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This article is part of our ongoing coverage coverage, with 150 published articles analyzing coverage 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 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.
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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.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Insurance Coverage Issues in New York
Coverage disputes determine whether an insurance policy provides benefits for a particular claim. In the no-fault context, coverage questions involve policy inception, named insured status, vehicle registration requirements, priority of coverage among multiple insurers, and the applicability of exclusions. These articles examine how New York courts resolve coverage disputes, the burden of proof on coverage defenses, and the interplay between regulatory requirements and policy language.
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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.
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