Opinion
12454N Index No. 29384/19E Case No. 2020-00762
11-19-2020
In re GLOBAL LIBERTY INSURANCE COMPANY OF NEW YORK, Petitioner–Appellant, v. AVANGARD SUPPLY, INC., etc., et al., Defendants–Respondents.
The Law Office of Jason Tenenbaum, P.C., Garden City (Jason Tenenbaum of counsel), for appellant. Samandarov & Associates, P.C., Floral Park (David M. Gottlieb of counsel), for respondents.
The Law Office of Jason Tenenbaum, P.C., Garden City (Jason Tenenbaum of counsel), for appellant.
Samandarov & Associates, P.C., Floral Park (David M. Gottlieb of counsel), for respondents.
Webber, J.P., Gonza´lez, Scarpulla, Shulman, JJ.
Order, Supreme Court, Bronx County (Alison Y. Tuitt, J.), entered January 15, 2020, which denied the petition to vacate a master arbitration award, dated June 17, 2019, affirming the no-fault arbitrator's award of no-fault benefits to respondents, and dismissed the proceeding brought pursuant to CPLR article 75, unanimously affirmed, without costs, and the matter remanded to Supreme Court for a determination of respondents' reasonable attorneys' fees for this appeal.
The no-fault arbitrator found that petitioner's vague and conclusory explanation that the denial was based on an independent medical examination (IME) which did not support reimbursement, without providing any of the examination's findings, or checking boxes on the NF–10 form to indicate that the denial was based on a lack of medical necessity, was insufficient. The master arbitrator reviewed the no-fault arbitrator's determination and the parties' submissions, and confirmed the no-fault arbitrator's award of benefits to respondent assignees. Supreme Court, reviewing the findings of the master and no-fault arbitrators, correctly found that the award was rational, and was not arbitrary and capricious (see Matter of Petrofsky [Allstate Ins. Co.], 54 N.Y.2d 207, 211, 445 N.Y.S.2d 77, 429 N.E.2d 755 [1981] ; Matter of Rose Castle Redevelopment II, LLC v. Franklin Realty Corp., 184 A.D.3d 230, 234, 126 N.Y.S.3d 2 [1st Dept. 2020] ; Azrielant v. Azrielant, 301 A.D.2d 269, 275, 752 N.Y.S.2d 19 [1st Dept. 2002], lv denied 99 N.Y.2d 509, 760 N.Y.S.2d 100, 790 N.E.2d 274 [2003] ). Petitioner's vague declination of benefits lacked the degree of specificity required by statute and case law, which provide that insurers must clearly inform applicants of their position regarding disputed matters by "appris[ing] the claimant with a high degree of specificity of the ground or grounds on which the disclaimer is predicated" ( General Acc. Ins. Group v. Cirucci, 46 N.Y.2d 862, 864, 414 N.Y.S.2d 512, 387 N.E.2d 223 [1979] ; see 11 NYCRR 65–3.2 [e] ). Respondents are entitled to reasonable attorneys' fees for this appeal, to be determined by Supreme Court (see Matter of Country–Wide Ins. Co. v. Bay Needle Acupuncture, P.C., 167 A.D.3d 404, 89 N.Y.S.3d 69 [1st Dept. 2018] ; 11 NYCRR 65–4.10 [j][4] ).