American Tr. Ins. Co. v Nexray Med. Imaging PC 2025 NY Slip Op 31611(U)
April 11, 2025
Civil Court of the City of New York, New York County Docket Number: Index No. CV-701110-22/NY Judge: Wendy C. Li
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.
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CIVIL COURT CIVIL OF THE
COURT OF THE CITY OF NEW
CITY OF NEW YORK
YORK
COUNTY OF NEW COUNTY OF NEW YORK
YORK
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AMERICAN AMERICAN TRANSITINSURANCE TRANSIT INSURANCE COMPANY, COMPANY, Petitioner, Petitioner,
-against- -against- Decision and Order Decision Order Motion Motion Sequence
Sequence #1,
#1, #2
NEXRAY NEXRA Y MEDICAL
MEDICAL IMAGING
IMAGING PC
PC
D/B/A SOUL RADIOLOGY D/B/A SOUL RADIOLOGY Al A/O DAVID A/A/O DA YID CLARKE,
CLARKE,
Respondent. Respondent.
---------------------------------------------------------------------X _____________________________________________________________________Ç
LI, J.C.C. LI, J.C.C.
I. Recitation I. Recitation of the papers of the papers considered
considered in the review
in the review of
of this
this
Motion Motion as required by CPLR required by CPLR 2219(a)
2219(a)
Upon Upon reviewing
reviewing Petitioner's
Petitioner' s Petition to vacate Petition to vacate the arbitration award ("Motion the arbitration ("Motion #1")
#1 ") and
Respondent's Respondent' s opposition
opposition and cross motion ("Opposition"
cross motion ("Opposition" or or "Motion
"Motion #2"), together with #2"), together with allall
supporting documents, Motion supporting documents, Motion #1 #1 isis decided
decided as
as follows.
follows.
II. Background II. Background
The The instant action concerns instant action concerns a no-fault benefits reimbursement no-fault benefits for MRI reimbursement for MRI testing testing services
services
sought sought by
by Respondent, arising from Respondent, arising from an an automobile
automobile accident occurred on accident occurred on May
May 27,
27, 2018,
2018, where
Respondent's assignor, David Respondent' s assignor, David Clarke Clarke ("Clarke"), sustained ("Clarke"), sustained injuries. Petitioner injuries. Petitioner denied the denied the
reimbursement based on reimbursement based lack of on lack of medical necessity and medical necessity and Respondent's Respondent's alleged
alleged failure
failure to
to provide
provide a
response response to
to verification requests pursuant verification requests to 11 NYCRR pursuant to 65-3.8(b). The NYCRR 65-3.8(b). total amount The total amount inin dispute dispute
was was $3,075.34.
$3,075 .34. Thereafter, matter atat hand the matter
Thereafter, the hand was was submitted
submitted to
to arbitration
arbitration before
before Arbitrator
Arbitrator Lucille
Lucille
S. DiGirolomo S. ("DiGirolomo") on DiGirolomo ("DiGirolomo") on July 2021 , who July 8,8, 2021, who issued an award issued an award inin favor of Respondent favor of Respondent
("Award"), which ("Award"), which was
was subsequently affirmed inin aa Master subsequently affirmed Arbitration Award Master Arbitration by Master Award by Master Arbitrator Arbitrator
Richard B. Ancowitz Richard B. ("Ancowitz") on Ancowitz ("Ancowitz") on October October 25,
25 , 2021.
2021 .
1
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On On February
February 7,
7, 2022,
2022, Petitioner
Petitioner filed
filed the
the instant
instant petition
petition to
to vacate
vacate the arbitration award the arbitration
pursuant to CPLR pursuant to CPLR 751
7 511l(b)(1)(iii),
(b )(1 )(iii), asserting that both asserting that the Award both the A ward and the
the Master Arbitration Award Master Arbitration Award
were arbitrary, capricious and incorrect arbitrary, capricious matter of incorrect as a matter of law and without without a rational
rational basis.
basis. Petitioner
Petitioner
alleged alleged that
that the arbitrators ignored the arbitrators the evidence ignored the evidence submitted submitted by
by Petitioner,
Petitioner, failed
failed to
to apply the proper
apply the proper
burdens and rendered
evidentiary burdens evidentiary rendered an award that that was not
not a final definite, which final and definite, which was prejudicial prejudicial
to Petitioner. On to Petitioner. On March
March 21, 2022, Respondent opposed, 21 , 2022, opposed, contending contending that
that the Petition must be the Petition
dismissed as itit was untimely dismissed as untimely and improper improper and failed to demonstrate failed to any of demonstrate any the grounds of the for vacatur grounds for vacatur
set forth set CPLR
forth inin CPLR 7511. Additionally, Respondent cross-moved 7511 . Additionally, cross-moved in its Opposition in its to confirm Opposition to confirm the the
Award the amount Award inin the amount of
of$3,075.34, plus statutory $3,075.34, plus statutory interest, interest, attorney's
attorney's fees, costs and disbursements, fees , costs disbursements,
and and sought
sought reasonable
reasonable attorney's fees pursuant attorney' s fees to 11 NYCRR pursuant to in connection 65-4.1 O(i)(4) in
NYCRR 65-4.10(j)(4) connection with with the
the
instant proceeding. Motion instant proceeding. Motion #1 and Motion Motion #2 were subsequently subsequently assigned
assigned to this Court
to this for a
Court for
determination. determination.
III. Discussion III. Discussion
Petitioner's Petition 1. Petitioner's 1. to vacate Petition to vacate the arbitration award the arbitration award
"[J]udicial review of "[J]udicial review of arbitration extremely limited"
arbitration awards isis extremely limited" (see & Malkin LLP vv
(see Wien & Malkin
Inc., 6 NY3d
Helmsley-Spear, Inc., Helmsley-Spear, NY3d 471, 479, 846 N.E.2d 471 , 479, N .E.2d 1201, 813 N.Y.S.2d 1201 , 813 N.Y.S.2d 691 [2006]). "CPLR 691 [2006]). "CPLR
arbitration"
article 75 article codifies a limited 75 codifies limited role role for
for the
the judiciary (see American judiciary inin arbitration" (see American Intl. Specialty Lines Intl. Specialty Lines
Co. vvAllied
Ins. Co. Ins. Allied Capital Corp., 35 Capital Corp., NY3d
35 NY3d 64, 70, 125 N.Y.S.3d 64, 70, N.Y.S.3d 340, 149 N.E.3d 340, 149 N.E.3d 33
33 [2020]).
[2020]).
In In that
that regard, CPLR
regard, CPLR 751l(b)(1)
751 l(b)(l) sets forth narrow sets forth narrow circumstances circumstances for judicial review for judicial review of
of a
master master arbitrator's
arbitrator's award, including when award, including rights of when rights of the petitioner were prejudiced the petitioner by an "arbitrator prejudiced by "arbitrator
the award
making the making award exceeded his power exceeded his power or
or so imperfectly executed so imperfectly executed itit that final and definite that a final definite award
upon upon the subject matter
the subject not made"
submitted was not
matter submitted (see CPLR made" (see 7511 [b ][1 ][iii]). "It CPLR 7511[b][1][iii]). " It isis well-settled well-settled
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that an arbitrator that arbitrator 'exceed[s]
'exceed[s] his power'
his power' under of the the meaning of
under the statute where the statute his 'award where his 'award violates violates
a strong
strong public
public policy, irrational policy, isis irrational or clearly or exceeds a specifically clearly exceeds specifically limitation enumerated limitation on the on the
power'" [New York State arbitrator's arbitrator's (see Matter power"' (see of Kowaleski Matter of Kowaleski [New Dept. of State Dept. Correctional of Correctional Servs.},
Servs.], 16
NY3d NY3d 85, 90-91, 942 N.E.2d 85, 90-91, 291, 917 N.Y.S.2d N.E.2d 291,917 N.Y.S.2d 82 [2010], quoting Matter [2010], quoting of New Matter of New York City
City Tr.
Tr.
Workers'
Auth. Transport Workers' Union of Auth. v Transport of Am., Local JOO, Am., Local 100, AFL-CIO, NY3d 332, AFL-CIO, 6 NY3d 336, 845 N.E.2d 332, 336, N.E.2d
1243, 812 N.Y.S.2d 1243, [2005]).
N.Y.S.2d 413 [2005]).
Here, the issue Here, the issue in
in dispute
dispute during the initial during the initial arbitration arbitration proceeding in relation proceeding was in relation to whether to whether
Petitioner's Petitioner's denials of the denials of MRI testing the MRI testing performed Clarke on June 29, performed on Clarke 2018 and 29, 2018 and July
July 9,
9, 2018,
2018,
which were based which peer review based on a peer review report Peter Chiu, report by Peter Chiu, M.D., could be sustained M.D., could (Motion # sustained (Motion 1,
#1,
Exhibit Exhibit A, p.
p. 1). Upon a review
1). Upon of the
review of the peer review report peer review Peter Chiu, report by Peter Chiu, M.D., Arbitrator M.D., Arbitrator
DiGirolomo found that DiGirolomo that Petitioner Petitioner failed to
failed to sufficiently
sufficiently meet its
its burden and concluded
burden and concluded that the peer that the
review report review not persuasive report was not persuasive as the peer reviewer's the peer reviewer's rationale rationale failed to
failed disprove the
to disprove medical
the medical
records, records, not explain
not explain how Clarke's
how Clarke's condition
condition was purely
purely pre-existing
pre-existing not exacerbated and not exacerbated or
or
aggravated in aggravated in any way by the automobile accident.
the automobile accident.
Thereafter, Thereafter, Arbitrator Master Arbitrator Ancowitz upheld Ancowitz upheld the lower Award, the lower Award, finding
finding "no infirmity
infirmity in
in
[A]ward"
and that
the [A]ward" and the that the Award was the Award was "well
"well within
within the arbitrator's
the arbitrator's discretion discretion in
in weighing the
weighing the
evidence, evidence, as was done, and coming done, and conclusion that coming to a conclusion that [Petitioner]
[Petitioner] had not
had not met their of burden of
their burden
defenses"
sustaining their defenses" (see sustaining their Motion #1, (see Motion Exhibit B, p.
#1, Exhibit p. 2).
2).
"[U]nless there "[U]nless there is proof whatever is no proof whatever to
to justify
justify the award so as to the render it to render it entirely
entirely
oversight"
irrational...the irrational ... the arbitrator's arbitrator's finding
finding is not subject
is not judicial subject to judicial oversight" (see Matter of (see Matter of Peckerman v
D& D &D
D Assoc.,
Assoc., AD2d 289,
165 AD2d 567 N.Y.S.2d 289, 567
[1"
N.Y.S.2d 416 [Pt 1991]). It Dept 1991]). It is in what way unclear in is unclear way
Petitioner Petitioner construed the
construed Award and
the Award and the Master Arbitrator the Master Arbitrator Award to be "arbitrary, Award "arbitrary, capricious capricious [and]
[and]
basis"
incorrect incorrect as a matter of law and matter of and without without a rational
rational basis" (see Motion #1, (see Motion #1, ,i
¶ 6). While Petitioner
6). While Petitioner
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argued that argued that the
the instant petition was not instant petition not a request for a de novo review, request for review, stating stating that
that "the
"the arbitrator
arbitrator
Master Arbitrator
and Master Arbitrator both both failed
failed to
to even conduct initial review conduct an initial of the review of the evidence, prejudicing the evidence, prejudicing the
[P]etitioner" [P]etitioner" (see Motion (see #1, ,r
Motion #1, ¶ 63),
63), it appears that
it appears that Petitioner Petitioner is, in
is, in essence, improperly seeking essence, improperly seeking a
review of
de novo review of the
the instant matter. Based on the instant matter. the submission, appears that submission, itit appears that the Award set the Award set forth
forth
Arbitrator DiGirolomo's Arbitrator examination of DiGirolomo ' s examination of the evidence provided, the evidence provided, notably notably the peer review
the peer review report of report of
Peter Chiu, Peter M.D., , which Chiu, M.D. Master Arbitrator which Master Arbitrator Ancowitz Ancowitz affirmed.
affirmed. It is beyond the It is the scope of this scope of Court
this Court
to to "the path
examine "the of analysis, path of analysis, proof
proof and persuasion which the persuasion by which arbitrator the arbitrator reached this reached this
conclusion"
in an Article
conclusion" in Article 75 proceeding (see Matter proceeding (see Matter of Cherrington v New of Cherrington New York City City Tr. Auth.,
Tr. Auth.,
AD3d 539,
203 AD3d 539, 165 N.Y.S.3d [1st 1
N.Y.S.3d 492 [l5 Dept 2022]
2022] quoting AD2d 289, quoting Peckerman, 165 AD2d 289, 567
[1st 1
N.Y.S.2d N.Y.S .2d 416 [l5 Dept 2018]), Dept 2018]), unless
unless Petitioner
Petitioner sufficiently
sufficiently establishes
establishes the Award violated the Award violated a
strong public strong public policy,
policy, and was irrational irrational or clearly
or exceeded a specifically clearly exceeded specifically limitation enumerated limitation
on the
the arbitrator's
arbitrator's power (see
power (see Matter of Kowaleski Matter of [New York State Kowaleski [New Dept. of State Dept. Correctional Servs.}, of Correctional Servs.],
16 NY3d
NY3d 85, 90-91, 942 N.E.2d 85, 90-91, N.E.2d 29
291, N.Y.S.2d 82 [2010]).
l , 917 N.Y.S.2d [2010]). ""Indeed, Indeed, 'the ultimate disposition 'the ultimate disposition
of the of the merits
merits is of course
is of course reserved
reserved for
for the
the arbitrators
arbitrators and the
the courts
courts are
are expressly
expressly prohibited
prohibited from
considering considering whether the
whether claim with
the claim with respect
respect to which arbitration to which arbitration is sought is is sought is tenable,
tenable, or otherwise
or otherwise
dispute'"
passing upon the passing of the merits of
the merits the dispute"' (see (see Peckerman, 165 AD2d 289,567 I65 AD2d 289, 567 N.Y.S.2d [1st 1
N.Y.S.2d 416 [l5
Dept 2018] Dept quoting Matter 2018] quoting of Nationwide Matter of Nationwide Gen. Ins. Co. v Investors Ins. Co. Investors Ins. NY2d 91 Co., 37 NY2d
Ins. Co., 91,, 95 95,, 332
N.E.2d 333, 371 N.Y.S.2d N.E.2d 333, N.Y.S.2d 463 [1975]
[1975] [Internal
[Internal quotation
quotation marks and brackets brackets omitted]).
omitted]). In
In fact,
fact,
even in even circumstances where misapplication in circumstances misapplication of substantive of substantive rules of law or rules of or error of fact error of fact were
committed by arbitrators, committed arbitrators, the the courts have upheld
courts have upheld and not not disturbed
disturbed the of such awards the outcome of
(see (see Wien & Malkin
Wien & LLP, 6 NY3d Malkin LLP, NY3d 471 at 479-480).
at 479-480).
As such, As such, this Court finds this Court finds Petitioner's Petitioner's contention
contention that
that the Award was irrational the Award irrational to to be
unavailing, unavailing, and therefore, therefore, the
the Petitioner'
Petitioner's s Petition
Petition to
to vacate
vacate the
the arbitration
arbitration award is
is denied.
denied.
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2. Respondent's 2. Respondent's Cross-Motion to confirm Cross-Motion to confirm the arbitration award the arbitration
Pursuant to CPLR Pursuant to CPLR 7510,
7510, "[t]he
"[t]he court
court shall confirm an award upon application shall confirm application of of a party
party
made within
within one year
year after
after its
its delivery
delivery to
to them,
them, unless the award isis vacated unless the vacated or modified upon a or modified
ground ground specified
specified in
in section
section seventy-five eleven of seventy-five hundred eleven of this this article [Emphasis added]"
article [Emphasis added]" (see (see
CPLR CPLR 7510;
751 0; see generally Matter see generally of Bernstein Matter of Bernstein Family Family Ltd.
Ltd. P'ship
P 'ship vv Sovereign
Sovereign Partners, L.P. 66 Partners, L.P.
A.D.3d A.D.3d 1,1, 883 N.Y.S.2d 101 [1St N.Y.S.2d 101 [1 st Dept 2009];; Matter Dept 2009] of New Matter of New York Tr. Auth. v American Tr. Auth. American Tr.
Tr. Ins.
Ins.
[1st
211 A.D.3d
Co, 211 643 , 181 N.Y.S.3d A.D.3d 643, N.Y.S.3d 218 [1 st Dept Dept 2022]).
2022]). Here,
Here, the signed Master
the signed Master Arbitration Arbitration
Award by Master Award by Arbitrator Ancowitz Master Arbitrator Ancowitz was on mailed mailed on October 25, 2021 and Petitioner October 25, Petitioner filed filed itsits
cross-motion to confirm cross-motion to confirm the arbitration award on March the arbitration March 21, 21 , 2022, within one year 2022, within year of
of the
the delivery
delivery
on the
the award.
award. In
In addition,
addition, Petitioner's
Petitioner's Petition
Petition to
to vacate
vacate the arbitration award pursuant the arbitration to CPLR pursuant to CPLR
7511 7511 isis denied.
denied.
Accordingly, the Accordingly, favor of the Award inin favor of Respondent isis confirmed.
confirmed.
2. Reasonable 2. Reasonable attorney's connection with fees inin connection
attorney's fees with the the instant
instant court
court proceeding
proceeding
Pursuant Pursuant to Insurance Law to Insurance 5106(a), ifif a valid Law §§ 5106(a), valid claim claim or portion of
or portion of a claim
claim for
for no-fault
no-fault
benefits isis overdue, benefits "the claimant overdue, "the claimant shall also be shall also be entitled to recover entitled to recover his
his [or
[or her]
her] attorney's
attorney's reasonable
reasonable
fee, for fee, for services necessarily performed services necessarily performed inin connection connection with securing payment with securing payment of
of the
the overdue
overdue claim,
claim,
subject to subject to the limitations promulgated the limitations promulgated by by the
the superintendent
superintendent inin regulations".
regulations". Since
Since Petitioner
Petitioner seeks
seeks
to to vacate the master
vacate the arbitration award master arbitration award pursuant pursuant to
to 11 NYCRR
65-4.1 0(j)(4), Respondent 11 NYCRR 65-4.10(j)(4), Respondent isis entitled entitled
to to attorney's fees which
attorney's fees "shall be which "shall be fixed
fixed by
by the
the court
court adjudicating the matter"
adjudicating the matter" (see NYCRR (see 11 NYCRR 65-
65-
4.10 4.10 [j][4];
Li][4]; see also Matter
see also ofCountry-Wide Matter of Country-Wide Ins.
Ins. Co. Bay Needle
Co. vv Bay Needle Care
Care Acupuncture,
Acupuncture, P.C.,
P.C., 162
162
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AD3d 407, AD3d 407, 408, N. Y .S.3d 321 [[1"
408, 78 N.Y.S.3d Dept 2018)).
151 Dept 2018]). Respondent's request Accordingly, Respondent's Accordingly, for request for
reasonable attorney's reasonable attorney's fees fees it incurred
it incurred in defending
in defending the is granted.
the award is granted.
3. The issue 3. The issue of whether the of whether the Petition
Petition was timely
was timely
In light In of the
light of Court's denial the Court's of Petitioner's denial of Petitioner's to vacate Petition to Petition vacate the arbitration the arbitration award in
award the
in the
foregoing, foregoing, the branch
the of Respondent's branch of Respondent's contention contention that Petitioner's that Petitioner's petition was untimely petition was untimely is
is
academic. academic.
Order
IV. Order IV.
Accordingly, Accordingly, it
it is
is
ORDERED ORDERED Motion #1,
that Motion that #1, Petitioner's Petitioner's Petition
Petition to vacate the
to vacate arbitration the arbitration award ts
award is
and it
DENIED; and is further it is further
ORDERED ORDERED that the
that the clerk
clerk is directed
is directed calendar Respondent's to calendar to Respondent's opposition and cross opposition and cross
motion as Motion motion Motion #2;
#2 ; and it is further
it is further
ORDERED ORDERED Motion #2,
that Motion that Respondent's cross-motion #2, Respondent's cross-motion to confirm the to confirm the arbitration arbitration award,
award,
plus statutory plus statutory interest,
interest, reasonable attorney's reasonable attorney's fees, fees, costs and disbursements costs and disbursements is GRANTED.
is GRANTED.
This constitutes This constitutes DECISION and the DECISION the ORDERof
and ORDER of the
the Court.
Court.
.
Dated: April Dated: April 11,
11, 2025
County of County NewYork
of New York Honorable Li, Honorable J.C.C. .
Li, J.C.C
.SON. WENDY liON. WENDY C. u
C. Li
Entered ,...__..JUDGE JUDGE
APRIL 11 2025 NEWYORKCOUNTY CMLCOURT
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