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.
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.
Insurers Must Establish That Exclusions Apply in “All Possible Worlds”
Insurers’ often combat policyholders’ quests for potential coverage of lawsuits by asserting exclusions that bar a defense based on the “gravamen” of the suit. The principal focus of a lawsuit characterized by insurers as “what the suit is about” or equivalent phrasing purportedly bars a defense because of various exclusions. Courts, which typically look to the tort claims asserted to discern what the lawsuit is about, believe that determining if potential coverage exists requires no more than a common sense view of what the lawsuit is about. That approach, however, is not the legal test in evaluating the duty to defend. It is therefore not uncommon for appellate courts to routinely reverse district court decisions that fail to apply the proper legal analysis called for in addressing whether there is any possibility that coverage will arise.
Recovery of Pre-Tender Defense Fees When Notice Is Late
Many intellectual property lawyers routinely litigate copyright lawsuits and immediately provide notice to a Commercial General Liability (“CGL”) insurer. Thereby, they secure defense fees for “Personal and Advertising Injury – offense (g)” “infringement of copyright, trade dress or slogan in your ‘advertisement,’” which broadly defines the term “advertisement.” But what if the covered claim is inchoate such as fact allegations that evidence trade dress claims not labeled as such?
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.
When Does Appointed Counsel Not Discharge an Insurer’s Duty to Defend?
Insurers often fall short of properly discharging their duty to defend by not providing the counsel demanded by the law and the terms of the policy. In some instances, insurers will deny coverage but still provide a “courtesy defense.” In other cases, the insurer may agree that a claim triggers the duty to defend but only provide attorneys who are ultimately loyal to the insurance company, despite the conflicts of interest created by that loyalty. In either situation, the insurer is attempting to take advantage of the policyholder’s ignorance and failing to hold up its end of the agreement.
Are Insurance Policy Applications Traps for the Unwary?
When applying for insurance coverage, the policyholder must complete a policy application. Completing the policy application can be a tedious process containing a number of questions that, to the average person, can seem convoluted and confusing. This is especially the case as policyholders face questions that do not have objective answers. The complicated nature of policy applications raises serious issues where insurers have the ability to rescind the policy contract if the policyholder misrepresents information provided in their policy application.
Policyholder's Rights to Challenge Insurer's Control of Counsel
Commercial General Liability (“CGL”) policies, however, rarely bestow a right on the policyholder to select counsel. Nonetheless, policyholders may still secure its choice of counsel where an ethical conflict arises because of the insurer’s “reservation of rights” (“ROR”).
TRIGGERS FOR RECOVERY OF PREJUDGMENT INTEREST
Where an insurer had denied a claim and many years have ensued until an adjudication of its duty to defend, prejudgment interest recovery can be significant. This, in turn, can make choice of the forum to pursue a coverage case, as well as what law that forum may apply, a critical decision element for coverage litigation.
Illusory Coverage - A Continuing Thorn in the Side of Policyholders
The application of the “illusory coverage” doctrine bars policyholders from coverage they reasonably believe they have. Courts differ on the fact circumstances that trigger application of the “illusory coverage” doctrine. These methods can be categorized into three (3) distinct approaches.
Duplicitous and Overbroad Insurer Constructions of Exclusions Improperly Deprive Policyholders of Coverage Benefits
Insurers, incentivized to avoid their duty to defend policyholders in lawsuits, have sometimes embraced the idea that even one connection between a policy exclusion and a claim is enough to relieve them of that duty. While a policy may state that it does not indemnify certain alleged offenses by the insured, the insurer should not be able to deny a defense where those allegations comprise only a portion of an otherwise covered suit.
Narrow, Narrower and Narrowest: The Insurer's Playbook to Avoid Coverage
A recurring theme in Commercial General Liability (“CGL”) policy forms is that there has been an ongoing narrowing of “personal injury”/ “advertising injury” coverage provisions.
The Implied Right to Recoupment--A Tale of Smoke and Mirrors
In recent years, more and more courts have recognized that, absent some bilateral agreement, insurers do not have the right to recoup costs spent defending a policyholder when it is later determined that no duty to defend existed.
Navigating Issues of Dual Representation Where Both Appointed Counsel and Independent Counsel Jointly Defend a Covered Lawsuit
In many cases, a defendant in a lawsuit may want to select their own lawyer, even if they believe that their liability insurance obligates the insurer to appoint one. If the defendant chooses to do so: “both the counsel provided by the insurer and independent counsel selected by the insured shall be allowed to participate in all aspects of the litigation. Counsel shall cooperate fully in the exchange of information that is consistent with each counsel’s ethical and legal obligation to the insured.”
Assuring Pre-Tender Fees Are Recoverable by Providing Proper Notice to Insurers
A Failure to Provide Notice Even Where it Does Not Preclude the Right to Any Defense May Limit a Client to Recovery Of Only Post-Notice Attorneys’ Fees.
Avoiding Malpractice by Providing Prompt Notice of Intellectual Property Claims to Insurers
“Intellectual property attorneys may have a duty to apprize their clients of the need to notify their clients’ insurers of claims as part of their retention in order to fully represent their clients’ interests in a lawsuit for which they are counsel of record.”
Insurers May Owe an Obligation to Defend Ongoing Lawsuits
Some policyholders, if queried, might presume that a lawsuit which incepts before they have a policy in force could not trigger coverage under that later-issued policy of insurance. Insurers would argue that no insurer would issue a policy that had a defense obligation as of the date of its inception so that a notice provided contemporaneously with the policy’s issuance would trigger any rights thereunder. Generally accepted insurance coverage principles, as applied to standardized commercial general liability policies, do not preclude coverage for claims/lawsuits alleging continuous tortious conduct which incept prior to issuance of “occurrence” based insurance. This article will explore circumstances where post-claim/lawsuit coverage may be available to policyholders.
Buried Treasure
Many professionals with Errors & Omissions Coverage may find that their insurance includes no “advertising injury” coverage despite their widespread use of digital marketing to reach potential new clients. One solution is to secure express coverage for intellectual property (“IP”) infringement claims through an insurer.