Workers Compensation Defense in No-Fault Cases: Specialized Expertise Required

When a work-related vehicle accident involves both workers’ compensation and no-fault insurance, there are two distinct questions: whether workers’ compensation applies, and how the available benefits are coordinated.

This January 2011 note concerns the first question. The December 2010 Devonshire decision required a Workers’ Compensation Board determination before the court resolved competing summary-judgment motions. It did not announce a blanket bar to all no-fault benefits.

Historical note (September 2026): this note reads the 2011 Devonshire decision on the workers’ compensation defense in no-fault litigation; Insurance Law § 5102(b)(2) and the Board’s primary jurisdiction are explained in the text. For the current coordination rules see no-fault claims and workers’ comp and a car accident while working in New York.

The Devonshire Surgical Facility Decision: Expertise Matters

Devonshire Surgical Facility, L.L.C. v Hereford Ins. Co., 30 Misc 3d 129(A), 2010 NY Slip Op 52297(U), was decided December 7, 2010, by the Appellate Term, First Department.

Civil Court had dismissed the providers’ assigned no-fault claims. The appellate court reversed and remanded for a new determination of the motions after an application to the Board. The insurer’s evidence raised a factual issue about whether the accident occurred during the assignor’s employment.

The passage quoted in the original note remains:

“Therefore, resolution of the factual question presented on this record “is best suited for determination by the Board, given its expertise in the area” (Arvatz, 171 AD2d at 269), and the parties’ respective summary judgment motions should have been held in abeyance pending a determination by the Workers’ Compensation Board as to the applicability of the Workers’ Compensation Law to plaintiffs’ claim”

The court also upheld the finding that the insurer had timely mailed its denials. The result was a referral on the unresolved coverage question, not an immediate award to either side. Compare the separate discussion of workers’ compensation defenses and denial timing.

Understanding Workers’ Compensation Defense in No-Fault Cases

Coverage, coordination and duplicate payment

A motor vehicle accident can raise claims under both systems. That does not allow duplicate payment for the same loss.

Insurance Law § 5102(b)(2) reduces first-party no-fault benefits by amounts recovered or recoverable for the injury through workers’ compensation and certain other benefits. That is a coordination rule, not a statement that workers’ compensation erases every possible no-fault benefit.

Medical expenses have a specific rule. Under 11 NYCRR 65-3.16(a)(9), when an applicant is entitled to workers’ compensation benefits for the same accident, the workers’ compensation carrier is the sole source of reimbursement for medical expenses.

Any possible remaining no-fault benefit must be evaluated by category, with the applicable offsets, eligibility rules and policy limits. A work-loss claim requires its own calculation; the claimant cannot simply collect the full amount from each carrier.

Why the Workers’ Compensation Board?

Devonshire concerns the Board’s primary jurisdiction to determine the applicability of workers’ compensation on the disputed employment facts. It does not transfer every no-fault dispute to the Board or resolve all questions about reimbursement.

For related historical context, see the firm’s note on the Workers’ Compensation Board’s role. The legal issue and procedural posture of each case still matter.

What if the workers’ compensation carrier denies liability?

11 NYCRR 65-3.19(c) addresses a denial of workers’ compensation liability, in whole or in part. It provides for no-fault payment without deducting the withheld benefits when the applicant executes the prescribed NF-9 agreement.

That agreement requires diligent pursuit of the compensation claim and repayment of the relevant no-fault benefits if the withheld amounts are later paid. The no-fault insurer retains its right to independently verify the claim. This is not an unconditional promise to pay every disputed bill.

Keep the denial and ask counsel whether this procedure applies. Do not treat uncertainty about the proper carrier as permission to ignore notices, verification requests or filing obligations.

Practical Implications for Long Island Healthcare Providers

Initial Assessment and Documentation

When treating patients injured in motor vehicle accidents, healthcare providers should carefully document:

• Employment Status: Was the patient working at the time of the accident?
• Scope of Employment: Was the patient performing work-related duties?
• Vehicle Usage: Was the patient driving a company vehicle or their personal vehicle for work purposes?
• Location and Time: Where and when did the accident occur in relation to work activities?

Payment and Reimbursement Considerations

Do not assume that workers’ compensation rates are generally lower than no-fault rates. Insurance Law § 5108 ties covered health-service charges to workers’ compensation schedules, with implementing rules and an exception for justified excess charges.

Identify the service, applicable schedule and proper payer before asserting a reimbursement amount. Preserve the bills, assignments, payment history, denials and Board decisions. Separate a dispute about coverage from one about the fee for a covered service.

Frequently Asked Questions

How do I know if workers’ compensation or no-fault insurance applies to my case?

The facts of the employment and accident matter. Devonshire required a Board determination on a disputed workers’ compensation question before the court decided the motions. Identifying the proper payer is separate from calculating the benefits available.

Can I receive benefits from both workers’ compensation and no-fault insurance?

The systems may both be relevant, but they do not provide duplicate recovery for the same loss. Section 5102(b)(2) requires offsets. When workers’ compensation entitlement exists for the same accident, section 65-3.16(a)(9) makes that carrier the sole medical-expense payer. Any remaining no-fault benefits depend on the applicable rules and limits.

What should healthcare providers do when facing competing insurance claims?

Keep the accident and employment records, claim submissions, denials and payment history. If workers’ compensation liability has been denied, ask whether the NF-9 procedure applies. Do not merely wait for the carriers to agree while deadlines pass.

How does this affect my personal injury lawsuit?

The employer-liability rule in Workers’ Compensation Law § 11 is distinct from no-fault offsets. Section 29 addresses claims against third parties and related recovery rules. Counsel should review those issues separately before any settlement.

What happens if the Workers’ Compensation Board determines coverage doesn’t apply?

That determination does not automatically establish every element of a no-fault claim. Coverage, timely submissions, verification, exclusions and available limits still need review. The earlier denial and any NF-9 agreement may also affect how the claim should proceed.

Conclusion: Expertise and Coordination

Keep the coverage question, benefit calculation and any third-party lawsuit separate. The existence of workers’ compensation is not a sufficient explanation for denying every category of no-fault benefits, nor does a compensation denial guarantee no-fault payment.

For help reviewing a disputed claim, request a Free Case Review. Have the relevant denials, Board decisions and approaching deadlines ready for counsel; do not post claim records in public comments.

Connect to the Encyclopedia

• Topic hub: Priority of Payment
• Workers Compensation Defense in No-Fault Cases: Standing vs. Exclusion Analysis
• Why does a Malella defense survive an untimely disclaimer, while a workers compensation defense doesn’t?
• Strategic Decision-Making in Appeals: When Not to Fight Workers’ Compensation Rulings
• Priority coverage determinations between no-fault insurance and workers compensation
• Workers Compensation Board authority and specialized expertise
• Priority of payment and the no-force-arbitration regulation (2024–2025)

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Last reviewed: September 2026. The original 2011 case quotation is preserved. The court identification and benefit-coordination discussion have been corrected using the linked opinion, statute and regulations. This historical note is general information, not advice about a particular claim.