Significant Cases

Dismissal Obtained in Nevada Case Involving “Sunset” Provision in Accident Medical Expense Benefit Policy

Albert Alikin and Nicholas Directo obtained the dismissal of their client, an insurance carrier, in Nevada federal court in a lawsuit brought by the client’s insured seeking benefits under an occupational accident medical expense policy.…

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Albert Alikin and Nicholas Directo obtained the dismissal of their client, an insurance carrier, in Nevada federal court in a lawsuit brought by the client’s insured seeking benefits under an occupational accident medical expense policy. The insured filed suit against the client alleging breach of contract and bad faith after the client denied the insured’s insurance claim seeking coverage for medical expenses resulting from a work-related accident that occurred over three years before the insured gave the client notice of the accident or his claim for benefits under the policy. The client’s policy contains a “sunset” provision which states that no claim is “considered valid and collectible unless full details of such claim are presented to” the client within three years of the date of the accident from which the claim arises. FMG filed a motion for judgment on the pleadings on the basis that the policy’s “sunset” provision is strictly enforceable because, unlike the usual “notice” provision in an insurance policy that requires a showing of prejudice to be enforceable, the “sunset” provision provides an explicit time limitation for the insured to tender a claim. FMG also argued that the policy’s “suit against us” provision barred the insured’s lawsuit. After a spirited debate on the issues between counsel, we convinced the insured’s counsel to dismiss our client with prejudice in lieu of opposing our motion and showing their “cards” to the other defendant carriers.

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Summary Judgment in Insurance Coverage Dispute in Georgia

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