Key Takeaway
Understanding "not an insured event" defenses in no-fault insurance cases. Long Island and NYC personal injury attorney explains coverage challenges and solutions.
Understanding “Not an Insured Event” Defense in No-Fault Insurance Cases
When dealing with no-fault insurance disputes across Long Island and New York City, one of the most challenging defenses that injured parties face is the claim that their accident was “not an insured event.” This defense can completely bar recovery, even when all procedural requirements have been met and medical treatment was clearly necessary.
The Law Office of Jason Tenenbaum regularly handles cases where insurance companies attempt to deny coverage by claiming the underlying incident doesn’t qualify for no-fault benefits. The recent Appellate Division decision in St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co. provides crucial insight into how courts analyze these coverage disputes and what evidence is required to establish that an accident qualifies for no-fault protection.
The Foundation Case: St. Vincent’s Hospital v Allstate
St. Vincent’s Hosp. & Med. Ctr. v Allstate Ins. Co., 2010 NY Slip Op 00668 (2d Dept. 2010)
“In support of its cross motion, the defendant made a prima facie showing of entitlement to judgment as a matter of law by demonstrating that the accident in which the plaintiff’s assignor was injured was not an insured incident (see Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195, 199; see generally Alvarez v Prospect Hosp., 68 NY2d 320). In opposition to the defendant’s prima facie showing, the plaintiff failed to raise a triable issue of fact. Contrary to the plaintiff’s contention, the defense of lack of coverage is not precluded by the defendant’s failure to pay or deny the subject no-fault claim within the requisite 30-day period (see Hospital for Joint Diseases v Travelers Prop. Cas. Ins. Co., 9 NY3d 312, 318; Central Gen. Hosp. v Chubb Group of Ins. Co., 90 NY2d at 199).”
Since i wondered what this case was about, I copied the relevant portions of the motion papers from the clerk’s office. Here is what I found out:
This case involves the “my car was not there” defense. There were numerous EUO’s that were done in this case and, without going into detail, the substance of the proof was sufficient to grant defendant summary judgment.
As to the form of the papers, the defendant annexed uncertified EUO transcripts and documentation without a business record foundation or other type of foundation. Plaintiff in his opposition papers objected to the form of Defendant’s evidentiary presentation. While I was unable to read the appellate briefs, I would imagine that Plaintiff’s admissibility argument was also presented in its Respondent’s brief. Thus, it seems interesting that Defendant was able to get this decision reversed.
What “Not an Insured Event” Means for Long Island and NYC Residents
For accident victims in Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx, understanding what constitutes an “insured event” under New York’s no-fault insurance law is critical. Not every accident automatically qualifies for no-fault benefits, and insurance companies are increasingly sophisticated in challenging coverage.
The “My Car Was Not There” Defense
The St. Vincent’s case involved what practitioners commonly call the “my car was not there” defense. This occurs when the insurance company argues that their insured vehicle was not actually involved in the accident that caused the plaintiff’s injuries.
This defense can arise in several scenarios:
- Identity disputes: Questions about whether the correct vehicle is identified as causing the accident
- Location disputes: Claims that the insured vehicle was elsewhere when the accident occurred
- Timing issues: Arguments about whether the accident happened when claimed
- Fraudulent claims: Allegations that no accident involving the insured vehicle actually occurred
The EUO Process and Its Critical Importance
Examinations Under Oath (EUOs) play a crucial role in these coverage disputes. As the St. Vincent’s case demonstrates, insurance companies often conduct multiple EUOs when investigating potential “not an insured event” defenses.
What to Expect During an EUO
If you’re called for an EUO in connection with a coverage dispute, understanding the process is essential:
- Sworn testimony: Everything you say is under oath and can be used in court
- Detailed questioning: Expect thorough questions about the accident circumstances
- Document review: You may be asked about various documents related to the claim
- Multiple sessions: Complex cases may require several EUO sessions
The Evidentiary Challenge
One interesting aspect of the St. Vincent’s case is the appellate court’s handling of evidentiary objections. Despite the plaintiff’s objections to uncertified EUO transcripts and inadequate foundation for documentary evidence, the Appellate Division still granted summary judgment to the defendant.
This suggests that courts may be more lenient with evidentiary requirements in coverage disputes, particularly when the insurance company can make a strong showing that no coverage exists.
The Relationship Between Coverage Defenses and Procedural Requirements
A crucial point established in St. Vincent’s is that coverage defenses are not waived by an insurer’s failure to comply with the 30-day payment or denial requirement. This has significant implications for accident victims throughout the New York metropolitan area.
Why This Matters for Your Case
Many injured parties assume that if their insurance company fails to promptly pay or deny their claim within 30 days, they’ve automatically waived all defenses. The St. Vincent’s decision makes clear this isn’t always true.
Coverage defenses survive procedural failures when the insurance company can demonstrate that the claimed accident simply wasn’t covered under the policy in the first place. This means even if you have a strong argument about procedural violations, you still need to be prepared to prove that your accident was actually covered.
Building a Strong Case Against Coverage Challenges
When facing “not an insured event” defenses, accident victims and their attorneys must be prepared with comprehensive evidence to establish coverage.
Essential Documentation
Successful coverage disputes typically require:
- Police reports: Official documentation of the accident and vehicles involved
- Witness statements: Independent confirmation of accident circumstances
- Photos and video: Visual evidence of the accident scene and vehicle damage
- Medical records: Documentation linking injuries to the specific accident
- Vehicle registration: Proof of insurance coverage for the relevant vehicle
Strategic Considerations
Given the St. Vincent’s ruling, consider these strategic approaches:
- Early investigation: Gather evidence quickly before it disappears or degrades
- Independent verification: Don’t rely solely on the insured party’s version of events
- Expert analysis: Consider accident reconstruction when circumstances are disputed
- Comprehensive discovery: Use all available discovery tools to uncover relevant evidence
Common Coverage Defense Scenarios in Long Island and NYC
Understanding when “not an insured event” defenses commonly arise can help accident victims and their families prepare for potential challenges.
Hit-and-Run Cases
When the at-fault driver flees the scene, insurance companies may later claim their insured wasn’t involved, even if initially identified as responsible.
Parking Lot Accidents
Complex scenarios in parking lots can lead to disputes about which vehicle actually caused injuries, particularly when multiple vehicles are involved.
Multi-Vehicle Accidents
Chain-reaction accidents often involve coverage disputes about which insurer is responsible for which injuries.
Alleged Staged Accidents
Insurance companies may argue that accidents were staged or fabricated, particularly in areas with high claim frequencies.
The Impact on Healthcare Providers
The St. Vincent’s decision has particular significance for hospitals, medical providers, and healthcare facilities throughout the region who rely on no-fault insurance reimbursement.
Financial Risk Considerations
When treating accident victims, healthcare providers must consider the possibility that coverage may be challenged later. This creates financial risks that must be managed through:
- Thorough documentation: Detailed records of how injuries relate to the claimed accident
- Insurance verification: Confirming coverage before providing extensive treatment
- Legal consultation: Working with experienced counsel when coverage is disputed
Practical Steps for Accident Victims
If you’ve been injured in an accident on Long Island or in New York City, taking certain steps immediately can help protect against later coverage challenges.
At the Scene
- Get police involvement: Official reports carry significant weight in coverage disputes
- Document everything: Photos, witness information, and detailed notes
- Obtain insurance information: From all drivers involved in the accident
- Seek immediate medical attention: Creating a clear connection between the accident and your injuries
Following the Accident
- Report promptly: Notify all relevant insurance companies quickly
- Maintain detailed records: Keep copies of all communications and documents
- Comply with requests: Attend EUOs and provide requested documentation
- Seek legal counsel: Especially if coverage is questioned
Frequently Asked Questions
What does “not an insured event” mean?
This defense means the insurance company claims their policy doesn’t cover your accident because their insured vehicle wasn’t actually involved in causing your injuries, or the circumstances don’t meet the policy requirements for coverage.
Can an insurance company deny coverage even if they missed the 30-day deadline?
Yes. As the St. Vincent’s case shows, fundamental coverage defenses survive procedural failures. If the accident truly wasn’t covered under the policy, the insurer can still deny the claim despite missing deadlines.
What should I do if an insurance company claims their car “wasn’t there”?
Gather all available evidence proving their insured vehicle was involved: police reports, witness statements, photos, and any other documentation. Work with an experienced attorney to present this evidence effectively.
How important are Examinations Under Oath (EUOs) in these cases?
EUOs are critical. Insurance companies use them to build their coverage defense, and inconsistencies in testimony can be devastating to your case. Always prepare thoroughly and consider having legal representation.
What evidence do I need to prove coverage exists?
You typically need evidence showing the insured vehicle was involved in your accident, including police reports, witness testimony, physical evidence, medical records linking your injuries to the accident, and documentation of the vehicle’s insurance coverage.
How do these cases affect hospitals and medical providers?
Healthcare providers face financial risk when treating accident victims if coverage is later denied. They must balance providing necessary care with protecting against potential non-payment when coverage is disputed.
The Broader Implications for No-Fault Insurance
The St. Vincent’s decision reflects broader trends in no-fault insurance litigation, where insurers are becoming more aggressive in challenging fundamental coverage rather than relying solely on procedural defenses.
Increased Scrutiny of Claims
Insurance companies are investing more resources in investigating claims to identify potential coverage defenses. This means accident victims must be prepared for more thorough scrutiny of their cases.
The Need for Stronger Evidence
With courts upholding coverage denials even when procedural violations exist, having strong evidence supporting coverage becomes more critical than ever.
Contact an Experienced Personal Injury Attorney
Facing a “not an insured event” defense can be overwhelming, especially when you’re already dealing with injuries and medical treatment. The complex legal and evidentiary issues involved in these cases require experienced legal representation to navigate successfully.
At the Law Office of Jason Tenenbaum, we have extensive experience handling coverage disputes throughout Long Island and New York City. We understand the strategies insurance companies use to deny coverage and know how to build compelling cases that establish your right to no-fault benefits.
Our team has successfully challenged “not an insured event” defenses by:
- Conducting thorough accident investigations
- Gathering and presenting compelling evidence
- Preparing clients for EUOs and depositions
- Challenging inadequate insurance company investigations
- Fighting for full compensation when coverage exists
We serve clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx, and we understand the unique challenges these cases present in each jurisdiction.
Call us today at 516-750-0595 for a free consultation. Don’t let insurance company coverage challenges prevent you from getting the compensation you deserve. Our experienced team will review your case, explain your options, and fight to establish your right to no-fault insurance benefits.
When insurance companies claim your accident “never happened” or their vehicle “wasn’t there,” you need attorneys who understand how to prove otherwise. Contact the Law Office of Jason Tenenbaum today and let us help you overcome these coverage challenges and secure the compensation you need for your recovery.
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- Procedural defects in New York no-fault insurance cases
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2010 post, New York’s no-fault insurance regulations have undergone several amendments, including updates to coverage definitions, procedural requirements, and evidentiary standards for establishing insured events. Practitioners should verify current Insurance Law provisions and regulatory amendments when analyzing “not an insured event” defenses, as both statutory language and appellate interpretations may have evolved significantly over the past sixteen years.
