Key Takeaway
Court confirms workers' compensation policies don't cover no-fault benefits. Healthcare providers must verify correct insurance type before filing claims.
Medical providers seeking reimbursement for no-fault benefits must ensure they’re filing claims under the correct type of insurance policy. A recent appellate court decision highlights the importance of distinguishing between workers’ compensation coverage and automobile insurance policies when pursuing no-fault benefits.
The case involved a healthcare provider that attempted to recover assigned first-party no-fault benefits under what turned out to be a workers’ compensation policy. This fundamental mismatch between the type of coverage and the benefits sought proved fatal to the plaintiff’s case, demonstrating how critical it is to verify policy details before initiating legal action.
Jason Tenenbaum’s Analysis:
Gentlecare Ambulatory Anesthesia Servs.; Lyonel F. Paul M.D. v Hereford Ins. Co., 2020 NY Slip Op 51379(U)(App. Term 2d Dept. 2020)
“The papers submitted by defendant in support of its [ ] 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, ” (Ultimate Health Prods., Inc. v Hereford Ins. Co., 51 Misc 3d 127, 2016 NY Slip Op 50367, *1 ; Flatbush Chiropractic, P.C. v Hereford Ins. Co., 49 Misc 3d 149, 2015 NY Slip Op 51712, *1 ).”
It is probably not a good idea to seek NF benefits under a WC policy.
Key Takeaway
Workers’ compensation policies and automobile insurance policies serve different purposes under New York law. Healthcare providers must verify they’re seeking no-fault benefits under valid automobile insurance coverage, as workers’ compensation policies simply don’t provide this type of reimbursement. Proper policy identification prevents costly litigation missteps.
