Key Takeaway
Court rules medical provider cannot sue assignor who failed to appear at EUO, highlighting limits of assignment-based lawsuits in no-fault insurance cases.
Understanding Assignment Rights and EUO No-Shows in No-Fault Insurance
When medical providers treat patients injured in auto accidents, they often receive assignments of the patient’s New York No-Fault insurance benefits. This assignment typically allows the provider to pursue payment directly from the insurance company. However, complications can arise when the original insured person (the assignor) fails to cooperate with the insurance company’s requirements, such as appearing for an Examination Under Oath (EUO).
The Appellate Term’s decision in Sunlight Med. Care, P.C. v Esurance Ins. Co. addresses a critical question: can a medical provider sue its assignor when that person’s EUO no-show undermines the provider’s ability to collect from the insurer? This case illustrates the complex relationship between assignment rights and the underlying obligations between assignor and assignee.
The court’s analysis reveals important distinctions about what rights are actually transferred through an assignment versus what obligations remain between the original parties. Understanding these nuances is crucial for medical providers navigating no-fault insurance disputes.
Jason Tenenbaum’s Analysis:
Sunlight Med. Care, P.C. v Esurance Ins. Co., 2015 NY Slip Op 51410(U) (App. Term 2d Dept. 2015)
“While plaintiff argues on appeal that the branch of its motion seeking summary judgment against its assignor should have been granted, it offers no reasoning in support of its argument. We note, however, that while plaintiff purports to sue its assignor pursuant to the assignment it received from the assignor, such a cause of action is based upon plaintiff’s own alleged rights against its assignor, and is not properly based upon the assignment.”
I sense an Amos citing here….
Key Takeaway
The court clarified that assignment of no-fault benefits does not create a cause of action against the assignor based solely on the assignment itself. Medical providers cannot use the assignment as the legal basis to sue patients who fail to cooperate with insurance requirements. Any such lawsuit must be grounded in separate contractual or other legal obligations between the provider and patient, not the assigned insurance benefits.
