Key Takeaway
New York court rules police accident report alone can trigger Workers' Compensation inquiry, potentially barring no-fault insurance benefits in workplace injury cases.
Understanding the Intersection of Workers’ Compensation and No-Fault Insurance
The relationship between Workers’ Compensation and no-fault insurance benefits creates a complex legal landscape for accident victims and healthcare providers. Under New York law, Workers’ Compensation primacy means that if an injured person was acting as an employee at the time of an accident, they must seek benefits through the Workers’ Compensation system rather than no-fault insurance.
This principle becomes particularly important for medical providers seeking payment for treatment. When an insurance carrier raises a Workers’ Compensation defense, it can significantly impact reimbursement claims. The challenge often lies in determining whether sufficient evidence exists to establish an employment relationship at the time of injury.
In workplace accident cases, insurance companies frequently scrutinize the circumstances to determine if Workers’ Compensation defense requires substantiation. The burden of proof and the types of evidence that can trigger a Workers’ Compensation inquiry have been subjects of ongoing litigation.
Jason Tenenbaum’s Analysis:
Parkway Pain Mgt., PLLC v American Tr. Ins. Co., 2013 NY Slip Op 50521(U)(App. Term 2d Dept. 2013)
“We find that defendant’s proof, including the police accident report, was sufficient to raise a question of fact as to whether plaintiff’s assignor had been acting as an employee at the time of the accident, which issue must be resolved by the Workers’ Compensation Board”
The police accident report was sufficient to raise an issue of fact requiring the eligibility of no-fault benefits to go before the board.
Key Takeaway
This decision demonstrates that relatively basic documentation, such as a police accident report, can be sufficient evidence to trigger a Workers’ Compensation inquiry. Medical providers and patients should be aware that cases may be remitted to the Workers’ Compensation Board based on limited initial evidence, potentially delaying no-fault insurance reimbursements while employment status is determined.
Legal Update (February 2026): Since this 2013 post, Workers’ Compensation Board regulations and procedural requirements may have been amended, particularly regarding evidentiary standards for establishing employment relationships and the sufficiency of police reports to trigger compensation inquiries. Practitioners should verify current Workers’ Compensation Board provisions and recent appellate decisions interpreting the burden of proof for employment-related accident claims.
