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January 2, 2020

Matter of Metro Pain Specialist P.C. v Country-Wide Ins. Co. (2020 NY Slip Op 50014(U))

https://www.beynensonlaw.com/case-law/matter-of-metro-pain-specialist-p-c-v-country-wide-ins-co-2020-ny-slip-op50014u/

Court
Appellate Term, Second Department
Decided
January 2, 2020
Citation
2020 NY Slip Op 50014(U)
Posture
Article 75 petition
Outcome
Provider prevailed
Later treatment
Followed in 1 later decision (see Cited by)
Issues
CPLR article 75 (arbitration awards) Interest and attorney fees
Cite as
Matter of Metro Pain Specialist P.C. v Country-Wide Ins. Co., 2020 NY Slip Op 50014(U) (App Term, 2d Dept, 9th & 10th Jud Dists 2020)

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 may not review factual issues de novo, weigh evidence, or resolve credibility when reviewing a no-fault award. An arbitrator awarded the provider benefits after finding its prima facie case unrebutted. The master arbitrator vacated that award based on perceived evidentiary insufficiency and ordered a new hearing. The Appellate Term, Second Department, found a rational basis for the original award and held that the master arbitrator exceeded the permissible scope of review. It affirmed the District Court's vacatur of the master award and confirmation of the original award under CPLR 7511 (b) (1) (iii) and CPLR 7510. The provider also received appellate attorney's fees under 11 NYCRR 65-4.10 (j) (4), with remittal to determine their reasonable amount.

Reported in New York Official Reports at Matter of Metro Pain Specialist P.C. v Country-Wide Ins. Co. (2020 NY Slip Op 50014(U))

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 9th and 10th JUDICIAL DISTRICTS

In the Matter of Metro Pain Specialist, P.C., as Assignee of Ramiro Loaiza-Hurtado, Respondent,

against

Country-Wide Insurance Company, Appellant.

Jaffe & Velazquez, LLP (Jean H. Kang of counsel), for appellant. Gabriel & Shapiro, LLC (Lenard Brumfield, Esq.), for respondent (no brief filed).

Appeal from an order of the District Court of Suffolk County, Third District (James F. Matthews, J.), dated November 2, 2017. The order granted the petition in a CPLR 7511 proceeding to vacate a master arbitrator’s award dated December 19, 2016, and, upon such vacatur, in effect, confirmed the arbitrator’s award and awarded attorney’s fees to petitioner.

ORDERED that the order is affirmed, with $25 costs, and the matter is remitted to the District Court for further proceedings consistent herewith.

After a provider’s claims for assigned first-party no-fault benefits had been denied based on the provider’s “failure to cooperate” at an examination under oath, and upon “improper kickbacks,” “improper fee splitting,” “improper fee scheduling” and “billing for services not rendered,” the provider submitted the claims to arbitration pursuant to Insurance Law § 5106 (b). Following a hearing, the arbitrator found that the provider had established its prima facie case which the insurer had failed to rebut, and awarded the provider the monies it sought. The insurer appealed the award to the master arbitrator who, by an award dated December 19, 2016, vacated the arbitrator’s award and remitted the matter for a hearing before a new arbitrator. The provider then commenced this proceeding to vacate the master arbitrator’s award, pursuant to CPLR 7511 (1) (b) (iii), on the ground that the master arbitrator had exceeded his power. The insurer opposed the petition and requested that the master arbitrator’s award be confirmed. The District [*2]Court, by order dated November 2, 2017, from which the insurer appeals, found that there was a rational basis for the original arbitrator’s award, that the master arbitrator had “exceeded his statutory authority,” granted the petition, vacated the master arbitrator’s award, and, upon such vacatur, “reinstated” the original arbitrator’s award, and awarded attorney’s fees to the provider.

The scope of judicial review of a master arbitrator’s award is limited to whether the master arbitrator exceeded his power (see Matter of Smith [Firemen’s Ins. Co.], 55 NY2d 224 [1982]; Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d 207 [1981]). The role of a master arbitrator “is to review the arbitrator’s determination to assure that it was reached in a rational manner and that the decision was not arbitrary and capricious. It does not include the power to review, de novo, the matter originally presented to the arbitrator” (Matter of Allstate Ins. Co. v Keegan, 201 AD2d 724, 725 [1994]; see also Matter of Petrofsky [Allstate Ins. Co.], 54 NY2d 207; Matter of Progressive Cas. Ins. Co. [Elite Med. Supply of NY, LLC], 162 AD3d 1471, 1472 [2018]). A master arbitrator exceeds his statutory power by making factual determinations, by reviewing factual and procedural errors committed at the original arbitration hearing, by weighing the evidence, or by resolving issues of credibility (see Matter of Smith [Firemen’s Ins. Co.], 55 NY2d 224; Matter of Richardson v Prudential Prop. & Cas. Ins. Co., 230 AD2d 861 [1996]; Matter of Allstate Ins. Co. v Keegan, 201 AD2d at 725).

Here, the master arbitrator vacated the arbitrator’s award based on “[t]he rational and what appears to [sic] insufficient evidence presented,” which necessarily involves a review of the facts by the master arbitrator (see e.g. Matter of Allstate Ins. Co. v Keegan, 201 AD2d at 725). Upon our review of the record, we find that there was a rational basis for the original arbitrator’s award. Consequently, the master arbitrator exceeded his authority by reviewing, de novo, factual issues already determined by the original arbitrator (see Matter of Richardson v Prudential Prop. & Cas. Ins. Co., 230 AD2d 861). We, thus, affirm the order of the Civil Court which vacated the master arbitrator’s award and, in effect, confirmed the arbitrator’s award (see CPLR 7511 [b] [1] [iii]; 7510).

Furthermore, the provider is entitled to recover reasonable attorney’s fees for this appeal (see 11 NYCRR § 65-4.10 [j] [4]; Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co., 170 AD3d 1168, 1169 [2019]; Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 148 AD3d 703, 705 [2017]). Therefore, the matter is remitted to the District Court to determine the provider’s reasonable attorney’s fees for this appeal (see Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co., 170 AD3d at 1168).

Accordingly, the order is affirmed and the matter is remitted to the District Court for further proceedings relating to attorney’s fees.

It is noted that a proceeding to vacate or to confirm an arbitrator’s award is a special proceeding brought pursuant to CPLR article 4 and should, therefore, terminate in a judgment rather than an order (see CPLR 411).

ADAMS, P.J., TOLBERT and GARGUILO, JJ., concur.


ENTER:
Paul Kenny
Chief Clerk
Decision Date: January 02, 2020

Cited in this decision

  • Matter of Progressive Cas. Ins. Co. (Elite Med. Supply of N.Y., LLC) (2018 NY Slip Op 04122)A master arbitrator may vacate a no-fault award for substantive legal error without conducting de novo factual review.
  • Matter of GEICO Ins. Co. v AAAMG Leasing Corp. (2017 NY Slip Op 01552)A provider may recover an additional attorney's fee for an article 75 proceeding to confirm or vacate a master arbitration award.

Cited by

A label shows how the later decision treated this one.

  • New York Recovery PT, P.C. v American Tr. Ins. Co. (2025 NY Slip Op 25166) FollowedA provider may recover attorney's fees for confirming an overdue master arbitration award and for the ensuing appeal.

Similar decisions

  • Matter of Advanced Orthopaedics PLLC v Unitrin Advantage Ins. Co. (2020 NY Slip Op 51017(U))No-fault arbitration is compulsory, and denial of a petition to vacate a master arbitrator's award requires confirmation of the award.
  • Matter of American Tr. Ins. Co. v Atlantic Med. Care, P.C. (2025 NY Slip Op 07297)A master arbitrator's legal error does not warrant vacatur unless the determination is irrational.
  • Matter of Bay Needle Care Acupuncture, P.C. v Country Wide Ins. Co. (2019 NY Slip Op 07061)The provider's challenge to its arbitration attorney fee failed because it submitted no documentation of hours worked.
  • Wellness Diagnostic Imaging, P.C. v American Tr. Ins. Co. (2025 NY Slip Op 50628(U))The master arbitrator's award had a rational basis because the parties' stipulation limited the dispute to the assignor's IME appearance.
  • Matter of Acuhealth Acupuncture, P.C. v Country-Wide Ins. Co. (2019 NY Slip Op 07245)An arbitrator acts within discretionary authority by refusing to consider late submissions.
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