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Coverage Counsel - 5 new articles
No-Fault Insurer Found Entitled to Breakdown of What Hospital Services Constituted Necessary Emergency Health Services
NO-FAULT – NECESSARY EMERGENCY HEALTH SERVICES – STABILIZATION – INTOXICATION-CAUSED INJURIESSt. Barnabas Hospital v. Government Employees Insurance Company
(Sup. Ct., Nassau Co., decided 2/1/2017)
Once upon a time (before 2011) New York no-fault insurers could deny personal injury protection (no-fault) coverage benefits to a person "injured as a result of operating a motor vehicle while in an intoxicated condition or while his ability to operate such vehicle is impaired by the use of a drug within the meaning of section  of the vehicle and traffic law[.]"
Since January 26, 2011, when the amended Insurance Law § 5103(b)(2) went into effect, however, New York no-fault insurers could no longer exclude from coverage payments for "necessary emergency health services rendered in a general hospital" to a person injured as the result of operating a motor vehicle while in an alcohol intoxicated or drug impaired condition.
In August 2015 I blogged about the new law and was surprised to report that in the more than four years since the new law's effective date, no New York court had yet issued a decision on its interpretation and application to no-fault claims. ...
PROPERTY – RESIDENCY REQUIREMENT – CHANGE IN OCCUPANCY – AGENT LIABILITY
At some point after the plaintiffs had moved, plaintiffs' two sons, a cousin, and a friend began staying at the insured dwelling at different times and for various amounts of time. The house was destroyed by a fire on August 30, 2012. After plaintiffs filed a claim for insurance coverage, Allstate disclaimed liability on the ground that, as plaintiffs had not resided in the home for nearly three years, the home did not meet the policy's definition of a covered "dwelling".
I've blogged several times about the consumer advisory paragraph of New York Insurance Regulation 64 (11 NYCRR Part 216). Personal Lines insurers that do business in New York State should know that Regulation 64 requires certain letters to "prominently set out" a certain paragraph advising those to whom your letters are addressed that they may complain about you or your coverage position to New York's insurance regulator, known since October 2011 as the New York State Department of Financial Services.
Should you wish to take this matter up with the New York State Department of Financial Services, you may file with the Department either on its website at http://www.dfs.ny.gov/consumer/fileacomplaint.htm or you may write to or visit the Consumer Assistance Unit, Financial Frauds and Consumer Protection Division, New York State Department of Financial Services, at: One State Street, New York, NY 10004; One Commerce Plaza, Albany, NY...
It has been said that someone who lies about little things will lie about big things. Not may lie. Will lie. True or not, many jurisdictions recognize the legal maxim of falsus in uno, falsus in omnibus ("false in one thing, false in everything"), at least in terms of permitting the principle to be charged to juries or otherwise applied by the trier-of-fact.
If you find that any witness has wilfully testified falsely as to any material fact, that is as to an important matter, the law permits you to disregard completely the entire testimony of that witness upon the principle that one who testifies falsely about one material fact is likely to testify falsely about everything. You are not required, however, to consider such a witness as totally "unbelievable." You may accept so much of his or her testimony as you deem true and disregard what you feel is false. By the processes which I have just described to you, you, as the sole judges of the facts, decide which of the witnesses you will believe, what portion of their testimony you accept and what weight you will give to it....
COMMERCIAL PROPERTY – TURKEY FLOATER POLICY – MALICIOUS MISCHIEF
A poult is a young turkey being raised for food. Plaintiff's family owned and operated a turkey farm in Iowa (still does, apparently, albeit with two fewer barns and 11,000-12,000 fewer turkeys as of two weeks ago) that as of 1965 had raised and marketed about 9,500 turkeys a year for 15 years. ...