Key Takeaway
Court denies summary judgment in no-fault case where insurer failed to prove assignor wasn't eligible injured person despite out-of-state accident location.
Understanding Eligible Injured Person Status in Multi-State Accidents
No-fault insurance disputes become particularly complex when accidents occur outside New York but involve New York residents. Insurance companies often attempt to deny coverage by arguing that out-of-state accidents fall outside their policy obligations. However, the determination of whether someone qualifies as an “eligible injured person” under New York No-Fault Insurance Law depends on multiple factors beyond just the accident location.
This case demonstrates how residency can override accident location in establishing coverage obligations. When medical providers seek reimbursement through assignment of benefits, insurers must carefully examine all relevant facts before denying claims based on geographic assumptions.
Jason Tenenbaum’s Analysis:
TAM Med. Supply Corp. v Country Wide Ins. Co., 2018 NY Slip Op 50578(U)(App. Term 2d Dept. 2018)
“Although the accident occurred in Pennsylvania, the NF-2 form annexed to defendant’s cross motion states that plaintiff’s assignor resides in Bronx County. As a result, defendant’s cross motion for summary judgment should have been denied, because defendant failed to establish, as a matter of law, that plaintiff’s assignor is not an eligible injured person (see 11 NYCRR § 65-1.1 ).”
What probably happened here is that the Assignor was a stranger to the policy and Defendant tried to articulate that since the MVA occurred in PA and (arguably?) the EIP lived outside NY, there would be no coverage. This would be a valid coverage defense if the facts played as out as above. But… they did not.
Key Takeaway
Insurance companies cannot rely solely on accident location to deny no-fault coverage. When the injured party resides in New York, they may still qualify as an eligible injured person regardless of where the accident occurred. Insurers must thoroughly establish all facts before seeking summary judgment on coverage defenses, as incomplete documentation can lead to failed defense strategies.
