ENS Med., P.C. v Nationwide Ins. Co.

Holding The court held that no-fault arbitration has subject matter jurisdiction over disputes regarding lost earnings incurred by health service providers when attending examinations under oath (EUOs) demanded by insurers. However, the court confirmed the master arbitration award because the arbitrators’ denial of the claim was not irrational, arbitrary, or capricious, and ordered the American Arbitration Association to modify its arbitration request form to accommodate such claims.

The court’s words

the court concludes that in prescribing the subject matter jurisdiction of such arbitration, Insurance Law § 5106 (b) does encompass disputes concerning lost earnings incurred from attending an EUO demanded by the insurer as part of the additional verification process

89 Misc 3d 1044, at the official text

Arbitrator Philipson’s analysis of the issue presented was neither irrational, arbitrary, nor capricious considering that Insurance Law § 5106 (b) does not explicitly provide for arbitration of reimbursement to those attending EUOs

89 Misc 3d 1044, at the official text

ordering the American Arbitration Association to modify its prescribed arbitration request form to include a space for the listing of compensation for attendance at an examination under oath as a disputed matter

89 Misc 3d 1044, at the official text