Anatomy of an Insurance Dispute
In early 2025, we participated in a panel discussion about the similarities and differences in the process of resolving a disputed insurance claim. We were both so taken by the striking differences in the process and had such a good time learning about each other’s process that we decided to prepare this joint article to share with a wider audience.
Comparatively examining the anatomy of an insurance dispute in the US and the UK is an exercise in contrasts. In many ways, the two are strikingly opposite. Here, we examine, from start to finish, how the process differs in the two jurisdictions and how those differences may contribute to different outcomes, and discuss what lessons perhaps can be gleaned from each other’s experience.
Pre-litigation process
The US Perspective
What stands out about the insurance dispute process in the US as a point of comparison, is the vastness of the arena you are working in. In stark contrast to the UK (as will be discussed below), the US insurance market is sprawling. Hartford, Connecticut might claim to be the insurance capital of the US, while Des Moines, Iowa would claim to be the insurance capital of the Midwest, yet, while there might be more significant insurance companies formally based in either of those two cities than in other US cities, there are many multiples of that more sprawled out across the full country. On top of that, US insureds regularly access the excess and surplus lines market to place insurance through London-based insurers.
This makes the industry, for the average insured, rather impersonal. From the coverage lawyer’s perspective, dealing with a claim under a specialty line of insurance issued by a large insurer, even in the same jurisdiction or region, may result in experiencing the same combination of insurer counsel and assigned claim adjuster. However, more often than not, each dispute reveals an entirely new set of individuals to try to resolve your claim with.
Brokers placing multiple significant programs with larger insurers can sometimes create a more direct line to a personal relationship that can help influence the direction of the claim before it becomes too adversarial. Still, this seems to pale in comparison to the degree that relationships play a role in the UK process.
On top of the geographical scope of the arena, there are a vast number of playing fields within the arena in the US. The federal government does not regulate insurance, leaving insurance law entirely to the states. This means that each state resolves legal issues involving insurance differently and, in many cases, in ways that are directly contrary to each other. The first step in an insurance dispute in the US is not to determine how the issues are properly resolved, but to determine which US states’ law might govern the issue. Once you know which states’ law could apply, then there are often multiple states where the dispute could be filed, each of which will have a different set of rules to determine which of the states’ law should apply.
On top of all of that, there are federal courts sitting in each state, which have different jurisdiction over parties than the state courts do, and which apply substantive state law to decide the coverage issues, but federal law to govern the procedural process. A Florida federal court might conduct a different choice-of-law analysis than a Florida state court, resulting in a different state’s substantive law applying to a case depending on whether it is in the state’s own courts or the federal court sitting there.
In a claim where a company based in New York does work in California, but uses a broker in Texas to place its insurance through an insurance company based in Florida, an insured would be assessing (1) which state(s) would allow the insured to file litigation over the claim, (2) what state’s law each state the insured could file in would choose if conducting a choice of law analysis, and, finally, (3) which state’s substantive insurance law would be most favorable. Of course, the insurer is likely to contend that a less favorable set of state law will apply to the claim than the insured, who will argue for a more favorable set of state law. In other words, the parties may not even agree on the rules by which they are to have their dispute or on which “playing field” they should have it on.
On top of the differences in the states’ approaches to the substantive rules of insurance law, each state varies significantly in its approach to the concept of bad faith claims – referring to a situation where the insurer is deemed to have violated the implied covenant of good faith and fair dealing, which some US jurisdictions impose as a part of all contracts. Just as the different states take different approaches to the substantive issues, the insured may contend the appropriate body of law is that of a state that allows a bad faith claim, while the insurer contends a different state’s law applies, yielding the opposite result. A classic example of this friction is California, which allows bad faith, and New York, which effectively does not. Where the controlling state law is not settled in the pre-litigation claims process, this can make it very difficult to resolve a disputed claim, as the two jurisdictions have very different substantive law and also very different potential remedies, given the bad faith differences.
Finally, barring a few contrary specific rules in specific jurisdictions, parties to litigation in the US pay their own attorneys’ fees. This seems to have the effect of encouraging commercial litigation of insurance claims, while unfortunately dissuading personal litigation of insurance claims, usually except among wealthy individuals. The economics of the situation make this inevitable. For a corporation, if the insurance claim is large enough, it will almost certainly make sense to litigate a claim that has not resolved through the normal claim process, as even a partial recovery will easily cover the cost of the fees to bring the lawsuit and then some. The company can predict, based on its own attorney’s budget, what its costs will be for the lawsuit, without the unknown of a potential fee award to the other side if the company is not successful. On the other hand, for an individual, many insurance claims are simply cost-prohibitive, unless the lawyer is willing to work for discounted rates, pro bono, or on an alternative fee arrangement, such as a contingency.
Each of these factors influencing the pre-litigation claims process contribute to a claims environment where litigation often feels inevitable.
The UK Perspective
While sharing certain common characteristics, there are some key differences in how insurance disputes are resolved in the US and the UK.
The most central is that, unlike in the US, there is a single body of law applicable in England and Wales. Also, there is no concept of bad faith.
Further, compared with the US, the insurance market in the UK is geographically more defined – being centred around the Lloyds Building in what is known as the insurance district in the City of London. All of the major players in the London market, including insurers, brokers, and law firms, are situated within the same square mile.
While we would agree that, as in the US, aside from the largest industry participants, relationships with insurers are typically short-term, managed by the broker, and not significantly customized, equally it is a much smaller marketplace, and for those who have made their life’s work a career in insurance, those main players work cheek by jowl.
It would be fair to say that, traditionally, both insurance law and its application by the English courts were perceived to be, and indeed were, pro-insurer. That fact, combined with the “loser pays” cost regime in the UK, has led to a conservative approach to litigation: the stakes are high.
Notably, until recently, insurers were able to decline claims on the basis of a failure by the insured to disclose every circumstance they knew or ought to have known which would influence an insurer in underwriting the risk, and many policies contained ‘basis’ clauses which effectively meant that any and all representations made were warranties, the breach of which discharged an insurer from liability.
The introduction of the Insurance Act 2015 sought to level the playing field for policyholders by bringing in a duty of fair presentation, breach of which would not necessarily lead to a voidance of the policy but a more proportionate remedy based on the terms on which the insurer would have entered into the policy had the breach not occurred. The Act also banned ‘basis’ clauses, and brought in provisions whereby if non-compliance with a warranty did not increase the risk of the loss in the circumstances in which it occurred, insurers could not rely on that breach to avoid liability under the policy.
In terms of the pre-action process, this differs depending on the court in which the claim is brought. For complex high-value commercial disputes, including insurance coverage disputes, brought in the Commercial Court, which is a division of the High Court, the court expects the parties to have exchanged sufficient information to understand each other’s position and to try to settle the proceedings without proceedings, including considering ADR. This process will include sending a Letter of Claim and allowing the defendant time to respond, from 14 days to 3 months, depending on the complexity of the matter. For certain types of claims, there are more specific Pre-action Protocols.
Of particular relevance is the Pre-Action Protocol for Construction and Engineering Disputes brought before the Technology and Construction Court, which has a more prescribed process that includes deadlines that must be adhered to, exchanges of information, and a pre-action meeting. Costs sanctions can be applied for non-compliance with the Protocol. Compliance is taken seriously by the parties and the courts, such that it can be an effective tool for exploring whether pre-action resolution is possible, or if not, at least narrowing the issues in advance of the issue of formal proceedings.
Substantive Framework for contract/policy interpretation
The US Perspective
While the US states each have their own approach to insurance issues, there are certain fundamental rules where they tend to come together in near unanimity. At the most fundamental level, nearly every jurisdiction considering an insurance dispute is going to start with the question of whether the court can interpret the meaning of the policy provisions applicable to the claim solely from the policy’s plain language, without considering anything else. If the court decides that it can do this, that is the end of the analysis. If there is clear policy language, that will control. Further, there is extensive caselaw interpreting many common policy provisions, so there is a large body of guidance as to whether a particular term is or is not likely to be deemed clear from the plain language.
It is only if the court decides that the language at issue is subject to more than one reasonable interpretation, yielding different results (i.e., is ambiguous), that the court potentially looks beyond the policy language. However, even then, this is not guaranteed. Some jurisdictions simply interpret ambiguous policy language in favor of coverage, giving the benefit of the doubt automatically to the policyholder. Others will look to extrinsic evidence (i.e., the underwriting file) or the reasonable expectations of the insured to try to determine what the most appropriate interpretation is.
The UK Perspective
English law takes an objective approach to policy interpretation, asking what a reasonable person, with all the background knowledge which would reasonably have been available to the parties when they entered into the contract, would have understood the language of the contract to mean. The subjective intention or understanding of the parties as to what the policy wording means or is intended to achieve is not relevant to the exercise. However, market practice or understanding, if it can be established that there was one, can form part of the background knowledge that would reasonably have been available to the parties.
Commercial common sense is not permitted to be invoked retrospectively to rewrite a clause in an attempt to assist an unwise party or to penalize an astute party: where the parties have used unambiguous language, the court will apply it. In recent years, the courts have taken an increasingly strict approach in this regard, making it clear that it is not their job to rescue a commercial party from a bad bargain. If the wording is clear, the court will give effect to it.
However, where there is ambiguity and there are two possible constructions, the court is entitled to prefer the construction which is consistent with business common sense and to reject the other. In an insurance context, the doctrine of contra proferentem applies so that where there is ambiguity, the clause is interpreted against the party responsible for drafting the wording – usually the insurer – and is, therefore, helfpul for the policyholder. Also helpful for policyholders is a recent ruling that held that “a construction which advances the purpose of the cover is to be preferred to one that hinders it.” (LCA Marrickville Pty Limited v Swiss Re International SE [2022] FCAFC 17, in the Federal Court of Australia, per Derrington and Colvin JJ at [15])
In the context of the recent Covid-19 business interruption litigation, the courts have identified what has been termed a ‘pick and mix’ approach to drafting insurance policies, with clauses adapted from other contracts such that the policy does not necessarily hang together as an internally consistent whole. That is a factor that may influence interpretation in that reference to the same or similar language elsewhere in the policy may carry little weight.
Litigation Process – Initial Stages and Discovery
The US Perspective
In most jurisdictions, there is essentially no procedural barrier to entry to begin litigating an insured’s disputed claim. An insured who has submitted a claim can file a lawsuit the next day, even if the claim has not yet been denied. Declaratory judgment actions, which ask the court to declare the parties’ respective rights and obligations under the policy, can be procedurally appropriate even without a denial.
There are few procedural opportunities to put a binding end to that lawsuit prior to trial. There is an opportunity for the defendant to challenge the sufficiency of the complaint at the outset, but the standard to prevail on that is exceedingly difficult. There is an opportunity to seek judgment based on the complaint and answer together but, again, the standard is challenging to meet. Finally, there is an opportunity to have the case decided prior to trial, through a motion for summary judgment, but only if the issues to be decided are exclusively legal ones. A single disputed issue of fact material to the outcome of the case will be cause for the case to be sent to trial.
This forces the parties through the fact-finding phase of the case, known as discovery. Discovery in US litigation can be extremely expensive and time-consuming, and there typically is not any limitation imposed on discovery in a case based on the nature or size of the case. Thus, an individual with a claim against an insurer may have the same right to take the deposition of a senior person at the insurance company as a Fortune 500 company would. The individual would be equally entitled to all potentially relevant documents and to ask the same number of interrogatory written questions in the process. Many high-profile individuals – i.e., Donald Trump, Mark Zuckerberg – have been deposed in US litigation. This is a high-stakes process, as there are few limitations on what can be sought and asked from the other party in discovery, provided it is credibly connected to the insurance dispute.
The cost and discomfort of this process force many claims to settle. The process of reviewing sometimes tens of thousands of documents to ensure only relevant non-privileged documents are produced is extremely time-consuming and expensive. Similarly, the process of having to go through the intensive full-day questioning of the deposition process can be a daunting prospect for decision-makers on both sides. The parties also gain a significantly more acute understanding of their cases during this time, given the amount of document scrutiny and preparation involved. Many, if not most, insurance disputes settle during the discovery phase of litigation.
The UK Perspective
Litigation in the UK begins with a sequential exchange of pleadings: the claim form and particulars of claim, the defense, and the reply.
Notably, and unlike in the US, in the UK, we have a split profession with the court advocacy being carried out by barristers who also draft the pleadings. Issuing proceedings, therefore entails instructing a barrister in addition to the existing solicitor firm that will have been initially instructed and had day-to-day conduct of the matter through the pre-action stages.
There are another three key reasons why litigation is not something one embarks upon lightly: although relatively modest, the £10,000 court fee for issue of claims above a certain value is sufficient to deter many a vexatious litigant; the potential liability for adverse costs triggered by commencing litigation coupled with the fact that once underway the litigation may take on a life of its own; and finally the level of specificity needed to plead the claim to the satisfaction of the court and/or the defendant. A poorly pleaded claim may lead to rounds of requests for further and better particulars or applications for strike out or summary judgment.
While not as onerous as in the US, disclosure – our equivalent of discovery – is nevertheless in many cases disproportionately time-consuming and expensive. The volume of electronic documents that are likely to have been generated in any dispute will typically require the parties to engage an e-disclosure provider and agree to search terms and a review process in an attempt to unearth the “smoking gun” that will unlock the dispute. The policyholder bears the brunt in that, since having suffered the insured event, they will hold the majority of the documents and have the burden of proving their case. Attempts by the courts in recent years to overhaul the process and make the exercise more manageable have, as often as not, only served to frontload the cost and add additional layers of procedure. Insurance cases often settle after the disclosure stage once insurers are satisfied that the claim is genuine and that any adverse documents that might provide justification for declining the claim have been shared.
There is no equivalent of the US deposition process. Written witness evidence is prepared by each party’s own legal team and exchanged. There is no opportunity to interrogate that evidence until the witness is cross-examined at trial. Few insurance cases ever make it that far.
The key to unlocking an insurance claim, particularly in the construction sector, can often be strong technical expert evidence. Although written expert evidence is not exchanged until relatively late in the process (after disclosure and witness statements), it can be helpful to share expert evidence at an earlier juncture – even pre-action – to demonstrate the robust basis for the claim.
Litigation Process – ADR
The US Perspective
Although a large percentage of insurance litigation settles during discovery, it rarely happens without assistance from a third party. The courts in the US know this well. Accordingly, it is almost uniformly true now that courts require the parties, from the outset, to participate in some form of official alternative dispute resolution process during the course of the litigation.
While private mediation is the most common in our experience, this can take other forms as well, depending on the jurisdiction. Many jurisdictions have judges in the same court, other than your assigned judge, conduct settlement conferences or early neutral evaluations, which are often similar in format to mediation, but have some additional formality around them due to the presence in the courthouse and the neutral being a judge.
Judges also have significant discretion in how they set the case calendar. It has become increasingly common, in our experience, for judges in insurance disputes to not set a date for trial until after motions for summary judgment have been resolved. A federal judge recently expressly told the SDV author of this article that she would not set a trial date until after summary judgment motions because, in her experience, most of her insurance disputes settle at or around that time. Sure enough, the case settled at the end of discovery, just before those motions would have been filed. This is a significant departure from the typical procedure for other forms of litigation in the US.
The UK Perspective
While ADR and, specifically, mediation has been a very common way of resolving insurance disputes, in recent years, a number of issues that have had wide-ranging implications for the entire insurance sector, with billions of pounds at stake, have meant an unprecedentedly high volume of insurance disputes going not just to trial, but to the Court of Appeal and the Supreme Court. This wave of litigation has included the Covid-19 business interruption litigation, the Russian aviation litigation, and the construction litigation relating to the cost of remedying fire-safety issues affecting buildings throughout the country following the Grenfell tragedy and introduction of the Building Safety Act 2022. In the context of disputes relating to those issues, insurers have often been reluctant to enter into commercial settlements through ADR pending clarity from the courts on the extent of their liability. Further, settling one claim would have repercussions for claims being brought by other policyholders on similar wordings.
More generally, the court’s approach had traditionally been to encourage – but not require – the parties to a dispute to engage in ADR. However, following the introduction of new procedural rules in 2024, courts now have the power to order parties to engage in ADR and can impose costs sanctions on a party for failing unreasonably to engage in ADR. The extent to which the courts elect to exercise that discretion remains to be seen, and certainly it remains open to the parties to argue that, in the particular circumstances of their case, ADR would not be appropriate at any particular juncture.
Litigation Process – Trial and Judgment
The US Perspective
At the end of all of the pre-litigation, pleading, discovery, and motion practice phases of the insurance dispute, if the parties have not yet settled, there is still the prospect of a trial. Provided there is a disputed factual issue involved in the dispute, the insured is typically entitled to have the dispute heard by a jury.
Insurance companies have traditionally not benefited from positive news coverage in the US. Juries are composed of local individuals within the geographic jurisdiction of the court and include people from all social classes and bands of life. All residents in the geographic jurisdiction are subject to being called into the court for jury duty. These individuals are also regularly exposed to negative news coverage about insurance companies pulling out of insurance markets, denying claims, and charging ever-increasing rates for reduced coverage. Accordingly, there is a negative perception of the industry from average US citizens. Aside from specific situations where the policyholder carries a similar negative public perception, policyholders typically feel more confident bringing a disputed fact issue to trial than insurers do. This also contributes to driving settlement.
Relatively few insurance disputes in the US are resolved through arbitration, usually only occurring in select situations where the insurer included a mandatory arbitration provision in the policy. For those disputes that do go through arbitration, the process is similar, but with more limited discovery and less predictability in the procedural rules, as the arbitrator is typically not bound by state or federal procedural rules in how they administer the proceeding. Policyholders find that the perceived advantage in perception typically lacks in arbitration, due to the absence of a jury.
Another reason for the policyholder’s aversion to arbitration is the inability to appeal. Insurance issues are often extremely complex. Appeal of a trial court decision is typically a matter of right for the policyholder, at least to the intermediate state or federal appellate court. Insurance issues are typically not heard by the US Supreme Court, but state supreme courts may also agree to hear a further appeal following the intermediate court of appeals’ decision. This gives policyholders a reasonable degree of assurance that the correct result will ultimately be reached. If an arbitrator applies the law wrong, on the other hand, the case is typically over.
The UK Perspective
Civil trials in England and Wales are heard by a single judge at first instance, and without a jury. Juries are reserved solely for criminal trials. On appeal to the Court of Appeal, there is a panel of three judges, and should the matter come before the Supreme Court, the panel will typically consist of five, but potentially seven or even nine, of the twelve appointed judges – or justices, as they are called, of the Supreme Court.
From issue of proceedings to trial typically takes a period of 18 months to 2 years, and the process involves exchange of written statements of case (particulars of claim; defence and reply); a procedural hearing known as a case management conference to agree the directions to trial; usually followed by disclosure of documents (akin to discovery); sequential exchange of factual and expert witness statements; and trial. There may be interlocutory hearings, for example, for summary judgment.
The successful party at trial is awarded their legal costs. That is, the losing side bears not only their own costs but also adverse costs, being those of their winning adversary. The reasonableness of those costs is assessed, but typically around 65% - 70% can be recovered. The court also has a discretion to award indemnity costs, which results in a higher recovery. That potential exposure can be a bar to issuing proceedings – although it is possible (at a price) to obtain After The Event insurance (ATE) to cover the risk of being liable for adverse costs.
In the UK, the courts do not have the power to award punitive damages. Recent legislation has brought in the ability to claim damages for the late payment of insurance claims, but the threshold is high, and as a remedy, this has yet to gain significant traction.
The courts of England and Wales will not necessarily have jurisdiction over insurance disputes: many insurance policies contain arbitration clauses whereby any disputes, or disputes over quantum, are referable to arbitration. The advantages of arbitration for insurers are that their confidential nature means that decisions on certain contested clauses are not made public; conversely, the fact of litigation proceedings being heard in open court can provide policyholders with commercial leverage to the extent that not paying claims may open an insurer to negative reputational consequences. There is also a perception that many experienced insurance arbitrators hail from a long career on the insurer-side of the market, meaning that the outcome might be an insurer-friendly foregone conclusion – which as, in the US – is unlikely to be appealable.
Conclusion
Will: Most likely not to anyone’s surprise, there are some significant distinctions in the US and UK systems. Some of these distinctions – the ease of instituting litigation, impersonal nature of the insurance industry, and entitlement to highly probing discovery processes – perhaps help to explain the US’s reputation for litigiousness. The US system provides many opportunities for strategic gamesmanship, given the many forums to file in and the differences in state substantive law. I am left thinking that these considerations create an environment more favorable to corporate policyholders, who can take advantage of these processes as long as they are able to fund the process along the way.
Joanna: Drawing the threads together, and notwithstanding the fascinating and clear differences that we have explored between the two systems, some common themes do emerge, such as the relatively similar approaches to policy interpretation and propensity for claims to settle before trial. Despite the greater risks that litigating in the UK may pose to policyholders, similarly, those corporate policyholders that can fund the process are able to take advantage of a more favorable landscape post the Insurance Act 2015 and in light of the number of recent policyholder-friendly rulings. The challenge for us on both sides of the pond is how we bring about our shared goal of leveling the playing field for all policyholders.
Authors
Joanna Grant, Managing Partner, Fenchurch Law
Will S. Bennett, Partner, SDV Law
Fenchurch Law warns the clock is ticking for Covid-19 Business Interruption claims
Fenchurch Law, the UK’s leading firm for insurance policyholders, has issued a warning to brokers to ensure their clients file any Covid-19 business interruption (BI) claims now, before they are time-barred.
Five years on from the pandemic, experts at Fenchurch Law are highlighting that the limitation period for Covid-19 BI claims will expire in March 2026, leaving affected businesses with less than a year to act.
Over the last five years, a series of high-profile battles between insurers and policyholders in the UK over BI wordings have expanded the scope of BI policies. The result is that policyholders now have more potential opportunities to receive compensation for the loss of business during the early months of the pandemic.
Fenchurch Law’s Managing Partner, Joanna Grant, warns that brokers need to act now to give their clients the best chance of success:
“Many industries were decimated by the pandemic that swept the world in 2020, with few more severely impacted than the hospitality industry, the long periods of lockdown taking a significant toll.
“During the last five years, we’ve fought for clients to get a fair outcome from their insurers. Though the pandemic was unprecedented, insurance policy wordings should be fair, proportionate and transparent, and we have found time and time again, that this was not the case. We’re still coming up against legal challenges regarding how to apply policy wordings, most recently the Non-Damage Denial of Access appeal brought by Liberty, which found for policyholders in holding that in composite policies, 'any one loss' limits applied separately to each policyholder rather than in aggregate across all policyholders. We are also involved in new cases being issued in court, including most recently a claim brought by the owner of the Franco Manca chain of pizzerias against QIC in respect of their Covid-19 losses.
For some businesses, there may be a long road ahead, so we urge brokers start talking to clients now, long before the liability period runs out.”
Joanna Grant is the Managing Partner of Fenchurch Law UK
CrowdStrike Outage - Insurance Recoveries
Many businesses have suffered losses following a catastrophic IT failure when an update released on 19 July by US cybersecurity firm, CrowdStrike, caused crashes on Microsoft Windows systems globally.
We are recommending that policyholders review the scope of coverage available under their cyber and property damage/business interruption insurance.
What to look out for:
- Is there cyber cover for system failure that responds to accidental (i.e. non-malicious) events such as this?
- Are there any relevant business interruption waiting periods to consider?
- What other losses are covered – such as the cost of data restoration, incident response and voluntary shutdown?
- Is there cover for supply chain failure?
- In the context of PD/BI policies, the ‘damage’ trigger will need careful consideration.
What steps do you need to take?:
- Ensure timely compliance with notification provisions and other claims conditions
- Have steps been taken to mitigate losses so far as possible?
- Make sure accurate records are kept of the sequence of events and the losses that have been incurred as a result of the outage.
Please get in touch if we can be of any assistance, or if you have any queries.
Joanna Grant is the Managing Partner of Fenchurch Law
Covid-19 BI claims update: policyholder-friendly judgment in At The Premises litigation
London International Exhibition Centre Plc -v- Royal & Sun Alliance Insurance Plc and others [2023] EWHC 1481 (Comm)
In the latest instalment in the wave of Covid-19 business interruption litigation making its way through the courts since the pandemic, a group of policyholders have been successful in their claim that the Supreme Court’s approach to causation in relation to ‘radius’ wordings should equally apply to the ‘at the premises’ wordings.
This result has a much broader application than simply for the parties to this litigation, and paves the way for large numbers of policyholders on similar wordings to argue that their claims are covered.
The background
While the FCA test case litigation represented a victory for policyholders in many respects, it also left a number of loose ends – one of which this recent ruling ties up in their favour.
With regard to ‘radius’ wordings, that is, business interruption policies that respond to cases of a notifiable disease occurring within a specified radius of the premises, the Supreme Court concluded that that each case of Covid-19 was a concurrent cause of the restrictions. As such, in order to show that loss from interruption of the insured business was proximately caused by one or more occurrences of Covid-19, it was sufficient to prove that the interruption was the result of government action taken in response to cases of disease which included at least one case of Covid-19 within the geographical area covered by the clause.
‘At the premises’ wordings, namely clauses providing for cover for losses caused by restrictions resulting from cases of notifiable diseases at the premises themselves – as opposed to within a specified radius of the premises – were not within the ambit of the FCA test case.
As a result, there was uncertainty as to whether the Supreme Court’s causation analysis was equally applicable to such clauses. This judgment now clarifies that it is.
The policyholders’ position
The claimant policyholders, who included the London International Exhibition Centre the restaurant chain, Pizza Express, as well as a number of smaller businesses including a hairdresser, two gyms, and various hospitality venues, had all suffered significant BI losses as a result of the pandemic, and all had ‘at the premises’ cover as part of their business interruption insurance. Applying the same approach to proximate causation as adopted by the Supreme Court in the FCA test case, they argued that their policies should respond to cover their losses.
The insurers’ position
The insurers disagreed. One of the main themes was that ‘at the premises’ clauses and ‘radius’ clauses provided a “fundamentally and qualitatively different” nature of cover: they were “chalk and cheese”. The fact that they are engaged by incidents of disease at a precise location means that a direct causal connection is required, which in turns requires proof of ‘but for’ causation between the occurrence of disease at the premises, the action by the authorities, the consequent business interruption and loss.
The judgment
Mr Justice Jacobs held that the policyholders were correct in their submission that “at the premises” is simply about the geographical or territorial scope of the coverage, and where the parties have chosen to draw the line in that respect - it has no impact on the appropriate approach to causation. In their analysis, the Supreme Court did not draw a distinction between ‘radius’ clauses where the radius was 25 miles, 1 mile, or the vicinity, and there was no reason why the radius could not be further shrunk from the vicinity to the premises itself without making any difference to the causation analysis. He added that this seemed to him to be an appropriate result, since any other conclusion would give rise to anomalies which it would be difficult rationally to explain to a reasonable SME policyholder who read the policy.
Cover for cases pre-5 March 2020
He did however find for insurers in relation to another issue before the court, namely whether cases of Covid-19 that occurred before it was made a notifiable disease on 5 March 2020 were capable of falling for cover. On the basis that a disease must be notifiable at the time of the occurrence or outbreak he found that they did not qualify. He stated that an approach that asks whether the disease was notifiable at the time of the relevant occurrence was straightforward to apply and perfectly sensible. That this meant that some occurrences would, depending upon when they occur, fall outside coverage was simply the ordinary consequence of the application of the words of the policy.
What next?
This is not the end of the story for Covid-19 claims – the next instalments will come towards the end of the year when another group of policyholders with claims against insurers for business interruption losses under policies with ‘denial of access’ wordings will have their cases heard - closely followed by the appeals in the Stonegate, Various Eateries and Greggs cases – it is very much a case of watch this space!
Joanna Grant is a partner at Fenchurch Law
Recent developments in the W&I sector: Q&A with Howden M&A's Head of Claims, Anna Robinson
Hot on the heels of the release by Howden of its annual M&A Insurance Claims Report we caught up with their Head of Claims, Anna Robinson, to find out about trends across the sector in 2020/2021 and her predictions for 2022.
A copy of the full report can be accessed here.
Q: Despite the turmoil of the pandemic, we understand that M&A transactions continue to increase as companies use mergers and acquisitions to grow. Is this increase in deal-making, and increase in the use of M&A insurance, starting to lead to an increase in claims activity?
A: Yes on both counts. Following a significant drop in deal activity at the start of the pandemic, there was a phenomenal and unprecedented increase in deal activity from Q3 2020 onwards and throughout 2021. The same period saw an exponential increase in the use of M&A insurance, and a corresponding increase in the number of notifications. Although the number of notifications in percentage terms has fallen since 2019, the absolute number of notifications has risen, which is a factor both of the increase in use of M&A insurance and the increase in Howden M&A’s market share.
Q: Has Covid had the impact on M&A claim notifications that was envisaged by the insurance industry? Do you expect any COVID-19-related claims trends to emerge in the future?
A: Interestingly the predicted spike in notifications did not materialise. With hindsight, in some ways that is not surprising as the deals done, and associated policies placed, following the emergence of COVID-19 would either have diligenced COVID-19 or excluded claims arising out of it.
Q3: Has there been an impact on when claim notifications are made against the policy i.e. are claims now notified earlier following inception or later?
A: Our research indicates that notifications are being made later. For notifications received from 2015 to 2019, 90% were made within 18 months of the policy’s inception. In 2020/2021 the proportion of later notifications, made after 18 months, rose significantly. There are two potential reasons for this – the first is that longer warranty periods are available, and the other is the increase in tax claims which, of course, have longer notification periods reflecting the time it can take for these to materialise.
Q4. Has there been a change in the claim values being discovered and notified under the policy?
A: It is the larger deals, and in particular the mega-deals (above €1 billion EV) that have a higher notification rate, and which rate increased again in 2021. These large and complex deals are both more difficult to diligence and often conducted at a fast pace meaning issues can be missed.
Q5. What’s the most common cause for claims and are there any emerging trends? Are there any sector trends for claims notifications?
A: The top three most commonly breached warranties that we see are: Material Contract warranties, for example where a known issue with a supply contract wasn’t disclosed; Financial Statement warranties, reflecting errors in the financial statements; and Compliance with Law warranties, where relevant legislation has not been complied with. This latter type of breach is something that arises commonly in relation to real estate deals where planning, environmental and safety laws are not complied with. While Tax warranties have historically been one of the most common breaches, it still takes up a large portion of notifications received at 17.8%. Taken together these four amount to just over three quarters of all notifications.
Q6. Has the percentage of notifications turning into paid claims changed?
A: The data shows that three-quarters of claims were resolved positively, which is a slight reduction from the previous period but is explained, in part, by the increase in precautionary notifications.
Q7. What would be your top tips for policyholders in getting their claims paid?
A: Good question! Notify early and in accordance with the policy provisions; particularise each element of the warranty breach and provide robust supporting evidence; keep the insurer updated and provide them with the documentation they need to investigate the claim, and, perhaps most importantly, make sure you can evidence the impact of the breach on the purchase price. Also, involve your broker as their relationship with the claims handler can be key to ensuring a smooth claims process.
Q8. What role does Howden M&A play in getting claims paid, can you give an example?
A: We provide assistance with the claims process as a W&I claim is often the first time an insured has dealt with an insurer in this context. We also assist clients with policy interpretation and quantum issues – quantum is typically the most complex part of a W&I claim. As brokers, we are able to deal directly with the insurers, and we can negotiate outcomes based on commercial as well as legal imperatives.
Q9. What role do coverage specialists, like Fenchurch Law have to play in the claims process?
A: Where a case turns on a point of law or policy interpretation, and the insurer/insured have reached stalemate and commercial negotiation has not assisted (which is rare!), it is vital for us, and our clients, to be able to have specialist advisers to call in that situation. Knowing that Fenchurch Law offer a free preliminary advice service is very reassuring!
Q10. Finally, what are your predictions for the coming year?
A: We predict a tidal wave of notifications in the coming year, reflecting the phenomenal increase in policies placed in 2020 and 2021. In similar vein, given the increasing number and size of the deals on which we advised in 2021 we anticipate that claim size and complexity will increase. In line with the trend for more policies (title and tax in particular) to include cover for ‘known issues’, we anticipate that notifications and claims arising under these policies will increase. Watch this space!
Short and sweet: insurers liable for bank’s cocoa product losses
ABN Amro Bank N.V. -v- Royal & Sun Alliance Insurance plc and others [2021] EWCA Civ 1789
The Court of Appeal has given insurers short shrift in their appeal against the finding of the Commercial Court that they were liable to the claimant bank, ABN Amro for losses it incurred following the collapse of two leading players in the cocoa market.
In a judgment notable for its brevity – a mere 26 pages compared to the 263-page first instance judgment - the Court of Appeal took just 5 paragraphs to set out their reasons for dismissing the appeal, finding that it simply did not ‘get off the ground’. It was, however, a sweet victory for the defendant broker, Edge, who, was successful in its appeal from the first instance decision, with an earlier finding of liability against it, arising from an estoppel by convention, being overturned.
The short first appeal
At first instance, the claimant bank, ABN Amro, succeeded in its claim for indemnity under an insurance policy placed in the marine market, relying on a clause the effect of which was to provide the equivalent of trade credit insurance. Such a clause was unusual in that marine policies typically provide an indemnity for physical loss and damage to the cargo, and not for economic loss. However, the court found the wording of the clause to be clear and to extend to the losses incurred by the bank on the sale of the cargo.
The insurers appealed this finding on the basis that the judge ought to have interpreted the clause as providing only for the measure of indemnity where there was physical loss or damage to the cargo.
The Court of Appeal disagreed, finding firstly that add-ons to standard physical loss and damage cover were common in the market and, where there were clear words, could result in wider cover; and secondly, that the wording of the clause was clear and operated to provide cover for economic loss. The wording of the clause was that of coverage, not of measure of indemnity or basis of valuation contingent on physical loss. Therefore, the bank’s losses incurred when selling the cargo, comprising various cocoa products, following the default by its cocoa market playing-customers on their credit policies, were covered by the policy.
The sweet second appeal
At first instance, the broker had been found liable to two of the defendant insurers, Ark and Advent, as a result of a finding of estoppel by convention. Ark and Advent had contended that they had been induced to write the policy following a representation that the policy being renewed was the same as the prior policy. It was, however, not in fact the same but included the clause in question providing trade credit cover. Neither Ark nor Advent read the policy and so were unaware of the inclusion of the clause. The representation that the policy was “as expiry” was found to give rise to an estoppel by convention meaning that the bank could not rely on the clause as against Ark and Advent, which in turn gave rise to a liability for the broker.
In appealing the finding of estoppel by convention, the broker sought to argue that the terms of a non-avoidance clause in the policy, which provided that the insurers would not seek to avoid the policy or reject a claim on the grounds of non-fraudulent misrepresentation, operated to preclude them from doing so. The Court of Appeal agreed, finding that the “as expiry” representations were non-fraudulent misrepresentations and as such, pursuant to the terms of the non-avoidance clause, the insurers could not rely on them to reject the claim. The judge at first instance was found to have erroneously focused on the ‘non-avoidance’ aspect of the clause, overlooking the fact that it also prohibited the rejection of a claim.
In sum
Given what the Court of Appeal described as the “sound and comprehensive” nature of the first instance analysis on the interpretation of the clause, it is perhaps surprising that the insurers sought to appeal, and certainly no surprise that they were not successful. Equally, the first instance finding of liability on the part of the broker was regarded by many as being out of keeping with the rest of the judgment – not least since Ark and Advent were effectively being relieved of their obligations by virtue of their failure to read the terms of the policy. As such, the finding is a welcome one on both counts, making it clear that, for good or ill, parties will be bound by the terms of the contracts they enter into.
Joanna Grant is a partner at Fenchurch Law
If your name’s not down…: no policy cover where developer incorrectly named
Sehayek and another v Amtrust Europe Ltd [2021] EWHC 495 (TCC) (5 March 2021)
A failure to correctly name the developer on a certificate of insurance has entitled insurers to avoid liability under a new home warranty policy.
The homeowner claimants had the benefit of insurance that covered them for the cost of remedying defects in their new build property at the Grove End Garden development in St John’s Wood.
Under the policy, “developer” was a defined term, being an entity registered with the new home warranty scheme from whom the policyholder had entered into an agreement to buy the new home, or who had constructed the new home. Cover was available under the policy for the cost of rectifying defects for which the developer was responsible, but had not addressed for various reasons including its insolvency.
Following the discovery of significant defects at their property, the claimants sought to bring a claim under the policy.
The certificate of insurance named a particular company called Dekra Developments Limited (Dekra) as the developer. Dekra was an established developer and had been registered with the new home warranty scheme since 2005. One of Dekra’s directors had confirmed to insurers that it was the developer of the Grove End Garden development. However, in fact, the developer was an associated company of Dekra set up for the purpose called Grove End Gardens London Limited.
Insurers therefore declined the claim on the basis that Dekra did not meet the policy definition of developer, being neither the entity named as seller on the sale agreement, nor the builder of the new homes. Its insolvency was not therefore a trigger for cover.
The homeowners sought to argue for an implied term extending the definition of developer to include its associated companies, and brought alternative claims based on estoppel and waiver.
Their claims did not succeed. The court found that this was not a “misnomer” case, in that the claimants were not able to demonstrate that there was a clear mistake on the face of the certificate of insurance as an objective reading of the evidence was consistent with cover having been agreed between Dekra and the insurer. Further, the proposed correction to imply the words “associated companies” was not a clear correction nor one that would be understood by an objective reader as needing to be made.
The alternative case based on estoppel and waiver also failed as no representation was made by the insurers to the effect that the cover extended to associated companies of Dekra. Nor did the initial rejection of the claim by insurers on other grounds amount to a waiver of the right subsequently to refuse cover on a different ground.
While undoubtedly legally correct, this was a harsh result in circumstances where Dekra effectively held itself out as being the developer, both to insurers and the world at large. This case highlights some of the challenges claimants under new home warranty policies can face as a result of the fact that, despite being the policyholders and having the benefit of the insurance, they are not involved in placing the policies. Nor will they necessarily be aware of the complex corporate structures common in the construction industry, including the use by developers of special purpose vehicles for different projects. The mismatch between the entity named on the sale agreement and that referred to on the certificate of insurance may however be one that they, or their conveyancing solicitor, might have been expected to identify and query at the time of purchase.
Joanna Grant is a partner at Fenchurch Law
All round protection for brokers: how protecting the underwriter can protect your client and protect you!
Our March 2021 article ‘Insurers bound by the small print? I should cocoa!’ briefly noted that the judgment in ABN Amro considered the scope of a broker’s duty to procure cover that meets the insured’s requirements and protects it against the risk of litigation. But what does that mean in practice, and can it really extend, as was argued in this case, to a duty to explain unusual clauses to underwriters?
One of the many roles brokers perform is in relation to policy placement, which role involves advising their clients and dealing with underwriters. As part of that exercise a broker must: (i) ensure that it understands its client’s instructions and in the event of uncertainty query, clarify or confirm the instructions given; (ii) explain to its client the terms of the proposed insurance; and (iii) ensure that a policy is drawn up, that accurately reflects the terms of the agreement with the underwriters and which are sufficiently clear and unambiguous such that the insured’s rights under the policy are not open to doubt. It is well-established law that in the performance of these tasks, a broker must exercise reasonable care and skill.
If the coverage is unclear, the client will be exposed to an unnecessary risk of litigation, and the broker will be in breach of its duty.
The scope of this duty was considered in the recent ABN Amro Bank case. By way of brief factual background, the claimant bank provided instructions to its broker that it required cover against its clients defaulting under a finance agreement. The broker placed the risk with RSA under an all risks marine policy. A bespoke clause was added to the policy midway through the policy period which had been drafted by the bank’s external lawyers. The effect of the clause was to provide the equivalent of trade credit insurance.
When subsequently presented with a £33.5 million for financial losses suffered by the bank, the insurer refused cover on the basis that the clause had widened the scope of the policy beyond what a marine policy would ordinarily provide. That disputed claim resulted in litigation, as part of which the court had to consider the role of the broker and what it was required to do in order to fulfil its duty to arrange cover which clearly and indisputably met the client’s requirements, and did not expose the client to an unnecessary risk of litigation.
On the facts, it was held that:
- a reasonably competent broker would have advised its client from the outset that the credit risk market and not the marine insurance market was a more appropriate market in which to place the cover the bank had instructed it to obtain. Such advice would have enabled the bank to make an informed decision as to how to proceed;
- having gone to the incorrect market, it became important for the brokers to explain to the underwriters what the clause was intended to cover; and
- any reasonably competent broker would have specifically pointed out the clause to the underwriters and talked through the amended wording and its implications.
The broker argued that this effectively imposed an unprincipled “duty to nanny”. The court clarified that there was nothing in its reasoning or conclusions which was intended to suggest that brokers generally owe duties to their clients to explain particular clauses, including unusual clauses, to underwriters.
Rather, in order to fulfil its duty to obtain cover that met the bank’s requirements and did not expose it to an unnecessary risk of litigation, and thereby protect its client’s position, the broker needed to give information to underwriters and discuss the implications of that information. In doing so, it would avoid problems which would potentially arise in the future if underwriters did not share the bank’s understanding of the unusual clause.
As such, the requirement did not amount to a duty to protect underwriters, it was about the steps that needed to be taken to fulfil the duty of a broker to protect its own client.
Having failed to take those steps, on the facts of this case the broker was in breach of its duty and consequently liable to the underwriters and the bank for costs.
In this case, protecting the underwriter was a necessary part of protecting the client, and, in turn, protecting the broker from the consequences of failing to obtain cover that met its client’s requirements.
Authors
Waste not, want not: recycling plant’s claim for cover upheld
Zurich Insurance PLC v Niramax Group Ltd [2021] EWCA Civ 590 (23 April 2021)
Finding that the ‘but for’ test is insufficient to establish inducement, the Court of Appeal has dismissed an insurer’s claim that it would not have underwritten the policy had the material facts been disclosed.
Zurich’s appeal was from a first instance decision that had found largely in its favour in respect of cover for losses arising out a fire at the policyholder’s waste recycling plant. Zurich challenged a finding of partial cover in respect of mobile plant on that basis that, as with the policyholder’s claim for the fixed plant that had not succeeded, it had similarly been induced by a material non-disclosure to underwrite the Policy renewal.
The main focus of the appeal was on whether, in circumstances where the premium charged would have been higher had full disclosure been made, the judge at first instance had been wrong to hold that inducement had not been established. Zurich argued that the increase in premium that would have resulted was of itself sufficient to meet the causation test for inducement, irrespective of the amount of the increase or the thought process by which the additional premium would have been calculated. Niramax contended that the non-disclosure had to be an effective and real and substantial cause of the different terms on which the risk would have been written if full disclosure had been made and there was no such causation on the facts.
The Court of Appeal found that the relevant test is whether the non-disclosure was an efficient cause of the difference in terms: it is not sufficient merely to establish that the less onerous terms would not have been imposed but for the non-disclosure.
The distinction is of particular relevance on the facts of this case because the impact of the non-disclosure was that the premium was calculated by a junior trainee who made a mis-calculation. Conversely, had the disclosure been made, the risk would have been referred to the head underwriter who would have priced the premium correctly. The non-disclosure therefore fulfils a ‘but for’ test of causation in that it provided the opportunity for a mistake to be made in the calculation of premium that would not otherwise have been made.
It was, however, necessary to apply the relevant test, namely whether the non-disclosure was an effective, or efficient cause, of the contract being entered into on the relevant terms. On the facts of this case, the process by which the premium was calculated took into account: the amount insured, nature of the trade, and the claims history. The undisclosed facts, which related to Niramax’s attitude to risk, were irrelevant to the rating of the risk. Therefore, the non-disclosure could not have had any causative efficacy in the renewal being written on cheaper terms than would have occurred if disclosure had been made.
The underlying principle is that if a non-disclosure has not had any influential effect on the mind of the insurer, impacting on the underwriting judgment, then there is no connection between the wrongdoing and the terms of the insurance, and no justification for the insurer to be awarded a windfall.
Of note is that this decision is based on the law prior to the Insurance Act 2015, the application of which may have led to a different outcome. Under the provisions of the Act, an insurer has a remedy for a breach of the duty of fair presentation if, but for the breach, the insurer would not have entered into the contract of insurance at all or would have done so only on different terms. Policyholders should be aware, therefore, that under the new law, the ‘but for’ test alone may be sufficient to entitle the insurer to a remedy.
Joanna Grant is a Partner at Fenchurch Law
Insurers bound by the small print? I should cocoa!
ABN Amro Bank N.V. -v- Royal & Sun Alliance Insurance plc and others [2021] EWHC 442 (Comm)
In the latest in a line of policyholder-friendly judgments, this recent ruling from the Commercial Court confirms that underwriters will be bound by the terms of policies they enter into whether they have read them or not.
The court found no grounds for departing from the important principle of English law that a person who signs a document knowing that it is intended to have legal effect is generally bound by its terms. Any erosion of that principle, which unpins the whole of commercial life, it was noted, would have serious repercussions far beyond the business community.
A foregone conclusion perhaps? Indeed the judge commented that prior to this case he would have regarded as unsurprising the proposition that underwriters should read the terms of the contract to which they put their names. What was it then that spurred the 14 defendant underwriters to seek to argue the contrary, apparently oblivious to the irony of their taking a point which routinely falls on deaf ears when more commonly made by policyholders unaware of implications of the small print for their claims?
In brief, the claimant bank, ABN Amro, was seeking an indemnity of £33.5 million under a policy placed in the marine market that unusually, and perhaps unprecedentedly, contained a clause the effect of which was to provide the equivalent of trade credit insurance, and not simply an indemnity for physical loss and damage to the cargo. As such, when the cargo, which in this instance comprised various cocoa products, was sold at a loss following the collapse of two of the leading players in the cocoa market and the default by them on their credit facility, the bank incurred losses that it contended were covered by the policy.
The underwriters submitted that the non-standard nature of this clause was such that clear words would have been required to widen the scope of cover beyond physical loss and damage, given the presumption that marine cargo insurance is limited to such loss. The court however found that, applying the well-established principles of legal construction, the wording of the clause was clear, and therefore its natural meaning should not be rejected simply because it was an imprudent term for the underwriters to have agreed, given the adverse commercial consequences for them.
The underwriters further submitted that they had not read the policy, and that the particular wording and its effect should have been brought to their attention as it was unfair to expect a marine cargo underwriter to understand the purpose of the clause. The bank contended that it was “frankly bizarre” for the underwriters to be essentially arguing that they, as leading participants in the London insurance market had to be told what terms were contained in the written policy wording presented to them and what those terms meant. The court agreed, finding that the underwriters could not properly allege that the clause was not disclosed to them when it was there in the policy to which they subscribed, and that further, as the bank contended, the insured was under no duty to offer the insurer advice. The insurer was presumed to know its own business and to be able to form its own judgment on the risk as it was presented.
Many other principles of insurance law were raised by this case and are covered in the wide-ranging 263-page judgment including (i) the applicable principles of legal construction; (ii) the incorporation and impact of a non-avoidance clause in the policy (it prevented the insurers from repudiating the contract for non-disclosure or misrepresentation in the absence of fraud); (iii) whether the underwriters had affirmed the policy by serving a defence that was consistent with a position that recognised its continuing validity (they had); (iv) whether mere negligence, as opposed to recklessness, was sufficient to breach a reasonable precautions clause in the policy (it was not); and (v) the scope of a broker’s duty to procure cover the meets the insured’s requirements and protects it against the risk of litigation (which duty had been breached and would have led to a liability on the part of the broker had the claims against the underwriters not succeeded).
However, the key takeaway for insurers, policyholders and commercial contracting parties alike is that a court will not step in to relieve a party of the adverse consequences of a bad bargain: the purpose of interpretation is to identify what the parties have agreed, not what the court thinks that they should have agreed. In other words, it always pays to read the small print.
Joanna Grant is a Partner at Fenchurch Law.