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Picciano & Scahill, P.C. Newsletter
iNews
In this Issue
Decisions of Note
Turning up the Heat in Court
No-fault Drama
Featured Employee

DENISE GAGLIANO  
Denise

Denise Gagliano is a legal assistant in our No-Fault department. She started with the firm in 2007 and brings years of valuable experience to Picciano & Scahill, P.C.. Known for her attention to detail, critical in the world of PIP Litigation, Denise assists the managing attorney in case preparation and discovery matters. Denise is just one of the reasons we are able to provide consistent quality legal services for our clients.
Results that Matter

Congratulations  

to

Isaac Dana

dana 

for a defendant's verdict on damages in the matter of  Mohammed M. Shaaban v. Eric Cohen and Sharon S. Cohen (Index No. 100473/09) in Richmond  County on February 18, 2011.

 

 

Congratulations  

to

Frank Scahill

Frank Scahill 

for an impressive result in the Matter of Alicea v. Ferrandino (Index No. 22546/07) with a damages verdict limited to $285,000 following a two week trial before Judge F. Dana Winslow. The defendants were found 100% responsible on  liability in this automobile negligence action and the plaintiff sought damages, based on two back surgeries, in excess of the defendants' policy limits of 1.3 million dollars.


Revised Intoxication Exclusion

Insurance Law § 5103(b)(2) permits a no-fault insurer to exclude, from no-fault insurance coverage, a person who is injured as a result of operating a motor vehicle while in an intoxicated condition or while the person's ability to operate the vehicle is impaired by the use of a drug within the meaning of Vehicle and Traffic Law § 1192. Section 65-3.14(b)(1) of 11 NYCRR 65-3 (Regulation 68-C) states that a no-fault insurer only may exclude a person from coverage if the intoxicated or drugged condition was a contributing cause of the accident causing the injuries.

 

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iNews Issue: 25   February 2011   
Decisions of Note
legal

Legal Malpractice v. a Bad Result. Every Attorney second guesses themselves after a loss. There is always something that you wished you could do differently to turn the tide. Plaintiff's attorneys bemoan a loss because of their financial stake in the case, the years of preparation, and lack of a fee. Defendant's fear the loss of confidence from their carrier clients and wonder how it will affect their business. Lipsig, Shapey, Manus & Moverman, P.C. was Harry Lipsig's firm.  He was one of the most famous and successful lawyers in New York, who was at it well into his 90's. The successor firm which bears his name is well respected and just as successful. Alicia Rodriguez would disagree, I suspect, and she filed a malpractice action against the firm following an adverse result at an arbitration proceeding. She claimed the associate handling the arbitration should have submitted repair bills and photographs of the damage to the automobile which supported her case. The associate made a judgment call that he would not and her malpractice case against the firm was tossed at the appellate level.

 

In an action for legal malpractice, "a plaintiff must demonstrate that [he or she] would have succeeded on the merits of the underlying action but for the attorney's negligence" (Davis v Klein, 88 NY2d 1008, 1009-1010 [1996]; see Dweck Law Firm v Mann, 283 AD2D 292, 293 [2001]). An attorney's "selection of one among several reasonable courses of action does not constitute malpractice" (Rosner v Paley, 65 NY2d 736, 738 [1985]).

 

Here, "Plaintiff's argument that the damage depicted in the photographs would have led the arbitrator to conclude that the uninsured driver was speeding, is insufficient speculation." Small comfort for the firm, I suppose, as a loss is a loss and a client's wrath does cause a high degree of agita.

 

Read full decision here.

__________________________________________________

Schoolyard fights were always over who gets to stay on the court. The older kids ruled when it came to court time even if it was your ball. Insurance Coverage fights are over Timely Notice, Timely disclaimers, Additional Insured's, Exclusions and creating coverage. These are all issues which an insurance defense attorney deals with on a daily basis. When does notice to a carrier by the primary insured constitute notice on a claim involving an additional insured? American Home Assur. Co. v BFC Constr. Corp. (2011 NY Slip Op 01337) decided on February 22, 2011 by the Appellate Division, First Department, reiterated the rule set forth in 2001 under an often quoted case, New York Tel. Co. v Travelers Casualty. & Surety. Co. of America., 280 A.D.2d 268, "The primary insured's forwarding of the summons and complaint in the underlying personal injury action to its carrier, constituted timely notice of the claim involving the additional insured, since the interests of the named insured were not adverse to the interests of the additional insured." Here, Sirius America Insurance Company was the loser in this coverage fight with the Appellate Division indicating, "Sirius' lengthy delays in disclaiming coverage, after it knew or should have known of the purported basis for disclaiming coverage based upon exclusions in its commercial general liability policy, were unreasonable as a matter of law, and thus ineffective (see Insurance Law § 3420[d])."  

 

Read full decision here

________________________________________________

Esteban Rivera and Julieann Rivera had a SUM action that concluded in an Arbitration award in their favor following a AAA arbitration before Bernard Kutner Esq., a AAA arbitrator. Amica Mutual was the SUM carrier with $300,000 SUM coverage.  Rather than issuing an award within the coverage limits and taking the required offset of $100,000 per claimant which the Riveras received from the adverse tortfeasor, Arbitrator Kutner awarded them each $200,000 and the Riveras petitioned the Court to confirm the award. Judge Howard Sherman in a decision issued on February 8, 2011 in Rivera v. Amica Mutual (260296/2010) rejected the Rivera's' reliance upon  Butler v. New York Central Mutual Fire Insurance Company, 274 AD 2d 924 (3rd Dept 2000) where the Appellate Division, Third Department held where the language in a SUM endorsement was ambiguous, the ambiguity must be held against the Insurance Carrier.  

 

The Butler Court framed the question, "On the facts presented here, we are of the opinion that the average insured would reasonably expect that $25,000 of SUM coverage would be available under defendant's policy." Amica argued the fourth department decision in Matter of Graphic Arts Mut. Ins. Co. (Dunham), 303 A.D. 2d 1038 [4th Dept. 2003], was controlling. Where the Court stated "We agree with petitioner that if [the policyholder] were permitted to collect on his SUM claim, respondents would receive in excess of the $100,000 to which they are entitled under the policy. Our determination is in accord with 11 NYCRR 60-2.1 [c] which states that "the maximum amount payable under the SUM coverage shall be the policy's SUM limit reduced and thus offset by motor vehicle bodily injury liability insurance policy or bond payments received from, or on behalf of, any negligent party involved in the accident."

 

11 NYCRR Section 60-2.1 [c] states that the "maximum amount payable under the SUM coverage shall be the policy's SUM limit reduced and thus offset by motor vehicle bodily liability insurance policy or bond payments received from, or on behalf of, any negligent party involved in this accident." Here, the Court declined to follow Butler indicating the Riveras, who collected $100,000 each from the adverse tortfeasor, were only entitled to $50,000 each. "The Court concludes that the policy of Underinsured Coverage is not ambiguous or unenforceable, and that the policy limit of $300,000 is applicable to both petitioners collectively, resulting in an award of $50,000 per petitioner, and not $200,000.00."

In Celebration of "Special Relationships"

Valentine's Day has come and gone and February is the month heartto celebrate "special relationships." What is a special relationship when it comes to insurance brokers and clients?

 

Some of us were fortunate to have Professor Siegel at St. John's Law during the years he taught New York and Federal Practice. He frequently commented on the need for prudence when it comes to matters of insurance, " If only the client could write the check for expanded coverage after the fact." Axis Constr. Corp. v O'Brien Agency, Inc. decided on February 22, 2011, by the Appellate Division, Second Department (2011 NY Slip Op 01419) involved a claim against an insurance broker for failing to procure proper insurance coverage for a client. The law in New York is that "An insurance agent or broker has a common-law duty to obtain requested coverage for a client within a reasonable amount of time, or to inform the client of the inability to do so (see Hoffend & Sons, Inc. v Rose & Kiernan, Inc., 7 NY3d 152, 157; Murphy v Kuhn, 90 NY2d 266, 270Core-Mark Intl. v Swett & Crawford Inc., 71 AD3d 1072Verbert v Garcia, 63 AD3d 1149). Absent a specific request for coverage not already in a client's policy or the existence of a special relationship with the client, an insurance agent or broker has no continuing duty to advise, guide, or direct a client to obtain additional coverage."

 

"A special relationship which gives rise to a duty to advise may exist, inter alia, where "there is a course of dealing over an extended period of time which would have put objectively reasonable insurance agents on notice that their advice was being sought and specially relied on" (Murphy v Kuhn, 90 NY2d at 272)." Here the Appellate Division reversed an award of summary judgment to the plaintiff indicating the plaintiff put forth sufficient evidence in opposition to the motion for summary judgment on the question of a "special relationship" to defeat the motion. A heavy burden indeed and most certainly that "special relationship" between plaintiff and the defendant is on the rocks for good.


Read full decision here.
No-fault Drama
All No Fault attorneys can recite the following mantra in their sleep, complete with citations, "A no-fault provider establishes its prima facie entitlement to summary judgment by proof of the submission to the defendant of a statutory claim form, setting forth the fact and the amount of the loss sustained, and that the defendant had failed to either pay or deny the claim within the requisite 30-day period (see Insurance Law § 5106 [a]; New York & Presbyt. Hosp. v Allstate Ins. Co., 31 AD3d 512[2006]; Mary Immaculate Hosp. v Allstate Ins. Co., 5 AD3d 742 [2004]; see also Westchester Med. Ctr. v Nationwide Mut. Ins. Co., 78 AD3d 1168 [2010]). In order for the claim forms to constitute prima facie proof of the fact and the amount of the loss sustained, the affidavit submitted by the plaintiff in support of its motion for summary judgment must lay a sufficient foundation to establish that the claim forms annexed thereto are admissible under the business records exception to the hearsay rule, which allows a document to be used as proof of the "act, transaction, occurrence or event" recorded in the document (CPLR 4518 [a]; see Art of Healing Medicine, P.C. v Travelers Home & Mar. Ins. [*2]Co., 55 AD3d 644 [2008]; Dan Med., P.C. v New York Cent. Mut. Fire Ins. Co., 14 Misc 3d 44 [App Term, 2d & 11th Jud Dists 2006])." 

 

 

 

Viviane Etienne Med. Care, P.C. v Country-Wide Ins. Co.

decided on February 8, 2011 by the Appellate Term, Second Department (2011 NY Slip Op 21039) dealt with the plaintiff's primary facie case. "Plaintiff sought to lay the requisite foundation for the admission of its claim forms by submitting an affidavit executed by the owner of its third-party billing company, who alleged that plaintiff had provided its medical records to his billing company, that his company had used those records to create the claim forms at issue and that his company had then mailed those claim forms to defendant." The Court cited to Matter of Carothers 914 N.Y.S. 199

decided on December 14, 2010 by the Appellate Division Second Department, "where a third-party billing company merely printed no-fault claim forms, which had been created by the healthcare provider, and mailed them to the insurance company". The Appellate Division held that the testimony of an employee of the billing company failed to provide the requisite foundation to demonstrate that the claim forms should be considered under the business records exception to the hearsay rule, since the billing company did not create the records and there was no showing that its employee was familiar with the plaintiff's record-keeping procedures.

 

In Viviane Etienne the plaintiff sought to circumvent Carothers by stating the plaintiff's medical record billing procedures satisfied CPLR 4518(a) however the owner of the billing company had insufficient knowledge of the plaintiff's practice and procedures. The plaintiff also argued, "that plaintiff's medical records were incorporated into its billing company's records and that its billing company relied upon the medical records in its regular course of business."

 

Nice try, says the Appellate term, "we find that plaintiff failed to make the necessary showing that its billing company incorporated plaintiff's medical records into its own and relied upon them (see Matter of Carothers, __ AD3d __, 2010 NY Slip Op 09256), plaintiff's medical records do not meet the test of the business records exception to the hearsay rule. As a result, the claim forms created by plaintiff's biller from the medical records do not fall within the business records exception to the hearsay rule (see Matter of Leon RR, 48 NY2d 117). Consequently, to the extent plaintiff relies on the claim forms to prove the fact and the amount of the loss sustained, plaintiff has failed to demonstrate that they are any more trustworthy than the claim forms in Matter of Carothers."

 

The Court, in a "Sybil"-like pronouncement, (It is academy award season after all) goes on to state "We note that, simply because a document has not been shown to be admissible pursuant to the business records exception to the hearsay rule, so that it can be used as proof of the matter asserted therein, this does not mean that the document could not be admissible for another purpose (see Prince, Richardson on Evidence § 4-105 [Farrell 11th ed])." And in the next breath states, "the fact that the claim forms are prescribed by regulation does not render them inherently trustworthy or reliable. As recognized by the Court of Appeals, incidents of no-fault fraud are prevalent in New York, including instances where corrupt medical clinics "generate stacks of medical bills for each passenger, detailing treatments and tests that were unnecessary or never performed" (see Matter of Medical Socy. of State of NY v Serio, 100 NY2d 854 [2003])." Ah, no-fault machinations, will this ever be settled?

 

Read full decision here

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