Why Trust This Analysis
This article is part of our ongoing workers compensation coverage, with 23 published articles analyzing workers compensation issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
Understanding Coverage Defenses in Workers Compensation Insurance Disputes
Insurance coverage disputes often involve complex questions about policy language, exclusions, and the scope of protection. A recent New York appellate court decision highlights an important principle: insurers can assert lack of coverage defenses even when there are questions about how they handled claim denials.
The case of Ultimate Health Prods., Inc. v Hereford Ins. Co. demonstrates how courts analyze coverage disputes when different types of insurance policies become entangled. This situation commonly arises in New York’s complex insurance landscape, where businesses may carry multiple policies and where workers compensation defense requires substantiation to succeed in court.
The underlying dispute centered on whether a workers compensation policy could be used to cover first-party no-fault benefits—two distinct types of insurance coverage that serve different purposes under New York law.
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Ultimate Health Prods., Inc. v Hereford Ins. Co., 2016 NY Slip Op 50367(U)(App. Term 2d Dept. 2016)
“Contrary to plaintiff’s contention, a lack of coverage defense may be raised without regard to any issue as to the propriety or timeliness of an insurer’s denial of claim form (see Zappone v Home Ins. Co., 55 NY2d 131, 135-136 ; see also Central Gen. Hosp. v Chubb Group of Ins. Cos., 90 NY2d 195 ). The papers submitted by defendant in support of its cross motion were sufficient to establish that the policy being sued upon was a workers’ compensation insurance policy which did not cover plaintiff’s claim to receive reimbursement of assigned first-party no-fault benefits. As plaintiff failed to demonstrate the existence of an applicable automobile insurance policy issued by defendant or to otherwise raise a triable issue of fact in opposition to defendant’s cross motion, the order is affirmed.”
It is always interesting seeing cited to insurance companies and entities that do not exist. What happened to Home Ins Co.? Central General in Plainview, New York have been part of North Shore/LIJ for about 20 years.
Key Takeaway
This decision reinforces that insurers can successfully defend coverage lawsuits by demonstrating the policy type simply doesn’t cover the claimed benefits. Courts will dismiss cases where plaintiffs cannot establish that the right type of policy exists or that coverage should apply, regardless of procedural issues with claim handling.
Related Articles
- Workers compensation defense requires substantiation in court
- 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?
- Priority coverage disputes between no-fault insurance and workers compensation in New York
- Workers Compensation Defense in No-Fault Cases: Specialized Expertise Required
Legal Context
Why This Matters for Your Case
New York's Workers' Compensation Law provides benefits to employees injured on the job, regardless of fault. The system covers medical treatment, lost wages (typically two-thirds of average weekly wages subject to a statutory maximum), and permanency awards for lasting disabilities. Claims are filed with the Workers' Compensation Board, where administrative law judges hear contested cases.
However, employers and their insurers frequently challenge claims through Independent Medical Examinations, surveillance investigations, and appeals to the Workers' Compensation Board panel. Attorney Jason Tenenbaum has represented injured workers throughout Long Island and New York City for over 24 years, handling everything from initial claim filings through Board hearings, Third Department appeals, and third-party personal injury lawsuits against property owners and contractors. This article provides the expert legal analysis that workers and practitioners need to navigate the complexities of New York workers' compensation law.
About This Topic
Workers Compensation Law in New York
New York's workers compensation system provides benefits for employees injured on the job, covering medical treatment, lost wages, and disability payments regardless of fault. But navigating the Workers Compensation Board process, understanding benefit calculations, and overcoming employer and insurer challenges requires experienced legal guidance. These articles analyze workers compensation case law, the intersection of workers comp with personal injury claims, and the procedural requirements that govern the system.
23 published articles in Workers Compensation
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a workers compensation matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
