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An intentional act is precluded if not raised in a timely denial
Coverage

An intentional act is precluded if not raised in a timely denial

By Jason Tenenbaum 8 min read

Key Takeaway

New York court ruling transforms intentional act from coverage issue to policy exclusion, creating new category of precludable coverage defenses in no-fault insurance law.

This article is part of our ongoing coverage coverage, with 151 published articles analyzing coverage issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.

The landscape of New York no-fault insurance law continues to evolve through judicial interpretation, particularly regarding how coverage defenses must be raised and preserved. A significant development emerged from the Second Department’s ruling in Nyack Hospital v. Allstate Insurance Co., which fundamentally altered how intentional acts are categorized within the framework of New York No-Fault Insurance Law.

This decision represents a notable shift in how courts approach the distinction between coverage issues and policy exclusions. The ruling’s implications extend beyond the immediate case, potentially affecting how insurers must structure their denials and how practitioners approach similar coverage challenges in the future.

Jason Tenenbaum’s Analysis:

Nyack Hosp. v Allstate Ins. Co., 2011 NY Slip Op 04644 (2d Dept. 2011)

This Medicaid crisis has spurred judicial activism from the Appellate Division, Second Department. Now an intentional act, both a coverage issue and a policy exclusion has been deemed to be the latter, to the exclusion of the former.

I swear people who practice other areas of law or PIP outside New York must look at the decisions and either laugh or cry. It is decisions like this that undoubtedly created the Unitrin monster.

Anyway, I guess I have to create a new category for precludable coverage defenses.

Key Takeaway

This ruling reclassifies intentional acts from coverage issues to policy exclusions, making them subject to timely denial requirements. The decision reflects the Second Department’s evolving approach to no-fault insurance disputes and creates new procedural hurdles for insurers seeking to assert this defense after initial claim processing.


Legal Update (February 2026): Since this 2011 post, New York’s approach to no-fault coverage defenses and denial requirements has continued to evolve through subsequent appellate decisions and regulatory amendments. The classification of intentional acts and the procedural requirements for raising coverage defenses may have been further refined by courts or modified through Insurance Department regulations. Practitioners should verify current provisions regarding denial timeframes and the preservation of coverage defenses under contemporary no-fault law.

Legal Context

Why This Matters for Your Case

New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.

Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.

About This Topic

Insurance Coverage Issues in New York

Coverage disputes determine whether an insurance policy provides benefits for a particular claim. In the no-fault context, coverage questions involve policy inception, named insured status, vehicle registration requirements, priority of coverage among multiple insurers, and the applicability of exclusions. These articles examine how New York courts resolve coverage disputes, the burden of proof on coverage defenses, and the interplay between regulatory requirements and policy language.

151 published articles in Coverage

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Common Questions

Frequently Asked Questions

What are common coverage defenses in no-fault insurance?

Common coverage defenses include policy voidance due to material misrepresentation on the insurance application, lapse in coverage, the vehicle not being covered under the policy, staged accident allegations, and the applicability of policy exclusions. Coverage issues are often treated as conditions precedent, meaning the insurer bears the burden of proving the defense. Unlike medical necessity denials, coverage defenses go to whether any benefits are owed at all.

What happens if there's no valid insurance policy at the time of the accident?

If there is no valid no-fault policy covering the vehicle, the injured person can file a claim with MVAIC (Motor Vehicle Accident Indemnification Corporation), which serves as a safety net for people injured in accidents involving uninsured vehicles. MVAIC provides the same basic economic loss benefits as a standard no-fault policy, but the application process has strict requirements and deadlines.

What is policy voidance in no-fault insurance?

Policy voidance occurs when an insurer declares that the insurance policy is void ab initio (from the beginning) due to material misrepresentation on the application — such as listing a false garaging address or failing to disclose drivers. Under Insurance Law §3105, the misrepresentation must be material to the risk assumed by the insurer. If the policy is voided, the insurer has no obligation to pay any claims, though the burden of proving the misrepresentation falls on the insurer.

How does priority of coverage work in New York no-fault?

Under 11 NYCRR §65-3.12, no-fault benefits are paid by the insurer of the vehicle the injured person occupied. For pedestrians and non-occupants, the claim is made against the insurer of the vehicle that struck them. If multiple vehicles are involved, regulations establish a hierarchy of coverage. If no coverage is available, the injured person can apply to MVAIC. These priority rules determine which insurer bears financial responsibility and are frequently litigated.

What is SUM coverage in New York?

Supplementary Uninsured/Underinsured Motorist (SUM) coverage, governed by 11 NYCRR §60-2, provides additional protection when the at-fault driver has no insurance or insufficient coverage. SUM allows you to recover damages beyond basic no-fault benefits, up to your policy's SUM limits, when the at-fault driver's liability coverage is inadequate. SUM arbitration is mandatory and governed by the policy terms, and claims must be made within the applicable statute of limitations.

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Attorney Jason Tenenbaum

About the Author

Jason Tenenbaum, Esq.

Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.

Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.

24+ years in practice 1,000+ appeals written 100K+ no-fault cases $100M+ recovered

Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.

New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.

If you need legal help with a coverage matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.

Jason Tenenbaum, Personal Injury Attorney serving Long Island, Nassau County and Suffolk County

About the Author

Jason Tenenbaum

Jason Tenenbaum is a personal injury attorney serving Long Island, Nassau & Suffolk Counties, and New York City. Admitted to practice in NY, NJ, FL, TX, GA, MI, and Federal courts, Jason is one of the few attorneys who writes his own appeals and tries his own cases. Since 2002, he has authored over 2,353 articles on no-fault insurance law, personal injury, and employment law — a resource other attorneys rely on to stay current on New York appellate decisions.

Education
Syracuse University College of Law
Experience
24+ Years
Articles
2,353+ Published
Licensed In
7 States + Federal

Discussion

Comments (23)

Archived from the original blog discussion.

RZ
Raymond Zuppa
Where was the outrage when the First Department called a pre-condition a coverage defense and cited to Chubb; which decision stated that a pre-condition is not a coverage defense. I’ll be at the First Department tomorrow at 2:00. I expect the same: Court: “How dare you say that the law must be enforced … just because the plainly worded statute commands enforcement via the word “shall” and the statute is remedial in nature and should be expounded to its fullest extent to protect the public — there is corruption — excuse me … strike that from the record — there is discretion” RZ: Discretion is where corruption is born and lives. So you were right the first time. Court: Get out of here. Leave. Court Officers rough him up a little bit on the way out. Court Officers: No … he’s too big and nasty looking.
MS
mitchell s. lustig
I am not sure I understand this decision. Is this decision limited to a fact pattern where an insured attempts to committ suicide? But then again, how is attempting to committ sucide different than an intentionally staged loss. In both cases, there is not a true accident and the event is outside the scope of coverage. This is the Second Department’s Unitrin fiasco.
RZ
Raymond Zuppa
Mr. Lustig. Good to hear from you. I missed you. I really did and I have a place for you in my heart. I do for Rogak too. Sorry to include Rogak with you Mitchell. Anyway let me explain. Attempted suicide is very different from a staged loss. A staged loss is meant to profit the stager in some way. An attempted suicide does not have the fraudulent mens rea. In an attempted suicide the person crashing the car wants to die and therefore is not eligible for benefits. Also someone who commits suicide via crashing a car is obviously mentally ill. That is an intervening factor. The lack of death leaves an injured person who should not have to languish about without benefits.
RZ
Raymond Zuppa
Let me clarify: in a suicide attempt via crashing the auto scenario the goal is death, not the collection of benefits which death negates. Therefore there is no fraud. Just a sick person that is innocent of wrongdoing. And you cannot deny benefits to someone because of a medical condition — obviously depression or worse — caused the accident. Can you deny coverage to someone if they crash the car because of seizure. I ask you …
J
JT Author
Zuppa on mental health. Fits like a hand in a glove…
RZ
Raymond Zuppa
Thank you J.T. Of all the healths mental health is the one I pride myself most on. As such I attend regular counselling and ingest large amounts of medications prophylatically to stave of any incipient mental illness that may be lurking. I can insure you that I will not intentionally crash my car unless it is to run over someone fleeing from the commision of a crime, etc.
LR
Larry Rogak
To say that all suicide is the result of mental illness is a fallacy. There are plenty of people who commit suicide for objectively rational reasons. No-fault is supposed to compensate people for injuries sustained in accidents — it is not a health insurance plan for people who attempt suicide but fail (or to provide a death benefit for those who succeed). In any event, if a person can form the intent to commit suicide — rational or not — no-fault should not be read so expansively as to pay benefits. Even irrational intent is still intent — not an accident.
KL
kurt lundgren
Ray, there is a fine line between genius and insanity. In your case, you have to be a little bit of insane to be you. Pure genius!!! Is it intent if the insured didnt intend to survive the crash!!! Larry, suicide is seldom an act of rational mind, nor is it irrational. Its mental illness. But should no-fault pay for it – absolutely, unless the defense is preserved in a timely denial. But I expect that this is the next line of defense by the carrier after staged accidents – the accident was caused by the suicidal acts of the driver. Anything to deny a claim.
D
DMG
Can an insurance co have the body exhumed for verification?
RZ
Raymond Zuppa
Larry. Life is a gift. You know that. You have a wonderful life and family. Only severe chemical/electrical and genetically passed down diseases such as depression can cause one to take their own life. In fact there is no rational decision to end a life via crashing a vehicle. It is inefficient. Painful. And could leave one crippled but alive — unable to commit suicide but now having to contend with depressing circumstances along with a horrible disease — a stark jejune world of helpless suffering. The crashing of the car is not planned. It is an uncontrollable impulse brought on by the disease. Barbara Bush suffered from Depression. In her memoirs she talked of having these very impulses while driving her car. A rational suicide is a jump off an incredible height. Injestion of a cyanide. Kurt Cobain’s shotgun under the chin, etc. Do you want to push the mentally ill back into vile institutions Larry. Shame on you. What if I am the driver of a car. Terrorists car jack me and the car. They put high explosives in the trunk. They get in. They instruct me to drive at gun point. I discover they are going to have me drive into a house of worship — Church or Temple. I think to myself “no way.” I intentionally crash the car into a solid concrete divider. By some miracle I survive, the evil plan thwarted. I just saved thousands of People. Americans. Worshippers. You and your insurance company cronies would refuse to pay for my medical benefits under no fault. “Claim Denied: Zuppa Intentionally Crashed the Car” How un-American. My family would get you Larry.
LR
Larry Rogak
@Ray: I would endorse an amendment to Reg 68 that made an exception to the intentional act exclusion for “carjacked claimant who intentionally crashes car to thwart terrorist act.” That should take care of your scenario. But since you bring up terrorism, let’s take a realistic scenario: a Jihadist Muslim packs a car full of explosives and blows it up in Times Square with the intent to kill as many people as possible. He survives but is badly injured. Shall he receive no-fault benefits? Since it is a realistic possibility, give me your realistic answer.
RZ
Raymond Zuppa
Absolutely not Larry. Under your scenario the Jihadist is 1)with intention and in full possession of his mental capacity, faculties and abilities blowing up the insured vehicle; (2) this is no accident Larry, this man blew up the car — he did not crash it; (3) the insured vehicle was being used to assist the Jihadist in the commission of a felony. I would not worry too much Larry. Stop with the color alerts. Thankfully George W. Bush is no longer in office. So while we may have to suffer with a wimpy President he is at least not friends with the Bin Laden family and in fact ordered the death of Bin Laden. Secondly our own men and women — New York law enforcement — knows not to rely on the Federal government for our defense. Don’t want to be an American Idiot Larry.
S
slick
The terrorist is going to the secured wing of Bellevue regardless of whether he has no-fault coverage or not. Even if it was an intentional event, the hospital will still have to patch them up. The real question is whether the hospital will be paid. My vote is yes. To me, there should be an emergency exception for intoxication and intentional act defenses. Insurers can chase after the assignors for reimbursement to the degree they are able.
RZ
raymond zuppa
I do agree with the emergency exception and think it is brilliant. Why should the hospital be stuck with the bill for doing what we want doctors to do: save lives. In the end it’s just another way of having the public pay if the hospital gets stiffed.
J
J
With regard to the recent holding in Nyack Hospital a/a/o Ferguson v. Allstate, that an intentional act requires a timely denial, when considering staged loss cases and DJs, couldn’t the holding in Unitrin switch the defense back to a lack of coverage defense which does not require a timely denial where participant defendants/assignors and/or provider defendants/providers were noticed for EUO?
KL
kurt lundgren
Bottom line …. doctor performs bone fide services and doesnt get paid. Insurance companies profit and doctor/hospital gets stiffed. Insurance is good until you need it.
J
J
Your all assuming the assignor was a driver or passenger in a vehicle, but nowhere in the decision does it state that.
RZ
Raymond Zuppa
Well in theory here — and correct me if I am wrong — the assignor has to be injured. So it can only be a driver or a passenger in the covered vehicle or some poor citizen pedestrian/cyclist that was run down by the subject vehicle. Are you trying to say that the decision was driven by the fact that the covered vehicle hit an old lady on the sidewalk?
RZ
Raymond Zuppa
Imagine there is a craps game on a Brooklyn sidewalk. Rogak, Bugsy Seigal and Meyer Lansky stick it up. A suicidal driver decides to end it all. The car strikes Rogak thwarting the stick up because Seigal and Lansky flee. But Rogak is hurt bad. Do you want to see a man argue for coverage.
RZ
Raymond Zuppa
The assignee had to be the driver. I read the case. How else could it be alleged that she attempted suicide. She was a pedestrian that jumped in front of the car. I doubt it. This is a very big case for me and the law and extremely timely. We shall see why.
S
slick
I’ve seen more than one case where an insurer argues that a pedestrian was hit because he or she intentionally got in the way of the car.
RZ
Raymond Zuppa
I had one where they presented this stupid hand written statment wherein the driver basically states that the pedestrian must have plunged into the windshield on purpose because the driver did not see the pedestrian. What in God’s name is a driver going to say given that the driver is undoubtedly being sued. Fortunately the Judge was good that day because the judge said: “Where did this guy come from if the driver did not see him before he ended up on the windshield. Did he fall out of the sky.” We won that one. Amazing they didn’t appeal. I am sure the App Term would have said “question fo fact.”
J
J
Zuppa, with no disrespect at all, “slick” has a valid point, I think you will be very surprised . . .

Legal Resources

Understanding New York Coverage Law

New York has a unique legal landscape that affects how coverage cases are litigated and resolved. The state's court system includes the Civil Court (for claims up to $25,000), the Supreme Court (the primary trial court for unlimited jurisdiction), the Appellate Term (which hears appeals from lower courts), the Appellate Division (divided into four Departments, with the Second Department covering Long Island, Brooklyn, Queens, Staten Island, and several upstate counties), and the Court of Appeals (the state's highest court). Each court has its own procedural requirements, local rules, and case-assignment practices that can significantly impact the outcome of your case.

For coverage matters on Long Island, cases are typically filed in Nassau County Supreme Court (at the courthouse in Mineola) or Suffolk County Supreme Court (in Riverhead). No-fault arbitrations are heard through the American Arbitration Association, which assigns arbitrators throughout the metropolitan area. Workers' compensation claims go to the Workers' Compensation Board, with hearings at district offices across the state. Understanding which forum is appropriate for your case — and the specific procedural rules that apply — is essential for a successful outcome.

The procedural landscape in New York also includes important timing requirements that can affect your case. Most civil actions are subject to statutes of limitations ranging from one year (for intentional torts and claims against municipalities) to six years (for contract actions). Personal injury cases generally have a three-year deadline under CPLR 214(5), while medical malpractice claims must be filed within two and a half years under CPLR 214-a. No-fault insurance claims have their own regulatory deadlines, including 30-day filing requirements for applications and 45-day deadlines for provider claims. Understanding and complying with these deadlines is critical — missing a filing deadline can permanently bar your claim, regardless of how strong your case may be on the merits.

Attorney Jason Tenenbaum regularly practices in all of these venues. His office at 326 Walt Whitman Road, Suite C, Huntington Station, NY 11746, is centrally located on Long Island, providing convenient access to courts and offices throughout Nassau County, Suffolk County, and New York City. Whether you need representation in a no-fault arbitration, a personal injury trial, an employment discrimination hearing, or an appeal to the Appellate Division, the Law Office of Jason Tenenbaum, P.C. brings $24+ years of real courtroom experience to your case. If you have questions about the legal issues discussed in this article, call (516) 750-0595 for a free, no-obligation consultation.

New York's substantive law also presents distinct challenges. In motor vehicle cases, the no-fault system under Insurance Law Article 51 provides first-party benefits regardless of fault, but limits the right to sue for non-economic damages unless the plaintiff establishes a "serious injury" under one of nine statutory categories. This threshold — codified at Insurance Law Section 5102(d) — requires medical evidence showing more than a minor or subjective injury, and courts have developed detailed standards for each category. Fractures must be documented through imaging studies. Claims of permanent consequential limitation or significant limitation of use require quantified range-of-motion testing with comparison to norms. The 90/180-day category demands proof that the plaintiff was unable to perform substantially all of their usual daily activities for at least 90 of the 180 days following the accident.

In employment discrimination cases, the legal standards vary depending on whether the claim arises under state or local law. The New York State Human Rights Law employs a burden-shifting framework: the plaintiff must first establish a prima facie case by showing membership in a protected class, qualification for the position, an adverse employment action, and circumstances giving rise to an inference of discrimination. The burden then shifts to the employer to articulate a legitimate, non-discriminatory reason for its decision. If the employer meets this burden, the plaintiff must demonstrate that the stated reason is pretextual. The New York City Human Rights Law, by contrast, applies a broader standard, asking whether the plaintiff was treated less well than other employees because of a protected characteristic.

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