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From the eyes of the insured has its limitsDecember 25, 2014

Nationwide Gen. Ins. Co. v Pontoon, 2014 NY Slip Op 09001 (2d Dept. 2014)

“The referee incorrectly concluded that GEICO was required to submit evidence that Pontoon was involved in staging the collision in order to support a disclaimer of coverage. Contrary to the referee’s conclusion, if GEICO can prove that the collision was staged by Robinson, its insured, it would not be obligated to provide coverage under the policy regardless of whether Pontoon was an innocent third party (see Matter of Travelers Indem. Co. v Richards-Campbell, 73 AD3d 1076, 1077; Matter of Government Empls. Ins. Co. v Shaulskaya, 302 AD2d 522, 523; Morris v Allstate Ins. Co., 261 AD2d 457, 458; see also Matter of Liberty Mut. Ins. Co. v Goddard, 29 AD3d 698, 699; State Farm Mut. Auto Ins. Co. v Laguerre, 305 AD2d 490, 491)”

Perhaps we can call this the staged accident exception to Langan.  I think this is wrong since under Langan, an intentional act is looked at through the perspective of the Claimant.  Here, Pontoon said he had nothing to do with the staged accident.  Under Langan, it would appear that Claimant would be entitled to a framed issue hearing to protest his innocence.  Yet, the Court here is saying that where there is evidence of a staged accident scheme, anyone seeking coverage is barred (regardless of whether they were aware of it).  All I can say is wow.

5 Responses

  1. Anonymous says:

    The decision is clearly wrong under Langan. Someone over there had a brain fart.

  2. Anonymous says:

    I have reviewed the decision. I think the Court was making a distinction between liability coverage and first party coverage, to wit, uninsured motorist and no-fault. What I think the Court is saying is that Geico as THE THIRD PARTY LIABILITY insurer does not have to prove that the injured party was a participant in the staged action in order to disclaim liability insurance to its insured. As I read the decision, it does not apply to either uninsured motorist or no-fault. Therefore, I do not believe that there is a staged accident exception to Lagan.

  3. Anonymous says:

    Good point, Anonymous #2. Langan applies to UM and no-fault, not liability. Here, the court never reached the issue of whether Nationwide is required to provide UM coverage because further proceedings are necessary. One would hope that this court would, on a full record, hold that Nationwide is required to provide UM coverage despite any allegations of intentional/staged acts. Compare to the recent decision in Matter of Utica Mut. Ins. Co. v Burrous, 2014 NYSlipOp 06986 (2d Dept 2014).

  4. SunTzu says:

    Silly to make the distinction in the first instance– if anything, medical treatment should be considered more fundamental than UM and liability coverage in any reasonable statutory MV insurance scheme.

  5. SunTzu says:

    Of course, this is not a No-fault case, was only commenting with respect to above comments….

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