American Transit Insurance Company v. PDA NY Chiropractic P.C.

Appearances on Papers The following numbered papers (submitted by Petitioner) were read on this petition: Petition (NYSCEF Doc No. 1) Notice of Petition               (NYSCEF Doc No. 2) Exhibit A — Arbitration Award          (NYSCEF Doc No. 3) Exhibit B — Master Arbitration Award              (NYSCEF Doc No. 4) Exhibit C — Respondent’s Arbitration Request Form and Arbitration Submission (“PDA’s Arbitration Request Form & Submission”)       (NYSCEF Doc No. 5) Exhibit D — Petitioner’s Arbitration Submission and Master Arbitration Appeal (“ATIC’s Arbitration Submission and Master Arbitration Brief”)       (NYSCEF Doc No. 6) Statement of Authorization for Electronic Filing             (NYSCEF Doc No. 7) Request for Judicial Intervention     (NYSCEF Doc No. 8) Affidavit of Service             (NYSCEF Doc No. 9) Statement of Authorization for Electronic Filing             (NYSCEF Doc No. 10) Affidavit of Service             (NYSCEF Doc No. 11) DECISION, ORDER and JUDGMENT Issue Presented Is it incorrect as a matter of law and irrational for a No-Fault insurance master arbitrator to affirm a hearing arbitrator’s¹ award determining that (1) a health service provider met its obligation to submit additional verification requested by the insurer under a standard of “substantial compliance,” (2) an insurer’s seeking sign-in sheets was not reasonable when “medical documentation” was submitted, and (3) an insurer’s seeking information as to whether Workers’ Compensation benefits were available was not necessary when the assignor testified that he was not working and the insurer did not issue denials of claim based on a Workers’ Compensation defense? Background Petitioner American Transit Insurance Company (“ATIC”) commenced this CPLR Article 75 proceeding by notice of petition, seeking an order and judgment vacating a No-Fault insurance master arbitration award of Victor J. Hershdorfer, Esq. (dated December 21, 2022), which affirmed the arbitration award of John Kannengieser, Esq. (dated September 26, 2022) granting Respondent PDA NY Chiropractic P.C.’s (“PDA”) claim for No-Fault insurance compensation in the amount of $4,150.27 for chiropractic treatment reflected in a total of eight bills.^2,3 The services at issue were provided to Leonidis Rodriguez, who claimed to have been injured in a motor vehicle accident on February 2, 2020. He assigned his No-Fault insurance benefits to PDA, and is denoted as “Assignor.”⁴ (See NYSCEF Doc No. 1, Petition