Insurance Liltigation for Non Legal Insurance Professionals


Published on

Visit us at

The program will address:

 Overview of different types of actions, such as policy holder actions, insurer contribution actions, subrogation etc.
 Submitting and perfecting claims
 Claim handling, including application of Department of Insurance regulations
 Relationships between policy holder, agent, wholesaler, managing general agents, and insurers
 Risk management techniques to avoid litigation
 Strategies to achieve earlier and more cost-effective resolutions

Published in: Economy & Finance, Business
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Insurance Liltigation for Non Legal Insurance Professionals

  1. 1. Insurance Litigation For Non-legal Insurance Professionals
  2. 2. Your Instructors Today The Law Offices of 15250 Ventura Blvd., 9th Floor Sherman Oaks, CA 91403 (818) 205-9955 P (818) 205-9944 F [email_address] Johnna Hansen, Esq. Timothy Lake, Esq . Robert Freedman, Esq. Ms. Hansen is a Firm Partner and Trial Attorney who has handled over 100 bench and jury trials during her career. Mr. Lake is a Firm Partner and Chair of its Insurance Coverage and Bad Faith Practice Group.
  3. 3. Panel Members Tim Lake Insurance Coverage Opinions, Litigation and Appeals Johnna Hansen Insurance Coverage Litigation Trial Attorney Robert Freedman Commercial Transactions Litigation
  4. 4. Disclaimers <ul><li>California Law </li></ul><ul><li>Information Purposes ONLY </li></ul><ul><li>Information does not constitute legal advise </li></ul><ul><li>Contact Attorney To Discuss Specific Matters </li></ul>
  5. 5. About Tharpe and Howell, LLC <ul><li>65 Attorney Civil Litigation Firm </li></ul><ul><li>Representing Insureds, Self -Insureds, and Insurers </li></ul><ul><li>California, Nevada, Arizona, Utah And Washington </li></ul><ul><li>Tharpe-Howell.Com </li></ul>
  6. 6. Topics To Be Discussed <ul><li>Constitutes Majority Of Appellate Opinions </li></ul><ul><li>Insurance Coverage Opinions </li></ul><ul><li>Insured V. Insurer – Breach Of Contract / Bad Faith </li></ul><ul><li>Insurer V. Insurer – Indemnity And Contribution </li></ul><ul><li>Insurer V. Insured – Subrogation </li></ul>
  7. 7. Topics To Be Discussed <ul><li>Agents / Broker E&O </li></ul><ul><li>California Claims Handling Statutes </li></ul><ul><li>Risk Management Tips </li></ul>
  8. 8. Goals of Webinar <ul><li>Insight Into Active Areas Of Insurance Coverage Litigation </li></ul><ul><li>How And Why Cases Develop </li></ul><ul><li>Touch On Important Cases And Statutes </li></ul><ul><li>Tips For Risk Management </li></ul>
  9. 9. Active Areas Of Insurance Coverage Litigation <ul><li>Breach Of Contract – Denial Of Coverage </li></ul><ul><li>Bad Faith – Extra Contractual Damages </li></ul><ul><li>Bad Faith – Refusal To Defend And Indemnify </li></ul>
  10. 10. Active Areas Of Insurance Coverage Litigation <ul><li>Declaratory Relief </li></ul><ul><li>Contribution </li></ul><ul><li>Subrogation </li></ul>
  11. 11. Formal Insurance Coverage Letters <ul><li>Tender Letters: Timely And Complete </li></ul><ul><li>Opinion Letters: Predict How Courts Will Interpet Coverage / Analysis Of Facts, Law And Policy Terms </li></ul><ul><li>Opinion Letters: Use With Advice Of Counsel – Defense For Bad Faith Claims </li></ul>
  12. 12. Formal Insurance Coverage Letters <ul><li>Reservation Of Rights Letters: Preserves Insurer’s Rights To Deny Or Limit Coverage While Investigating / Defending Claims </li></ul><ul><li>Buss V. Superior Court – Allocation Between Covered And Uncovered Claims </li></ul>
  13. 13. California Claims Handling Statutes California Code of Regulations   <ul><li>Section 2695.5(e)(1):   </li></ul><ul><ul><li>15 days to acknowledge claim and specify information needed </li></ul></ul><ul><li>Section 2695.5(b)(1): </li></ul><ul><ul><li>  15 days to respond to communication from claimant </li></ul></ul><ul><li>Section 2695.7(b): </li></ul><ul><ul><li>Insurer required to accept/ deny claim within 40 days after receiving proof </li></ul></ul>
  14. 14. California Claims Handling Statutes California Code of Regulations <ul><li>Section 2695.7(c)(1): </li></ul><ul><ul><li>If more time is required, insurer must provide written notice and specify additional information required, and reasons for inability to make a decision; written notice must be provided every thirty (30) days until a determination is made or notice of legal action. </li></ul></ul>
  15. 15. Typical Reasons For Denial Of Coverage <ul><li>Insured Party / Insured Interest: </li></ul><ul><li>Bodily Injury, Property Damage, Advertising Injury Caused By “Occurrence” </li></ul><ul><li>Completed Operations Coverage </li></ul><ul><li>Failure To Satisfy Sir </li></ul><ul><li>Continuous Trigger: Montrose V. Admiral </li></ul>
  16. 16. Typical Reasons For Denial Of Coverage <ul><li>Professional Liability Policies : </li></ul><ul><li>Claims Made And Reported Policies </li></ul><ul><li>E&O Claims: “Claim” During The Policy Period Against An “Insured” For Wrongful Act” In Rendering “Professional Services” </li></ul>
  17. 17. Bad Faith-Refusal To Defend And Indemnify <ul><li>Wrongful Denial Of Benefits Or Defense </li></ul><ul><li>Duty Of Good Faith And Fair Dealing  </li></ul><ul><li>First Party – Duty To Reasonably Investigate And Pay Benefits </li></ul><ul><li>CGL -   Duty To Investigate; Provide Defense Upon “Potential” For Coverage </li></ul><ul><li>CGL -   Duty To Pay Damages “Actually” Covered </li></ul><ul><li>CGL -   Duty To Achieve Reasonable Settlements Within Policy Limits </li></ul>
  18. 18. Bad Faith-Refusal To Defend And Indemnify <ul><li>Tort Liability: Breach Of Duty Of Good Faith And Fair Dealing </li></ul><ul><li>No Bad Faith If There Is No Coverage Under The Policy </li></ul><ul><li>Damages:  Policy Benefits, Accrued Interest, Consequential Damages </li></ul><ul><li>Time Limitations: (Absent Policy Limitations): 4 Years Breach Of Contract & 2 Years - Covenant Of Good Faith And Fair Dealing </li></ul>
  19. 19. Bad Faith Extra Contractual Damages <ul><li>Economic Losses </li></ul><ul><li>Emotional Distress </li></ul><ul><li>Attorneys’ fees Incurred To Enforce Payment Of Benefits Denied Or Delayed In Bad Faith Are Recoverable As Tort Damages: Brandt V. Superior Court </li></ul><ul><li>Punitive Damages </li></ul>
  20. 20. Equitable Subrogation <ul><li>Insurer That Has Paid Loss “Steps Into The Shoes Of Its Insured” To Recover From Parties Legally Responsible  </li></ul><ul><li>Policy Provisions Or Assignment </li></ul><ul><li>Action In Name Of Insurer Or Insured </li></ul><ul><li>Same Defenses May Be Asserted </li></ul><ul><li>Anti-Subrogation – Can Not Sue Insured For Loss </li></ul>
  21. 21. Agent & Broker E&0 <ul><li>Distinction Between Agent And Broker </li></ul><ul><li>Duty To Obtain Policy And Coverage Requested </li></ul><ul><li>Claims Handling Exposure </li></ul><ul><li>Extent Of Duty Based On Relationship And Expertise </li></ul><ul><li>Failure To Procure / Misrepresentations As To Coverage </li></ul>
  22. 22. Agent & Broker E&0 <ul><li>Two (2) Year Statute Of Limitations  </li></ul><ul><li>Duty To Third Party Beneficiary ( Business To Business Markets, Inc. V. Zurich ) </li></ul><ul><li>Trial Within A Trial </li></ul><ul><li>Damages: Insurance Benefits </li></ul>
  23. 23. Risk Management <ul><li>Maintain Records Of Correspondence </li></ul><ul><li>Document Requests For Coverage From Insureds </li></ul><ul><li>Disclose (In Writing) Coverage Limitations / Exclusions / SIR’s / Deductibles </li></ul><ul><li>Insured To Complete And Execute All Applications </li></ul><ul><li>Know Insured’s Business Models, Risks, And Entities </li></ul>
  24. 24. Risk Management <ul><li>Confirm Coverages Obtained </li></ul><ul><li>Confirm Persons, Entities, & Properties Insured </li></ul><ul><li>Written Authorization / Endorsement From Insurers For AIE’s </li></ul><ul><li>Communicate Notice Of Claim To Proper Insurers </li></ul><ul><li>Request Status Of Claim From Insurer Every 30 Days </li></ul>
  25. 25. In Conclusion <ul><li>Provided A General Overview </li></ul><ul><li>Contact Us For More Information: </li></ul><ul><li> </li></ul><ul><li>Offices in: California, Nevada, Arizona, Utah and Washington </li></ul><ul><li>Visit us on the web! </li></ul><ul><li> </li></ul>