Putting aside certain disdain towards the Second Department punting the “absolute coverage” component of Unitrin and ATIC v. Lucas, the IDS case said that when carrier wants an EUO of whoemever, no is not a suitable answer. The case also spoke about “partial performance”, which probably means showing up to the EUO. I am not sure what needs to be answered to constitute partial performance, although answering relevant questions would seem to fit the bill.
The question that of course lingers, and is quite manifest is what happens when the provider says I will not show up because you did not do ………. or do not have ……….. and the carrier either says we stand by our demand or ignores the provider. Master Dachs said the following in Blank v. Geico, 412013060819
“Indeed, “It is well established that the failure to comply with the standard policy provision requiring disclosure by way of submission to an examination under oath, as often as may be reasonably required, as a condition precedent to performance of the promise to Indemnify, constitutes a material breach of the policy, precluding recovery of the policy proceeds.” IDS Property Cas. Ins. Co. v. Stracar Medical Services, P.C., 116 AD3d 1005 (2d Dept. 2014) (internal quotation marks and citations omitted). Insofar as applicant’s complaint that the Lower Arbitrator “Ignored the Insurance carrier’s failure to respond to the applicant’s … objection letters” is concerned, assuming, arguendo, that responses were required, the record before me demonstrates that adequate responses were given.”
Note: “assuming arguendo”. Read this how you want, but I think assuming arguendo leads to a certain result.
6 Responses
I think you are reading way too much into this one decision by a Master Arbitrator.
The Insurance Company Imp always reads to much into these decisions.
What the Imp wants is time wasting insurance company demands for additional verification to kill claims.
Masterbator Dachs is but an employee of the insurance industry — let us not forget.
Prompt payment is no longer the goal of no fault. Stopping fraud is said the appellate brief of a major insurance company written by a white shoe no fault firm.
I think there is a constitutional problems with f8&k off — I mean No Fault.
Jesus … Master Dachs … WTF … sounds like he belongs in an Episode of Star Wars.
I wonder what Master Putz thinks.
I notice that Master Putz … I mean Dachs was appointed by the Superintendent of Insurance. Well there goes his credibility since the Superintendent is nothing more but the Supreme Imp of the Insurance Industry who should be punched in the face on a regular basis.
This just gets more stupid by the day.
Did I forget to mention that I hate Master Dachs. I have never met him but I can tell he still clings to the comb over hair style; has bad breath; voraciously sucks mints to cover up his bad breath which has been a total failure — the mints are so powerful they burnt a hole through his tongue; he uses a pencil to clean out the insides of ears and then proudly surveys the dirty greasy ear wax on the eraser — he ships the ear wax to Hydro F*^k Cuomo who uses it as hair tonic; and picks his nose.
PS he never showers
F’in’ A … must be pretty slow in F^%k off — I mean no fault land if an obscure arbitration decision dominates New York’s most important No F*&K — I am sorry — no fault Blog.
Sorry, I was preparing for an involved trial in Suffolk and have been covering quite a few depositions and EUO’s lately, spanning anywhere from Eastern Suffolk to Rochester. I have not posted in a week or have responded to certain emails, etc. It has been slow though – I think we are all waiting for Avanguard and its implications.
I never met Mr. Dachs, but he is a very well written master arbitrator, regardless of where on the spectrum I fall with him.
-JT