Blog

My car was not there damnit!April 23, 2009

Mid Atl. Med., P.C. v Harleysville Worcester Ins. Co.
2009 NY Slip Op 50736(U)(App. Term 2d Dept. 2009)

One of the biggest problems medical providers dealing with assigned claims have is defending against certain coverage issues. This usually involves in hit and run cases, “it never happened cases” and even causation defenses, predicated upon a degeneration claim.

If a carrier’s papers are satisfactory on its motion for summary judgment and sufficient to shift the burden to the Assignee provider, then the provider many times needs to procure the assistance of its Assignor. And we all know the effort and sheer impossibility it many times takes to locate the Assignor.

That is what appears to have happened here. I would opine that this happens frequently on the “my car did not make contact with that person” or “It was not me” defense.

Here are the facts:

“In support of its motion, defendant annexed affidavits from its insured and its insured’s wife in which they stated that although they own a 1995 Oldsmobile, they live in Fredonia, New York and neither they nor their vehicle was involved in an accident in Brooklyn. They further stated that they are the only individuals who have access to their vehicle and that they have not been to Brooklyn in over 30 years.”

Plaintiff could not or did not procure an affidavit or other admissible proof to raise an issue of fact. Summary judgment was granted to Defendant.

Not only did Plaintiff lose, but here comes the real rub.

Plaintiff Assignor, who was probably a pedestrian, will probably be collaterally estopped from contesting in his or her BI or even UM case that he or she was hit by the 1995 Oldsmobile. This is classic Lobell.

I guess my thought, and you can tell me if I am wrong, is that you need to be really careful when litigating certain coverage issues in the context of an assigned no-fault case. You just never know when a potential malpractice claim may be brought by the Assignor, who is in privity with the Assignee, when that Assignor learns that he or she is collaterally estopped from bringing or succeeding on his or her BI or UM case.

I would go so far as to say that the minute a coverage issue that can really hurt an Assignor arises in an assigned no-fault action, execute a stip of discon. If the Defendant will not consent, then move to discontinue without prejudice.

Leave a Reply