Key Takeaway
Court ruling explores complex standing issues when major medical providers attempt to pursue no-fault insurance claims through assignment of rights.
Understanding Standing in No-Fault Insurance Cases
The relationship between major medical insurance providers and no-fault carriers can create complex legal scenarios, particularly when it comes to who has the right to pursue claims. A recent New York Supreme Court case highlights the intricate issues surrounding standing when major medical carriers attempt to recover benefits they’ve paid on behalf of injured parties.
This case demonstrates how assignment of rights doesn’t always provide the clear pathway to recovery that healthcare providers might expect. The decision also reveals potential errors in arbitration proceedings that could have significant implications for similar disputes between insurance carriers.
Jason Tenenbaum’s Analysis:
AETNA Health Plans v Hanover Ins. Co., 2013 NY Slip Op 33221(U)(Sup. Ct. Bronx Co. 2013)
In this case, Defendant provided no-fault services to Plaintiff’s Assignor. Defendant cut-off Plaintiff’s Assignor, who then sought to have medical benefits paid for by Aetna. When all was said and done, Aetna paid over $42,000 in benefits. Plaintiff asserted a lien on its assignor’s personal injury case and its assignor sought arbitration with AAA. The arbitrator found that since major medical paid for the benefits, the assignor could not maintain an case against no-fault carrier. The master arbitrator affirmed.
Now, Plaintiff assigns whatever rights it has to the Assignee major medical carrier. This does not go anywhere as is discussed in this opinion.
Just note that the lower arbitrator’s and master arbitrator’s decisions were wrong based upon Todaro v. Geico.
Key Takeaway
This case illustrates the challenges major medical providers face when attempting to recover benefits through assignment of rights. Even when significant amounts are at stake—over $42,000 in this instance—courts may find that the assignment doesn’t confer proper standing to pursue claims against no-fault carriers, particularly when arbitrators have made determinations that may conflict with established precedent.
