In the following guest post, Christopher Bannon of the Aronberg Goldgehn law firm takes a look at a recent ruling in which the court addressed the question of whether a lawsuit seeking the return of an administrative fee is a suit for “damages” within the meaning of the applicable insurance policy. A version of this article previously was published as an Aronberg Goldgehn client alert. I would like to thank Chris for allowing me to publish his article as a guest post on this site. I welcome guest post submissions from responsible authors on topics of interest to this site’s readers. Please contact me directly if you would like to submit a guest post. Here is Chris’s guest post.
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No Coverage for Claim First Made Prior to the Policy Period of a Claims Made Policy
In a recent decision in an insurance coverage dispute, a federal court applying Puerto Rico law concluded that there was no coverage under a management liability insurance policy for a discrimination claim that had first been made prior to the policy period of the claims made policy at issue, and that notice of the claim was untimely as well. The court’s conclusion is in a sense unremarkable. What is worth considering about the ruling is how often these same problems recur, as discussed below. The District of Puerto Rico’s May 28, 2020 opinion can be found here. A June 17, 2020 post on the Wiley law firm’s Executive Summary Blog about the decision can be found here.
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Guest Post: For Businesses at Risk of COVID-19 Lawsuits, Consider Providing Notice of Circumstance
This blog’s readers know that a claim arising from the current coronavirus-related outbreak could present a number of insurance-related issues, including, among many others, perennial issues involving timeliness of notice of claim. In the following guest post, Daniel Wolf, an associate at the Gilbert LLP law firm, take a look at notice of claim considerations businesses may want to take into account with respect to potential coronavirus-related claims A version of this article first appeared on his firm’s blog. I would like to thank Daniel for allowing me to publish his article as a guest post on this site. I welcome guest post submissions from responsible authors on topics of interest to this blog’s readers. Please contact me directly if you would like to submit a guest post. Here is Daniel’s article.
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Material and Immaterial Conditions of Notice of Claim
Regular readers of this blog know that among my hobby horse issues are the various questions surrounding late notice of claim. Timeliness is of course a standard conditions for complying with an insurance policy’s notice requirements. Policies also contain other notice conditions, such as, for example, where the notice must be sent and so on. In an interesting recent ruling, the Fifth Circuit examined a professional liability insurance policy’s conditions of notice, finding that while the timely provision of notice is a material condition, others of the policy’s notice conditions were immaterial, and held, applying Texas law, that the insurer could be relieved of its coverage obligations for the policyholder’s failure to comply with an immaterial condition only if the failure prejudiced the insurer.
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Not Providing Notice of Subpoena That Wasn’t a Claim Doesn’t Bar Coverage for Later Lawsuit
As the policy definition of the term “Claim” has expanded in recent years, the range of incidents and procedures for which the policyholder must provide notice to the insurer has also grown. Among the recent expansions has been the inclusion in many policies of a “subpoena” within the meaning of the term “Claim.” As a result, a policyholder’s failure to notify its insurer of a “subpoena” could imperil coverage for a later related lawsuit. However, as a federal district court recently held, applying New York law, the notice requirement is not triggered if the prior “subpoena” does not meet the professional liability insurance policy’s definition of the term “claim,” and, the court further held that the failure to notify the insurer of the subpoena did not preclude coverage for a later suit. The court’s decision sheds interesting light on a number of frequently recurring coverage issues.
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“Voluntary Parting” Exclusion Precludes Coverage for Social Engineering Fraud Loss
Social engineering fraud, or as it is sometimes called, business instruction fraud, has unfortunately become all too common. In many instances, the defrauded companies’ losses are huge. In a recent insurance coverage dispute, the social engineering fraud loss involved was not as large as some of the others have been. Unfortunately, and notwithstanding the relatively small size of the loss, the court concluded that coverage for the company’s loss was precluded by the “voluntary parting” exclusion in its crime policy. As discussed below, there are still some lessons to be drawn from this case. Eastern District of Virginia Judge John A. Gibney, Jr.’s February 20, 2020 opinion in the case can be found here.
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Broad Form Statutory Claims Exclusion Does Not Preclude Coverage for Common Law Claims
Policy exclusions with the broad “based upon or arising out of” sometimes may be applied very broadly to sweep beyond the claims that the exclusion aimed to exclude. In a recent coverage dispute, a professional liability insurer sought to apply an exclusion with the broad preamble language and precluding coverage for ERISA and securities law claims in order to preclude coverage even the common law and bankruptcy law claims alleged against the insured. In a February 7, 2020 opinion (here), Eastern District of Michigan Judge Laurie J. Michelson, applying Michigan law, concluded that the exclusion’s preclusive effect did not apply to the common law claims, because the insurer failed to establish the exclusion’s required causal connection between the alleged statutory violations, on the one hand, and the common law and bankruptcy law claims, on the other hand. Judge Michelson’s opinion provides an interesting perspective on exclusions with the broad “based upon and arising out of” preamble language.
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Despite Factual Overlap, Later Claim Unrelated to Prior Demand and Suit
In numerous prior posts, I have meditated on the meaning of “relatedness” and what it takes to make two claims sufficiently similar that they should be treated as the same claim. That was the question that a Pennsylvania federal district court addressed in a recent decision in an insurance coverage dispute. As discussed below, on January 27, 2020, Eastern District of Pennsylvania Judge Timothy J. Savage, applying Pennsylvania law, concluded that, despite overlaps, a subsequent shareholder derivative suit was not sufficiently related to another shareholder’s prior demand letter and lawsuit to preclude coverage for the later claim. The court’s decision provides abundant grounds for further ruminations on the meaning of relatedness.
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Guest Post: Key 2019 Management and Professional Liability Insurance Coverage Decisions
In the following guest post, Alison Finn, Claims Counsel, DWF Claims; Elan Kandel, Member, Bailey Cavalieri; and James Talbert, Associate, Bailey Cavalieri, take a look at the most important management and professional liability coverage decisions for 2019, involving the perennial coverage issues for insurers and policyholders. I would like to thank Alison, Elan, and James for allowing me to publish their article as a guest post on this site. I welcome guest post submissions from responsible authors on topics of interest to this blog’s readers. Please contact me directly if you would like to submit a guest post. Here is the authors’ article.
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11th Circuit: Crime Policy Covers Payment Instruction Fraud Loss
Earlier this week, I published a post noting the challenges policyholders can face in establishing coverage under traditional crime and cyber liability insurance policies for losses arising from “payment instruction fraud” (sometimes called “social engineering fraud). I also discussed the recent availability of sublimited coverage extensions for these kinds of losses. In response to my earlier post, several readers sent me messages noting that several courts have, in fact, found coverage under commercial crime policies for payment instruction fraud losses. As if to prove their point, the same day as I published my post, the 11th Circuit issued an opinion affirming a district court ruling that a firm’s payment instruction fraud losses are covered under the “fraudulent instruction” provisions of the applicable commercial crime policy. The 11th Circuit’s December 9, 2019 opinion can be found here.
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