tag:blogger.com,1999:blog-4754540220266106237.comments2024-03-17T16:43:50.668-04:00Coverage CounselRoy A. Murahttp://www.blogger.com/profile/06367888044845855898noreply@blogger.comBlogger551125tag:blogger.com,1999:blog-4754540220266106237.post-64719242947434681252020-11-24T13:05:03.821-05:002020-11-24T13:05:03.821-05:00In the award, Arbitrator Lutzen characterized the ...In the award, Arbitrator Lutzen characterized the peer review report as being "well-reasoned and persuasive", which highlights the importance of having a medical opinion to support a defense based on lack of causation. While it might seem obvious to some that medical treatment for a heart attack is not related to injuries sustained in a motor vehicle incident, a medical opinion to support that conclusion is still necessary to make the defense viable.<br /><br />The arbitrator also took note of the fee schedule calculations prepared by our certified professional coder, Melissa Kurgan. The practice point here is that arbitrators routinely require carriers to prove a fee schedule defense with evidence of the proper calculation.<br /><br />Please feel free to reach out to me directly by email (ryan.mura@muralaw.com) if you have any questions about the award or its findings.Ryan Murahttps://www.blogger.com/profile/16301404706155956072noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-69185991443182877382020-08-06T10:09:09.924-04:002020-08-06T10:09:09.924-04:00You now know what 'Double secret probation'...You now know what 'Double secret probation' is.<br /><br />Perhaps Dean Wormer of Faber College ("Animal House") is advising the NY Executive office.Pat Kelahannoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-77725978752749156932020-01-08T19:45:19.711-05:002020-01-08T19:45:19.711-05:00I'm sure the commuter also went through the &q...I'm sure the commuter also went through the "cash lane" instead of EZ Pass on all those trips. Great job, Roy....Dave B.noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-19586308129969934512019-09-09T08:49:58.223-04:002019-09-09T08:49:58.223-04:00I love your blog. Have been following it for years...I love your blog. Have been following it for years. Glad you are sharing these cases and your thoughts again!Mike Fnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-78304976586045092132019-01-29T11:46:45.677-05:002019-01-29T11:46:45.677-05:00So glad to see you updating this. This is by far t...So glad to see you updating this. This is by far the best coverage blog. Keep up the amazing work. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-62390197072530386402018-06-26T07:57:32.211-04:002018-06-26T07:57:32.211-04:00Certainly a wise carrier adjuster will keep a PA a...Certainly a wise carrier adjuster will keep a PA appraised of pertinent customer communications, but it is agreed- there is no prohibition of a carrier adjuster contacting an insured. One must respect a customer's wishes if all communications are requested to be made with the PA, but a prohibition does not exist by regulation.<br />Legal, regulatory and policy requirement communications are to be made with the insured, copied to the PA as warranted. A good topic.Patrick Kelahannoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-70871530344929613922018-05-22T10:42:13.763-04:002018-05-22T10:42:13.763-04:00Permission to appeal is being sought. There is no ...Permission to appeal is being sought. There is no requirement under the policy that a caretaker be hired or even a friend or family be asked to enter a person's home during the winter to check on the heat. The insured was away from the premises due to an injury she eventually died from. She gave an statement to the carrier's representative while she was alive that the heat was on. The defendant's expert established that there was little gas usage but did not establish that the thermostat was down too low or off and when the boiler stopped working or specifically why it stopped working such as power outage, pilot light going out or other reasons other than low gas usage. None of the heating equipment was examined or tested. Did it fail the day after she left or several days after she left the premises? If people go to Florida or other warm climates in the winter do they now have to hire someone to "maintain the heat"? Isn't it a question of fact and not as a matter of law under the facts of this case whether the heat was maintained ? The terms "maintain the heat" are not defined any further under the policy. Lets hope the court of Appeals takes it up.Gustave DeTragliahttps://www.blogger.com/profile/08872807558565619226noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-76221338454046317762018-05-13T01:32:42.105-04:002018-05-13T01:32:42.105-04:00Well, I for one want to thank you for providing th...Well, I for one want to thank you for providing this information and updating the document as even the Westlaw site is unreliable when trying to access this regulation. I am currently in negotiations with my insurer regarding their laughably low valuation of my motorcycle and knowing the regulation is very helpful.<br />Many thanks!Sascha M.https://www.blogger.com/profile/12330404190943429560noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-70060346386881391662018-03-02T17:37:30.977-05:002018-03-02T17:37:30.977-05:00I think we can agree on this: Lawyers are guarante...I think we can agree on this: Lawyers are guaranteed to use the decision to go fishing, thereby requiring courts to winnow demands and exercise in camera reviews. There is no way in hell that footnote comes true.<br /><br />The courts will be swamped by lawyers trying to give this decision a more expansive read than I think was intended.<br /><br />I'm expecting a cascade of litigation over the issue.<br /><br />All the best,<br />--Eric T.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-56402340037580546872018-02-27T12:23:46.518-05:002018-02-27T12:23:46.518-05:00I don't think I've over-read the decision,...I don't think I've over-read the decision, at all. It now aligns New York's rule of discovery of non-public social media content with the FRCP rule (see Giacchetto, 293 FRD 112 https://www.sfbar.org/forms/cle/yosemite2014/panel1/Giachetto.pdf). Material and necessary is all that's required, and a discovery demand that is "appropriately tailored and reasonably calculated" to discover such information should withstand accusations and challenges that they are improper fishing expeditions. And as Judge DiFiore observed in Footnote #2 of the opinion, if attorneys do their jobs as "officers of the court", there should be "little need for a court in the first instance to winnow the demand or exercise its in camera review power to cull through the universe of potentially responsive materials to determine which are subject to discovery." <br /><br />Not sure what you mean by "[l]itigants must still make a good faith showing that there is something discoverable." If you mean that the party seeking the disclosure still needs to show a factual predicate (that there's something there), I have to disagree with you. The factual predicate requirement of earlier New York case law is gone.Roy A. Murahttps://www.blogger.com/profile/06367888044845855898noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-43268306429830036082018-02-27T11:26:16.836-05:002018-02-27T11:26:16.836-05:00I think you've over-read the decision. It focu...I think you've over-read the decision. It focuses on the distinction between public and private, essentially saying that there is none. <br /><br />This is the same as if someone wrote about their busted arm in their private diary. That would be discoverable, but the parts about romantic encounters or visits to the Gyn would not be.<br /><br />Litigants must still make a good faith showing that there is something discoverable.<br /><br />I do predict, however, that a small army of referees will be needed to handle the many<i>in camera</i> reviews that will be necessary as a result of attempted fishing expeditions.<br /><br />--Eric T. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-42622676519095100212016-10-11T10:32:50.998-04:002016-10-11T10:32:50.998-04:00"State Farm has demonstrated that Gloria'..."State Farm has demonstrated that Gloria's acts were intentional and therefore not an occurrence under the homeowner's policy as an intentional act is not an "accident." <br />---<br />"the Court finds that the policy provisions are not ambiguous, and that the dispute <br />between the parties turns on whether the alleged assault constitutes an occurrence <br />or loss under the State Farm policies." <br />---<br />If State Farm demonstrated the acts were intentional - what is left to prove? I think after the criminal plea/conviction it is no longer an "alleged" assault.Tom Murinhttps://www.blogger.com/profile/09763200486501331592noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-79371736168113594402016-10-04T22:56:43.250-04:002016-10-04T22:56:43.250-04:00Yes, interpleader is available in New York, althou...Yes, interpleader is available in New York, although I haven't seen it used for third-party claims. Just first-party claims, although yours is an interesting thought. Roy A. Murahttps://www.blogger.com/profile/06367888044845855898noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-73419804872369492016-10-04T21:55:13.439-04:002016-10-04T21:55:13.439-04:00Can you file an interpleader in NY?Can you file an interpleader in NY?Tom Murinhttps://www.blogger.com/profile/09763200486501331592noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-13284825670875109172015-09-08T09:53:56.428-04:002015-09-08T09:53:56.428-04:00I am a huge Google Scholar fan. Other than search ...I am a huge Google Scholar fan. Other than search and Google+, it's the Google tool I use most in my day-to-day work. I developed a continuing education course last year on the scaffold law, and Google Scholar was invaluable. Highly recommended. Tim Dodgehttp://www.iiabny.orgnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-27662904422283058902015-01-12T12:32:29.666-05:002015-01-12T12:32:29.666-05:00I disagree. The ruling is no more a facile attemp...I disagree. The ruling is no more a facile attempt to circumvent precedent than you would want folks to perceive your comment to be a facile attempt to advertise. Liability insurers that have an opportunity to defend their insureds but don't can't challenge the merits of any judgment subsequently taken against their insureds. Liability insurers that don't have the opportunity to defend -- because of the lack of notice until AFTER a judgment has been taken -- should be able to challenge the merits of the underlying judgment if, of course, they are found to owe coverage. No circumvention needed. The Second Department correctly recognized that the Lang v. Hanover rule did not apply. Privity has nothing to do with it.Roy A. Murahttps://www.blogger.com/profile/06367888044845855898noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-22564937455324698242015-01-12T00:21:35.345-05:002015-01-12T00:21:35.345-05:00This case is a facile attempt by the Appellate Div...This case is a facile attempt by the Appellate Division to improperly circumvent the time-honored rule that a liability insurer is in privity with its insured, as its indemnitor, and under Lang-v-Hanover, is thus bound by the covered factual and/or legal basis supporting a liability or damages determination already adjudicated against its insured in the underlying tort action, unless there is some independent basis upon which it can still disclaim coverage (See, K2 Investment Group v. American Guarantee & Liability Insurance, 22 N.Y.3d 578). <br /><br />Here, it appears that the only possible independent basis for disclaimer available to insurer NYCM was late notice, which at the time of the underlying matter ostensibly was governed by New York's "no-prejudice" rule applicable to liability policies issued or delivered in New York before January 17, 2009. So, short of being able to successfully disclaim predicated on late notice or some other independent basis, NYCM would have been stuck covering the loss in question!<br /><br />Yours,<br /><br />Matthew Siegel, President<br />Telesis Liability Insurance Coverage Software<br />White Plains, New YorkMatthew siegelnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-51259515150597734012014-06-19T12:15:10.723-04:002014-06-19T12:15:10.723-04:00Larry, the policy only said "operating."...Larry, the policy only said "operating." If it said "use" then I'm sure the passenger would be insured. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-50908861288453121832014-04-22T10:52:33.987-04:002014-04-22T10:52:33.987-04:00This comment has been removed by a blog administrator.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-65687929999257228512014-04-19T13:10:01.661-04:002014-04-19T13:10:01.661-04:00Thank you for this heads up. This was just tried o...Thank you for this heads up. This was just tried on me by Mr Lin. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-46117094448897197322014-02-28T11:58:12.986-05:002014-02-28T11:58:12.986-05:00Good ruling by the state of NY. I had a large 4 mi...Good ruling by the state of NY. I had a large 4 million dollar loss where the dispute went on for 3 years. Even after that the home could not have been built within a two year time frame.Joe Brennanhttp://www.insuranceclaimsgroup.comnoreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-50711870125639392632014-02-25T07:54:55.394-05:002014-02-25T07:54:55.394-05:00Would the code or ordinance exclusion found in mos...Would the code or ordinance exclusion found in most Homeowners policies be of any help ? The delay in repairs was reportedly caused by code problems? Anonymoushttps://www.blogger.com/profile/13378859646470308832noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-55930796162295341462014-02-04T08:31:00.414-05:002014-02-04T08:31:00.414-05:00Its quite simple, GEICO screwed up.Its quite simple, GEICO screwed up.Anonymoushttps://www.blogger.com/profile/13378859646470308832noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-10016328486322113302013-12-11T14:16:09.497-05:002013-12-11T14:16:09.497-05:00@Heidi - it sounds to me like you are right - she ...@Heidi - it sounds to me like you are right - she negotiated the contract and the stipulations thereof, and assuming the contract released the contractor from liability, this would not be a case of fraud.Tarahttp://threecbodyshop.com/noreply@blogger.comtag:blogger.com,1999:blog-4754540220266106237.post-49456149798700483382013-09-23T14:48:27.566-04:002013-09-23T14:48:27.566-04:00Still wouldn't be covered under a standard per...Still wouldn't be covered under a standard personal auto policy. Roy A. Murahttps://www.blogger.com/profile/06367888044845855898noreply@blogger.com