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Insurance

It is Not Hearsay if You Said It: Broker and Agent Statements are Representations of the Insurer in Minnesota

Introduction Recent legislation and Minnesota court decisions have changed how courts treat statements by insurance brokers and agents.  Historically, to determine if a policyholder or insurer was responsible for the statements and actions of the insurance brokers or agent you had to look to the principles of legal authority.  The possession of authority, whether actual or apparent, was a question of fact to be determined by the context surrounding the act and/or representation.[1]  However, that approach began to change in 2001 with the passage of legislation that makes any person performing acts that require a producer license an agent of the insurer and not the policyholder.[2]  The Minnesota Supreme Court[3] and Court of Appeals[4] have both addressed this change. Western National Mutual Insurance Company v. Prospect Foundry A recent case brought the change in law into clearer focus.  In Western Nat’l Mut. Ins. Co. v. Prospect Foundry, the parties had a dispute over whether the policyholder was entitled to a dividend (return of insurance premium) based upon their claims history.  At the heart of the case were representations allegedly made by the insurance agent to the policyholder on how certain claims would be handled.  At trial, the policyholder representative was allowed to testify about what the insurance agent told him over the hearsay objections of counsel for the insurer. Minnesota Hearsay Rule The issue for the trial court to decide in Prospect was whether the testimony of the policyholder about what the agent stated was hearsay. Minnesota adheres to the classic hearsay rule: Hearsay is not admissible except as provided by these rules or by other rules prescribed by the Supreme Court or by the Legislature.[5] ‘Hearsay’ is a statement, other than one made by the declarant while testifying at the trial or hearing, offered in evidence to prove the truth of the matter asserted.[6] Minnesota also recognizes the classic exceptions to hearsay, including: Statements which are not hearsay. A statement is not hearsay if – . . . (2) Statements by a party-opponent.  The statement is offered against a party and is  . . . (C) a statement by a person authorized by the party to make a statement concerning the subject, or (D) a statement by the party’s agent or servant concerning a matter within the scope of the agency or employment,  made during the existence of the relationship . . .[7] The Applicable Evidence at Trial Expert testimony established that the agent had authority to communicate regarding the relevant policy on behalf of the carrier.  A representative from the carrier testified that one of the services the company provides is communication about claims, and all communication between Western and the policyholder flowed through the broker.[8]  The agency agreement between the broker and Western gave the broker the authority to provide “all usual and customary services of an insurance agent on all insurance contracts placed by the Agent.”[9]  The Court found that the statements about the claims were not hearsay because, as statements of Western’s authorized agent, they were statements by a party-opponent.[10] Minnesota Agency Statute At the heart of the court’s decision was Minnesota’s agency statute, Minnesota Statute § 60K49, Subd. 1., that states in relevant part: Agent of insurer.  A person performing acts requiring a producer license under this chapter is at all times the agent of the insurer and not the insured.  (Emphasis added.) [11] The “acts” referred to in the statute, are enumerated in Minnesota Statute §60K.32: A person shall not sell, solicit, or negotiate insurance in this state for any class or classes of insurance unless the person is licensed for that line of authority under sections 60K.30 or 60K.56.  The license itself does not create any authority, actual, apparent, or inherent, in the holder to represent or commit an insurance carrier.  (Emphasis added.)[12] Finally, “negotiate” is specifically defined in the statutes as well.  Minnesota Statute §60K.31, Subd. 12, reads: Subd. 12 Negotiate.  “Negotiate” means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning any of the substantive benefits, terms, or conditions of the contract if the person engaged in that act either sells insurance or obtains insurance from insurer for purchasers.[13] Because there was no dispute in the case that the broker sold and obtained insurance, and there was no dispute that the communication relating to claims was advice about the particular Western policies issued to Prospect concerning substantive benefits, the court held that the broker was the agent for Western for purposes of those communications. The Minnesota Supreme Court’s Approach. The Minnesota Supreme Court has also recognized the agency statute, and mentioned that the distinction between a broker and agent for certain communications has been eliminated by the statute.[14] Conclusion. Courts interpreting Minnesota’s agency statute have held that representations made by an insurance broker are representations of the insurer, regardless of the relationship between the broker and the prospective policyholder.  Therefore, it is important that both policyholders and insurers alike carefully monitor and document these communications because they can have a substantive effect on application of the underlying policies. [1] Morrison v. Swenson, 142 N.W.2d 640, 644 (Minn. 1966) (citing to William R. Vance, Handbook on the Law of Insurance 2nd, Sec. 118, pg. 415 (1930); Eddy v. Republic Nat’l Life Ins. Co., 290 N.W.2d 174, 176 (Minn. 1980) (agents act on behalf of insurer, brokers act on behalf of prospective policyholder). [2] Minnesota Statute § 60K49, Subd. 1. [3] Graff v. Robert M. Swendra Agency, Inc., 800 N.W.2d 112, 118 n.5 (Minn. 2011) (“This distinction [between agent and broker], however, appears to have been superseded by statute.”). [4] Western Nat’l Mut. Ins. Co. v. Prospect Foundry, 2018 WL 1787687, No. A17-0992 (Minn. Ct. App. April 16, 2019). [5] Minnesota Rules of Evidence 802. [6] Id., 801(c). [7] Id. 801(d)(2)(C &D). [8] Prospect at *5. [9] Id. [10] Id. at *6. [11]  Minnesota Statute § 60K49, Subd. 1. [12] Id. §60K.32 [13] Id.  §60K.31, Subd. 12 [14] Graff v. Robert M. Swendra Agency, Inc., 800 N.W.2d 112, 118 n.5 (Minn. 2011) (“This distinction [between agent and broker], however, appears to have been superseded by statute.”).

Insurance

Policy Renewals Create Increased Risk in a Hardening Market

COVID-19 and the recent political unrest have come with implications that are either direct or consequential to the insurance market.  Many businesses looking to renew long-standing commercial insurance policies are finding either increased premiums or a refusal of certain excess carriers to extend the same policy limits.  This has caused many businesses to either shop their insurance program to new carriers altogether or at least to add carriers to their excess insurance tower.  Some policyholders have even chosen to reduce the policy limits available to them, potentially putting their business at risk of catastrophic loss. I addressed risk relating to Directors and Officers coverage in my prior posts: Directors and Officers Coverage Renewal: Pitfalls to Avoid and Directors and Officers Coverage Renewal: Pitfalls to Avoid (Part II ).  Below I add to my original comments and outline additional issues that businesses should consider when renewing their insurance. Gaps in Coverage The biggest risk stemming from changing insurance carriers is the creation of gaps in coverage.  Coverage gaps can be created simply because different policies have different language.  All commercial policies are not the same.  Directors and Officers policies, Employment Practices policies, and Cyber Insurance policies for example, do not have a standard form.  Each insurance company has its own policy form providing unique coverage language.  It is important to work closely with your broker and insurance coverage counsel to assess your highest risk, and whether a change in policy language will significantly decrease the coverage you have available for potential claims. Additionally, make sure that your prior acts date and retroactive date are not changed.  These dates in policies are the times that triggering acts must occur to invoke coverage.  If you are replacing a policy, the new carrier should carry these dates over.  By failing to do so, later claims can be precluded by the old policy no longer being valid, and the new policy precluding old occurrences. Deductibles or Self-Insured Limits It is important to make sure that your deductible or self-insured limit — the amount you have to pay first before the obligation of the insurer kicks in — is appropriate.  Including a higher deductible can significantly reduce the cost of coverage because it limits the claims that an insurer must respond to.  However, make sure the number is not so high that your business would be adversely affected, particularly if you have regular claim experiences.  Additionally, you may want to consider different deductibles for different coverages.  For example, you may want to have a very low deductible, or even no deductible, for claims against directors and officers. Read Your Endorsements Endorsements can expand coverage, but they can also drastically reduce it.  Make sure you carefully read all of your endorsements and understand their effect on coverage.  Often endorsements completely re-write coverages or add exclusions not in the original policy language.  Endorsements are also a way to expand coverage or to have a new carrier adopt beneficial language from prior insurance policies.  Work with your broker to review and understand these provisions. Defense Make sure the policy clearly defines who has the duty to defend, and who has the right to select defense counsel.  You should have your normal counsel listed in the policy.  In Minnesota, it is extremely advantageous to a policyholder for the policy to create a duty on the carrier to defend.  In this situation, if the insurer breaches the duty, the policyholder has the right to recover its attorneys’ fees establishing the duty.  The right does not exist if the policy only requires the insurer to reimburse defense costs.  It is also possible to have a hybrid policy where the duty is first on the policyholder, but the policyholder can tender it to the insurer within a certain period of time.  Again, make sure you understand these provisions and the obligations they create. Intentional Acts Most policies have exclusions for intentional or criminal acts.  It is common for a policyholder to dispute the allegations.  Make sure your policies limit these exclusions so that they only apply if there is a final adjudication of inappropriate conduct.  Remember, over ninety-five percent of cases settle, and it is unlikely that there will be a final adjudication of improper acts.  This is particularly important where the insurer has a duty to defend.  You should also insist on a provision that the insurer cannot bring a separate action to adjudicate the allegations if they are no proven in the underlying case. Conclusion Shopping for insurance based on the lowest premium is not always a good business decision.  All policies are not created equal.  When businesses are faced with increased premiums or decreased policy limits, a detailed analysis of the difference in the proposed insurance language is extremely important.  It is also important to remember that the purpose of insurance is to spread risk and to be sure that your business is protected if a significant claim arises.  Cutting costs where it ultimately leads to a reduction in your insurance coverage eliminates the very reason for buying insurance in the first place.

Insurance

Was Your Business’s Property Damaged during the Civil Unrest? Ten Things You Can Do if Your Property Has Been Damaged.

Notify Your Insurer. Typically, property insurance policies require notice of a claim as soon as practicable. Notice requires a description of when, where and what happened to result in a claim.  If you have a loss, put your insurer on notice immediately. File a Police Report. Make sure to file a police report.  Many policies require a police report if the damage results from unlawful activity.  This can be a challenge, as it is now, because the police and fire departments are inundated investigating fires and incidents of property damage.   Make every effort to report the damage and memorialize your efforts.  Obtain a police report or, at a minimum, an investigation number for your insurer. Assemble Evidence of Damage. If there are photos, surveillance or any other proof of damage, the material should be secured and provided to the insurance carrier when appropriate. Protect Your Damaged Property if Possible. Most insurance policies require a policyholder to take reasonable steps to minimize damage.  Board up and secure the property if it is feasible and safe to do so.  However, the obligation to mitigate damages is tempered by reasonableness.  There is no obligation for a policyholder to put itself or its employees in harm’s way. Collect Evidence of Lost or Damaged Personal Property. Secure evidence of inventory and personal property lost.  Make a list and assemble records of purchase price, inventory, renovations, etc. Begin gathering evidence substantiating personal property damage immediately. Secure Financial Records. Your policy may include coverage for damages resulting from a business interruption. Gather historical financial records of sales, expenses and income for as many prior years as is reasonably possible.  Pay attention to the months leading up to the event.  The challenge of proving business interruption claims is meeting the burden of proof for lost income. Assembling historical financial information is invaluable. Identify Potential Witnesses. Make a list of the individuals who can corroborate personal property damage, inventory, property value or other losses.  Assemble this list as soon as possible as it is easy to lose contact with important witnesses after a business suffers a significant loss. Write Down Important Information. Write down everything you remember about the incident and create a loss journal.  Memorialize names, communications with your insurer, persons who may have important information, involved authorities, and other important dates, times or discussions.  Memories fade quickly.  Write down everything that could be important before the information is lost. Find Reputable Contractors to Perform Repairs. If your property suffered damage, start looking for qualified construction experts who can help assess damage and propose necessary repairs.  Insurance policies often limit the recovery of damages to the “period of restoration.”  That is the theoretical period of time during which repairs should reasonably be completed and your business up and running again.  It is important to get your business functioning fully in the shortest reasonable time. Promptly Respond to Reasonable Requests for Information. Your insurer may request that you produce employees for interviews and provide photographs, historical information and inspection reports. .  Respond to reasonable requests in a timely manner.  If the insurer’s requests become intrusive or unreasonable you may want to consider hiring counsel to protect your rights.  Ultimately, the insurer will ask that you provide a Sworn Proof of Loss attesting to the amount of damages. Preparation, thoroughness and diligence substantiating the extent of loss will reduce disputes with your insurer and maximize the speed with which your claims will be processed.  The first step is always to understand the coverages afforded by your insurance policy.  If you understand your insurance coverage, memorializing your claim is exponentially easier. As always, Larkin Hoffman is available to help policyholders on their insurance claims.

Insurance

Bisnow Town Hall: Insurance and Liability Implications of the COVID-19 Pandemic

On Thursday, May 14, 2020, I had the pleasure of moderating a panel with Tim Worke, CEO of Associated General Contractors of Minnesota, and Jason Wilsey, a Vice President and Shareholder at CSDZ, an insurance agent and broker focusing on construction clients. The panel addressed liability and insurance stemming from the COVID-19 Pandemic. Tim discussed the concerns his constituents have raised with the Stay-At-Home Order in Minnesota and the coming changes. Specifically, he discussed the changes in the order and how businesses are going to get back to work, change their work practices, and consider protections they will need to put into place. He emphasized disruption in supply chain issues,  the fact that some contracts may be delayed, who will pay for the delays, and whether force majeure clauses may be implicated. He further discussed the developing and changing best practices of businesses in dealing with worker safety and the virus, particularly in the construction field. Jason discussed the types of liability policies that may be implicated if construction companies experience delays or illness on site. He discussed builders risk insurance mentioned commercial general liability policies and how they would potentially interact with losses. Jason emphasized the importance of putting carriers on notice of losses. I described the difference between first-party insurance (like property and business interruption), and third-party insurance (like commercial general liability, and employment practices coverage). I shared Jason’s advice to put carriers on notice now.  Under first-party coverage, it is the date of loss that governs when notice should be given, and many policies have limited periods after a loss to bring an action to enforce coverage. Additionally, I walked through a number of issues with business interruption coverage, including the requirement for a direct physical loss, the existence of exclusions, and also the fact that different policies have a different language. Some policies don’t have virus exclusions, some don’t require a physical loss to implicate business interruption coverage, and some have contingent business interruption coverage. The panel discussed generally how liability would be apportioned and the general nature of insurance. It is difficult to spread risk when everyone is affected. The panel also discussed different state and federal legislation that could potentially affect the issue of coverage for COVID-19 losses. The panel then turned to third-party liability policies and the fact that many of these policies do not have exclusions for a virus.  Jason described the efforts of some carriers to change or reduce coverage at renewal and to “clarify” coverage mid-term.  It was agreed it is important for businesses to assess their insurance program and keep abreast of any possible coverages and limitations on coverage.  This is particularly important now, before any third-party claims come in. The panel discussed the different types of policies that could potentially be implicated, including Directors & Officers and Employment Practices coverage, if a company fails to institute appropriate protections for employees.  Workers compensation insurance could be implicated if employees get sick on the job. Commercial General Liability insurance could be triggered if claims are brought for damages because of property damage or bodily injury stemming from the Novel Coronavirus. Finally, the panel discussed the implications of different government regulations.  Some programs penalize businesses who lay off or do not offer work to employees, but the employees may be better off in the short-term receiving unemployment benefits.  It is important for employees and employers to look carefully at the implications of all employment decisions. The COVID-19 Pandemic has and will test many business relationships and the insurance that businesses have put in place to protect them from unexpected events. It is important for businesses to educate themselves on their insurance programs to maximize these protections. Click here to listen to the Twin Cities Deep Dive: Insurance and Liability Implications webinar. Christopher Yetka is the chair of Larkin Hoffman’s Insurance Coverage and Advice Group.  He, or another member of the group, is available to answer your insurance questions.  Christopher Yetka, cyetka@larkinhoffman.com, 952-896-3308.

Insurance

COVID-19, Business and Insurance: Three Things You Should Do Now to Protect Your Business

The Novel Coronavirus and related COVID-19 pandemic has had an unprecedented effect on businesses across the country.  Even “essential” businesses like construction have seen their businesses turned on their heads.  These types of unpredictable events are the very reason that businesses carry insurance.  What can your business do now to make sure that they maximize the insurance they have? 1. Put Your Carrier on Notice if You Have a Loss. If you have property or business interruption insurance, and have a loss, put your insurance carrier on notice.  We have seen some instances where because of media coverage, policyholders assume that they will not be covered by their policy.  Some have reported that exclusions preclude coverage, or that the virus does not meet the requirement of a physical loss.  However, property insurance policies, and particularly business interruption policies, have widely varying language.  Some policies have exclusions for a virus, but others exclude damages stemming from “microorganisms.”  Technically, a virus is not an organism, and those exclusions may not apply.  Additionally, some policies only apply the physical damage component to the property coverage under the policy, and not the business interruption coverage.  Still, other policies have coverage for contingent business interruption where the physical loss does not have to occur at the policyholder’s premises. Additionally, as of the writing of this article, at least seven states had draft legislation addressing business interruption coverage for the COVID-19 pandemic, as well as the Federal Government.  Even if your business does not have coverage now, that could change, and you don’t want to be left without recourse because you didn’t file a claim in the first place.  The point is, it is important to have someone experienced review your policy, and you lose nothing by putting the claim in. 2. Don’t Sleep on Your Rights. If you do make a property or business interruption claim, don’t sleep on your rights.  Most property policies require the policyholder to bring a lawsuit within two years of their loss if the claim hasn’t been paid.  In Minnesota, this two-year time frame is shorter than the typical six years you have to bring a breach of contract action. 3. Don’t Forget About Your Liability Insurance. Property damage, income and profits are not the only potential losses your business could face.  If you have been doing business during the pandemic, or as you slowly get your workforce back into the office or the field, there is a significant potential for liability.  Customers, vendors, or other businesses you work with could bring claims against you if individuals become sick with COVID-19, and they can show that you were negligent in providing the necessary protections from exposure. It is not just third-parties who could bring claims. Your own employees could bring claims if they are not provided with a safe work environment.  They could also argue that they were constructively discharged or discriminated against because they were unwilling to work in an environment that they deemed unsafe.  Even your own shareholders could bring derivative claims against the company’s directors and officers for failing to provide proper leadership in protecting employees or others.  These claims could implicate commercial general liability, workers compensation, employment practices or director and officer insurance, just to name a few.  The point is, now is the time to access your insurance program, before any claims come in, to be sure that you have adequate insurance and limits in place.  If you are up for a policy renewal, make sure that the insurer is not inserting new exclusions into your liability policies. Conclusion Insurance is meant to be there for your business when you have unexpected losses.  Make sure you are taking the necessary steps to maximize your ability to recover any losses. Chris Yetka is a Shareholder and head of Larkin Hoffman’s Insurance Coverage and Advice practice group.  He or another member of their group are available to answer any insurance questions you may have.

Insurance

First Insurance Bad Faith Award in Minnesota Federal District Court

The first award of bad faith damages in Minnesota’s Federal District Court after an evidentiary hearing was entered on Tuesday. There have been a number of awards in state court since the statute was enacted, but this is the first ruling of its kind in Federal Court. On April 21, 2020, Judge Schiltz issued an order in Selective Insurance Company of South Carolina v. Amit Sela. The order, in addition to confirming $493,789 in hail loss damages stemming from a prior jury trial, awarded $214,394.50 in bad faith damages pursuant to Minnesota Statute §604.18. This case is a vindication for Mr. Sela, who was accused of fraud by his insurance carrier and forced to prove he did nothing wrong, when all he wanted was payment for his hail-damaged property. Instead of protection, he got unfounded accusations. The opinion addresses a number of important issues apart from being the first of its kind in the Minnesota Federal District Court. Appraisal Award and its Effect on Recovery of Bad Faith Damages First, while there was a jury trial on the issue of insurance coverage, the parties agreed to submit to appraisal to determine damages.  Selective argued that the appraisal precluded the award of bad faith damages. The Court disagreed, pointing out that initially “Sela demanded that Selective agree to appraisal of his insurance claim, and Selective refused.” (Opinion at 30, n. 14, emphasis in original). Bad Faith Standard Second, the Court addressed the two-prong test for proving bad faith: the existence of an objective reasonable basis to deny the claim, and the subjective prong of whether the insurer knew of, or acted in reckless disregard to, the lack of reasonable basis. Objective Prong As to the first prong, the Court recognized that expert testimony was not necessary unless the issue was so esoteric that jurors of common knowledge would not be able to form a valid judgment. The Court then analyzed the investigation of Selective, who had accused its policyholder of Fraud. The court pointed out that the primary fraud investigator admitted that “’she did not care’ what Mr. Sela may or may not have told people,” that she ignored photos of “some of the most critical evidence,” and didn’t understand the relevance of evidence that was provided to her. The Court then pointed out that reliance on Selective’s retained expert was not appropriate. The expert was tainted by being provided with an anonymous letter, containing significant false statements that Selective knew to be false, and furthermore was not provided with all of the relevant evidence, even when the expert stated that “what could have changed his opinion would have been if Sela produced some evidence from some company to show work done,” the very evidence that Selective had been provided. Finally, the Court pointed out that nobody at Selective bothered to read the report. Subjective Prong The subjective prong of the bad faith statute requires the insurer to knowingly ignore, or recklessly disregard a lack of objective basis to deny a claim.  Here the Court pointed out that the primary adjuster admitted that he didn’t do any investigation into fraud, the basis for the denial, yet he was one of the individuals who approved counsel’s decision to deny Sela’s claim based on fraud. The fraud investigator, as mentioned above, ignored evidence and what she was actually told by the policyholder, and ignored everything he said even when she had objective evidence corroborating it. The Court also pointed out that the investigator failed to reach out to people who had relevant information. Selective hired an expert, but then never read the report issued by the expert. The Court then described the fact that the basis for Selective’s allegations of fraud kept changing, and new allegations were raised at trial that were not in its Second Amended Complaint, even after being admonished to “clearly and specifically identify each instance.” The Court went so far as to state “Selective should be embarrassed. Any reasonable insurer that denied its insured . . . indemnification on the basis of fraud would have no difficulty identifying (1) who made that decision and (2) the fraudulent statements.” Taxable Costs The Court next allowed taxable costs which it determined to be one-half of the actual cash value awarded by the appraisal panel, minus the highest settlement offer, not to exceed $250,000. Pre-Award Interest Next the Court applied Minnesota’s Pre-award interest statute, 549.09, from the date the original claim was submitted to Selective. Again, Selective claims that because of the appraisal, and a jury did not award the damages, pre-judgment interest should not be allowed. The Court rejected that approach recognizing that when the jury found no fraud, “the jury necessarily found – as a matter of law and logic – that Selective breached the insurance contract and had to pay damages to Sela.” The court recognized that a claim made by an insurance agent was a “written notice of claim” as required by statute because it clearly was a demand for payment Interest on ACV or RCV Finally, the Court recognizes that the appraisal award provided amounts for both actual cash value and replacement cost value. The court awarded interest on the ACV, but also specifically held that should the policyholder become entitled to replacement cost after repairs are made, that interest on that higher amount would also be allowed.

Construction

Insurance and COVID-19: Are We Covered?

For a period of time now businesses have seen the effects of COVID-19 on supply lines and suppliers. But now that the virus has been officially labeled a pandemic, and businesses are being asked to shut their doors to effectuate social distancing, will insurance be the last bulwark against financial harm? The answer, as always, depends. There are generally two types of claims that businesses will deal with. One is third-party claims brought by others seeking recovery due to some perceived shortcoming on the part of the business. The other is first-party losses suffered directly by the company. How can COVID-19 play into these two concerns and what are the implications for insurance? Most businesses will carry Commercial General Liability (CGL) insurance to deal with third-party claims. But what are the issues relating to disease? If a business simply fails to fulfill contracts, an argument for coverage may be difficult. Most policies contain “business risk” exclusions that expressly exclude coverage for breach of contract damages. However, if a business is sued because it allegedly failed to protect against transmission of disease, or caused another company to have to shut down its offices, there is a strong argument that coverage would be provided under the Standard CGL policy. The normal language of the policy provides coverage for “sums the insured becomes legally obligated to pay as damages because of ‘bodily injury’ or ‘property damage’”. “Bodily injury” is usually defined to include “sickness or disease”, and “property damage” usually includes ‘loss of use of tangible property that is not physically injured.” There are exclusions that insurers could point to, like the pollution exclusion, and some policies have specific exclusions for infectious disease. A close review of your policy is important. The bigger risk is likely the first-party loss caused by businesses being shut down entirely, or significantly curtailed. This is just the type of loss that business interruption policies were created to address. The problem is that unlike CGL policies that are pretty uniform, there is a significant amount of variance in the language of business interruption policies. Generally, these policies are meant to cover the loss of business income along with extra expenses that are occasioned by a covered cause of loss. What causes trigger coverage can vary from insurance form to insurance form. However, nearly all policy forms require some form of damage, which is often undefined. The Oxford English Dictionary defines ‘damage’ as ‘Harm or injury impairing the value and usefulness of something or the health or normal function of a person’. Additionally, the Insurance Services Office “Business Income” form (CP 00 30 04 02) provides additional coverage for losses “caused by action of civil authority that prohibits access to the described premises due to direct physical loss of or damage to property, other than the described premises, caused by or resulting from any Covered Cause of Loss.” The coverage requires damage to property and a covered cause of loss, which will depend on the language of your policy, but clearly there are strong arguments for coverage. The process of policy interpretation has already started. The Oceana Grill restaurant in the French Quarter of New Orleans commenced, what is believed to be, the first case seeking a declaration of coverage for COVID-19 caused losses under a business interruption policy. Cajun Conti, LLC, et al. v. Certain Underwriters at Lloyd’s London, et al.,Civil District Court for the Parish of Orleans, Louisiana. The restaurant’s policy covered “direct physical loss unless the loss is specifically excluded or limited.” It also included an extension of coverage “in the event of the businesses (sic) closure by order of Civil Authority.” The Oceana Grill’s Complaint argues that the virus causes direct physical loss to the affected premises in that the virus infects and stays on the surface of objects for an extended period of time and that contamination of the premises constitutes direct physical loss requiring remediation. Taking the argument one step further, they asserted that if the restaurant is shut down because of the presence of the COVID-19 virus in other restaurants, then they are entitled to coverage for losses under the Civil Authority coverage extension. It is important to note that the Oceana Grill’s policy did not contain a “virus” exclusion. The most important point is that the policies and circumstances differ. Making an informed decision regarding the availability of coverage requires an analysis of both. Given the breadth of the current pandemic, the best time for a review and assessment of possible insurance is now so you can make a timely claim if and when losses arise.

Insurance

You Have Been Sued. You Are Insured. Who Gets to Choose Your Lawyer?

When an insured business is faced with litigation, sometimes the question of who gets to select defense counsel arises. Third-party liability policies often state that the insurer has both the duty and right to defend the policyholder. Most courts interpret these policies to give the insurer the right to select defense counsel. However, the right to defend is limited by both the Rules of Professional Conduct that apply to all lawyers and fiduciary duties inherent in the contract. These limitations can, in many circumstances, create a policyholder’s right to select defense counsel. Defense counsel hired by an insurer are obligated to follow the applicable Rules of Professional Conduct, regardless of any language in the applicable insurance policy. Two particularly applicable rules are Rules 1.7 and 1.8(f) of the Minnesota Rules of Professional Conduct (“MRPC”). A.           MRPC 1.7 Rule 1.7(a) prohibits counsel from representing a policyholder if the representation involves a “concurrent conflict of interest.” A concurrent conflict of interest exists if: · the representation of one client will be directly adverse to another client; or · there is a significant risk that the representation of one or more clients will be materially limited by the lawyer’s responsibilities to another client, a former client or a third person, or by a personal interest of the lawyer. The Comments to the Rule reiterate that conflicts of interest can arise not just from the lawyer and law firm’s responsibilities to another client, but also from their responsibilities to a third person or from their own personal interests. MRPC 1.7, cmt. [1]. Thus, regardless of whether the liability insurer is a client, defense counsel must evaluate whether there is a significant risk that representation of the policyholder will be materially limited by the responsibilities and personal interests inherent in counsel’s relationship with the liability insurer. B.           MRPC 1.8 Counsel must also assess Rule 1.8(f), dealing with payments on behalf of clients. This rule prohibits a lawyer from accepting compensation from a third party for representation of the client, unless: · the client gives informed consent or the acceptance of compensation from another is impliedly authorized by the nature of the representation; · there is no interference with the lawyer’s independence of professional judgment or with the client-lawyer relationship; and · information relating to the representation of a client is protected as required by Rule 1.6. The insurance contract between the insurer and policyholder may constitute implied authorization for counsel’s acceptance of compensation from the insurer. However, insurer-imposed conditions or limitations, like litigation guidelines, would not be impliedly authorized if they run afoul of the Rules of Professional Conduct or defense counsel’s obligations to its policyholder client. See, e.g., MRPC 5.4 (prohibiting lawyer from allowing a person who pays it to render legal services for another to direct or regulate a lawyer’s professional judgment in rendering such legal services). On its face, Rule 1.8(f)’s protections of confidentiality and against third-party interference apply regardless of the need to obtain informed consent. Defense counsel may not defend a client if he or she believes that the confidentiality of the client’s information would not be protected, or that there would be interference with the client-lawyer relationship. C.           Informed Consent If, after conducting the above conflicts analysis, counsel believes their defense would comply with Rule 1.8(f), but would pose a conflict under Rule 1.7(a), the counsel may nevertheless defend the policyholder if all of the following conditions are met: · the lawyer reasonably believes that the lawyer will be able to provide competent and diligent representation to each affected client; · the representation is not prohibited by law; · the representation does not involve the assertion of a claim by one client against another client represented by the law firm in the same litigation or other proceedings before a tribunal; and · each affected client gives informed consent, confirmed in writing. MRPC 1.7(b). “Reasonable belief” means that the circumstances are such that a lawyer of reasonable prudence and competence would hold that belief under the circumstances. MRPC 1.0(i) & (j). “Informed consent” requires a decision after the lawyer has communicated adequate information and explanation about the material risks and alternatives to the proposed course of conduct. MRPC 1.0(f). “Informed Consent” should be read broadly. It can include: (a) the facts and circumstances giving rise to the matter; (b) an explanation reasonably necessary to inform the client of the material advantages and disadvantages of the proposed course of conduct; (c) a discussion of the client’s options and alternatives; (d) any material matters bearing upon the lawyer’s duty of undivided loyalty or duty to protect confidentiality; and (e) in some circumstances, whether it is appropriate to seek the advice of other counsel. See, e.g., MRCP 1.0, cmt [6]. Conclusion If there is a reservation of rights, and litigation strategy or information could affect coverage, defense counsel has an ethical obligation to provide full information to their client and protect them. This includes information that could affect litigation and settlement strategy, confidential information, litigation guidelines, and a full disclosure of the relationship between defense counsel and the insurer. If any of those factors create a situation where the defense is compromised, the policyholder may have a right to select their own defense counsel regardless of any language in the policy.

Insurance

Directors and Officers Coverage Renewal: Pitfalls to Avoid (Part II )

In Part I of this blog, I discussed issues that real estate and construction companies face when placing and renewing Directors and Officers Coverage.  Specifically, I addressed avoiding gaps in coverage, knowledge of insureds, the definition of who is an insured, and notice.  In this Part II, I will address arbitration provisions, choosing policy limits, and defense provisions. Arbitration and Litigation Provisions Many D&O policies contain an arbitration provision.  Some are mandatory and the arbitration results are binding.  Others are optional requiring agreement of the parties.  While arbitration provisions may be inviting, policyholders may want to think twice before agreeing to them.  They are touted as a cost saver, but in my experience, arbitrations can be as costly as litigation.  Some arbitration organizations require up-front fees that are set based upon the potential size of the underlying claim, regardless of the likelihood of recovery.  Additionally, without the benefit of the civil rules of procedure, certain witnesses may be unavailable, and some arbitrators may or may not rein-in the discovery process.  In the absence of fraud or conflict of interest, unfavorable arbitration awards are very difficult or impossible to appeal, even if they deviate from legal precedent.  Finally, there are some built in safeguards that are lost as a policyholder.  The rules of interpretation that are applied against carriers are sometimes lost in arbitration.  Arbitrators are likely to see the same, few carriers repeatedly, but are very unlikely to see the policyholder in a future arbitration.  The fact that they might be selected by a carrier in the future can have a not-so-subtle effect on the results of the arbitration.  As a policyholder attorney I generally recommend that these provisions be avoided, or that any arbitration provision be optional. Finally, look to make sure that the policy doesn’t have a limitations period that is shorter than what your state law allows.  Many policies state that a claim under the policy must be made within two years of a loss.  Minnesota, for example, has a six-year statute of limitations for breach of contract.  These shorter contractual periods can work to significantly limit coverage. Policy Limits The issue of how much coverage to buy could take up an entire blog post.  There are several factors that go into the analysis of choosing policy limits.  It is always better to have more coverage, but cost will be a significant factor.  That cost is particularly important with the tightening insurance market we are presently experiencing.  Some excess coverages may no longer be available at all.  In the case of D&O, one must ask whether the policy limits available are shared with other coverages and will claims likely implicate more than one coverage.  Are there separate limits with, for example, employment practices liability coverage, and are there separate limits for the different coverages under the D&O policy?  That is, will a claim made by the company under either Side B or C coverage erode the limits available to pay directly to the directors and officers?  Many policies provide for separate, additional, limits for Side A coverage.  If there is excess coverage, lower primary limits may make sense if the excess insurance follows form.  However, if the excess policy has different coverages or does not provide a defense, that can significantly affect what limits should be purchased.  Additionally, as will be discussed below, is the policy a duty to defend policy, or does it only require the insurer to reimburse defense costs?  Is the policy a wasting policy where defense costs erode the limits available to pay claims, or are defense costs provided in addition to the policy limits?  These factors can be substantial because often the biggest expense in these claims is the cost of defense. Duty to Defend vs. Duty to Reimburse Does the policy state that the insurer has the duty and right to defend the policyholder, or does it state that the carrier will reimburse the defense costs incurred for covered claims?  While this difference doesn’t seem that significant on its face, it can be in application.  In most states the duty to defend is separate from and broader than the duty to indemnify.  That is, a duty to defend arises if there is arguable, or probable coverage.  This is true even if it is later found that there is no coverage under the policy.  Therefore, if the policy provides a duty to defend, that kicks in well before a finding of actual coverage under the policy.  However, the duty to reimburse defense costs only applies when there is a determination of actual coverage under the policy.  In addition, as discussed above, certain exclusions in the policy for intentional acts, fraud, improper financial advantage, may not apply unless there is a final adjudication.  In those instances, the duty to defend would still apply.  Finally, most policies are silent on the right to select counsel, or state that counsel will be selected from panel counsel lists of the insurer.  The time for the policyholder to negotiate who will represent them is before the claim arises.  If the policyholder has trusted counsel, they should make sure that the counsel is approved at the time the policy is placed, because insurance carriers will be much less flexible after a claim comes in.  Finally, as discussed above, strong consideration should be made to policy limits and whether defense costs will impact those limits.  Policyholders should be sure that they have enough coverage for a settlement or judgement after lengthy litigation. Conclusion These are but a few of the considerations that a policyholder should factor when they are placing or renewing their D&O insurance.  Consultation with a trusted broker or insurance attorney is always recommended. Larkin Hoffman’s insurance coverage department can help you and your business assess its insurance and maximize coverage.  You can contact Chris Yetka at cyetka@larkinhoffman.com

Insurance

Directors and Officers Coverage Renewal: Pitfalls to Avoid

Introduction What do all construction and real estate companies have in common?  They have directors or managers and officers concentrating on running the companies and remaining profitable.  Most companies maintain Directors and Officers (D&O) insurance to protect these important stakeholders from liability and lawsuits that can arise from their work.  Because there is no standard form D&O policy, it is important to pay attention when placing and renewing this insurance. D&O coverage traditionally offers three different insuring provisions.  The first is referred to as Side A coverage and provides defense and indemnity directly to directors and officers when claims are made against them.  The second, or Side B coverage, reimburses a company that makes defense or indemnity payments on behalf of directors and officers.  Finally, Side C coverage provides coverage directly to the company.  A company need not, and often does not, obtain all the available coverages.  But the decision on which coverages to buy should be considered carefully.  While expectations initially may be that a company is going to defend and indemnify directors and officers, certain allegations can alter a company’s obligation, and direct coverage may be required to keep an officer from incurring expense out of pocket. In this first of a two-part blog, I will address avoiding gaps in coverage, knowledge of insureds, the definition of who is an insured, and notice.  In a future blog, I will address arbitration provisions, choosing policy limits, and defense provisions. Avoiding Gaps in Coverage As mentioned above, D&O policies are not standardized.  Different carriers use different forms, and therefore provide different coverages.  When renewing coverage with a new insurer, for example, the new insurer may include different retroactive dates, or dates for prior acts.  Historically, when you renew with the same carrier, those restrictive dates remain the same, but new carriers may want to move those dates up.  By moving those dates, prior acts that may not yet have led to a claim may no longer be covered if a claim does arise. The insuring provisions and exclusions in the new policy should also be closely reviewed to make sure that the same or broader coverage is provided.  If there is excess coverage, do the excess policies follow the same form as the primary policy, or are there different provisions?  Finally, there can be benefits and risks of having your entire insurance program with the same carrier.  If you have the same carrier, it becomes more difficult for that carrier to try to pass off a related (e.g. employment) claim to a different carrier.  On the other hand, where claims may trigger different policy types, having different carriers could lead to having more coverage available to pay for the defense and any settlement or judgment.  Again, this is a complicated analysis and requires time and attention. Knowledge, and Existing Claims or Suits An important issue in many D&O claims is who had knowledge of an event that could lead to a claim and when they obtained that knowledge.  Knowledge can affect when the insurer must be notified of a clam or possible claim and can lead to denials of coverage.  Many D&O policies have provisions that specifically dictate who must have knowledge in order to invoke the obligation to provide notice.  It is best if the person or persons designated is specific and limited.  For example, requiring notice when the risk manager or general counsel becomes aware of the claim or potential claim may be reasonable.  It is also advisable that the policy contain a provision that knowledge be severable.  That way, if a bad-acting director has knowledge and fails to provide notice, that failure will not adversely affect other insured directors and officers or the company.  Additionally, there are often exclusions for intentional or criminal acts.  Many policies provide that those exclusions will not apply unless the intentional or criminal act is finally adjudicated.  In those instances, the policy may have to provide a defense and possible contribution to settlement if a finding is never made. The Definition of Insured Who is defined as an insured under the policy matters.  If the purpose of the policy is to provide coverage only to directors, managers and officers, the policy should reflect that.  Often the definition of “insured” will include employees, which substantially broadens and dilutes the coverage provided.  Policies may also include past directors or officers.  Again, this can substantially affect coverage.  If employees, or officers who have been gone for five years, are covered, and they bring a claim, insurance may be precluded by the insured versus insured exclusion in the policy.  It may seem counter-intuitive, but the broader the definition of insured in the D&O policy, the less insurance may be provided when you apply standard exclusions.  Determine who you want covered by the policy, and then make sure the definition fits that decision Reporting Periods and Notice of Circumstances We touched on notice above when discussing the importance of who must have knowledge of a claim.  The question is often asked, when should I provide notice to my insurance carrier?  The answer to that question from the standpoint of an attorney who represents policyholders is tender the claim early and tender the claim often.  There is very little cost in providing notice to your carrier.  If the claim goes nowhere, it will have little effect.  Insureds are often afraid that if they tender a claim it will have an adverse effect on their premiums.  In my experience, absent exceptional circumstances, that is not the case.  However, the contrary is almost always true.  Big claims almost always are initially considered to be small.  If they are not noticed early, the insurer will use the benefit of 20/20 hindsight to argue that notice should have been provided sooner.  Notice provisions may require notice to be given as soon as practicable, or within a certain defined period.  Either way, make sure that the language of the notice provision does not state that compliance is a condition precedent to coverage.  Without that language, many states, including Minnesota, require late notice to cause actual prejudice to the insurer before it will be enforced.  Additionally, if you are changing carriers, review the language of the policy and strongly consider an extended reporting period, especially if the new carrier shortens the retroactive or prior-acts dates. In a future blog, I will address arbitration provisions, choosing policy limits, and defense provisions. Larkin Hoffman’s insurance coverage department can help you and your business assess its insurance and maximize coverage.  You can contact Chris Yetka at cyetka@larkinhoffman.com.

Insurance

When it Comes to Insurance Claims, it is the Language of the Policy That Controls Whether the Policyholder Will Get Paid – What Could be Unclear About That?

The language of a policyholder’s insurance policy determines whether all those premiums will translate into dollars paid after a loss.  For the most part, it is the insurance company that controls that language.  Therefore, it is very important that policyholders pay attention to that language at the time they buy insurance to be sure that the language supports coverage for the most likely claims that may arise.  Even the most diligent policyholder cannot foresee all possible claims, and those instances may lead to a dispute with the insurance company. On November 19, 2019, Larkin Hoffman’s insurance coverage lawyers were successful in getting the Wisconsin Court of Appeals to reverse a Circuit Court decision that had dismissed Superior Water Light and Power Company’s insurance coverage claim for the environmental clean-up of a manufactured gas plant.  Superior Water Light & Power v. Certain Underwriters at Lloyds, No. 2018AP1926 (Wisc. Ct. App. Nov. 19, 2019).  Back before natural gas became the standard, manufactured gas was created from coal and other petroleum products to heat homes, for lighting and other purposes.  MGPs or manufactured gas plants existed around the country to produce this gas.  The SWLP case involved Wisconsin’s first interpretation of certain terms of the Lloyds Blanket Form Excess Liability Policy. The SWLP site at issue produced carbureted water gas from 1889 until 1904, and then stored manufactured gas at the facility until 1959.  In 2001 the Wisconsin DNR claimed that SWLP was potentially liable for contamination at the site.  SWLP notified Lloyds, who provided Blanket Excess Liability Insurance to SWLP from the 1940s into the 1980s.  Lloyds acknowledged receipt of notice and reserved its rights. Once the nature of the cleanup became clearer, SWLP brought an action against Lloyds seeking payment under Lloyds’ policies, which provided coverage for all sums as a result of any occurrence.  “Occurrence,” in turn, was defined as “one happening or series of happenings arising out of or caused by one event taking place during the term of this contract.”  The parties agreed that “one happening or series of happenings” included the third-party groundwater contamination that SWLP was required to address.  At issue was the interpretation of “one event.”  Lloyds argued that “one event” had to be the original release or spill of contaminates at the site.  Because Lloyds didn’t start issuing policies until the 1940s, Lloyds argued the “one event” could not have taken place during its policy period.  SWLP, on the other hand, argued that the “one event” was the exposure of clean groundwater to contaminates in the soil, and that event was continuous, including during the policy period at issue. Relying on cases from New Jersey, New Hampshire, New York and Massachusetts, the Circuit Court held that “one event” required a new release or spill during the policy period to trigger coverage.  The Wisconsin Court of Appeals disagreed.  Relying on Wisconsin law, the court found that either parties’ interpretation of the term “one event” was reasonable, and therefore the term was ambiguous.  The court cited to SECURA Insurance v. Lyme St. Croix Forest Co., LLC, 918 N.W.2d 885 (Wisc. 2018), interpreting a different policy’s use of the term “one event” to include both a three-day fire and the original spark that caused the fire.  Based on this decision, the Court of Appeals held that “both the initial spill or release of contaminates, as well as the influx of new groundwater into the Site’s subsoil” would be an “event” triggering the policy.  The court recognized that SWLP’s resort to a recognized dictionary definition of “event” as “something that happens” was appropriate to discern the plain meaning of undefined words in an insurance policy. The court was not persuaded by Lloyd’s assertion that SWLP was conflating the cause of the damage with the damage itself.  The court held that the mere presence of contaminates in SWLP’s soil would not trigger coverage.  Third-party property had to be impacted.  The court recognized that the relevant event was when third-party property, here groundwater, contacted chemical substances in SWLP’s subsoil, not the initial spill which may have never impacted groundwater (i.e. it could have been cleaned up prior to contact). This is an important decision distinguishing Wisconsin law from decisions in New Jersey (Public Serv. Elec. and Gas. Co. v. Certain Underwriters at Lloyd’s of London, 1994 U.S. Dist. LEXIS 21072 (D.N.J. 1994), New Hampshire (Energy North Natural Gas, Inc. v. Associated Electric & Gas Ins. Services, Ltd., 1999 U.S. Distr. LEXIS 23307 (D.N.H. 1999), New York, (Long  Island Lighting Co. v. Allianz Underwriter, Ins. Co., 301 A.D.2d 23, 749 N.Y.S.2d 448 (1st Dept. 2002), and Massachusetts (One Beacon Am. Ins. Co. v. Narragansett, 87 Mass. App. Ct. 1126 (Mass. App. Ct. 2015). Larkin Hoffman’s insurance coverage department can help you and your business assess its insurance and maximize coverage.  You can contact Chris Yetka at cyetka@larkinhoffman.com.

Insurance

Exactly Who is Insured Under Your Insurance Policy?

The insurance application process is often the only time a policyholder thinks of who should be covered under a policy. Most policies have a “named insured” and  other “insureds” specifically listed.  “Additional insureds” can also be added by endorsement or operation of specific language in the policy.  A recent case demonstrates the importance of considering these issues not only at the time the policy is placed, but also on a regular basis as business progresses. In C.S. McCrossan Inc. v. Federal Insurance Company, the Eighth Circuit Court of Appeals upheld denial of coverage under a crime policy for losses of two companies affiliated with McCrossan.  An individual working for the property manager of the two affiliates created false invoices and paid herself by forging checks in excess of $800,000.  McCrossan made claims under its crime policy with Federal Insurance Company for both employee theft and forgery.  Federal denied the claims. The first hurdle to coverage was whether either of the McCrossan affiliates were insureds under the policy. The policy provided coverage for “subsidiaries” but only if the named insured either directly or through a subsidiary owned more than 50% of the outstanding voting shares.  Federal Insurance agreed that one of the affiliates was an insured, but denied that the second affiliate was.  Because that other affiliate was owned by a shareholder of McCrossan, and not McCrossan or its subsidiaries, the court held it was not an insured under the policy. Next, the court held that the property manager was not an employee of McCrossan. Under the language of the policy, to be included as an employee, there had to be a contractual relationship with either the bad actor or an entity “acting on behalf of” the bad actor.  The property management agreement was between the McCrossan affiliate and the property management company, not the bad actor. The court held that the property management company was not acting on behalf of the individual relating to the fraud. Finally, the policy contained an exclusion relating to the forgery provision for acts of authorized representatives. While the bad actor was not an employee, because she had authority to do bookkeeping and other functions, the court held that she was an authorized representative and therefore the policy’s exclusion applied. There are a handful of concepts to take away from this case. First, if you want coverage for your subsidiaries and affiliates, make sure that your policy defines them appropriately.  If a common shareholder is what matters to you, make sure the definition in the policy reflects that or that the affiliated companies are explicitly listed as insureds.  Second, identify where your potential loss is most likely to come from.  How “employee” is defined can have a significant impact on how broad or narrow your coverage is, or how broadly or narrowly an exclusion is interpreted.  Not all policies are worded in the same way–it is important to work with your insurance agent or broker to identify and properly cover the most likely risks.  Third, look closely at the exclusions in your policy.  Many times the exclusions can swallow much of the coverage that you would ordinarily expect from a policy.  While the language in some exclusions may not be subject to negotiation, often times it is.  Again, it is important to understand your primary risks and choose your insurance accordingly.  Finally, and not addressed in the opinion, is the fact that there may be insurance coverage available from other parties.  If you will be doing significant business with vendors or other agents, it pays to ask for copies of their insurance policies so that you have them on hand if an issue arises. In future blogs, I will be discussing common insurance issues that are faced by businesses, including who should be included as insureds, common exclusions and how to avoid gaps in insurance coverage. C.S. McCrossan Inc. v. Federal Insurance Company, (No. 18-1949) (8th Cir. Aug. 6, 2019) https://ecf.ca8.uscourts.gov/opndir/19/08/181949P.pdf