Acuhealth Acupuncture, P.C. v. N.Y.C. Transit Auth.
Decision Date | 01 March 2016 |
Docket Number | No. 9533/2015.,9533/2015. |
Citation | 36 N.Y.S.3d 406 (Table) |
Parties | ACUHEALTH ACUPUNCTURE, P.C., a/a/o Lancy Estremera, Petitioner, v. NEW YORK CITY TRANSIT AUTHORITY, Respondent. |
Court | New York Supreme Court |
Daniel Klein, Esq., Tsisirelman Law Firm PLLC, Jackson Heights, Attorneys for Petitioner.
Aaron E. Meyer, Esq., Foley, Smit, O'Boyle & Weisman, Hauppauge, Attorneys for Respondent.
Upon the foregoing papers, the petitioner Acuhealth Acupuncture, P.C, moves for an order (1) pursuant to CPLR § 7511, vacating a master arbitrator's award; (2) granting the petitioner $1,831.24 plus statutory interest, attorney's fees, costs and disbursements including arbitration fees; (3) or in the alternative remanding the matter to arbitration for further proceedings not inconsistent with the insurance law and implementing regulations and case law thereunder; and (4) such other and further relief as the Court deems just and proper. Respondent the New York City Transit Authority (N.Y.CTA), opposes the application
Petitioner, Lancy Estremera, was injured in an automobile accident on April 3, 2010. The respondent, NYCTA, is self-insured. At the time of the accident the automobile insurance policy contained New York State no fault law benefits for health insurance expenses. Petitioner, Acuhealth Acupuncture, P.C. (Acuhealth), performed services and is the assignee for Lancy Estremera. Acuhealth did not receive payment in full for services provided and filed a request for arbitration.
Robyn McAllister, an arbitrator designated by the American Arbitration Association, rendered an arbitration award on November 23, 2014. The issue presented to the arbitrator was “whether applicant is entitled to reimbursement for acupuncture treatment where the policy of insurance has been exhausted.” (Notice of Petition, Exhibit 2, Arbitration Award). Acuhealth sought reimbursement in the amount of $1,831.24. “Respondent partially denied the majority of the Applicant's claim predicated on the Worker's Compensation Fee Schedule and denied the remainder of the claim based on exhaustion of the policy of insurance” (Notice of Petition, Exhibit 2, Arbitration Award). Respondent paid for all of the acupuncture services on the chiropractic fee schedule. The claims in dispute are as follows:
Dates of Service | Billed | Bill Received | Disputed Amount |
07/07/10–08/07/10 | 08/16/10 | 08/20/10 | $955.09 |
09/03/10–09/30/10 | 10/13/10 | 10/27/10 | $270.07 |
10/07/10–10/14/10 | 11/16/10 | 12/02/10 | $253.02 |
10/23/10–11/03/10 | 11/16/10 | 12/02/10 | $107.44 |
11/04/10–11/18/10 | 12/06/10 | 12/10/10 | $80.50 |
01/01/11–01/19/11 | 02/03/11 | 02/03/11 | $165.04 |
The arbitrator found that the partial denials for dates of service 07/07/10–8/7/10; 10/07/10–10/14/10; and 11/04/10–11/18/10 “were late on their face”. And there was no specific denial for services on 01/01/11–1/19/11.1
The arbitrator further found that Acuhealth “sustained its burden of demonstrating a prima facie showing of entitlement to reimbursement for the acupuncture service”. However, at the time that Acuhealth's last bill was received on February 7, 2011, the policy was exhausted. The arbitrator stated that the “Applicant may not recover any of the outstanding fees since any such award would exceed my authority”. In making this determination, the arbitrator relied, in part, on Matter of Brijmohan v. State Farm Ins. Co., (92 N.Y.2d 821, 699 N.E.2d 414, 677 N.Y.S.2d 55 [1998] ) and Matter of State Farm Ins. Co. v. Credle (228 A.D.2d 191, 643 N.Y.S.2d 97 [1 Dept., 1996] ).
The petitioner commenced the instant proceeding pursuant to CPLR 7511(b) to vacate the arbitration award contending that the master arbitrator's award is arbitrary, capricious, irrational, and in violation of the letter and the spirit of the no-fault law. In opposition to the petition, NYCTA asserted that the arbitrator's determination had a reasonable hypothesis and was not arbitrary and capricious.
It is well settled that a court may vacate an arbitration award only if it violates a strong public policy, is irrational, or clearly exceeds a specifically enumerated limitation on the arbitrator's power (see Matter of New York City Tr. Auth. v. 1199 69 Transport Workers' Union of Am., Local 100, AFL–CIO, 6 NY3d 332, 336, 812 N.Y.S.2d 413, 845 N.E.2d 1243 [2005] ; Matter of United Fedn. of Teachers, Local 2, AFT, AFL–CIO v. Board of Educ. of City School Dist. of City of NY, 1 NY3d 72, 79, 769 N.Y.S.2d 451, 801 N.E.2d 827 [2003] ; CPLR 7511[b][1][iii] ). Even where an arbitrator has made an error of law or fact, courts generally may not disturb the arbitrator's decision (see Transport Workers' Union of Am., Local 100, AFL–CIO, 6 NY3d at 336, 812 N.Y.S.2d 413, 845 N.E .2d 1243 [ ).
The Codes Rules and Regulations of the State of New York state that an arbitration award may be vacated or modified solely by appeal to a master arbitrator, when “an award rendered in an arbitration under section 65–4.4 or 65–4.5 of this Subpart, was incorrect as a matter of law (procedural or factual errors committed in the arbitration below are not encompassed within this ground)” (11 NYCRR 65–4.10(a)(4) ; see Colon v. GEICO, 18 AD3d 467,794 N.Y .S.2d 431 [2 Dept., 2005] ; see also Matter of Petrofsky, 54 N.Y.2d 207, 445 N.Y.S.2d 77, 429 N.E.2d 755 [1981] ). “The power of the master arbitrator to review factual and procedural issues is limited to whether the arbitrator acted in a manner that was arbitrary and capricious, irrational or without a plausible basis' “ (Matter of Petrofsky, 54 N.Y.2d 207, 211, 445 N.Y.S.2d 77, 429 N.E.2d 755 ).” (Liberty Mut. Ins. Co. v. Spine Americare Medical, P.C., 294 A.D.2d 574, 743 N.Y.S.2d 144 [2 Dept., 2002] ). Further, an arbitration award may be modified or vacated pursuant to CPLR section 7511(b)(1)(iii) if it “manifestly exceeds a specific, enumerated limitation on the arbitrator's power.” (Kowaleski v. New York State Department of Correctional Services, 16 NY3d 85, 942 N.E.2d 291, 917 N.Y.S.2d 82 [2010] ).
Since arbitration pursuant to Insurance Law § 5105(b) is compulsory, the arbitrators determination is subject to “closer judicial scrutiny” than an arbitration conducted pursuant to a voluntary agreement (Motor Vehicle Acc. Indemnification Corp. v. Aetna Cas. & Sur. Co., 89 N.Y.2d 214, 674 N.E.2d 134, 9652 N.Y.S.2d 584 [1996] ).
“Moreover, with respect to determinations of law, the applicable standard in mandatory no-fault arbitrations is whether any reasonable hypothesis can be found to support the questioned interpretation' “ (Fiduciary Ins. Co. v. American Bankers Ins. Co. of Florida, 132 AD3d 40, 14 N.Y.S.3d 427 [2 Dept., 2015], quoting Shand v. Aetna Ins. Co., 74 A.D.2d 442, 428 N.Y.S.2d 462 [2 Dept., 1980] ).
At issue here is the interplay of the priority of lien regulation and the arbitrators authority to direct payment in excess of the no fault policy.
“The no-fault regulations provide that “[n]o-[f]ault benefits are overdue if not paid within 30 calendar days after the insurer receives proof of claim, which shall include verification of all of the relevant information requested pursuant to section 65–3.5” (11 NYCRR 65–3.8 [a][1] ). With exceptions not relevant to this appeal, an insurer may not deny a claim “prior to its receipt of verification of all of the relevant information requested pursuant to section 65–3.5 (11 NYCRR 65–3.8 [b][3] ).” (Nyack Hosp. v. General Motors Acceptance Corp., 8 NY3d 294, 864 N.E.2d 1279, 832 N.Y.S.2d 880 [2007] ).
(11 NYCRR 65–3.15 ).
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