Insurance Claims

Overview of the Committee’s Focus:

Even though insurance products are sold in advance of loss when policyholders are free to evaluate the scope of coverage and to purchase supplementary protection of their choice, malpractice claims are nevertheless brought against insurance agents and brokers when disgruntled policyholders choose insufficient coverage. Always “20/20 hindsight” driven, these claims may include producer criticisms pertaining, for example, to:

• Policy Procurement Decisions
• Coverage Binder Follow Through
• Additional Insured Designations
• Coverage Placement Propriety
• Premium Payment Submissions
• Policy Expiration or Cancellation Management
• Coverage Explanation Adequacy
• Coverage Needs Updates
• Limits Adequacy Recommendations

Policyholder lawyers may assert claims alleging breach of the common law standard of care, breach of fiduciary duty, negligent misrepresentation, and breach of statutory duties unique to each state’s law. The Insurance Claims Committee of PLDF serves as a member clearinghouse of information important to the strategic defense of these claims. Coverage scope, “reasonable agent” proof approaches, comparative fault of sophisticated policyholders, the agent/broker distinction, vicarious liability of the insurer, and the scope of agent duties to the insurer are also within the ambit of issues important to this committee.

Committee members are asked to contribute to article publication, to monitor the PLDF news and respond to member inquiries for assistance, and to assist in annual meeting seminar presentation planning.