UNINSURED AND UNDERINSURED MOTORIST CLAIMS: UNDERSTAND WHAT THE INSURER IS - AND ISN’T - RESPONSIBLE FOR Paul D. McCormick...
A.  The Details Of Offering/Purchasing Coverage, Waiving Coverage And Selecting Limits <ul><li>Uninsured Motorist (UM) Cov...
<ul><ul><li>The MVAICA established the Motor Vehicle Accident Indemnification Corporation (MVAIC). </li></ul></ul><ul><ul>...
<ul><ul><li>Mandatory </li></ul></ul><ul><ul><ul><li>“ Uninsured Motor Vehicle” </li></ul></ul></ul><ul><ul><li>“ Serious ...
<ul><ul><li>Definition </li></ul></ul><ul><ul><li>Limits </li></ul></ul><ul><ul><li>SUM notification </li></ul></ul><ul><u...
B.  Nature And Extent Of UM And SUM Coverages <ul><li>Types of Claimants </li></ul><ul><ul><li>UM and SUM coverage claims ...
<ul><li>Claims Involving “Insured Persons” </li></ul><ul><ul><li>Scope of coverage </li></ul></ul><ul><li>1.  “Named Insur...
<ul><li>“ Occupancy Insureds” </li></ul><ul><ul><li>Definition </li></ul></ul><ul><ul><li>Inclusions / Exclusions </li></u...
<ul><li>Claims Involving “Qualified Persons” </li></ul><ul><ul><li>Who? </li></ul></ul><ul><ul><li>Statutory definition </...
C.  Measure The Impact Of Step-Down Provisions <ul><li>What is a step-down provision? </li></ul><ul><li>Do the New York ma...
D.  Stacking Of Coverages And Excess Liability <ul><li>Generally prohibited as a matter of policy </li></ul><ul><li>UM Cov...
E.  Exclusions And Limitations On Coverage <ul><li>1.  Offending Vehicle Must Be “Uninsured” or  “Underinsured” </li></ul>...
<ul><ul><li>Stolen vehicles/vehicles operated without the permission of the owner </li></ul></ul><ul><ul><li>Hit-and-run v...
<ul><li>2.  Offending Vehicle Must Be a “Motor Vehicle” </li></ul><ul><ul><li>Definition of a “motor vehicle” </li></ul></...
<ul><li>4.  Injury Must Be Caused By An “Accident” </li></ul><ul><ul><li>“ Accident” versus intentional act </li></ul></ul...
<ul><li>7.  Express UM and SUM Endorsement Exclusions </li></ul><ul><ul><li>Operating his or her motor vehicle with a susp...
F.  How To Proceed With Injury Claims <ul><li>Filing a Notice of Intention to Make Claim  </li></ul><ul><ul><li>Condition ...
G.  Offsets And Reimbursements <ul><li>Provisions reducing the insurer’s liability, either through offsets or reduction-in...
Offsets And Reimbursements (cont.) <ul><li>SUM endorsement </li></ul><ul><ul><li>The difference between the SUM limits and...
H.  Does The Insurer Have Subrogation Rights To UM Benefits? <ul><li>UM endorsement </li></ul><ul><li>SUM endorsement </li...
I.  Statute Of Limitations <ul><li>UM endorsement </li></ul><ul><ul><li>6-year SOL applicable to contract actions </li></u...
UNINSURED AND UNDERINSURED MOTORIST CLAIMS: UNDERSTAND WHAT THE INSURER IS - AND ISN’T - RESPONSIBLE FOR Paul D. McCormick...
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Uninsured And Underinsured Motorist Claims In New York

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A PowerPoint explaining what the insurer is responsible for in terms of uninsured (UM) and underinsured (UIM or SUM) coverage in New York.

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Uninsured And Underinsured Motorist Claims In New York

  1. 1. 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_address] Website: www.goldbergsegalla.com
  2. 2. A. The Details Of Offering/Purchasing Coverage, Waiving Coverage And Selecting Limits <ul><li>Uninsured Motorist (UM) Coverage </li></ul><ul><li>Supplemental Uninsured/Underinsured Motorist (SUM) Coverage </li></ul><ul><ul><li>SUM and UIM are often used interchangeably. </li></ul></ul><ul><li>History </li></ul>
  3. 3. <ul><ul><li>The MVAICA established the Motor Vehicle Accident Indemnification Corporation (MVAIC). </li></ul></ul><ul><ul><li>The AAIC required that every New York automobile liability policy include a mandatory UM coverage endorsement. </li></ul></ul><ul><ul><li>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. </li></ul></ul>Statutory and Regulatory Scheme
  4. 4. <ul><ul><li>Mandatory </li></ul></ul><ul><ul><ul><li>“ Uninsured Motor Vehicle” </li></ul></ul></ul><ul><ul><li>“ Serious Injury” </li></ul></ul><ul><ul><li>Limits </li></ul></ul><ul><ul><li>Post-Regulation 35-D </li></ul></ul><ul><ul><ul><li>If SUM coverage is purchased, the SUM endorsement applies instead of the mandatory UM endorsement. </li></ul></ul></ul>UM Coverage
  5. 5. <ul><ul><li>Definition </li></ul></ul><ul><ul><li>Limits </li></ul></ul><ul><ul><li>SUM notification </li></ul></ul><ul><ul><ul><li>Requirements </li></ul></ul></ul><ul><ul><ul><li>Exception to the general rule </li></ul></ul></ul><ul><ul><ul><ul><li>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. </li></ul></ul></ul></ul>SUM Coverage
  6. 6. B. Nature And Extent Of UM And SUM Coverages <ul><li>Types of Claimants </li></ul><ul><ul><li>UM and SUM coverage claims are divided into two categories: </li></ul></ul><ul><ul><ul><li>“ Insured Persons” </li></ul></ul></ul><ul><ul><ul><li>“ Qualified Persons” </li></ul></ul></ul><ul><ul><li>Condition of recovery </li></ul></ul><ul><ul><li>Mutually exclusive </li></ul></ul><ul><ul><li>Coverage the same or different? </li></ul></ul>
  7. 7. <ul><li>Claims Involving “Insured Persons” </li></ul><ul><ul><li>Scope of coverage </li></ul></ul><ul><li>1. “Named Insureds” and resident spouses and relatives. </li></ul><ul><ul><ul><li>How determine? </li></ul></ul></ul><ul><ul><ul><li>Corporate or governmental entity </li></ul></ul></ul><ul><ul><ul><li>“ Resident spouses and relatives” </li></ul></ul></ul><ul><ul><ul><li>The widest possible scope of coverage </li></ul></ul></ul>
  8. 8. <ul><li>“ Occupancy Insureds” </li></ul><ul><ul><li>Definition </li></ul></ul><ul><ul><li>Inclusions / Exclusions </li></ul></ul><ul><ul><li>“ Occupying” </li></ul></ul><ul><li>“ Derivative Insureds” </li></ul><ul><ul><li>Definition </li></ul></ul><ul><ul><li>Generally includes … </li></ul></ul>
  9. 9. <ul><li>Claims Involving “Qualified Persons” </li></ul><ul><ul><li>Who? </li></ul></ul><ul><ul><li>Statutory definition </li></ul></ul><ul><ul><li>Exclusions </li></ul></ul><ul><ul><li>The scope of coverage </li></ul></ul><ul><ul><ul><li>What does that mean? </li></ul></ul></ul>
  10. 10. C. Measure The Impact Of Step-Down Provisions <ul><li>What is a step-down provision? </li></ul><ul><li>Do the New York mandatory UM endorsement or the SUM endorsement contain such provisions? </li></ul>
  11. 11. D. Stacking Of Coverages And Excess Liability <ul><li>Generally prohibited as a matter of policy </li></ul><ul><li>UM Coverage </li></ul><ul><ul><li>Rule </li></ul></ul><ul><ul><li>Exception </li></ul></ul><ul><li>SUM Coverage </li></ul><ul><ul><li>Anti-stacking provision </li></ul></ul><ul><ul><li>“ Priority of Coverage” provision </li></ul></ul>
  12. 12. E. Exclusions And Limitations On Coverage <ul><li>1. Offending Vehicle Must Be “Uninsured” or “Underinsured” </li></ul><ul><ul><li>Condition precedent to recovery </li></ul></ul><ul><ul><li>Joint tortfeasors </li></ul></ul><ul><ul><li>Case-by-case basis </li></ul></ul><ul><ul><li>Situations in which offending vehicles have been found to be “uninsured </li></ul></ul>
  13. 13. <ul><ul><li>Stolen vehicles/vehicles operated without the permission of the owner </li></ul></ul><ul><ul><li>Hit-and-run vehicles </li></ul></ul><ul><ul><li>Motor vehicles specifically excluded from the definitions of an “uninsured motor vehicle” found in either the mandatory UM endorsement or the SUM endorsement </li></ul></ul><ul><ul><li>Motor vehicles owned or operated by a self-insurer or a governmental subdivision or agency </li></ul></ul><ul><ul><li>Motor vehicles specifically excluded from the definitions of an “uninsured motor vehicle under the under the SUM endorsement </li></ul></ul>
  14. 14. <ul><li>2. Offending Vehicle Must Be a “Motor Vehicle” </li></ul><ul><ul><li>Definition of a “motor vehicle” </li></ul></ul><ul><ul><li>What is considered a “motor vehicle” </li></ul></ul><ul><ul><li>Exclusions </li></ul></ul><ul><li>3. Offending Vehicle Must Be “Underinsured” </li></ul><ul><ul><li>“ Trigge r” </li></ul></ul>
  15. 15. <ul><li>4. Injury Must Be Caused By An “Accident” </li></ul><ul><ul><li>“ Accident” versus intentional act </li></ul></ul><ul><li>5. Injury Must Arise Out of the Ownership, Maintenance or Use of the Offending Vehicle </li></ul><ul><ul><li>UM coverage </li></ul></ul><ul><ul><li>SUM coverage </li></ul></ul><ul><ul><li>MVAIC. </li></ul></ul><ul><li>6. UM Coverage Only Applies To Accidents Occurring in New York </li></ul><ul><ul><li>Unlike SUM coverage </li></ul></ul><ul><ul><li>Exceptions </li></ul></ul>
  16. 16. <ul><li>7. Express UM and SUM Endorsement Exclusions </li></ul><ul><ul><li>Operating his or her motor vehicle with a suspended license </li></ul></ul><ul><ul><li>Settling with/proceeding to judgment without the written consent of the UM insurer </li></ul></ul><ul><ul><li>SUM endorsement Condition 10 </li></ul></ul><ul><ul><ul><li>Effect of violation </li></ul></ul></ul><ul><ul><ul><li>Notification and insurer’s options </li></ul></ul></ul><ul><ul><li>SUM endorsement Condition 9 </li></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul>
  17. 17. F. How To Proceed With Injury Claims <ul><li>Filing a Notice of Intention to Make Claim </li></ul><ul><ul><li>Condition precedent </li></ul></ul><ul><li>“ Qualified Persons” </li></ul><ul><ul><li>In affidavit form </li></ul></ul><ul><ul><ul><li>Requirements (5) </li></ul></ul></ul><ul><li>“ Insured Persons” </li></ul>
  18. 18. G. Offsets And Reimbursements <ul><li>Provisions reducing the insurer’s liability, either through offsets or reduction-in-coverage clauses. </li></ul><ul><ul><li>UM endorsement </li></ul></ul><ul><ul><ul><li>“ All sums …” </li></ul></ul></ul><ul><ul><ul><li>Zero </li></ul></ul></ul><ul><ul><li>MVAIC statute </li></ul></ul>
  19. 19. Offsets And Reimbursements (cont.) <ul><li>SUM endorsement </li></ul><ul><ul><li>The difference between the SUM limits and … </li></ul></ul><ul><li>Workers’ compensation or disability benefits </li></ul><ul><ul><li>“ Limits of Liability” provision of the UM endorsement </li></ul></ul><ul><ul><li>“ Limits of Liability” provision of the SUM endorsement </li></ul></ul><ul><ul><ul><li>“ Nonduplication” condition </li></ul></ul></ul><ul><ul><ul><li>Offset for no-fault payments? </li></ul></ul></ul>
  20. 20. H. Does The Insurer Have Subrogation Rights To UM Benefits? <ul><li>UM endorsement </li></ul><ul><li>SUM endorsement </li></ul>
  21. 21. I. Statute Of Limitations <ul><li>UM endorsement </li></ul><ul><ul><li>6-year SOL applicable to contract actions </li></ul></ul><ul><ul><ul><li>Accrual </li></ul></ul></ul><ul><ul><ul><li>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. </li></ul></ul></ul><ul><li>SUM endorsement? </li></ul><ul><li>MVAIC </li></ul><ul><ul><li>3-year SOL applicable to personal injury actions. </li></ul></ul><ul><li>Tolling? </li></ul><ul><li>Insurer’s 3-year subrogation action accrual date </li></ul>
  22. 22. 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_address] Website: www.goldbergsegalla.com

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