The issue before the Court of Appeals of New York, in Aetna Health Plans v. Hanover Ins. Co., 2016 N.Y. Slip Op. 04658 (N.Y. June 14, 2016) was whether a health insurer that paid for medical treatment that arguably should have been covered by the insured’s no-fault automobile insurance carrier could maintain a reimbursement claim against the no-fault insurer within the framework of the New York no-fault law. The Court ruled that the health insurer could not maintain such a claim.
The Court reasoned that the no-fault law and governing regulations provide that reimbursement can be made to a health care provider, but do not contemplate any such reimbursement to a health insurer. The Court furthermore decided that the insured’s putative assignment of her no-fault benefits to the health insurer did not help the health insurer because the insured previously had assigned her no-fault benefits to her health care provider, which left the insured with no rights to assign to the health insurer. The Court also noted that the no-fault regulations permit only the insured—or providers of health care services by an assignment from the insured—to receive direct no-fault benefits. Because a health insurer is not a “provider of health care services” and does not fall under the term “health care provider,” the insured could not assign her rights to it, the Court concluded.