Topic: Insurance

Days of grace do not apply to a repudiated life insurance policy

By Donald Dinnie on June 14, 2021 Posted in Insurance

In a June 2021 judgment, the Supreme Court of Appeal held that the 30 day grace period for an unpaid premium in a life policy does not apply where the cancellation of the policy is a result of a repudiation by the insured herself. The grace period only applies where the non-payment of the premium … Continue reading

True brokers may be paid a secret commission (UK)

By Patrick Bracher (ZA) on May 26, 2021 Posted in Insurance

In negotiations between parties who were negotiating charterparty terms for the chartering of two vessels, third parties involved in the negotiations received commission unknown to the party paying the price for the charter of the two vessels. It was held that although the third parties were intermediaries they were not agents in the full legal … Continue reading

No insurance claim for shooting because of assault exception (US)

By Patrick Bracher (ZA) on May 24, 2021 Posted in Insurance

The Illinois District Court rejected a liability claim by a nightclub against the insurer arising from a personal injury suit resulting from a shooting because of an assault exception. The exception excluded any claim “arising out of, related to, or, in any way involving any actual or alleged assault, battery, harmful or offensive contact, or … Continue reading

Touting for clients not an insured professional service (US)

By Patrick Bracher (ZA) on May 24, 2021 Posted in Insurance

After the oil rig blowout off the coast of Louisiana in 2010 which led to a litigation frenzy, practising attorneys paid runners millions of dollars to sign up tens of thousands of potential plaintiffs who were unaware of what their information was required for. The lawyers also filed unauthorised presentment forms on behalf of the … Continue reading

New York state financial regulator warns of cyber risk

By Patrick Bracher (ZA) on May 19, 2021 Posted in Insurance

In April 2021 the New York State Department of Financial Services issued a Report on the SolarWinds Cyber Espionage Attack and Institutions’ Response warning that the next great financial crisis could come from a cyberattack because with each passing day our world gets more interconnected. The report ends with the following passage: “The SolarWinds Attack … Continue reading

Covid-19 insurance claims and physical loss (US)

By Donald Dinnie on May 18, 2021 Posted in Insurance

Another American court in G & A Family Enterprises, LLC d/b/a Smokin’ Pig BBQ & Others v American Family Insurance Company 1: 20-CV-03912-JPB has held that State-imposed Covid-19 restrictions do not qualify as a “direct physical loss” under the insurance policy held by the insureds. The court held that while the phrase “direct physical loss” … Continue reading

The payment of medico-legal damages in services not money

By Donald Dinnie on April 26, 2021 Posted in Insurance

The problem facing departments of health around the country is how to improve service delivery to the public and the quality of medical care provided to patients and so significantly reduce the number and quantum of medico-legal claims. Instead of funding healthcare programmes and facilities, a large portion of the annual budgets is allocated to … Continue reading

Insurance fraud and fraud clauses

By Donald Dinnie on April 23, 2021 Posted in Insurance

The Supreme Court of Appeal in an April 2021 judgment dealt with the interpretation and application of a fraud clause found in the policy.. The clause read: “If you, or anyone acting on your behalf submits a claim, or any information or documentation relating to a claim, that is in any way fraudulent, dishonest or … Continue reading

Excess reinsurances and the applicable jurisdiction regime

By Donald Dinnie on April 19, 2021 Posted in Insurance

The United Kingdom High Court in the judgment of 13 April 2021 granted the excess reinsurer’s UK interim anti-suit injunction in respect of the insurer/defendants’ claims in South Africa under the excess reinsurance agreements. Those claims in the English courts to the exclusion of the South African courts will represent the bulk of the defendants’ claims … Continue reading

Covid-19 claim rejected because of virus exception (US)

By Patrick Bracher (ZA) on April 14, 2021 Posted in Insurance

A Kentucky US district court rejected the business interruption insurance claim of a retail business specialising in sale of outdoor sportswear and equipment for losses suffered as a result of government restrictions following the outbreak of Covid-19. The all-risks policy covered physical loss and damage but excluded damage caused directly or indirectly regardless of any … Continue reading

Insurance policies and absolute and relative warranties

By Donald Dinnie on April 14, 2021 Posted in Insurance

In South African insurance law a warranty is usually a condition precedent to inception or continuation of cover or payment of a claim. The consequence of breach or non-fulfilment is that there is no obligation on the insurer to indemnify the insured. Warranties may be absolute or relative. An obligation requiring that a certain state … Continue reading

Business Interruption Insurance and the absence of Damage

By Donald Dinnie on April 6, 2021 Posted in Insurance

A claim under a business interruption policy generally requires a valid claim under the material damage section of the policy. And the damage must occur during the currency of the policy. In TKC London Limited v Allianz Insurance PLC [2020] EWHC 27 10 (Comm.), the insured operated a café in London. Following the Covid-19 outbreak of … Continue reading

Policy interpretation – “interruption”

By Donald Dinnie on March 31, 2021 Posted in Insurance

The United Kingdom Supreme Court, in the FCA Test case appeal, dealt with the meaning of “interruption” in a Business Interruption policy. The policy wording required there to be losses resulting from “an interruption to your activities…” The court held that the ordinary meaning of “interruption” is quite capable of encompassing interference or disruption which … Continue reading

Subrogated claim against fire-causing students rejected because students were insureds (US)

By Patrick Bracher (ZA) on March 29, 2021 Posted in Insurance

The insurer was denied the right to sue two former college students for $4.5 million the insurer had paid to the school after the students accidentally set fire to the dormitory. It was held that the students accommodated in dormitories were equivalent to tenants and insured under the school’s fire policy. The two students used a … Continue reading

Policy interpretation – prevention of access

By Donald Dinnie on March 29, 2021 Posted in Insurance

The United Kingdom Supreme Court in the FCA Test Case appeal dealt with the meaning of “prevention of access” in respect of the prevention of access due to the actions or advice of the local authority because of an emergency which is likely to endanger life or property in a Business Interruption policy. The relevant … Continue reading

Policy interpretation – “inability to use”

By Donald Dinnie on March 26, 2021 Posted in Insurance

The FCA Test Case appeal in the UK Supreme Court dealt with the meaning of “inability to use” business premises in the relevant non-damage extensions to the business interruption section of the policy considered by the court. The relevant non- damage Public Authority clauses did not cover all business interruption due to “restrictions imposed” by … Continue reading

An independent cleaning contractor does not assume a shopping mall owner’s duty of care

By Siyabonga Mathe on March 9, 2021 Posted in Insurance

The duty to take reasonable steps to ensure that a shopping mall is reasonably safe, falls on the owner or any person who may be in control of the premises. The appointment of an independent cleaning contractor, does not entitle the owner or the person in control to avoid liability for claims which arise as … Continue reading

Insurer not required to pay for medical marijuana (US)

By Patrick Bracher (ZA) on March 3, 2021 Posted in Insurance

The Massachusetts Appeals Court refused to order an insurance company to pay for the medical marijuana expenses to treat the claimant’s pain stemming from a work-related injury he sustained in 2014. The US situation is curious in that medical marijuana is allowed in some states but is still unlawful under federal law. The Massachusetts law … Continue reading

Payment to broker may not be payment to insurer (US)

By Patrick Bracher (ZA) on February 10, 2021 Posted in Insurance

The Georgia Court of Appeals (US) found that payment of premiums by house owners insurance policyholders to their insurance agent was not payment to the insurer where notice had been given to the policyholders to pay directly to the insurer. In October 2014, the insurer sent a renewal notice to the policyholders requiring them to … Continue reading

124 food poisoning claims is one ‘occurrence’ (US)

By Patrick Bracher (ZA) on February 10, 2021 Posted in Insurance

A Texas district court held that 124 claims for food poisoning from salmonella bacteria suffered by patrons at a restaurant was one ‘occurrence’ within the terms of the restaurant’s insurance policy. An occurrence was defined as ‘an accident including continuous or repeated exposure to the same general harmful conditions’. An occurrence was ‘an accident’ and … Continue reading

Claim for loss of use of building precluded by ‘impaired property’ exclusion (US)

By Patrick Bracher (ZA) on February 10, 2021 Posted in Insurance

A conveyor company failed in its claim against its insurers for a loss arising from the supply of a defective cookie packaging machine to a biscuit manufacturer because the policy specifically excluded coverage for “impaired property”. The claim by the biscuit manufacturer against the insured alleged that they were unable to use their new building … Continue reading

New York regulator issues a cyber-insurance risk framework

By Patrick Bracher (ZA) on February 9, 2021 Posted in Insurance

Concerned about pandemic-related extra cyber activity, the rise in ransomware and recent cyber-espionage campaigns, the New York State Department of Financial Services (DFS) issued a cyber-insurance risk framework on 4 February 2021. After describing the risks for insurers and concluding that insurers play a critical role in mitigating and reducing the risks of cyber-crime, the … Continue reading

Application of the bump-up exclusion in a D&O policy (US)

By Patrick Bracher (ZA) on January 27, 2021 Posted in Insurance

The bump-up exclusion in a D&O policy excluded claims ‘alleging that the price paid … for the acquisition … of an entity is inadequate’. The insurers do not have to pay any amount due under a judgment or settlement representing the amount by which the price or consideration would be effectively increased. This is to … Continue reading

Interpreting insurance contracts (part 7 – causation)

By Donald Dinnie on January 22, 2021 Posted in Insurance

An insured loss must be caused legally and factually by the insured peril. Even where factual causation is established legal causation does not automatically follow. In Concord Insurance Co Limited v Oelofsen N.O. (1992) the court said that in the contractual context policy considerations do not enter the enquiry (unlike in criminal law or delict, … Continue reading