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November 15, 2024

Ola v American Family Connect Ins. Co. (2024 NY Slip Op 51804(U))

https://www.beynensonlaw.com/case-law/ola-v-american-family-connect-ins-co-2024-ny-slip-op-51804u/

Court
Appellate Term, Second Department
Decided
November 15, 2024
Citation
2024 NY Slip Op 51804(U)
Posture
Article 75 petition
Outcome
Provider prevailed
Issues
CPLR article 75 (arbitration awards) Assignments and standing
Legal questions
Court review of arbitration awards (see the maps)
Cite as
Ola v American Family Connect Ins. Co., 2024 NY Slip Op 51804(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2024)

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.

Vacatur of the no-fault awards was affirmed for the Civil Court's reasons: the master arbitrator upheld an award contrary to settled law. The Appellate Term, Second Department, affirmed the reargument order, insofar as reviewed, vacating the arbitrator's and master arbitrator's awards, denying confirmation, and directing a rehearing before a new arbitrator. The awards had denied no-fault benefits for shoulder surgery and related services. The court relied on the Civil Court's reasons for vacatur and also noted that the arbitrator's ruling requiring the insured to prove the absence of an assignment, absent proof of one, was contrary to settled law under 11 NYCRR 65-3.11 (a) and Lopes v Liberty Mut. Ins. Co. The appeal from the original order was dismissed as superseded; the reargument determination was reviewed under CPLR 5517 (b).

Reported in New York Official Reports at Ola v American Family Connect Ins. Co. (2024 NY Slip Op 51804(U))

[*1]
Ola v American Family Connect Ins. Co.
2024 NY Slip Op 51804(U)
Decided on November 15, 2024
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This opinion is uncorrected and will not be published in the printed Official Reports.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 November 15, 2024
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : CHEREÉ A. BUGGS, J.P., MARINA CORA MUNDY, PHILLIP HOM, JJ
2023-917 Q C

Eufrosine Ola, Respondent-Appellant,

against

American Family Connect Insurance Company, Formerly Known as
Ameriprise Insurance Company, Appellant-Respondent.


Callinan & Smith, LLP (Steven Daniel Levy of counsel) for appellant-respondent. Law Offices of Jonathan B. Seplowe, P.C. (Alan M. Elis of counsel) for respondent-appellant.

Appeal and cross-appeal from an order of the Civil Court of the City of New York, Queens County (Karen Lin, J.), entered July 14, 2023. The order, insofar as appealed from by cross-petitioner, American Family Connect Insurance Company, formerly known as Ameriprise Insurance Company, granted the petition by Eufrosine Ola to vacate an arbitrator’s award and a master arbitrator’s award, and denied the insurance company’s cross-petition to confirm the arbitrator’s award and the master arbitrator’s award. The order, insofar as cross-appealed from by petitioner Ola, upon granting the petition to vacate the arbitrator’s award and master arbitrator’s award, did not order a rehearing before a new arbitrator. The appeal from the order entered July 14, 2023 brings up for review so much of an order of that court (Soma S. Syed, J.) entered June 25, 2024 as, upon reargument, made the same determination as was made in the order appealed from but added that “the case shall be heard before a new arbitrator,” thereby substantially adhering to the prior determination (see CPLR 5517 [a] [1]; [b]).

ORDERED that the appeal from the order entered July 14, 2023 is dismissed, as that order was superseded by the order entered June 25, 2024, made upon reargument; and it is further,

ORDERED that the order, entered June 25, 2024, insofar as reviewed, is affirmed, without costs.

Eufrosine Ola (the insured) commenced this proceeding, pursuant to CPLR 7511, to vacate both an arbitrator’s award denying the insured’s claims to recover first-party no-fault benefits for a left shoulder surgery performed on July 17, 2019 and other related medical services, and a master arbitrator’s award which upheld the award of the arbitrator, specifically requesting that, upon such vacatur, the matter be remitted for a new arbitration hearing before a different arbitrator (see CPLR 7511 [d]). American Family Connect Insurance Company (the [*2]insurer) cross-petitioned to confirm the arbitrator’s award and the master arbitrator’s award. By order entered July 14, 2023, the Civil Court (Karen Lin, J.) granted the insured’s petition on the ground that the master arbitrator’s award was arbitrary because the arbitrator’s award was contrary to settled law, but did not order a rehearing, and denied the insurer’s cross-petition. The insurer appeals, and the insured cross-appeals, from that order.

The insured moved for leave to reargue the petition on the ground, among others, that her request that the matter be remitted for a rehearing before a different arbitrator had not been granted. The insurer cross-moved for leave to reargue the cross-petition. By order entered June 25, 2024, the Civil Court (Soma S. Syed, J.) in effect granted the respective branches of the motion and cross-motion seeking leave to reargue and, upon reargument, made the same determination as was made in the original order, adding only a directive that “the case shall be heard before a new arbitrator.”[FN1] Upon the appeal from the July 14, 2023 order, we review so much of the June 25, 2024 order as, upon reargument, substantially adhered to the prior determination (see CPLR 5517 [b] [permitting review of a subsequent order which “upon reargument mak[es] the same or substantially the same determination as is made in the order appealed from” (CPLR 5517 [a] [1])]).

For the reasons stated by the Civil Court, we find that the petition to vacate the arbitrator’s and master arbitrator’s awards was properly granted and the cross-petition was properly denied. To the extent that the insured purports to cross-appeal from so much of the July 14, 2023 order as “failed to address the arbitrator’s ruling that the Petitioner must prove the lack of an assignment, in the absence of proof of an assignment,” that ruling has been vacated as the entire award has been vacated. Nevertheless, we note that the insured correctly argues that this determination was contrary to settled law (see 11 NYCRR 65-3.11 [a]; Lopes v Liberty Mut. Ins. Co., 24 Misc 3d 127[A], 2009 NY Slip Op 51279[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]).

Accordingly, the order entered June 25, 2024, insofar as reviewed, is affirmed.

BUGGS, J.P., MUNDY J., concur.

HOM, J. Taking no part.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 15, 2024
 
Footnotes


Footnote 1: The June 25, 2024 order states that the insurer “did not object to a new arbitrator in their supporting papers.”

Legal questions

A question 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

Open the full map

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

This decision: Award vacated or modified because it was irrational, arbitrary and capricious, without evidentiary support or contrary to settled law

Affirmed vacatur of the arbitrator's and master arbitrator's awards, adopting the lower court's reasons that the master arbitrator's award was arbitrary because the underlying award was contrary to settled law, with rehearing before a new arbitrator.

  • Court of AppealsCt App 1
  • Appellate DivisionApp Div 34
  • Appellate TermApp Term 46
  • Trial courtsTrial 38
2010, Court of Appeals: 1 decision (1 Award stands)2022, Appellate Division: 1 decision (1 Vacated: irrational/arbitrary)2019, Appellate Division: 6 decisions (3 Award stands, 1 Vacated: irrational/arbitrary, 2 Vacated: master overstepped)2018, Appellate Division: 2 decisions (1 Award stands, 1 Vacated: irrational/arbitrary)2017, Appellate Division: 1 decision (1 Award stands)2016, Appellate Division: 1 decision (1 Award stands)2015, Appellate Division: 1 decision (1 Award stands)2013, Appellate Division: 1 decision (1 Award stands)2010, Appellate Division: 2 decisions (2 Award stands)2007, Appellate Division: 2 decisions (1 Vacated: irrational/arbitrary, 1 Vacated: exceeded power)2005, Appellate Division: 2 decisions (2 Award stands)2025, Appellate Division: 5 decisions (5 Award stands)2026, Appellate Division: 9 decisions (6 Award stands, 1 Vacated: irrational/arbitrary, 2 Vacated: exceeded power)2009, Appellate Division: 1 decision (1 Award stands)2020, Appellate Term: 2 decisions (1 Award stands, 1 Vacated: master overstepped)2019, Appellate Term: 1 decision (1 Award stands)2017, Appellate Term: 4 decisions (4 Award stands)2016, Appellate Term: 2 decisions (2 Award stands)2011, Appellate Term: 1 decision (1 Award stands)2010, Appellate Term: 3 decisions (3 Award stands)2009, Appellate Term: 1 decision (1 Award stands)2008, Appellate Term: 11 decisions (7 Award stands, 4 Vacated: irrational/arbitrary)2007, Appellate Term: 14 decisions (14 Award stands)2006, Appellate Term: 3 decisions (3 Award stands)2023, Appellate Term: 1 decision (1 Vacated: irrational/arbitrary)2024, Appellate Term: 1 decision (1 Vacated: irrational/arbitrary)2025, Appellate Term: 1 decision (1 Award stands)2004, Appellate Term: 1 decision (1 Award stands)2023, Trial courts: 13 decisions (12 Award stands, 1 Vacated: irrational/arbitrary)2019, Trial courts: 1 decision (1 Award stands)2017, Trial courts: 1 decision (1 Vacated: master overstepped)2015, Trial courts: 2 decisions (2 Award stands)2013, Trial courts: 2 decisions (2 Vacated: irrational/arbitrary)2008, Trial courts: 1 decision (1 Award stands)2006, Trial courts: 1 decision (1 Vacated: irrational/arbitrary)2005, Trial courts: 7 decisions (5 Award stands, 2 Vacated: irrational/arbitrary)2004, Trial courts: 1 decision (1 Vacated: irrational/arbitrary)2024, Trial courts: 3 decisions (3 Award stands)2026, Trial courts: 1 decision (1 Award stands)2009, Trial courts: 2 decisions (1 Award stands, 1 Vacated: irrational/arbitrary)2011, Trial courts: 1 decision (1 Award stands)2016, Trial courts: 1 decision (1 Award stands)2018, Trial courts: 1 decision (1 Vacated: exceeded power)This decision
20052010201520202025
Award standsVacated: irrational/arbitraryVacated: exceeded powerVacated: master oversteppedThis decision

Of the 119 decisions on this question in the Second Department courts and the Court of Appeals, 19 (this one included) are in the same category.

Cited in this decision

  • Lopes v Liberty Mut. Ins. Co. (2009 NY Slip Op 51279(U))A payment authorization showing no intent to transfer no-fault rights does not deprive an injured claimant of standing.

Similar decisions

  • State Farm Mut. Auto. Ins. Co. v Hereford Ins. Co. (2020 NY Slip Op 51304(U))An intercompany reimbursement arbitration cannot relate back to a lawsuit against a different party to toll the limitations period.
  • 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.
  • 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 American Tr. Ins. Co. v Sovereign Med. Servs., P.C. (2026 NY Slip Op 03160)The master arbitrator's application of collateral estoppel to reject a verification defense was rational and supported by evidence.
  • Dr. Orenbakh Psychologist, P.C. v Nationwide Affinity Ins. Co. of Am. (2022 NY Slip Op 50566(U))The insurer proved EUO nonappearance for later claims, but its first EUO request was a nullity for a claim received more than 30 days earlier.
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