emerging issues with insurer recoupment or reimbursement from policyholder
TRANSCRIPT
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLPPhiladelphia New York Buffalo Rochester Syracuse Albany White Plains Long Island Princeton Hartford
EMERGING ISSUES WITH INSURER RECOUPMENT OR
REIMBURSEMENT FROM POLICYHOLDER
Daniel W. Gerber Esq.
Goldberg Segalla LLP
716.566.5425
www.goldbergsegalla.com
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Understanding the Issue
• Assume 10,000 asbestos claims against manufacturer with exposure from 1950 until 1990
• In 1990, with few claims made, policies are found for 6 years from Alpha insurer and 3 years from Beta insurer
• A cost share is entered with insured paying 25% of defense and indemnity
• Insurers agree on and appoint defense counsel In 1995, thousand of claims pour in and two insurers agree to a cost share of 2/3 and 1/3
• In 1990 Alpha reserves its rights to recoup• In 1995, thousand of claims pour in and two insurers agree to
a cost share of 2/3 and 1/3
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
• In 1990 Alpha reserves its rights to recoup• In 1999 Beta reserves its rights to recoup• In 2001 Charlie insurer found with 3 years of coverage• Charlie’s policy requires reimbursement• Insured contributes to one claim in 2003 then refuses to
contribute• In 2004, Alpha unilaterally drops its defense payments to 25%
leaving an unpaid amount to defense counsel• Several settlements after 2003 and each carrier reserves• Insured is consulted and involved extensively in all claims and
has paid to have separate monitoring counsel
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Reimbursement of Defense Costs
• Step on the Buss (Buss v. Superior Court)
• Insurer must:– Obtain a judgment of no coverage– Show defense costs were “solely” attributable to
uncovered portion/cause of action
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Policy Language Implications
• “Implied-in-law” right (majority rule)– Did insurer place insured on notice and reserve its
rights?– Did insured object?
• Policy language requirement (minority rule)– Otherwise there is a “unilateral amendment to the
insurance contract”
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Logistics of Repayment
• Duty to defend considerations
• Timing and content of notice to policyholder
• Timing of declaratory judgment action
• Unilateral action and bad faith considerations
• Indemnity considerations
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Recouping Uncovered Settlement Funds
• Majority allows where:(1) Insurer issues timely
reservation
(2) Insurer notifies insured of intent prior to settlement; and
(3) Insured has meaningfully participated in defense and settlement
• Minority view– Policy language controls
– Frank’s Casing
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Fraud
• No applicable exclusion of limitation
• Coverage would otherwise exist under policy
• Policyholder’s actions makes it ineligible for coverage
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Unilateral Mistake
• Can an insurer seek restitution for an erroneous payment?– Yes
• Is detrimental reliance a consideration?– Yes
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Policyholder’s Defenses Against Repayment
• Equitable estoppel – Can prejudice be shown?
• Waiver• Collateral estoppel • Lack of or timing of
notice• Lack of policy language
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Key Considerations
• Look to the policy• Reserve early and reaffirm often• Considering making the defense
contingent upon acceptance of reimbursement terms
• Considering asking policyholder to consent to arbitration before there is a “dispute”
• Considering an early affirmative declaratory judgment action
• Hiring coverage counsel to monitor the defense
• Leveraging coverage with claimant
• Investigate, understand and hire experts early
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Key Considerations (Ethical Implications)
• Place policyholder and defense counsel on notice of billing requirement
• Ask for detailed/separate billing
• Seek defense counsel’s testimony
• Look to defense counsel representations in correspondence and court
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
PRACTICAL TIP
Create a Claims Matrix• Name of lawsuit(s) (i.e. Parties) and when filed
• Jurisdiction
• Claims alleged
• Status (i.e. initial pleadings, motion to dismiss, discovery)
• Amount sought as damages (if possible)
• What coverage is potentially available
• Corresponding DJ Matrix (if necessary)
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Practical Tip Control Your Own Destiny
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Practical Tip Control Your Own Destiny
• Use “controlled aggression”- Demand regular status meetings- Do not settle for written status updates- Get all coverage opinions relative to all jurisdictions- Challenge defense counsel- Develop your own defense theories- Keep apprised of defense costs- Demand detailed invoices
• Recognize that sometime you want to fly under the radar
• Avoid being surprised!!!
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Practical Tip
Two Heads Are Better Than One
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Practical TipTwo Heads Are Better than One
• Organize meetings/calls with other insurers
• Make alliances
• Strength in numbers
• Be cognizant that other carriers on your tower may not have identical interests (i.e. don’t be bound by unilateral decisions)
• Negotiate Cost Share Agreements
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLP
NEW YORK NEW JERSEY PENNSYLVANIA CONNECTICUT
Practical Tip Be Ready for Anything
GGOLDBERG OLDBERG SSEGALLAEGALLA LLPLLPPhiladelphia New York Buffalo Rochester Syracuse Albany White Plains Long Island Princeton Hartford
Thank you and Happy Holidays!
Daniel W. Gerber Esq.Goldberg Segalla LLP
www.goldbergsegalla.com