Workers Comp

Understanding Workers’ Compensation vs. No-Fault Insurance Coverage

The relationship between workers’ compensation and New York no-fault insurance law can create complex coverage disputes. A recent appellate decision demonstrates how courts handle situations where an injured person’s employment status at the time of an accident becomes a crucial factor in determining which insurance system provides coverage.

This case involved a medical provider seeking payment under no-fault insurance, but the insurance company argued that workers’ compensation might be the appropriate coverage instead. The dispute centered on whether the injured person was acting within the scope of employment when the accident occurred—a determination that affects which insurance system has primary responsibility for benefits.

Similar to how insurance companies must substantiate their defenses, carriers cannot simply claim workers’ compensation coverage applies without providing sufficient evidence to support their position.

Jason Tenenbaum’s Analysis:

Metro Psychological Servs., P.C. v Travelers Prop. & Cas. Ins. Co., 2019 NY Slip Op 51150(U)(App. Term 2d Dept. 2019)

“Defendant proffered sufficient evidence to support its contention that there was an issue as to whether plaintiff’s assignor had been acting in the course of his employment at the time of the accident and that, therefore, workers’ compensation benefits might be available (see e.g. Arce Med. & Diagnostic Svce v American Tr. Ins. Co., 39 Misc 3d 134, 2013 NY Slip Op 50531 ; Jamaica Med. Supply, Inc. v American Tr. Ins. Co., 34 Misc 3d 133, 2011 NY Slip Op 52371 ; D.A.V. Chiropractic, P.C. v American Tr. Ins. Co., 29 Misc 3d 128, 2010 NY Slip Op 51738 ; cf. Westchester Med. Ctr. v American Tr. Ins. Co., 60 AD3d 848 ). ” ‘Since primary jurisdiction with respect to determinations as to the applicability of the Workers’ Compensation Law has been vested in the Workers’ Compensation Board,’ it is ‘inappropriate for the courts to express views with respect thereto pending determination by the board‘“

Key Takeaway

Courts will defer to the Workers’ Compensation Board when there’s a legitimate question about whether an injured person was acting within the scope of employment during an accident. Insurance companies must present sufficient evidence supporting their workers’ compensation defense, but once they do, the specialized administrative board—not the courts—has primary authority to make the final coverage determination.

Legal Update (February 2026): Since this 2019 post, New York Workers’ Compensation Law provisions and Workers’ Compensation Board regulations governing the interaction between workers’ compensation and no-fault insurance coverage may have been amended. Additionally, appellate decisions issued after 2019 may have further clarified the evidentiary standards for determining scope of employment in coverage disputes. Practitioners should verify current Workers’ Compensation Board rules and recent case law when analyzing coverage priority issues between these insurance systems.