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Proper Claims Handling to Avoid Bad Faith Claims
1.
Proper Cl i P
Claims H dli t A id Handling to Avoid Bad Faith Claims © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
2.
Presenters Richard
D. Porotsky, Jr., E Ri h d D P t k J Esq. Cincinnati ^ 513.977.8256 richard.porotsky@dinslaw.com Ansley Westbrook, Esq. Pittsburgh ^ 412.288.5864 ansley.westbrook@dinslaw.com ansley westbrook@dinslaw com © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
3.
PROPER CLAIMS HANDLING
TO AVOID BAD FAITH CLAIMS © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
4.
Outline I. Introduction &
C I I d i Context II. II Ohio Bad Faith Standards III. Framework for Proper C a s Handling a e o o ope Claims a d g A. Policyholder Duties: Notice & Cooperation B. Insurer Duties & Reservation of Rights – Details needed for letter? – Waiver of coverage defenses occur? – Recovery of defense costs? © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
5.
Outline
C. Key Elements of Proper Claims Investigation D. Use of Litigation – When and How - When does collateral estoppel dictate action? pp IV. Examples: Bad Faith Results in a Claims Handling Context © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
6.
Introduction / Context
Policyholders have certain obligations Provide notice, Cooperate in investigation They also have certain rights Prompt and diligent defense, potentially covered claims Notice of Insured Client Rights (see book) Good faith investigation and decision Proper reservation of rights or denial Key: know the proper balance © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
7.
THE OHIO BAD
FAITH STANDARD Current Definitions © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
8.
Bad Faith Standard
in Ohio Zoppo v. Homestead Ins (1994) 71 Ohio St 3d 552 Ins. (1994), St.3d 552: Bad faith: “refusal . . . not predicated upon circumstances that furnish reasonable justification therefor “ therefor. Similar to negligence Does not warrant punitive d D t t iti damages Timing: when assessment of coverage is being considered © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
9.
Bad Faith Standard
in Ohio No Bad Faith Where the Issue is "Fairly Debateable“ Debateable "Genuine dispute over either the status of the law at the time of the denial or the facts giving rise to the claim " claim. Abon v. Transcont'l Ins. Co. (5th Dist.), 2005-Ohio-3052, at ¶¶ 37-46 ("fairly debatable“) 37 46 ( fairly debatable ) “Mere refusal to pay” is not enough to prove bad faith © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
10.
Types of Bad
Faith Claims Bad Faith Failure to Settle a Covered Claim, Resulting in Excess Liability Original basis for bad faith Liability for entire judgment against the insured, above policy limits “Incentive” to accept settlement offer with damages “near or over its policy limits.” For more details see book © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
11.
Types of Bad
Faith Claims Bad Faith Refusal or Delay in Paying Covered Claim Regardless of excess liability Punitive damages due to unreasonable handling Bad Faith Failure to Defend Even if Indemnity Is Ultimately Disproven Potential for establishing punitive damages Lack of good faith in “processing” a claim © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
12.
Types of Bad
Faith Claims Failure to Reasonably Handle a Non-covered Claim Bullet Trucking, Inc. v. Glenfalls Ins. Co. (Montgomery Co. 1992), 84 Ohio App.3d 327, 333, 616 N.E.2d 1123. Criticism and disapproval of Bullet Possibly limited to intentional failure to determine a basis to deny or t contractual limitations i to t t l li it ti issues © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
13.
FRAMEWORK FOR PROPER
CLAIMS HANDLING --Policyholder s Duties of Notice and Policyholder’s Cooperation © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
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Duty To Provide
Notice & Cooperate Threshold Th h ld requirement f covering a ‘ l i ’ / ‘ it’ i t for i ‘claim’ ‘suit’ Typical terms: “As soon as practicable” or “Immediately” Interpretation: reasonable time under the circumstances Usually for “finder of fact” But ne c sed B t unexcused significant dela can be a matter of la delay law Lack of notice / non-cooperation raises issue of p j p prejudice © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
15.
Cases Law Regarding
Notice Summary judgment possible for insurer Ormet, 80 Ohio St. 3d 292 (decades-old envir’l damage) Bellaire TV , (7th Dist.) 2002-Ohio-3203 (litigation progressed) Novak (9th Dist), 2009 Ohio-6952 (consent judgment) Facts may preclude summary judgment Hundsrucker v. Perlman (6th Dist.), 2004-Ohio-4851 4½ yrs but no prejudice © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
16.
Case Law Regarding
Notice Delay Excused in Certain Circumstances Contribution in complex environment’l / asbestos cases Pennsylvania Gen’l Ins. v. Park-Ohio (2010), 126 Ohio St.3d 98 Multiple insurers involved “All sums” approach © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
17.
Duty to Provide
Notice © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
18.
Duty To Provide
Notice Park-Ohio (2010), 126 Ohio St. 3d 98 Notified only the “targeted insurer” Contribution claim after underlying settlement Court allowed arguments of prejudice But “all sums” presupposes one targeted insurer all sums Excused the delay Effect on notice requirements? © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
19.
FRAMEWORK FOR PROPER
O O O C CLAIMS HANDLING S G --Insurer’s Duty to Defend and Provide Insurer’s Reservation of Rights © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
20.
Reservation Of Rights
Insurer Options Upon Receipt of Notice (1) Accept coverage, defend unconditionally (2) Deny coverage (3) Investigate while defend under reservation of rights © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
21.
Reservation Of Rights
Honoring the broad duty to defend “Potentially or arguably” within coverage “Prompt and diligent” defense Amid questions, must defend under reservation Motorists M t Ins v. Trainor (1973) 33 Ohio St 2d 41 Mut. Ins. (1973), St. Willoughby Hills v. Cinti Ins. (1984), 9 Ohio St. 3d 177 © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
22.
Reservation Of Rights
Why is a reservation of rights required? Potential conflict of interest “The insured should know of the potential for a conflict in interest before accepting or proceeding with the insurer’s offer to provide a defense.” Collins v. Grange Mut. (1997), 124 Ohio App.3d 574 See Book for more on conflicts / ethics for defense counsel Control of the defense to shape outcomes Policyholder might have to pay © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
23.
Reservation Of Rights
Goal of the Reservation of Rights Letter Enough for “knowing choice” to proceed or get independent counsel Fairly apprise of possible denial Cannot lull a policyholder into inaction Prejudice Utica Mut. Ins. v. David Agency, 327 F.Supp.2d 922 (N.D. Ill 2004) © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
24.
Reservation Of Rights
Details for the letter: Each potential basis for such denial P ti Pertinent policy provisions t li i i Pertinent facts Right to rely upon all policy provisions Policy date(s) and number(s) Date when the policyholder was served with suit Limit of liability if relevant © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
25.
Reservation Of Rights
Optional details / clauses – how far can the insurer go? Right to discontinue and withdraw defense Court approval usually sought Right to reimbursement of defense costs © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
26.
Reservation Of Rights
Reservation of rights for first party claims Often necessary Regulations relevant Ohio Admin. Code § 3901-1-54(F) and ( ) ( to 3 weeks) ( ) (G) (2 ) © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
27.
Reservation Of Rights
Waiver of Defenses Absent Proper Reservation Timely at start of defense Adequate information Supplemental letter if additional bases of denial arise Waiver occurs if prejudice results Lost settlement opportunity Inability to produce witnesses Time for adequate trial prep © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
28.
Reservation Of Rights
Examples of waiver E l f i Dietz-Britton v. Smythe (8th Dist. 2000), 139 Ohio App. 3d 337 Two years late, near trial T l t ti l Collins v. Grange (12th Dist. 1997), 124 Ohio App. 3d 574 One year late, lost settlement opportunities late INA v. Travelers (8th Dist. 1997),118 Ohio App.3d 302 10 months’ delay “of necessity...establish[ed] prejudice months of necessity establish[ed] prejudice” © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
29.
Reservation Of Rights
Examples of no waiver due to prejudice Roark Medmarc C R k v. M d Cas. I Ins. (9 Di t ) 2007 Ohi 7049 Dist.), 2007-Ohio-7049 Five months delay, remand to examine prejudice Yates v. Estate of Ferguson (1st Dist.), 2010-Ohio-892 One year but then underlying case dismissed © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
30.
Reservation Of Rights
Optional Clause: Reserving Right to Reimbursement of Defense Costs “Majority rule,” not addressed by Ohio state courts Majority rule, United Nat’l Ins. v. SST Fitness (6th Cir. 2002), 309 F.3d 914 “implied in fact” contract to reimburse Travelers Prop. Cas. Co. v. Hillerich & Bradsby Co., 596 F S F. Supp. 2d 1020 (W D K 2008) (W.D. Ky. Objection to reservation immaterial © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
31.
Reservation Of Rights
Some Courts Reject Reimbursement General Agents Ins. Co. of Am., Inc. v. Midwest Sporting Goods Co. (Ill. 2005), 828 N.E.2d 1092 Am. Am & Foreign Ins. v. Jerry s Sport Ctr., 2 A 3d 526 (Pa 2010) Ins v Jerry's Ctr A.3d (Pa. American Motorist Ins. v. Custom Rubber, (Aug. 23, 2006), N.D. Ohio No. 1:05cv2331 (2006 WL 2460861) ( ) refusing to reimburse judgment Policyholders’ Options? y Accept / Object / Decline / DJ © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
32.
FRAMEWORK FOR PROPER
CLAIMS HANDLING -- Key Elements of Proper Investigations © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
33.
Claims Investigations
Two basic inquiries 1) Facts behind the claim 2) Terms and meaning of the policy © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
34.
Claims Investigations
Key Fact Issues for Investigation (1) Named insured (2) Type of damages (3) Timing of notice (4) Timing of damages / events (5) Other insurance (6) Issues from specific exclusions © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
35.
Claims Investigations
Defining the facts First party claims: policyholder statements Third party claims: lawsuit or others’ allegations Duty to defend, reservation of rights, based upon complaint Confine the third party’s claim © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
36.
Claims Investigations
Understanding pertinent law Coverage issues arising out of the policy Legal Issues with the underlying claim Key elements Legal and/or Technical Expertise i.e. IP Claims © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
37.
Ca s Claims Investigations
es ga o s Involvement of Coverage Counsel Possible benefit in establishing reasonable justification Might be a problem if counsel is not consulted? But can create discoverable materials if claim denied Boone v. VanLiner Ins. Co. (2001), 91 Ohio St. 3d 209 Bad faith context © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
38.
FRAMEWORK FOR PROPER
CLAIMS HANDLING -Use of Li i i U f Litigation: when and h h d how © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
39.
Use of Litigation
Flows from the insurer’s initial decision to: (1) Accept or deny coverage / defense (2) Investigate while d f di I ti t hil defending © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
40.
Use of Litigation
Decision to litigate often turns on whether any coverage issues decided by the underlying case If not, there is more flexibility as to strategy / timing: File a separate DJ Intervene Wait and see If yes, beware of collateral estoppel Howell v. Richardson (1989), 45 Ohio St. 3d 365 Alternative claims of negligence or intentional © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
41.
Use of Litigation
Insurer s Insurer’s Options per Howell: Decline to defend, intervene in underlying case Attempt to defeat coverage Usually submit jury interrogatories Could involve advocacy? y May be able to defend under reservation? Use “independent counsel” independent counsel More discussion in Book . . . © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
42.
BAD FAITH RESULTS
IN THE CLAIMS HANDLING CONTEXT © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
43.
Example of Bad Faith Claims Handling Goodrich Corp. v. Commerc’l Union Ins. (9 Dist. 2008) One i O insurer guilty of b d f ith ilt f bad faith One insurer absolved of bad faith Difference i conduct – dili Diff in d t diligence and i d investigation ti ti © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
44.
Examples of Insurers Absolved of Bad Faith Absolved via MSJ or DV even when taking a losing coverage position Helmick v. Republic-Franklin Ins. (1988), 39 Ohio St.3d 71, 75-76 (reasonably justified to question) Schuetz State F S h t v. St t Farm (F kli C C (Franklin Co. Comm. Pl 2007) Pls. 2007), 147 Ohio Misc.2d 22, ¶¶83-84 (some courts agreed with insurer) © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
45.
For more details
see details, Richard D. Porotsky, Jr., OHIO INSURANCE LAW: POLICY ANALYSIS, BAD FAITH, AND ETHICAL CONFLICTS (Ohio State Bar Assoc’n CLE, 2011). Assoc n Available for sale in the lobby . . . © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
46.
Questions? Richard
D. Porotsky, Jr., E Ri h d D P t k J Esq. Cincinnati ^ 513.977.8256 richard.porotsky@dinslaw.com Ansley Westbrook, Esq. Pittsburgh ^ 412.288.5864 ansley.westbrook@dinslaw.com ansley westbrook@dinslaw com © 2011 DINSMORE & SHOHL | LEGAL COUNSEL | www.dinsmore.com
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