Matter of Integrated Specialty ASC, LLC v American Transit Insurance Company
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Attorneys and Parties
Brief Summary
This no-fault insurance dispute concerned the amount of attorney's fees recoverable after a medical provider successfully confirmed a master arbitration award in court.
The Supreme Court granted the unopposed petition to confirm the award, but the final judgment awarded only $1,000 in attorney's fees under 11 NYCRR 65-4.6(d) and omitted any additional attorney's fees under 11 NYCRR 65-4.10(j)(4).
The Appellate Division reversed the judgment insofar as appealed from, increased the fee under 11 NYCRR 65-4.6(d) to $1,360, and remitted for a determination of additional fees under 11 NYCRR 65-4.10(j)(4).
The regulation capped the applicable fee at $1,360 rather than $1,000, and a proceeding to confirm a no-fault arbitration award is a court appeal for purposes of additional attorney's fees. The record also showed that the provider had properly submitted an attorney affirmation supporting those additional fees.
Background
Integrated Specialty ASC, LLC, as assignee of Mayra Machuca, sought no-fault benefits from American Transit Insurance Company for medical services. American Transit denied the claim. Integrated Specialty prevailed in arbitration and was awarded $15,219.04 plus interest on May 8, 2023. A master arbitrator affirmed that award on August 1, 2023. Integrated Specialty then commenced a proceeding under CPLR article 75 [procedure to confirm or challenge arbitration awards] to confirm the master arbitration award and requested attorney's fees under 11 NYCRR 65-4.6(d) [limits fees in arbitration or court proceedings to 20 percent of first-party benefits plus interest, subject to a maximum of $1,360] and additional attorney's fees under 11 NYCRR 65-4.10(j)(4) [authorizes additional attorney's fees for services rendered in a court appeal from a no-fault arbitration matter]. American Transit did not oppose the petition.
Lower Court Decision
The Supreme Court, Nassau County, granted the unopposed petition. In its November 17, 2023 order, the court stated that Integrated Specialty was entitled to fees under 11 NYCRR 65-4.6(d) and to additional fees under 11 NYCRR 65-4.10(j)(4), with the additional amount to be fixed after submission of an attorney affirmation. However, the judgment entered January 12, 2024 awarded only $1,000 under 11 NYCRR 65-4.6(d) and did not award any additional fees.
Appellate Division Reversal
The Appellate Division held that the Supreme Court should have awarded $1,360 under 11 NYCRR 65-4.6(d), as American Transit conceded. It further held that Integrated Specialty was entitled to additional attorney's fees under 11 NYCRR 65-4.10(j)(4) because a proceeding to confirm an arbitration award qualifies as a court appeal for that regulation. The appellate court rejected American Transit's argument that the fee affirmation had not been properly submitted, finding the record sufficiently certified and also taking judicial notice that the affirmation had been filed on the New York State Courts Electronic Filing System (NYSCEF). The matter was remitted for the Supreme Court to determine the amount of additional fees and enter an amended judgment.
Legal Significance
The decision reinforces that in no-fault insurance matters, courts must apply the regulatory attorney-fee cap in 11 NYCRR 65-4.6(d) as written and may not reduce the award below the applicable maximum when the formula reaches that amount. It also confirms that a CPLR article 75 proceeding to confirm a no-fault arbitration or master arbitration award is treated as a court appeal for purposes of additional attorney's fees under 11 NYCRR 65-4.10(j)(4).
A successful no-fault medical provider confirming a master arbitration award is entitled to the correct capped fee under 11 NYCRR 65-4.6(d) and may also recover additional court-proceeding fees under 11 NYCRR 65-4.10(j)(4), so long as the supporting fee submission is properly before the court.