INJURY LAW BLOG

Valid insurance claims can be denied for several reasons. You may have suffered injury caused by a traffic accident, being on an employer or other business's premises, or injured working on a construction site. Whatever the cause, you may be entitled to compensation and damages. There are basic procedures to follow when submitting a valid claim, and the insurance company must also follow certain procedures when they receive a claim. Despite everything, insurance claim denial happens, but you also have options.

Insurance Claim Denial

There are some obvious and sensible steps to take if you receive written notification that your insurance claim has been denied. Your initial response may be anything from anger to disappointment, or deciding to just "throw in the towel." The best thing to do is to study the denial and decide what practical steps to take.

• - New York State has laws and standards in place that both you the claimant, and the insurance company must adhere to, so if your claim has been denied, the insurance company must give you a reason.
• - Even though the insurance company hires professionals to handle claims, everyone is human, and humans can make mistakes. It is also possible, but unlikely, that the insurance company is acting in bad faith, and just hoping that a denial will make your claim disappear.
• - Decide where you believe they are at fault in denying your claim.
• - Contact the insurance company in writing, keep a record of all communications, explaining why you believe they are "mistaken." Submit as much supporting documentation as possible. Highlight pertinent parts of the material you send. If they missed something and denied your claim, make it easy for the insurance company to see its own error.
• - If that fails to get your claim approved, consider appealing their decision to the New York State Insurance Commissioner.
• - Inform the insurance company that you are filing an appeal. Your goal is to have your claim approved. If the company made an honest mistake or even if they attempted to pressure you by incorrectly denying your claim, the threat of appealing to the Commissioner may be enough to get them to reopen your claim.
• - Decide if you should also file a lawsuit against the company for, for example, bad faith and/or violating New York's insurance code by not working to legal standards, or simple breach of contract.

If it is a Workers' Compensation Claim

If your workers' comp claim is denied, the company will issue a "notice of controversy" and file it with the Workers' Compensation Board for review. Either party may appeal the review decision, and it will go to a separate review panel for further consideration. If you disagree with the second review, you may decide to make an appeal to the Appellate Division of New York's Supreme Court.

The Takeaway

Injury claims may run smoothly or they may not. If you, the claimant, are dissatisfied with how your valid claim is handled, you have options. The legal standards are complex, but we hope these basic guidelines will help you understand the steps. While you may decide to handle everything yourself, you may also choose to seek legal advice on what to do and how to do it. Simply click here to contact us so we can arrange a free, initial discussion.

Do’s and Don’t When Getting Pulled Over

You often hear the stories friends tell about getting pulled over or maybe it was you telling the story. Many people have a general idea of what to do when they get pulled over by an officer, but they don't know what exactly to do. It's similar to as a child you had a general idea of how to drive but you don't know completely until someone teaches it to you. Here are the do's and don't of getting pulled over by an officer:.

DO: Acknowledge The Officer And Pull Over

No matter how tempting it may seem, ignoring the officer will put you in a precarious situation and can quickly escalate the situation. Turn on your emergency lights and pull over to a safe area. Compliance will provide a good image and this is beneficial to you.

DON'T: Panic

It's common to feel nervous about getting pulled over, but you shouldn't panic. Take deep and slow breaths. Unless you've done something out-rightly criminal, you have nothing to worry about. At most, you'll have to pay a fine and your insurance may go up a bit.

DO: Say "Sorry"

Cops are people too and sometimes they may write you off with only a warning if you are courteous enough. They aren't out to get you like they are commonly misconstrued.

DON'T: Expedite the Process

Don't expedite the process by giving your documents before the officer asks for it. They may be prepared to simply give you a warning, but your help can secure your ticket without even giving it a chance.

DO: Be Civil

Once again, officers are human too and being civil is simply common courtesy. Also, if the officer has to give a testament or report in the court, being civil would have helped your case.

DON'T: Argue

The side of the road isn't a place to argue about a charge. Arguing is done in the court in front of a judge.

DO: Sign the Citation

A citation isn't an admittance of guilt. It simply confirms that you received the citation and agree to either 1) pay a fine or 2) appear in court.

DON'T: Act Suspicious

Don't do any unnecessary movements. Officers are just as nervous as you are. If you have a gun, some states require that you inform the officer beforehand. Officers can feel threatened if you are constantly moving or reaching under your seat. Sudden movements are highly discouraged.

The Takeaway

Don't ignore the officer and treat the officer as if they were another human, which they are. Being courteous or polite is always beneficial regardless of whether you receive a citation or not and acting civil is also advantageous to you as well. In addition, don't expedite the process and wait until the officer asks for documentation. Unnecessary and sudden movements are highly discouraged. If you find yourself in need of a legal expert or are interested in more information about legal situations, contact us.

Can You Sue the City if a Street Sign Falls on You?

The short answer is, "Yes, you can - but." There are several "buts" to be taken into account. Successfully suing New York City because a street sign falls on you depends on specifics which we will discuss. The important thing is where does the fault for the injury lie? It may be with the city itself, a city employee's actions or inactions, someone totally separate from the city, an Act of God, or even the injured party. The basic fact that determines whether you can sue the city is - who is responsible.

City Government Negligence

The city is responsible for maintaining its property. If a street sign falls and injures you because it was not installed properly or has not been properly maintained, then one could say the city bears some responsibility. Proving poor installation or improper maintenance will be a big part of a successful lawsuit.

A street sign may be, or appear to be, in overall good condition but if it causes injury, there may still be a case. Here are four hypothetical examples:

• - A sign that was either not erected properly or which has not been maintained properly falls and injures someone.
• - As part of the Vision Zero Action Plan, road work is being carried out. Construction signs are being placed at, or collected from, the side of the road. A city employee or contractor mishandles a sign, it falls from the truck and hits you. If it can be shown that the employee had not been trained properly to handle the task, had been trained but was not paying attention while performing the task, or if the truck was unsuitable for carrying the number and type of signs, there may be a case to answer.
• - A city vehicle is being driven carelessly or dangerously, and the driver collides with a street sign which falls and injures a cyclist or pedestrian. This may be an example of negligent or illegal behavior by a city employee.
• - A city police chase is in progress, but is violating police department regulations. The vehicle being chased collides with a street sign which falls and injures someone. This may also be an incident resulting from municipal regulations being violated.

In these three examples, it may be possible to prove negligence or failure to perform. In such instances it is possible to sue the city.

Two "Buts"

• It is New Year's Eve, you are out celebrating with friends. You climb onto a traffic sign, swing on it, fall off, the sign follows you down and injures you. As long as the sign was in good condition, it would be difficult to show the city or a city employee is responsible for the injury.
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• There is a storm and a state of emergency has been declared. Strong winds and lightning strikes make venturing outside dangerous. You go out and are struck by a flying street sign. The city would say you have some responsibility for your own safety and venturing out was irresponsible, therefore the injury was caused by your actions plus a random accident caused by an act of God.

In these examples it would be difficult to prove the city bore responsibility for the injuries.

The Takeaway

New York City has responsibilities. To prove a case it is important to show that the city had a duty of care to the injured party, and it failed. If you have been injured by a street sign, or in any other way that may involve NYC's failure to perform, please click this link to contact us, so we can arrange a free consultation.