Картинки на тему «Navigating the Insurance Claims Handling Process: A Practical View With a Focus on DO Insurance» |
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![]() Navigating the Insurance Claims Handling Process: A Practical View |
Автор: Don Kiel. Чтобы познакомиться с картинкой полного размера, нажмите на её эскиз. Чтобы можно было использовать все картинки для урока английского языка, скачайте бесплатно презентацию «Navigating the Insurance Claims Handling Process: A Practical View With a Focus on DO Insurance.PPT» со всеми картинками в zip-архиве размером 507 КБ.
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1 | Navigating the Insurance Claims | 15 | practicable 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. | 16 | Notice (cont’d). Who within the | |
2 | Commercial 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 | 17 | Notice (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 | ||
3 | Program 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. | 18 | Notice (cont’d). Notice of | |
4 | I. A Short Primer on D&O | Circumstances v. Notice of Claim (claims | |
Insurance. | made policies only) What constitutes a | ||
5 | A 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 | 19 | Notice (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 | ||
6 | A 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 | 20 | Notice (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. | ||
7 | II. Evaluating the Claim for Coverage. | 21 | The Course of a Claim. Written notice |
8 | Evaluating 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 | 22 | IV. Claims Disputes. | |
limits Multiple coverage lines e.g., | 23 | Most Common D&O Claims Disputes. | |
policies that covered corporate | Was the Claim “first made” before or | ||
predecessors. | during the policy period? Is the | ||
9 | Evaluating 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 | ||
10 | Evaluating 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 | 24 | Most 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. | 25 | Statute of Limitations. At what point | |
11 | Evaluating 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 | ||
12 | III. The Claims Process. | coverage. | |
13 | How is a Claim Presented. Through | 26 | Statute 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 | 27 | Venue 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 | ||
14 | How 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 | ||
15 | Notice. Timely notice to the insurer | policies. | |
(not the TPA) Notice obligations differ | 28 | Venue 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 | |||
Navigating the Insurance Claims Handling Process: A Practical View With a Focus on DO Insurance.PPT |
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