1. #1
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    Exclamation Beware of the Utica National Insurance Company

    I knew insurance companies were sneaky, but this really LOW!!

    Quote Originally Posted by 10NBC / WHEC TV-10
    A Wayne County volunteer firefighter, who was hit by a car while doing traffic control for another accident, is being denied medical coverage by the fire department’s insurance provider.
    Jim Gallaher is a former chief of the Lincoln Fire Department, in Wayne County.
    He's been a volunteer for 30 years. In February he was nearly killed in a hit and run accident while on the job. The suspect has still not been found. Now the insurance company is refusing to pay for his pain and suffering.

    Gallaher still wears a cast on his leg. He has constant headaches, memory loss and he can't drive anymore. In his words, his quality of life is down the tubes.

    “The thing is I can't do stuff myself, I’ve got to rely on my friends, neighbors, relatives to do everything for me,” said Gallaher.

    It all began in late February. A car hit Gallaher as he was diverting traffic from another accident. He woke up hours later at Strong Memorial Hospital. Now, the fire department's insurance provider has denied his claim.

    Gallaher's lawyer, Tony DiNitto showed NEWS 10NBC the insurance company's denial. It said because Gallaher was not physically in a department car and because his name is not specifically listed on the policy, he is not considered covered.

    The case has far reaching implications for all volunteer firefighters whose names may not appear on their department's insurance policy.

    Gallaher has contacted State Senator Mike Nozzolio about the problem, but a lawsuit may be next. “It doesn't make any sense so that's why we're trying to look into it, but they're not budging. They say tough. I'm not a member even though I am a member. It doesn't make any sense,” said Gallaher.

    NEWS 10NBC called the insurance company, Utica National. The company said it does not comment publicly on its claims. In its denial, Utica National said the policy in this hit and run case covers the fire department but not the firefighters. Jim Gallaher says the firefighters are the department.

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    "Utica National said the policy in this hit and run case covers the fire department but not the firefighters."

    That's like saying the fire department is there to "protect the public, but not the citizens". What a load of crap! I hope a Judge will set them straight.

    What I think of most insurance companies cannot be posted on this board!




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    Quote Originally Posted by fireman4949
    "Utica National said the policy in this hit and run case covers the fire department but not the firefighters."
    I wonder if somebody made a nasty mistake here, and didn't buy worker's compensation insurance? With a comment like that, it makes me think the Utica policy is an equipment policy......?
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    All I can say is read your insurance policy, ask questions if you don't undestand. I work in a adjustment company. We get hired by the Allstate, Liberty Mutual, Utica etc...to investigate and report on insurance claims.
    Many times people and businesses really don't understand whats in their policy.
    I am sure this fire departments policy had what are called "non-covered" losses.

    And contrary to some TV commercials by "ambulance chasing lawyers", adjusters work for both the "injured person" and the insurance company. Thye just give a non-biased report as to what they find.
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    Beginning of each year, we must furnish our insurance company with a list of our membership. Also one for the town which covers our Work Comp stuff. Doesn't sound unreasonable to me.

    In an honest question, if the insurance company does not know who to cover, can the FD just throw anyone's name in as a claim when necessary? What proof of membership would be required to be considered "covered"?
    "This thread is being closed as it is off-topic and not related to the fire industry." - Isn't that what the Off Duty forum was for?

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    Quote Originally Posted by Bones42
    Beginning of each year, we must furnish our insurance company with a list of our membership. Also one for the town which covers our Work Comp stuff. Doesn't sound unreasonable to me.

    In an honest question, if the insurance company does not know who to cover, can the FD just throw anyone's name in as a claim when necessary? What proof of membership would be required to be considered "covered"?
    I'd say it must be like when you get a new car? Maybe just call your company?
    Last edited by Resq1scnd2none; 05-11-2006 at 09:10 AM.

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    OK, here is the deal,

    The fireman that was hit is my father. We are both active members of the Lincoln Fire Department and both past chief's. All of the medical bills are being paid currently by workmans comp. Every fire department in our county is self insured through the county and they pick up all of our workmans comp. That is currently in progress and he receives his $400 a week from the comp board. Let me ask you this, cna you live off of $400 a week when you ahvea mortgage to pay and other bills??? What Utica is shafting him on is our department automobile policy. Everyone that has car insurance is required by law (at least in NY) to have supplemental coverage to cover you in case you are hit by someone without insurance or in this case, a hit & run. Every year the department gives a list of names and driver's license numbers to Utica for review and checks (DWI, reckless driving, etc. do they can adjust their rate). So for them to say that he is not on the policy is pure BULL#(@! Their other point is that was not in the vehicle. He used a department vehicle to get to the intersection, he used a department vehicle to block the road. He was then run down by someone that left the scene. By NY state law, just being hit by the hit & run driver should put this policy into effect.

    What he is looking for is Utica National to step to the plate and take of him under this policy. He is a General Contractor and has been out of work for 10 weeks, and it will be at least another 6-8 weeks before he gets back to work. He is looking for the difference in his lost income as well as something down the line. It is very likely that he will have some sort of permanent disability. They don't know if his head aches will ever go away. He has no sense of taste, he gets disoriented very easily and his left knee will most likely have to go under the knife to repair the ligament damage.

    Utica National and the other insurance companies have no problem collecting our high premiums but they sure get cheap when it comes time to pay out on them. What they are doing is morally wrong!!! Our policy in our department is up June 30th. Needles to say, we are looking very seriously at a new carrier.

    I would recommend that everyone look long and hard at their policies whether it be Utica National or some else's and make sure you have it in writing that you be covered. This is no different than stepping out of a pumper at a fire scene and getting run down and having the care take off. The Firemans Association of New York State (FASNY) and the New York State Chief's are already working on my father's behalf as well as our state senators and assemblyman to get this resolved. I wll let everyone know how he makes out.

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    Just a quick response, but my vehicle coverage covers damages to the vehicle, not people standing outside the vehicle.
    "This thread is being closed as it is off-topic and not related to the fire industry." - Isn't that what the Off Duty forum was for?

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    Quote Originally Posted by Bones42
    Just a quick response, but my vehicle coverage covers damages to the vehicle, not people standing outside the vehicle.
    In New York State, your auto policy covers anything vehicle related. If you are a pedestrian that gets run down by a car and the car leaves or has no insurance, your own auto policy goes into effect. It's probably one reason insurance rates in New York are so high.

    Here is a link to another news story about the whole story.


    http://www.wroctv.com/news/local.asp

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    There was a similar story on the news last night about one women who was dropped from her homeowners insurance because the risk of hurricanes yet she lives in BROOKLYN. They also stated that a dozen or so people in the area recieved the same letter.
    NEVER FORGET!
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    yankee thanks for the info...............I hope your father makes a speedy recovery............I can appreciate the lack of performance from the insurance industry as far as a homeowners policy goes.
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    Isn't Utica the company that touts the fact they have volunteer firefighters as employees in the ads that they run in trade magazines?
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    Quote Originally Posted by MIKEYLIKESIT
    Isn't Utica the company that touts the fact they have volunteer firefighters as employees in the ads that they run in trade magazines?
    Correct. They used to have a picture of a small town chief from Central NY (along with 2 other firefighters) on their ads but I believe he recently retired. He was a fire protection specialist for many years there.

    Yankee, I'm sorry your father has to go through this. I will do my best to make sure that our department NEVER gives these jerks a dime

    I hope your father has a speedy recovery.
    Tom

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    Stay safe out there!

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    Not to sound odd or anything but I have never heard of being covered by your own auto insurance while walking down the road. Can you find where this is stated in your policy. I am a past president of my vol fire co very close to utica. I have read several policies and have never sean anything about that. I hope your father has a speedy recovery.
    Stay Safe and live long

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    Quote Originally Posted by Yankee750
    In New York State, your auto policy covers anything vehicle related. If you are a pedestrian that gets run down by a car and the car leaves or has no insurance, your own auto policy goes into effect.
    Huh? That doesn't even make sense. Anyhow, I've gotta say I haven't seen anything yet that tells me the claim shouldn't be denied.

    But I'm listening.

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    Quote Originally Posted by WebFire
    Huh? That doesn't even make sense. Anyhow, I've gotta say I haven't seen anything yet that tells me the claim shouldn't be denied.

    But I'm listening.
    Did you read the information on the link he provided or just skip that part?

    Injured volunteer firefighter is denied insurance coverage
    http://www.wroctv.com/news/story.asp?id=22907&r=l
    5/10/2006 6:00 PM
    (Cathy Orosz, WROC-TV)

    It was a bone-chilling night in February when Lincoln Volunteer Firefighter James Gallaher was struck by a hit and run driver while directing traffic at an accident scene in Walworth. Ten weeks later he's still suffering the consequences with a dislocated kneecap, head injuries, and more.

    "My neck, I can't turn all the way across without hurting a lot," said Gallaher. "I'm not able to drive. I don't know when I'll be able to drive."

    Now, adding insult to injury, Gallaher is dealing with a denial of insurance coverage. His fire department spends $10,000 a year for a policy with Utica National; a policy he assumed would cover him.

    "It's ridiculous," said Gallaher. "They're just trying to pull a fast one and it affects every volunteer fireman in New York State because the same law applies to them."

    Utica National sent a letter of explanation. Because Gallaher wasn't named specifically on the policy and wasn't inside the insured vehicle, his claim was denied. So now he has hired an attorney.

    "He should be entitled to this coverage under the policy of the fire department," said Tony DiNitto, an attorney with Faraci Lange.

    DiNitto says volunteer firefighters are always directing traffic in dangerous environments: Coverage is a must.

    "The likelihood of being struck by a car is high under these circumstances... and they should have coverage to protect themselves," said DiNitto.


    Fortunately workers compensation is covering him for now, but Gallaher's afraid time will run out. And with no driver to take the blame, litigation may be the only option.

    "I don't know. It's frustrating," said Gallaher. "I just hope Utica National steps up to the plate like they're supposed to."

    We tried contacting Utica National for comment. A manager told us to write a letter, which would be forwarded to the company's corporate counsel.

    Meanwhile, the driver who fled the scene that night remains at large. A reward fund has been set up for information leading to an arrest. Thanks in large part to neighboring fire departments; the fund is now more than $3,000.
    Tom

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    Stay safe out there!

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    Quote Originally Posted by sfdtim11
    Not to sound odd or anything but I have never heard of being covered by your own auto insurance while walking down the road. Can you find where this is stated in your policy. I am a past president of my vol fire co very close to utica. I have read several policies and have never sean anything about that. I hope your father has a speedy recovery.
    Call your insurance agent or company, it is in there. I believe it is under the SUM Coverage area of your policy.

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    I don't know if this is the same, but in Texas, we have PIP (Personal Injury Protection). I believe that it covers you if you are hit whether the other person is insured or not. Anyway, Yankee750, tell your dad that he is in our prayers. Hope that he has a full recovery. Take care.
    Just someone trying to help! (And by the way....Thanks for YOUR help!)

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    Quote Originally Posted by NYSmokey
    Did you read the information on the link he provided or just skip that part?
    Yep. I read it. Here is what we know to be fact.

    1. His name is not on the policy.
    2. He was not in the vehicle when he was hit.
    3. The claim was denied.

    How can anyone say whether he should or shouldn't be covered with those 3 facts?

    Now, I don't know NY insurance law, but if I am walking down the street and get hit by a car, why would my car insurance cover it? That doesn't even seem logical to me. That was the part that didn't make sense.

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    BTW, everything you highlighted enforced my opinion that he wouldn't be covered (unless he would be covered by some wacky NY law).

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    http://www.ins.state.ny.us/autocg02.htm

    1. No-Fault Benefits—Personal Injury Protection (PIP)

    No-Fault, also called Personal Injury Protection (PIP), is designed to pay promptly regardless of who might have been at fault or whether there was any negligence—for actual economic losses (meaning medical expenses, lost earnings, and other reasonable and necessary expenses related to injuries sustained), up to $50,000 per person ("basic No-Fault coverage"), to a driver or passenger injured in your car and to pedestrians injured by your car, because of its use or operation.



    The purpose of No-Fault insurance is to restore individuals hurt in auto accidents to health and productivity as swiftly as possible. Because of New York’s No-Fault law, lawsuits due to auto accidents can be brought only for economic losses that exceed No-Fault benefits and for non-economic damages (such as pain and suffering) only if a "serious injury" (as defined in the Insurance Law) is sustained.

    No-Fault is a personal injury coverage and does not pay for auto body repair of your car or damage to any other party’s motor vehicle or real or personal property. No-Fault is also primary to health insurance, which means it pays first in the event injury is due to an auto accident.

    Under this coverage, your insurer pays you and relatives living with you for economic losses arising from injuries sustained in motor vehicle accidents anywhere within the United States, its territories and possessions, or Canada. It also covers any passengers injured in accidents in New York State while in your vehicle, as well as any guest passengers who are New York State residents injured in your vehicle anywhere in the United States, its territories and possessions, or Canada, if they are not covered under another auto insurance policy in New York State.

    Pedestrians injured by motor vehicles in the State are also protected by No-Fault.

    Basic No-Fault auto insurance coverage includes:

    necessary medical and rehabilitation expenses (in accordance with established fee schedules);

    80% of lost earnings from work, up to a maximum payment of $2,000 per month for up to three years;

    up to $25 a day, for up to a year from the date of the accident, to reimburse other reasonable and necessary expenses resulting from the auto accident; and

    a $2,000 death benefit (in addition to the $50,000 basic No-Fault limit), payable to the estate of a person eligible for No-Fault benefits but killed in a motor vehicle accident.

    However, under most insurance policies, a person will be ineligible for No-Fault benefits, if:

    driving while intoxicated or impaired by use of a drug that contributes to the accident;

    intentionally causing his or her own injuries;

    riding an all terrain vehicle (ATV) or a motorcycle (as operator or passenger);

    injured while committing a felony;

    injured while in a vehicle known to be stolen; or

    an owner of an uninsured vehicle.


    Don't know if this helps...but if his name wasn't on the policy, what can you do?

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    The key to this whole thing is....

    " to a driver or passenger injured in your car and to pedestrians injured by your car, because of its use or operation. "

    Neither of those happened in this case.

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    "Pedestrians injured by motor vehicles in the State are also protected by No-Fault."

    "Under this coverage, your insurer pays you and relatives living with you for economic losses arising from injuries sustained in motor vehicle accidents anywhere within the United States, its territories and possessions, or Canada."


    Seems to me he should be covered...IF his name was on the policy.
    Last edited by ThNozzleman; 05-12-2006 at 11:17 AM.

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    I hope for all the mutts that are siding with the insurance company find themselves in similar circumstances in the future.
    Just another one of the 99%ers looking up.

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    I hope for all the mutts that are siding with the insurance company find themselves in similar circumstances in the future.
    Mister, you are WAY out of line, there.

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