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  1. Out-of-state drivers clarified | Ask PIA

    There is an accident in New Jersey and both drivers are Pennsylvania residents. The claimant’s insurance company does not do business in New Jersey and the defendant’s does. Would the New Jersey verbal threshold apply?

    The answer is no. If the person claiming damages for personal injuries is an out-of-state resident (Pa.), whose auto policy is issued by an insurer not authorized to do business in New Jersey, then the New Jersey Deemer Statute does not apply and the claimant is not subject to the...

  2. Roof’s undamaged portion | Ask PIA

    I have a homeowners insured with a roof claim who has a detached garage and there is considerable shingle damage to one slope of the roof. The other slope has suffered no shingle damage but the shingles are old and dried out and there is some moss on the shingles...

    This is one of those nasty claim negotiation areas where little definitive guidance exists. Some states have case law on this, and a few have statutes (e.g., Connecticut and Florida), but I’m not aware of anything in New York. The courts in most jurisdictions will take into consideration uniformity in...

  3. “Will endeavor” language | Ask PIA

    We have frequent requests to strike the “will endeavor ...” language with extended notification periods. What is your position on this? We refuse to do so. But on many occasions, we hear from the certificate holders that the language is routinely stricken by other agents.  

    The wording on a certificate can only be modified with the approval of the insurer. In a case such as this which actually modifies the policy, in addition to having the insurer agree, the policy contract wording also needs to be modified, as the certificate in and of itself offers...

  4. Coverage C scheduled property | Ask PIA

    Does a payment made for a loss to scheduled property reduce the Coverage C limit available under an ISO Homeowners Policy?

    The homeowners Coverage C limit for personal property is not reduced by amounts paid out under scheduled coverage. The homeowners policy excludes “articles separately described and specifically included in this or other insurance” as covered property under Coverage C, so payments made for scheduled property have no impact on the...

  5. Separate entities under one policy | Ask PIA

    I have an insured who is interested in having three separate entities with three separate Federal Employer Identification Numbers employing individuals carrying workers’ compensation at one location. Does New York Workers’ Compensation Law allow me to list all entities under one policy or do I need three separate policies?

    All of the entities can be listed under one policy as long as there is more than 50% common ownership.

  6. Coverage C scheduled property | Ask PIA

    Does a payment made for a loss to scheduled property reduce the Coverage C limit available under an ISO Homeowners Policy?

    The homeowners Coverage C limit for personal property is not reduced by amounts paid out under scheduled coverage. The homeowners policy excludes “articles separately described and specifically included in this or other insurance” as covered property under Coverage C, so payments made for scheduled property have no impact on the...

  7. Rate filing | Ask PIA

    What is the process in New Jersey to obtain a carrier’s rate filing?

    In order to request copies of a rate filing from the New Jersey Department of Banking and Insurance you need to submit a request pursuant to the Open Public Records Act. To make a request, log on to the DOBI’s website at http://www.state.nj.us/dobi/index.html and click “Open Public Records Act” (lower...

  8. PIP coverage—definition of an “automobile” | Ask PIA

    What vehicles are eligible for personal injury protection coverage?

    According to N.J.S.A. 39:6A-2(a), the only vehicles eligible for PIP coverage are “automobiles.” An “automobile” is defined to include: A private-passenger automobile of a private-passenger or station-wagon type that is owned or hired and is neither used as a public or livery conveyance for passengers...

  9. Duty to report suspected insurance fraud | Ask PIA

    Do I have a duty to report suspected insurance fraud in New Jersey?

    Yes. N.J.S.A. 17:33A-9 requires any person who believes that there is insurance fraud occurring to notify the Division of Insurance Fraud Prevention (http://www.njinsurancefraud.org/) via this site: http://www.njinsurancefraud.com/reply102808.htm. The entire Insurance Fraud Prevention Act is available at http://www.nj.gov/oag/insurancefraud/pdfs/fraud-prevention-act.pdf and the relevant part reads as follows:“Section 17:33A-9. Alleged violations; civil liability; records a.      Any...

  10. Notice to mortgagee | Ask PIA

    I’m concerned about the mortgagee notice provisions in the Insurance Services Office Inc. homeowners contracts. The policy language states, “If we decide to cancel or not to renew this policy, the mortgagee will be notified at least 10 days before the date cancellation or nonrenewal takes effect.” What if the named...

    An insurer has an obligation to notify the mortgagee under the terms of New York’s “standard mortgagee clause.” Section 3404 of New York’s Insurance Law sets forth the terms of the Standard Fire Insurance Policy, including a clause entitled “mortgagee interests and obligations.” This clause states: If loss...

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