Opinion
10312-04
Decided March 31, 2005.
Weiss, Wexler Wornow (Cory I. Zimmerman of counsel) for petitioners. Wenig Wenig (Joseph Szalyga of counsel) for respondent.
On October 26, 2001, Wayne Wells, an employee of the URS Corporation (URS), was involved in an automobile accident on his way home from work. As a result of the accident, Wells sustained serious injuries and filed a workers' compensation claim and a no-fault claim for payment of medical bills and lost wages. He also filed a claim for disability benefits with First UNUM Life Insurance Company (First UNUM) and a personal injury action.
Farmers New Century Insurance Company (Farmers) is the no-fault automobile insurance carrier for Mr. Wells. URS was insured by National Union Fire Insurance Company (National) for Workers' Compensation insurance liability. American International Group Claim Services, Inc., (AIG) handles workers' compensation claims that URS employees bring under the National policy. AIG denied Mr. Wells workers' compensation benefits on the ground that he was not injured during the course of his employment. As a result of National's denial of coverage and pursuant to its insurance policy with the insured, Farmers alleges it paid first-party benefits to Mr. Wells. 11 NYCRR 65.15[q] [3] [I]. First UNUM, URS and claimant's major medical insurer also paid monies to Mr. Wells. Since other insurers paid benefits to the claimant, AIG allegedly alerted the Workers' Compensation Board of this fact and requested that the Board determine the amounts due as reimbursement from AIG.
On June 10, 2002, the Workers' Compensation Board issued a decision finding that claimant's injuries were work-related, entitling him to an award. See Pet. Aff., Ex. C, Workers' Compensation Board Decision, dated June 14, 2002. On that date, AIG withdrew its objections to claimant's claim. By application dated January 7, 2004, respondent commenced arbitration proceedings against petitioner at Arbitration Forums, Inc. Farmers claimed it paid no-fault benefits to Mr. Wells from the date of the accident until June 10, 2002 in the amount of $55, 460.45, and now was seeking reimbursement from petitioner through arbitration.
After receiving notice of the intent to arbitrate, petitioner commenced this Article 75 proceeding for a stay of arbitration, arguing it could not be obligated to participate in the arbitration. First, petitioner argued that the Workers' Compensation Board is vested with primary jurisdiction as to the applicability of workers' compensation or no-fault insurance coverage in work-related motor vehicle accidents. O' Rourke v. Long, 41 NY2d 219, 228. Petitioner then contended that the matter was already pending before the Workers' Compensation Board, that respondent was included and involved in that action and that the only proper forum for determining the amounts, if any, which AIG was responsible to repay to respondent was the Board. In the alternative, petitioner argued that if the court allowed the arbitration to proceed, then the court should add the claimant as an additional respondent in the arbitration proceeding, so that the arbitrator would be able to make an award, if any, against the proper party, the claimant himself. Respondent opposed the petition, arguing that there was no basis for a stay. To avoid inconsistent decisions on the matter, a temporary stay of the arbitration was granted by this Court pending a decision by the Board on the issue of lien priority among the disability carrier, employer, and the no-fault carrier.
On July 29, 2004, a Workers' Compensation Board hearing was held before Judge Jonathan Frost. Petitioner alleges that respondent failed to submit a brief to the Board explaining the reasons Farmers believed it was entitled to reimbursement. Following the hearing at which Farmers was allowed to participate, a decision was issued on November 19, 2004, finding that no-fault benefits were not reimbursable, as a matter of law, under the Workers' Compensation statute. See Letter from Joseph W. Szalyga, Respondent's Counsel, to the Court, dated November 23, 2004; Workers' Compensation Board Decision, dated November 19, 2004. The Board determined that the disability carrier was liable for paying benefits pending the outcome of the compensation litigation. Because the disability carrier was legally obligated to pay benefits during the period in question and the employer was not obligated to continue wage payments to claimant during the same period, the Board held that the disability carrier's lien had priority over the employer's lien. Therefore, the disability carrier was to be reimbursed in full for the period of time in which benefits were paid. After the disability carrier's lien was satisfied, the employer could be reimbursed for "the difference between the proper compensation rate payable to claimant during that period and the amount reimbursed to the disability carrier." id.
Judge Frost also held that the compensation carrier was not entitled to a lien under Workers' Compensation Law section 29 on the amount of monies claimant received under his employer's underinsurance coverage. He reasoned that the lien and offset provisions of section 29 could only be applied against recoveries from third-party tortfeasors who were responsible for Wells' injuries. Furthermore, he found "irrelevant that the underinsured policy claimant received these proceeds from was the employer's because the employer was not the person whose negligence or wrong caused the claimant's injuries." id. citing Shutter v. Philips Display Components Co., 90 NY2d 703. The case was to continue on the issue of proper awards consistent with the decision.
Respondent argues that the dispute is subject to mandatory arbitration pursuant to Workers Compensation Law 29 (1-a) and the loss transfer provisions of Insurance Law section 5105. Petitioner argues that if respondent made any erroneous payments to claimant, AIG's remedy is to seek reimbursement of these monies directly from claimant or his medical providers. As well, petitioner contends that if respondent is entitled to reimbursement of any sum of money, it is not entitled to the amount claimed.
By definition, uninsured motorist coverage compensates for "noneconomic" loss and economic loss in excess of basic economic loss, and shall not duplicate any element of basic economic loss. Insurance Law § 3420 [f] [1]. Workers' compensation benefits by definition are limited to reimbursement for basic economic loss. Workers' Compensation Law § 10 et seq.
As part of the No-Fault Law, the Legislature enacted section 674 (now section 5105) adopting a new procedure that authorizes first-party benefits with a resulting equitable adjustment between insurers without the need for the formalities applicable to litigation of claims. Matter of City of Syracuse v. Utica Mut. Ins. Co., 61 NY2d 691. Section 5102 [g] of the Insurance Law defines an insurer as:
"[T] he insurance company or self-insurer, as the case may be, which provides the financial security required by article six or eight of the vehicle and traffic law."
Insurance Law section 5105 and 11 NYCRR section 65. 10 of the Regulations of the Superintendent of Insurance provide for mandatory arbitration of certain priority of payment or joint coverage situations. That statute reads, in part, as:
"Settlement between insurers. (a) Any insurer liable for the payment of first party benefits to or on behalf of a covered person and any compensation provider paying benefits in lieu of first party benefits which another insurer would otherwise be obligated to pay pursuant to subsection (a) of section five thousand one hundred three of this article or section five thousand two hundred twenty one of this chapter has the right to recover the amount paid from the insurer of any other covered person to the extent that such other covered person to the extent that such other covered person would have been liable, but for the provisions of this article, to pay damages in an action at law. In any case, the right to recover exists only if at least one of the motor vehicles involved is a motor vehicle weighing more than six thousand five hundred pounds unloaded or is a motor vehicle used principally for the transportation of persons or property for hire.
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(b) The sole remedy of any insurer or compensation provider to recover on a claim arising pursuant to subsection (a) hereof, shall be the submission of the controversy to mandatory arbitration pursuant to procedures promulgated or approved by the superintendent. Such procedures shall also be utilized to resolve all disputes arising between insurers concerning their responsibility for the payment of first party benefits.
"Insurance Law section 5105 is inapplicable in this matter. The mandatory arbitration provisions are concerned with a party's status as an insurer or compensation provider. See Pacific Ins. Co. v. State Farm Mut. Auto Ins. Co., 150 AD2d 455 [2nd Dept 1989]; see also Shutter v. Philips Display Components Co., 90 NY2d 703. While the statutory scheme requires mandatory arbitration to resolve all disputes arising between insurers concerning their responsibility for the payment of first-party benefits or between compensation providers, the courts have held that a workers' compensation carrier is not bound to arbitrate a claim by a no-fault insurer for money it was obligated to pay during the time that the workers' compensation carrier was contesting the claim.
In American Mut. Ins. Co. v. Merchants Ins. Group ( 123 Misc 2d 331 [Sup Ct Onondaga County 1984]), the court determined that although a good case could be made for including a no-fault insurer's action to recover from a workers' compensation carrier within the mandatory arbitration provision of section 674 of the Insurance Law (now section 5105), the statute did not encompass this kind of controversy. "The failure of the Legislature to include a particular situation was an excellent indication that its exclusion was intended." id. at 332 citing McKinney's Cons Laws of NY, Book 1, Statutes, § 74. In such cases, the court was not at liberty to supply an omitted provision. id. This matter is not factually distinguishable from American Mut. Ins. Co. v. Merchants Ins. Group. That being the case, Farmers does not possess an arbitrable claim against AIG and the demand that arbitration be ordered is denied.
As well, an insurer can present a claim to recover basic economic loss from the insurer of another covered person, if (a) one of the motor vehicles involved in the accident weighs more than 6, 5000 lbs. unloaded; or (b) is a motor vehicle used for the transportation of persons or property for hire. Under those circumstances, arbitration is mandatory. There was no evidence presented that the vehicles involved in the accident met this condition precedent to arbitration.
The Court, by this decision, does not mean to imply that respondent is not entitled to reimbursement. The decision is limited merely to a finding that the parties have not agreed to arbitration and Insurance Law section 5105 does not impose arbitration upon them.
Accordingly, petitioner's application to permanently stay the arbitration between the parties is granted and respondent's cross-motion to dismiss the application is denied.
This constitutes the Decision and Order of the Court.