In Matter of Nationwide Mut. Ins. Co. v. Mackley, the insurer disclaimed its insureds' SUM claim on the grounds that the insureds had failed to provide a "proof of claim" pursuant to the terms of the insurance contract.
The underlying automobile accident occurred on June 8, 2003 and the insureds' attorney sent the insurer a letter dated July 1, 2003 in which he notified the insurer of the no-fault claim and of a "potential uninsured/ underinsured motorist claim." The insureds' attorney sent another letter dated July 15, 2003 and enclosed a police report which indicated that no other coverage existed for any other policy in the household or from the vehicle involved in the accident.
In January 2004, the insureds' attorney notified the insured that a SUM claim would be pursued, and the insurer then sent a letter enclosing a "proof of claim" form, which was not returned until April 14, 2004. In the meantime, the insureds' attorney sent medical records to the insurer in February 2004, and the insurer disclaimed coverage on March 29, 2004 due to the insureds' failure to provide the "proof of claim" form.
The Court noted that:
The Court of Appeals has recently held that "where an insured previously gives timely notice of the accident, the carrier must establish that it is prejudiced by a late notice of SUM claim before it may properly disclaim coverage" (Rekemeyer v State Farm Mut. Auto Ins. Co., 4 NY3d 468, 476 ; see Matter of Brandon [Nationwide Mut. Ins. Co.], 97 NY2d 491, 496-497 ; cf. Argo Corp. v Greater N.Y. Mut. Ins. Co., 4 NY3d 332, 339-340 ). The rationale in Rekemeyer applies here...
The Court concluded that since the insurer had failed to establish prejudice as a result of the insureds' failure to provide the "proof of claim" in a timely manner, that it should not be allowed to disclaim coverage.
It would seem that the lesson to be learned is that form over function isn't always the rule.