Key Takeaway
Court ruling shows defendant successfully proved wrong insurance carrier was sued using claims manager's affidavit, potentially breaking from precedent requiring underwriter testimony.
In New York no-fault insurance litigation, establishing which insurance carrier actually provided coverage is a fundamental threshold issue. When healthcare providers sue for unpaid benefits, they must ensure they’re targeting the correct insurer. A misstep in identifying the proper defendant can derail an entire case, as demonstrated in a recent Appellate Term decision that may signal a shift in how courts evaluate coverage defenses.
Traditionally, insurance companies seeking to prove they didn’t provide coverage have been required to submit affidavits from underwriters with specific knowledge of policy issuance. However, this requirement appears to be evolving, with courts potentially accepting testimony from other insurance professionals who can authenticate coverage details. This development has significant implications for both healthcare providers pursuing New York No-Fault Insurance Law claims and insurers defending against such actions.
Jason Tenenbaum’s Analysis:
Great Health Care Chiropractic, P.C. v Omni Indem. Co., 2013 NY Slip Op 51450(U)(App. Term 2d Dept. 2013)
“In support of its motion, defendant submitted affidavits of its litigation manager and the claims litigation manager of American Independent Insurance Company (AIIC) which sufficiently established defendant’s lack of coverage defense”
“Notably, the AIIC claims litigation manager attested that his company had issued the policy in question. Consequently, defendant demonstrated that plaintiff had sued the wrong insurance carrier and that defendant was not the carrier which covered the present accident.”
On this case, the carrier looks to have relied on the affidavit of a claims representative who stated that the insurance carrier was insured the adverse vehicle. Usually, the courts have held that an underwriter’s affidavit was necessary to make a prima faice showing of lack of coverage. This case seems to represent a break from prior precedent.
Key Takeaway
This decision suggests courts may be more flexible in accepting coverage testimony from claims managers rather than requiring underwriter affidavits. For healthcare providers, this underscores the importance of thorough pre-litigation research to identify the correct insurance carrier, as coverage defense strategies may be easier for insurers to establish than previously expected.
Legal Update (February 2026): Since this 2013 post, New York’s no-fault insurance regulations and coverage identification requirements may have been modified through regulatory amendments or updated court precedents. Practitioners should verify current provisions regarding acceptable forms of coverage authentication, underwriter affidavit requirements, and procedural standards for establishing proper insurance carrier defendants in no-fault litigation.
