Key Takeaway
Understanding coverage disputes in assigned no-fault claims and their impact on personal injury cases. Expert legal guidance from Long Island attorney Jason Tenenbaum.
When Your Car “Wasn’t There”: Understanding Coverage Disputes in Assigned No-Fault Claims
As a Long Island attorney who has spent years navigating New York’s complex no-fault insurance landscape, I’ve witnessed countless situations where medical providers find themselves caught in coverage disputes that can have far-reaching consequences. The case we’re examining today illustrates a critical trap that both providers and accident victims need to understand.
The Foundation of No-Fault Coverage Disputes
In New York’s no-fault insurance system, medical providers often find themselves dealing with assigned claims – cases where the patient’s own insurance coverage is insufficient or unavailable, and the claim gets assigned to another insurer. These situations present unique challenges, particularly when coverage disputes arise.
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.
The Case Facts: When the Insured Says “It Wasn’t Me”
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.
The Collateral Estoppel Trap: Understanding Lobell
The reference to “Lobell” here points to a fundamental principle in New York law regarding collateral estoppel. When an issue has been decided in one case, parties who were involved (or in privity with those who were involved) may be prevented from re-litigating that same issue in subsequent cases.
For accident victims in New York and Long Island, this creates a dangerous scenario. If your medical provider’s assigned claim case results in a determination that you were never hit by a particular vehicle, you may find yourself unable to pursue a personal injury claim against that same vehicle’s owner and insurer.
Strategic Considerations for Medical Providers
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 stipulation of discontinuance. If the Defendant will not consent, then move to discontinue the action.
Practical Guidance for Long Island Accident Victims
If you’ve been injured in an accident in Nassau County, Suffolk County, or anywhere on Long Island, understanding these dynamics is crucial. Here’s what you need to know:
Immediate Steps After an Accident
- Gather as much evidence as possible at the scene
- Obtain witness contact information
- Take photographs of all vehicles involved
- Get medical attention promptly and keep all records
Working with Medical Providers
Your medical providers play a crucial role in your no-fault claim. However, their interests and yours may not always align perfectly, especially in assigned claim situations. It’s important to stay informed about any coverage disputes that could affect your future personal injury claim.
The Broader Impact on New York’s No-Fault System
Cases like Mid Atlantic Medical highlight the complexities inherent in New York’s no-fault insurance system. While the system was designed to provide prompt payment for medical expenses regardless of fault, coverage disputes can create unexpected pitfalls for everyone involved.
For medical providers, these cases underscore the importance of careful case evaluation and strategic decision-making. For accident victims, they highlight why having experienced legal representation from the outset is so critical.
Frequently Asked Questions
What is an assigned claim in New York no-fault insurance?
An assigned claim occurs when a person injured in an auto accident doesn’t have adequate no-fault coverage, and the claim is assigned to an insurer selected through the state’s assigned claims plan.
Can a medical provider’s coverage dispute affect my personal injury case?
Yes, if the coverage dispute results in a determination about key facts in your case (like whether you were actually hit by a particular vehicle), you could be prevented from re-litigating those facts in your personal injury lawsuit due to collateral estoppel.
What should I do if my medical provider is facing a coverage dispute?
Contact an experienced personal injury attorney immediately. The outcome of the coverage dispute could significantly impact your ability to recover damages in a separate personal injury case.
How can I protect myself from these issues?
The best protection is to have adequate no-fault coverage and to work with an experienced attorney who understands both no-fault claims and personal injury litigation from the beginning.
What is collateral estoppel and how does it apply to my case?
Collateral estoppel prevents parties from re-litigating issues that have already been decided in a previous case involving the same parties or those in privity with them. In the context of assigned claims, this could prevent you from disputing facts that were determined in your medical provider’s coverage case.
Moving Forward: Protecting Your Rights
The key takeaway from cases like this is that every decision in no-fault litigation has potential consequences beyond the immediate case. Medical providers, accident victims, and their attorneys must consider the broader implications of their litigation strategy.
If you’ve been injured in an accident on Long Island or in New York City, don’t navigate these complex waters alone. The interplay between no-fault benefits, assigned claims, and personal injury litigation requires experienced legal guidance to protect your rights and maximize your recovery.
Get the Legal Help You Need
At the Law Office of Jason Tenenbaum, we understand the intricate relationships between no-fault insurance claims and personal injury cases. We’ve helped countless Long Island residents navigate these complex situations and protect their rights every step of the way.
Don’t let a coverage dispute derail your case. If you’re dealing with a no-fault claim, an assigned claim situation, or any coverage disputes, call us today at 516-750-0595 for a consultation. We’ll review your situation, explain your options, and help you develop a strategy that protects both your immediate no-fault benefits and your long-term personal injury rights.
The information provided in this blog post is for educational purposes only and should not be construed as legal advice. Every case is unique, and the outcome of your case will depend on the specific facts and circumstances involved. Contact an experienced attorney to discuss your particular situation.
Related Articles
- Appeals court grants summary judgment when loss wasn’t an insured event
- District court accepts detailed affidavit proving vehicle wasn’t in accident
- Business record gaps can prove no motor vehicle accident occurred
- Collateral estoppel implications in coverage disputes
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this post was published in 2009, New York’s no-fault insurance regulations have undergone several significant revisions, including amendments to fee schedules, procedural requirements for assigned claims, and coverage dispute protocols. The regulatory framework governing medical provider rights in assigned claim coverage disputes may have been substantially modified. Practitioners should verify current provisions under the most recent Insurance Law amendments and departmental regulations.
