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Avoid Agent E&O Claim Denial
Avoid Agent E&O Claim Denial
By Brent Winans of Clear Advantage Risk Management
Insurance agents do not want their own errors and omissions (E&O) claims denied or their policies canceled because of the way they have handled E&O incidents. To avoid that situation, agents should overcome their fear of reporting E&O claims and potential claims and be careful not to violate the other requirements in their own policies .
The claims manager for a surplus lines broker that specializes in professional liability policies told me, "When it comes to E&O claims against themselves, retail insurance agents are unrealistic. They downplay the severity of the problem and overestimate their own ability to solve it." That rose-colored glasses approach often leads to the following mistakes—mistakes that can have severe consequences.
Failing To Comply with Claim Reporting Requirements
You would think that insurance agents would never violate this prime directive of claims-made policies. But agents often think that they can resolve the problem themselves through the use of the "Agency Pressure Endorsement." Then when those efforts fail, they may face a denial under their own coverage for late reporting.
For example, Susan's agency had been a preferred producer with Big Moose Insurance Company for decades. So she was confident she could get them to pay a $75,000 business interruption claim, even though her new producer had not realized that the policy he sold did not automatically include it. She pressured the Big Moose regional manager for months but never reported it as a claim. When Big Moose issued a final denial, she was stunned—and stuck with a $75,000 claim.
Here are three simple rules for agents to follow when deciding whether or not to report an incident to their E&O insurer:
When you are having a discussion with someone in the office about whether or not to report an incident, report it.
When there is a claim, and you discover that the policyholder had requested coverage that was not provided, report it.
When there is a denial on a claim, and you want to write to the insurance company and argue that it should pay the claim, report it.
The third point may make agents scratch their heads. Why should they report a potential claim to their E&O insurer before they advocate for their client's claim in writing? Surprisingly, agent defense attorneys say that, from an E&O standpoint, such advocating is one of the most hazardous moves an agent can make. By seeking counsel from their E&O insurer first, agents can enlist their E&O insurer's advice and assistance in resolving the issue without putting themselves at risk in the process. For a fuller explanation of this issue, see "
Avoid Agent E&O When Handling Problem Claims " at
www.IRMI.com .
Agents are afraid that reporting many E&O "incidents" will result in higher rates, more restrictive terms, or nonrenewals. While it varies by E&O insurer, E&O underwriters tell me that, generally, incident reports do not get much attention. They are clear that the dangers of not reporting are much greater than the dangers of overreporting. Mary Salerno, Claims Manager for Axis Insurance Services, a surplus lines broker with extensive experience in agent E&O, added, "It is still a very soft market for agent E&O. We have yet to come across an account that we cannot place. Most underwriters do not pay any attention to incidents that did not result in claim payments."
While that may generally be true in today's market, I am not suggesting that all E&O insurance underwriters view incidents and claims in the same way. Just as with other lines of business, some E&O insurers seek to find coverage for their policyholders while others use the policy as a weapon against them. If an agency believes that its current insurer is the harsher type, it should find a better insurer, even if it means paying a higher premium for the more liberal claims philosophy. The same company that is likely to penalize an agent for reporting many incidents is probably also the company that is likely to deny coverage when reporting requirements have not been strictly followed.
A "sister" mistake to not reporting potential claims promptly is to not disclose them on new E&O applications. Some insurers now even require that they be disclosed on renewal applications. A surplus lines broker commented, "If an agent doesn't provide an accurate incident and claim history on the application, the carrier has the right to rescind the policy. Then the agent has no coverage, no retroactive date, and cannot buy a tail, and that is a real problem. I've seen it happen."
Failing To Comply with Other Prohibitions
Not all agent E&O policies prohibit the following actions, but many do. Even if these actions are not expressly prohibited in the policy, avoiding them makes good sense.
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