• Capell Insurance

Notice Not Compliant With Policy Provision - Claims Made

Claims made policies require special attention - many companies spend big money securing insurance only to wind up with no coverage because the coverage and reporting nuances weren't known or properly explained.

Inherent areas of concern under a claims made style policy can be: continuity dates, retro dates, reporting requirements, notice requirements, representations, definitions as it relates to these items... among others. Aside from the inherent issues of a claims made arrangement the policies have other focus areas requiring a highly skilled insurance technician.

A 2016 New Jersey decision is resonating with claims made policyholders for its warning shot on reporting requirements. In Templo Fuente De Vida Corp (Templo) v National Union Fire Insurance a claim was made against the policy holder in February and reported to the insurance company in August. The insured's policy required notice of any claim be provided to the insurance company as soon as practicable. The policy period ran January 1 - January 1. The court handed down a decision that the six month delay was not in accordance with the policy's reporting provision (being as soon as practicable) and therefore the insurer was not obligated to the insured for any loss. The decision was with regard to timing and policy provisions and not prejudice to the insurer.

This decision and others underscore the importance of proper handling and understanding of claims made policies by both the broker and the insureds.

#claimsmade #litigation #newjersey

19 views0 comments