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“This number (224) likely represents just a small fraction of the notice-based denials that never
make their way to a courtroom. More must bedone to educate policyholders on how to comply with their policies’ claims-made reporting requirements. How did notice-based denials under claimsmade forms become so common? To understand how the industry has arrived at this
point, it is important to explore the history and evolution of the claims-made form.
There are six main reasons for these denials.
1.Late reporting of a claim after policy expiration
2.Failure to disclose known claims or potential facts and circumstances that could
give rise to claims later on an application (and not reporting same under the notice
of potential claim provisions)
3.Failure to identify that the current claim being reported is related to a prior claim reported to a previous insurer or previous policy with the same insurer
4.Failure to disclose prior-pending claims made on an insurance application
5.Reporting the claim in a manner that is not as directed by the policy language itself
6.Claims denied for not reporting “as soon as practicable”
The main driver of denials is that the policyholder reported the claim after the policy expired, as represented by 101 denials upheld by the courts. Not too far behind that category is
the situation where the insured knew of a claim or wrongful act before the inception of a policy.
Here is a breakdown of the six categories. … “
“There are inherent dangers when a company is acquired, not only for the selling company, but for the acquiring company. It is not uncommon for the buyer to require the seller purchase several years of extended reporting coverage. This is because the buyer, when either acquiring the assets or the stock transaction, wants no exposure to any known or unknow liabilities created by activities before the acquisition.
We’ve all seen companies get acquired, with the seller invoking whatever extended reporting coverage they can acquire, sometimes at a significant price. But that is not the only problem, and this is where the approach and analysis become important. Asking the right questions is thus necessary to provide the appropriate financial protection to those involved, with the avoidance of any error and omission claim that might be made against the broker, despite whether they are simply following an “order take” standard or not.”
Last year I wrote a commentary, “To Dress or Not—Is Professional Attire Outdated?,” on whether or not students should be expected to dress professionally for interviews and career fairs. I asked for feedback and encouraged responses. I’m pleased to say I got a lot of thoughtful responses from a wide range of readers. Executives, claims adjusters, independent agents, corporate trainers, and many others chimed in.
“What are some of the additional problems raised however by following the concept of being only an order taker? You have a customer that comes in your office who says I have a business and I need insurance. What do you recommend? How does in the insurance agent or broker therein not give advice by answering the question. Are they supposed to say
“what is it you’re worried about? We have numerous commercial policies we could provide , then we could confirm we will provide it depending on what your needs are and as you know, you must have Worker’s Comp. Perhaps you might consider should insuring your property, or consider insuring your business for liability. What are your concerns and what are your needs? “
I can’t imagine any consumer of any kind would want to do business with a broker that would fail to advise them as to what might be needed. But let’s take it a step further. I don’t know any Insurance Broker that would advertise that they have no duty to advise, guide or direct clients as to the appropriate types of insurance coverages for its business operations. But there is another reality that is ignored. That is, your average insurance agent or broker with five years experience in any line, whether it be Personal Lines, like homeowners and auto, or Commercial lines knows more about the ins and outs and extensions to coverage of the insurance policy and what may be needed by an Insured than any Insured regardless of sophistication.”
Mr. Roberts, upon separating from the retail insurance industry in 2010, established his consulting firm that very same year. His focus is these three (3) distinct areas of his insurance consulting practice: Teaching continuing education (CE) classes for licensed agents & brokers on a national level Providing sales coaching, sales training and sales management services…
With over 30 years experience, Mr. Miltenberger has worked on the brokerage and company side of the insurance industry. He has extensive expertise in both the life and health and property and casualty space. His has proven ability to leverage his knowledge, relationships and experience on behalf of his clients issues. He also has an…
Peter Marchel is President and Founder of Marchel & Associates Risk Consulting. Types of the services offered: Risk review and consulting, broker review and selection, insurance policy review, analysis, and placement, program development, insurance management issues, policy enforcement, claims advocacy and expert witness testimony. Peter has more than 24 years experience in Legal…
Over the years, Al has been thoroughly immersed in all facets of insurance agency operations including serving on committees, instructing, consulting and as an author. Building a solid track record of performance assisting agencies and company operations including mergers, acquisitions, divestitures, perpetuation and strategic planning, organizational development, compensation and salary administration programs, administrative and financial…
