Assignment of Benefits: Can insurer claim...No assignment

The Court of Appeals today in Hospital for Joint Diseases v. Travelers Prop. Cas. Ins. Co., 2007 NY Slip Op 09067 (Ct. of App., 2007) was in favor of the insured.

The insured, injured in a car accident submitted an assignment of benefits form to the hospital for monies paid from his insurance policy for medical care expenses.

The insurance company then tried to get out of their liability by claiming that the form wasn't really signed because the form stated signature on file. In real dollars, the insurance company argued that the patient should be sued for the money, not them.

The court did not agree and upheld the assignment of benefits due under insured's car insurance policy for benefits due under no fault insurance.

In this case, the insurance company was trying to get out of their liability to the hospital by severing their obligation to their insured, the court didn't buy it.

Task a day insurance: Assignment of benefits means that the insurance company will pay the health care provider directly instead of reimbursing the insured. Insurance companies can delay this payment to the health care provider by asking for additional information or making a denial for some reason, usually within the first thirty days after the claim. Do not pay your bill for which you have assigned benefits before resolution of the case. Keep a copy of the form assigning benefits to the medical care provider so that if the provider comes to you, you 1) Show evidence you were insured 2) Show evidence that you assigned benefits 3)Show that you received the medical care for which you are being billed. This will hopefully prevent hospitals and health care providers from harrassing consumers for payment where there was an assignment of benefits.

In this case, the insurer tried to avoid obligation through the delay of arguing that the insured's signature wasn't on the form, therefore there was no assignment of benefits. What sunk their case was that the insured wasn't notified within any reasonable time that the assignment was defective.