IN RE: GLOBAL LIBERTY INSURANCE COMPANY (2019)

Judgment, Supreme Court, Bronx County (Julia I. Rodriguez, J.), entered August 29, 2016, against petitioner in favor of respondent, and bringing up for review an order, same court and Justice, entered January 12, 2016, which denied petitioner's motion to vacate an arbitral award and remand to the lower arbitrator for a de novo hearing, and granted respondent's motion to confirm the award, unanimously reversed, on the law, without costs, the judgment vacated, petitioner's motion granted, and respondent's motion denied.

Respondent seeks from petitioner no-fault insurance benefits for medical equipment that respondent provided to its assignor, who was involved in a motor vehicle accident.  In denying respondent's claim, petitioner relied on a peer review report that concluded, based on a review of the medical records, that the assignor's condition was degenerative in nature and not post-traumatic and therefore that the surgery undergone by the assignor was “not medically necessary in relation to the accident ” (emphasis supplied).  The arbitral award must be vacated and a de novo hearing held, because, on the record before us, as argued, it would be irrational to conclude that the need for the subject medical equipment was causally related to the accident (see Matter of Smith [Firemen's Ins. Co.], 55 N.Y.2d 224, 232, 448 N.Y.S.2d 444, 433 N.E.2d 509 [1982];  Mount Sinai Hosp. v. Triboro Coach, 263 A.D.2d 11, 18–19, 699 N.Y.S.2d 77 [2d Dept. 1999];  Shahid Mian, M.D., P.C. v. Interboro Ins. Co., 39 Misc.3d 135[A], 2013 N.Y. Slip Op. 50589[U], 2013 WL 1633134 [App. Term, 1st Dept. 2013] ).