SlideShare ist ein Scribd-Unternehmen logo
1 von 12
Managing Claims and Losses –
Protect Your Insurance Coverage and Your
Premiums
Ariel DeJong
May 30, 2007
Organization & Due Diligence
• Who is responsible for insurance in coverage in your
company?
• Risk manager or risk management department
• Broker – good relationship important
• Counsel (internal or external) – liaison critical
• Access to coverage expertise essential
• Understand the coverage you have
• Read your policies and know what they say
• Know what policies you have (CGL, Property, BI, Builder’s Risk,
D&O, E&O, project specific)
• Policies others you contract with have covenanted to provide –
“additional insured”
• Ensure your and others covenants to insure are being
complied with
Organization & Due Diligence
• Keep all your policies including those others are obliged to
place
• Don’t throw away old policies (especially occurrence based)
• Includes application, declarations page, policy wording, all
endorsements
• Don’t rely on your broker to keep copies
• Manage, retain and store (30 years)
• Make informed decisions about coverage
• Avoid overlapping coverage
• Avoid gaps in coverage (claims made, exclusions)
Responding to a major claim or loss - General
• Put together a team
• Business drivers (marketing, production, customers, relationships)
• Risk manager
• In-house counsel
• Insurance advisors (legal and other)
• Experts
• Why?
• To understand potential coverage issues before claim or loss
presented or denied (statements to adjusters)
• To avoid denials by way claims and losses presented
• To ensure compliance with obligations under policies
• To manage information flow
• To ensure coverage implications of decisions made are considered
Responding to Claims (Liability – Third Party)
• Reporting duty (read your policy - don’t assume)
• Occurrence based policies
• Report claims immediately before you settle or defend
• Report occurrences
• Report to all insurers under all possible policies
• Delay – relief - policyholder good faith and insurer prejudice
• Claims made policies
• Report circumstances which may give rise to a claim
• Report claims made during the policy period
• Delay – can result in no coverage – no relief
• Purchase extending reporting period coverage
• Tender claims to insurer where insurer has duty to defend
Responding to Claims (Liability – Third Party)
• Duties of policyholder
• Co-operate in defence and investigation of a claim
• Access to documents
• Protect right of subrogation
• Not to admit liability
• Not to make voluntary payments or settlements without insurer’s
consent except at own expense
• Non-waiver agreements
• Don’t sign them without seeking advice – no obligation
• Respond to them – invite specifics regarding coverage concerns
• Reservation of rights – unilateral
• Conflicts - independent counsel- can waive if don’t respond
Responding to Claims (Liability – Third Party)
• Duty of insurer to defend and indemnify
• Duty to defend is broader
• Real value in many liability policies
• Not always a duty to defend but obligation to pay for defence
• Dealing with denials of coverage
• Don’t take no for an answer
• Get it in writing
• Obtain advice on coverage position
• Respond to denials – ask for reasons
• Challenge denial – meeting, lawyer’s letter, arbitrate, litigate
• Be wary of limitation periods – can be one year from unequivocal
denial of coverage despite what policy says (Demers case)
• Insurance Act amendment being considered - 2 year limitation
Responding to Claims (Liability – Third Party)
• Allocation of defence costs between covered and
uncovered claims
• Insurer required to pay for all defence costs except those “solely
and undeniably” referable to an uncovered claim
• Onus on insurer
• Costs which benefit both are payable by insurer
• Allocation before judgment or settlement usually premature
• Don’t agree to an allocation up front
• Some policies have a specific allocation clause (80/20)
• Get advice
Responding to Losses (Property – First Party)
• Report to insurer as soon as loss occurs
• One person should be responsible
• Failure to comply can result in no coverage
• Understand potential coverage issues before you meet with
adjuster – get advice
• Consider retaining consultants and experts
• Faulty design/workmanship/material exclusion – resultant damage
• Soft costs/business interruption/delayed opening
• Track costs and maintain records of expenses based on coverage
• Sue and labour
• Purpose: to require the policyholder to take reasonable steps to
prevent imminent loss or damage to insured property and to
require the insurer to pay for those costs
Responding to Losses (Property – First Party)
• Proof of Loss
• Interim or final
• Insurance Act sets out requirements (s. 6 of s.126)
• Insurer required to send form
• Get experts involved if complicated (sometimes these costs are
covered)
• Any fraud or wilfully false statement vitiates claim
• Get advice on potential coverage issues before you file
• Usually sworn – be careful and be accurate
• Loss usually payable within 60 days – can’t sue till then
Responding to Losses (Property – First Party)
• Dealing with denials of coverage
• See above
• What are the issues in dispute (amount of loss or coverage)
• Appraisers or experts needed?
Lessons Learned
• After each loss or claim evaluate outcome
• Can you avoid unfavourable outcomes in future
• Coverage gaps or overlap
• Internal policies and procedures – how can we respond
better

Weitere ähnliche Inhalte

Ähnlich wie Managing Claims And Losses

Insurance.pptx
Insurance.pptxInsurance.pptx
Insurance.pptxjincejohn6
 
Commercial Disputes – Have you got them covered?
Commercial Disputes – Have you got them covered?Commercial Disputes – Have you got them covered?
Commercial Disputes – Have you got them covered?watsonburton
 
Insuring Construction Related Risks
Insuring Construction Related RisksInsuring Construction Related Risks
Insuring Construction Related RisksArielDeJong
 
What Every Business Tort Lawyer Needs To Know
What Every Business Tort Lawyer Needs To KnowWhat Every Business Tort Lawyer Needs To Know
What Every Business Tort Lawyer Needs To Knowamystewart
 
Professional Indemnity Presentation
Professional Indemnity Presentation Professional Indemnity Presentation
Professional Indemnity Presentation Chris Fitzgerald MBA
 
Avoiding the Minefields of Claims-Made Insurance Policies
Avoiding the Minefields of Claims-Made Insurance PoliciesAvoiding the Minefields of Claims-Made Insurance Policies
Avoiding the Minefields of Claims-Made Insurance PoliciesL. D. Simmons
 
Coleman Greig Credit Management Workshop presentation - 25 July 2017
Coleman Greig Credit Management Workshop presentation - 25 July 2017Coleman Greig Credit Management Workshop presentation - 25 July 2017
Coleman Greig Credit Management Workshop presentation - 25 July 2017Rebecca Hegarty
 
Insurance Institute of Coventry
Insurance Institute of CoventryInsurance Institute of Coventry
Insurance Institute of CoventryMichael Howard
 
CPCU India Chapter | Webinar on Claim Operations - By Sneha RoyChoudhury
CPCU India Chapter  |  Webinar on Claim Operations - By Sneha RoyChoudhuryCPCU India Chapter  |  Webinar on Claim Operations - By Sneha RoyChoudhury
CPCU India Chapter | Webinar on Claim Operations - By Sneha RoyChoudhuryIndia Chapter CPCU
 
What brings most agribusiness undone
What brings most agribusiness undoneWhat brings most agribusiness undone
What brings most agribusiness undonePeter Alderson
 
Life insurance: What PFMP Staff and Military Families Need to Know
Life insurance: What PFMP Staff and Military Families Need to KnowLife insurance: What PFMP Staff and Military Families Need to Know
Life insurance: What PFMP Staff and Military Families Need to Knowmilfamln
 
DiConza's slides on bankruptcy law, from NYU class, 2013.pdf
DiConza's slides on bankruptcy law, from NYU class, 2013.pdfDiConza's slides on bankruptcy law, from NYU class, 2013.pdf
DiConza's slides on bankruptcy law, from NYU class, 2013.pdfChristian Olesen
 
Insurance act presentation - southampton May 2016
Insurance act presentation - southampton May 2016Insurance act presentation - southampton May 2016
Insurance act presentation - southampton May 2016Michael Howard
 
banking and insurance hgjhgjhgjhgjhghjgjhg.pptx
banking and insurance hgjhgjhgjhgjhghjgjhg.pptxbanking and insurance hgjhgjhgjhgjhghjgjhg.pptx
banking and insurance hgjhgjhgjhgjhghjgjhg.pptxsgtuniversity
 
Life Insurance Webinar Slides
Life Insurance Webinar SlidesLife Insurance Webinar Slides
Life Insurance Webinar SlidesBarbara O'Neill
 

Ähnlich wie Managing Claims And Losses (20)

Economic Risk in Commercial Agreements
Economic Risk in Commercial Agreements Economic Risk in Commercial Agreements
Economic Risk in Commercial Agreements
 
Insurance.pptx
Insurance.pptxInsurance.pptx
Insurance.pptx
 
Commercial Disputes – Have you got them covered?
Commercial Disputes – Have you got them covered?Commercial Disputes – Have you got them covered?
Commercial Disputes – Have you got them covered?
 
Insuring Construction Related Risks
Insuring Construction Related RisksInsuring Construction Related Risks
Insuring Construction Related Risks
 
What Every Business Tort Lawyer Needs To Know
What Every Business Tort Lawyer Needs To KnowWhat Every Business Tort Lawyer Needs To Know
What Every Business Tort Lawyer Needs To Know
 
Professional Indemnity Presentation
Professional Indemnity Presentation Professional Indemnity Presentation
Professional Indemnity Presentation
 
Avoiding the Minefields of Claims-Made Insurance Policies
Avoiding the Minefields of Claims-Made Insurance PoliciesAvoiding the Minefields of Claims-Made Insurance Policies
Avoiding the Minefields of Claims-Made Insurance Policies
 
Coleman Greig Credit Management Workshop presentation - 25 July 2017
Coleman Greig Credit Management Workshop presentation - 25 July 2017Coleman Greig Credit Management Workshop presentation - 25 July 2017
Coleman Greig Credit Management Workshop presentation - 25 July 2017
 
business ppt
business ppt business ppt
business ppt
 
Insurance Institute of Coventry
Insurance Institute of CoventryInsurance Institute of Coventry
Insurance Institute of Coventry
 
CPCU India Chapter | Webinar on Claim Operations - By Sneha RoyChoudhury
CPCU India Chapter  |  Webinar on Claim Operations - By Sneha RoyChoudhuryCPCU India Chapter  |  Webinar on Claim Operations - By Sneha RoyChoudhury
CPCU India Chapter | Webinar on Claim Operations - By Sneha RoyChoudhury
 
What brings most agribusiness undone
What brings most agribusiness undoneWhat brings most agribusiness undone
What brings most agribusiness undone
 
Life insurance: What PFMP Staff and Military Families Need to Know
Life insurance: What PFMP Staff and Military Families Need to KnowLife insurance: What PFMP Staff and Military Families Need to Know
Life insurance: What PFMP Staff and Military Families Need to Know
 
DiConza's slides on bankruptcy law, from NYU class, 2013.pdf
DiConza's slides on bankruptcy law, from NYU class, 2013.pdfDiConza's slides on bankruptcy law, from NYU class, 2013.pdf
DiConza's slides on bankruptcy law, from NYU class, 2013.pdf
 
Insurance act presentation - southampton May 2016
Insurance act presentation - southampton May 2016Insurance act presentation - southampton May 2016
Insurance act presentation - southampton May 2016
 
banking and insurance hgjhgjhgjhgjhghjgjhg.pptx
banking and insurance hgjhgjhgjhgjhghjgjhg.pptxbanking and insurance hgjhgjhgjhgjhghjgjhg.pptx
banking and insurance hgjhgjhgjhgjhghjgjhg.pptx
 
About surety bonds
About surety bondsAbout surety bonds
About surety bonds
 
Life Insurance Webinar Slides
Life Insurance Webinar SlidesLife Insurance Webinar Slides
Life Insurance Webinar Slides
 
RISK & INSURANCE.pptx
RISK & INSURANCE.pptxRISK & INSURANCE.pptx
RISK & INSURANCE.pptx
 
Hinkel Chapter 10
Hinkel Chapter 10Hinkel Chapter 10
Hinkel Chapter 10
 

Kürzlich hochgeladen

VIP Call Girl in Mira Road 💧 9920725232 ( Call Me ) Get A New Crush Everyday ...
VIP Call Girl in Mira Road 💧 9920725232 ( Call Me ) Get A New Crush Everyday ...VIP Call Girl in Mira Road 💧 9920725232 ( Call Me ) Get A New Crush Everyday ...
VIP Call Girl in Mira Road 💧 9920725232 ( Call Me ) Get A New Crush Everyday ...dipikadinghjn ( Why You Choose Us? ) Escorts
 
The Economic History of the U.S. Lecture 26.pdf
The Economic History of the U.S. Lecture 26.pdfThe Economic History of the U.S. Lecture 26.pdf
The Economic History of the U.S. Lecture 26.pdfGale Pooley
 
TEST BANK For Corporate Finance, 13th Edition By Stephen Ross, Randolph Weste...
TEST BANK For Corporate Finance, 13th Edition By Stephen Ross, Randolph Weste...TEST BANK For Corporate Finance, 13th Edition By Stephen Ross, Randolph Weste...
TEST BANK For Corporate Finance, 13th Edition By Stephen Ross, Randolph Weste...ssifa0344
 
Log your LOA pain with Pension Lab's brilliant campaign
Log your LOA pain with Pension Lab's brilliant campaignLog your LOA pain with Pension Lab's brilliant campaign
Log your LOA pain with Pension Lab's brilliant campaignHenry Tapper
 
Pooja 9892124323 : Call Girl in Juhu Escorts Service Free Home Delivery
Pooja 9892124323 : Call Girl in Juhu Escorts Service Free Home DeliveryPooja 9892124323 : Call Girl in Juhu Escorts Service Free Home Delivery
Pooja 9892124323 : Call Girl in Juhu Escorts Service Free Home DeliveryPooja Nehwal
 
Booking open Available Pune Call Girls Shivane 6297143586 Call Hot Indian Gi...
Booking open Available Pune Call Girls Shivane  6297143586 Call Hot Indian Gi...Booking open Available Pune Call Girls Shivane  6297143586 Call Hot Indian Gi...
Booking open Available Pune Call Girls Shivane 6297143586 Call Hot Indian Gi...Call Girls in Nagpur High Profile
 
(DIYA) Bhumkar Chowk Call Girls Just Call 7001035870 [ Cash on Delivery ] Pun...
(DIYA) Bhumkar Chowk Call Girls Just Call 7001035870 [ Cash on Delivery ] Pun...(DIYA) Bhumkar Chowk Call Girls Just Call 7001035870 [ Cash on Delivery ] Pun...
(DIYA) Bhumkar Chowk Call Girls Just Call 7001035870 [ Cash on Delivery ] Pun...ranjana rawat
 
Booking open Available Pune Call Girls Talegaon Dabhade 6297143586 Call Hot ...
Booking open Available Pune Call Girls Talegaon Dabhade  6297143586 Call Hot ...Booking open Available Pune Call Girls Talegaon Dabhade  6297143586 Call Hot ...
Booking open Available Pune Call Girls Talegaon Dabhade 6297143586 Call Hot ...Call Girls in Nagpur High Profile
 
VIP Call Girl Service Andheri West ⚡ 9920725232 What It Takes To Be The Best ...
VIP Call Girl Service Andheri West ⚡ 9920725232 What It Takes To Be The Best ...VIP Call Girl Service Andheri West ⚡ 9920725232 What It Takes To Be The Best ...
VIP Call Girl Service Andheri West ⚡ 9920725232 What It Takes To Be The Best ...dipikadinghjn ( Why You Choose Us? ) Escorts
 
Dharavi Russian callg Girls, { 09892124323 } || Call Girl In Mumbai ...
Dharavi Russian callg Girls, { 09892124323 } || Call Girl In Mumbai ...Dharavi Russian callg Girls, { 09892124323 } || Call Girl In Mumbai ...
Dharavi Russian callg Girls, { 09892124323 } || Call Girl In Mumbai ...Pooja Nehwal
 
Indore Real Estate Market Trends Report.pdf
Indore Real Estate Market Trends Report.pdfIndore Real Estate Market Trends Report.pdf
Indore Real Estate Market Trends Report.pdfSaviRakhecha1
 
Solution Manual for Principles of Corporate Finance 14th Edition by Richard B...
Solution Manual for Principles of Corporate Finance 14th Edition by Richard B...Solution Manual for Principles of Corporate Finance 14th Edition by Richard B...
Solution Manual for Principles of Corporate Finance 14th Edition by Richard B...ssifa0344
 
The Economic History of the U.S. Lecture 23.pdf
The Economic History of the U.S. Lecture 23.pdfThe Economic History of the U.S. Lecture 23.pdf
The Economic History of the U.S. Lecture 23.pdfGale Pooley
 
High Class Call Girls Nashik Maya 7001305949 Independent Escort Service Nashik
High Class Call Girls Nashik Maya 7001305949 Independent Escort Service NashikHigh Class Call Girls Nashik Maya 7001305949 Independent Escort Service Nashik
High Class Call Girls Nashik Maya 7001305949 Independent Escort Service NashikCall Girls in Nagpur High Profile
 
03_Emmanuel Ndiaye_Degroof Petercam.pptx
03_Emmanuel Ndiaye_Degroof Petercam.pptx03_Emmanuel Ndiaye_Degroof Petercam.pptx
03_Emmanuel Ndiaye_Degroof Petercam.pptxFinTech Belgium
 
The Economic History of the U.S. Lecture 19.pdf
The Economic History of the U.S. Lecture 19.pdfThe Economic History of the U.S. Lecture 19.pdf
The Economic History of the U.S. Lecture 19.pdfGale Pooley
 
The Economic History of the U.S. Lecture 30.pdf
The Economic History of the U.S. Lecture 30.pdfThe Economic History of the U.S. Lecture 30.pdf
The Economic History of the U.S. Lecture 30.pdfGale Pooley
 
Solution Manual for Financial Accounting, 11th Edition by Robert Libby, Patri...
Solution Manual for Financial Accounting, 11th Edition by Robert Libby, Patri...Solution Manual for Financial Accounting, 11th Edition by Robert Libby, Patri...
Solution Manual for Financial Accounting, 11th Edition by Robert Libby, Patri...ssifa0344
 
Gurley shaw Theory of Monetary Economics.
Gurley shaw Theory of Monetary Economics.Gurley shaw Theory of Monetary Economics.
Gurley shaw Theory of Monetary Economics.Vinodha Devi
 

Kürzlich hochgeladen (20)

VIP Call Girl in Mira Road 💧 9920725232 ( Call Me ) Get A New Crush Everyday ...
VIP Call Girl in Mira Road 💧 9920725232 ( Call Me ) Get A New Crush Everyday ...VIP Call Girl in Mira Road 💧 9920725232 ( Call Me ) Get A New Crush Everyday ...
VIP Call Girl in Mira Road 💧 9920725232 ( Call Me ) Get A New Crush Everyday ...
 
The Economic History of the U.S. Lecture 26.pdf
The Economic History of the U.S. Lecture 26.pdfThe Economic History of the U.S. Lecture 26.pdf
The Economic History of the U.S. Lecture 26.pdf
 
TEST BANK For Corporate Finance, 13th Edition By Stephen Ross, Randolph Weste...
TEST BANK For Corporate Finance, 13th Edition By Stephen Ross, Randolph Weste...TEST BANK For Corporate Finance, 13th Edition By Stephen Ross, Randolph Weste...
TEST BANK For Corporate Finance, 13th Edition By Stephen Ross, Randolph Weste...
 
Log your LOA pain with Pension Lab's brilliant campaign
Log your LOA pain with Pension Lab's brilliant campaignLog your LOA pain with Pension Lab's brilliant campaign
Log your LOA pain with Pension Lab's brilliant campaign
 
Pooja 9892124323 : Call Girl in Juhu Escorts Service Free Home Delivery
Pooja 9892124323 : Call Girl in Juhu Escorts Service Free Home DeliveryPooja 9892124323 : Call Girl in Juhu Escorts Service Free Home Delivery
Pooja 9892124323 : Call Girl in Juhu Escorts Service Free Home Delivery
 
Booking open Available Pune Call Girls Shivane 6297143586 Call Hot Indian Gi...
Booking open Available Pune Call Girls Shivane  6297143586 Call Hot Indian Gi...Booking open Available Pune Call Girls Shivane  6297143586 Call Hot Indian Gi...
Booking open Available Pune Call Girls Shivane 6297143586 Call Hot Indian Gi...
 
(DIYA) Bhumkar Chowk Call Girls Just Call 7001035870 [ Cash on Delivery ] Pun...
(DIYA) Bhumkar Chowk Call Girls Just Call 7001035870 [ Cash on Delivery ] Pun...(DIYA) Bhumkar Chowk Call Girls Just Call 7001035870 [ Cash on Delivery ] Pun...
(DIYA) Bhumkar Chowk Call Girls Just Call 7001035870 [ Cash on Delivery ] Pun...
 
Booking open Available Pune Call Girls Talegaon Dabhade 6297143586 Call Hot ...
Booking open Available Pune Call Girls Talegaon Dabhade  6297143586 Call Hot ...Booking open Available Pune Call Girls Talegaon Dabhade  6297143586 Call Hot ...
Booking open Available Pune Call Girls Talegaon Dabhade 6297143586 Call Hot ...
 
VIP Call Girl Service Andheri West ⚡ 9920725232 What It Takes To Be The Best ...
VIP Call Girl Service Andheri West ⚡ 9920725232 What It Takes To Be The Best ...VIP Call Girl Service Andheri West ⚡ 9920725232 What It Takes To Be The Best ...
VIP Call Girl Service Andheri West ⚡ 9920725232 What It Takes To Be The Best ...
 
Dharavi Russian callg Girls, { 09892124323 } || Call Girl In Mumbai ...
Dharavi Russian callg Girls, { 09892124323 } || Call Girl In Mumbai ...Dharavi Russian callg Girls, { 09892124323 } || Call Girl In Mumbai ...
Dharavi Russian callg Girls, { 09892124323 } || Call Girl In Mumbai ...
 
Indore Real Estate Market Trends Report.pdf
Indore Real Estate Market Trends Report.pdfIndore Real Estate Market Trends Report.pdf
Indore Real Estate Market Trends Report.pdf
 
Solution Manual for Principles of Corporate Finance 14th Edition by Richard B...
Solution Manual for Principles of Corporate Finance 14th Edition by Richard B...Solution Manual for Principles of Corporate Finance 14th Edition by Richard B...
Solution Manual for Principles of Corporate Finance 14th Edition by Richard B...
 
The Economic History of the U.S. Lecture 23.pdf
The Economic History of the U.S. Lecture 23.pdfThe Economic History of the U.S. Lecture 23.pdf
The Economic History of the U.S. Lecture 23.pdf
 
High Class Call Girls Nashik Maya 7001305949 Independent Escort Service Nashik
High Class Call Girls Nashik Maya 7001305949 Independent Escort Service NashikHigh Class Call Girls Nashik Maya 7001305949 Independent Escort Service Nashik
High Class Call Girls Nashik Maya 7001305949 Independent Escort Service Nashik
 
03_Emmanuel Ndiaye_Degroof Petercam.pptx
03_Emmanuel Ndiaye_Degroof Petercam.pptx03_Emmanuel Ndiaye_Degroof Petercam.pptx
03_Emmanuel Ndiaye_Degroof Petercam.pptx
 
The Economic History of the U.S. Lecture 19.pdf
The Economic History of the U.S. Lecture 19.pdfThe Economic History of the U.S. Lecture 19.pdf
The Economic History of the U.S. Lecture 19.pdf
 
The Economic History of the U.S. Lecture 30.pdf
The Economic History of the U.S. Lecture 30.pdfThe Economic History of the U.S. Lecture 30.pdf
The Economic History of the U.S. Lecture 30.pdf
 
Solution Manual for Financial Accounting, 11th Edition by Robert Libby, Patri...
Solution Manual for Financial Accounting, 11th Edition by Robert Libby, Patri...Solution Manual for Financial Accounting, 11th Edition by Robert Libby, Patri...
Solution Manual for Financial Accounting, 11th Edition by Robert Libby, Patri...
 
(Vedika) Low Rate Call Girls in Pune Call Now 8250077686 Pune Escorts 24x7
(Vedika) Low Rate Call Girls in Pune Call Now 8250077686 Pune Escorts 24x7(Vedika) Low Rate Call Girls in Pune Call Now 8250077686 Pune Escorts 24x7
(Vedika) Low Rate Call Girls in Pune Call Now 8250077686 Pune Escorts 24x7
 
Gurley shaw Theory of Monetary Economics.
Gurley shaw Theory of Monetary Economics.Gurley shaw Theory of Monetary Economics.
Gurley shaw Theory of Monetary Economics.
 

Managing Claims And Losses

  • 1. Managing Claims and Losses – Protect Your Insurance Coverage and Your Premiums Ariel DeJong May 30, 2007
  • 2. Organization & Due Diligence • Who is responsible for insurance in coverage in your company? • Risk manager or risk management department • Broker – good relationship important • Counsel (internal or external) – liaison critical • Access to coverage expertise essential • Understand the coverage you have • Read your policies and know what they say • Know what policies you have (CGL, Property, BI, Builder’s Risk, D&O, E&O, project specific) • Policies others you contract with have covenanted to provide – “additional insured” • Ensure your and others covenants to insure are being complied with
  • 3. Organization & Due Diligence • Keep all your policies including those others are obliged to place • Don’t throw away old policies (especially occurrence based) • Includes application, declarations page, policy wording, all endorsements • Don’t rely on your broker to keep copies • Manage, retain and store (30 years) • Make informed decisions about coverage • Avoid overlapping coverage • Avoid gaps in coverage (claims made, exclusions)
  • 4. Responding to a major claim or loss - General • Put together a team • Business drivers (marketing, production, customers, relationships) • Risk manager • In-house counsel • Insurance advisors (legal and other) • Experts • Why? • To understand potential coverage issues before claim or loss presented or denied (statements to adjusters) • To avoid denials by way claims and losses presented • To ensure compliance with obligations under policies • To manage information flow • To ensure coverage implications of decisions made are considered
  • 5. Responding to Claims (Liability – Third Party) • Reporting duty (read your policy - don’t assume) • Occurrence based policies • Report claims immediately before you settle or defend • Report occurrences • Report to all insurers under all possible policies • Delay – relief - policyholder good faith and insurer prejudice • Claims made policies • Report circumstances which may give rise to a claim • Report claims made during the policy period • Delay – can result in no coverage – no relief • Purchase extending reporting period coverage • Tender claims to insurer where insurer has duty to defend
  • 6. Responding to Claims (Liability – Third Party) • Duties of policyholder • Co-operate in defence and investigation of a claim • Access to documents • Protect right of subrogation • Not to admit liability • Not to make voluntary payments or settlements without insurer’s consent except at own expense • Non-waiver agreements • Don’t sign them without seeking advice – no obligation • Respond to them – invite specifics regarding coverage concerns • Reservation of rights – unilateral • Conflicts - independent counsel- can waive if don’t respond
  • 7. Responding to Claims (Liability – Third Party) • Duty of insurer to defend and indemnify • Duty to defend is broader • Real value in many liability policies • Not always a duty to defend but obligation to pay for defence • Dealing with denials of coverage • Don’t take no for an answer • Get it in writing • Obtain advice on coverage position • Respond to denials – ask for reasons • Challenge denial – meeting, lawyer’s letter, arbitrate, litigate • Be wary of limitation periods – can be one year from unequivocal denial of coverage despite what policy says (Demers case) • Insurance Act amendment being considered - 2 year limitation
  • 8. Responding to Claims (Liability – Third Party) • Allocation of defence costs between covered and uncovered claims • Insurer required to pay for all defence costs except those “solely and undeniably” referable to an uncovered claim • Onus on insurer • Costs which benefit both are payable by insurer • Allocation before judgment or settlement usually premature • Don’t agree to an allocation up front • Some policies have a specific allocation clause (80/20) • Get advice
  • 9. Responding to Losses (Property – First Party) • Report to insurer as soon as loss occurs • One person should be responsible • Failure to comply can result in no coverage • Understand potential coverage issues before you meet with adjuster – get advice • Consider retaining consultants and experts • Faulty design/workmanship/material exclusion – resultant damage • Soft costs/business interruption/delayed opening • Track costs and maintain records of expenses based on coverage • Sue and labour • Purpose: to require the policyholder to take reasonable steps to prevent imminent loss or damage to insured property and to require the insurer to pay for those costs
  • 10. Responding to Losses (Property – First Party) • Proof of Loss • Interim or final • Insurance Act sets out requirements (s. 6 of s.126) • Insurer required to send form • Get experts involved if complicated (sometimes these costs are covered) • Any fraud or wilfully false statement vitiates claim • Get advice on potential coverage issues before you file • Usually sworn – be careful and be accurate • Loss usually payable within 60 days – can’t sue till then
  • 11. Responding to Losses (Property – First Party) • Dealing with denials of coverage • See above • What are the issues in dispute (amount of loss or coverage) • Appraisers or experts needed?
  • 12. Lessons Learned • After each loss or claim evaluate outcome • Can you avoid unfavourable outcomes in future • Coverage gaps or overlap • Internal policies and procedures – how can we respond better