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Challenging the “Intoxication” Defense: The Horn Wright, LLP Secures $131,905.57 No-Fault Arbitration Award

In a significant win, our firm successfully obtained a $131,905.57 No-Fault Arbitration Award for Erie County Medical Center (ECMC) against State Farm. The victory follows State Farm’s denial of a reimbursement claim for in-patient treatment provided to a 66-year-old man injured in a motor vehicle accident.

For a duration of two months, ECMC, a public benefit corporation, extended critical in-patient treatment to a victim of a motor vehicle accident. Following the provision of these essential medical services, ECMC submitted a reimbursement claim to the No-Fault insurer, State Farm. However, over 30 days post-receipt, State Farm denied the claim, citing “intoxication” as the grounds.

Responding swiftly, The Horn Wright, LLP initiated arbitration on behalf of ECMC.

At the arbitration hearing, State Farm argued that “intoxication” falls under the category of exclusions from coverage, absolving it of any obligation to make payment. In opposition, our attorney Ryan Woodworth, citing precedent from the Court of Appeals Decision in Presbyterian Hospital in the City of New York v. Maryland Casualty, 90 NY2d 274 (1997), argued that State Farm’s invocation of “intoxication” as a defense was fatally flawed due to the untimely issuance of the denial. The Arbitrator, recognizing the merit in our argument, ruled decisively in favor of ECMC.

The Arbitrator’s ruling mandates that State Farm pay ECMC $131,905.57, plus an additional 2% per month in interest (approx. $19,000.00).

This triumph underscores The Horn Wright, LLP’s resolute commitment to securing compensation for hospital clients, which encounter distinctive challenges when billing No-Fault insurers for services provided in emergency settings.

Erie County Medical Center v. State Farm Mutual Automobile Ins. Co., AAA Case No. 17-23-1294-4942 (Arbitrator Tasha Dandridge-Richburg, 11/13/2023). Read the full arbitration award here.

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