Special Case Blog: What Happened in Ameriprise Ins. Co. v Zwanger-Pesiri Radiology Group, LLP?

On March 12, 2016, Luis Ramirez was injured when he was hit by a 2015 Toyota Corolla following an altercation that ensued in a bar’s parking lot. The Corolla was owned by Deborah and Bernard Johnson and insured by Ameriprise Insurance Company. However, at the time of the car accident, the Corolla was driven by Ronald Ashley, who was not one of the insured individuals.

The Facts – What Happened

Samantha Johnson, the daughter of Deborah and Bernard Johnson, drove the insured Corolla from the insured’s house to visit her boyfriend, Paul Wells, on March 12, 2016.

After she fell asleep, Paul Wells took the Corolla without her permission and drove it to a bar, where he consumed alcoholic beverages. At about 3 a.m., he exited the establishment. In the bar’s parking lot, a fight between two females broke out and grew to incorporate many of the other individuals there. While Paul Wells was attempting to leave, he allegedly entered and started the Corolla. However, he exited soon after to help his friend, Ronald Ashley.

According to the police report and deposition testimony of witnesses and those involved, the fight ended when Ronald Ashley got into the Corolla and intentionally ran over four individuals, including Luis Ramirez, Bryan Dewar, Dylan Mullen, and Paul Wells. Before crashing the car into a nearby store.

Following the incident, Mr. Ramirez received an MRI from Zwanger-Pesiri Radiology Group, LLP, who submitted the $878.67 bill to Ameriprise Insurance Company. However, Ameriprise denied the claim, indicating that Mr. Ramirez’s injuries were not covered because the car was handled without the insured’s permission, and Ronald Ashley used the Corolla to cause intentional bodily injury. As a result, this incident did not qualify as an accident. Consequently, Zwanger-Pesiri Radiology Group, LLP commenced arbitration proceedings with the American Arbitration Association.

The Arbitration Proceedings

Ben Feder, the arbitrator, found in favor of Zwanger-Pesiri Radiology Group, LLP. Determining that according to New York’s regulations, Mr. Ramirez was an eligible injured individual because he was a person who sustained a personal injury that arose out of the use or operation of an insured motor vehicle in New York while not occupying another car. To support this conclusion, Mr. Feder cited the State Farm Mutual Automobile Insurance Company case, where a motorist of a vehicle intentionally struck and killed another pedestrian. In that case, the Court found that an innocent third-party victim was eligible for no-fault benefits regardless of which insurance policy the claim was filed under.

The Appeal

Following Mr. Feder’s decision, Ameriprise Insurance Company decided to appeal the ruling. Ameriprise Insurance Company argued that Mr. Feder did not correctly extend the Court of Appeals’ decision in the State Farm Mutual Automobile Insurance Company case. However, Victor J. D’Ammora, the Master Arbitrator, agreed with Mr. Feder’s conclusions and analysis and found that the award should not change in accordance with the standard of review.

The Court’s Discussion and Final Decision

A judicial review of arbitration awards is limited. In fact, an arbitration award must be upheld when an arbitrator offers some concrete justification for the outcome to be reached. In cases that involve compulsory arbitration, the court has indicated that this justification includes a review of whether the award is supported by some evidence or basis in reason and whether the decision was rational or had a reasonable basis.

In the present case, Ameriprise Insurance Company has not met their burden of proof of demonstrating that the award was without sound basis in reason or that it was arbitrary and capricious. The arbitrator Feder based his decision on an extensive record, which consisted of multiple insurance documents, briefs, and depositions.

Based on his research, Mr. Feder found that Mr. Ramirez was an eligible injured individual as he was a pedestrian who was struck by an insured vehicle. Mr. Feder’s justification for using the State Farm Mutual Automobile Insurance Company case as an example was based on its holding that an innocent victim of an intentional motor vehicle attack is entitled to no-fault benefits.

In contrast, Ameriprise Insurance Company tried to argue that Mr. Feder misapplied the State Farm Mutual Automobile Insurance Company case’s holding. Ameriprise Insurance Company stated that Mr. Feder applied the reasoning to all innocent and injured third parties seeking coverage under any policy, as opposed to applying it to innocent and injured third-parties who are seeking coverage under their own policies.

However, Mr. Feder already discussed this point in his decision, stating that he did not read the holding in the State Farm Mutual Automobile Insurance Company case narrowly. Rather, Mr. Feder found that the case’s clear intent was to provide no-fault benefits to innocent third-parties who did not intentionally cause an accident regardless of which insurance policy the claim was filed under.

Based on Mr. Feder’s arguments, the standard of review, and the analysis undertaken, the court could not find that the award was issued without regard to facts or a sound basis in reason. Additionally, the court found that Ameriprise Insurance Company did not cite any specific cases that postdate the State Farm Mutual Automobile Insurance Company case. Consequently, the court concluded and ordered that Ameriprise Insurance Company’s Petition to vacate the award be denied, and the Petition was dismissed. \

Finally, because Zwanger- Pesiri Radiology Group, LLP, also requested an award for reasonable attorneys’ fees, and Ameriprise Insurance Company did not oppose the request. The court also found that the Supreme Court has the authority to award attorney’s fees in an action that is an appeal from a master arbitration award. As a result, Zwanger- Pesiri Radiology Group, LLP, was entitled to attorneys’ fees.

New York’s No-Fault Benefits- What Are They?

To fully understand why the holding in Ameriprise Insurance Company versus Zwanger-Pesiri Radiology Group, LLP is so important, it is imperative to understand New York’s no-fault laws and benefits.

In New York, no-fault is also referred to as Personal Injury Protection (PIP), which is designed to pay for injuries following an accident. Regardless of who was at fault for the accident. Based on this no-fault coverage, individuals may obtain economic losses, which are actual verifiable losses resulting from the accident, including medical expenses, lost earnings, and other necessary costs related to the injuries up to $50,000 per individual. This coverage extends to the driver, all passengers injured in the car, and pedestrians injured by the vehicle.

If your injuries are greater than $50,000 or if you can show you suffered a serious and qualifying injury which includes disfigurement, dismemberment, a fracture, loss of a fetus, a permanent loss of use of a body organ, body member, body function, or bodily system, a significant restriction on the use of a body function or system, or a non-permanent injury or impairment that prevents you from substantially performing acts that make up your normal activities for at least 90 days during the 180-day period immediately after suffering your injury, you can step outside the confines of no-fault and proceed with a lawsuit against the wrongful party.

What The Ameriprise Insurance Company Case Can Mean for New York’s No-Fault Benefits

The whole purpose of no-fault insurance is to restore those hurt in a motor vehicle accident as quickly as possible. Unfortunately, no-fault is only personal injury coverage and does not extend to personal property repairs, such as paying for damage to a car or other personal property.

Under this New York no-fault coverage, the insurer provides that the insured and all their relatives who reside in the household are protected against economic losses arising from injuries resulting in a motor vehicle accident. It also provides coverage for those passengers injured in accidents while in the insured’s vehicle, any guest passengers who are not covered under another auto insurance policy, and all pedestrians who are injured by the motor vehicle.

Based on these no-fault laws, if you are involved in a motor vehicle accident, even if you are not at fault, you can file a claim with your own insurance company for damages and injury payments. If you try to proceed with a claim against the at-fault driver’s insurer, they may tell you to seek compensation from your own insurance because it has no evidence of the policyholder’s fault.

However, per the holding in Ameriprise Insurance Company versus Zwanger-Pesiri Radiology Group, LLP, this rationale may no longer apply in every motor vehicle accident case, as the court agreed that no-fault benefits should be provided to innocent-parties who did not intentionally cause a crash regardless of which policy the claim is filed with.

Be Careful What You Say to the Insurance Company

Those involved in a motor vehicle accident often wrongly assume that the insurance company wants to work with them. Unfortunately, in most situations, the opposite is true. The insurance company wants to limit the amount of a claim or deny it altogether. Why? Because they are a business that wants to make money. They accomplish this goal by paying you less than you deserve following an accident. As a result, anything you say to the insurance company can be used against you to deny or reduce your claim.

Even answering questions that may appear simple can have negative consequences that can harm your case. It is important to remember that the insurance company does not want to help you. Do not fall for their traps. Just know they are ready to fight on their own behalf, as they did in the Ameriprise Insurance Company case.

That is why, before you say anything that can damage your claim, speak with an experienced personal injury attorney who knows how to negotiate and fight against these deceiving insurance companies.

Why You Need a Personal Injury Lawyer More Than Ever Following a Motor Vehicle Accident

Motor vehicle accident claims and New York’s no-fault laws are already extremely complicated. Add the fact that new cases are constantly coming out that can change how these regulations apply and any victim involved in a car accident can feel lost with the process. However, when you retain an experienced personal injury attorney, you do not have to go through this complicated ordeal alone.

These lawyers can not only investigate the applicable laws and recent legislation to figure out if any of them apply to your case, but they can also:

  • Answer any questions you have: Following a motor vehicle accident, you may have numerous questions and concerns about the future, your health, and your finances. Your attorney understands these worries and can answer your questions while also going over your case and providing you with the best legal options.
  • Investigate the accident scene: To be successful in an accident claim, you need to provide evidence that is not only relevant but can help establish liability and damages. That is why as soon as you retain your personal injury lawyer, they can get to work—gathering critical evidence, available video footage of the accident, talking to relevant witnesses, and obtaining essential reports that can show fault and what happened.
  • Taking over negotiations: As you could see from the Ameriprise Insurance Company case, the insurance company will come fighting. They will try to do or say anything to deny your claim, whether it is getting you to say statements to admit fault or applying case law in their favor. However, when your attorney takes over these negotiations, they can ensure that you do not say anything that can hurt your claim while they fight for maximum compensation on your behalf.
  • Head to trial: If the other side is unwilling to negotiate fairly. Your attorney can take your case to trial and fight for the compensation you deserve.
Jacoby & Meyers, LLP
Personal Injury Law