Key Takeaway
Court rejects insurance carrier's attempt to overturn no-fault arbitration award after failing to include required reimbursement language in IME notices.
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). 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 ; see 11 NYCRR 65-4.10)”
Unfortunately for the provider, AAMG limits reimbursement to $70 an hour.
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Legal Update (February 2026): Since this 2016 decision, the no-fault regulations cited (11 NYCRR 65-3 and 65-4) may have been amended, particularly the IME notice requirements under section 65-3.5 regarding mandatory reimbursement language. Additionally, procedural rules governing arbitration proceedings and Article 75 petition standards may have evolved. Practitioners should verify current regulatory provisions and recent case law developments when handling IME compliance and arbitration challenges.
