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New York Insurance Coverage Law Update - May 2021 | Rivkin Radler LLP


WDNY Follows Other New York Courts Holding That COVID-19 Losses Are Not Covered
The insured operated a martial arts and fitness business in Buffalo, New York, that sustained losses in revenue when its business closed due to the COVID-19 pandemic and related executive orders. The insured sought coverage under its commercial property policy.  The United States District Court for the Western District of New York held that the insured’s allegations that the virus became widespread and governmental orders led to business closures by sharply reducing occupancy fell short of the requirements of a “direct physical loss or damage” to the insured premises to trigger the business income coverage.  As to the  insured’s claim for civil authority coverage, the court sympathized about the devastating impact of the pandemic on businesses, but held that the insured had not “provide[d] specific, non-general allegations that document a direct physical injury to property (not theirs) ....

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New York State Department of Financial Services Summarizes Changes Relating to Administrative Denials, Prior Authorizations, and Claims Payment | Epstein Becker & Green


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On March 10, 2021, the New York State Department of Financial Services (“DFS”) issued Insurance Circular Letter No. 4 (“Circular Letter”),[1] which both explains modifications to the Insurance Law and the Public Health Law brought about by statutory changes in 2021 and sets forth two policy statements by DFS. More specifically, the Circular Letter summarizes a host of important statutory changes relating to common managed care issues, including administrative denials, utilization review, coding, and denials of pre-authorized services. In addition to covering statutory changes, the Circular Letter clarifies the DFS’s positions on when down-coding requires a utilization review determination and on the subsequent denial of a claim that had received pre-authorization. These changes relate to commercial and Medicaid products in New York; they do ....

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New Members Appointed to New York State Insurance Advisory Board


New Members Appointed to New York State Insurance Advisory Board
February 24, 2021
The New York State Department of Financial Services (DFS) has appointed members to serve a three-year term on the New York State Insurance Advisory Board. Members of the board include representatives of the insurance industry and consumer advocates, as required by statute.
DFS Superintendent Linda Lacewell has evaluated the nominations received and selected board members that reflect the diversity of the state of New York and the insurance industry, according to a DFS press release.
The board, established by Section 201 of the New York Insurance Law, is tasked with encouraging and promoting the growth of the insurance industry in the state and furthering the goals of DFS as they relate to the insurance industry and the protection of consumers. ....

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New York First Department Clarifies Effect of New York Insurance Law Section 3420 on Claims Made-and-Reported Policies | Carlton Fields


In
Certain Underwriters at Lloyd’s London v. Advance Transit Co., a New York appellate court provided valuable clarity into how New York Insurance Law section 3420 applies to claims-made-and-reported insurance policies.
Underwriters issued a claims-made-and-reported liability policy to Advance Transit Co., effective October 30, 2016, to October 30, 2017. The policy provided that if it were renewed, Advance would have an additional 60 days after the expiration of the policy to report a claim to Underwriters. A personal injury claim was made by a third party against Advance during the policy period, but Advance did not report the claim to Underwriters until after the 60-day extension had expired. Underwriters denied coverage and sought a declaratory judgment that it was not liable to indemnify Advance for the personal injury claim asserted against it. ....

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