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Affirmatively Manage E & O Exposure
Affirmatively Manage E & O Exposure
Recognizing Conflicting Interests of the E & O Carrier and Defense Counsel By Andrew Whitman, Ph.D., J.D., CPCU
There are conflicts of interest and disclosure restrictions among the Agency, the E & O carrier the E &O defense counsel and other parties involved in the claim. This article explains why agency management must have experienced senior members trained in methods of dealing with E & O litigation to affirmatively guard the interests of the Agency.
Ethical Obligations of E & O Counsel:
Who is the E & O defense counsel's client? It's now settled that defense counsel's client is the insured agency, but the E & O defense counsel is selected by and paid by the E & O carrier. The coverage under the E & O policy for the duty to defend is broader than obligation to pay third party claimants, but defense costs are applied to policy limits. In addition the E & O carrier has the right to defend and settle claims upon consent of the carrier and the Agency. What is the scope of the carrier's and the defense counsel's obligation to communicate with the agency regarding the guidelines and process of settlement negotiations? The interests of the agency, the carrier and defense counsel potentially conflict. The cost/benefit evaluations are likely to be adverse to each other: the agency, the carrier and the defense counsel.
Is the potentially catastrophic cost of to the agency of going to trial communicated and considered in the cost/benefit evaluation of settlement or are the carrier and defense counsel only explicitly recognizing the direct legal costs balanced against the strength of defenses and amount of a potential damage and its closeness to policy limits? At what point is the agency advised to obtain its own counsel?
The stage:
An E & O insurance carrier receives notice of a potential claim. The agency is following advice to give notice since it's a claims-made policy. The carrier acknowledges the notice. A compliant is tendered to the carrier within the policy period The carrier reviews the complaint for coverage and responds with a reservation of rights letter agreeing to provide defense, and reminds the insured that defense costs use-up policy limits.
The carrier assigns the claim to local defense counsel according to the carrier's acceptable criteria: experience, proven track record, cost and decision compliance.
E & 0 counsel's obligation to advise the Agency may not extend to issues of coverage under the E & O insurance policy. This potentially conflicts with the interests of the E & 0 carrier. Does this extend to knowledge about legal costs getting close to policy limit? And to agency expenses and income loss paid under the Supplementary Payments sections in addition to the applicable policy limit? When is the agency advised to retain independent counsel?
Pre E & O Claim Risk Management:
The agency is advised that most claims by insureds are filed after a carrier with whom the agency as placed business denies a large loss claim or agrees to pay less than the insured reasonably expected. Agency counsel advises the agency to implement SOPs to control the risk of the agencies being sued by the insured client and the risk that a carrier sues to be indemnified alleging the agency acted beyond its scope of authority. (See Chapter 1 of the ebook)
All communications with high loss clients should be made under the supervision of a senior experienced agency member trained in risk control techniques. This includes any communication with the client's loss adjuster, damage mitigation company, contractor, supplier, and most significantly, any request to provided a recorded statement or letters to the insured's insurance company.
Issues In Affirmatively Monitoring the E & O Claims Process
Should agency counsel join or monitor the client's settlement process to protect agency interests, for example in Miller-Shugart settlement proposals between the insured and plaintiffs? Make sure any release includes all agency interests.
When the E & O defense attorney has been assigned to the agency E & O claim the following questions/issues required attention:
When should the agency counsel or E&O defense counsel review with the insured agency the terms of the E & O policy?
When should agency counsel or E&O defense counsel review with the insured agency the terms of any settlement offers?
When should agency counsel or E&O defense counsel review with the insured agency the stages of negotiation including the carriers' SOPs and settlement guidelines?
When should the agency or its counsel be affirmatively involved in the claims process?
When should the E&O defense counsel and carriers consider the potentially catastrophic costs to the agency of not settling or the precedent setting potential of a published court decision? (See my AoA tip on risk managing the catastrophic costs).
Clearly agency management must work with experienced consultants or counsel to properly protect agency interests against conflicting interest of others.
Andrew Whitman, Ph.D., J.D., CPCU, has testified in court in ten states, served as Deputy Insurance Commissioner and Acting Chief Counsel in the Pennsylvania Insurance Department. He is the author/co-author of insurance articles and books, including co-author of the new Thomson-West treatise, The Law of Commercial Insurance Agents and Brokers .
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