Insurer’s Obligation to Pay Reasonable Settlement When It Refuses to Defend
Despite their legal obligations to defend any claims with even a potential for coverage under a policy, insurers often fail to abide by that standard, looking for any excuse to deny a defense. Litigating to obtain policy benefits can take years in some cases, so the underlying action is often resolved before the battle for coverage comes to a close. When that underlying action is resolved via settlement, the denying insurer is obligated to reimburse the policyholder, even if the claim would not have met the standard for indemnity coverage. A number of cases in jurisdictions across the country have addressed this issue and reached the same conclusion.
When Timely Notice Isn’t Enough and When It Isn’t Even Necessary
Policyholders must be diligent in providing notice of potential claims to their insurers. Many policyholders, and even insurance brokers, make the mistake of assuming there will be no coverage for a particular matter and fail to do so. This is a mistake. Another mistake can be made by failing to provide notice according to the procedure required by the policy. Though ultimately resolved in favor of the policyholder, one Illinois case had to be litigated up to the state’s Supreme Court to secure coverage, all of which could have been avoided by providing notice according to the terms of the policy.
Lawsuits Filed Prior to Policy Inception May Still Be Covered
Many policyholders operate under a mistaken belief that a lawsuit filed prior to acquiring insurance can never be covered by that policy. Insurers would be quick to assure them they are correct in that assumption. The truth, however, is more nuanced. Insurance Services Office (“ISO”) Commercial General Liability (“CGL”) policies provide coverage for claims asserting continuous tortious conduct, and general principles of insurance law allow that coverage to extend even to claims where the conduct began before inception of an “occurrence” based policy.
Insurer’s Rights and Obligations Surrounding Settlement Negotiations
The vast majority of civil litigation in America ends with a settlement rather than a judgment. As the most likely endgame for any given claim, policyholders should understand their rights during the settlement process. It is almost important to know how those rights are affected both by an insurer’s acceptance of its duty to defend and by a denial of coverage.
First-Party Bad Faith under California’s “Genuine Dispute” Doctrine
Policyholders are generally eager to include a bad faith count along with breach of contract whenever a dispute with an insurer rises to the level of litigation. This is understandable as a successful bad faith claim can open the door to much greater recovery, including some forms not otherwise obtainable for simple breach of contract. The most viable for opportunity for recovery is typically limited to Brandt fees, which cover only the portion of fees incurred by counsel to establish the insurer’s obligations under the contract.
Insurers Escaping Duty to Defend Mixed Actions with New Exclusion Language
Many cases address some claims that are potentially covered by insurance and some that are clearly outside coverage. The rule in California (and generally throughout the country) is that these “mixed actions” must be defended in their entirety. Some jurisdictions allow the insurer to recover defense expenses associated with the non-covered claims. In order to avoid these obligations, however, some insurers incorporated expansive exclusions that eliminate any coverage for an entire suit if any claims asserted fall within a stated exclusion.
Insurer Orchestrated Settlements Purporting to Eliminate Coverage Are Suspect
In our previous blog, we discussed how policyholders can potentially weaponize poorly drafted policies. This tactic of course relies upon an underlying complaint with sufficient fact allegations to trigger potential coverage, which occurs more often than insurers are prepared to admit. Complaints, however, can be amended. So what would happen if an insurer were to conspire with the plaintiff to remove all allegations triggering potential coverage, thereby leaving the policyholder stranded without a defense?
Turning Ambiguous Draftsmanship Against the Insurer
Insurance policies are notoriously difficult to understand. Many policyholders fail to realize that this applies to insurance brokers and adjusters as much as it does to anyone else. Even on the rare occasions that an insurance worker is fully informed of all the legal contours of a policy’s coverage provisions, they obviously have a bias clouding their view of how it would apply to a costly claim.
Potential Liability from Use of ChatGPT’s Responses
ChatGPT has made frequent appearances in headlines lately for its ability to quickly draft lucid responses that feel much less “artificial” than the content normally associated with artificial intelligence programs. The answers it provides are so good that many have begun wondering how they might take advantage of the tool for promoting themselves or their businesses. As is so often the case for insurance lawyers, this is the part where we have to advise caution and consider the potential liability that might stem from proposed activity.
Finding Appropriate Media Policy Coverage
Businesses beyond obvious multimedia categories, such as advertisers, producers, publishers, or others like them, may need to acquire media liability coverage to protect against the rising use of and threats associated with integrating social media and online business operations. Social media is becoming a key aspect of business operations for advertising and making virtual connections to consumers and partners which calls for more attention for the need to secure coverage of media risks.
Why Policyholders Should Retain Insurance Coverage Savvy Counsel
Intellectual property litigation proceeds through a variety of causes of action. They can include a number of distinct factual allegations that often trigger insurance policy benefits entitling policyholders to a defense at their insurer’s expense. While the most common form of business insurance to secure coverage remains the Commercial General Liability (“CGL”) policy, securing defense benefits under such policies presents increasing challenges.
To secure that benefit, the parties may evaluate facts beyond the complaint (“extrinsic evidence”) that clarify how the claims asserted implicate insurance coverage. Enlisting the assistance of insurance-coverage-savvy policyholder council who are also intellectual property litigators enhances the prospects for securing insurance policy benefits.
Ten Common Mistakes Policyholders Make Re IP Claims
IP claims are misunderstood even by most people in the insurance industry, so it’s no surprise that policyholders also struggle with them. This blog addresses the most common mistakes I’ve seen clients make and tries to offer some advice on how to avoid them.
Alternative Approaches to Stays of Coverage Suits and Underlying Actions
Our previous blog focused on the California approach to this issue, which stems from the California Supreme Court case Montrose Chemical Corp. v. Superior Court. The Montrose ruling permits policyholders to avoid the complications that would arise if the merits of the claims against them were litigated. Coverage benefits are not impaired by requiring the policyholder to forfeit its rights to protect its defense to the claims asserted against it in the underlying action.
Several states have adopted similar policies. Others have taken the exact opposite stance. They opt instead to grant stays in the underlying action, allowing the coverage suit to be resolved first. Additional factors are also implicated in the common scenario where a coverage suit for Declaratory Relief brought in federal court to address the insurer’s obligations to defend a policyholder in an underlying state court action.
Stay of a Coverage Suit Due to Overlapping Facts
California courts have recognized that where the underlying action and coverage action both address the same “substantive issues,” a duty to defend, delaying the adjudication of the coverage issues by issuing a stay is appropriate. In the case of Aspen American Insurance Co. v. Harry William Ou, the court employed this doctrine to stay the coverage case addressing the plaintiff’s right to independent counsel due to the overlap of facts that could prove the plaintiff’s liability with those that might prove the applicability of a policy exclusion.
Ten Recurring Questions on How to Use Policyholder Counsel
PROBLEM 1.
Who is going to pay your bill if we use you to assist us?
ANSWER: Our firm’s blended hourly rate experience is $350–$400 for the pursuit of insurance coverage issues. We have, on multiple occasions, secured recovery of the lion’s share of our insurance coverage fees where the insurer’s denial of coverage evidences unreasonable conduct.
Beware of “Insurers Bearing Gifts”
Your insurers are not necessarily your friends. Their practical goal is to avoid paying money on any claim made by the insured. Despite the friendly, customer-first appearance they cultivate, many seemingly generous offers are often illusionary. A few common traps to be wary of are: (1) re-definition of policy terms which imbed limitations to coverage without expressly adding policy exclusions; (2) withholding of advice that an insured is entitled to independent counsel despite issuing a comprehensible reservation of rights that allows the insurer to change its mind about coverage as new facts come to light; and (3) reticence to truly pay defense fees or to advance payment of necessary sums to settle.
Directors & Officers Coverage for Government Investigations
The availability of insurance coverage for investigation defense costs is unclear leading to apparent inconsistent decisions. The policyholder, however, that actually pursues coverage for those claims often succeed. The failure to notify the insurers of the claims will deprive insured of any potential coverage where the investigation proceeds to a “Claim.” At minimum, these interactions should be reported to the present D&O carrier as a potential claim under the policy provisions allowing the report of a “notice of circumstance.”
Settlement May Be Recoverable Against a Non-Defending Insured Without a Trial
If the underlying case settles before judgment is issued, the court assessing the insurer’s duty to indemnify monies paid in settlement may not have the benefit of adjudication for liability or damages in the underlying action. Such an insurer, therefore, must assess the its obligation to compensate the insured for amounts it paid in settlement based on the insured's potential for liability in the underlying action. This determination is made based on the facts established in the case at the point of settlement, including the facts that were assumed by the parties and formed the basis for the settlement.
Battling for Equity-Securing Appropriate Fee Rates in C. C. §2860 Disputes
The rates insurers pay their appointed counsel to defend similar actions in similar communities sets the benchmark when California Civil Code § 2860 is applied. To pay a rate less than the reasonable rate virtually every other forum requires strict and complete compliance with California Civil Code § 2860.
WHAT A CEO NEEDS TO KNOW ABOUT INSURANCE
When is the last time you thought about your company’s insurance coverage? How broad is its scope? How might it address litigation which could arise out of the company’s operations?
Insurance concerns are rarely a priority for CEOs. But, a CEO brings a unique perspective to the oversight of insurance acquisition and use. CEO involvement is inescapable where a Lawsuit becomes an “existential” concern for the Company.