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Property & Casualty Insurance Procurement & Litigation (Ten Things Every Lawyer Should Know)

6. The insurance application process now requires more attention.
There was a time, in the not too distant past, when most applications for property and casualty insurance did not require the signature of the insurance buyer. Agents routinely completed applications and underwriters readily accepted them without anyone’s signature on the application. This custom and practice is no more. Insurance applications have become more than just tools to gather underwriting information to determine the eligibility of the applicant for coverage and for premium determination purposes. The necessity for thoroughness and precision has greatly increased. It is more than appropriate and appreciated by the underwriter for the applicant to provide supplemental answers and explanations along with the standardized application. These relatively recent changes in the usual and customary practices of making an application for insurance can make the difference between having a claim covered and not having it covered. An ambiguity or misunderstanding can become an allegation of misrepresentation, which can lead to no coverage at all, rather than just a possible increase in premiums. Policy rescission and voiding policies ab initio are on the rise, along with underwriters using application information as “Warrants” thereby making the application a part of the policy (which has always been the case with life insurance policy applications).
These developments make providing accurate information to underwriters more than just important. Accurate information becomes the basis for the existence of the contract itself and adds an increased threshold to the concept of “utmost good-¬‐faith” which is the traditional basis of all insurance relationships. However, “utmost good-¬‐faith” is a two-¬‐way street. Insurance companies sometimes attempt to deny coverage based on conditions and exclusions that are not, and never were intended, appropriate to the situation or the claim at hand. Some prohibitions were intended to exclude coverage because the hazard is better transferred by another type of policy, not to be used to exclude an otherwise covered claim. This type of unfair claims settlement practice is rare and usually caused by poor attention to detail in the filing of a claim and/or inexperienced claims adjusters. The insurance buyer needs to be equally diligent and vigilant as to the accuracy of applications of insurance and in the filing of a claim under an insurance policy.

Lesson: Insurance applications are more important than they once were. Plan and prepare in a careful, thorough manner before submitting an application for insurance or filing a claim.

Scott E. Bushnell

Mr. Bushnell is a Certified Public Accountant with over 20 years of experience providing Forensic Accounting services through national and global professional services firms. Know as the “numbers guy” his professional expertise covers Business Interruption Claims, Economic Damage Analysis, and Fraud Investigations. Mr. Bushnell has advised clients in mediation, arbitration and appraisal as a third…

Damian J. Arguello

Risk management & insurance thought leader & influencer, law professor, coverage counsel, & insurance expert witness.

In A Hurry To Get To Destinations Not Considered

It is often said that the police and firemen run towards the danger when others are running away from the danger. Thing is, the danger is generally a known danger, not an unknown one.

AAIMCo Members Featured in latest CLEW Newsletter

•Wrongful Designation by Thomas M. Braniff, JD, CPCU and Robert P. Gaddis, JD;
•The Essential Bookshelf for Expert Witnesses by Kevin Quinley, CPCU, ARM, AIC;
•The 411 on Becoming an Expert Witnesses by Elise M. Farnham, CPCU, ARM, AIM, CPIW;
•Working as an Expert Witnesses by Douglas R. Emerick; and
•“Be Careful What You DON’T Ask For” By Bill Wilson, CPCU, ARM, AIM, AAM.

Contingent Business Interruption Claims, What Happens When the Loss You Experience is Not Your Own?

In today’s business climate more focus is placed on lean operations. This trend is becoming increasingly more commonplace as corporations are divesting of business lines and returning to core competencies. As decentralization continues to grow and corporations are relying on supply and sales agreements with non-related parties, the impact of a supplier or customer’s loss on a business’ operations increases substantially.

The Business Behind Business Interruption, A Forensic Accountant’s Approach to BI Claims.

Preparing business interruption claims takes thoughtful planning and insightful
analysis, clearly communicated to all of the parties involved in the claims process. One
of the most important factors is the breadth and depth of analyzing relevant financial
information related to interrupted business operations. Although this may seem like an
intuitive step, there is often a gap between the internally prepared financial information
and the analysis to determine lost profits. Application of due diligence results in a
smooth claim process, quicker payment from the insurer and a fair and equitable
recovery.

A Review of the Modern Claims Made Form

“Since its creation, “claims made” wording’s use has expanded outside of the “profession” and professional liability realm, finding use in diverse liability coverages. But the roots of “claims made” wording, and its most common use still, is found in covering the exposures created by a “professional’s” activities. As seen by the list of true “professions,” professionals are individuals who provide a service to society which, if done poorly, could cause extreme or irreparable personal or financial harm. …

The expansion of claims made policy forms beyond “professions” caused the basic “claims made” concept to diverge and evolve into two distinct forms. One evolutionary branch commenced in professional liability coverages (known also as “errors and omissions” coverages in this series) and the second branch grew out of the financial services industry and the need for directors and officers liability protection, fiduciary liability and employment practices liability (referred throughout this series as “executive liability” coverages).

Although both branches attach to the tree at the same point; greatly different “claims made triggers” have resulted. Additionally, coverage terms, conditions and definitions differ between the two branches.”

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