Pursuant to New York No-Fault law, if a pedestrian is struck by an automobile and subsequently loses time from work, she may recover her lost wages from the insurance company that insured the vehicle that struck her. But in the case of a client of the firm, Allstate Insurance Company refused to pay the firm’s client her lost wages. The client worked as a supervisor for Home Depot and missed a total of 34 weeks from work.
After Insurance Company Refuses to Pay Wages
Because Allstate refused to pay the client’s lost wages as a result of the accident, a request for arbitration was submitted to the American Arbitration Association. The arbitrator’s written decision summarized the issue in dispute to be whether the client, as the victim of a pedestrian accident, was entitled to reimbursement for lost wages incurred by her after she was knocked down by a motor vehicle in January of 2015, and after Allstate denied her lost wage claim based on her alleged failure to provide verification within 120 days of its initial request; and further denied for lack of coverage based on her supposed breach of a condition precedent to coverage by failing to appear for an Independent Medical Examination, known as an IME.
Arbitrator’s Conclusions Concerning Lost Wage Claim
The arbitrator found that the pedestrian knocked down by a motor vehicle sustained injuries to her left wrist, bilateral knees and cervical and lumbar spine preventing her from returning to work as a Home Depot retail supervisor for a total of 34 weeks. Allstate’s denials based on negative IME’s did not explicitly deny lost wages based on those IMEs. Allstate issued its denial for lost wages based on failure to provide verification within 120 calendar days from its initial request. However, the arbitrator found Allstate’s denial to be defective because it was issued only 119 days after Allstate’s initial request. The arbitrator also wrote that the firm’s client appeared in person and credibly testified that during the relevant time period when the clock was ticking, she never had possession of any disability note from her treating physician because her physician’s office would not give it to her.
The arbitrator went on to write that the pedestrian accident victim was a very compelling and sympathetic witness, and importantly, that Allstate treated her like an adversary which in not permitted under the no-fault law. She was awarded $16,000.00 in lost wages, interest accrued from December, 2017 plus additional attorneys fees due to the additional time required to research the questions of law presented, namely, whether the client was an eligible injured person (EIP) entitled to supplemental personal injury protection (PIP) benefits purchased by the insured vehicle that struck her.