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Insurance Coverage

posted May 6, 2018, 7:25 AM by Michael Treybich   [ updated May 6, 2018, 8:16 AM ]
May, 2018

My client, a family-owned Pharmacy in Port Jervis, NY was recently sued by one of its customers, who claimed that he slipped, fell and was injured on the sidewalk in front of the business.

In and of itself, that does not make this particular case noteworthy, nor is it when my participation began, but rather, after my client timely tendered the claim to its insurance carrier, the insurer disclaimed coverage.

The insurance broker had made a mistake when they placed my client into a “claims made” insurance policy, instead of an “occurrence based” insurance policy. Usually, that kind of mistake is not actionable, but it became something more because at the time the policy was being shopped for, the insurance broker lied to my client when they wrote that they were placing them into an occurrence based policy.

A claims based policy, which is usually less expensive, provides insurance only if the claim is made (i.e., filing of the lawsuit) during the policy period, or during the tail which may be purchased separately. This is important, because the typical insurance policy is one year, while the statute of limitations for negligence (any slip and fall) is three years from the injury.

An occurrence based policy provides insurance if the incident which is the basis for the claim occurs during the policy period.

In short, my client had no insurance for this slip and fall because the broker had placed them with a different type of policy than what they had told the client.

Treybich Law, P.C. answered the slip and fall plaintiff’s complaint, and after demanding that the insurance broker defend my client, I engaged in negotiations with the attorney for the insurance broker.

We were able to settle with both the slip and fall plaintiff and with the insurance broker by having the insurance broker pay off the slip and fall plaintiff and my client’s attorney’s fees.

As always, prior results cannot and do not guarantee a similar outcome.


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