Subia v. Cosmopolitan Mutual Insurance

80 Misc. 2d 1090, 364 N.Y.S.2d 118, 1975 N.Y. Misc. LEXIS 2322
CourtNew York Supreme Court
DecidedFebruary 5, 1975
StatusPublished
Cited by4 cases

This text of 80 Misc. 2d 1090 (Subia v. Cosmopolitan Mutual Insurance) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Subia v. Cosmopolitan Mutual Insurance, 80 Misc. 2d 1090, 364 N.Y.S.2d 118, 1975 N.Y. Misc. LEXIS 2322 (N.Y. Super. Ct. 1975).

Opinion

Louis Wallach, J.

In an action for a declaratory judgment declaring that the plaintiff is entitled to recover no-fault benefits under an automobile liability insurance policy issued by the defendant to the plaintiff, the latter moves for summary judgment.

The operative facts are not denied. On September 17, 1973 the defendant issued an automobile liability policy to the plaintiff for a one-year period. Effective February 1, 1974, pursuant to the New York Comprehensive Automobile Insurance Reparations Act (Insurance Law, art. XVIII), the policy was amended to include no-fault benefits. Although the date the defendant was furnished with the amended policy, including its terms and conditions, does not appear in any of the affidavits, it does appear on the face of the defendant’s exhibits that the policy was not actually amended until March 5, 1974 or later, that being the date the amended policy was countersigned.

On February 28, 1974 the plaintiff’s automobile was struck in the rear on the Van Wyck Expressway, causing injuries to her leg and pelvis. She was taken by ambulance to the Jamaica Hospital where she received emergency treatment and was discharged. On March 6, 1974 she was taken from [1092]*1092her home to the Interboro Hospital where she was confined until March 17, 1974. On April 8, 1974 she was brought to an attorney’s office where a no-fault claim form was prepared and mailed to the defendant. This claim was postmarked April 10, 1974, but the defendant contends that it did not receive it until April 15, 1974. The defendant, noting the allegedly "late notice”, requested further information from the plaintiff, including the reason for the "delay”. It reserved its right to reject the claim. On May 7, 1974 the plaintiff submitted to an examination by the defendant’s claims adjuster and signed a statement prepared by him. On June 27, 1974 she also submitted to a physical examination by the defendant’s physician. The report of this physician confirms that the plaintiff sustained injuries. On July 5, 1974 the defendant disclaimed coverage of any no-fault benefits on the ground that plaintiff had breached a condition of the policy requiring notice of the accident "as soon as reasonably practicable”.

The defendant has pleaded two affirmative defenses, one based on lack of notice and the other based on an alleged failure to provide all pertinent information necessary to determine the amount due and payable. The latter defense is stricken since it was not raised in the letter of disclaimer (11 NYCRR 65.6 [d] and Appendix 13, Denial of Claim Form; 11 NYCRR 216.3 [b]) and is not supported by any facts in the opposing affidavits submitted on this motion.

It is well settled that language in ordinary insurance policies that notice is to be given as soon as reasonable or as soon as practicable requires that written notice be given within a reasonable time under all of the circumstances. (Deso v London & Lancashire Ind. Co., 3 NY2d 127; Allstate Ins. Co. v Manger, 30 Misc 2d 326.) A failure to satisfy the requirements of this clause by timely written notice vitiates the contract.

The rule is well stated in Allstate Ins. Co. v Manger (30 Misc 2d 326, 329, supra):

"Delay on the part of an insured to give notice may be excused where he lacks knowledge of the accident or of an injury and also where there is a justifiable lack of knowledge of the fact that there was insurance coverage. If such excuses are claimed then there is a triable issue as to whether the notice was timely. (Gluck v London & Lancashire Ind. Co., 207 Misc 2d 471, revd 2 AD2d 751, affd 2 NY2d 953.) Delay on the part of the injured party to give notice may be excused where he had difficulty ascertaining the identity of the insured or [1093]*1093the insurer (Lauritano v American Fid. Fire Ins. Co., 3 AD2d 564, affd 4 NY2d 1028), but he must show that he exercised diligence. (Safeguard Ins. Co. v Baldauf, 20 Misc 2d 667.)

"Where no excuse is offered the question of whether notice was timely is one of law for the court. (Greenwich Bank v Hartford Fire Ins. Co., 250 N. Y. 116, 128.) Thus unexcused delay of 51 days (Deso v London & Lancashire Ind. Co., 3 NY2d 127, supra), 27 days (Reina v United States Cas. Co., 228 App. Div. 108, affd. 256 N. Y. 537), 22 days (Rushing v Commercial Cas. Ins. Co., 251 N. Y. 302, supra), 30 days (Mason v Allstate Ins. Co., 12 A D 2d 138, supra) and 49 days (Abitante v Home Ind. Co., 240 App Div 553) have been held as matter of law to violate the condition of the policy.”

Accordingly, under general principles of insurance law this court would be constrained either to grant summary judgment to the defendant since the plaintiff has failed to show sufficient facts to demonstrate due diligence in giving notice, or to deny summary judgment to the plaintiff on the basis that her hospitalization during part of the period between the accident and the claim creates a sufficient inference of excuse to warrant a trial on the question of reasonableness.

The issue in the instant case, however, is whether no-fault insurance coverage differs enough from other types of insurance so that new principles of construction should be utilized. This court is of the opinion that it does.

The impetus for no-fault coverage in New York came from the Stewart Report to Governor Rockefeller, dated February 12, 1970, which was published under the title: "Automobile Insurance * * * For Whose Benefit?” This report found certain disadvantages in the fault system of handling personal injury and damage costs of automobile accidents, both theoretical and practical. It also listed the criteria for a "good system” to replace the fault system and made a proposal for a "better system”. Although the Stewart proposal was not enacted in total, the study, particularly those parts which criticized the fault system and set forth the criteria for a better system, was the forerunner of the present no-fault law. Among the principal deficiencies of the fault system were found to be uncompensated victims, delay, unpredictability, lack of co-ordination of benefits, hindrance to rehabilitation, inefficiency and overreaching and dishonesty of insurance companies and others. The "good system” was to provide compensation for all victims, efficiency, prompt payment, reli[1094]*1094ability and fair settlement of claims. It was also to help, rather than to hinder, the work of the courts so that automobile cases would not continue to clog the calendars.

The New York no-fault law attempted to accomplish these goals by means of mandatory personal injury protection which is required to be provided in all owners’ policies of liability insurance (Insurance Law, § 672), by limiting the common-law right to recover damages for personal injuries arising out of negligence in the use of a motor vehicle where the damages do not exceed a specific threshold (Insurance Law, §§ 671, 673; Schwartz, No-Fault Insurance: Litigation of Threshold Questions Under The New York Statute — The Neglected Procedural Dimension, 41 Brooklyn L. Rev. 37, 42, 43), and by other provisions designed to implement the law. The Superintendent of Insurance was charged with the duty of approving insurance policy forms for no-fault coverage and establishing minimum benefit standards and regulations. (Insurance Law, §§ 21, 672, subd. 4.) The superintendent’s regulations implementing the no-fault law and approved form of policy are set forth in Part 65 of vol.

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Bluebook (online)
80 Misc. 2d 1090, 364 N.Y.S.2d 118, 1975 N.Y. Misc. LEXIS 2322, Counsel Stack Legal Research, https://law.counselstack.com/opinion/subia-v-cosmopolitan-mutual-insurance-nysupct-1975.