Lost wage benefits under current No-Fault regulations

July 25, 2017

By: Frank Scahill

Lost wage benefits under current No-Fault regulations are designed to fairly compensate the eligible injured party. Insurance Law Section 5102 (a) (2) provides that an individual who makes a claim under the no-fault law must be compensated for "[l]oss of earnings from work which the person would have performed had he [or she] not been injured."

In reality, the insurance carriers defending the lost earnings claim face an uneven playing field, skewed in favor of the claimant.

The Department of Financial Services has issued an advisory opinion as early as 2003 indicating when an injured person can demonstrate that they could reasonably expect to earn overtime wages of a projected amount, but for being injured, those lost wages would be reimbursable under No-Fault. The department has also opined when an injured insured is unable to return to work due to injuries arising from an automobile accident and, the insured's employer hires another person to fill the insured's vacant position during the insured's period of disability, so that the insured cannot immediately resume her employment when she is medically cleared to return to work, the insured may recover lost wages for the period after she is medically cleared but before she actually resumes work. Furthermore, § 65-3.16(b)(3) of N.Y. Comp. Codes R. & Regs. tit. 11 (Regulation 68-C) states that "[l]oss of earnings from work shall not necessarily be limited to the applicant's actual level of earnings at the time of the accident, but may also include demonstrated future earnings reasonably projected." Thus, under the no-fault scheme, injured persons may recover certain future earnings in addition to earnings from employment at the time of the accident.

Defending these claims requires time intensive and exhaustive presentations to the American Arbitration Association. Two decisions are attached from the American Arbitration Association which demonstrate the commitment required to defend a lost wage claim. Bruce Burgos v. State Farm Mutual Automobile Insurance Company (AAA No.: 41-16-1048-0611) Amount in dispute - $40,000 and Sonnia Martinez v State Farm Mutual Automobile Insurance Company (AAA Case: 41-15-1021-8871) Amount in dispute - $66,690. A forensic accounting examination and the sworn opinion of an economist is essential on a speculative claim for past or future benefits by a self-employed claimant. Verification in the form of tax records frequently contradict the testimony of the claimant on earnings. Case law is also critical, to argue to the arbitrator the precedents on the interpretation of the regulations.

"Claims for lost earnings must be ascertainable with a reasonable degree of certainty and may not be based on conjecture." (Glaser v County of Orange, 54 AD3d 997, 998 [2d Dept. 2008], Schiller v New York City Tr. Auth., 300 AD2d 296, 296-97 [2d Dept. 2002]; Davis v City of New York, 264 AD2d 379 [2d Dept. 1999].) It is the claimant's burden to establish damages for past [and future] lost earnings with reasonable certainty, such as by submitting tax returns or other relevant documentation. See State Farm Mutual Auto. Ins. Co. v. Stack 55 A.D.3d 594, 869 N.Y.S. 2d. 536, 2008 NY Slip Op 07651 (NY App. Div., 2nd Dept., October 07, 2008).

Read the Bruce Burgos decision here. Read the Sonnia Martinez decision here.

Paralegal

Scahill Law Group is a prominent Insurance Defense firm on Long Island. We are seeking experienced and motivated paralegals and Legal assistants to join our team.

Essential Duties and Responsibilities:

Following is a summary of the essential functions of this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

Provide efficient administrative support.
Assist attorneys in handling cases from inception to the resolution of the matter.
Draft pleadings, discovery demands, responses, motions, various correspondence to clients and adversaries, etc.
Assist in trial preparation and various discovery.
Mail, fax, E-File, or arrange for delivery of legal correspondence to clients, witnesses, and court officials.
Assist attorneys in collecting information such as employment, medical, and other records.
Receive and place telephone calls.

Requirements

· 3 Plus years of experience as a Paralegal with working knowledge of insurance defense and/or Personal Injury Law

- Customer service skills
- Knowledge of Microsoft Office Suite

· Attention to detail, organized, time management

Ability to work in a fast-paced, high volume firm

Job Type: Full-time – Hybrid Remote Work

Benefits:

401(k)

Dental insurance

Health insurance

Paid time off

Trial Attorney-Insurance Defense

Scahill Law Group seeks a full-time Trial Attorney with a minimum of ten years of experience with an insurance defense background to take over a full pending caseload. The attorney would be responsible for representing civil defendants with primary venues being the five boroughs of New York City, Nassau, and Suffolk in Long Island and the Lower Hudson Valley. The position would require the Attorney to analyze lawsuits, prepare pleadings, conduct depositions and attend arbitrations, conferences, motions, and trials. The candidate must be organized, a team player, and able to handle a high volume of court appearances, virtual or/and in-person while handling a large caseload.

RESPONSIBILITIES INCLUDE

Analyze complex lawsuits referred from Claims and prepare necessary answers and responsive pleadings.
Interface and develop a rapport with our clients, claim customers, and our office team.
Conducts depositions and attends court conferences, arbitrations, motions, and trials.
Participates as a trial and/or appellate attorney in matters of significant exposure and complexity.
Possesses excellent knowledge of rules of evidence and civil procedure.
Possesses excellent knowledge of all aspects of Automobile Litigation, UM/SUM, and Premise Liability Insurance Law.
Provides legal research, advice, and direction to Claims on cases of significant exposure and complexity.
Work independently in making decisions in file handling, communicating those decisions appropriately, and keeping the Legal Management Team apprised.
Adept at working in a paperless environment, video conferencing skilled and proficient in computer legal case management systems.
Maintain minimum billing requirements

QUALlFICATIONS:

Possesses a minimum of ten years of relevant litigation and trial experience encompassing liability and damages verdicts.
Fully licensed to practice law in New York State and admitted to Federal Court in the Eastern and Southern Districts.
Must be able to handle a large caseload of High Indemnity matters including reporting requirements, roundtables, and a moderate to a significant amount of trial work.
Have a comprehensive knowledge of motor vehicle, premises, UM/SUM, and subrogation claims.

ADDITIONAL KNOWLEDGE. SKILLS AND ABILITIES

Excellent written and Oral Communication Skills
Willingness to work within the established system while also looking to improve processes and procedures and able to be flexible in all work assignments.
Proficiency with computer software including current Windows Operating System, MS Word, MS Teams, MS Outlook, and ability to adapt to new programs.

Legal Case Management Program experience is a plus. LexisNexis/TM

Attorney - Insurance Defense

Full Job Description

Attorney – Scahill Law Group
Responsible for handling a large volume of assigned litigation cases from inception through trial and to ensure all internal case handling and reporting requirements are consistent with the Scahill Law Group Litigation Philosophy and Litigation Management Guidelines. Provide the highest level of legal representation for Scahill Law Group Clients and their insureds.

Essential Duties and Responsibilities:
Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

Answer summonses and complaints
Initiate and respond to written discovery.
Prepare and respond to motions before the court.
Prepare for and attend all court appearances, as necessary.
Prepare for [including written submissions] and attend arbitrations where appropriate.
Prepare for, schedule, and conduct depositions and examinations under oath, as necessary.
Prepare for and attend trials, as necessary.
Maintain reporting procedures (i.e., file reviews, diary control)

Minimum Skills and Competencies:
The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

J.D. (Juris Doctor) Degree from an accredited US law school
Maintain appropriate licensing and educational requirements.
3 plus years of experience in insurance defense on behalf of an insurance carrier in any combination of the following areas: automobile liability, premise liability, liability claims and homeowner/premises,
Experience in all phases of litigation (including trials to verdict) involving complex, high risk and/or high exposure cases.
Possess a strong understanding of insurance law, including the laws and rules governing civil practice in the state of practice.
Ability to analyze legal issues and identify relevant case opinions and facts, as well as the ability to interpret laws, rules, and regulations.

Job Type: Full-time

Benefits:

401(k)
Dental insurance
Health insurance
Paid time off

Schedule:

Monday to Friday

Application Question(s):

Do you have experience in meeting hourly billing requirements?

Experience:

Insurance Defense: 3 years (Required)

Work Location: One location

Full Job Description

Primary Purpose:

Responsible for handling a large volume of assigned litigation from inception through trial and to ensure all internal case handling and reporting requirements are consistent with the Scahill Law Group Litigation Philosophy and Litigation Management Guidelines. Provide the highest level of legal representation for Scahill Law Group Clients and their insureds. Take ownership of any issue, problem, or error that could impact the company, policyholder, and/or loss participant.

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

Answer summonses and complaints
Initiate and respond to written discovery.
Prepare and respond to motions before the court.
Prepare for and attend all court appearances, as necessary.
Prepare for [including written submissions] and attend arbitrations where appropriate.
Prepare for, schedule, and conduct depositions and examinations under oath, as necessary.
Prepare for and attend trials, as necessary.
Maintain reporting procedures (i.e., file reviews, diary control)
Research and analyze legal questions and issues.
Write confidential legal memoranda.
Draft confidential opinions
Research and prepare post-trial motions and appeals.
Maintain current knowledge of applicable insurance law in the state of practice.

Minimum Skills and Competencies:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

J.D. (Juris Doctor) Degree from an accredited US law school
Maintain appropriate licensing and educational requirements.
3-5 years of experience in insurance defense on behalf of an insurance carrier in any combination of the following areas: automobile liability, premise liability, liability claims and homeowner/premises,
Experience in all phases of litigation (including trials to verdict) involving complex, high risk and/or high exposure cases.
Possess a strong understanding of insurance law, including the laws and rules governing civil practice in the state of practice.
Ability to analyze legal issues and identify relevant case opinions and facts, as well as the ability to interpret laws, rules, and regulations.
Possess strong analytical and critical thinking skills with the ability to provide concise, practical advice to non-lawyers.
Possess strong verbal and written communication skills with the ability to write motions and legal prose with clear and cogent arguments.
Possess strong organizational and time management skills.
Possess strong skills in attention to detail.
High degree of initiative, mature judgment, discretion, and the ability to handle sensitive matters on a confidential basis.
Possess strong client relationship skills with the ability to resolve conflicts and empathize with insured clients.
Possess strong negotiation skills.
Knowledge of complex medical issues, particularly orthopedic and neurological, with the understanding of etiology, causation, and treatment of injuries consistent with motor vehicle and premises accidents
Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
Proficient in Westlaw software
Solid understanding of the insurance industry and organizational relationships of the company, including the functions of other departments.

Desired Skills:

Experience in Legal Files case management software

Calendar Clerk

Job Description

A calendar clerk at Scahill Law Group, PC, is part of a team of dedicated professional’s that can handle a high-volume calendar. Under general supervision compile, verify and schedule daily calendars for court appearances of attorneys and perform other administrative duties related to the Calendar Department.

Essential Functions

· Experience scheduling Depositions

· Knowledge and understanding of the various court reporting agencies.

· Confirming court calendar, including but not limited to virtual conference, motions.

· Experience using a calendar system, such as a case management system to enter and keep track of all appearances.

· Contact attorneys and/or other parties regarding changes to court dates, including adjournments and cancellations.

· Review calendars to prevent over-booking.

· Interact with court, clients and attorneys on a daily basis.

Skills

· Oral Communication: Ability to communicate effectively with others using the spoken word.

· Organizing, Planning, and Prioritizing Work: The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words).

· Attention to Detail: Requires being careful about detail and thorough in completing work tasks.

· Time Management: Ability to manage one’s own time and utilize available work time to organize and complete work within given deadlines.

· Adaptability: Ability to adapt to change in the workplace.

· Dependability: Requires being reliable, responsible, dependable, and fulfilling obligations.

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Lost wage benefits under current No-Fault regulations