American Tr. Ins. Co. v Bay Ridge Orthopedic Assoc. PC 2024 NY Slip Op 31990(U) June 4, 2024 Supreme Court, Kings County Docket Number: Index No. 502769/2024 Judge: Peter P. Sweeney Cases posted with a "30000" identifier, i.e., 2013 NY Slip Op 30001(U), are republished from various New York State and local government sources, including the New York State Unified Court System's eCourts Service. This opinion is uncorrected and not selected for official publication. FILED: KINGS COUNTY CLERK 06/07/2024 INDEX NO. 502769/2024 NYSCEF DOC. NO. 26 RECEIVED NYSCEF: 06/10/2024
SUPREME COURT OF THE S 'ATE OF NEW YORK Index No.: 502769/2024 COUNTY OF KINGS, PART 71----. ·. ____________ --X Motion.Date:.5-20-24 Mot. Seq. No.: 2, 3 AMERICANTRANSITINSU i NCE COMPANY,
Plaintiff, -against:- DECISION/ORDER
Bay Ridge O,thopedic Assoc. P a/a/o Tiny A11toine.
Defendant. - . ·---. ·-- ·---------- ·--------------· -- ---· ----· . -------------· ---X
The follo,..,·ing papei's. wl ich arc e-filecl with NYCEF as items 4-19, ,vere read on these motions:
The·d½.fen.da.11.t.moves.fo lan order (l)dismissing the complaint, pursuant to CPLR § 3211 (a)(7) as the complaint as p eaded fails to state a cause of action; (2) confirming the
underlying arbitration award in tlefollowing sums: (i) ~rincipe in t~e smn of $~:~98,00; (ii) Interest at the rate of2% per mo th from 3-16-2023 until entry of a Judgment; (111) Statutory attorney fee of20% of the ptincii le and interest up to a maximum of$J,360.00: (iv}Art arbitration filing fee of$40.00; (~) A master arbitration attorney fee of $195.00: (vi) Reasonable attorney's fee.sin defending this ~ction, pursuant to 11 NYC RR§ 65-4. l 0(j}(4); (3) award costs . . and disbursements as taxed by tlt clerk; and (4) granting such other and fmther relief as this I . .
Court deems just, proper and eq*itable (Motion Sequence# 2). ! i By Notice of Cross,.,.Moti~n, I the plaint_iffmoves . .. for an order: l). Pursuanrto CPLR 3211 (b)_, dismissing Defendant'slAtfirrt1ative Defenses ,vith respec:tto·i} failllre to state a cause ofaction, CPl,R 3211 (a.)(7) and . I Ii) additional attorney's fees pursuant to Insurance Law 5106 and .. . . . . . ·. . ... an.award ofattbrneis fees purstttant to 11 N.Y.C.R,R. 65-4.6(h); 11 N.Y.C.R.R. 65~3. lO(d); 2} . . I Ordering Defondantto file its a:~swer and appear in this actio1i, and fat such and other relief as . ' . tbi s Honora:b le Court may deem Uust, proper aitd equitable. ·The motion and ctoss-motion. are consolid.ated for dispo;itio1i. I . i
1 of 4 [* 1] FILED: KINGS COUNTY CLERK 06/07/2024 INDEX NO. 502769/2024 NYSCEF DOC. NO. 26 RECEIVED NYSCEF: 06/10/2024
Background:
The defendant,. a heal the re provider, submitted claims for first-party no-fault he11efits to the plaintiff for healthcare servi+~s provided to its assignor, Tii1y Antoine. The total amount of these claims wc1s $8,211.29. Thf plai11tiff denied the claims asserting various defenses, including defenses based on: plai11tiff's coritcntion that the defendant billed the plai11tiff amounts that exceeded the fee schedt.tle atnouhts allo\ved under the Insurance Law, The defendant theteafter I initiated an arbitration .proceedirlg I to recover the above amount. At the scheduled arbitration, the attorney for the defendant sougll1 leave to amend the amount ih dispute to$4;998.00; by \Vithdrawingth.os~ claims which \Vere denied ;base~ upon an independen~ me~icalexa~1ination held by the plamhffand to refle ,t the appropnate tee schedule amounts m this case. 1 he . I
arbitrator granted th~ reg uest. T~e plaintiff did not submit any proof at the arbittation in support ofits fee schedule defenses. Thel arbitrator awarded the defendant the sum of $4,998.00, plus I statutory·.interest a11d attorney fe~s and appropriate fees. The Master Arbiti•ator affimtcd. I . ii The plaintiff thereafter ctmmenced this action seeking a de nova adjudication of the dispute. The plaintiff claims thaf even though CPLRSJ 06(c) only allows for de nova adjudications ofarbitration disp~tes if the amount of the arbitration awmd is $5,000 at greater, ' exclusive of attorney's fees and fntere:st, it is e11titledto a de nova adjudication ofthe dispute in this· case because the defendant. tcted at bitrarily and contrary to law in seeking to amend. the i amo~mt in dispute to $4,998.00. Plaintiffclaims if the appropriate foe schedules were used, the ' . .
actual amount that would be dud and owing on the claims that were not withdrawn would by ! $5,912.10. Plai11tiff Sltbmitted tl~taffirtnation I of Carolyn Mallory, .. CPC (NYSCEF # 14) in support of this contei1tioh. The ~laintiff claims that b)' amending.the amount in dispute to I $4,998.00, the defendant's real totive v.'a.s to unlawfully de11y the plaintiff the right to a .de nova adjudication of the dispute under CPLR 5Jb6(c). the plaintifffmther claims that by amending . I
the amount.in dispute, the defentlant adm1tted that the defei1dunt submitted btlls ..in excess ofthe. I apprOpriate fee schedule$ a)1d isithetebY disqualifie:cl {ram recovering attorney's foes under the i no-fo u1t regulations~
.......................... , ......... ~__. ...) 2 of 4 [* 2] FILED: KINGS COUNTY CLERK 06/07/2024 INDEX NO. 502769/2024 NYSCEF DOC. NO. 26 RECEIVED NYSCEF: 06/10/2024
Discussion:
Plaintiff's claim that de£ ndant is not entitled to attorney's fees will be addressed first It is well settled thatto prevail ont fee~schedule defense, a No-Fault insurer must demonstrate by competei1t evidentiary proof tha~ the .amount ofa healthcare provider's dain1 for assigned for first-party no~fault benefits was in excess ofthe appropriate fee schedules {see Com'! i\1ed, P.C v. Travelers !11den1. Co., 11 Misl 3d 145(A), 819 N.Y.S.2d 847 (App. Term2006J,Jamif A4. Abt-aham i\ID. P.C. v. Coww:v~Vide Ins. C'o,, 3 Misc; 3d 130(A), 787 N.Y.S.2d 678 (App. Tenn 2004}. Here, since the plaintiff f d not submit any competent evidentiary proofat the arbitration supporting its fee schedule defe,l'ses, the plaintiff never demonstrated that defen.dant's bills were .excessIVe.
While plaintiff correctly fates that "if the charges by a health care provider. who is an I applicant for benefits, exceed th~ limitations contained in the schedules established pursuant to section 5108 of the Insurance La~; no attorney's fee shall be payable by the insurer'' (11 NYCRR § 6.5-4.6(h)). the plaintiff di.d not demonstrate at the arbitration that defcnd.an's charges were excessive. The court does 401 view defendant·s request to amend the amounts m dispute as an ad1t1ission of excessive billini. 'i If the plaintiffwas desirous of not pa:yiri:g ' ' any attorney's ' fees, nothing prevented it from pro vi9g at the arbitration that de feridant' s bills. ,;,vere excessive. For the above reasons, the court rejects ~laintiff's contention that the. defendant is not entitled to attorney's fees. !' 'i I The Court also· rejects plfin tiff's. contention that the. defendant acted arbitrarily and contrary to la\v by amending th.el amount in dispute to less than $5000. As stated, plaintiff's
. to a de novo contends that the purpose ofthe Iumei1dment was to deny. the plaintiff aright adjudication of the dispute . pursqant I to CPLR 5106(c). . ''The policy of this State isto favor and encourage arbitration as· a 111ean1 •of expedhing the reso Iuti on -of disputes and conservingjudi cial resources';(Rio Algofn v, Sammtj_Siee!Co .. hd.. 168 A,D.2d 250,251, 562N.Y.S.2d 486; see also, S'zctbado:~· 11• Pe~)sl~:'.olc1B~i[tiin,g ~:o. (fNew York, 174_A.O;~d 342 1J4~,-.57_D N.Y.S:2d ~53; 5 54). AcceptI ng. plaintiffs po51 ~rnn.
Free access — add to your briefcase to read the full text and ask questions with AI
American Tr. Ins. Co. v Bay Ridge Orthopedic Assoc. PC 2024 NY Slip Op 31990(U) June 4, 2024 Supreme Court, Kings County Docket Number: Index No. 502769/2024 Judge: Peter P. Sweeney Cases posted with a "30000" identifier, i.e., 2013 NY Slip Op 30001(U), are republished from various New York State and local government sources, including the New York State Unified Court System's eCourts Service. This opinion is uncorrected and not selected for official publication. FILED: KINGS COUNTY CLERK 06/07/2024 INDEX NO. 502769/2024 NYSCEF DOC. NO. 26 RECEIVED NYSCEF: 06/10/2024
SUPREME COURT OF THE S 'ATE OF NEW YORK Index No.: 502769/2024 COUNTY OF KINGS, PART 71----. ·. ____________ --X Motion.Date:.5-20-24 Mot. Seq. No.: 2, 3 AMERICANTRANSITINSU i NCE COMPANY,
Plaintiff, -against:- DECISION/ORDER
Bay Ridge O,thopedic Assoc. P a/a/o Tiny A11toine.
Defendant. - . ·---. ·-- ·---------- ·--------------· -- ---· ----· . -------------· ---X
The follo,..,·ing papei's. wl ich arc e-filecl with NYCEF as items 4-19, ,vere read on these motions:
The·d½.fen.da.11.t.moves.fo lan order (l)dismissing the complaint, pursuant to CPLR § 3211 (a)(7) as the complaint as p eaded fails to state a cause of action; (2) confirming the
underlying arbitration award in tlefollowing sums: (i) ~rincipe in t~e smn of $~:~98,00; (ii) Interest at the rate of2% per mo th from 3-16-2023 until entry of a Judgment; (111) Statutory attorney fee of20% of the ptincii le and interest up to a maximum of$J,360.00: (iv}Art arbitration filing fee of$40.00; (~) A master arbitration attorney fee of $195.00: (vi) Reasonable attorney's fee.sin defending this ~ction, pursuant to 11 NYC RR§ 65-4. l 0(j}(4); (3) award costs . . and disbursements as taxed by tlt clerk; and (4) granting such other and fmther relief as this I . .
Court deems just, proper and eq*itable (Motion Sequence# 2). ! i By Notice of Cross,.,.Moti~n, I the plaint_iffmoves . .. for an order: l). Pursuanrto CPLR 3211 (b)_, dismissing Defendant'slAtfirrt1ative Defenses ,vith respec:tto·i} failllre to state a cause ofaction, CPl,R 3211 (a.)(7) and . I Ii) additional attorney's fees pursuant to Insurance Law 5106 and .. . . . . . ·. . ... an.award ofattbrneis fees purstttant to 11 N.Y.C.R,R. 65-4.6(h); 11 N.Y.C.R.R. 65~3. lO(d); 2} . . I Ordering Defondantto file its a:~swer and appear in this actio1i, and fat such and other relief as . ' . tbi s Honora:b le Court may deem Uust, proper aitd equitable. ·The motion and ctoss-motion. are consolid.ated for dispo;itio1i. I . i
1 of 4 [* 1] FILED: KINGS COUNTY CLERK 06/07/2024 INDEX NO. 502769/2024 NYSCEF DOC. NO. 26 RECEIVED NYSCEF: 06/10/2024
Background:
The defendant,. a heal the re provider, submitted claims for first-party no-fault he11efits to the plaintiff for healthcare servi+~s provided to its assignor, Tii1y Antoine. The total amount of these claims wc1s $8,211.29. Thf plai11tiff denied the claims asserting various defenses, including defenses based on: plai11tiff's coritcntion that the defendant billed the plai11tiff amounts that exceeded the fee schedt.tle atnouhts allo\ved under the Insurance Law, The defendant theteafter I initiated an arbitration .proceedirlg I to recover the above amount. At the scheduled arbitration, the attorney for the defendant sougll1 leave to amend the amount ih dispute to$4;998.00; by \Vithdrawingth.os~ claims which \Vere denied ;base~ upon an independen~ me~icalexa~1ination held by the plamhffand to refle ,t the appropnate tee schedule amounts m this case. 1 he . I
arbitrator granted th~ reg uest. T~e plaintiff did not submit any proof at the arbittation in support ofits fee schedule defenses. Thel arbitrator awarded the defendant the sum of $4,998.00, plus I statutory·.interest a11d attorney fe~s and appropriate fees. The Master Arbiti•ator affimtcd. I . ii The plaintiff thereafter ctmmenced this action seeking a de nova adjudication of the dispute. The plaintiff claims thaf even though CPLRSJ 06(c) only allows for de nova adjudications ofarbitration disp~tes if the amount of the arbitration awmd is $5,000 at greater, ' exclusive of attorney's fees and fntere:st, it is e11titledto a de nova adjudication ofthe dispute in this· case because the defendant. tcted at bitrarily and contrary to law in seeking to amend. the i amo~mt in dispute to $4,998.00. Plaintiffclaims if the appropriate foe schedules were used, the ' . .
actual amount that would be dud and owing on the claims that were not withdrawn would by ! $5,912.10. Plai11tiff Sltbmitted tl~taffirtnation I of Carolyn Mallory, .. CPC (NYSCEF # 14) in support of this contei1tioh. The ~laintiff claims that b)' amending.the amount in dispute to I $4,998.00, the defendant's real totive v.'a.s to unlawfully de11y the plaintiff the right to a .de nova adjudication of the dispute under CPLR 5Jb6(c). the plaintifffmther claims that by amending . I
the amount.in dispute, the defentlant adm1tted that the defei1dunt submitted btlls ..in excess ofthe. I apprOpriate fee schedule$ a)1d isithetebY disqualifie:cl {ram recovering attorney's foes under the i no-fo u1t regulations~
.......................... , ......... ~__. ...) 2 of 4 [* 2] FILED: KINGS COUNTY CLERK 06/07/2024 INDEX NO. 502769/2024 NYSCEF DOC. NO. 26 RECEIVED NYSCEF: 06/10/2024
Discussion:
Plaintiff's claim that de£ ndant is not entitled to attorney's fees will be addressed first It is well settled thatto prevail ont fee~schedule defense, a No-Fault insurer must demonstrate by competei1t evidentiary proof tha~ the .amount ofa healthcare provider's dain1 for assigned for first-party no~fault benefits was in excess ofthe appropriate fee schedules {see Com'! i\1ed, P.C v. Travelers !11den1. Co., 11 Misl 3d 145(A), 819 N.Y.S.2d 847 (App. Term2006J,Jamif A4. Abt-aham i\ID. P.C. v. Coww:v~Vide Ins. C'o,, 3 Misc; 3d 130(A), 787 N.Y.S.2d 678 (App. Tenn 2004}. Here, since the plaintiff f d not submit any competent evidentiary proofat the arbitration supporting its fee schedule defe,l'ses, the plaintiff never demonstrated that defen.dant's bills were .excessIVe.
While plaintiff correctly fates that "if the charges by a health care provider. who is an I applicant for benefits, exceed th~ limitations contained in the schedules established pursuant to section 5108 of the Insurance La~; no attorney's fee shall be payable by the insurer'' (11 NYCRR § 6.5-4.6(h)). the plaintiff di.d not demonstrate at the arbitration that defcnd.an's charges were excessive. The court does 401 view defendant·s request to amend the amounts m dispute as an ad1t1ission of excessive billini. 'i If the plaintiffwas desirous of not pa:yiri:g ' ' any attorney's ' fees, nothing prevented it from pro vi9g at the arbitration that de feridant' s bills. ,;,vere excessive. For the above reasons, the court rejects ~laintiff's contention that the. defendant is not entitled to attorney's fees. !' 'i I The Court also· rejects plfin tiff's. contention that the. defendant acted arbitrarily and contrary to la\v by amending th.el amount in dispute to less than $5000. As stated, plaintiff's
. to a de novo contends that the purpose ofthe Iumei1dment was to deny. the plaintiff aright adjudication of the dispute . pursqant I to CPLR 5106(c). . ''The policy of this State isto favor and encourage arbitration as· a 111ean1 •of expedhing the reso Iuti on -of disputes and conservingjudi cial resources';(Rio Algofn v, Sammtj_Siee!Co .. hd.. 168 A,D.2d 250,251, 562N.Y.S.2d 486; see also, S'zctbado:~· 11• Pe~)sl~:'.olc1B~i[tiin,g ~:o. (fNew York, 174_A.O;~d 342 1J4~,-.57_D N.Y.S:2d ~53; 5 54). AcceptI ng. plaintiffs po51 ~rnn. would be contrary· to tlus po h cy and would force the part1 es in\o protraotecj Ii tigatiqn before re Co,1111s. This ;o ul d se1·ve to squander scare c judicial
. . . . J. . 3···················· of 4 . . . . . . . . . . . . . . . . . . . . . . .. [* 3] FILED: KINGS COUNTY CLERK 06/07/2024 INDEX NO. 502769/2024 NYSCEF DOC. NO. 26 RECEIVED NYSCEF: 06/10/2024
resources and increase the length of time and the amount of resources necessary to resolve relatively minor disputes. The C urt notes that there is no statutory or regulatory authority, or case law, prohibiting such amen ments and it this Court's view, such amendments should be encouraged, not discouraged.
Accordingly it is hereby
ORDERED that the bra1 ch of defendant's motion to ctismiss the comp laint pursuant to CPLR § 3211 (a)(7). on the groUI ds that the complaint fails to state a cause of action for a de novo adjudication of the arb itrati n dispute pursuant to CPLR 5106(c) because the amount in dispute exclusives of attorney's ees, interest, and other fees is less than $5000, is GRANTED, it is further
ORDERED the branch o the motion to confirm the arbitration award is DENIED as moot, inasmuch as the award ha already been confirmed by a master arbitrator; it is further
ORDERED that defend t ' s motion to the extent it seeks an award of additional attorney's fees is DENIED inas uch as attorney's fees are not awardable in actions for de novo adjudications of arbitration a war s; and it is further "' r=· c_ - I - ORDERED that plaintif s motion is in all respects 2_enied. -I
This constitutes the decis on and order of the Court. -- '
:. - ci ~ C)
Dated: June 4, 2024
PETER P. SWEENEY, J.S.C. ote: This signature was generated electronicall y pursuant to Administrative Order 86/20 dated April 20 , 2020
4 of 4 [* 4]