Massapequa General Hospital v. Allstate Insurance

118 Misc. 2d 155, 460 N.Y.S.2d 251, 1983 N.Y. Misc. LEXIS 3284
CourtNew York District Court
DecidedMarch 1, 1983
StatusPublished
Cited by6 cases

This text of 118 Misc. 2d 155 (Massapequa General Hospital v. Allstate Insurance) is published on Counsel Stack Legal Research, covering New York District Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Massapequa General Hospital v. Allstate Insurance, 118 Misc. 2d 155, 460 N.Y.S.2d 251, 1983 N.Y. Misc. LEXIS 3284 (N.Y. Super. Ct. 1983).

Opinion

OPINION OF THE COURT

Jerome S. Medowar, J.

This is an action by plaintiff hospital as assignee of an injured party against a defendant insurer for payment of hospital expenses incurred by the injured party in accordance with article 18 of the Insurance Law (Comprehensive Automobile Reparations Act [known more commonly as the No-Fault Law]) as well as an action by plaintiff’s attorney individually against the defendant under said law for reasonable legal fees in connection with his efforts to collect such medical expenses.

This matter came up for trial before this court on December 3, 1982 at which time the parties stipulated to the underlying facts and this decision is based upon such facts.

Plaintiff hospital’s assignor was injured on March 5, 1981 and a claim for the sum of $2,556 was made of defendant on March 27, 1981. Payment was denied with a request for additional documentation. On April 23, 1981 the hospital requested a fee of $24 for the hospital records. [156]*156On the next day defendant paid the sum and the hospital contends the records were forwarded on May 6, 1981 thus completing all the claim requirements. The defendant failed to make payment by September 9, 1981 and this litigation was commenced. Issue was joined on November 12, 1981. During the interim and on October 12, 1981 defendant paid the hospital’s claim and on January 8,1982 paid an additional sum of $322.57 representing six months’ interest on the outstanding hospital bill.

The issue before this court is whether plaintiff hospital is entitled to reasonable attorney’s fees, and if it is, the extent of same. A subsidiary issue is whether plaintiff attorney as an individual has a cause of action for such reasonable attorney’s fees if they are found to be owing.

The following statutes and regulations are applicable to this matter: section 675 of the Insurance Law which in part provides:

“§ 675. Fair claims settlement

“1. Payments of first party benefits and additional first party benefits shall be made as the loss is incurred. Such benefits are overdue if not paid within thirty days after the claimant supplies proof of the fact and amount of loss sustained. If proof is not supplied as to the entire claim, the amount which is supported by proof is overdue if not paid within thirty days after such proof is supplied. All overdue payments shall bear interest at the rate of two percent per month. If a valid claim or portion thereof was overdue, the claimant shall also be entitled to recover his attorney’s reasonable fee, for services necessarily performed in connection with securing payment of the overdue claim, which shall be subject to limitations promulgated by the superintendent in regulations.

“2. Every insurer shall provide a claimant with the option of submitting any dispute involving the insurer’s liability to pay first party benefits, or additional first party benefits, the amount thereof or any other matter which may arise under subdivision one of this section to arbitration pursuant to simplified procedures to be promulgated or approved by the superintendent.”

The pertinent regulations which were implemented in accordance with the above statute’s mandate are as fol[157]*157lows: Insurance Superintendent regulations (11 NYCRR 65.15, 65.16):

11 NYCRR 65.15 sets forth the procedures for filing claims, the forms to be used, the time limitations to be observed, the various methods of calculating benefits for the injured party, and as pertains herein the circumstances when interest and reasonable attorney’s fees are payable, and that is when claims are overdue.

11 NYCRR 65.16 spells out the options available to a claimant for the prompt resolution of no-fault claims, as well as the various procedures, tribunals, and details for the determination of reasonable legal fees based upon the nature of the dispute.

The first issue to be resolved is whether the benefits were “overdue” and this court finds that they were. This is based upon the facts agreed to in the stipulation, namely, that the initial claim was made on March 27, 1981 but complete proof was not supplied until May 6, 1981 when the medical records were delivered to the defendant. The claim was paid October 12, 1981. Interest was paid January 8, 1982. There was the apparent acknowledgment of the defendant that said payment was overdue since defendant made a payment of six months’ interest. The court further determines that the payment of benefits and interest was made after the institution of suit and was the result of such suit, and accordingly plaintiff hospital as assignee of the injured party is entitled to recover reasonable attorney’s fees for services necessarily performed in connection with the securing payment of the overdue claim.

The next issue is the determination of what the reasonable attorney’s fee should be. It is plaintiff’s contention that it should be based upon quantum meruit or upon the actual necessary time and skill devoted to the recovery. Plaintiff’s attorney is an experienced practitioner who bills at the rate of $150 per hour and has expended 2OV2 hours for total charges of $3,075. It is the defendant’s contention that plaintiff is limited in its recovery of reasonable attorney’s fees by reason of 11 NYCRR 65.16 (c) (8) in the sum of $64.51 or 20% of the $322.57 which was paid as interest on overdue payments.

[158]*158Plaintiff’s response is that said regulation applies only to arbitration proceedings described in said regulation and has no applicability to lawsuits brought in court. His rationale for such position is the fact that the title of the regulation is: “Optional arbitration procedures under section 675(2) of the Insurance Law with respect to personal injuries sustained on and after December 1, 1977” and since title does not make reference to court proceedings or to plenary proceedings the regulation is inapplicable. In addition he points out that the eight-paragraph preamble in subdivision (a) likewise makes no reference to court or plenary proceedings and as such this is a confirmation that the regulation was not intended to regulate court proceedings or the within action in particular.

It is the determination of this court that plaintiff hospital’s recovery of its attorney’s fee for services rendered in this court action is governed and controlled by 11 NYCRR 65.16 (c) (8) notwithstanding the failure to note this limitation in the title or preamble of the regulation. As one cannot tell a book by its cover neither can one determine the provisions of a section of law by its heading or title. The statute or regulation must be read and studied to be understood and determinative of the rights of the parties. A preamble is an introduction to a statute and is no substitution for the statute itsélf. It has little or no weight of law unto itself.

We need only analyze 11 NYCRR 65.16 (c) to determine the rights of the parties in this action. Paragraphs (3) through (7) describe the type and make-up of various arbitration tribunals and the jurisdiction that each of these has. For example “A.A.A. expedited” is responsible for determining validity of an insurance policy; and “health service arbitration” is responsible for determining whether treatment was unnecéssary or excessive; and “Insurance department arbitration” has jurisdiction over matters similar to the instant one determining whether a claim is overdue and the correct amount of interest or attorney’s fees; and finally ordinary “A.A.A.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Pops & Estrin, P. C. v. Reliance Insurance
149 Misc. 2d 147 (Civil Court of the City of New York, 1990)
Deepdale General Hospital v. American Colonial Insurance
142 Misc. 2d 115 (New York District Court, 1988)
Central General Hospital v. Allstate Insurance
130 Misc. 2d 563 (New York District Court, 1985)
Staten Island Hospital v. Liberty Mutual Insurance
122 Misc. 2d 523 (Nassau County District Court, 1984)
Scheiner v. Empire Mutual Insurance
122 Misc. 2d 249 (Nassau County District Court, 1983)
Hempstead General Hospital v. Allstate Insurance
120 Misc. 2d 303 (New York Supreme Court, 1983)

Cite This Page — Counsel Stack

Bluebook (online)
118 Misc. 2d 155, 460 N.Y.S.2d 251, 1983 N.Y. Misc. LEXIS 3284, Counsel Stack Legal Research, https://law.counselstack.com/opinion/massapequa-general-hospital-v-allstate-insurance-nydistct-1983.