Contractual deemer

Out-of-state insurance companies often attempt to avoid New York no-fault coverage obligations by claiming they lack sufficient ties to the state. However, New York’s regulatory framework includes specific provisions that can “deem” certain policies to satisfy the state’s financial security requirements, regardless of the insurer’s geographic connections. Understanding these contractual deemer provisions is crucial for medical providers seeking payment under New York No-Fault Insurance Law.

The relationship between an insurer’s state connections and their coverage obligations under New York law creates complex legal questions that require careful analysis of both statutory requirements and specific policy language.

Jason Tenenbaum’s Analysis:

Domny Med. Servs., P.C. v Universal Ins. Co., 2021 NY Slip Op 50301(U)

“Defendant does not deny that it issued the insurance policy pursuant to which plaintiff seeks payment, but argues that, as an out-of-state company with no ties to New York, it is not liable for these services. Contrary to defendant’s contention, it has not demonstrated, as a matter of law, that its policies should not “be deemed to satisfy New York’s financial security requirements and to provide for the payment of first-party benefits” (Matter of American Ind. Ins. Co. v Nova Acupuncture, P.C., 137 AD3d 1270, 1272 ; see Insurance Law § 5107; 11 NYCRR § 65-1.8) or that the policy at issue does not otherwise mandate coverage under the circumstances

The defense that you do not have ties to New York will warrant statutory deemer dismissal.. But does it mean that the policy itself does not provider for the benefits? Read the policy carefully.

Key Takeaway

Courts must look beyond an insurer’s geographic ties when evaluating no-fault coverage obligations. Even out-of-state insurers may be subject to New York’s deemer provisions, which can establish coverage requirements regardless of the company’s connections to the state. The specific policy language remains the determining factor for coverage obligations.

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