Appellate Term, Second Department
Aug 4, 2023
2023 NY Slip Op 50891(U)
Provider prevailed
A prior declaratory judgment did not preclude the provider's claims for treatment rendered after that judgment. The Appellate Term, Second Department, reversed the order, insofar as appealed from, and denied the defendant's request for a permanent stay based on res judicata or collateral estoppel. The February 2017 judgment barred actions arising from an earlier accident because the provider had operated unlawfully and was ineligible for reimbursement under 11 NYCRR 65-3.16 (a) (12) and Mallela. That judgment could not determine whether the provider continued operating unlawfully when rendering treatment in December 2017 and January 2018 for a different accident. The eligibility issue was therefore not identical, and extending the judgment to this action exceeded its explicit scope.
Trial court, Second Department
Aug 4, 2023
2023 NY Slip Op 50814(U)
Provider prevailed
A no-fault arbitrator need not require a formal rebuttal specifically addressing an insurer's peer review or IME report. The Supreme Court, Kings County, denied the insurer's vacatur petition and granted the provider's cross-petition to confirm. Following American Tr. Ins. Co. v Right Choice Supply, it held that summary judgment rebuttal requirements do not govern no-fault arbitration; medical necessity and evidentiary weight remain within the arbitrator's discretion under 11 NYCRR 65-4.10 (a) (4). The arbitrator found the peer reviews insufficient and the IME rebutted by clinical examination findings. Although the master arbitrator omitted the asserted legal issue, the affirmance was rational and resolved the parties' rights and obligations, so no ground for vacatur under CPLR 7511 (b) (1) was established.
