Key Takeaway
Court ruling shows workers compensation defenses must be backed by concrete evidence, not just conclusory statements from claims administrators.
When insurance carriers attempt to assert workers compensation defenses in no-fault cases, they must provide more than bare allegations. A recent Appellate Term decision illustrates how insufficient documentation can doom an otherwise potentially valid defense, highlighting the importance of proper substantiation in insurance coverage disputes.
This case involved a medical provider seeking payment for services rendered to an injured party. The insurance carrier claimed that workers compensation coverage was primary, which would shift liability away from the no-fault insurer. However, the court’s analysis reveals the critical difference between making a claim and proving it with adequate evidence.
Jason Tenenbaum’s Analysis:
Central Radiology Servs., P.C. v First Am. Ins., 2013 NY Slip Op 51031(U)(App. Term 2d Dept. 2013)
“Defendant failed to demonstrate a meritorious defense as it did not submit adequate proof to raise a question of fact regarding whether the assignor had been acting within the course of her employment when the accident had occurred. The affidavit of defendant’s third-party claims administrator merely alleged in a conclusory manner that the assignor “was injured during the course of her employment and therefore, workers’ compensation was primary for this loss,” without substantiating this assertion with any evidence”
If this was a cab or livery issue, carrier should have put a declarations page, police report or some other corroborative proof to allow the case to be kicked to the board.
Key Takeaway
Insurance carriers defending workers compensation claims must support their positions with concrete documentation rather than conclusory statements. Courts require substantive evidence such as employment records, declarations pages, or police reports to establish that an injury occurred within the course of employment, making workers compensation the primary coverage.
Related Articles
- 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?
- Workers Compensation Defense in No-Fault Cases: Specialized Expertise Required
- Strategic Decision-Making in Appeals: When Not to Fight Workers’ Compensation Rulings
