East Acupuncture, P.C. v. Allstate, Appellate Term 2nd &11th
2005-01081
This case was decided Jan 3, 2007 and as of today 1/9 remains unpublished, although I hear it should be published soon.
This case is unusual in the there were amicus briefs. One on behalf of the Superintendent of Insurance and one on behalf of the Acupuncture Society of New York.
The Court held that where “there is no payment and an untimely denial, interest accrues 30 days from the date the claim is submitted.” Now here is where it gets interesting. In the next sentence the Court writes: “Interest is thereafter stayed only where the claimant fails to submit the claim to arbitration or to commence an action within 30 days after receipt of the untimely denial of claim and resumes when either action is taken.” (emphasis added; citations left out).
The majority of the case involved a discussion of 11 NYCRR 65-3.9, particularly the fact that sub (c) did not mention “assignee,” as it did in other sub-parts. Plaintiff argued that because of it that sub (c) does not apply to assignees and as a result they are not subject to the provision regarding staying the accrual of interest. The Court in the end (after giving much deference to the Superintendent of Insurance) held that “the use of ‘applicant, ‘ eligible injured person’ and ‘assignee‘…are often used interchangeably.”
It’s an interesting decision, but I believe that there are several issues that will come up as Courts interpret and apply it. We’ll just have to wait and see how it goes.