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Judge Vitaliano http://nycourts.law.com/CourtDocumentViewer.asp?view=Document&docID=44437 PETITIONER MEDICAL provider challenged an arbitrator’s denial of first-party no-fault benefits. Despite respondent’s failure to deny petitioner’s claims within 30 days of presentation for payment, a master arbitrator upheld the arbitrator’s finding that there was insufficient evidence to establish a prima facie case that certain tests were medically necessary. Respondent insurer argued that, in light of the Court of Appeals’ decision in Medical Society of the State of New York v. Serio, arbitrators and courts must defer to the insurance superintendent’s advisory opinion requiring claimants to establish a prima facie case even where an insurer untimely denied payment. The court vacated the arbitrator’s decision. Deeming itself bound by the appellate determination in Das/N.Y. Medical Rehab PC v. Allstate Insurance Co., it held that petitioner’s prima facie burden was met when it presented its claim and proof that respondent insurer failed to deny the claim within 30 days after presentation.

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