WHAT EVERY LAWYER SHOULD KNOW ABOUT INSURANCE COVERAGE

Transcription

1 WHAT EVERY LAWYER SHOULD KNOW ABOUT INSURANCE COVERAGE Jean H. Hurricane SSL Law LLP John S. Worden Schiff Hardin LLP 1

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3 I. TYPES OF INSURANCE 3

4 4 FIRST PARTY V. THIRD PARTY

5 5 CLAIMS MADE V. OCCURRENCE

6 ''Loss'' ''Claim'' D&O (DIRECTORS AND OFFICERS) First made during the policy period "Wrongful Acts" 6

7 CGL (COMMERCIAL GENERAL LIABILITY) ''Occurrence'' Coverage A Bodily Injury Property Damage Coverage B Personal and Advertising Injury 7

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9 II. THE DUTY TO DEFEND 9

10 "LITIGATION INSURANCE?" Breach of Contract Construction Delay Lost Income Building Code Violations 10

11 DUTY TO DEFEND "We will have the right and duty to defend any suit seeking damages for bodily injury and property damage to which this insurance applies." 11

12 DUTY TO DEFEND V. THE DUTY TO INDEMNIFY The duty to defend is broader than the duty to indemnify. The duty to defend can include: Groundless claims; False claims; Fraudulent claims; Allegations of intentional torts; Allegations of willful acts; or Allegations of criminal conduct. 12

13 THE TEST TO TRIGGER A DEFENSE OBLIGATION The carrier must defend a suit which potentially seeks damages within the coverage of the policy." Gray v. Zurich, 65 Cal. 2d 263 (1966). The defense is excused only where ''the third party complaint can by no conceivable theory raise a single issue which could bring it within the policy coverage." Montrose I, 6 Cal. 4th 287 (1993). 13

14 THE DETERMINATION OF THE EXISTENCE OF A DUTY An insurer may have a duty to defend based on either: The allegations in the third-party complaint Any facts known to the insurer from any source No potential for coverage exists for speculative pleadings 14

15 WHEN THE DUTY BEGINS AND ENDS The duty to defend arises when the insured tenders the defense of a ''suit'' The duty to defend does not end until: The underlying lawsuit is concluded The facts show that there is "no potential for coverage'' The policy limits are exhausted 15

16 WHO CONTROLS THE DEFENSE? The insurer controls the defense absent a conflict of interest Not all conflicts of interest entitles the insured to Cumis counsel Insurer merely disputing coverage or reserving rights does not automatically trigger Cumis 16

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18 CONFLICTS ENTITLING THE INSURED TO CUMIS COUNSEL Insurer has filed suit against the insured. Insurer insures opposing parties in a suit. Insurer pursues settlement in excess of policy limits without insured's consent. Insurer reserves rights on a given issue and the outcome of that issue can be controlled by the insurer retained counsel. 18

19 WHAT ARE DEFENSE COSTS? Repair costs? Investigation costs? Filing affirmative cross-complaints? ''Chase'' costs Costs that are reasonable and necessary to "avoid or at least minimize liability." Aerojet- General Corp. v. Transport Indemnity Co., 17 Cal. 4 th 38, 60 (1997) 19

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21 III. THE TENDER OF DEFENSE 21

22 The One Thing You Should Remember About Insurance If You Remember Nothing Else: CLAIMS THAT MIGHT BE INSURED SHOULD BE TENDERED TO THE INSURER AS EARLY AS POSSIBLE Schiff Hardin LLP. All Rights Reserved 22

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24 WHY TENDER EARLY? A liability insurer generally has the right and duty to defend a case The insurer cannot be held responsible for that duty until it is asked to undertake the defense Therefore insurers are generally not held responsible for defense costs incurred before tender 24

25 TENDERING IS NOT DIFFICULT Name of insured Policy information Summons, complaint, and any other pleadings filed Date of service Any correspondence from plaintiff, counsel or other parties 25

26 Settlements reached or judgments entered before a claim is tendered may be covered, depending on which approach the court takes: Late notice as absolute bar to coverage Policyholder s burden to show prejudice Insurer s burden to show predudice (California) 26

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28 IV. WHAT IS A SUIT? 28

29 Standard form CGL policies typically provide that the insurer: Shall have the right and duty to defend any suit against the insured seeking damages. 29

30 ARE THESE SUITS? Settlement demands? Arbitrations? Governmental administrative actions? 30

31 BROAD INTERPRETATION The duty to defend does not hinge on the form of action taken or the nature of relief sought, but on an actual or threatened use of legal process to coerce payment or conduct by a policyholder. Fireman's Fund Ins. Cos. v. Ex-Cell-O Corp., 662 F. Supp. 71, 75 (E.D. Mich. 1987). 31

32 MINORITY VIEW The duty to defend is limited to a "suit seeking damages;" i.e., a lawsuit filed in a trial court Foster-Gardner, Inc. v. Nat l Union Fire Ins. Co. 18 Cal. 4 th 857 (1998) But see Ameron Internatl. Corp. v. ICOP, 50 Cal.4 th 1370 (Federal Administrative Proceeding before an administrative law judge is a suit ) 32

33 V. ALLOCATION BETWEEN INSURER AND INSURED RE "MIXED" CLAIMS 33

34 MAJORITY VIEW If an underlying action against a policyholder alleges several claims, some covered and some not, the insurer must provide a defense as long as at least one claim raises the potential of insurance coverage 34

35 RETREATING VIEW? An insurance company can obtain reimbursement from the policyholder for defense costs paid solely for claims that are not even potentially covered. Buss v. Superior Court., 16 Cal. 4th 35, 39 (1997). 35

36 VI. THE CONTINUOUS INJURY TRIGGER OF COVERAGE 36

37 Schiff Hardin LLP. All Rights Reserved 37

38 THE OCCURRENCE A CGL or occurrence-based policy is "triggered" if bodily injury or property damage "occurs" during the policy. The date of the wrongdoing or negligent act that ultimately causes the injury is essentially irrelevant. 38

39 MONTROSE II'S ''CONTINUOUS TRIGGER'' The "continuous injury trigger of coverage should be adopted for third-party liability insurance cases involving continuous or progressively deteriorating losses." 10 Cal. 4th

40 WHERE DOES THE CONTINUOUS TRIGGER APPLY? Asbestos Property Damage Carey Canada, Inc. v. California Union Ins. Co., 748 F. Supp. 8, 11 (D.D.C 1990) Asbestos Personal Injury J. H. France Refractories v. Allstate Ins. Co., 626 A.2d 502 (Pa. 1993) Environmental Contamination Montrose Chem. Corp. v. Admiral Ins. Co., 10 Cal. 4th 645 (1995) Soil Subsidence Rot Stonewall Ins. Co. v. City of Palos Verdes Estates, 4 Cal. App. 4th 1810 (1996) Time Oil Company v. CIGNA Property & Cas. Ins. Co., 743 F. Supp. 1400, 1416 (W.D. Wash. 1990) Construction Leakage Corrosion 40

41 VII. THE DUTY TO INDEMNIFY 41

42 THE DUTY TO INDEMNIFY IS LESS BROAD DUTY TO DEFEND DUTY TO INDEMNIFY Duty to defend is triggered by allegations of complaint Duty to indemnify is triggered by actual grounds of judgment 42

43 Example: MULTIPLE CAUSES OF ACTION Plaintiff sues for fraud and negligence Duty to defend entire action is triggered by claim for negligence even though fraud is not covered Jury finds fraud but no negligence Duty to indemnify policyholder for cost of judgment is not triggered, because the judgment is based soley on a noncovered cause of action 43

44 VIII. ALLOCATION AMONG MULTIPLE INSURERS 44

45 HOW DOES THE DUTY TO DEFEND APPLY WITH MULTIPLE INSURERS? Each insurer with a duty to defend has an obligation to defend the entire action It is the responsibility of the insurer not the insured to allocate defense costs among other insurers with an applicable duty to defend 45

46 IX. THE NUMBER OF OCCURRENCES 46

47 MULTIPLE OCCURRENCES ''The issue of how to determine the number of occurrences has huge financial significance" to insurers and insureds alike. Dow Chem. v. Associated Indem., 727 F. Supp. 1524, 1526 (E.D. Mich. 1989) 47

48 MULTIPLE OCCURRENCES = Multiple policy limits Multiple per-occurrence deductibles 48

49 THE STANDARDS Majority rule: If the injury or injuries result from a "single proximate cause," there is likely one occurrence. If multiple injuries result from multiple causes or intervening causes, each cause may be deemed a separate occurrence. "Unfortunate events" test (New York rule): There is a separate occurrence for each unfortunate event that results in bodily injury or property damage. Courts generally look to the cause to determine the number of accidents or occurrences, rather than the effects. 49

50 X. EXCLUSIONS 50

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52 Schiff Hardin LLP. All Rights Reserved 52

53 POLICY EXCLUSIONS The test insurer has the burden to prove an exclusion applies. Exclusions are construed narrowly in favor of coverage. 53

54 TYPICAL EXCLUSIONS AFFECTING REAL ESTATE CLAIMS Your "work'' Owner, Renter, Occupier Subsidence/earth movement Montrose exclusion Mold Pollution EIFS Condo exclusion Wrap policy 54

55 WHEN EXCLUSIONS DON'T APPLY Concurrent cause third-party cases Efficient proximate cause - first-party cases 55

56 XI. THE LAW IS DIFFERENT IN EVERY STATE 56

57 CHOICE OF LAW Place of Contracting Place of Injury Place of Insured Place of Insurer Place of Insured Risk Governmental Interest 57

58 SUCCESSOR LIABILITY Insurable: Georgia New Jersey Wisconsin Non-insurable: California 58

59 Insurable: Connecticut Illinois Michigan Non-insurable: California Florida New York PUNITIVE DAMAGES 59

60 DISCRIMINATION AND HARRASSMENT CLAIMS (Vicarious Liability) Insurable: California Illinois Minnesota New Jersey Non-insurable: Georgia Texas 60

61 Insurable: Maryland New York (split) Wisconsin Non-insurable: California Connecticut Illinois EMOTIONAL DISTRESS 61

62 DIRECT CLAIMS Allowed: Louisiana Wisconsin Disallowed: Almost everywhere else 62

63 XII. LOST POLICIES 63

64 CLAIMANT MUST PROVE: It was insured under a policy lost in good faith which covered the applicable years; and The substance of each policy Dart Industries v. Commercial Union Ins. Co., 28 Cal. 4th 1059 (2002) 64

65 XIII. COVERAGE FOR CORPORATE SUCCESSORS 65

66 HAS YOUR CLIENT/COMPANY/INSURED IN THE LAST 50 YEARS: Been involved in a merger of any kind? Acquired any division? subsidiary? product line? real property? 66

67 "SUCCESSOR" CORPORATION IS LIABLE IF IT: is a "continuation of the old business has "practically the same stockholders and directors continues to carry on the same business Beatrice v. State Board, 6 Cal. 4th 767 (1993). 67

68 THE CURRENT TREND IN CALIFORNIA NO COVERAGE FOR SUCCESSOR CORPORATIONS According to the California Supreme Court, courts will enforce insurance policies antiassignment clauses. Henkel v. Hartford, 29 Cal. 4th 934 (2003) 68

69 XIV. ADDITIONAL INSURANCE 69

70 TYPICAL ADDITIONAL INSURANCE CLAUSE Insurance. Contractor shall obtain... the following Insurance in a company or companies satisfactory to Builder: *** (b) Liability Insurance... providing coverage at least equivalent to a standard [CGL] insurance policy... Any policy of insurance herein required shall contain a contractual liability endorsement covering indemnity and defense obligations of Contractor and such other coverage as may be required by Builder... *** and name the Builder as an additional insured under the policy. 70

71 PRESLEY HOMES 90 Cal. App. 4th 571 (2001) A-1 insurer was obligated to provide developers with full and complete defense even though its indemnification was more limited. See also: Aerojet, 17 Cal. 4th 38 (1997) Buss, 16 Cal. 4th 35 (1997) 71

72 72 CALIFORNIA CONSTRUCTION CONTRACT INDEMNITY LAW AND INSURANCE

73 XV. BAD FAITH AND PUNITIVE DAMAGES 73

74 BAD FAITH AND PUNITIVE DAMAGES Standard-Insured must show by clear and convincing evidence that the insurer acted with fraud, malice, and/or oppression Limits on punitive damages: State Farm v. Campbell, 538 U.S. 408 (2003) 74

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