parisien v Erie Ins. Co. of N.Y. (2026 NY Slip Op 50400(U))

Reported in New York Official Reports at Parisien v Erie Ins. Co. of N.Y. (2026 NY Slip Op 50400(U))

[*1]

Parisien v Erie Ins. Co. of N.Y.

2026 NY Slip Op 50400(U) [88 Misc 3d 1241(A)]

Decided on March 25, 2026

Civil Court Of The City Of New York, Richmond County

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This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on March 25, 2026

Jules Francois Parisien MD, As Assignee of Manuel Plasencia, Plaintiff, against Erie Insurance Company of New York, Defendant.

Index No. CV-759232-24/RI



Plaintiff –
Law Offices of Marina Josovich, P.C.
1733 Sheepshead Bay Road, Suite 11
Brooklyn, NY 11235
Phone: (718) 645-7770

Defendant –
MURA LAW GROUP, PLLC
14 Lafayette Sq, Ste 930
Buffalo, NY 14203-1909
Phone: (716) 855-2800
Mark Kagan, J.

The defendant Erie Insurance Company of New York has moved pursuant to CPLR §3212 seeking summary judgement dismissing the action on the grounds the accident was staged. The plaintiff has opposed the motion. Pursuant to CPLR §2219(a) the court has reviewed all the papers submitted including NYSCEF document numbers 1-44 and now renders the following determination.

On April 24, 2024 a vehicle driven by Miguel Angel Palaciosromero was involved in an accident with a vehicle driven by Mohamed Mohamed. The assignor, Manuel Plasencia, a passenger in the vehicle driven by Palaciosromero, sought No-Faults benefits in the amount of $1,449.69. The defendant, the insurer of the assignor refused the payment on the grounds the accident was staged. The plaintiff commenced this action seeking payment and the defendant duly answered. The defendant has now moved seeking summary judgement dismissing the [*2]action arguing there are no questions of fact the action should be dismissed. They assert there is evidence which establishes as a matter of fact that the accident was staged. As noted, the motion is opposed.

Concerning first party no-fault benefits, an insurer may move seeking summary judgement dismissing the action on the grounds additional verification information was sought from the plaintiff and not provided (Eagle Surgical Supply Inc., v. Travelers Indemnity Company, 29 Misc 3d 129(A), 958 NYS2d 307 [Supreme Court Appellate Term Second Department 2010]).

It is well settled that “an intentional and staged collision caused in furtherance of an insurance fraud scheme is not a covered accident under a policy of insurance” (National General Insurance Online Inc., v. Blasco, 210 AD3d 786, 177 NYS3d 350 [2d Dept., 2022]). In truth, the intentional nature of the event does not have to be rooted in efforts to defraud an insurance company, rather, any reason the event is intentional will foreclose the availability of No-Fault benefits (see, V.S. Medical Services P.C., v. Allstate Insurance Company, 11 Misc 3d 344, 811 NYS2d 886 [Civil Court Kings County 2006]). In seeking summary judgement dismissing the action on the grounds the accident was staged the insurance company bears the burden of presenting sufficient proof in admissible form establishing the absence of any material fact (Repwest Insurance Company v. Sasan Family Chiropractic P.C., 2016 WL 4000626 [Supreme Court New York County 2016]). Thus, mere unsubstantiated suspicions are insufficient to establish the necessary proof required to conclude an accident was staged (AB Medical Services PLLC v. Eagle insurance Company, 3 Misc 3d 8, 776 NYS2d 434 [Appellate Term Second Department 2003]).

In support of the motion the accident was staged Erie Insurance has introduced the examination under oath of Mohamed Mohamed, the driver of the other vehicle who testified that when the accident occurred there were only two individuals in the vehicle, namely the driver Palaciosromero and the assignor (see, EUO of Mohamed Mohamed, page 23 [NYSCEF Doc. No. 9]). Mr. Mohamed was specifically asked whether any assertions there was a third person in the vehicle would constitute a fabrication. He responded “No, there’s no third person, you know. And I remember when the accident happened, they come out. I came out on the highway right there, we just looking what happened. And before even we moved to the shoulder, there was two people. And then when we went into the shoulder, there’s two people came out. So if there is a third person, it will be there, right? There’s no third person” (see, EUO of Mohamed Mohamed, pages 36,37 [NYSCEF Doc. No. 9]). The defendant argues that “significantly, Mohamed, who has nothing to gain by doing so, unequivocally affirms that there were only two occupants inside the insured vehicle at the time of the subject incident impact” (see, Affirmation of Brendon Byrne, ¶36 [NYSCEF Doc. No. 6]).

However, the driver, the assignor and the third individual, Francisco Monserrate all testified at examinations under oath and all testified that all three were in the vehicle at the time of the collision. First, the driver Palaciosromero was asked “is it your testimony that at the time of this accident in April that both Francisco and Manuel were occupants of your vehicle at the time of the impact?” and he responded “yes” (see, EUO of Miguel Angel Palaciosromero, page 26 [NYSCEF Doc. No. 11]). Further, Palaciosromero was presented with possibility that there were four people in the vehicle. He responded “I deny that completely. There was nobody else in my car aside from me, Francisco and Manuel” (see, EUO of Miguel Angel Palaciosromero, [*3]page 107 [NYSCEF Doc. No. 11]).

Next, the assignor, Manuel Placensia was asked concerning the accident in question “was anybody with you in the vehicle at that time?” and he responded “Miguel and Francisco” (see, EUO of Manuel Plasencia, pages 36,37 [NYSCEF Doc. No. 14]). Further, Plasencia was informed that Mohamed testified there were only two occupants in the vehicle and was then asked “so with that said, is it fair to say that Francisco was not in the vehicle at the time of the accident?” Plasencia responded “No, the three of us were together” (see, EUO of Manuel Plasencia, page 48 [NYSCEF Doc. No. 14]). He was then asked “are you sure you’re going to stick with that story in light of the evidence of that driver that it was only Miguel and an older male passenger which could be you since you’re 40 and not 26?” and he responded “I—well, I think that other driver might have gotten scared or shocked because of the impact, but like I said from the beginning, that I’m under oath and inside our vehicle was Miguel, myself and Francisco” (see, EUO of Manuel Plasencia, pages 48, 49 [NYSCEF Doc. No. 14]).

Moreover, Francisco Monseratte testified that he was present in the vehicle when the accident occurred (see, EUO of Francisco Monseratte, page 17 [NYSCEF Doc. No. 13]). Moreover, he repeatedly reiterates throughout the testimony that he was in the vehicle at the time of the accident.

Thus, notwithstanding Mohamed’s disinterest in the number of occupants in the Palaciosromero vehicle there are clearly questions of credibility concerning whether in fact Monseratte was present in the vehicle when the accident occurred. It is well settled that “it is not the function of a court deciding a summary judgment motion to make credibility determinations or findings of fact, but rather to identify material triable issues of fact (or point to the lack thereof)” (see, Vega v. Restani Construction Corp., 18 NY3d 499, 942 NYS2d 13 [2012]). Therefore, summary judgement cannot be granted when facts are in dispute (Young v. Kamath, — AD3d —, — NYS3d —, 2026 WL 516800 [2d Dept., 2026]).

In this case, clearly, there are credibility determinations that must be made concerning whether Monseratte was a passenger in the vehicle. That determination cannot be made at this juncture.

Next, the defendant argues that notwithstanding any credibility issues whether Monseratte was a passenger in the vehicle there are so many inconsistencies in the testimony of Palaciosromero, Plasencia and Monseratte that as a matter of law it may be determined that Monseratte was not a passenger in the vehicle and that the assignor engaged in fraud and summary judgement should be granted.

It is true that inconsistencies between various occupants of a vehicle can be used to support the contention the accident was staged or fraudulent (State Farm Fire and Casualty Company v. Advanced Recovery Equipment and Supplies LLC, 2022 NY Slip Op 32805(U) [Supreme Court New York County 2022]). However, the inconsistencies must relate to the subject accident. Thus, in Pavlova v. Allstate Insurance Company, 62 Misc 3d 1207(A), 112 NYS3d 871 [Supreme Court Kings County 2019] the court conceded there were inconsistencies between the testimonies of the various individuals that were in the accident however, there was no explanation how those inconsistencies demonstrated the accident was staged. The court specifically noted that the “defendant did not proffer any affidavit from an investigator who can elaborate on why the inconsistencies demonstrate intentional losses. Without a cogent and detailed investigative summary of this type of alleged intentional loss and solely relying on the transcripts alone in this matter, the testimonies given do not rise to the level of a founded belief [*4]that the accident was staged” (id). Again, in State Farm Mutual Auto Insurance Company v. Allmed Merchandise and Trading Inc., 2022 WL 596992 [Supreme Court New York County 2022] the court held that inconsistencies surely raised issues of credibility but they were, standing alone, insufficient to support the conclusion the accident was staged as a matter of law. Further, in Hereford Insurance Company v. All Nations DME Corp., 2026 WL 147211 [Supreme Court New York County 2026] the court held that even inconsistencies about the accident, such as the time and place and the whereabouts of the participants prior to the accident does not in any way demonstrate the accident was fraudulent.

In this case, there are numerous inconsistencies found in the testimony of the three alleged participants present in the Palaciosromero vehicle. However, those inconsistencies do not support whether Monseratte was present when the accident occurred. Regarding that sole issue, upon which the entire allegation of fraud is based, there is no inconsistency. There are credibility issues with Mohamed in that regard. Precisely for these reasons summary judgement must be denied.

So ordered.

Dated: March 25, 2026
Brooklyn, NY
Hon. Mark Kagan, JCCYumi Acupuncture, P.C. v 21st Century Ins. Co. (2026 NY Slip Op 50433(U))

Reported in New York Official Reports at Yumi Acupuncture, P.C. v 21st Century Ins. Co. (2026 NY Slip Op 50433(U))

Yumi Acupuncture, P.C. v 21st Century Ins. Co.

2026 NY Slip Op 50433(U) [88 Misc 3d 1244(A)]

Decided on March 23, 2026

Civil Court of the City of New York, Kings County

Sandra E. Roper, J.

As corrected in part through July 17, 2026; it will not be published in the printed Official Reports.

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

Civil Court of the City of New York, Kings County

Decided on March 23, 2026

Index No. CV-738094-18/KI

Sandra E. Roper, J.

[*1]

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

Papers:

D’s Notice of Motion and Affidavits Annexed 1-2

P’s cross-motion for SJ and Exhibits 3-4

D’s Opposition 5

P’s Supplemental memo of law as requested by Court 6

D’s Supplemental memo of law as requested by Court 7

Upon the foregoing cited papers and after oral argument, This Court Decides and Orders, Defendant MID-CENTURY INSURANCE COMPANY, sued herein as 21st Century Insurance Company, Motion for Summary Judgment and to Amend the Caption to so reflect, and Plaintiff Yumi Acupuncture, P.C. Cross-Motion for Summary Judgment as follows:

BACKGROUND AND PROCEDURAL POSTURE

This is an action to recover assigned first-party New York No-Fault benefits for health-care services rendered to Plaintiff’s assignor following a motor vehicle accident which occurred outside the State of New York on January 9, 2017.

The motion record reflects that Defendant issued verification requests to Plaintiff’s assignor dated January 12, 2017, and February 20, 2017, seeking a “Declaration of No Other Insurance,” to determine primacy of coverage, as Plaintiff’s assignor was not a listed party on the New York insurance policy which covered the vehicle. Following receipt of the bills in controversy, Defendant also sent delay letters dated February 20, 2017, and March 23, 2017, advising Plaintiff that claim processing would be delayed pending receipt of such Declaration [*2]from Plaintiff’s assignor. Plaintiff contends that its provider affidavit sufficed to respond to any legitimate inquiry, however the post-assignment demand for an injured-party’s Declaration of No Other Insurance was improper, and Defendant failed to timely pay or deny the claims. Whereas Defendant seeks dismissal on the theory that the claims were not ripe for suit as Plaintiff’s purported verification response is not responsive for failure to provide the requested Declaration, rendering the claims open and pending in a delayed status.

DISCUSSION

Neither Plaintiff’s purported provider affidavit verification response, nor Defendant’s purported verification request for a Declaration of No Other Insurance are statutorily compliant nor proper. Although dated after the commencement of Defendant’s motion, Plaintiff’s purported verification response was not responsive to Defendant’s verification request solely for the Declaration of No Other Insurance. Nevertheless, Plaintiff’s deficiency is of no moment where Defendant’s verification request is neither material nor necessary for the processing and evaluation of the first-party New York No-Fault claims. A Declaration of No Other Insurance is neither material nor necessary, but rather an issue of interinsurer priority of payment, which as the sole request is dispositive herein, rendering Defendant’s purported verification request a nullity. As such, Plaintiff was not required to provide verification responses thereto. Where, as here, there is a Primary Insurer which is the first to receive notice of No-Fault claim, and a potentiality of a Contingent Insurer whether unidentified, as herein, or identified, the dispute as to payor responsibility is not a material nor necessary basis for a Primary Insurer’s verification request to toll the statutory 30-day time to pay or deny No-Fault claims.

Pursuant to Insurance Law § 5105 (b) mandatory arbitration is to be undertaken to resolve interinsurer disputes regarding responsibility for the payment of first-party benefits. The implementing regulations are equally as explicit. Pursuant to 11 NYCRR 65-3.12 (b) (1), where two or more insurers dispute which is responsible for payment of first-party benefits, “the first insurer to whom notice of claim is given shall be responsible for the payment of benefits.” Pursuant to 11 NYCRR 65-4.11 (a) (6), controversies between insurers regarding “the responsibility or obligation to pay first-party benefits (i.e., priority or sources of payment pursuant to section 65-3.12)” are not coverage issues subject to verification requests upon medical providers seeking payment reimbursement. Rather, interinsurer coverage issues must be submitted to mandatory arbitration, without delay in the processing of the underlying first-party medical claims in furtherance of the No-Fault legislative intent for prompt resolutions. Precedential case law on this issue of competing interinsurer coverage is indeed scant.

Although not as yet addressed by the Second Department FN1, the First Department’s holding on this issue is encapsulated by a court of concurrent jurisdiction to This Court.

“Where an insurer’s denial raises a defense that another insurer is responsible for paying first-party benefits, the defense must be resolved through mandatory intercompany [*3]arbitration, not by way of a claimant’s plenary no-fault action; in an action to recover first-party No-Fault benefits, the first insurer to whom notice of proof of claim was given is obligated to pay the benefits irrespective of any issues relating to the priority or source of payment.” (Country-Wide Ins. Co. v Bronx Chiropractic Rehabilitation P.C., 2021 NY Misc LEXIS 60240 [Sup Ct, NY County Mar. 31, 2021, No. 650051/2021], citing M.N. Dental Diagnostics, P.C. v Govt. Empls. Ins. Co., 81 AD3d 541 [1st Dept 2011], aff’d, 24 Misc 3d 43 [App. Term 1st Dept. 2009]).

In further clarification of this interinsurer coverage issue, which is deemed immaterial to the processing of the claim and in and of itself cannot delay a medical provider’s No-Fault plenary action without a distinct other proper defense alleged, the First Department held:

“Insofar as defendant sought discovery pertaining to its affirmative defense that another insurance carrier was primarily liable, the information was immaterial and, in result, the demands were palpably improper since defendant cannot properly rely on this defense as a basis to deny plaintiff’s no-fault claim. Nor has defendant set forth any case-specific allegations in support of its defense that plaintiff was fraudulently incorporated so as to justify discovery on this issue. Defendant ‘will not be allowed to use pretrial discovery as a fishing expedition when they cannot set forth a reliable factual basis for what amounts to, at best, mere suspicions'” (Pomona Med. Diagnostic P.C. v Adirondack Ins. Co., 36 Misc 3d 127[A], 2012 NY Slip Op 51165[U] [App Term 2012], quoting Devore v Pfizer, Inc., 58 AD3d 138 [1st Dept 2008], lv denied 12 NY3d 703, 904 NE2d 841, 876 NYS 2d 704 [2009], citing Duhe v Midence, 1 AD3d 279, 767 NYS 2d 585 [2003]; 11 NYCRR 65-3.12[b]; M.N. Dental Diagnostics, P.C. v. Government Employees Ins. Co., 81 AD3d 541, 916 NYS 2d 598 [2011]).

In this instant matter, Defendant is the Primary Insurer upon which the proof of claim was first served. Consequently, it is statutorily mandated to process the plenary claim as if it is the sole insurer to resolution maintaining all the available proper defenses. The potentiality that there may be a Contingent Insurer whether unidentified, as here, or identified is not a defense to the No-Fault claim and does not foreclose nor delay the Primary Insurer’s statutory responsibility to fully process the first-party claims to completion. Either thereafter or concurrently but separate and apart from the underlying claims, Primary Insurer may pursue its interinsurer quasi-subrogation claim in mandatory arbitration as against a Contingent Insurer. However, medical provider claimants are walled off from interinsurer coverage disputes to avoid encroaching on the No-Fault Law’s legislative intent for prompt resolutions. It is emphatically reiterated; the Primary Insurer maintains all the very same defenses as if there were no interinsurer coverage payor dispute. Thus, Defendant here as Primary Insurer, may have properly issued verification requests for its alternative defense of fee-schedule which would have indeed required Plaintiff Provider to issue timely proper verification responses. To its detriment, Defendant failed to do so. Defendant’s verification request solely for the Declaration of No Other Insurance is statutorily improper. Whereas its alternative fee schedule defense which may have salvaged the material and necessary prongs for a proper verification request by Defendant to toll the claims, was not included. Since the proper fee-schedule defense was available but not included in Defendant’s verification request, the fee schedule defense falls as well for being untimely in violation of the 30-Day Rule. Notably, since the services herein were rendered post April 1, 2013, 11 NYCRR 65-3.8 (g) (1) (ii) has been held by trial courts of concurrent jurisdiction to render fee-schedule a non-precludable defense contravening the 30-Day Rule. Although at times [*4]considered persuasive legislative interpretations, these holdings are not binding precedential stare decisis case law. This Court disagrees with these legislative interpretations and is not bound by these holdings. The legislature had the opportunity to explicitly state fee-schedule is a non-precludable defense and failed to do so.FN2 Thus, followed herein is the well-established 30-Day Rule to timely pay, toll or deny, which Defendant did neither.

For the foregoing reasons, it is:

ORDERED, ADJUDGED, AND DECREED

ORDERED, that as no prejudice has been shown to the Plaintiff, the branch of Defendant’s Motion seeking to Amend The Caption is GRANTED, so that the named Defendant in this case shall be changed to MID-CENTURY INSURANCE COMPANY to reflect Defendant’s proper name. The amendment is to take effect immediately without need for service of further papers. All papers previously filed are deemed amended without need for service of further papers.

ORDERED, that the branch of Defendant’s Motion seeking summary judgment is DENIED in its entirety.

ORDERED, that the Court holds, as a matter of law, that where Defendant was the first insurer to receive notice and proof of claim, Defendant was required to process and pay the provider’s claim irrespective of any interinsurer dispute over priority or source of payment, subject only to any separate and properly preserved defense independent of the mere possibility that another insurer may be responsible.

ORDERED, that any dispute between Defendant and any other insurer concerning the priority or source of payment of first-party benefits must be resolved through mandatory intercompany arbitration pursuant to Insurance Law § 5105 (b), 11 NYCRR 65-3.12 (b), and 11 NYCRR 65-4.11 (a) (6), and not by withholding or delaying payment to Plaintiff in this plenary no-fault action.

ORDERED, that Defendant’s requests and delay letters seeking a “Declaration of No Other Insurance” did not toll the thirty-day pay-or-deny period, and do not render this action premature.

ORDERED, that Plaintiff’s Cross-Motion for Summary Judgment is GRANTED to the extent that judgment shall be entered in favor of Plaintiff and against Defendant on the claims at issue in the motion record.

ORDERED, that Plaintiff is entitled to entry of judgment for the principal amount of unpaid no-fault benefits recoverable on the claims at issue, together with statutory interest, attorney’s fees, costs and disbursements as provided by law.

This constitutes the Decision, Opinion and Order of This Court.

DATE March 23, 2026

HON. SANDRA E. ROPER

Tristate Multi-Specialty Med. Servs., P.C. v Progressive Cas. Ins. Co. (2026 NY Slip Op 50340(U))

Reported in New York Official Reports at Tristate Multi-Specialty Med. Servs., P.C. v Progressive Cas. Ins. Co. (2026 NY Slip Op 50340(U))

[*1]

Tristate Multi-Specialty Med. Servs., P.C. v Progressive Cas. Ins. Co.

2026 NY Slip Op 50340(U) [88 Misc 3d 1235(A)]

Decided on March 17, 2026

Civil Court Of The City Of New York, Kings County

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.

Decided on March 17, 2026

Tristate Multi-Specialty Medical Services, P.C., a/a/o JORDAN, CEDRICK, Plaintiff, against Progressive Casualty Insurance Company, Defendant(s)

Index No. CV-730109-22/KI



The Rybak Firm PLLC, Brooklyn, for Plaintiff.

McCormack & Mattei, P.C., New Hyde Park, for Defendant.
Sandra Elena Roper, J.

At Trial held on March 6, 2026, Decision, Opinion and Order upon due deliberation as follows:

Previously agreed upon stipulation for prima facie to both parties placed on the record, after which Plaintiff Rested. Defendant moved for Directed Verdict upon an offer of proof of the Declaratory Judgment Order Supreme Court Nassau County Index No. 604151/20. Staged accident Declaratory Judgment (hereinafter “DJ”) barred payment by Defendant to Plaintiff Provider for any and all bill payment reimbursements for relevant date of incident and policy number for No-fault bills of Assignor. However, DJ did not apply to Assignor as there was an inconsistency with his address. Defendant Counsel’s statement at Trial is not sworn witness statement of the truth of Assignor’s address and therefore found inadmissible and was not credited although he is an individual party defendant named in the DJ. Consequently, the DJ did not apply to the Assignor. Thereupon, pursuant to the defense of Res Judicata and Collateral Estoppel, Directed Verdict Granted in favor of Defendant.

However, in a rather novel argument. Plaintiff contended that the natural consequence of the DJ not applying to Assignor is judgment in the amounts sued upon should be granted in favor of Assignor as an individual. Indeed, quite a legal leap. Firstly, Assignor is not a party in this instant action. It is well established that an assignor is a non-party rather than a real party-in-interest and assignors cannot be considered as real parties of interest (Inwood Hill Med., P.C. v Gen. Assur. Co., 10 Misc 3d 18 [App Term 2005]). Further, Assignor herein is not represented by counsel since a non-party. Arguendo, the DJ establishes the potential of a conflict of interest between Plaintiff Provider and Assignor, foreclosing Plaintiff’s counsel from ethically representing the interests of Assignor at Trial herein. Nevertheless, Plaintiff’s counsel errs in its application for judgment in favor of individual Assignor exclusive of, aside and apart from Plaintiff Provider, which is denied.

For the foregoing reasons, Judgment Granted in favor of Defendant. Case is dismissed with prejudice.

This constitutes Decision, Opinion and Order of Court.

Dated: March 17, 2026
Brooklyn, New York
Hon. Sandra Elena Roper, JCCReactive Physical Therapy, P.C. v Progressive Cas. Ins. Co. (2026 NY Slip Op 50343(U))

Reported in New York Official Reports at Reactive Physical Therapy, P.C. v Progressive Cas. Ins. Co. (2026 NY Slip Op 50343(U))

[*1]

Reactive Physical Therapy, P.C. v Progressive Cas. Ins. Co.

2026 NY Slip Op 50343(U) [88 Misc 3d 1235(A)]

Decided on March 17, 2026

Civil Court Of The City Of New York, Kings County

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.

Decided on March 17, 2026

Reactive Physical Therapy, P.C., a/a/o Valle, Jordy, Plaintiff, against Progressive Casualty Insurance Company, Defendant(s)

Index No. CV-738351-22/KI



The Rybak Firm PLLC, Brooklyn, for Plaintiff.

McCormack & Mattei, P.C., New Hyde Park, for Defendant.
Sandra Elena Roper, J.

At Trial held on March 6, 2026, Decision, Opinion and Order upon due deliberation as follows:

Previously agreed upon stipulation for prima facie to both parties placed on the record, after which Plaintiff Rested. Defendant moved for Directed Verdict upon an offer of proof of the Declaratory Judgment Order Supreme Court Nassau County Index No. 611017/21. Staged accident Declaratory Judgment (hereinafter “DJ”) barred payment by Defendant to Plaintiff Provider for any and all bill payment reimbursements for relevant date of incident and policy number for No-fault bills of Assignor. However, DJ did not include the Assignor although an individual party defendant. Consequently, the DJ did not apply to the Assignor. Thereupon, pursuant to the defense of Res Judicata and Collateral Estoppel, Directed Verdict Granted in favor of Defendant.

However, in a rather novel argument. Plaintiff contended that the natural consequence of the DJ not including Assignor, is judgment in the amounts sued upon should be granted in favor of Assignor as an individual. Indeed, quite a legal leap. Firstly, Assignor is not a party in this instant action. It is well established that an assignor is a non-party rather than a real party-in-interest and assignors cannot be considered as real parties of interest (Inwood Hill Med., P.C. v Gen. Assur. Co., 10 Misc 3d 18 [App Term 2005]). Further, Assignor herein is not represented by counsel since a non-party. Arguendo, the DJ establishes the potential of a conflict of interest between Plaintiff Provider and Assignor, foreclosing Plaintiff’s counsel from ethically representing the interests of Assignor at Trial herein. Nevertheless, Plaintiff’s counsel errs in its application for judgment in favor of individual Assignor exclusive of, aside and apart from Plaintiff Provider, which is denied.

For the foregoing reasons, Judgment Granted in favor of Defendant. Case is dismissed with prejudice.

This constitutes Decision, Opinion and Order of Court.

Dated: March 17, 2026
Brooklyn, New York
Hon. Sandra Elena Roper, JCCMatter of Sampilov v Motor Veh. Acc. Indem. Corp. (2026 NY Slip Op 50312(U))

Reported in New York Official Reports at Matter of Sampilov v Motor Veh. Acc. Indem. Corp. (2026 NY Slip Op 50312(U))

[*1]

Matter of Sampilov v Motor Veh. Acc. Indem. Corp.

2026 NY Slip Op 50312(U) [88 Misc 3d 1232(A)]

Decided on March 13, 2026

Supreme Court, Kings County

Maslow, 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.

Decided on March 13, 2026

In the Matter of the Application of Arsalan Sampilov, Petitioner, For leave to commence an action pursuant to Section 5218 of the Insurance Law, against The Motor Vehicle Accident Indemnification Corporation, Respondent.

Index No. 528467/2025



Law Office of Yuriy Prakhin, P.C., Brooklyn (Alex Gould of counsel), for petitioner.

Law Office of Jaime E. Gangemi, Manhattan (Paul Catsandonis of counsel), for respondent.
Aaron D. Maslow, J.

The following papers efiled on NYSCEF were used in this special proceeding: 1-33.

Upon the foregoing papers, having heard oral argument, and due deliberation having been had, the within motion is determined as follows.

Petitioner Arsalan Sampilov petitions in this special proceeding for leave to commence an action against MVAIC. In an order dated November 7, 2025, the petition was denied: “Petitioner failed to demonstrate that the identity of the owner and operator was unknown or not readily ascertainable through reasonable efforts . . .” (NYSCEF Doc No. 15 at 2). Petitioner moves again for leave to commence an action against MVAIC.

The matter stems from a motor vehicle accident on November 17, 2023, at approximately 9:30 p.m., in Brooklyn, in which Petitioner claims he was struck by a hit-and-run motorist while in the crosswalk at the intersection of Bay Parkway and Bath Avenue, and sustained personal injuries. Neither Petitioner nor anyone in his household owned a motor vehicle at the time of the accident and Petitioner has never been listed as an “insured person” on an automobile policy.

Petitioner now offers an MV-104 report dated November 29, 2023 which he signed (see NYSCEF Doc No. 22), notices to preserve surveillance footage from two businesses located at the intersection of the accident (see NYSCEF Doc No. 21), and his affirmation that it was too dark to see the license plate on the night of the accident (see NYSCEF Doc No. 19). As no surveillance footage of the accident was located, Petitioner claims that due diligence was properly performed.

Insurance Law § 5208 requires that to be considered a “qualified” person on the basis of [*2]a hit-and-run accident the petitioner must report the accident “within twenty-four hours after the occurrence to a police, peace or judicial officer in the vicinity or to the commissioner [of motor vehicles], and . . . file[ ] with the corporation within ninety days of the accrual of the cause of action, as a condition precedent . . .” (Insurance Law § 5208 [a] [2] [A]). This requirement may be waived “if it is shown that it was not reasonably possible to make such a report or that it was made as soon as was reasonably possible” (id. § 5208 [a] [2] [B]).

Here, Petitioner is not considered a “qualified” person under Insurance Law § 5208 due to his failure to file a report with a police, peace or judicial officer, or with the commissioner, within 24 hours after the subject accident. The MV-104 report was not only not completed by a peace or police officer, but it was also filed 12 days following the subject accident. It is not compliant with Insurance Law § 5208 [a] [2] [A]. As MVAIC notes, Petitioner could have submitted an ambulance report, the 911 spring sheet, or phone records of the 911 call to overcome this issue. However, he did not do so.

Petitioner states in a supplemental petition that at the time of the accident, “I was in a state of shock, dizziness, and elevated blood pressure. I was alone at the time of the incident.” (NYSCEF Doc No. 19 at 2.)

At oral argument, Petitioner’s counsel argued that no police arrived after the accident and that Petitioner “was an immigrant who was not keen on what was to be done.” That being so, they do not constitute legally sufficient excuses for not reporting the accident to the authorities within 24 hours. In fact, the accident was not reported by Petitioner until 12 days later.

Petitioner argued that MVAIC acknowledged his status as a qualified person in a May 17, 2024 letter. This, however, related solely to No-Fault benefits, not to recovery for non-economic loss.

“MVAIC was created to compensate innocent victims of hit-and-run motor vehicle accidents” (Matter of Chinn v Motor Veh. Acc. Indem. Corp., 240 AD3d 889, 890 [2d Dept 2025]). “[T]he statutory provisions creating and regulating MVAIC should be liberally construed to serve those ends” (Englington Med., P.C. v Motor Veh. Acc. Indem. Corp., 81 AD3d 223, 232 [2d Dept 2011]). Nonetheless, “A petitioner seeking leave of court to commence an action against the MVAIC has the initial burden of demonstrating that he or she is a ‘[q]ualified person’ within the meaning of Insurance Law § 5202 and by making an evidentiary showing that he or she has satisfied certain other statutory requirements (see Matter of Hernandez v Motor Veh. Acc. Indem. Corp., 120 AD3d 1347, 1349 [2014]; Englington Med., P.C. v Motor Veh. Acc. Indem. Corp., 81 AD3d 223, 232 [2011]). In a special proceeding, to the extent that no triable issues of fact are raised, the court is empowered to make a summary determination (see CPLR 409 [b]). If, however, triable issues of fact are raised, an evidentiary hearing must be held (see CPLR 410).” (Matter of Laszlone v Motor Veh. Acc. Indem. Corp., 167 AD3d 894, 894-895 [2d Dept 2018].)

Here there are no triable issues of fact. Petitioner has failed to make a factual showing that it was not reasonably possible to report the accident to the authorities or that it was reported as soon as was reasonably possible (see Matter of Pagan v Motor Veh. Acc. Indem. Corp., 82 AD3d 1102 [2d Dept 2011]). Inasmuch as Petitioner failed to establish compliance with all conditions precedent to suing MVAIC, his petition must be denied. There is no need for an evidentiary hearing.

It is hereby ORDERED and ADJUDGED that Petitioner Arsalan Sampilov’s motion (Motion Seq. No. 2) in support of his petition for leave to commence an action against MVAIC [*3]is DENIED, and the special proceeding is dismissed.

Matter of American Tr. Ins. Co. v Stand Up MRI of Manhattan (2026 NY Slip Op 01353)

Reported in New York Official Reports at Matter of American Tr. Ins. Co. v Stand Up MRI of Manhattan (2026 NY Slip Op 01353)

Matter of American Tr. Ins. Co. v Stand Up MRI of Manhattan

2026 NY Slip Op 01353 [247 AD3d 881]

Decided on March 11, 2026

Appellate Division, Second Department

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

As corrected through Wednesday, May 6, 2026

March 11, 2026

In a proceeding pursuant to CPLR article 75 to vacate a master arbitration award dated September 2, 2022, Stand Up MRI of Manhattan appeals from a judgment of the Supreme Court, Kings County (Richard Velasquez, J.), entered November 17, 2023. The judgment, insofar as appealed from, in effect, granted that branch of the cross-petition of Stand Up MRI of Manhattan which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) to the extent of awarding the sum of only $300.

Ordered that the judgment is affirmed insofar as appealed from, with costs.

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 Stand Up MRI of Manhattan (hereinafter Stand Up), a medical provider. Stand Up filed a cross-petition to confirm the master arbitration award and for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) for services rendered in this proceeding. In an judgment entered November 17, 2023, the Supreme Court, inter alia, denied the petition, granted that branch of the cross-petition which was to confirm the master arbitration award, and, in effect, granted that branch of the cross-petition which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) to the extent of awarding the sum of $300. Stand Up appeals from so much of the judgment as, in effect, granted that branch of the cross-petition which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) to the extent of awarding the sum of only $300.

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.” As applicable here, the superintendent’s regulations provide that “[t]he attorney’s fee for services rendered . . . 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]). The term “court appeal” includes a proceeding, such as here, pursuant to CPLR article 75 to vacate or confirm a master arbitration award (see Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 236 AD3d 782, 782-783 [2025]; Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d 703, 705 [2017]).

“ ’The determination of what constitutes a reasonable attorney’s fee is a matter within [*2]the sound discretion of the Supreme Court’ ” (Hershfield v Davidoff, 233 AD3d 923, 924 [2024], quoting Lancer Indem. Co. v JKH Realty Group, LLC, 127 AD3d 1035, 1035-1036 [2015]). “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” (Lancer Indem. Co. v JKH Realty Group, LLC, 127 AD3d at 1036).

Contrary to Stand Up’s contention, the Supreme Court did not err or improvidently exercise its discretion in awarding Stand Up an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) in the sum of $300 without first conducting a hearing (see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d 724, 725 [2025]; Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC, 243 AD3d 558, 560 [2025]). As an initial matter, since Stand Up failed to submit an affirmation or affidavit in support of its cross-petition, inter alia, describing the nature of the work performed and the amount of time expended on the matter, it was within the court’s discretion to determine a reasonable amount of an attorney’s fee (see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d at 725). Moreover, Stand Up failed to request a hearing on the issue of an award of an additional attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) (see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d at 725; Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC, 243 AD3d at 560). Under these circumstances, and given the legislative intent of the no-fault insurance law “to promptly resolve no-fault reimbursements, ‘reduce the burden on the courts and to provide substantial premium savings to New York motorists’ ” (American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 239 AD3d 1, 9 [2025], quoting Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498, 505 [2015]), the court was not required to conduct a hearing prior to awarding an additional attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4). Iannacci, J.P., Chambers, Taylor and McCormack, JJ., concur.

Matter of American Tr. Ins. Co. v Baltic Supply Corp. (2026 NY Slip Op 01349)

Reported in New York Official Reports at Matter of American Tr. Ins. Co. v Baltic Supply Corp. (2026 NY Slip Op 01349)

Matter of American Tr. Ins. Co. v Baltic Supply Corp.

2026 NY Slip Op 01349 [247 AD3d 873]

Decided on March 11, 2026

Appellate Division, Second Department

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

As corrected through Wednesday, May 6, 2026

March 11, 2026

In a proceeding pursuant to CPLR article 75 to vacate a master arbitration award dated September 30, 2022, Baltic Supply Corp. appeals from a judgment of the Supreme Court, Kings County (Richard Velasquez, J.), entered November 17, 2023. The judgment, insofar as appealed from, in effect, granted that branch of the cross-petition of Baltic Supply Corp. which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) to the extent of awarding the sum of only $300.

Ordered that the judgment is affirmed insofar as appealed from, with costs.

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 Baltic Supply Corp. (hereinafter Baltic), a medical provider. Baltic filed a cross-petition to confirm the master arbitration award and for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4). In a judgment entered November 17, 2023, the Supreme Court, inter alia, denied the petition, granted that branch of the cross-petition which was to confirm the master arbitration award, and, in effect, granted that branch of the cross-petition which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) to the extent of awarding the sum of $300. Baltic appeals from so much of the judgment as, in effect, granted that branch of the cross-petition which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) to the extent of awarding the sum of only $300.

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.” As applicable here, the superintendent’s regulations provide that “[t]he attorney’s fee for services rendered . . . 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]). The term “court appeal” includes a proceeding, such as here, pursuant to CPLR article 75 to vacate or confirm a master arbitration award (see Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 236 AD3d 782, 782-783 [2025]; Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d 703, 705 [2017]).

[*2]“ ’The determination of what constitutes a reasonable attorney’s fee is a matter within the sound discretion of the Supreme Court’ ” (Hershfield v Davidoff, 233 AD3d 923, 924 [2024], quoting Lancer Indem. Co. v JKH Realty Group, LLC, 127 AD3d 1035, 1035-1036 [2015]). “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” (Lancer Indem. Co. v JKH Realty Group, LLC, 127 AD3d at 1036).

Contrary to Baltic’s contention, the Supreme Court did not err or improvidently exercise its discretion in awarding Baltic an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) in the sum of $300 without first conducting a hearing (see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d 724, 725 [2025]; Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC, 243 AD3d 558, 560 [2025]). As an initial matter, since Baltic failed to submit an affirmation or affidavit in support of its cross-petition, inter alia, describing the nature of the work performed and the amount of time expended on the matter, it was within the court’s discretion to determine a reasonable amount of an attorney’s fee (see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d at 725). Moreover, Baltic failed to request a hearing on the issue of an award of an additional attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) (see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d at 725; Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC, 243 AD3d at 560). Under these circumstances, and given the legislative intent of the no-fault insurance law “to promptly resolve no-fault reimbursements, ‘reduce the burden on the courts and to provide substantial premium savings to New York motorists’ ” (American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 239 AD3d 1, 9 [2025], quoting Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498, 505 [2015]), the court was not required to conduct a hearing prior to awarding an additional attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4). Iannacci, J.P., Chambers, Taylor and McCormack, JJ., concur.

American Tr. Ins. Co. v Bruno Med. Supply, Inc. (2026 NY Slip Op 01332)

Reported in New York Official Reports at American Tr. Ins. Co. v Bruno Med. Supply, Inc. (2026 NY Slip Op 01332)

American Tr. Ins. Co. v Bruno Med. Supply, Inc.

2026 NY Slip Op 01332 [247 AD3d 827]

Decided on March 11, 2026

Appellate Division, Second Department

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

As corrected through Wednesday, May 6, 2026

March 11, 2026

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 (Sharon A. Bourne-Clarke, J.), dated November 28, 2023. The order, in effect, denied the defendant’s motion pursuant to CPLR 5015 (a) (1) to vacate an order and judgment (one paper) of the same court dated May 30, 2023, entered upon its failure to appear or answer the complaint, and pursuant to CPLR 3012 (d) to compel the plaintiff to accept its late answer.

Ordered that the order is affirmed, with costs.

The plaintiff, a no-fault insurance carrier, commenced this action pursuant to Insurance Law § 5106 (c) for a de novo adjudication of a dispute regarding its denial of the defendant’s claim for no-fault insurance benefits for medical services rendered to its assignor. Prior thereto, an arbitrator had determined that the defendant was entitled to no-fault compensation in the amount of $5,454.80, plus interest and attorneys’ fees. The plaintiff appealed the award to a master arbitrator, who affirmed the award.

After the defendant failed to timely appear or answer the complaint in this action, the plaintiff moved for leave to enter a default judgment. By order and judgment dated May 30, 2023, the Supreme Court, in effect, granted the plaintiff’s motion and issued a default judgment.

Thereafter, the defendant moved pursuant to CPLR 5015 (a) (1) to vacate the order and judgment and pursuant to CPLR 3012 (d) to compel the plaintiff to accept its late answer. In an order dated November 28, 2023, the Supreme Court, in effect, denied the motion. The defendant appeals.

Contrary to the plaintiff’s assertion, the record does not show that the defendant’s appeal is untimely, as the record does not contain proof of service of the order with notice of entry upon the defendant (see CPLR 5513 [a]; Hart v New York City Hous. Auth., 161 AD3d 724, 724-725 [2018]; Matter of Oliver v City of New York, 76 AD3d 1017, 1018 [2010]).

“A defendant seeking to vacate a default in answering a complaint on the basis of excusable default (see CPLR 5015 [a] [1]) and to compel the plaintiff to accept an untimely answer (see CPLR 3012 [d]) must show both a reasonable excuse for the default and the existence of a potentially meritorious defense” (Nurhan v Harley, 237 AD3d 728, 730-731 [2025] [internal quotation marks omitted]; see Allstate Ins. Co. v North Shore Univ. Hosp., 163 AD3d 745, 746 [2018]).

Here, the defendant was not entitled to relief pursuant to CPLR 5015 (a) (1) and 3012 (d), as it failed to demonstrate a reasonable excuse for its default. The defendant’s allegations of law office failure were contradictory and conclusory and did not constitute a reasonable excuse (see Saleh v Hudson 418 Riv. Rd., Ltd., 225 AD3d 812, 814 [2024]; Giotis v Besser, 207 AD3d 526, 528 [2022]).

[*2]

In light of the defendant’s failure to set forth a reasonable excuse for its default, it is not necessary to determine whether the defendant demonstrated a potentially meritorious defense to this action (see Saleh v Hudson 418 Riv. Rd., Ltd., 225 AD3d at 814; HSBC Bank USA, N.A. v Hutchinson, 215 AD3d 645, 647 [2023]).

Accordingly, the Supreme Court properly, in effect, denied the defendant’s motion pursuant to CPLR 5015 (a) (1) to vacate the order and judgment and pursuant to CPLR 3012 (d) to compel the plaintiff to accept its late answer. Dillon, J.P., Chambers, Wan and McCormack, JJ., concur.

Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Ctr., LLC (2026 NY Slip Op 01350)

Reported in New York Official Reports at Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Ctr., LLC (2026 NY Slip Op 01350)

Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Ctr., LLC

2026 NY Slip Op 01350 [247 AD3d 875]

Decided on March 11, 2026

Appellate Division, Second Department

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

As corrected through Wednesday, May 6, 2026

March 11, 2026

In a proceeding pursuant to CPLR article 75 to vacate a master arbitration award dated July 20, 2022, Bay Ridge Surgi-Center, LLC, appeals from a judgment of the Supreme Court, Kings County (Aaron D. Maslow, J.), entered July 18, 2023. The judgment, insofar as appealed from, in effect, granted that branch of the cross-petition of Bay Ridge Surgi-Center, LLC, which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) to the extent of awarding the sum of only $280.

Ordered that the judgment is affirmed insofar as appealed from, with costs.

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 Bay Ridge Surgi-Center, LLC (hereinafter Surgi-Center), a medical provider. Surgi-Center filed a cross-petition to confirm the master arbitration award and for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) for services rendered in this proceeding. In a judgment entered July 18, 2023, the Supreme Court, inter alia, denied the petition, granted that branch of the cross-petition which was to confirm the master arbitration award, and, in effect, granted that branch of the cross-petition which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) to the extent of awarding the sum of $280. Surgi-Center appeals from so much of the judgment as, in effect, granted that branch of the cross-petition which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) to the extent of awarding the sum of only $280.

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.” As applicable here, the superintendent’s regulations provide that “[t]he attorney’s fee for services rendered . . . 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]). The term “court appeal” includes a proceeding, such as here, pursuant to CPLR article 75 to vacate or confirm a master arbitration [*2]award (see Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 236 AD3d 782, 782-783 [2025]; Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d 703, 705 [2017]).

“ ’The determination of what constitutes a reasonable attorney’s fee is a matter within the sound discretion of the Supreme Court’ ” (Hershfield v Davidoff, 233 AD3d 923, 924 [2024], quoting Lancer Indem. Co. v JKH Realty Group, LLC, 127 AD3d 1035, 1035-1036 [2015]). “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” (Lancer Indem. Co. v JKH Realty Group, LLC, 127 AD3d at 1036).

Contrary to Surgi-Center’s contention, the Supreme Court did not err or improvidently exercise its discretion in awarding Surgi-Center an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) in the sum of $280 without first conducting a hearing (see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d 724, 725 [2025]; Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC, 243 AD3d 558, 560 [2025]). As an initial matter, since Surgi-Center failed to submit an affirmation or affidavit in support of its cross-petition, inter alia, describing the nature of the work performed and the amount of time expended on the matter, it was within the court’s discretion to determine a reasonable amount of an attorney’s fee (see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d at 725). Moreover, Surgi-Center failed to request a hearing on the issue of an award of an additional attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) (see Matter of American Tr. Ins. Co. v Integrated Medicine of S.I., P.C., 244 AD3d at 725; Matter of American Tr. Ins. Co. v Bay Ridge Surgi-Center, LLC, 243 AD3d at 560). Under these circumstances, and given the legislative intent of the no-fault insurance law “to promptly resolve no-fault reimbursements, ‘reduce the burden on the courts and to provide substantial premium savings to New York motorists’ ” (American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 239 AD3d 1, 9 [2025], quoting Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co., 25 NY3d 498, 505 [2015]), the court was not required to conduct a hearing prior to awarding an additional attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4).

In light of our determination, Surgi-Center’s remaining contention has been rendered academic. Iannacci, J.P., Chambers, Taylor and McCormack, JJ., concur.

Matter of American Tr. Ins. Co. v SCOB, LLC (2026 NY Slip Op 01352)

Reported in New York Official Reports at Matter of American Tr. Ins. Co. v SCOB, LLC (2026 NY Slip Op 01352)

Matter of American Tr. Ins. Co. v SCOB, LLC

2026 NY Slip Op 01352 [247 AD3d 879]

Decided on March 11, 2026

Appellate Division, Second Department

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

As corrected through Wednesday, May 6, 2026

March 11, 2026

In a proceeding pursuant to CPLR article 75 to vacate a master arbitration award dated September 20, 2022, SCOB, LLC, appeals from a judgment of the Supreme Court, Kings County (Richard Velasquez, J.), dated September 21, 2023. The judgment, insofar as appealed from, awarded SCOB, LLC, an attorney’s fee 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 an attorney’s fee to be awarded pursuant to 11 NYCRR 65-4.10 (j) (4) in accordance herewith.

SCOB, LLC (hereinafter SCOB), is a medical provider that made a claim for no-fault benefits from the petitioner, an insurance carrier. The petitioner denied the claim on the ground that the treatment was not medically necessary. SCOB sought arbitration of the claim, and in an arbitration award dated May 21, 2022, the arbitrator awarded SCOB, inter alia, a substantial portion of the amount claimed. The petitioner sought review of the arbitration award by a master arbitrator. In a master arbitration award dated September 20, 2022, the master arbitrator, among other things, confirmed the arbitration award.

The petitioner commenced this proceeding pursuant to CPLR article 75 to vacate the master arbitration award. SCOB filed a cross-petition to confirm the master arbitration award and for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) for the representation in this proceeding. In opposition to the cross-petition, the petitioner contended, inter alia, that any award of an attorney’s fee was limited by 11 NYCRR 65-4.6 (d) and that the Supreme Court should limit the amount of billing time allowed in light of the repetition of the legal issues in the no-fault area of the law. In an order dated July 26, 2023, the court, among other things, denied the petition, granted the cross-petition, and directed SCOB to file an affirmation of fee request with respect to the amount of an attorney’s fee to be awarded pursuant to 11 NYCRR 65-4.10 (j) (4).

Thereafter, SCOB submitted an attorney’s affirmation seeking an award in the sum of $4,600 as an attorney’s fee in connection with this proceeding. In a judgment dated September 21, 2023, the Supreme Court, inter alia, awarded SCOB an attorney’s fee pursuant to 11 NYCRR [*2]65-4.10 (j) (4) in the sum of $1,000. SCOB appeals, contending that the award was inadequate.

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 [the] limitations promulgated by the superintendent in regulations.” The recoverable attorney’s fees include those related to representation in a CPLR article 75 proceeding to vacate or confirm a master arbitration award (see 11 NYCRR 65-4.10 [j] [4]; Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 236 AD3d 782, 783 [2025]; Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d 703, 705 [2017]). Contrary to the petitioner’s contention, the amount of the attorney’s fee for services rendered in connection with a CPLR article 75 proceeding is not controlled by 11 NYCRR 65-4.6 (d), but rather, “shall be fixed by the court” (id. § 65-4.10 [j] [4]; see Matter of American Tr. Ins. Co. v Comfort Choice Chiropractic, P.C., 236 AD3d at 783; Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d at 705).

“[A] reasonable attorney’s fee is commonly understood to be a fee which represents the reasonable value of the services rendered” (Diaz v Audi of Am., Inc., 57 AD3d 828, 830 [2008]; see RMP Capital Corp. v Victory Jet, LLC, 139 AD3d 836, 839 [2016]). 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” (Diggs v Oscar De La Renta, LLC, 169 AD3d 1003, 1005 [2019]; see Matter of Freeman, 34 NY2d 1, 9 [1974]; RMP Capital Corp. v Victory Jet, LLC, 139 AD3d at 839). “While a hearing is not required in all circumstances, the court must possess sufficient information upon which to make an informed assessment of the reasonable value of the legal services rendered” (Citicorp Trust Bank, FSB v Vidaurre, 155 AD3d 934, 935 [2017] [internal quotation marks omitted]; see Sterling Natl. Bank v Alan B. Brill, P.C., 186 AD3d 515, 520 [2020]).

Here, the Supreme Court awarded SCOB the sum of only $1,000 for an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) without stating the basis for that determination. Nor is the basis for that determination evident from the record. Contrary to SCOB’s contention, the petitioner did, in fact, oppose that branch of the cross-petition which was for an award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4) and argued, among other things, that recovery of such a fee was limited. However, the petitioner did not submit evidence of the customary fee charged for similar services and the reasonable amount of time required to defend the petition and support the cross-petition. Contrary to SCOB’s contention, the court was not obligated to accept SCOB’s representation as to its 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” (Ricciuti v Lombardi, 256 AD2d 892, 893 [1998]) to determine a reasonable attorney’s fee. Nonetheless, since the basis for the court’s award is not evident from the judgment appealed from or the record, the matter must be remitted to the Supreme Court, Kings County, for a new determination of the amount of the award of an attorney’s fee pursuant to 11 NYCRR 65-4.10 (j) (4), stating the evidentiary basis for the award (see Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d at 706).

SCOB’s remaining contentions either need not be reached in light of our determination or are improperly raised for the first time in reply. Brathwaite Nelson, J.P., Ford, Voutsinas and Love, JJ., concur.