Recent Decision Explains Standard and Burdens of Production Regarding Where No-Fault Claim is Not Covered

As anyone who practices in the No-Fault arena knows, there is not a lot of case law exists addressing the numerous issues surrounding trials.   Justice Bluth wrote this extremely enlightening decision in S. Med. Servs. P.C. v. Allstate Ins. Co. [Civ. Ct., Kings County], concerning what is an insurer's burden in the context of a first-party No-Fault claim where the insurer claims the accident was intentional.  Justice Bluth discusses the misnomer that these cases all encompass a showing of fraud, explaining that the insurer must proffer evidentiary proof that the accident was not unintentional [going along with one of the main principles of insurance].  Justice Bluth also explained the burden of production of both the insured and insurer.

In this case, Justice Bluth determined that the insurer supported its claim that the insured's accident claim was not an accident, and the insured failed to rebut that showing.  The insurer's proof was mostly circumstantial, which Justice Bluth noted was frequently the case on these types of claims.

This case is a great overview of the issue most Courts have deemed as "fraud."  Thank  you to Damin Toell of Bruno Gerbino & Soriano LLP for bringing my attention to this case.