Reimbursement Claim for No-Fault Paid to Health Insurer Not Permitted

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.

2016-11-05T15:59:17+00:00 October 28th, 2016|Legal News|