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MANHATTAN TOTAL HEALTH & MEDICAL DIAGNOSTIC, P.C., et al., Plaintiffs-Respondents, v. OXFORD HEALTH PLANS, Defendant-Appellant.
Order, Supreme Court, New York County (Richard B. Lowe III, J.), entered March 12, 2007, which, to the extent appealed from as limited by the briefs, denied defendant's motion for summary judgment with respect to the first and second causes of action, unanimously affirmed, with costs.
The court did not err in declining to compel plaintiffs to exhaust their administrative remedies, in light of the affirmative defenses and counterclaims challenging the propriety of all monies paid or due to plaintiffs (see e.g. Ludwig v. NYNEX Serv. Co., 838 F.Supp. 769, 781 [S.D.N.Y.1993] [decision to require exhaustion of administrative remedies is an assessment of whether it is fair to require the dismissal of the claimant's suit pending compliance with administrative procedures] ). Exhaustion is not required where a claimant is unlikely to receive an unbiased review (Matter of Counties of Warren & Washington Indus. Dev. Agency v. Village of Hudson Falls Bd. of Health, 168 A.D.2d 847, 849, 565 N.Y.S.2d 236 [1990] ).
The issue whether plaintiffs intentionally waived or failed to collect coinsurance and deductibles could not be resolved as a matter of law, and defendant has offered no basis for overturning that determination. We have considered defendant's remaining arguments and find them unavailing.
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Decided: October 09, 2007
Court: Supreme Court, Appellate Division, First Department, New York.
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Get help with your legal needs
FindLaw’s Learn About the Law features thousands of informational articles to help you understand your options. And if you’re ready to hire an attorney, find one in your area who can help.
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