Legal Questions

Can a no-fault insurer deny or delay payment because workers’ compensation or another insurer is primary?

Short answer: Settled at the Appellate Division, no conflicting department. The governing rules are uniform where they have been decided. Workers' compensation is primary over no-fault (Insurance Law § 5102 [b] [2]; Arvatz, 1st Dept 1991; Quick, 3d Dept 2024), and the Workers' Compensation Board has primary jurisdiction over whether it applies (Court of Appeals: O'Rourke, Botwinick, Liss, not in the database), so a court faced with an insurer's showing of 'potential merit' must hold the no-fault claim in abeyance for a prompt Board application rather than decide employment status itself (2d Dept: LMK 2009, Dunn 2010; App Term 1st and 2d follow), while an insurer that offers no competent proof gets no referral and the defense fails (2d Dept: Westchester v American Tr. 2009, Abdelhaq 2007; 1st Dept: Global Liberty v North Shore 2019). As to another motor vehicle insurer, the first insurer notified must pay and arbitrate priority (1st Dept: M.N. Dental 2011; 2d Dept: Unitrin v Brand 2014, App Term 2d SZ Med. 2005). No department disagrees. The one open seam is preclusion: the Second Department holds the WC 'offset' is not a lack-of-coverage defense and is precluded without a timely denial (Westchester v Lincoln Gen. 2009, lv denied 13 NY3d 714), but App Term 2d treated an actual Board award as a lack of coverage that is not precluded (Active Care v Hartford 2018), and a 2005 Civil Court upheld an arbitrator's ruling that the defense is an exception to preclusion (JSI 2005).

Scope. Deciding this question means ruling, in a claim for first-party no-fault benefits (action, arbitration, or article 75 review of the award), on the insurer's position that someone else must pay first. Mostly that is workers' compensation: whether the injured person may have been an employee injured in the course of employment (including livery and black-car drivers, the Black Car Fund and the Uninsured Employers' Fund), whether the court must defer to the Workers' Compensation Board's primary jurisdiction and hold the claim in abeyance, whether the insurer's proof shows the defense's potential merit, whether the claim fails because the Board awarded compensation or the claimant never applied to the Board, and whether the defense is precluded by an untimely denial. It also covers the mirror rule for another motor vehicle insurer: under 11 NYCRR 65-3.12 (b) and 65-4.11 (a) (6) the first insurer notified must pay and arbitrate any priority dispute with the other insurer, unless it is not 'otherwise liable' at all (a lack of coverage).

Based on 79 decisions in our database, the most recent decided May 5, 2026.

Leading authorities · Governing regulations · Authority map · Decisions by court · Plain-text version (Markdown)

Leading authorities

  • LMK Psychological Serv., P.C. v American Tr. Ins. Co. (2009 NY Slip Op 06004) Appellate Division, Second Department, 2009Board has primary jurisdiction; courts must refer, not decide, WC barThe trial court erred in dismissing no-fault claims as barred by Workers' Compensation Law § 11 where the Board had made no determination; the Board has primary jurisdiction over coverage under the Workers' Compensation Law, so the claims had to be referred to it and the cross motion decided afterwards.
    Those claims must be referred to the Workers’ Compensation Board for a determination as to whether the plaintiffs have a valid cause of action to recover no-fault benefits, or whether they are relegated to benefits under the Workers’ Compensation Law
  • M.N. Dental Diagnostics, P.C. v Government Empls. Ins. Co. (2011 NY Slip Op 01333) Appellate Division, First Department, 2011First insurer notified pays; priority dispute goes to arbitrationGEICO's denial on the ground that another insurer (Fidelity) was responsible raised a priority-of-payment dispute, not a coverage question (11 NYCRR 65-4.11 [a] [6]); as the first insurer notified it had to pay the provider, and the dispute between insurers belongs in mandatory arbitration.
    Thus, as “the first insurer to whom notice of claim [was] given” (11 NYCRR 65-3.12 [b]), defendant was responsible or obligated to pay the no-fault benefits for the health services provided by plaintiff, irrespective of any issues of priority or source of payment.
    Later history: Affirms the Appellate Term, First Department (M.N. Dental Diagnostics v GEICO, 2009 NY Slip Op 29266, post 8366)
  • Quick v State Farm Mut. Auto. Ins. Co. (2024 NY Slip Op 06268) Appellate Division, Third Department, 2024WC primary even with uninsured employer; seek WC firstBecause workers' compensation is primary to no-fault, an employee injured in the course of employment must first seek workers' compensation, through the Uninsured Employers' Fund where the employer had no coverage, before no-fault benefits; summary judgment dismissing his no-fault action was affirmed, with eligibility for the Board to decide first.
    The fact that plaintiff’s employer did not possess workers’ compensation coverage at the time of the accident does not render him ineligible for Workers’ Compensation benefits; instead it changes the potential source of payment. As such, plaintiff was required to seek workers’ compensation benefits as the primary source of payment for his basic economic loss
  • Matter of Global Liberty Ins. Co. of N.Y. v North Shore Family Chiropractic, PC (2019 NY Slip Op 08951) Appellate Division, First Department, 2019Insurer must prove course of employment to deny on WCThe insurer's petition to vacate an award for the provider was dismissed: it failed to establish that the livery driver was injured in the course of employment (his TLC license was issued that day and there was no evidence he was on duty or carrying a passenger), so its workers' compensation denial was not proper.
    Petitioner failed to establish that respondents’ assignor was injured in the course of his employment, and therefore that it properly denied his claim because workers’ compensation benefits were available to him
  • Westchester Med. Ctr. v Lincoln Gen. Ins. Co. (2009 NY Slip Op 02589) Appellate Division, Second Department, 2009WC offset is not a coverage defense; precluded if not timelySummary judgment for the hospital: the insurer raised no triable issue on workers' compensation coverage (investigator's hearsay only), and its possible entitlement to offset workers' compensation recovery is not a lack-of-coverage defense, so it is subject to the 30-day denial requirement.
    Moreover, the defendant’s possible entitlement to offset any no-fault benefits it pays by any recovery pursuant to a Workers’ Compensation claim does not constitute a defense of lack of coverage, which is not subject to the requirement that there be timely service of the disclaimer
    Later history: Leave to appeal denied, 13 NY3d 714 (2009), as cited in Devonshire Surgical Facility v Hereford (App Term 1st 2010, post 7582) and other decisions
  • A.B. Med. Servs., PLLC v American Tr. Ins. Co. (2009 NY Slip Op 29271) Appellate Term, Second Department, 2009Model order: abeyance pending Board, 90-day conditional dismissalThe insurer's proof raised a question of fact whether the assignor was acting as an employee, which the Board must resolve first; the provider's summary judgment motion was to be held in abeyance pending a prompt Board application, and dismissed if no proof of an application was filed within 90 days.
    In the event plaintiffs fail to file proof with the District Court of such application within 90 days of the date of the order entered hereon, the District Court shall deny plaintiffs’ motion and grant reverse summary judgment in favor of defendant dismissing the complaint unless plaintiffs show good cause why the complaint should not be dismissed.
    Later history: On the later appeal, A.B. Med. Servs. v American Tr. Ins. Co. (2012 NY Slip Op 50764(U), post 6906) affirmed summary judgment dismissing the complaint because no proper Board application had been made within the 90 days
  • O'Rourke v Long 41 NY2d 219Where WC availability turns on questions of fact or mixed questions, the claimant may not choose the courts; the Board decides first. Cited by about 33 decisions in the database.Not in our database.
  • Botwinick v Ogden 59 NY2d 909Primary jurisdiction over the applicability of the Workers' Compensation Law is vested in the Board; courts should not express views pending its determination (quoted in Dunn and most App Term decisions).Not in our database.
  • Liss v Trans Auto Sys. 68 NY2d 15If the issue was not litigated before the Board, the court should remit to the Board; a party without the chance to participate in the Board hearing is not bound by it (Lutheran).Not in our database.
  • Arvatz v Empire Mut. Ins. Co. 171 AD2d 262As between no-fault and workers' compensation, WC is primary and the injured person may not elect; employee vs independent contractor status of a livery driver is best decided by the Board.Not in our database.
  • Lanpont v Savvas Cab Corp. 244 AD2d 208A WC defense warrants Board review only where the record shows its 'potential merit' (A.B. Med. 2005 and trial courts).Not in our database.
  • Matter of Pacific Ins. Co. v State Farm Mut. Auto. Ins. Co. 150 AD2d 455Disputes between insurers about responsibility for first-party benefits must go to mandatory arbitration under § 5105 (b) (relied on by M.N. Dental and SZ Med.).Not in our database.
  • Paramount Ins. Co. v Miccio 169 AD2d 761, lv denied 78 NY2d 851Which insurer must pay first-party benefits is an inter-company dispute subject to mandatory arbitration (M.N. Dental).Not in our database.
  • Dietrick v Kemper Ins. Co. 76 NY2d 248No-fault benefits are reduced by workers' compensation recoverable under § 5102 (b) (2) (cited in Quick).Not in our database.

Governing regulations

Whether workers' compensation applies (employment, course of employment) is for the Workers' Compensation Board, which has primary jurisdiction; its primacy comes from Insurance Law § 5102 (b) (2) and the Workers' Compensation Law, not Part 65.

  • 11 NYCRR 65-3.16 (a) (9) When the applicant is entitled to workers' compensation for the same accident, the compensation carrier is the sole source of reimbursement for medical expenses (Insurance Law 5102 (b) (2)).
  • 11 NYCRR 65-3.12 (b) (1) In a priority dispute among insurers otherwise liable, the first insurer given notice pays the claimant and the insurers settle it in mandatory arbitration; under the case law another insurer's priority is no defense to the claim.

Also relevant

Chosen by us from the regulation text and the decisions on this question that cite it. Each link opens our copy of the regulation, which is unofficial; the official text is in the NYCRR.

Authority map

Each circle is a decision on this question, placed by court and date; its colour is the position it took. Lines are citations between them. Select a circle (or find a decision by name) to see its links and summary. The same decisions are listed by court below the map.

Workers' compensation may apply: the Board decides first and the no-fault claim waitsWorkers' compensation is primary and the claim against the no-fault insurer is dismissed or deniedThe insurer did not show that workers' compensation may apply; no referral, and the defense failsThe insurer may not rely on workers' compensation because it did not raise it in timeAnother insurer's possible priority is no defense: the first insurer notified pays, then arbitrates with the other insurerThe insurer was never liable: its objection is a lack of coverage, so the pay-first rule does not applyRing: rules on the question, but another ground decided the caseContrasted, distinguished or limitedDeclined to follow, questioned, overruled or reversedCited
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How the rule was applied, by court

Court Referred to WC Board WC primary: claim fails WC defense not shown WC defense precluded First insurer must pay No coverage, not priorityTotal
Appellate Division, First Department0010102
Appellate Division, Second Department4021108
Appellate Division, Third Department0100001
Appellate Term, First Department2001205
Appellate Term, Second Department259341042
Trial courts in the First Department1000012
Trial courts in the Second Department41552219

Decisions (79)

Every decision in our database that rules on this question: highest court first, then by department, newest first. 72 turn on it; the others rule on it alongside a different main ground (marked "also decides"). The one-sentence summaries describe what each court said on this question.

How this page is made: the decisions are those in our case-law database that cite this question's leading cases or were tagged with its subject. A language model read each one in full and recorded whether it rules on the question, the position it took and a one-sentence summary; a second, independent reading checked every entry. Court, department, date and the citation links come from the database. Read the decision before relying on it.