ARBITRATION AWARD. Injured Person(s) hereinafter referred to as: injured person-assignor

Transcription

1 American Arbitration Association New York No-Fault Arbitration Tribunal In the Matter of the Arbitration between: 5 Borough Anesthesia (Applicant) - and - State Farm Fire and Casualty Company (Respondent) AAA Case No Applicant's File No. Insurer's Claim File No. 325F20158 NAIC No ARBITRATION AWARD I, Tracy Morgan, the undersigned arbitrator, designated by the American Arbitration Association pursuant to the Rules for New York State No-Fault Arbitration, adopted pursuant to regulations promulgated by the Superintendent of Insurance, having been duly sworn, and having heard the proofs and allegations of the parties make the following AWARD: Injured Person(s) hereinafter referred to as: injured person-assignor Hearing(s) held on 07/21/2017 Declared closed by the arbitrator on 07/21/2017 Marc Schwartz, Esq. from Cean Owens Law Group PLLC participated in person for the Applicant Scott Schwaber, Esq. from Nicolini, Paradise, Ferretti, Sabella participated in person for the Respondent The amount claimed in the Arbitration Request, $ 2,800.00, was NOT AMENDED at the oral hearing. Stipulations WERE NOT made by the parties regarding the issues to be determined. Summary of Issues in Dispute The Applicant is the assignee of no-fault benefits from injured person-assignor (MDD), a 34 year old female who was involved in a motor vehicle accident on March 11, Following the accident, the injured person-assignor was treated by Applicant on June 23, 2016 and July 7, Applicant seeks reimbursement for the anesthesia services rendered in connection with injections performed on these dates of service. Respondent failed to pay or deny the claims in a timely manner. Applicant acknowledges Respondent's late payment representing the full amount owed on each bill including interest. Applicant herein seeks attorney fees. Page 1/5

2 Whether Applicant is entitled to reimbursement for attorney's fees and return of filing fee for this claim for medical services provided? 4. Findings, Conclusions, and Basis Therefor Applicant seeks attorney's fees and return of filing fee in connection with this arbitration filed on October 11, Respondent acknowledges that payment was made late on January 25, Respondent uploaded payment screens and a cashed check in the amount of $1, representing payment for both dates of service with interest. Applicant acknowledges the amount paid as payment in full for the principal and interest owed for both dates of service and seeks attorney fees. Applicant argues it is entitled to attorney's fees and return of filing fee for this claim which was resolved after transmittal to the arbitration forum. I agree. Accordingly, Applicant's request for attorney's fees and return of filing fee is granted. Attorney fees shall be calculated at 20% of $1, in accordance with section C below. 5. Optional imposition of administrative costs on Applicant. Applicable for arbitration requests filed on and after March 1, I do NOT impose the administrative costs of arbitration to the applicant, in the amount established for the current calendar year by the Designated Organization. 6. I find as follows with regard to the policy issues before me: The policy was not in force on the date of the accident The applicant was excluded under policy conditions or exclusions The applicant violated policy conditions, resulting in exclusion from coverage The applicant was not an "eligible injured person" The conditions for MVAIC eligibility were not met The injured person was not a "qualified person" (under the MVAIC) The applicant's injuries didn't arise out of the "use or operation" of a motor vehicle The respondent is not subject to the jurisdiction of the New York No-Fault arbitration forum Accordingly, the applicant is AWARDED the following: A. Medical From/To Claim Amount Status Page 2/5

3 5 Borough Anesthesia 06/23/16-07/07/16 $2, Awarded (non-monetar y) Total $2, Awarded: $0.00 B. The insurer shall also compute and pay the applicant interest as set forth below. (The filing date for this case was 10/11/2016, which is a relevant date only to the extent set forth below.) Interest has been previously paid and acknowledged by Applicant. C. Attorney's Fees The insurer shall also pay the applicant for attorney's fees as set forth below Applicant is entitled to an attorney's fee pursuant to Insurance Law 5106(a). After calculating the sum total of the first-party (No-Fault) benefits paid by Respondent for the claims herein plus the interest paid thereon, Respondent shall pay Applicant an attorney's fee equal to 20 percent of that sum total, subject to the following limitations: In the event the above filing date was on or after Feb. 4, 2015, the attorney's fee is subject to a maximum of $1,360.00, per 11 NYCRR (d). D. The respondent shall also pay the applicant forty dollars ($40) to reimburse the applicant for the fee paid to the Designated Organization, unless the fee was previously returned pursuant to an earlier award. This award is in full settlement of all no-fault benefit claims submitted to this arbitrator. State of New York SS : County of Nassau I, Tracy Morgan, do hereby affirm upon my oath as arbitrator that I am the individual described in and who executed this instrument, which is my award. 08/11/2017 (Dated) Tracy Morgan Page 3/5

4 IMPORTANT NOTICE This award is payable within 30 calendar days of the date of transmittal of award to parties. This award is final and binding unless modified or vacated by a master arbitrator. Insurance Department Regulation No. 68 (11 NYCRR ) contains time limits and grounds upon which this award may be appealed to a master arbitrator. An appeal to a master arbitrator must be made within 21 days after the mailing of this award. All insurers have copies of the regulation. Applicants may obtain a copy from the Insurance Department. Page 4/5

5 ELECTRONIC SIGNATURE Document Name: Final Award Form Unique Modria Document ID: 98de098bd113298b f Electronically Signed Your name: Tracy Morgan Signed on: 08/11/2017 Page 5/5