In re the Arbitration between Shand & Aetna Insurance
OPINION OF THE COURT
This appeal confronts us with an opportunity to attempt definition of the standard to be applied when reviewing a compulsory arbitration award which has been infected by
At issue is a judgment of Special Term confirming an arbitrator’s denial of first-party no-fault benefits in which the facts are relatively undisputed. While driving his own car, petitioner was involved in an accident and applied to his insurance carrier, respondent Aetna Insurance Company, for no-fault benefits. The application was rejected with the statement that "[t]his accident arises out of and in the course of applicant’s employment. The matter should be referred to applicant’s Workers Compensation carrier.” The petitioner was also informed that if he wished to contest Aetna’s determination he could file a written complaint with the State Insurance Department, "submit this dispute to binding arbitration, "or bring a court action. He chose arbitration.
At the conclusion of the arbitration proceeding the claims for medical expenses and lost earnings were denied. The arbitrator found that petitioner’s virtual one-man gardening-landscaping business had been incorporated under the name Shand Landscaping Corporation some time prior to the accident, that the workers’ compensation policy the corporation obtained from Aetna had been canceled upon its expiration on June 17, 1976, and that at the time of the accident, nine months later, the policy still had not been replaced. After deciding that the accident arose in the course of petitioner’s employment while driving with an employee-passenger to solicit a customer, the arbitrator ruled:
"The fact that [petitioner] violated the workmens compensation law by failing to have his corporation continue obtaininga policy of insurance, should not work to his benefit, since it must be noted that although no evidence of injuries to his passenger was brought out, if his passenger who he testified was going to help him on this job, had been injured, that passenger would have been left without a workmens compensation remedy.
"Of one further note, while it is true that if a policy of workmens compensation had been maintained in this case, he would have been entitled to the difference that the workmens compensation carrier would have paid him for loss of wages and eighty percent of his loss of earnings. However, other than his bare testimony with regard to his wages, no evidence was presented to me by way of any books, records, income tax statements or anything else with regard to lost earnings.
"I therefore find that the claimant has failed to sustain his burden of proof and am constrained to deny him benefits.”
The arbitrator’s conclusion that the petitioner’s failure to carry workers’ compensation insurance defeated his claim clearly was predicated upon the language of section 671 (subd 2, par [b]) of the Insurance Law, which relevantly provides:
"2. 'First party benefits’ means payments to reimburse a person for basic economic loss on account of personal injury arising out of the use or operation of a motor vehicle, less * * *
"(b) amounts recovered or recoverable on account of such injury under state or federal laws providing * * * workmen’s compensation benefits”.
In any event, the petitioner instituted the current proceeding to vacate the award pursuant to CPLR 7511 on the grounds that (1) he "was operating a private passenger vehicle * * * on the date of the accident, and did not feel that he was in the course of his employment” and (2) "[a]s no Workmen’s Compensation policy existed, and no Workmen’s Compensation claim had been made or pending, the 'No-Fault’ benefit claims should have been honored.”
Special Term found that whether the injuries arose during the course of petitioner’s employment was "a factual issue which cannot be reviewed by this Court”; that petitioner could file for workers’ compensation under section 26-a of the Workers’ Compensation Law (Uninsured Employers’ Fund); and that these "recoverable” benefits precluded payment of any further benefits by the no-fault carrier. Having concluded that
On appeal, petitioner argues that Special Term erred because (1) the injuries did not arise "out of and in the course of employment” (Workers’ Compensation Law, §2, subd 7); and (2) petitioner had no workers’ compensation remedy since his corporation had provided no security to compensate injured employees as required by statute (Workers’ Compensation Law, §§ 10, 50, 52). The latter contention implicates interpretation of the no-fault law, but whether we can decide the correctness of his construction of that law depends upon the standard of review to be utilized when the challenge to a no-fault arbitration award is based on a claim of error of law.
I
The applicable statute, of course, is CPLR article 75 of which section 7511 (subd [b], par 1, cl [iii]) provides:
"The award shall be vacated on the application of a party * * * if the court finds the rights of that party were prejudiced by * * *
"(iii) an arbitrator, or agency, or person making the award exceeded his power or so imperfectly executed it that a final and definite award upon the subject matter submitted was not made” (emphasis added).
The classic interpretation of this provision is that the arbitrator will be deemed to have exceeded his power if he gives a completely irrational construction to the parties’ governing agreement (see Lentine v Fundaro,
But the cited tests and reasoning have been applied principally to consensual arbitrations—those deriving from the voluntary submission to the arbitral forum by the disputing parties. The dispute here, however, arises under subdivision 2 of section 675 of the Insurance Law which requires insurers to submit to binding arbitration of no-fault claims at the option of the insured. Such compelled submissions are classified as compulsory arbitrations (see Matter of Furstenberg [Aetna Cas. & Sur. Co.],
When a party to a controversy is compelled by statute to submit to arbitration—and thereby loses the right of initial resort to a judicial forum—the right to review the resulting arbitration award cannot in turn be overly limited in scope without involving a due process issue. Thus, the Court of Appeals has interpreted CPLR article 75 as requiring broader review when compulsory arbitration is in issue than when the matter has a consensual origin (see Matter of Furstenberg [Aetna Cas. & Sur. Co.] supra [Insurance Law, § 675, subd 2]; Mount St. Mary’s Hosp. of Niagara Falls v Catherwood,
In welding article 78 review tests to article 75, however, the Mount St. Mary’s court dealt with the arbitrator’s quasi-legislative power to write a new contract for the parties (cf. Matter of National Cash Register Co. [Wilson],
A literal application of this suggestion would result in
"3. whether a determination was made in violation of lawful procedure, was affected by an error of law or was arbitrary and capricious or an abuse of discretion, including abuse of discretion as to the measure or mode of penalty or discipline imposed; or
"4. whether a determination made as a result of a hearing held, and at which evidence was taken, pursuant to direction by law is, on the entire record, supported by substantial evidence.”
Unsurprisingly, this was the approach taken by the courts once a determination was made that no-fault arbitration was "compulsory” under Mount St. Mary’s. Some decisions referred directly to subdivision 3 grounds (Matter of Nationwide Mut. Ins. Co. v Sheldon,
But the Court of Appeals has repudiated any literal application of its suggestion in Mount St. Mary’s that the review test is that used for administrative action taken in the exercise of quasi-judicial functions (i.e., CPLR 7803, subds 3, 4; Matter of Garcia v Federal Ins. Co.,
The test we must articulate cannot be the extremely restricted standard under article 75 nor the certiorari standard set forth in article 78. Our conclusion is reached by examining the various tests derived from the rule traditionally applied to both administrative and arbitration law—"rationality”—in following the Court of Appeals lead in looking to administrative law for guidance; and, by considering the Court of Appeals decisions in Garcia, Furstenberg and Levine to see what tests the court actually is applying in no-fault arbitration cases. Pending further guidance from our highest court, and despite the functional disparities that vitiate any direct anology of no-fault arbitration to quasi-legislative administrative determinations, the test actually applied in the Court of Appeals seems to be the minimum rationality test akin to that utilized for qtiasi-legislative determinations. The significance of this conclusion for the instant case and those like it that challenge an award as based upon an error of law lies in the shifting of primary responsibility for interpreting law from the courts to the arbitrator-qua-administrator, and the consequential restricting of the courts’ power to review such legal interpretations.
II
The term "rationality” has been used in voluntary arbitration review under CPLR 7511 (subd [b], par 1, cl [iii]), although consistently qualified by a particular adverb indicating the extremely broad discretion vested in the arbitrator (i.e., "completely irrational” [see Lentine v Fundaro,
The pliancy of the "rationality” standard merely reflects the degree of discretion vested in the administrative body or the arbitrator. Therefore, by determining the degree of discretion vested in the decision-making body, the appropriate review test can be found. The use of a less stringent review test requiring some rationality in administrative determinations— but not such rationality as would eliminate any difference of opinion about their correctness between administrative agencies and the reviewing courts—has emerged in contexts involving administrative determinations of nonjudicial (i.e., discretionary) character (see People ex rel. Schau v McWilliams,
Ill
In Garcia (
The Court of Appeals disagreed in the following language (pp 1041-1042): "Since section 1192 of the Vehicle and Traffic Law makes operating a motor vehicle while intoxicated a misdemeanor, we do not find the decision of the arbitrator, requiring a conviction or guilty plea to a charge under that section so irrational as to warrant vacatur. It is noted that the arbitrator’s decision has no necessary precedential effect since it does not construe the statute but merely resolves its application as between the parties to the arbitration. In addition it would seem most inappropriate to criticize the arbitrator for determining the very question presented to him for resolution by the parties.” (Emphasis added.)
In Furstenberg, dealing with the notorious 12-point type question (see Liberty Mut. Ins. Co. v Donahue,
Sound as this reasoning may appear, it was rejected by the Court of Appeals, which declared (49 NY2d, at pp 758-759): "[W]e agree that the standard for judicial review of the award is more exacting than in voluntary arbitration (cf. Mount St.
In Levine (
The conclusion in each of these cases
IV
Returning, finally, to the instant arbitration, it is apparent to us that the arbitrator correctly ruled that petitioner’s injuries arose out of and in the course of employment (see Matter of Lief v Walzer & Son,
Special Term suggested that this analysis was rationally
Actually, however, in the few States in which this specific issue has been resolved by decision or special statutory provision, the majority view is to the contrary (e.g., a no-fault carrier must advance sums expected to be paid from the primary workers’ compensation carrier subject to reimbursement through subrogation or otherwise) (Col Rev Stat, § 10-4-707, subd [5]; Del Code, tit 21, § 2118, subd [f]; Fla Stat, § 627.736, subd [4]; Hawaii Rev Stat, § 294-5, subd [b]; Md Code Ann, art 48A, § 543, subd [d]; NJ Stat Ann, § 39:6A-6; Solimano v Consolidated Mut. Ins. Co., 146 NJ Super 393; see, also, Toppi v Prudential Ins. Co., 153 NJ Super 445; 40 Pa Stat, § 1009.106, subd [a], par [3]; S C Code, § 56-11-150, subd [d]), and the Insurance Department’s regulations similarly might be construed to the contrary (see 11 NYCRR 65.6 [n] [1] [vii], 65.6 [p] [3], [5], 65.15 [n] [1] [viii], 65.15 [p] [3], [5]).
Correct or not, however, it is apparent that the arbitrator’s construction of the Insurance Law (§671, subd 2, par [b]) was not so irrational as to require vacatur. Accordingly, the judgment of Special Term confirming the arbitration award should be affirmed.
Gulotta, Cohalan and Martuscello, JJ., concur.
Notes
. The undefined standard was most recently applied by this court in Matter of De Benedetto (Government Employees Ins. Co.) (
. See Matter of Humphrey v State Ins. Fund,
. "[W]hether a determination was made in violation of lawful procedure, was affected by an error of law or was arbitrary and capricious or an abuse of discretion” (CPLR 7803, subd 3). The phrase was added to the CPLR as an equivalent to "abuse of discretion” in order to broaden review of discretionary exercises because of lingering distinctions that limited review based on mandamus instead of certiorari (8 Weinstein-Korn-Miller, NY Civ Prac, par 7803.06; People ex rel. Schau v McWilliams,
. Later the review of agency rate making was held to be affordable under the declaratory judgment provision of CPLR 3001 instead of the mandamus and certiorari provisions of CPLR article 78, at least in situations where the nature of the agency act was quasi-legislative rather than quasi-judicial, although the grounds for such challenge were held to be identical to those available under article 78 (Matter of Lakeland Water Dist. v Onondaga County Water Auth.,
. In Levine, the arbitrator’s function was to find a fact rather than to interpret the law. The Court of Appeals decision indicates that the article 78 provision for review of this function, "substantial evidence” (CPLR 7803, subd 4), is just as inappropriate as is "error of law” (CPLR 7803, subd 3) for the legal interpretation function dealt with in Garcia and Furstenberg. (See, also, Matter of Central Gen. Hosp. v Hanover Ins. Co.,
. Indeed, reliance on a review test derived from administrative law has become even more attractive in view of the recent amendment to the no-fault insurance law, which provides for unrestricted review of compulsory arbitration awards by "master” arbitrators, whose functioning under authority of the insurance superintendent might be argued to qualify them as administrative officers. Subdivision 2 of section 675 of the Insurance Law was amended in 1977 (L 1977, ch 892, § 13) to provide for a system of "master” arbitration, which would review no-fault arbitration awards without limitation as to grounds for modification or vacatur. The decision of the master arbitrators, however, can be reviewed only on the grounds specified in CPLR article 75 unless the amount of the award is at least $5,000, in which case either insurer or insured may obtain de novo review in court. With respect to the constitutionality of this purported restriction of judicial review of compulsory arbitration for no-fault awards under $5,000, we note that we recently considered the serious issue of due process violation in light of the reasoning in Mount St. Mary’s Hosp. and Furstenberg, as well as the apparent reliance on the former case’s authorization of broader review grounds in Country-Wide Ins. Co. v Harnett (