R.J. Professional Acupuncturist, P.C. v Travelers Prop. Cas. Ins. Co. (2008 NY Slip Op 50541(U))

SUPREME COURT OF THE STATE OF NEW YORK

APPELLATE TERM: 2nd and 11th JUDICIAL DISTRICTS

Appeal from an order of the Civil Court of the City of New York, Kings County (Genine D. Edwards, J.), entered August 24, 2006. The order, insofar as appealed from, denied the petition to vacate a master arbitrator’s award.

Order, insofar as appealed from, reversed without costs, awards of the master arbitrator and arbitrator vacated, and matter remitted for a rehearing before a different arbitrator.

R.J. Professional Acupuncturist, P.C. (R.J.) commenced this proceeding pursuant to CPLR 7511 to vacate a master arbitrator’s award which upheld the denial of its claim for assigned first-party no-fault benefits. The insurer opposed the petition, asserting, inter alia, that the arbitrator properly found that R.J. failed to make a prima facie showing of its entitlement to reimbursement since it did not provide documentation to support the bills for the services which it rendered. The insurer also cross-petitioned for confirmation of the master arbitrator’s award. The court denied the petition and the cross petition. This appeal by R.J. ensued.

The standard applicable to judicial review of a compulsory arbitration proceeding is whether the award was “supported by a reasonable hypothesis’ and was not contrary to what could be fairly described as settled law” (Matter of State Farm Mut. Auto. Ins. Co. v Lumbermens Mut. Cas. Co., 18 AD3d 762, 763 [2005], citing Matter of Motor Veh. Acc. Indem. Corp. v Aetna Cas. & Sur. Co., 89 NY2d 214, 224 [1996]; see Matter of Hanover Ins. Co. v State Farm Mut. Auto. Ins. Co., 226 AD2d 533, 534 [1996]; Matter of Adams v Allstate Ins. Co., 210 AD2d 319, 320 [1994]). Applying this standard to the instant proceeding, we find that the master arbitrator’s award and the arbitrator’s award were irrational (see Matter of State Farm [*2]Mut. Auto. Ins. Co., 18 AD3d at 763; Matter of Hanover Ins. Co., 226 AD2d at 534) since they were contrary to settled law.

It is well settled that a provider seeking to recover assigned first-party no-fault benefits makes a prima facie showing by demonstrating that a complete proof of claim setting forth the fact and amount of the loss sustained was submitted to the insurer and payment of no-fault benefits was overdue (see Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742 [2004]). Notwithstanding the foregoing, the arbitrator held that R.J. failed to make a prima facie showing because it did not submit sufficient additional evidence to substantiate its bills for the services rendered. Consequently, the
court below should have vacated the master arbitrator’s award as well as the arbitrator’s award (see e.g. Matter of Pradip Das/N.Y. Med. Rehab v Allstate Ins. Co., 297 AD2d 321 [2002]; Matter of Nyack Hosp. v Government Empls. Ins. Co., 139 AD2d 515 [1988]). Accordingly, the matter is remitted for a new hearing before a different arbitrator (see Matter of Health & Endurance Med., P.C. v Deerbrook Ins. Co., 44 AD3d 857 [2007]).

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

Golia, J., concurs in a separate memorandum.

Golia, J., concurs in the following memorandum:

I concur for the reasons stated in my concurrence in Metropolitan Radiological Imaging, P.C. v Country-Wide Insurance Company (___ Misc 3d ____, 2008 NY Slip Op _______ [No. 2006-1670 K C], decided herewith).
Decision Date: March 13, 2008