May 1, 2008

L.I. Community Med., P.C. v Allstate Ins. Co. (2008 NY Slip Op 51034(U))

https://www.beynensonlaw.com/case-law/l-i-community-med-p-c-v-allstate-ins-co-2008-ny-slip-op-51034u/

Court: Appellate Term, Second Department
Decided: May 1, 2008
Citation: 2008 NY Slip Op 51034(U) · 19 Misc 3d 142(A)
Posture: Article 75 petition
Outcome: Insurer prevailed
Issues: CPLR article 75 (arbitration awards) Assignments and standing
Legal questions: Court review of arbitration awards · Challenging the assignment of benefits (see the maps)

Cite as

L.I. Community Med., P.C. v Allstate Ins. Co., 19 Misc 3d 142(A), 2008 NY Slip Op 51034(U) (App Term, 2d Dept, 2d & 11th Jud Dists 2008)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

A master arbitrator's award had a rational basis where the provider's assignment named a different entity and did not establish standing. The arbitrator denied the provider's claim for assigned no-fault benefits on that ground, and the master arbitrator upheld the determination as supported by the evidence. The Appellate Term, Second Department, found the master arbitrator's determination neither arbitrary nor capricious and affirmed the denial of vacatur. It modified the order to confirm the award, as required by CPLR 7511 (e) upon denial of the petition, and noted that a special proceeding should terminate in a judgment under CPLR 411.

Reported in New York Official Reports at L.I. Community Med., P.C. v Allstate Ins. Co. (2008 NY Slip Op 51034(U))

[*1]

L.I. Community Med., P.C. v Allstate Ins. Co.

2008 NY Slip Op 51034(U) [19 Misc 3d 142(A)]

Decided on May 1, 2008

Appellate Term, Second Department

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This opinion is uncorrected and will not be published in the printed Official Reports.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 May 1, 2008

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

PRESENT: : WESTON PATTERSON, J.P., GOLIA and RIOS, JJ
2006-1662 K C.

L.I. Community Medical, P.C. a/a/o Victoria Ramos, Appellant,
against
Allstate Insurance Company, Respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Dolores L. Waltrous, J.), entered June 22, 2006. The order denied the petition to vacate the master arbitrator’s award.

Order modified by adding thereto a provision confirming the master arbitrator’s award; as so modified, affirmed without costs.

In this proceeding to vacate a master arbitrator’s award, the record reveals that the arbitrator denied petitioner’s claim for assigned first-party no-fault benefits based on a finding that the assignment of benefits was to an entity different from petitioner, and concluded that petitioner was without standing to seek reimbursement of no-fault
benefits. The master arbitrator upheld the arbitrator’s award as properly reached and supported by the evidence. In our view, the determination of the master arbitrator had a rational basis and was not arbitrary and capricious (Damadian MRI in Garden City v Windsor Group Ins., 2 Misc 3d 138[A], 2004 NY Slip Op 50262[U] [App Term, 2d & 11th Jud Dists 2004]; see Matter of Progressive Cas. Ins. Co. v New York State Ins. Fund, 47 AD3d 633 [2008]; see generally Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d 214 [1996]; Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d 207 [1981]). Accordingly, the court below properly denied the petition to vacate the master arbitrator’s award. However, upon denying the petition, the court was required, pursuant to CPLR 7511 (e), to confirm the award (see Matter of Exclusive Med. & Diagnostic v Government Empls. Ins. Co., 306 AD2d 476 [2003]).

We note that a special proceeding should terminate in a judgment, not an order (see CPLR 411).

Weston Patterson, J.P., Golia and Rios, JJ., concur.

Legal questions (2)

Questions of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Court review of arbitration awards

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When does a court vacate, modify or confirm a no-fault arbitrator’s or master arbitrator’s award under CPLR article 75?

This decision: No ground for vacatur or modification shown: the award is confirmed or left in place

Held the master arbitrator's affirmance of an award denying the claim for lack of standing had a rational basis and was not arbitrary, so vacatur was properly denied and the award had to be confirmed under CPLR 7511 (e).

Award standsVacated: irrational/arbitraryVacated: exceeded powerVacated: master oversteppedThis decisionCites it or cited by itCited or followed

Of the 119 decisions on this question in the Second Department courts and the Court of Appeals, 92 (this one included) are in the same category.

Challenging the assignment of benefits

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Could the insurer contest the validity of the provider’s assignment of benefits, or had it waived that defense?

This decision: Claimant lacks a valid assignment, or failed to prove one where the issue was preserved; claim fails or is not yet due

Upheld as rational, under the deferential article 75 standard, the arbitrator's finding that the assignment ran to an entity different from the petitioner, which therefore lacked standing to recover benefits.

Defense waivedAssignment sufficientAssignment defense upheldIssue of factThis decisionCites it or cited by itCited or followed

Of the 96 decisions on this question in the Second Department courts and the Court of Appeals, 14 (this one included) are in the same category.

Cited in this decision

Damadian Mri In Garden City v Windsor Group Ins. (2004 NY Slip Op 50262(U))The provider failed to establish entitlement to summary judgment because its assignment named an assignee whose identity remained uncertain.

Cited by

Matter of South Nassau Community Hosp. v Avis Budget Group, Inc. (2025 NY Slip Op 05954)The provider's petition to vacate a master award based on lack of standing was denied because the determination had a rational basis.
ENS Med., P.C. v Nationwide Ins. Co. (2026 NY Slip Op 26033)A provider may arbitrate a claim for lost earnings incurred in attending an insurer-demanded EUO. Insurance Law § 5106 (b) encompasses reimbursement disputes arising from claim verification, and 11 NYCRR 65-3.5 (e) requires reimbursement.

Similar decisions

S.P. Med. Ctr. v Allstate Ins. Co. (2007 NY Slip Op 51978(U))An award must be confirmed under CPLR 7511 (e) when a petition to vacate it is denied.
563 Grand Med., P.C. v Progressive Northeastern Ins. Co. (2008 NY Slip Op 50090(U))A no-fault arbitrator may raise any issue the arbitrator deems relevant under 11 NYCRR 65-4.4 (e) and 65-4.5 (o).
Allstate Ins. Co. v Longevity Med. Supply, Inc. (2018 NY Slip Op 50238(U))A master arbitrator may apply law to established facts and correct legal error even when reaching a conclusion different from the arbitrator's. The insurer sought vacatur under CPLR 7511 of an award of unpaid no-fault benefits and attorney fees.
Matter of Allstate Ins. Co. v Westchester Med. Group, M.D. (2015 NY Slip Op 00876)The insurer failed to establish a statutory ground to vacate a master arbitrator's award confirming payment of no-fault benefits.
563 Grand Med., P.C. v State-Wide Ins. Co. (2007 NY Slip Op 50362(U))Denial of a petition to vacate a master arbitrator's award requires confirmation of the award under CPLR 7511 (e).