Key Takeaway
New York appellate court identifies complex issues in no-fault insurance priority of payment disputes, highlighting challenges in determining proper provider reimbursement order.
Understanding Priority of Payment in No-fault Insurance Cases
Priority of payment rules in New York’s no-fault insurance system determine which healthcare providers get paid first when multiple claims compete for limited coverage benefits. These regulations, established by the New York State Insurance Department, create a hierarchy for reimbursing medical providers who treat accident victims.
The complexity of these rules becomes apparent when insurance carriers make payments to some providers before others, potentially exhausting available coverage. This can leave legitimate healthcare providers unpaid, leading to disputes about whether the carrier’s payment decisions followed proper regulatory procedures.
When such disputes arise, courts must examine whether the insurance company correctly applied priority rules and whether any payments made to other providers were appropriate under the governing regulations. These cases often involve intricate factual determinations about the timing of treatments, the nature of services provided, and compliance with regulatory requirements.
Court Ruling Creates More Questions Than Answers
Jason Tenenbaum’s Analysis:
Easy Care Acupuncture, PC v MVAIC, 2017 NY Slip Op 51346(U)(App. Term 1st Dept. 2017)
“The parties’ respective submissions reveal the existence of triable issues of fact as to whether defendant partially exhausted the coverage by payments to another provider, and whether those payments were proper under the insurance department regulations.”
I am unsure how you even resolve the above-issue under the priority of payment regimen, since the opinion does not contain any facts.
Key Takeaway
This appellate decision highlights the procedural challenges in priority of payment disputes. The court identified disputed factual issues about whether an insurance carrier properly allocated benefits among competing providers, but the published opinion lacks the factual details necessary to understand how such determinations should be made in practice.
