On 20 July 2001, a private individual was operating a 1996 Honda motorcycle which was involved in a motor vehicle accident or motorcycle accident, where he sustained severe personal injuries (broken bone, etc.) and required substantial health care and medical services thereafter, with one of defendant foreign corporation’s delivery trucks (truck accident) at the intersection of New York State Route 31 and Connors Road in the Town of Van Buren, County of Onondaga. Private defendant was the operator of the defendant foreign corporation’s vehicle in the course of his employment.
Prior to the accident, a private corporation had issued a group contract for HMO medical care coverage (hereinafter the HMO contract) to the private individual’s employer and the private individual was at all relevant times an eligible member under the HMO contract. A New York Injury Lawyer said by the terms of the HMO contract, the private corporation provided coverage to the private individual for certain medically necessary hospitalization and health care services. The cost of the benefits provided and paid for presently exceeds the sum of $100,000.
On or about 30 July 2001, a Nassau County Personal Injury Lawyer said the private individual commenced a civil action against private defendant and foreign corporation seeking to recover monetary damages for the personal injuries he sustained. There is no factual dispute that the private individual, within the personal injury action, is not seeking and has not advanced a claim for the recovery of past or future medical expenses.
On or about 17 April 2003, Excellus commenced this action against the defendants and advanced one cause of action, which alleged standing as subrogee of the private individual under the applicable HMO contract language and sought recovery of the cost of benefits paid to the private individual on the ground that defendants’ negligence was the proximate cause of the personal injuries and the medical expenses incurred thereby.
Thereafter, defendants commenced a third-party action against the Town seeking contribution or indemnity.
The present case involves an attempt by the insurer to directly enforce its subrogation rights against the alleged tortfeasor to recover amounts paid to the insured and, because of the manner in which the insured’s personal injury action has been pleaded and prosecuted, there simply is no possibility of the tortfeasor having to pay twice and no need to await settlement.
Subrogation itself `exists to prevent double recovery by the insured and to force the wrongdoer to bear the ultimate costs’.
Again, the focus and emphasis by those evaluating subrogation provisions and Civil Practice Law & Rules (CPLR) issues seem to be upon the necessity to put in place a regulatory scheme to prevent double recovery by the injured plaintiff insured and, to a lesser degree, the question of who should bear the cost of paying once for the injured plaintiff’s medical costs.
A Queens Personal Injury Lawyer said that clearly, in the absence of the the foreign corporation’s medical insurance coverage, which paid the insured plaintiff’s medical bills, defendants would be exposed to the potential liability for all of those costs in the insured plaintiff’s direct action against the defendants. Obviously, the private individual’s counsel made a tactical decision not to include a claim for these costs in the insured plaintiff’s personal injury action because of the prohibition against double recoveries embodied in CPLR.
However, in the absence of such insurance, assuming the insured plaintiff was successful in prosecuting a claim for past and future medical expenses in the personal injury action without apportionment of liability to the insured plaintiff, defendants would be responsible for every dime of those costs. There can be no double recovery to the insured plaintiff here.
Initially, there is only one claim for medical expenses being advanced against defendants and that is in this action. The private individual is not advancing such a claim in his personal injury action and there will be no verdict or judgment awarding medical expenses. Secondly, to the extent that one action results in a finding of liability as against defendants before tin such action. The other action is reduced to verdict or judgment, traditional principles of res judicata and collateral estoppel, if applicable, will come into play to resolve or harmonize the two actions.
The court finds, as a matter of law, that CPLR is not a bar to the private corporation’s contractual subrogation action against defendants to the extent that such action alleges that defendants are the responsible parties and seeks to recover the cost of medical expenses paid by them on behalf of its insured.
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