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IME no show not upheldOctober 13, 2016

Matter of Unitrin Advantage Ins. Co. Kemper A. Unitrin Bus. v Professional Health Radiology, 2016 NY Slip Op 06767 (1st Dept. 2016)

I read through this case.  The carrier left out page two of one of the letters (that contain the reimbursement language) and, after the arbitration, sought to include it in its Petition to set aside the arbitration award.  The Supreme Court was not impressed and neither was the Appellate Division.  But had Unitrin (or counsel) not committed as many errors, the rocket docket rule appeared to be malleable upon a finding of law office failure.  I am looking to see how this concept plays out in future cases.

” The no-fault regulations include mandatory notice requirements governing insurer requests for both IMEs and examinations under oath (11 NYCRR 65-3.5[e]). The regulations expressly provide that the insurer “shall inform the applicant at the time the examination is scheduled that the applicant will be reimbursed for any loss of earnings and reasonable transportation expenses incurred in complying with the request” (id.). Unitrin failed to establish that the requisite regulatory language was contained within its November 30, 2011 letters sent to the assignors, and, based on the multiple errors committed by Unitrin, it failed to establish inadvertent law office error, or that the cases should be remanded, in the interest of justice, for a new arbitration hearing.”

In addition, the Court correctly held that: “In a proceeding for judicial review of an award by a master arbitrator, an attorney’s fee shall be fixed by the court adjudicating the matter” (Matter of GEICO Ins. Co. v AAAMG Leasing Corp., 139 AD3d 947, 948 [2d Dept 2016]; see 11 NYCRR 65-4.10[j][4])”

Unfortunately for the provider, AAMG limits reimbursement to $70 an hour.

 

4 Responses

  1. Sun Tzu says:

    I wonder what happened at the master arb level- did unitrin attempt to vacate its default? Can’t locate on Modria

  2. Sun Tzu says:

    Dumb question. Of course Unitrin did not attempt to vacate. They likely just stuck the new material in the master arb brief. Insurers typically have a free pass in THE AAA to raise new matters and new proof on appeal. In fact when the proof is not there but might be, master arbs routinely remand to give the insurer a second bite at the apple. Haven’t seen this sort of treatment with medical providers even once.

    Jason, what the hells is going on with the text in your comments, i.e. lack of indication of caps?

    • jtlawadmin says:

      Sun,

      I will contact my web guy leisure suit larry. Since i moved everything to the dedicated website, there have been issues. This is hosted on WordPress. There should be an upgrade or plugin somewhere. I need assistance with this issue. Tech and computer issues are beyond my ken of knowledge. Think of the famous “Partner Affirmation” that created Alrof, damns Ameriprise, has made my life needlessly difficult and analogize it to my .php and .html skills. ughhhhhh

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