Topic: Insurance

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Aggregation of claims for related transactions

Where a policy aggregated claims for ‘similar acts or omissions in a series of related matters or transactions’ the enquiry was whether there was a real connection between the transactions in which they occurred. The use of the word ‘related’ implies there must be some interconnection between the matters or transactions so that they in … Continue reading

Insurance exclusion for ‘that particular part’ on which ‘performing operations’ (US)

The insured subcontracted a builder to build 53 prefabricated modular units for its residential blindness rehabilitation facility. The insurer denied an indemnity for water damage under a partly completed roof saying that the applicable exclusion barred coverage for ‘that particular part’ of property on which the policyholder or its subcontractors ‘are performing operations’. The units … Continue reading

Appeal Court confirms insurer liable to indemnify insured for failure to assess the risk of a schizophrenic prison inmate (Australia)

The New South Wales Court of Appeal upheld the decision of a lower court, holding an insurer liable to indemnify its insured, a prison detention centre for failing to assess the risk of a chronic schizophrenic prison inmate. The inmate threw himself from a building and suffered serious brain and other physical injuries. The issue … Continue reading

US court upholds Lloyd’s flood exclusion

A US court of appeals upheld the exclusion in a policy issued by Lloyd’s Underwriters for losses ‘caused directly or indirectly by flood’ in relation to a claim where a river basin marina lost five of its docks in a storm which generated strong winds and 18cm of rain causing the river to rise about … Continue reading

Reinstatement of cover only when claim paid

A New Zealand court has held that a policy undertaking by an insurer to reinstate the sum insured ‘after we have paid a claim under this policy’ does not give the insured a reinstatement right until a claim is actually paid. Where a loss happened, followed soon after by another loss before the first claim … Continue reading

Breach of policy requirement not to settle or disclaim liability does not include plea in criminal proceedings

An insurer in Singapore alleged that the insured had breached the obligation not to ‘make any admission in connection with any claim’ by pleading guilty to five charges of failing to comply with fire regulations. The defence was rejected on the basis that a person’s unfettered freedom of choice as to how to plead in criminal … Continue reading

Asbestos exclusion upheld in US

An exclusion for claims ‘arising out of asbestos’ was upheld by a US appeal court because it is unambiguous and therefore enforceable. The appeal court overturned a $36 million judgment against the insurer, which is only part of the policyholder’s liability for $120 million worth of asbestos-related claims. The court did not accept the argument that the … Continue reading

Claim rejected for misrepresentation (US)

A Pennsylvania court held that the insurer was not liable because of misrepresentation for a portion of a $227 million settlement by a building owner arising from a building collapse that took seven lives and injured 12 people. The event happened as a result of an uncontrolled collapse of a four-storey building which was being demolished … Continue reading

No cover for botched real estate deal (USA)

Where an insurance policy covered an estate agent for acts committed solely ‘in the performance of services as a real estate agent/broker of non-owned properties, for others for a fee’, the Utah Supreme Court denied coverage for an estate agent’s botched deal in which the agent persuaded a company to make an investment in a … Continue reading

Could v would (UK)

In a judgment in the lower court in a reinsurance non-disclosure case the judge referred to what ‘could’ have happened if certain loss statistics had been produced whereas the relevant test was what ‘would’ have happened in that situation. The appeal court held that people, including judges, do not always speak with precision in the … Continue reading

Digitizing the insurance value chain

If you are interested in using hi-tech to get your insurance or other financial services business to the front of the curve, you should read this. The Norton Rose Fulbright global team, in association with R3, has published a paper on applying blockchain and distributed ledger technology in the insurance sector. R3 is a leading … Continue reading

Laws amendment to accommodate demarcation regulations

The pending changes to the Medical Schemes Act and the Long-term and Short-term Insurance Acts to accommodate the demarcation regulations were made on 1 April 2017 including the new definition of ‘business of a medical scheme’. The definition of ‘business of a medical scheme’ in the Medical Schemes Act 1998 makes it clear that if you … Continue reading

Exclusion for medical services in a medical malpractice claim (US)

Over a 150 patients claimed damages against a hospital because of an outbreak of fungal meningitis and related infections which resulted from the patients receiving injections with contaminated substances. The court held that there was no claim under the insurer’s commercial package policy based on personal injury claims because the policies excluded bodily injury ‘due … Continue reading

Operation of retroactive date

Where an insurance policy had a retroactive date so that there was no indemnity for any claim ‘arising from or in any way involving any act, error or omission committed’ prior to 5 June 2009, the court held that the indemnity was due because there was no direct or indirect causal connection between the events preceding … Continue reading
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