Is Your Insurance Company Causing A Hassle After The Flood?

The record rains of Hurricane Irene and the remnants of the tropical storm that followed a week later left tens of thousands with water in their basements (including yours truly).  Others like those living along the Delaware River in Yardley and Morrisville, PA or those living along major streams like the Neshaminy in Langhorne experienced far more devastating damage from the flood waters.  Unfortunately, many homeowners with standard insurance policies will not be covered for these losses.  Flood insurance is typically provided through a separate policy under Federal Emergency Management Association (FEMA) guidelines and is only available to persons living in designated flood areas.  Even a wet basement will not be covered unless the homeowner purchased a separate rider for overflow of sumps.

If you did have the foresight to purchase the insurance, then your insurance company owes you a duty of good faith to settle your claim quickly and fairly.  Covered costs should include steps taken to mitigate or prevent further loss, for example, hiring a remediation company to remove soaked wallboard and carpets before mold forms.  Hopefully, you photographed the water damage before, during and after any remediation and kept receipts for all expenses incurred.  Your insurance company may ask for proof of the damage and receipts to substantiate your claim.

If the insurance company fails to respond, repeatedly asks for resubmissions or otherwise causes unreasonable delay, or denies all or part of a claim without a reasonable basis, the insurance company may be liable to the homeowner for “bad faith.”  “Bad faith” is defined as the unreasonable refusal to pay the proceeds of an insurance policy.  Damages for “bad faith” may include the policy proceeds denied, additional damages caused by failure to pay the proceeds (for example, money spent on lodging where the homeowner could not complete repairs and live in the home), attorney fees, and even punitive damages in egregious cases. 

If your insurance company is holding out on your claim, attorney review of your insurance policy and the insurer’s conduct will educate you on the merits of your claim and a letter from the attorney may very well expedite resolution.  DO NOT simply settle for the insurance company’s first offer (unless, of course, it is for the policy limits).  I guarantee you they will not willingly offer you full compensation for your damages on the first request.

Of course, the best way to be prepared for a natural disaster is to know what your policy provides before the disaster occurs.  Consult your agent and increase your coverage if necessary.  Being informed of what is and is not covered, and how to present and prove your claim to the insurance company, will save you time and money once the waters recede.

Law Offices of Scott I. Fegley, P.C.
301 Oxford Valley Rd, Suite 402 A YardleyPA19067-7710 USA 
 • (215) 493-8287
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Livengrin Foundation 45th Anniversary Gala

I have the pleasure of serving on the Board of Livengrin Foundation in Bensalem, Bucks County, PA.  Anyone who has unfortunately been arrested for DUI or underage drinking in Lower Bucks will be familiar with Livengrin as the place they went for court ordered evaluations and alcohol awareness classes.  However, I often encounter people, even area residents, who are unfamiliar with the difference Livengrin has made in the lives of people struggling to overcome alcoholism and addiction. 

Alcohol and drug dependency is a disease recognized within our legal system as a disability for which its victims are entitled to protection from discrimination and a reasonable accommodation in employment to enable them to get their lives back together.  For people suffering from alcoholism or addiction, a leave of absence to attend a treatment program at Livengrin may be the accommodation the individual needs to break the downward spiral and become sober. 

Livengrin is now in its 45th year of providing services to people afflicted with alcoholism and addiction.  Every year, it hosts a “Ride for Recovery” in which hundreds who have been through its doors gather to celebrate the fresh start Livengrin has given them.  On September 22, 2011, Livengrin will also be celebrating its 45th anniversary at a Gala dinner to be held at the Crystal Tea Room in the Wanamaker Building.  The evening will feature the antics of comedian Richard Lewis and will include, of course, an exceptional meal.  While the evening will be filled with celebration and laughs, it is nevertheless for a serious purpose . . . to make sure Livengrin can continue saving lives.  Individual tickets are only $135.00.  A Phillies game will cost you that much, more if you take the kids.  Bring your significant other and the bill is only $250.00.  Tickets can be ordered online through www.livengrin.org

In my 23 years of practice, I have represented clients who have suffered from alcoholism and addiction.  I have seen them struggle to hold jobs or maintain businesses as well as witnessed the impact their disease has on their families.  Livengrin is a light at the end of the tunnel for these individuals.  Please join me in supporting Livengrin and its work by attending the Gala dinner on September 22, 2011.

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What Are Juries Thinking?

Every month I receive a report of the civil verdicts rendered by juries in Bucks County, PA, where my main office is located.  No matter whether it is an accident, employment or contract case, or the skill of the attorneys involved, juries are returning verdicts for the defense in an alarming number of cases.  Even when juries find for a plaintiff, they are awarding amounts that often fail to compensate for the injuries or losses sustained at least from an attorney’s point of view.  While the insurance companies are happy, I doubt anyone will see a reduction in their insurance premiums anytime soon. 

So what are juries thinking?  If you have been on a jury recently, in any jurisdiction, I’d like to hear from you.

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Hire A Lawyer Before Your Unemployment Hearing

I’ve had a few potential clients come to my Yardley, PA office lately having represented themselves in an unemployment hearing and lost.  They did not understand the unemployment appeals process and did not realize the difficulty of an appeal to the Unemployment Compensation Board of Review after a hearing.  With the hope that some recently unemployed person might read this and avoid the same mistake, let me describe the unemployment decision-making process in Pennsylvania.

When you file your claim online, your submitted responses are reviewed by a claim examiner to determine your eligibility for unemployment benefits.  The UC office sends a questionnaire to the employer as well soliciting pertinent information on the reason for separation, length of employment, and salary or wages.  After receiving the employer’s responses, the examiner issues an initial “Notice of Determination” of the claimant’s eligibility and either grants or denies benefits.  Either the claimant or the employer may appeal the decision by completing and faxing or mailing the appeal form within ten days of receipt.  Thereafter, a hearing will be scheduled.  Hearings take place in the county where the claimant worked or was based.  The Bucks County office is located in Bristol, PA.

Unfortunately, some claimants, having won the first round, think all they have to do is show up for the hearing.  However, the hearing is actually a mini trial with the opportunity to introduce evidence and cross-examine witnesses.  One must approach the hearing with an understanding of the issues and be prepared to introduce evidence to prove eligibility for benefits.  It is at this stage that legal counsel can be the greatest value.  An employment attorney can identify the issues and the evidence needed to establish your claim or, conversely, tell you to save your time and money because your claim doesn’t have any legs.  Even if you choose to represent yourself at the hearing after a consultation, at least you are going in forewarned.

In one recent instance, the potential client was terminated for a violation of a company policy.  The employer came to the hearing with a written policy and proof that the employee was aware of the policy through an employee handbook acknowledgement.  The claimant told me the policy had largely been ignored by the employer and never enforced.  However, she did not bring any witnesses or other evidence to establish this.  Had she been able to do so, she may have persuaded the referee that if the employer disregarded its own rule, she should not be denied benefits for disregarding it as well.

After a hearing, a further appeal goes to the Unemployment Compensation Board of Review in Harrisburg.  The UCBR will reverse and/or remand for another hearing only if it determines the referee made an error of law or the record demonstrates that the referee’s decision was so clearly against the weight of the evidence that it was arbitrary and unreasonable.  The UCBR will not second guess the referee’s evaluation of the credibility of the witnesses, nor will it remand for another hearing because one party wishes to introduce evidence or testimony that was available at the time of the hearing but they forgot or did not consider important at the time.

It goes without saying that your unemployment benefits are an important source of income when you’re out of work.  Whether you appeal the Notice of Determination or the employer does, when a hearing is scheduled don’t go it alone.

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U.S. Supreme Court Stifles Class Actions

The U.S. Supreme Court of Corporate America is at it again.  After opening the floodgates of corporate contributions into the electoral process, the Supreme Court recently slammed the door on consumers banding together to hold corporations accountable for their misdeeds.

In the 5-4 decision in AT&T Mobility v. Concepcion, the Supreme Court upheld a clause in AT&T’s customer cell phone contracts requiring the customer to individually arbitrate any dispute with the company and prohibiting participation in a class action.  AT&T was marketing cell phones at discount prices, but charging consumers sales tax on the full retail price, a difference of $30.22.  Considering the number of cell phones sold by AT&T, a class action for $30.22 each, plus attorney fees, could have cost it millions.  The likelihood of any individual consumer seeking arbitration over $30.22, however, is practically nil.  Undoubtedly, the consumer will be hard pressed to find a lawyer willing to represent them.

Until the Supreme Court’s decision, some states had laws invalidating individual arbitration clauses.  Now the  Supreme Court says the states may not protect their residents from overreaching corporations.  Corporations are now free to fill their coffers with illegal fees and overcharges knowing that, if caught, they only risk reimbursement of $30.22 to the one knowing, rather than returning millions to many who never knew they had been fleeced. 

Legislation from Congress will be required to undo what the Supreme Court has done.  Don’t expect it anytime soon.

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FMLA 401: Employees’ Most Common Mistakes

Employees are responsible for following FMLA rules and regulations as well as employers.  The following are mistakes which can result in your request for FMLA leave being delayed or denied:

  • Failing to provide your employer at least 30 days notice of a foreseeable leave (e.g. birth of a child, elective surgery)
  • Failing to return employer forms and medical certification (if required) in a timely manner
  • Failing to periodically report status to employer during leave
  • Failing to be aware of the number of days of permitted leave to assure return from leave on time.  (The employer does not have to remind you while you are on leave that you only have so many days left or your leave will expire on a certain date.  It is only obligated to tell you at the beginning of your leave how many days you have.)
  • Failing to obtain timely clearance to return to work certificate from physician (if required)
  • Failing to pay any required health insurance co-pays during leave

Avoiding these mistakes will lessen the chances of any problems during your leave and smooth your transition between leave and back to work.

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FMLA 301: Unintentionally Granting Leave

Employers may voluntarily extend legal rights to employees which the employees would not otherwise be entitled to.  Employers of less than 50 persons may provide Family & Medical Leave because they believe it is the right thing to do for their employees.  More often, employers of less than 50 persons include Family & Medical Leave Act policies and terminology in handbooks because they cut and paste from another handbook or download an online template without an understanding of the legal implications.

If your company is a small employer, but has an FMLA leave policy printed in its handbook, you may be entitled to leave and the FMLA’s protection against interference and retaliation based on a legal principle called “estoppel.”  Estoppel simply means that an employer cannot say one thing and do another.  If the employer grants leave, the employer cannot thereafter deny a return to one’s job at the end of twelve weeks claiming the FMLA never applied.  The employer is prevented or “estopped” from arguing it is not a covered employer because of its earlier conduct.

However, the courts generally require reliance by the employee on the employer’s conduct before they will grant relief on an estoppel theory.  Consider the following examples:  Case #1 - Jenny Jones wishes to take leave to have elective surgery performed.  She reads her employee handbook and sees there is an FMLA leave policy.  However, the employer denies leave and tells her the policy was included in the handbook in error.  Under these circumstances, Jenny probably does not have a good case against her employer on an estoppel theory because she has not yet acted in reliance on any promise made by the employer.  It is unlikely anyone accepts a job based on the existence of FMLA leave and an employer is free to change its policies at any time. 

Case #2 – Let’s change the facts a little.  The employer grants Jenny FMLA leave.  After her surgery and while she is still recuperating, her employer calls her and informs her he needs her at work the next day.  If she does not return to work, she no longer has a job.  Jenny fails to return to work and is fired.  Now Jenny has a strong case against her employer.  She relied on the promised leave to undergo the surgery and have up to twelve weeks to recuperate.  The employer cannot change the rules and force her to return to work before the leave expires or fire her for not doing so. 

Because everyone is an individual and no one’s medical leave is quite the same, FMLA cases are fact sensitive.  Courts are reluctant to impose laws on employers who would not otherwise have to comply with them and will insist on employees demonstrating reliance on the employer’s conduct and harm resulting from it.  Small employers who do not wish to subject themselves to the FMLA should review their handbooks and remove any unintentionally included leave policy before it becomes a far more expensive error to fix.  And remember, employers of 50 or more persons must comply with the FMLA whether they like it or not.

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FMLA 201 – Counting the Days

How many FMLA leave days do I have?  Let me count the ways.  (My apologies to Emily Dickinson)

If on the calendar method, then twelve weeks it be within the year

of unpaid leave, just so we’re clear.

If by the rolling method, I look back one year from the day I’m in

and count all my FMLA leave days that have already been.

If I still have some of the 12 weeks left on the day I’m complaining,

then my employer must give me the time remaining.

If by the “anniversary method” it is decided,

then by my date of employment the 12 weeks is divided.

The rolling method is the employer’s most common plan of attack

It prevents employees from having two 12-week periods back-to-back.

Who gets to choose?  Well, the employer, at first, in a handbook or policy

provided in advance to all the employees.

If nothing is written, then the employee is free

to chose the method which suits him most favorably.

So when counting FMLA leave days, whether employer or employee,

you’ll want to keep track and of lawsuits be free.

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Will a Fall in a Mall Fountain Lead to a Lawsuit?

YouTube’s latest “must see” video shows a woman so engrossed with her smart phone that she walked straight into a shopping mall fountain and fell in.  Girl/Woman Falls in Mall Fountain While Texting It appears the phone is smarter than she is.  Mall security caught the episode on tape.  They can be heard laughing in the background.  The woman appears in the tape getting out of the fountain quickly and walking away with no apparent injury other than what must have been a fairly bruising blow to her ego.

Had the woman and her husband not appeared on Good Morning America and threatened to sue the mall, one wonders how many people would have ever known who it was who fell in the fountain?  Now she looks even more ridiculous than she did coming out of the fountain dripping wet.  I’d like to know what she intends to sue for?  Personal injury?  The tape shows her walking away apparently uninjured. Yet, even if she was injured, the accident was clearly caused by her own carelessness.

Will she sue for an invasion of privacy?  For heaven’s sake, she was in a public shopping mall with video cameras all around!

Perhaps she may sue for the humiliation and embarrassment caused by the posting of the tape on YouTube seen all over the world?  But would any of us have known this woman’s name (which I don’t even remember as I sit here writing) if she had not made an appearance, of her own free will, on a nationally televised morning show?

I suspect some attorney somewhere will attempt to come up with a novel theory if for no other reason than the publicity and notoriety of representing this woman and his own chance to appear on Good Morning America.  But when lawyers agree to be an accessory to foolishness and file a lawsuit under these circumstances, it unfortunately brings the entire profession into disrepute and makes lawyers the butt of a new round of jokes. Just read the comments under the YouTube posting from ABC News for the woman’s appearance on Good Morning America. I hope any lawyer she visits will tell her the best advice he can give her is to watch where she is going.

From an employment law perspective, I’ll bet the mall employee who posted the tape to YouTube did so without the consent of his superiors and will most likely be looking for new employment shortly.



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Family And Medical Leave 101

The federal Family & Medical Leave Act of 1993 established the right for certain employees to take up to 12 weeks of unpaid leave in a 12-month period due to special family or medical circumstances. Unfortunately, many employers and employees remain unaware of the FMLA’s protection and requirements. Hopefully, this blog series will dispel some of the confusion.

First, not every employee is eligible for FMLA leave. If your company employs less than 50 employees at your facility or within 75 miles of where you work, you are not eligible. If you have not been employed by the company for at least a year, or you have not worked 1250 hours for the company in the last year, you are not eligible. There are some ways employers with less than 50 employees may become covered employers, but I’ll leave that for another blog. Generally, the multitudes who work for small employers will not gain any protection from the FMLA.

If you do work for a covered employer and meet the time requirements, then FMLA leave is available to you for the following special circumstances:

  • Birth or adoption of a child
  • Foster care placement of a child
  • To care for an immediate family member (child, spouse or parent) with a serious medical condition
  • To seek treatment for one’s own serious medical condition.

The FMLA defines a “serious health condition” very broadly. Being out sick for more than three days for a condition requiring a doctor’s care is covered. Also, conditions that are chronic or require periodic time off for treatment like dialysis or physical therapy are covered. FMLA leave does not have to be taken all at once, or even in days or weeks. Intermittent FMLA leave may be used in increments as small as one hour enabling an employee to attend appointments for treatment of covered conditions and miss an hour or so of the workday on an ongoing basis.

The FMLA has been around long enough that covered employers should know who they are and have forms and procedures to handle requests for leave. An employee does not have to mention the FMLA when asking for time off, but should give the employer enough information to be aware that the FMLA may be applicable. Asking for a pregnancy leave gives the employer adequate notice. Simply calling out sick does not. A sick or injured employee may have someone else communicate the information and request leave on his or her behalf. Employees should give the employer as much advance notice as possible. A minimum of thirty days notice is required if the employee is aware of his or her intent to request leave, for example, in the case of pregnancy or an elective surgery.

Once the employer is aware of a potential leave situation, the employer must designate the leave as FMLA leave and give the employee written notice of the employee’s FMLA rights and obligations within 48 hours. Often, employers forget this requirement and it may result in the employee being entitled to extended leave. Employers may ask the employee to complete and return a physician certification documenting the serious medical condition. Employers may ask employees (or someone on their behalf) to regularly report their status while on leave. Employers may also require an employee to provide a doctor’s note clearing the employee to return to work. If the employee fulfills these requirements, then the employer must allow the employee to return to his job or a similar position with the same pay and benefits at the end of the leave.

It is illegal for an employer to interfere with the employee’s right to leave by delaying it or denying it altogether. It is also illegal for an employer to retaliate against an employee for requesting or taking leave. In the next few blogs, I’ll examine the most common situations in which the process can break down and ways to ensure your rights are protected.

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