The Impact of COVID-19 on the Insurance Coverage Industry - WEBINAR
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
WEBINAR The Impact of COVID-19 on the Insurance Coverage Industry Tuesday, April 6, 2021 Paul White Partner – Los Angeles, CA 213.330.8818 paul.white@wilsonelser.com
4/6/2021 Insurance Coverage Master Class The Fallout of COVID-19 & The Emerging Risks on the Insurance Industry April 6, 2021 Today’s Speaker Insurance Coverage Master Class Paul S. White Wilson Elser 555 South Flower Street 29th Floor Los Angeles, California 90071 213.330.8818 paul.white@wilsonelser.com COVID-19 Insurance Coverage Master Class Evolution of the Pandemic: Impact on Insurance 1
4/6/2021 The Cost: How It’s Being Transferred to Carriers Insurance Coverage Master Class Insurance Coverage Implications: Three Key Facts 1. Exponential Growth 2. It’s Not the Flu 3. Social Distancing is the Only Proven Effective Measure Mounk, Yascha, The Atlantic, “Cancel Everything” (March 10, 2020 Exponential Growth Insurance Coverage Master Class It’s Not the Flu Insurance Coverage Master Class Flu affects 9.3 to 45 million in USA 140,000 to 800,000 U.S. hospitalizations 12,000 to 61,000 deaths in U.S. 37,000 deaths in USA in 2019 Globally: 600 million to 1.2 billion infected 500,000 to 1 million deaths 280 million immunizations 2
4/6/2021 Social Distancing is the Only Proven Effective Measure John Hopkins University, Coronavirus Resource Center Insurance Coverage Master Class Social Distancing is the Only Proven Effective Measure John Hopkins University, Coronavirus Resource Center Insurance Coverage Master Class China: Total Cases: 101,861 Total Deaths: 4,841 Variants Raise Risk of Repeat Cycle Insurance Coverage Master Class 3
4/6/2021 Variants Raise Risk of Repeat Cycle Insurance Coverage Master Class Pandemics: Policy Wording & Litigation Insurance Coverage Master Class • COMMERCIAL PROPERTY • Commercial property • Contingent business interruption • Specialized business interruption • LIABILITY INSURANCE • General liability • Errors & omissions • Directors & officers • EVENT CANCELLATION • EMPLOYER LIABILITY / WORKERS COMPENSATION Commercial Property Coverage Insurance Coverage Master Class The Dollars at Issue • Organization for Economic Cooperation and Development • Projects $1.5 trillion lost to the disease. • American Property Casualty Insurance Association • Estimates losses for businesses with 100 or fewer employees could cost between $220 billion and $383 billion per month. • Insurance Journal • COVID-19 pandemic could result in net losses from $3.2 trillion and up to $4.8 trillion in U.S. real gross domestic product over the course of two years (citing USC study). 4
4/6/2021 Business Interruption Litigation Over 1,500 Declaratory Relief Actions in USA Insurance Coverage Master Class Direct Physical Loss: Physical Damage Insurance Coverage Master Class New York: Social Life Magazine, Inc. v. Sentinel Ins. Co. “I feel bad for your client. I feel bad for every small business that is having difficulties during this period of time. But New York law is clear that this kind of business interruption needs some damage to the property to prohibit you from going. You get an A for effort, you get a gold star for creativity, but this is just not what's covered under these insurance policies.” (May 14, 2020, hearing) Michigan: Gavrilides Mgmt. Co., et al. v. Michigan Insurance Co., Case No. 20-258-CB-C30 Court concluded policy was clear and only covered direct physical loss of or damage to property, which has to be something that alters the physical integrity of the property—and held there was none. Direct Physical Loss: Physical Damage Insurance Coverage Master Class “The word 'physical' is defined as 'of or relating to material nature, or to the phenomenal universe perceived by the senses; pertaining to or connected with matter; material; opposed to psychical, mental, spiritual.” Patel v. Am. Econ. Ins. Co., No. 12-CV-04719-WHO, 2014 WL 1862211, at *5 (N.D. Cal. May 8, 2014) (court held feng shui consultant fees were not covered business income expense and defined “direct physical loss.” Air may qualify as a physical thing: “Certainly air is not mental or emotional, nor is it theoretical.” Oregon Shakespeare Festival Ass’n. v. Great Am. Ins. Co., No. 1:15- CV-01932-CL, 2016 WL 3267247 at *9 (D. Or. June 7, 2016), vacated, No. 1:15-CV-01932-CL, 2017 WL 1034203 (D. Or. Mar. 6, 2017) (Court held structural damage to theater, which closed due to ambient wildfire smoke and poor air quality, was not required for there to be a physical loss since theater had to be cleaned and filters replaced). 5
4/6/2021 Direct Physical Loss: Physical Damage Insurance Coverage Master Class Policyholder counsel have repeatedly asserted that the unpublished decision of Gregory Packaging, Inc. v. Travelers Property and Casualty Co. of America, No. 12-CV-04418, 2014 U.S. Dist. LEXIS 165232 (D.N.J. Nov. 25, 2014) supports an argument that the presence of the virus in a building will satisfy the direct physical loss requirement. Notably, however, in Gregory Packaging, the presence of ammonia in the building had made the building uninhabitable. Direct Physical Loss: Actual or Feared Physical Damage? Insurance Coverage Master Class Business closures / lockdowns to prevent transmission Foster Farms: reasonable probability of actual contamination may qualify Source Tech: To consider border closure due to concerns re mad cow disease a “direct physical loss” would render the word “physical” meaningless Direct Physical Loss: Insurance Coverage Master Class Can the Property be Cleaned or Remediated? Insurers rely on case law to support that property that may be cleaned or remediated has not suffered direct physical loss. 6
4/6/2021 Direct Physical Loss: Physical Damage Insurance Coverage Master Class Missouri: Studio 417, Inc., et al. v. The Cincinnati Insurance Company, Case No. 20-cv-03127-SRB (W.D. Mo. August 12, 2020) • Judge Bough first held that plaintiffs adequately alleged a direct “physical loss” under the policies because relying on the plain meaning of physical loss, plaintiffs alleged a causal relationship between COVID-19 and their alleged losses. Judge Bough agreed with plaintiffs’ arguments that the complaint alleged COVID-19 “is a physical substance,” that it “live[s] on” and is “active on inert physical surfaces,” is also “emitted into the air,” and had attached to and damaged plaintiff’s property in a manner that left it unsafe. Based on these allegations, the Court held that plaintiffs plausibly alleged a “direct physical loss” based on “the plain and ordinary meaning of the phrase” sufficient to withstand the insurer’s Rule 12(b)(6) motion to dismiss. • Motion to Dismiss—not a ruling on the merits. Direct Physical Loss: Physical Damage Insurance Coverage Master Class North State Deli et. al v. Cincinnati Insurance Co., Case No. 20-CVS-02569 • Court granted the policyholders’ motion for partial summary judgment • Judge stated that “the use of the conjunction ‘or’ means - at the very least - that a reasonable insured could understand the terms ‘physical loss’ and ‘physical damage’ to have distinct and separate meanings.” Direct Physical Loss: Physical Damage Insurance Coverage Master Class Courts may vary within a single jurisdiction. In Virginia: Elegant Massage (State Court): “Based on the case law, the Court finds that it is plausible that a fortuitous “direct physical loss” could mean that the property is uninhabitable, inaccessible, or dangerous to use because of intangible, or non- structural, sources.” The court recognized other decisions finding that “direct physical loss” requires structural damage or distinct and demonstrable physical alteration, but concluded where multiple interpretations may exist, it should apply the interpretation most favorable to the insured. Skillets, LLC: “Sillets did not suffer a direct physical loss as a result of COVID-19 or the closure orders, and its business losses incurred as a result of these events are therefore not covered by the Policy.” (Note applying Florida law.) 7
4/6/2021 Direct Physical Loss: Civil Authority Insurance Coverage Master Class • Damage arose from civil authority action or order • Impair or prohibit access • Direct Physical Loss to Property Other Than Described Premises • Contagious or infectious disease (hospitality and health care) • Waiting Period (72 hours) • Restrictions on time / policy sublimit • Restrictions on geography (one-mile radius) Direct Physical Loss: Physical Damage Insurance Coverage Master Class Covid Coverage Litigation Tracker, cclt.law.upenn.edu/judicial-rulings/ April 4, 2021 Direct Physical Loss: Physical Damage Insurance Coverage Master Class Dismissal / Motion Denied Virus Exclusion Judgment for Judgment for Insured Insurer AL, AZ, CA, CT, DC, AL, CA, FL, IL, MO, AL, AZ, CA, CT, FL, IL, NC, OH, OK, PA, FL, GA, IA, IL, IN, NC, NJ, NV, NY, OH, GA, IA, IL, IN, KY, VA, WA KS, KY, LA, MA, MI, OK, PA, SC (insured MA, MI, MN, MO, MN, MO, MS, NC, msj), TN, TX, VA, MS, NC, NJ, NM, NJ, NM, NV, NY, OH, WA, WI, WV NV, NY, OK, PA, TN, OK, PA, TX, VA, WA, TX, VA, WA, WV WI, WV 31 STATES 19 STATES 27 STATES 7 STATES 8
4/6/2021 Commercial Property: Exclusions Insurance Coverage Master Class • Virus • Pollutants or Contaminants • Micro-organisms or other substances that threaten human health and life • Acts or decisions of government bodies • Arising from enforcement or compliance with any law • “Property damage” arising from exposure to land, water, air Commercial Property: Virus Exclusion Insurance Coverage Master Class • ISO form CP 01 40 07 06 provides in pertinent part: • EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA • The exclusion set forth in Paragraph B. applies to all coverage under all forms and endorsements that comprise this Coverage Part or Policy, including but not limited to forms or endorsements that cover property damage to buildings or personal property and forms or endorsements that cover business income, extra expense or action of civil authority. • We will not pay for loss or damage caused by or resulting from any virus, bacterium or other microorganism that induces or is capable of inducing physical distress, illness or disease. … (Emphasis added) Commercial Property: Virus Exclusion Insurance Coverage Master Class • When ISO submitted the exclusion to state regulators in July 2006, its circular LI-CF-2006-175 expressly identified SARS—the virus from which COVID-19 mutated—as a type of virus that the exclusion is designed to address. The ISO circular stated: [E]xamples of viral and bacterial contaminants are rotavirus, SARS, influenza (such as avian flu), legionella and anthrax. The universe of disease-causing organisms is always in evolution.” • “While property policies have not been a source of recovery for losses involving contamination by disease-causing agents, the specter of pandemic or hitherto unorthodox transmission of infectious material raises the concern that insurers employing such policies may face claims in which there are efforts to expand coverage and to create sources of recovery for such losses, contrary to policy intent. In light of these concerns, we are presenting an exclusion relating to contamination by disease- causing viruses or bacteria or other disease-causing microorganisms.” Id 9
4/6/2021 Virus Exclusion Insurance Coverage Master Class Does the government order cause the shutdown? Henderson Road Rest. Sys., Inc. v. Zurich Am. Ins. Co. (ND Ohio): The virus exclusion did not apply to bar coverage because the COVID-19 virus itself did not cause the losses at issue, but rather the government shutdown orders did. Franklin EWC v. The Hartford Financial Services Group Inc. et al., Case No. 3:20-cv- 04434: Federal California court upheld the virus exclusion in a COVID-19 business interruption case, calling the plaintiff’s argument that the exclusion should not apply because stay-at-home orders were the actual cause of loss “nonsense.” Commercial Property: Pollution Exclusion Insurance Coverage Master Class • Many Policies Exclude Pollutants and Contaminants • Many Policies Define Pollutant or Contaminant to Include Virus • Pollution Exclusions (Pollutant not defined): Courts are split-- • Virus can be a pollutant. See First Specialty Insurance Corp. v. GRS Management Associates, Inc., No. 08-81356, 2009 WL 2524613, at **3, 5 (S.D. Fla. Aug. 17, 2009). • Westport Insurance Corp. v. VN Hotel Group, LLC, 761 F. Supp. 2d 1337, 1343-44 (M.D. Fla. 2010) (Court determined legionella bacteria are not pollutants; pollution exclusion did not apply). • Johnson v. Clarendon National Insurance Co., No. G039659, 2009 WL 252619, at **2, 13 (Cal. Ct. App. Feb. 4, 2009) (pollution exclusion did not apply to mold and likely would not apply to viral infections; court interpreted in favor of coverage). Acts or Decisions of Government Bodies Insurance Coverage Master Class Florexpo LLC v. Travelers Property Casualty Co., Case No. 20-DV- 1024 JLS (DEB) We will not pay for any loss or damage caused by or resulting from . . . Acts or decisions, including failure to act or decide, of any person, group, organization or government body . . . . 10
4/6/2021 Acts or Decisions of Government Bodies Insurance Coverage Master Class Florexpo LLC v. Travelers Property Casualty Co., Case No. 20-DV- 1024 JLS (DEB) “First, the governmental action was the direct cause of the loss for which Plaintiffs seek relief in the Coverage Claim, bringing the claim within the Acts or Decisions Exclusion. Second, the Court refuses to read a negligence limitation into the Exclusion, where such language does not exist and where courts interpreting similar exclusions have not limited the clause to only negligent acts.” Exclusion: Micro Organisms Or Other Substances Insurance Coverage Master Class That Threaten Human Health And Life Henderson Road Rest. Sys., Inc. v. Zurich Am. Ins. Co. (ND Ohio) • Plaintiffs argued virus must be present on premises. • Insurance filing with Ohio DOI where carriers “explained that despite the broad language of the exclusion, they were seeking to avoid coverage for ‘viral and bacterial contamination’ of properties.” • Parties had stipulated that plaintiffs’ closures were not based on presence of virus at their properties. • Court delayed discovery on damages pending appeal based on “substantial ground for difference of opinion” on policy interpretation. (Similar question certified to Ohio Supreme Court same day in Neuro-Commc’n Serv., Inc. v. The Cincinatti Ins. Co. Business Interruption Litigation Over 1,500 Declaratory Relief Actions in USA Insurance Coverage Master Class 11
4/6/2021 Disease Clause Extension (EU) Insurance Coverage Master Class The insurer shall pay compensation if the competent authority closes the insured business in whole or in part to prevent the spread of notifiable diseases or pathogens on the basis of the law on the prevention and control of infectious diseases or pathogens. Disease Clause Extension (EU) Insurance Coverage Master Class • France: Manigold v. AXA • A Paris court ruled that insurer AXA must pay a restaurant owner two months’ worth of coronavirus-related revenue losses. • Court advised policy did not include “direct physical loss” requirement • French insurers estimate $21.8 billion per month • AXA as reportedly agreed to pay over 200 COVID-19 related claims • Germany: Government and group of insurers reached an agreement whereby government pays 70 percent of business interruption losses for policyholders in hospitality industry and insurers pay for half of business interruption losses not covered by the government • United Kingdom: FCA v. Hiscox et al. • Financial Conduct Authority selected eight insurers to participate in High Court test case. • Eight insurers—will impact 700 policy types, 60 insurers, 370,000 policyholders. • Selected representative policy language and wordings in order to provide guidance for many other business interruption policy forms • Direct Physical Loss not an issue (paragraph 80) • Disease clause cover extensions (or hybrids). Court determined COVID-19 in UK is an occurrence Specialized Business Interruption Insurance Coverage Master Class • Hospitality and Health Care • Communicable and Infectious Diseases • Pandemic Specific • Coverage • Exclusions 12
4/6/2021 Legislative Intervention Insurance Coverage Master Class • Retroactive imposition of contractual obligations • Absence of Underwriting or Premium • United States Constitution: • Contracts/ Impairments Clause: “[n]o state shall … pass any … Law impairing the Obligation of Contracts.” (U.S. Constitution, Art. I, § 10, emphasis added.) • Takings Clause • Due Process Clause • Pandemic Risk Insurance Act Liability Exposures Insurance Coverage Master Class Adjusting Claims in the Virtual World • General Liability: Bodily Injury and Property Damage • E&O: Health Care • E&O: Agent Broker • D&O: Securities • Waivers and Immunity Liability Exposures: GL / E&O / D&O Insurance Coverage Master Class Adjusting Claims in the Virtual World • Banking / Financial Services • Insurance • Challenge vs. Foreign Sovereigns or • Intellectual Property non-government organizations • Labor & Employment • Civil Rights • Miscellaneous Tort • Consumer cases • Libel, Slander, Defamation • Contract Disputes • Other • Education • Wrongful Death / Personal Injury • General court administrative orders (other than employment / consumer / re COVID-19 healthcare) • Habeas / Confinement / Prisoner • Health / Medical • Real Property • Securities Litigation 13
4/6/2021 Fear of Disease Insurance Coverage Master Class Does Not Support Emotional Distress Weisberger v. Princess Cruise Lines, Case No. 2:20-cv- 02267-RGK-SK (July 14, 2020) • Passenger-plaintiffs could not recovery for NIED based solely on their proximity and fear of contracting the disease from others with COVID- 19. • The Court noted that if it were to adopt the plaintiffs’ position, it would run afoul of a US Supreme Court decision leading “to a flood of trivial suits, and open the door to unlimited and unpredictable liability.” • It also expressed that the risk of exposing individuals to COVID-19 is not unique to cruise ships-“quite the contrary, in fact, as restaurants, bars, churches, factories, nursing homes, prisons, CNBC March 28, 2020, “CDC says coronavirus RNA found in and other establishments across the country Princess Cruise ship cabins up to 17 days after passengers left” CNBC.com last visited 3/7/2021) continue to report COVID-19 cases,” and as such creating a “cruise-ship exception” was not warranted. General Liability Insurance Insurance Coverage Master Class • Bodily Injury • Property Damage • Occurrence = Accident • Damages • Allegations of gross negligence • Allegations of intentionally disregarding warnings • Allegations of failure to comply with civil authority directives • Statutory Violations are not accidents • Requests for Injunctive Relief General Liability Insurance Insurance Coverage Master Class McDonald’s Corp., et al. v. Austin Mutual Insurance Company, Case: 1:20-cv-05057 (ND IL Feb. 22, 2021) • Claim for injunctive relief • “Damages because of bodily injury” • Court declined to address employment and workers compensation exclusions CNBC March 28, 2020, “CDC says coronavirus RNA found in Princess Cruise ship cabins up to 17 days after passengers left” CNBC.com last visited 3/7/2021) 14
4/6/2021 Insurance Coverage Master Class Other Insurance Product Lines Impacted by COVID-19 Errors & Omissions Insurance Health Care Insurance Coverage Master Class E&O coverage for medical professionals and managed care operations Coverage: Insuring clauses generally provide coverage for bodily injury to a patient arising out of acts, errors, or omissions in providing or failing to provide medical care or managed care. Exclusions: Policies generally exclude coverage for bodily injury to employees during the course of their employment (i.e., an employee being exposed to an infectious or contagious disease). Errors & Omissions Insurance Insurance Agent & Broker Insurance Coverage Master Class Standard of Care • Broker only required to obtain requested coverage • “Special Circumstances Rule” Broker makes representations re nature, extent, or scope of coverage being offered or provided Client requests specific coverage Broker assumes additional duty by express agreement or by “holding himself out” as having expertise in a given field. • Professional Standard Duty to advise 15
4/6/2021 Errors & Omissions Insurance Insurance Coverage Master Class Insurance Agent & Broker Casa Colina, Inc. v. Hartford Fire Ins. Co, HUB, 2020 U.S. Dist LEXIS 236698 (Dec. 23, 2020) (1) a broker warranting that Plaintiffs would receive “full and adequate insurance” is a generalized statement that is insufficient to amount to a misrepresentation that would trigger a heightened duty; (2) the broker did not have an affirmative duty to warn of potential coverage gaps or exclusions absent a specific inquiry; and (3) the broker was not “holding out” as having expertise when it discussed business interruption coverage on the broker’s website. Directors & Officers Insurance Insurance Coverage Master Class COVID-19 has roiled stock markets worldwide. Claims as to whether: • company was sufficiently prepared; • whether appropriate steps taken in response; • Responsibility for failed mergers • Exclusions for Bodily Injury and Property Damage • Absolute bodily injury exclusion: “based directly or indirectly arising out of, or relating to actual or alleged bodily injury.” Intended to preclude coverage for any claim, even economic loss, arising out of or related to bodily injury. Such exclusions are being challenged in courts. Event Cancellation & Contingency Nonappearance Insurance Insurance Coverage Master Class 16
4/6/2021 Event Cancellation & Contingency Nonappearance Insurance Insurance Coverage Master Class Communicable Diseases: “Most event cancellation insurance policies do not cover losses from communicable diseases like the coronavirus, except where such coverage is sold as an add-on. Moreover, that coverage is often only triggered when the government stops the event from going ahead, rather than when the organizer decides to cancel or attendees drop out.” Law360UK, “Swiss Re Faces $250M Loss if Olympics Canceled,” (March 20,2020) Generally: communicable or infectious diseases are not included as specified perils in standard event cancellation policies. See, e.g., “Coronavirus and Event Cancellation Insurance,” Washington State Office of the Insurance Commissioner,” https://www.insurance.wa.gov/coronavirus-and-event-cancellation-insurance (last visited April 4, 2020) Insurance Coverage Master Class Risks & Liabilities Facing Employers & Businesses Covid-Standards Workers’ Compensation Claims 17
4/6/2021 Remote Workers and Resulting Risks Wage & Hour Issues Performance Management Privacy & Cyber Workers’ Compensation Can Employers Require Employees To Be Vaccinated? Vaccines, Generally Employer Mandates Risks With Mandates Mandates For The Public Liability Traps Waivers for Businesses vs. Waivers for Employees 18
4/6/2021 Thank You! Paul S. White Wilson Elser 555 South Flower Street 29th Floor Los Angeles, California 90071 213.330.8818 paul.white@wilsonelser.com Dean A. Rocco Wilson Elser 213.330.8922 dean.rocco@wilsonelser.com 19
Paul S. White Partner Contact Los Angeles p. 213.330.8818 f. 213.443.5101 paul.white@wilsonelser.com Paul White focuses his practice on complex insurance coverage and bad faith litigation and Services represents defendants in commercial litigation. Paul's insurance coverage practice includes Appellate advising and representing insurers in bad faith litigation and insurance policy disputes, Germany including rst-party property policies, general liability coverage, errors and omissions insurance, and media liability insurance. He also advises and represents insurers in Insurer Litigation: subrogation actions on property losses. In addition, Paul has litigated and arbitrated disputes Coverage/Extra-Contractual throughout the United States involving domestic and foreign insurance agents and brokers in Insurance & Reinsurance all lines of coverage. He has broad experience in the business practices of all types of Coverage insurance intermediaries, including brokers at every level in the broking process, from producers to managing general agents to London Market brokers. Professional Liability & Services In his litigation practice, Paul focuses on commercial business litigation, including professional liability actions brought against insurance agents and brokers. In addition to his Admissions insurance practice, Paul advises entertainment and technology companies on the Bars management of intellectual property risks. California Paul regularly speaks and publishes for groups such as DRI, the Professional Liability Courts Underwriting Society (PLUS), Property & Liability Resource Bureau/Liability Insurance Supreme Court of the United States Research Bureau (PLRB/LIRB), the Federation of Defense and Corporate Counsel, and the U.S. Court of Appeals, Ninth Circuit National Business Institute on insurance coverage issues, including, among others, U.S. Court of Appeals, Tenth Circuit intellectual property, bad faith, professional liability, employment, environmental and U.S. District Court, Northern District of construction defects. In 2016, Paul received the Outstanding Presenter award from PLRB. California U.S. District Court, Central District of California U.S. District Court, Eastern District of California U.S. District Court, Southern District of California Memberships & A liations DRI: The Voice of the Defense Bar; chair, Insurance Coverage & Claims Institute, 2016; former chair, Insurance Committee; former chair, Publications Committee; former editor, “Covered Events” The Federation of Defense & Corporate Counsel (FDCC), Extra-Contractual Liability Section, vice chair Awards & Distinctions
Selected for inclusion in Southern California Super Lawyers®, 2017- 2020 Education University of Utah S.J. Quinney College of Law, J.D., 1989 Brigham Young University, B.A., 1985 Certi cations/Licenses
You can also read