v. ALL BORO MEDICAL REHABILITATION PLLC, A/A/O MIGUELINA ESPINOSA, Respondent.
SUPREME COURT OF THE STATE OF NEW YORK NEW YORK COUNTY: PART 18
Index No. 651075/2025 Motion Seq. No. 001 DECISION + ORDER ON MOTION
ALEXANDER M. TISCH, J.S.C.
Petitioner American Transit Insurance Company (American Transit) moves to vacate the arbitration awards issued by Arbitrator Eylan Schulman, Esq. and Master Arbitrator Henry Sawits, Esq. (American Arbitration Association (AAA) Case Nos. 17-24-1343-2908 and 99-24-1343-2908). Respondent All Boro Medical Rehabilitation, PLLC (All Boro) has not appeared in this action. The petition to vacate the arbitration awards is denied, and the award is confirmed.
According to the petition, a non-party was involved in a motor vehicle accident on or about December 20, 2018, and sustained injuries. The non-party allegedly assigned the right to All Boro to collect no-fault benefits for medical treatment the non-party received for said injuries. American Transit denied All Boro claims totaling $4,263.31 for services rendered from May 29, 2020, to August 4, 2023, because the services were not allegedly medically necessary as per the independent medical examination (IME) performed by Dr. Eric Roth. All Boro initiated arbitration with American Transit for their denial of the no-fault benefits claims.
In AAA Case No. 17-24-1343-2908 (“Lower Arbitration”), Arbitrator Eylan Schulman, Esq. determined American Transit incorrectly denied reimbursement to All Boro for medical services rendered and awarded $4,263.31 to All Boro. In AAA Case No. 99-24-1343-2908 (“Master Arbitration”), Master Arbitrator Henry Sawits, Esq. affirmed the Lower Arbitration in its entirety. Petitioner American Transit moves to vacate the Lower and Master Arbitration Awards pursuant to CPLR 7511.
American Transit alleges Arbitrator Eylan Schulman, Esq. exceeded the powers of an arbitrator by failing to follow well-settled law in rendering the decision. American Transit also alleges Master Arbitrator Henry Sawits, Esq. exceeded the powers of a master arbitrator by failing to vacate an arbitration award that was contrary to well-settled case law. American Transit contends that failure to follow well-settled law is grounds to vacate the arbitration award pursuant to CPLR 7511(b)(1)(i)-(iii).
The assignee of benefits under a no-fault insurance policy is entitled to recover payment if the services or supplies at issue were medically necessary. In a no-fault case, submission of a properly completed claim form is all that is needed to establish, prima facie, that the supplies at issue were medically necessary. The burden then shifts to the no-fault insurer to establish a lack of medical necessity. If the insurer establishes a lack of medical necessity, the burden shifts back to the assignee to prove the services were necessary.
American Transit’s “well-settled law” argument is not mandatory in this action. As held in Am. Tr. Ins. Co. v. Right Choice Supply, Inc., a no-fault hearing arbitrator is not required to apply the case law holding that the health service provider must submit expert opinion evidence which meaningfully refers to or rebuts the conclusions of the insurer’s expert witness. As such, Arbitrator Eylan Schulman, Esq. did not ignore well-settled law nor exceed an arbitrator’s power. This Court finds there are no grounds pursuant to CPLR 7511(b)(1) to vacate the arbitration awards.
Accordingly, it is hereby ORDERED and ADJUDGED that the petition (Motion Sequence No. 001) is DENIED, and the arbitration awards rendered in favor of All Boro Medical Rehabilitation, PLLC are confirmed; and it is further ORDERED and ADJUDGED that the Clerk is directed to enter judgment in favor of respondent dismissing this action, together with costs and disbursements to respondent, as taxed by the Clerk upon presentation of a bill of costs.
This constitutes the decision and order of the Court.