Roggio Not Applicable Where Assignor Executed Assignment Before Arbitrating Medical Bills in His Own Right

Key Takeaways

• Under Roggio v Nationwide Mut. Ins. Co. (66 NY2d 260), an eligible injured person who elects to arbitrate no-fault benefits is bound by that election for later disputes arising from the same accident.
• In Dayna Physical Therapy v Travelers, the Appellate Term held Roggio does not preclude a provider’s lawsuit where the assignor executed the assignment of benefits before commencing his own arbitration.
• The timing of the assignment controls: once the claims were assigned, they were no longer the assignor’s to elect a forum for.
• The flip side remains dangerous — an assignor who arbitrates bills and loses can collaterally estop the assignee in a later proceeding.

In New York no-fault practice, the choice between court and arbitration is binding under Roggio — and carriers routinely invoke that election to knock out provider suits. This Appellate Term decision draws a clean line around the doctrine’s outer boundary.

The Decision

Dayna Physical Therapy, P.C. v Travelers Ins. Co., 2013 NY Slip Op 50322(U)(App. Term 2d. Dept. 2013)

“In this action by a provider to recover assigned first-party no-fault benefits, defendant moved, pursuant to CPLR 3211 and CPLR 3212, to dismiss the complaint. Defendant contended that, pursuant to Roggio v Nationwide Mut. Ins. Co. (66 NY2d 260 ), plaintiff was precluded from litigating its claims for reimbursement of assigned first-party no-fault benefits since plaintiff’s assignor had, prior to this action, elected to arbitrate claims for no-fault benefits which he had not assigned and which arose out of the same accident as was involved in the instant action”

…

“The Civil Court properly denied defendant’s motion. As the Civil Court correctly noted, since plaintiff’s assignor had executed the assignment of benefits to plaintiff prior to his commencement of his own arbitration, the holding in Roggio (66 NY2d 260) does not apply here and, thus, plaintiff was not precluded from litigating the claims at issue in this action”

Roggio appears to be strictly construed to a prior election that a real plaintiff makes in adjudicating outstanding no-fault billing. Yet, an EIP who arbitrates bills and loses can collaterally estop his assignee in a future litigation or arbitration. Triboro Quality Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co.,36 Misc.3d 131(A)(App. Term 1st Dept. 2012)

The Legal Framework: Roggio’s Election Doctrine

New York’s no-fault scheme gives a claimant two forums for disputed first-party benefits: a plenary action in court or arbitration under Insurance Law § 5106. In Roggio, the Court of Appeals treated the choice of arbitration as a binding election — a claimant who opts for arbitration on no-fault billing from an accident cannot later pivot to court for further disputes from the same loss.

The doctrine prevents forum shopping — testing the waters in arbitration, then re-launching in Civil Court after an unwelcome result. Carriers have learned to plead Roggio aggressively whenever any arbitration appears in the claim file.

The limitation Dayna Physical Therapy enforces is temporal. An election binds only the person who made it, as to claims that person still owned. Here, the assignor signed the assignment of benefits before commencing his own arbitration; at the moment of election, the assigned bills belonged to the provider. His forum choice could not retroactively drag the provider’s claims into arbitration.

Why This Matters for Providers and Carriers

For medical providers, the dispositive document was the assignment of benefits and, critically, its date. A provider facing a Roggio motion should compare the AOB’s execution date against the commencement date of the assignor’s arbitration; if the assignment came first, the motion should fail.

For carriers, Dayna is a reminder that Roggio is not a magic word: the defense requires a prior, binding election covering claims the electing party still owned. A motion under CPLR 3211 or CPLR 3212 built on a chronology that does not line up will be denied — as it was here.

The Collateral Estoppel Trap on the Other Side

The closing observation cuts the other way: while the assignor’s forum election could not bind the provider, an assignor’s loss on the merits can, under Triboro Quality Med. Supply v State Farm (36 Misc 3d 131[A] [App. Term 1st Dept. 2012]).

The distinction runs through all of collateral estoppel law in New York: an assignee stands in its assignor’s shoes and takes the claim subject to issues actually litigated and decided against the assignor. Roggio polices where a claim may be heard; issue preclusion polices what has already been decided. A provider can win the Roggio battle and still lose if an arbitrator decided overlapping issues — medical necessity, coverage, an IME no-show defense — against the assignor.

Practice Pointers

• Providers: Date-stamp and preserve every assignment of benefits — the AOB execution date defeats a Roggio motion when the assignor later arbitrates his own claims.
• Providers: Before suing, learn whether your assignor arbitrated anything from the accident and what was decided; an adverse merits award can estop you even when Roggio cannot.
• Carriers: Build the chronology before moving. Where the assignment predates the arbitration, a collateral estoppel motion keyed to an actual adverse award is the stronger vehicle.
• Both sides: Treat election and preclusion as separate analyses with separate elements. Courts will.

Related Resources

• Collateral estoppel in New York personal injury and no-fault cases — the firm’s cluster hub on issue preclusion
• The firm’s Legal Encyclopedia — doctrine-by-doctrine coverage of New York insurance and procedure law
• No-Fault Defense practice
• Understanding collateral estoppel in New York no-fault insurance cases
• Combating litigation delay tactics in New York no-fault insurance cases
• Single motion rule and statute of limitations considerations
• CPLR 2106 procedural requirements for medical practice owners
• New York No-Fault Insurance Law

Frequently Asked Questions

What is the Roggio doctrine in New York no-fault cases?

It comes from Roggio v Nationwide Mut. Ins. Co., 66 NY2d 260, where the Court of Appeals held that a no-fault claimant who elects to arbitrate disputed benefits is bound by that election for further disputes arising from the same accident.

Does an injured person’s arbitration block a medical provider’s lawsuit on assigned bills?

Not if the provider received its assignment of benefits before the injured person commenced arbitration — Dayna Physical Therapy v Travelers holds the assignor’s later forum election cannot bind claims he had already assigned away. An assignor’s merits loss in arbitration, however, may still collaterally estop the assignee.

Why does the date on the assignment of benefits matter so much?

Because an election to arbitrate covers only claims the electing party owns at that moment. An assignment executed before the arbitration put those bills outside the reach of the assignor’s election — which is why providers should preserve dated AOBs in every file.

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Legal Update (February 2026): Since this 2013 post, New York’s no-fault arbitration procedures and assignment of benefits regulations may have been modified through regulatory amendments or updated fee schedules. Practitioners should verify current provisions regarding the timing of assignments relative to arbitration elections and any changes to the Roggio doctrine’s application in provider reimbursement cases.