All posts by Mark Miller

Who is Winning the Covid-19 Insurance Coverage Fight?


Who is Winning the Covid-19 Insurance Coverage Fight? It depends on where the lawsuits are being decided. In state court, policyholders are winning roughly one half to three quarters of all lawsuits filed. The one half number is for lawsuits containing virus exclusions, and the three quarters number is for lawsuits without a virus exclusions. Federal courts, however, are much more favorable to insurers. The result — insurance carriers are fighting to have federal courts decide Covid-19 cases. Statistics, however, do not explain everything.   Policyholders need to look deeper into these statistics to understand why litigation strategy is perhaps more important than the merits of any given claim.  But first, some context.

I. The Onslaught of Covid-19 insurance Coverage Lawsuits

Just over a year ago, the seemingly never-ending onslaught of lawsuits started.  Soon as the pandemic hit, almost immediately, plaintiffs’ lawyers began filing suit. To date, over 1500 lawsuits seeking insurance coverage for Covid-19 related business losses have been filed.

These early lawsuits were not the kind of lawsuits that seasoned insurance lawyers were accustomed to.  Historically, insurance coverage law revolved around large well-funded corporations fighting equally large or larger well-funded insurance companies.  Not here.  What we saw was a grassroots phenomenon, with small businesses like mom-and-pop restaurants, nail salons, barber shops, tanning salons, and the like, bringing lawsuits against insurers.  For the first time in the history of insurance law, traditional plaintiff lawyers were making insurance coverage litigation and class action lawsuits “a thing” for small businesses who otherwise would never have been able to seek justice.  

Many of these early lawsuits addressed policies containing a standard-form ISO VIRUS OR BACTERIA EXCLSION.  Many of these early lawsuits did not allege that the virus causing Covid-19 caused physical loss or damage to property.  Instead, they argued that other causes, such as government closure orders, led to their losses. 

Cumulative Covid-19 Insurance Coverage Actions

Source:  https://cclt.law.upenn.edu/


As time went on, larger more sophisticated businesses reviewed their coverage and began filing lawsuits.  Unlike coverage sold to many smaller businesses, much of this coverage addressed exclusionary language that was markedly different from that contained in the standard ISO form.  In many cases, the policies at issue did not contain any form of virus exclusion.  In others, the exclusionary language was amended by state specific endorsements deleting viruses from the exclusion, or the exclusion was drafted in such a way that it applied only to certain costs expended, and not business interruption losses themselves.  Accordingly, many of the early rulings pertinent to policies with a  standard ISO exclusions did not apply to claims brought by larger organizations.

II. Insurance Industry Response

Insurance carriers saw their exposure to Covid-19 claims from the start and conducted some very impressive public relations and lobbying to limit their liability.  

Initially, many commercial insurance brokers advocated on behalf of the insurance companies. For example, a major multinational broker, AON, stated in one of its client advisory pieces

“[m]ost property policies, including ISO, specific insurer forms and most manuscript policies, do not cover a loss resulting from a virus.” 

Similarly, Willis Towers Watson stated, that there was

“[v]ery limited, if any coverage.”

But not everyone fell in line.  The Independent Insurance Agents & Brokers of America, an insurance broker trade association, was outraged at the approach the insurance industry had taken withCovid-19 claims, stating

“insurance carriers are directing their agencies to deny certain claims related to the COVID-19/coronavirus . . .some carriers have even put this directive in writing.” 

Insurance company lawyers were next to come to the defense of their clients.  Just four days after the WHO declared Covid-19 as a pandemic, insurance company lawyers began publishing articles arguing that coronavirus claims are excluded from coverage. See Coronavirus excluded for over 15 Years, According to Insurance Company Lawyers

Aggressive insurance company lobbying soon followed.  States like New Jersey, Ohio, Massachusetts, and Pennsylvania all had pending legislative proposals requiring insurance companies to cover Covid-19 claims.  With involvement of insurance company lobbyists, those laws appear to have been quickly defeated.  Congress even wrote a letter to various industry trade associations, urging their member companies “to make financial losses related to COVID-19 . . . part of their commercial business interruption coverage for policyholders.” The insurance industry’s collective response: no thanks.  This could, according to insurance company lawyers, bankrupt the industry. See Reuters Article Where Insurance Company Lawyers Argue it is Better for them if They Can Just Get Paid to  Litigate Covid-19 Claims. 

Instead, the insurance industry offered support for a new Federal Government program where taxpayers would pay for business losses and insurance companies would be paid to administer that new program.  See Politico Article.  The insurance companies argued – everyone is on board; taxpayers should shoulder the burden.  They were supportive of legislation, so long as they did not have to pay for Covid-19 claims.   

III. Kinds of Covid-19 lawsuits

With their significant resources and political connections, it was perhaps an easy lift for insurance companies to defeat proposed legislation.  But litigation is a different story.  To answer the question of who is winning the Covid-19 insurance coverage fight, it is first helpful to break down the different kinds of litigation bring brought in different courts.  Although the language of each insurance policy needs to be independently analyzed, most Covid-19 cases fall into two distinct categories: 

  • Lawsuits over policies containing virus exclusions; and
  • Lawsuits over policies not containing virus exclusions.

Covid-19 litigation raises novel coverage issues and insurance coverage that are determined by state law.  It is also interesting to see how state courts decisions are different from federal court decisions.   

1. Lawsuits Over Policies Containing Virus Exclusions

On the first category, policyholders are wining just over ten percent of all lawsuits, even when those lawsuits contain virus exclusions.  At first glance, this number is deceivingly low.  It helps to put this statistic into better context.  For the most part, these are cases that contain the standard form ISO exclusion that excludes coverage for losses “directly or indirectly caused” by a virus.

Larger company policies typically do not contain the ISO exclusion that the courts so far have addressed.   To date, courts have not opined on policies that have virus exclusions that have been subsequently deleted by state-specific endorsements.   Nor have the courts addressed more prevalent contamination exclusions that carriers such as Chubb and XL have confirmed apply only to traditional pollution.   For the most part, courts have not addressed exclusions that apply only to costs (hard expenditures), as opposed to loss (business interruption coverage).

One of the biggest issues courts have yet to address is the issue of causation with respect to virus exclusions.  Courts almost universally recognize that there are at least four causes for policyholder loss:

  1. Covid-19 (the disease);
  2. The Pandemic;
  3. The virus; and
  4. Governmental closure orders.

Not every version of a virus exclusion approaches these causes the same way.  For instance, a ruling on the standard ISO exclusion with broad “directly or indirectly caused” causation language has no bearing on an exclusion that applies only to losses “caused” by the virus.  At most, only one of the four causes, the virus itself, would be excluded from coverage with the later language.  For example, if the governmental closure orders caused the loss, coverage would be provided.

2. Lawsuits Over Policies Not Containing Virus Exclusions

Policyholders, on the other hand are winning roughly 30 percent of cases where the policies at issue do not contain a virus exclusion.   Better odds for sure, but why so low?  The answer, as explained in more detail below, is that federal courts appear to be creating their own law, rather than following state law.

3. State Court vs. Federal Court

The question of who is winning the Covid-19 insurance coverage fight is highly dependent on whether the claim is being decided in state versus federal court.  Policyholders are wining roughly half of all cases filed in state court.  This is despite the fact that most of the cases decided contain standard form ISO virus exclusions.  And in most of the cases decided, for the same reason, the policyholder did not plead that the virus was the cause of the damage.   If policyholders are winning half of these kinds of cases, that is good news. 

The news gets even better, with policyholders winning roughly two thirds of cases decided in state court where no virus exclusion is present.  The odds perhaps should be higher, but winning half to two thirds of all cases filed is a good start.   

In federal court, the odds drop down significantly.  Overall, policyholders win only about ten percent of the time in federal court, and just fourteen percent of the time in federal court when there is no virus exclusion. The following table indicates just how different the outcomes are between state and federal courts is in the context of Covid-19 claims.

Percentage of Policyholder Victories

 State CourtFederal Court
Virus Exclusion33%4%
No Virus Exclusion66%14%

Based on statistics alone, something is drastically off.  Federal courts are not following state law.  The question of whether federal courts have the authority to create state law is not a novel issue.  Not only do federal courts have better things to do than decide state law insurance issues, but they are prohibited from creating new state law on issues of contract interpretation.  SeeErie Railroad Co, v. Tompkins, 304 U.S. 63 (1938). 

IV. Litigation Strategy

This explains why insurers are hell bent on having their disputes decided in federal Court.  Federal courts are known to be generally more favorable to insurers than state courts, but the difference for Covid-19 cases is far beyond what any rational person would expect.

For many larger organizations, the insurers have taken the position that they should not deny claims outright.  Rather, they are conducting mock investigations with no intent to pay any Covid-19 claims.  The benefit of this strategy is that some policyholders commit unintentional errors by missing suit limitations or proof of loss deadlines set forth in the policies. 

Policyholders in this situation can and likely should file declaratory judgment actions, not breach of contract actions.  First, the insurer, in this situation, may technically not have breached the contract, at least not yet.   So, a single declaratory judgment action is appropriate.  Second, if there is diversity jurisdiction the insurer will remove the action to federal court where their odds are five to ten times better than if the action remained in state court.  If the policyholder filed a declaratory judgment action only, the policyholder should then file a Brillhart Abstention motion.  See Brillhart v. Excess Insurance Co. of America, 316 U.S. 491 (1942) (recognizing that federal courts should abstain from exercising jurisdiction over state insurance law cases).  In fact, the proliferation of Covid-19 insurance coverage actions presenting similar questions of state law interpretation strongly suggests that federal abstention would be appropriate.

Insurers now claim unless we revisit 80 years of established law, they could suffer defeat.   This is not a valid reason to reevaluate legal precedent. 

* These statistics are for cases decided in state court.  Victory is defined as defeating an insurers’ motion to dismiss or prevailing on summary judgment.

Miller Friel Attorney Recognized as One of Four D.C. Insurance Lawyers to Watch by Best Lawyers

Best Lawyers recently recognized Miller Friel attorney Tae E. Andrews as one of four Ones to Watch for Insurance Law in the District of Columbia. 

Tae Andrews — Recognized as One to Watch in Insurance Law by Best Lawyers

Best Lawyers gives these recognitions to attorneys who are earlier in their careers for outstanding professional excellence in private practice in the United States.  All candidates must be nominated and vetted by their peers. 

https://www.bestlawyers.com/article/best-lawyers-washington-dc-2021/3125

Miller Friel Proudly Announces the Newest Member of Its Insurance Coverage Team – Stephen R. Mysliwiec

Miller Friel, PLLC is pleased to announce that Stephen R. Mysliwiec has joined the firm as a partner, serving clients from Miller Friel’s Washington, DC office.  Steve was previously a partner in the Washington, DC office of DLA Piper, one of the world’s largest law firms, where he was a partner for over 30 years.
 
Steve is recognized as one of the leading insurance recovery lawyers in the country, representing some of the largest and best known companies in the world with respect to all lines of commercial insurance.  Steve has litigated numerous insurance coverage disputes involving policyholders in the real estate, construction, banking, healthcare, life insurance, hotel, assisted living, computer, transportation, steel, commodities, and food service industries.  Steve also represents trade associations, builders, and owners regarding various insurance coverage and liability issues arising from claims of defective workmanship and defective building materials. He has submitted numerous amicus briefs in appellate courts around the country on these issues.  Steve iscurrently representing a number of companies in connection with their business income losses caused by COVID-19.  

Steve’s practice also involves advising clients with respect to the insurance aspects of transactional matters. He helps developers, contractors, owners, lenders, landlords, tenants and other clients in the real estate, construction and financial services sectors deal with insurance and indemnity issues in complex real estate and construction transactions. He also advises clients regarding the insurance aspects of mergers and acquisitions, insurance for initial public offerings, insurance issues in bankruptcy proceedings, trade credit insurance, reps and warranties insurance, and environmental insurance. He also has substantial experience advising owners and lenders regarding insurance programs for professional sports stadium projects, including OCIP programs.

“Miller Friel is thrilled to have a lawyer of Steve’s experience, reputation and caliber,” said Brian Friel, Co-Founder and Managing Partner.  Brian added, “with the addition of Steve to our team, Miller Friel continues its path forward asone of the leading insurance policyholder law firms in the country, exclusively representing companies pursuing insurance recovery.” As noted by Co-Founder, Mark Miller, “Steve shares our vision as a single practice law firm, focused entirely on representing corporate policyholders without any conflicts or constraints imposed by insurers or brokers, in a team effort to maximize insurance recovery.” 

“I share Miller Friel’s belief that a boutique insurance recovery law firm is the right model to most effectively and vigorously represent corporate policyholders,” added Steve.  “Also, I am drawn to Miller Friel because of its cohesive team atmosphere, surrounded by other attorneys who have been fighting for insureds since the early days of this practice area.”  Steve further stated, “DLA Piper is a wonderful firm, and it was difficult for me to decide to leave.  But my practice is focused on representing policyholders, which I will be able to continue to do with Mark and Brian and the rest of the Miller Friel team. I look forward to helping expand the firm’spolicyholder client base andtoburnishing the firm’s reputation as one of the leading, if not the leading, corporate policyholder law firms in the country.  There is a sense of excitement and focus here at Miller Friel that is very special.  I am excited about continuing to represent my policyholder clients and to expanding my practice both nationally and internationally.”  Steve received his B.A magna cum laude fromthe University of Notre Dame in 1970 where he was a member of Phi Beta Kappa, his M.A. from the University of Notre Dame in 1972, and his J.D. from Yale Law School in 1975, where he was Notes Editor of the Yale Law Journal. Steve was a law clerk in the Fifth Circuit for the renowned Judge John R. Brown.

INSURANCE COMPANIES WILL PAY FOR CV-19 LOSSES

Twenty-six years ago, I sat in an overcrowded courtroom filled with insurance company lawyers ready to argue that insurance companies should not pay for environmental cleanup costs.  A distinguished grey-haired gentleman lawyer, my boss, was leading an assault on the insurance industry.  He walked slowly to the podium and said, “Your Honor, you see all of these men and women here in nice suits?  They are all liars.”  The question American businesses should ask with respect to coronavirus is whether history repeats itself.

The CEO of the insurance giant Chubb, Evan G. Greenberg, stated in a recent WSJ Opinion that it won’t help anyone “to try to pin the damage on insurers like my company.”  Decades ago, insurance carriers made this same argument with respect to the environment.  There, insurance companies were held responsible, and American businesses were helped greatly.    The same will likely hold true for coronavirus losses.

Mr. Greenberg’s is wrong to assert that “virus is not covered.” At a minimum, Mr. Greenberg begs a legal question that will be decided by the courts.  Insurance companies willingly and knowingly sold insurance policies covering “all risks.”  For decades, if not longer, it has been the law that “all risks” policies cover all risks of direct physical loss or damage unless specifically and unambiguously excluded.  And, courts throughout this country have held that coverage is provided in similar situations, where property cannot be used for its intended purposes, or is otherwise rendered unsafe to use.  COVID-19 is a covered risk.  It has rendered property unsafe and unusable.  The presence of Covid-19 alone triggers coverage. 

The only question, then, is whether COVID 19 is excluded from coverage.  On April 10, President Trump correctly noted that there is a problem with what insurance carriers are pushing, stating: 

In a lot of cases, I don’t see it. I don’t see reference, and they don’t want to pay up.  I would like to see the insurance companies pay if they need to pay.

No insurance policies, other than those being currently issued, contain COVID-19 exclusions. Some policies address viruses.  Others do not.  Each policy needs to be individually considered, and in a lot of cases, coverage clearly exists.

Mr. Greenberg claims that it would be “wildly counterproductive” to force big insurance companies to pay for losses they didn’t insure.  Insurance companies litigated what they claimed were uncovered environmental claims for decades, only to pay in the end.  The failure to pay covered claims is and has always been counterproductive. 

Recognizing this, numerous states are considering bills requiring insurers to pay for Covid-19 losses.  To this, Greenberg claims protections under Article I of the Constitution.  This classic “red herring” distracts us from the fact that most insurance policies address this issue head on.  Insurance is a regulated industry, and insurers are contractually bound to follow newly enacted laws and regulations.  Constitutional crises avoided. 

History repeats itself.  We are in for a fight.  But, businesses that fight for coverage will be rewarded. See The Good News About Coronavirus Insurance Claims

Coronavirus Insurance Coverage Implications — Good News

A quick Google search would have businesses believing that there is no insurance coverage for coronavirus losses.  Insurance carriers and brokers have seized control of the narrative, and they have done a good job of convincing policyholders that coronavirus claims are not covered.  This analysis offers an alternative and correct view — businesses are covered.

Coronavirus Insurance Coverage — At Least One Thing is Positive for Business

There is a frenzy of misinformation about coverage for coronavirus claims. Fortunately, none of this has any bearing on coverage.  To get the correct answer, one must read the insurance contract without preconceived notions of coverage.  If this is done, businesses are left with many insurance-related options to counter coronavirus-related losses.

This point is illustrated by looking at how insurance policy language addresses three common coronavirus claims: (1) third-party lawsuits, (2) business interruption losses, and (3) event cancellation losses. 

1. Third-Party Lawsuits

With coronavirus, businesses are susceptible to lawsuits alleging that they should have done something to prevent injury to persons.  The first of these claims was just filed–a lawsuit alleging wrongdoing on the part of a cruise ship company.  Just as night follows day, more will follow. 

General Liability policies cover allegations of “bodily injury.”  If a claimant alleges that he or she was injured, coverage is triggered.  Coronavirus lawsuits are classic examples of covered general liability claims. 

Insurance carriers, however, are pushing the narrative that coronavirus is a pollutant and therefore excluded from coverage pursuant to pollution exclusions.  This is an old concept.  In the past, insurers found themselves paying pollution claims, no matter what kind of pollution exclusions they put in their policies.  So, they expanded the exclusions to prevent coverage for environmental cleanups.  

Insurance carriers now argue that pollutants include any kind of “irritant” and that pollution exclusions apply to almost any claim.  For example, if the sun got in a person’s eyes and that resulted in a car crash, insurers would argue that the sun is an irritant, and that the pollution exclusion precludes coverage.  Yet, everyone knows that sunshine is not a pollutant.  Similarly, if a third party is burned and sues, insurers will argue that fire is an irritant, and that the pollution exclusion precludes coverage.  Of course, fire is not a pollutant, and at least one court awarded bad-faith damages where an insurance carrier made this claim.  See Winning Bad Faith Coverage Cases at Trial.

Common sense will prevail here as well.  Coronavirus is not a pollutant. 

2. Business Interruption Losses

Almost certainly, the largest category of losses business will experience as a result of the coronavirus are business interruption losses.  Airline flights have been sidelined, people are not going out, and businesses of all kinds are suffering.  The narrative insurers push here is an old one: insurers argue that property policies are not triggered unless there is physical injury to tangible property.  This narrative was developed after 9/11 to stem payments to businesses suffering huge financial losses. 

Based on policy language, though, physical injury is not required.  All-risk property insurance policies cover “all risks of physical loss or damage.”  This insuring clause addresses two separate things.  First, it states that it covers all risks of physical loss.  Second, it states that it covers all risks of damage.  Damage includes all forms of financial loss.  Coronavirus is the risk.  If it caused damage in the form of financial loss, this falls squarely within coverage. 

There is substantial case law on this issue as well. 

  • Case Example One — A church smelled because gasoline was leaking into the basement.  The house was unsafe and smelled so bad that the owner had to move out.  The insurer denied coverage, stating that there was no physical damage to the house.  The court held otherwise, finding coverage.
  • Case Example Two – A river meandered, leaving a structure precariously sitting on a riverbank.  The structure was fine, but it could not be used because it was unsafe and could fall down.  The insurer argued there was no coverage because there was no physical damage to the property.  The court ruled otherwise, finding coverage.
  • Case Example Three – A homeowner rented its house to crack dealers.  After the crack dealers left, the home smelled so bad that it could no longer be rented.  The home had no structural damage, so the insurer denied coverage.  The court disagreed, as the house could not be used as intended. 

There are two overlapping and well-developed lines of cases holding that physical injury to property is not required.  The first relies on the inability of the property to be used as intended.  The second relies on the fact that the property was somehow rendered unsafe.  Both lines of cases are directly applicable to coronavirus losses. 

In addition, property policies contain numerous other insuring clauses that similarly do not contain a requirement of physical injury to property in order to be triggered.  Among them, ingress/egress coverage (covering financial losses when a business is prevented from entering their property) and civil authority coverage (covering losses when the government prevents normal operations). 

The leading case on these issues is Fountain Powerboat Indus. v. Reliance Ins. Co., 19 F. Supp. 2d 552 (E.D.N.C. 2000).  The Fountain Powerboat Decision is one of History’s Best Insurance Decisions.  There, the Fountain Powerboat company of North Carolina had a work slowdown as the result of a hurricane.  It pursued relief under their property insurance policy pursuant to an “ingress/egress” provision.  Its insurance carrier denied coverage based on an all-too-common insurance industry custom and practice—denying coverage because there was no physical damage to insured property.  The court flatly rejected this argument in favor of insurance policy language and awarded Fountain Powerboat the attorney’s fees it incurred to pursue the action against its insurer.   

3. Event Cancellation Losses

Every day now, more and more major events are being canceled or postponed because of the coronavirus, including trade association conferences, college and professional sporting events, and concerts.  Even a conference on Coronavirus was canceled because of coronavirus.  What is missing from the headlines are the myriad of trade associations that need money from events to survive but have been forced to cancel events because of coronavirus. 

Event cancellation insurance is commonly triggered when an event is necessarily cancelled, abandoned, curtailed, or postponed.  A typical scenario, where an event is cancelled (or postponed) due to coronavirus concerns, falls squarely within coverage.  See Event Cancellation Insurance Claim Denials Tips for Recovery

Yet, insurers are fighting coronavirus event cancellation claims.  One argument that insurance companies are making is that an event was cancelled due to fear and panic.  Given that policies don’t contain fear or panic exclusions, there is no merit to this argument.  Similarly, insurers allege that the events could have proceeded but for the public’s fear and panic. 

Not all event cancellation policies are the same.  In some situations, insurers argue that the cancellations must result from the “physical or legal inability to proceed” with an event, and short of either a physical barrier preventing the public from entering a hotel conference center or sports arena, or a government order banning any mass gatherings, there is no coverage.  Again, the insurers’ position is inconsistent with the policy language.  For example, if there is a genuine fear of contracting the virus, this is a “physical inability” to proceed with the event.  In addition, many companies have instituted travel bans, making it physically and legally impossible for employees to travel.  Also, even if a government recommends that the public not attend mass gatherings (events with over 250 people), this is a form of “legal inability” to proceed with events. 

Both of these reasons for denial bring to mind a situation that we are currently addressing.  We had a settlement meeting with seven insurance companies scheduled for months.  The meeting was to take place in NYC, and the insurers had agreed to be present in person at that meeting.  Several days before the meeting, various insurers notified us that they could not attend because of coronavirus.  Many had travel restrictions.  Others were just unwilling to subject themselves to any additional risk of contracting the virus. 

Were these insurers motivated by panic?  Should this insurer-scheduled event have gone forward as planned?  The insurers said, “No.  We won’t attend.  We are rational.  You need to cancel.  Coronavirus is a legitimate reason to cancel.”  In other words, events that insurers should attend must be canceled, but all others must go forward.  

Unless the insurers learn to be honest about what is going on, their hypocrisy will cost them dearly.  Coronavirus cancellations are exactly what event cancellation policies are designed to cover. 

Two Common Mistakes Policyholders Make with Property Insurance Claims

In this blog post, Mark Miller addresses two common mistakes policyholders make with property insurance claims.


To provide context, it is important to understand how corporate property insurance claims are typically handled. Because property insurance claims present a series of complex legal issues, insurance companies typically obtain legal advice on larger property claims from inception. Policyholders, on the other hand, typically do not. Policyholders typically engage an insurance broker or public adjuster to handle claims on their behalf. Brokers and public adjusters know insurance industry custom and practice, and they know how to handle claims in accordance with long-established understandings with insurance companies regarding what insurers will and will not pay. Legal involvement on the policyholder side, if at all, only comes into play down the road when the insurance company refuses to pay what they owe.


It is only at this point, perhaps a year or more into the claim, that policyholders are advised by counsel about the legal implications of their claim, including mistakes that were made. This video illustrates two common mistakes.


Proof of Loss Deadlines


The first mistake centers around proof of loss deadlines. A proof of loss is a sworn statement outlining the loss. Many property insurance policies state that a proof of loss must be filed within a specific period of time, such as 90 days from the date of loss. With complex corporate claims, it is impossible to assess a loss within 90 days, let alone swear under oath that the stated amount is the full amount of loss suffered. Moreover, business interruption and other “time element” losses often continue long after the proof of loss deadline has expired. So, policyholders are faced with an impossible-to-meet deadline.


For this reason, insurance industry custom and practice is to ignore proof of loss deadlines. When asked if a proof should be submitted, insurance adjusters will likely say that there is no need to submit a proof of loss until the loss has been agreed to by the policyholder and the insurer. In fact, if a policyholder offers to submit a proof of loss before they are asked to do so by the insurance company, the insurance company will treat the unrequested proof as a “hostile proof.” The word hostile says it all. In the insurance industry, irrespective of what the policy says, policyholders are instructed not to submit proofs of loss unless and until the insurance company asks them to do so.


The mistake with respect to proofs of loss arises because policy language and industry custom and practice are different. Although most jurisdictions will not require a policyholder to submit a proof of loss in this typical situation, the law is far from uniform. The solution to the problem, as addressed more fully in the video, is really quite simple, request an extension.


Suit Limitation Deadlines


The second mistake that policyholders make is by being lulled into thinking that the insurance company will pay the claim and missing a limitation on filing suit. Many property insurance policies have a limitation on filing suit against the insurance company. Commonly, these limitations are one or two years. Problems arise because complex property insurance claims are not typically resolved in this time period. In fact, in some situations, business interruption losses can continue for two years or more. Hence, it makes no sense for a policyholder to preemptively file suit if the parties are still working out the claim.


For these reasons, industry custom and practice is to ignore suit limitations deadlines. Typically, insurance carriers are negotiating claims, and cutting checks for losses, long after the suit limitations period has expired.


The issue comes up only when the insurance carrier decides they are done paying the claim. At that point, their counsel sends the policyholder a letter stating that the insurance company is finished paying, and that there is no recourse, given that the suit limitations period has expired.


The solution, as addressed more fully in the video, is to obtain a suit limitations extension from the carrier.

Please watch the video to learn more, or Contact us if you have any questions.

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Is Lloyd’s of London Still Relevant?

The question of whether Lloyd’s of London is still relevant in today’s insurance market is a good question for corporate policyholders to consider. On the one hand,Lloyd’s plays an important if not crucial role in the U.S. market. They are known to ensure risks that others will not touch. They are also known for using innovative policy language.

However, Lloyd’s of London is not an insurer. Rather, it is a marketplace for underwriting risks. For a typical Lloyd’s of London policy, there is no single entity insuring the risk. Rather, underwriters of various corporate and non-corporate structures take portions of the risk. Each underwriter gives its two cents on what they want to pay. If there may be no lead appointed, it is not uncommon for underwriters to disagree as to how a claim should be paid or defended. This can lead to chaos.

Whether Lloyd’s of London is still relevant in today’s insurance market is a good question for corporate policyholders to consider.

When this chaos is imposed on cases filed in what is known as the “rocket docket,” such as that employed in the Eastern District of Virginia, all hell breaks loose. There, cases go from filing to trial in less than 12 months. To say that defense decisions in the rocket docket need to be made quickly is an understatement. Recently, we had the opportunity to gauge Lloyd’s of London’s performance in this setting, and they did not perform admirably.

Please watch the video to learn more, or Contact us if you have any questions.

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Funny Insurance Decision — The Tale of the Malicious Raccoons

Reminiscent of those television adds where the insurance company brags about having seen everything, and paid it, the case of Capital Flip, LLC v. American Modern Select Insurance Company (W.D. Pa. 1999) is a funny insurance decision that illustrates a different story.  There, malicious raccoons damaged a dwelling, and the insurance company refused to pay the claim.  If you wonder how this crazy decision relates to large corporate insurance claims, please read on.

In Capital Flip, the policyholder bought a named peril property policy.  One of the numerous perils covered was “Vandalism or malicious mischief.”  The policyholder argued that the raccoons were engaged in malicious mischief.  The court, looking to common usage of the words vandalism and malicious mischief, found that these acts typically related to a person.  Since raccoons are not persons, the court held that there was no coverage. 

Given that our law firm handles only large corporate insurance claims, I was hesitant to even read a decision about a home owner claim gone bad. But, I was curious.  I wanted to see if raccoons really are malicious.  After reading the decision, I contemplated what lessons, if any, large corporate policyholders could learn from this comical situation. 

On reflection, there is only one lesson we can learn from Capital Flip – when insuring property, buy an “all risk” policy.  All risk policies are the norm.  They cover “all risks of physical loss or damage,” and case law interpreting these kinds of policies is settled and policyholder friendly.  Coverage is exceedingly broad.  Why then did Capital Flip buy a named peril policy covering such limited perils?  We don’t know, but perhaps it was to save money. 

This funny insurance decision illustrates a point we make over and over again.  If there is a claim, Insurance policy wording is all that matters.  What the insurance broker says the policy covers means nothing.  What the insurance company says the policy covers means even less.  All that matters is insurance policy language. 

Lloyd’s of London. Then and Now

We are often asked by clients to compare the claims practices of leading insurance carriers, which often leads to a conversation about Lloyd’s of London’s current insurance claim resolution practices.

Lloyd’s of London. Then and Now

A lot has changed since Lloyd’s of London earned its reputation in the United States 113 years ago. The Great San Francisco earthquake of 1906 presented a pivotal opportunity for Lloyd’s of London to show the United States that they were different and better than traditional U.S. insurance companies. Their approach then was to bring suitcases of cash, and pay policyholders on the spot, in full, irrespective of policy language. This aggressive stance helped to build a reputation for Lloyd’s of London, and U.S. policyholders purchased a lot of insurance from them because of this reputation.

Today, 113 years later, Lloyd’s approach to insurance claim resolution is dramatically different. Now, when a claim is made, it is difficult or impossible to find anyone who can speak for Lloyd’s, let alone any individual who can settle a claim. Lloyd’s employs lawyers as adjusters, and, as a result, many claims are unjustly viewed with skepticism. This approach has earned Lloyd’s of London the opposite reputation amongst corporate policyholders to positive reputation they justly earned 113 years ago.

Lloyd’s of London can turn this around, but to do so, they need to go back to their earlier approach of paying claims. If they do this, the growth in sales they desperately desire will follow, and the reputation of the institution will be saved.

Please watch the video to learn more, or Contact us if you have any questions.

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Cyber Insurance: What the Educated Policyholder Needs to Know Now

It has been reported that thirty-one percent of organizations have experienced cyber-attacks.  Moreover, cybercrime costs continue to accelerate with organizations spending nearly twenty-three percent more in 2017 than in 2016.  On a corporate level, the average cost per breach is now at $11.7 million.  While these statistics instill fear in some, they create opportunity for others. Insurers recognized an opportunity early on, and cyber insurance products quickly came to the rescue.  Many of these cyber insurance policies, by design, covered very little.  But they sell like hotcakes. 

Corporate policyholders are more educated now than they were in the early cyber insurance days, but insurers still sell deficient cyber insurance products, and routinely deny cyber insurance claims that should be paid. 

Please join Mark E. Miller, founding partner of Miller Friel, PLLC, as he addresses these and other concerns in his recent PLI CLE Briefing.  Topics include:

  • Coverage under current cyber insurance policies;
  • How cyber insurance policies can be improved through negotiation;
  • Common bases for denials of cyber insurance claims; and
  • Best practices for handling corporate cyber insurance claims.

For additional information, please see Cyber Insurance – What Educated Policyholders Need to Know Now Presentation Materials.