They did not act in good faith

Matter of Allstate Ins. Co. v Westchester Med. Group, M.D., 2015 NY Slip Op 00876 (2d Dept. 2015)

“In this case, the nonparty, Carmen Carvajal, allegedly was injured in a motor vehicle accident on February 22, 2011, and thereafter sought treatment from the Westchester Medical Group, incorrectly named herein as Westchester Medical Group, M.D. (hereinafter Westchester). As assignee of Carvajal, Westchester sought from her insurance carrier, the petitioner Allstate Insurance Company (hereinafter Allstate), no-fault benefits in the sum of $352.81 for medical services rendered to Carvajal. However, Allstate maintained that it had no duty to pay this sum since its request to Westchester for “additional verification” allegedly remained outstanding (see 11 NYCRR 65-3.5). In an award dated April 25, 2012, the arbitrator concluded that Westchester did in fact comply with the requests for additional verification, and that Allstate “did not appear to be acting in good faith.” That award was confirmed in an award issued by a master arbitrator on July 23, 2012. The Supreme Court denied Allstate’s petition to vacate the master arbitrator’s award and confirmed the award. We affirm.

“Consistent with the public policy in favor of arbitration, the grounds specified in CPLR 7511 for vacating or modifying a no-fault arbitration award are few in number and narrowly applied” (Matter of Mercury Cas. Co. v Healthmakers Med. Group, P.C., 67 AD3d 1017;see Matter of Green v Liberty Mut. Ins. Co., 22 AD3d 755, 755-756; Matter of Domotor v State Farm Mut. Ins. Co., 9 AD3d 367). Here, Allstate failed to demonstrate the existence of any of the statutory grounds for vacating the master arbitrator’s award. In addition, the determination of the master arbitrator confirming the original arbitration award had evidentiary support and a rational basis (see Matter of Smith , 55 NY2d 224, 231-232; Matter of Petrofsky , 54 [*2]NY2d 207, 211; Matter of Fireman’s Fund Ins. Co. v Allstate Ins. Co., 46 AD3d 560, 561). “It is not for to decide whether arbitrator erred ” (Matter of Falzone , 15 NY3d 530, 535). Accordingly, the Supreme Court properly denied the petition and confirmed the award.

I read the underlying decision.  The NF-2 was sought and the provider stated it was not in possession.  Respondent did not find this to be acceptable.  The claim was granted, master affirmed, Supreme Court confirmed and the Appellate Division affirmed.

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Legal Update (February 2026): The additional verification requirements referenced in 11 NYCRR 65-3.5 have been subject to multiple regulatory amendments since this 2015 decision, including changes to timeframes, documentation requirements, and insurer obligations regarding good faith responses. Practitioners should verify current provisions of Part 65-3 and any subsequent regulatory updates that may affect additional verification procedures and standards for determining insurer good faith compliance.