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Navigating the Insurance Claims Handling Process: A Practical View
Navigating the Insurance Claims Handling Process: A Practical View
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Navigating the Insurance Claims Handling Process: A Practical View With a Focus on DO Insurance

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1Navigating the Insurance Claims 15practicable and usually within same policy
Handling Process: A Practical View With a period when claim made Extended reporting
Focus on D&O Insurance. Presented by: period provisions for claims made at end
Donald W. Kiel, K&L Gates Anthony P. of policy period.
La Rocco, K&L Gates. 16Notice (cont’d). Who within the
2Commercial Insurance a Key Corporate company needs to know about the occurrence
Asset. Difference between potentially or claim to trigger the notice obligation?
overwhelming liabilities or losses, and Best Practice: endorsement specifying
survival or material impact to corporate corporate officers or risk manager can
profitability When a claim is asserted or offer special protection Timing – “as soon
a loss occurs, important for corporate as practicable” For occurrence policies:
counsel to be able to: Navigate through Prejudice standard in NJ/PA; no prejudice
the minefields of the claim process Know standard in NY.
when to negotiate and when to sue 17Notice (cont’d). For claims made
Additional complications in the D&O policies, including D&O, notice within
context. the policy period is required to trigger
3Program Organization. A Short Primer the policy, and notice after the policy
on D&O Insurance Evaluating the Claim period is likely to be a valid defense to
for Coverage The Claims Process Claims coverage, regardless of prejudice.
Disputes. 18Notice (cont’d). Notice of
4I. A Short Primer on D&O Circumstances v. Notice of Claim (claims
Insurance. made policies only) What constitutes a
5A Short Primer on D&O Insurance. claim? Usually defined in the policy to
Typically written on claims first made and include lawsuits, written demands;
reported basis Primary purpose to protect arbitration demands; certain types of
individual directors, officers, and administrative proceedings; formal
certain other individuals for claims investigations What constitutes a
arising out of “wrongful acts” Typical circumstance? Usually a circumstance
policy of public company insures company reasonably expected to give rise to a
only for securities claims, and claim.
indemnification of Ds and Os Typical 19Notice (cont’d). Notice of
policy of private company insures company circumstances during the policy period can
for claims arising out of “wrongful acts,” protect you from a future claim that might
with many exclusions, and for be excluded under a later policy If a
indemnification of Ds and Os. claim is later made, handled under policy
6A Short Primer on D&O Insurance under which notice of circumstances given
(cont’d). Many of the very wrongful acts Intersection with policy renewal
that trigger the policy may also trigger application.
application of an exclusion Intersection 20Notice (cont’d). Notice of
of broad definition of “Claim” and strict circumstance information requirements
notice requirements often leads to Wrongful act allegation anticipated
coverage disputes Some companies combine Reasons for anticipating claim Details –
D&O with EPLI insurance. dates, persons, entities involved.
7II. Evaluating the Claim for Coverage. 21The Course of a Claim. Written notice
8Evaluating the Claim for Coverage. to the insurer Assigned to adjuster or
Need to promptly evaluate to identify claims handler Insurers increasingly
proper policies to be noticed Non-D&O assigning D&O claims to counsel
claim Multiple types of policies e.g., Investigation Initial coverage
employment claim, including personal determination Declination, Reservation of
injury allegations Multiple years of rights, Acknowledgment Rarely a final
policies e.g., long-term exposure claims coverage determination for D&O claims
Multiple layers of coverage e.g., large until underlying claim concluded.
claim that could exceed primary policy 22IV. Claims Disputes.
limits Multiple coverage lines e.g., 23Most Common D&O Claims Disputes.
policies that covered corporate Was the Claim “first made” before or
predecessors. during the policy period? Is the
9Evaluating the Claim for Coverage proceeding or assertion against the
(cont’d). D&O Claim Multiple policies insured a “Claim” under the policy? Does
e.g., side A only, independent directors there need to be an allocation of defense
only Multiple layers e.g., large claim and indemnity payments between covered and
that could exceed primary policy limit non-covered claims? Does the insurer
Correct year e.g., making sure you notify contend that the basis for the Claim also
the correct policy in a timely manner. gives the insurer the right or ability to
10Evaluating the Claim for Coverage. void the policy ab initio for fraud in the
Need to determine whether proceeding or application?
other assertion of liability or potential 24Most Common D&O Claims Disputes.
liability is a “Claim” “Claim” defined in Does the Claim trigger application of
Policy Typically includes: Civil and fraud exclusion? Does the Claim trigger
criminal lawsuits Written assertions of application of improperly obtained
liability Certain administrative remuneration exclusion? If the Claim seeks
proceedings Formal investigations Target disgorgement of profits or ill-gotten
letters Failure to give notice of minor funds, does common law preclude recovery
“Claim” could prejudice coverage for of insurance indemnity?
serious “Claim” arising thereafter. 25Statute of Limitations. At what point
11Evaluating the Claim for Coverage to pull the trigger and sue the carrier?
(cont’d). Failure to notice correct In the liability policy context, general
policies on timely basis could prejudice contract statute applies (6 years in New
coverage Better to err on the side of Jersey) At what point does the 6 years
“over notice” Consult your professionals begin to run? When carrier denies
Broker Risk manager Counsel Make sure you coverage? When occurrence happens? When
have thorough understanding of your claim is made? In New Jersey, the rule is
company’s insurance program. that it begins when the carrier denies
12III. The Claims Process. coverage.
13How is a Claim Presented. Through 26Statute of Limitations. Some courts
Agent or Broker, or Directly to Carrier? have ruled that the statute of limitations
Look to Notice Provision for Recipient is “tolled” during the time between when
Some policies (and particularly D&O the claim is made and the carrier responds
policies) provide specific address or Best practice: negotiate a tolling
agent for notice If given orally, agreement where the statute of limitations
follow-up in writing Policy may require is tolled for a specified amount of time.
certain information to be provided with 27Venue Considerations. Choice of law
notice D&O policies usually only the rules Substantive coverage law All else
Claim – copy of suit or claim papers. being equal, New Jersey tends to be a
14How is Claim Presented (cont’d). Other policyholder-friendly jurisdiction
policies (e.g., GL) require notice of both Recovery of counsel fees in coverage
occurrence and claim Occurrence – how, litigation New Jersey court rules
when and where; names of injured persons specifically permit award of counsel fees
& witnesses; nature & location of to successful policyholder in coverage
injury or damage. litigation on liability or indemnity
15Notice. Timely notice to the insurer policies.
(not the TPA) Notice obligations differ 28Venue Considerations (cont’d). Answers
depending on type of policy Occurrence to these questions may impact the timing
policy – notice of occurrence and notice of your suit against the carrier.
of claim as soon as practicable Claims 29
made policy – notice of claim as soon as
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Navigating the Insurance Claims Handling Process: A Practical View With a Focus on DO Insurance

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