ARBITRATION AWARD. Hearing(s) held on 07/19/2016, 11/22/2016, 04/26/2017 Declared closed by the arbitrator on 04/26/2017

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1 American Arbitration Association New York No-Fault Arbitration Tribunal In the Matter of the Arbitration between: Dunamis Rehab PT, PC (Applicant) - and - New York Central Mutual Fire Insurance Company (Respondent) AAA Case No Applicant's File No. Insurer's Claim File No NAIC No ARBITRATION AWARD I, Karen Fisher-Isaacs, 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: Assignor Hearing(s) held on 07/19/2016, 11/22/2016, 04/26/2017 Declared closed by the arbitrator on 04/26/2017 Olga Sklyut from Law Office of Olga Sklyut P.C participated by telephone for the Applicant Christina Carollo from Gullo & Associates, LLP participated by telephone for the Respondent The amount claimed in the Arbitration Request, $ 2,023.35, 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 In dispute is Applicant's billing for medical services/diagnostic testing performed between February 11 and April 8, 2014 for Assignor, a 20 year old female, in connection with treating injuries allegedly sustained in a January 31, 2014 motor vehicle accident. Whether Respondent's denials based on Assignor's failure to cooperate with its demands for a signed statement/policy violation can be sustained. Page 1/5

2 4. Findings, Conclusions, and Basis Therefor I have reviewed the documents contained in the American Arbitration Association's ADR Center as of the date of the hearing in this matter and have considered all pertinent documents contained therein for the purpose of rendering this award. Applicant seeks reimbursement in the amount of $ for medical services/ diagnostic testing performed between February 11 and April 8, 2014 for Assignor, a 20- year old female, in connection with treating injuries allegedly sustained in a motor vehicle accident on January 31, Respondent timely denied Applicant's claim based on Assignor's failure to cooperate with Respondent's effort to obtain a statement regarding the facts and circumstances of the alleged accident. I find that Applicant has established its prima facie case as Applicant has met the requirements enunciated in Ave T MPC Corp. v Auto One Ins. Co., 32 Misc 3d 128[A], 2011 NY Slip Op 51292[U] [App Term, 2d, 11th & 13th Jud Dists 2011]). The Court held that "A no-fault provider establishes its prima facie entitlement to summary judgment by proof of the submission to the defendant of a claim form, proof of the fact and the amount of the loss sustained, and proof that the defendant either failed to pay or deny the claim within the requisite 30-day period, or issued a timely denial of claim that was conclusory, vague or without merit as a matter of law (see Insurance Law 5106 [a]; Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]; see also New York & Presby Hosp v. Allstate 31 AD3d 512 [2006])." Assignor was injured in a motor vehicle accident on January 31, Respondent's General Denial dated June 4, 2014 states that "Numerous attempts were made to obtain a statement regarding the facts and circumstances of the motor vehicle accident, which have been ignored. A cooperation letter was mailed which indicated that the final date to cooperate with regard to scheduling the statement of [Assignor] of 5/28/14, which you failed to attend." Respondent argued that the issue of Assignor's failure to cooperate has already been determined by Arbitrator Eileen Casey in AAA Case No That case involved the same Assignor, same Respondent and same defense. True the Applicant was different but any arguments regarding the letters were made by Applicant's counsel in Arbitrator Casey's case. I have reviewed Arbitrator Casey's decision and I adopt her reasoning and reach the same conclusion. Page 2/5

3 In support of its defense, Respondent submitted the affidavit of its SIU investigator John Ruiz. Mr. Ruiz detailed Respondent's multiple unsuccessful attempts to obtain Assignor's signed statement. Mr. Ruiz stated that the Assignor was originally scheduled to provide her written statement at her attorney's offices on April 17, Respondent submitted a copy of the scheduling letter dated April 8, 2014 to Assignor at the address listed on her No-Fault application. Respondent also submitted evidence that a copy of the letter was faxed directly to Assignor's attorney. Mr. Ruiz was present at the attorney's office on the scheduled time and date but Assignor did not appear. Mr. Ruiz stated that a second scheduling letter dated April 18, 2014 was sent re-scheduling Assignor's statement to be taken at her attorney's offices on April 29, Respondent also submitted evidence that a copy of the letter was faxed directly to Assignor's attorney. Mr. Ruiz was present at the attorney's office on April 29 but was advised that Assignor was not feeling well so the statement was re-scheduled for May 8, 2014, again at Assignor's attorney's offices. Assignor did not appear and the signed statement was rescheduled for May 23, Respondent faxed a rescheduling letter to Assignor's attorney's offices advising them that their client's signed statement would be taken on May 23, Mr. Ruiz stated that on May 22, 2014, he received a call from Assignor's counsel stating that Assignor was unable to appear the next day and the statement was re-scheduled for May 28, Respondent faxed a rescheduling letter to Assignor's counsel on May 23, 2014 advising them that Assignor's signed statement would be taken on May 28, Mr. Ruiz stated that he was present at Assignor's attorney's offices on May 28 th at the appointed time but Assignor again failed to appear. Mr. Ruiz stated that as a result of Assignors failure to appear the case was closed due to non-cooperation. 11 NYCRR provides: "No action shall lie against the Company unless, as a condition precedent thereto, there shall have been full compliance with the terms of this coverage." "Willful non-cooperation has been found to exist when there is a pattern of noncompliance for which no reasonable excuse can be offered... or where the failure to cooperate is persistent".., Levy v Chubb Ins, 240 A.D.2d 336, 337, 659 N.Y.S.2d 266. Applicant's attorney in this case argued that she was not the attorney in the earlier case and that she would have made additional arguments regarding the scheduling letters. I find that time to object to the letters has long passed and I sustain Respondent's defense based on Assignor's failure to cooperate. I find that Respondent established that multiple unsuccessful attempts were made to obtain a signed statement from Assignor and the Assignor failed to cooperate with Respondent's multiple attempts to secure Assignor's signed statement. I find that Assignor's failure to cooperate constitutes a breach of the policy conditions. Since Applicant/Assignee stands in the shoes of the Assignor and has no greater rights, Respondent's denials based on Assignor's failure to cooperate are sustained. Accordingly Applicant's claim is denied in its entirety. Page 3/5

4 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 claim is DENIED in its entirety This award is in full settlement of all no-fault benefit claims submitted to this arbitrator. State of New York SS : County of KIngs I, Karen Fisher-Isaacs, do hereby affirm upon my oath as arbitrator that I am the individual described in and who executed this instrument, which is my award. 05/13/2017 (Dated) Karen Fisher-Isaacs 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: 50e75e33f5dcb1ebbff01aafec9a969a Electronically Signed Your name: Karen Fisher-Isaacs Signed on: 05/13/2017 Page 5/5