Victim of random drive by shooting not due uninsured motorist benefits
Uninsured And Underinsured Motorist Claims In New York
22
G G OLDBERG OLDBERG S S EGALLA EGALLA LLP LLP Philadelphia New York Buffalo Rochester Syracuse Albany White Plains Long Isl Princeton Hartford UNINSURED AND UNDERINSURED MOTORIST CLAIMS: UNDERSTAND WHAT THE INSURER IS - AND ISN’T - RESPONSIBLE FOR Paul D. McCormick, Esq. Goldberg Segalla LLP 665 Main Street / Suite 400 Buffalo, New York 14203-1425 716.566.5466 Fax: 716.566.5401 Email: [email protected] Website: www.goldbergsegalla.com
description
A PowerPoint explaining what the insurer is responsible for in terms of uninsured (UM) and underinsured (UIM or SUM) coverage in New York.
Transcript of Uninsured And Underinsured Motorist Claims In New York
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLPPhiladelphia New York Buffalo Rochester Syracuse Albany White Plains Long Island Princeton Hartford
UNINSURED AND UNDERINSURED MOTORIST CLAIMS:
UNDERSTAND WHAT THE INSURER IS - AND ISN’T - RESPONSIBLE FOR
Paul D. McCormick, Esq.Goldberg Segalla LLP
665 Main Street / Suite 400Buffalo, New York 14203-1425
716.566.5466Fax: 716.566.5401
Email: [email protected]
Website: www.goldbergsegalla.com
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
A. The Details Of Offering/Purchasing Coverage, Waiving Coverage And Selecting Limits
• Uninsured Motorist (UM) Coverage
• Supplemental Uninsured/Underinsured Motorist (SUM) Coverage– SUM and UIM are often used interchangeably.
• History
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
– The MVAICA established the Motor Vehicle Accident Indemnification Corporation (MVAIC).
– The AAIC required that every New York automobile liability policy include a mandatory UM coverage endorsement.
– Because motorist who carry no liability insurance are not the only motorists who are “financially irresponsible,” further protection was afforded to innocent victims against those motorists who were insured but did not carry sufficient liability insurance limits with the adoption of SUM coverage in 1977.
Statutory and Regulatory Scheme
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
– Mandatory• “Uninsured Motor Vehicle”
– “Serious Injury”
– Limits
– Post-Regulation 35-D• If SUM coverage is purchased, the SUM
endorsement applies instead of the mandatory UM endorsement.
UM Coverage
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
– Definition
– Limits
– SUM notification• Requirements• Exception to the general rule
– Of course, the general rule that an agent or broker may be held liable for failing to procure insurance requested by the insured still applies.
SUM Coverage
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
B. Nature And Extent Of UM And SUM Coverages
Types of Claimants– UM and SUM coverage claims are divided into two
categories:
1. “Insured Persons”
2. “Qualified Persons”
– Condition of recovery
– Mutually exclusive
– Coverage the same or different?
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Claims Involving “Insured Persons”
– Scope of coverage
1. “Named Insureds” and resident spouses and relatives.
• How determine?
• Corporate or governmental entity
• “Resident spouses and relatives”
• The widest possible scope of coverage
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
2. “Occupancy Insureds”
– Definition
– Inclusions / Exclusions
– “Occupying”
3. “Derivative Insureds”
– Definition
– Generally includes …
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Claims Involving “Qualified Persons”
– Who?
– Statutory definition
– Exclusions
– The scope of coverage
• What does that mean?
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
C. Measure The Impact Of Step-Down Provisions
• What is a step-down provision?
• Do the New York mandatory UM endorsement or the SUM endorsement contain such provisions?
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
D. Stacking Of Coverages And Excess Liability
• Generally prohibited as a matter of policy
• UM Coverage
– Rule
– Exception
• SUM Coverage
– Anti-stacking provision
– “Priority of Coverage” provision
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
E. Exclusions And Limitations On Coverage
1. Offending Vehicle Must Be “Uninsured” or “Underinsured”
– Condition precedent to recovery
– Joint tortfeasors
– Case-by-case basis
– Situations in which offending vehicles have been found to be “uninsured
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
– Stolen vehicles/vehicles operated without the permission of the owner
– Hit-and-run vehicles
– Motor vehicles specifically excluded from the definitions of an “uninsured motor vehicle” found in either the mandatory UM endorsement or the SUM endorsement
– Motor vehicles owned or operated by a self-insurer or a governmental subdivision or agency
– Motor vehicles specifically excluded from the definitions of an “uninsured motor vehicle under the under the SUM endorsement
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
2. Offending Vehicle Must Be a “Motor Vehicle”
– Definition of a “motor vehicle”
– What is considered a “motor vehicle”
– Exclusions
3. Offending Vehicle Must Be “Underinsured”
– “Trigger”
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
4. Injury Must Be Caused By An “Accident”
– “Accident” versus intentional act
5. Injury Must Arise Out of the Ownership, Maintenance or Use of the Offending Vehicle
– UM coverage– SUM coverage– MVAIC.
6. UM Coverage Only Applies To Accidents Occurring in New York
– Unlike SUM coverage– Exceptions
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
7. Express UM and SUM Endorsement Exclusions
– Operating his or her motor vehicle with a suspended license
– Settling with/proceeding to judgment without the written consent of the UM insurer
– SUM endorsement Condition 10• Effect of violation• Notification and insurer’s options
– SUM endorsement Condition 9• It is the coverage of only a single offending vehicle,
and not the total number of tortfeasor vehicles involved in the accident, that must be exhausted.
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
F. How To Proceed With Injury Claims
Filing a Notice of Intention to Make Claim
– Condition precedent
• “Qualified Persons”
– In affidavit form
• Requirements (5)
• “Insured Persons”
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
G. Offsets And Reimbursements
• Provisions reducing the insurer’s liability, either through offsets or reduction-in-coverage clauses.
– UM endorsement
• “All sums …”
• Zero
– MVAIC statute
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Offsets And Reimbursements (cont.)
• SUM endorsement– The difference between the SUM limits and …
• Workers’ compensation or disability benefits– “Limits of Liability” provision of the UM
endorsement– “Limits of Liability” provision of the SUM
endorsement• “Nonduplication” condition• Offset for no-fault payments?
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
H. Does The Insurer Have Subrogation Rights To UM Benefits?
• UM endorsement
• SUM endorsement
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
I. Statute Of Limitations
• UM endorsement– 6-year SOL applicable to contract actions
• Accrual• Where more than 6 years has elapsed between the DOA and
the presentation of the UM claim, the claimant has the burden of showing that an accrual date later than the date of the accident is applicable.
• SUM endorsement?
• MVAIC– 3-year SOL applicable to personal injury actions.
• Tolling?
• Insurer’s 3-year subrogation action accrual date
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLPPhiladelphia New York Buffalo Rochester Syracuse Albany White Plains Long Island Princeton Hartford
UNINSURED AND UNDERINSURED MOTORIST CLAIMS:
UNDERSTAND WHAT THE INSURER IS - AND ISN’T - RESPONSIBLE FOR
Paul D. McCormick, Esq.Goldberg Segalla LLP
665 Main Street / Suite 400Buffalo, New York 14203-1425
716.566.5466Fax: 716.566.5401
Email: [email protected]
Website: www.goldbergsegalla.com
