Complex Liability Coverage Methods

1) Introduction of speakers
2) Goals of the lesson
a) Develop a logical, repeatable process
b) Recognize the distinction between tort and coverage issues
c) Utilize a systematic process
3) Differences between tort and coverage
4) Writing coverage letters in good faith
5) Overview of the approach to analysis
a) First, look exclusively at tort issues
i) Nature of the claims
ii) Parties involved
iii) Indemnity agreements
iv) Damages
b) Next, consider coverage issues
i) Look for additional coverage elsewhere
6) Time sensitivity of coverage defenses
7) Intro to example problem
a) Relations among parties
b) Tort and indemnity chart
8) Recap
9) Quiz
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz

1) Coverage rules vary by state
a) McCarran-Ferguson Act of 1945
b) Specific issues that can vary by state
i) Reservation of rights language
ii) Duty to defend trigger
iii) Licensing requirements
2) The insurance policy as a contract
a) Secure a complete and accurate copy of the policy
3) File splitting
a) Files should be split early if litigation is anticipated
4) Claims vs. Underwriting
a) Establish a cooperative relationship
b) Coverage issues can turn on underwriters’ intent
c) 30(b)(6) PMK witnesses
5) Recap
6) Quiz
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz

1) Finding coverage elsewhere
a) Identify all other carriers
b) Additional insured provisions, omnibus clauses, etc.
2) Whom to notify of a claim
a) Underwriting
b) National/local claim offices
c) Coordinating counsel
d) Other carriers
3) Six purposes of communication
4) Targeted tender states
5) Chart: Assembling policies
6) Multiple years of coverage
7) Coverage formula
a) Grant of coverage (What’s in)
b) Exclusions (What’s out)
c) Compliance with policy conditions
8) Recap
9) Quiz
a)5 multiple choice questions
b)4 choices per question
c)A second quiz if less than 80% score on first quiz

1) Facts of the case
a) Ambulance failed to start
b) Man died as a result
c) Lawsuit
2) Analysis of coverage in case
a) CGL
b) Auto
c) Professional liability
3) Grant of coverage
a) “Insured”
b) “Bodily injury,” “property damage,” “personal injury”
4) Exclusions
5) Compliance with policy conditions
a) Right/obligation to give notice
b) Timeliness of notice requirements
c) Cooperation
6) Recap
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz

1) How to write coverage letters
a) First, discuss the grant of coverage
b) Then, discuss exclusions
c) Finally, discuss policy conditions
2) Cumis Counsel
a) Varies by state
b) Ways to deal with problematic Cumis counsel
3) Three main types of coverage letters
a) Non-waiver agreement
i) Enter into a mutual agreement with the insured
ii) Be inclusive with your possible defenses
b) Reservation of rights letter
i) Inform the insured you are reserving rights
ii) Monitor the defenses as the claim goes forward
iii) If you wish to recoup costs, inform of your intent to do so
c) Disclaimer
i) State unequivocally there is no coverage
4) Recap
5) Quiz
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz

1) Facts of case for coverage for each party
2) Coverage for owner, GC, and subs
3) Contractor’s condition clauses
a) Requires subcontractor to name GC as additional insured
b) Insurance must be in fact in place
4) Obligations of a sub not naming GC as additional insured
5) Wrap-up: mapping out coverage
a) Coverage for each party
b) Anti-subrogation rules
6) Conclusion to presentation
7) Recap
8) Quiz
a) 5 multiple choice questions
b) 4 choices per question
c) A second quiz if less than 80% score on first quiz