New York City Debt Collection Defense Attorney

Dancing around the notice-of-occurrence clause

In the context of an insurer's duty to defend and/or indemnify, New York law holds that compliance with a notice-of-occurrence provision is a condition precedent to an insurer's liability. Two exceptions: 1) insured lacked knowledge of the occurrence; or 2) a reasonable belief of non-liability.

Prong 2 is relevant to a case of mine, where a young foreign exchange student was covered by a group health insurance plan provided through his college. After suffering ischemic cardiomyopathy that landed him in the hospital, a hospital doctor administrator called his college to clear his insurance. Therefore, my client felt it was not necessary to submit a formal claim through his school as mandated in his student handbook. Surely enough, the insurance company has disclaimed coverage based on lack of notice.

Was it reasonable for this young, foreign student to believe that he would not need to submit a claim form?