, Professional Indemnity Insurance : Coverage Investigations & Other Issues

Professional Indemnity Insurance : Coverage Investigations & Other Issues


Coverage Investigations

Upon notification of a circumstance or claim, professional indemnity insurers will consider the extent to which they are obliged to provide the firm and individual insureds with cover.

The principal ground upon which cover may be excluded is for dishonesty. If suspected, your insurer will commence a coverage investigation. They are likely to, and should, instruct a separate firm to handle the coverage investigation, as distinct from the firm acting for you on the notified claim.

You are required to cooperate with your insurer within reasonable limits. We can assist in identifying the extent to which cooperation is reasonably required.

Early engagement with us can assist you in preparing information for insurers, reducing the chances of a negative outcome, and increasing the speed at which matters are addressed.

If you are invited to attend an indemnity conference, you can be sure that your insurer intends to decline cover. Representation is very important. In our experience, the conference is used by insurers as a means to cross-examine you in advance of declinature with a view to litigation. Usually the insurer appoints Queens Counsel to question you.

Cover may be declined for one or more partners (and technically other individuals), which may cause the firm and its partners to become wholly exposed to the underlying claim, or the excluded partners facing reimbursements claims by the insurer.

The insurer may seek to limit its exposure by relying on an aggregation clause, and may claim damages for claims handling prejudice e.g. upon late notification.

Dishonesty?

Your contract of insurance will at least replicate the Minimum Terms & Conditions (MTCs) prescribed by the SRA. Your insurer will consider whether a dishonest act or omission was committed or condoned.

Application of the test for dishonesty in Ivey v Genting [2017] UKSC 67 varies. Your insurer may argue that recklessness is sufficient to establish dishonesty.

Dealings with your insurer may later be scrutinised by the SRA.

Will the insurer seek reimbursement?

The MTCs permit an insurer to seek reimbursement in the event that an insured commits or condones (whether knowingly or recklessly):

  • any breach of the duty to make a fair presentation of the risk, or misrepresentation;
  • any breach of the terms or conditions of the insurance; or
  • dishonesty or any fraudulent act or omission.

to the extent that is just and equitable having regard to the prejudice caused to the insurer’s interests by such failure.

Will the insurer cover my defence costs in the underlying claim while it conducts a coverage investigation?

The MTCs require insurers to meet defence costs as and when they are incurred, including defence costs incurred on behalf of an insured who is alleged to have committed or condoned dishonesty or a fraudulent act or omission, provided that the insurer is not liable for defence costs incurred on behalf of that insured after the earlier of:

  • that insured admitting to the insurer the commission or condoning of such dishonesty, act or omission; or
  • a court or other judicial body finding that that insured was in fact guilty of such dishonesty, act or omission.

Insurers may seek to argue that they are not obliged to provide such cover as soon as they have declined cover, i.e. relying upon their own finding whether dishonesty is made out. We’ve seen this, so how do you challenge this?

How to challenge an insurer?

The starting point is to make detailed written representations to the insurer’s appointed solicitors.

If that doesn’t succeed and an issue persists, the dispute may either be the subject of arbitration or court proceedings.

Insurers are dutybound to report declinatures for dishonesty to the SRA. A failure to mount a legal challenge to a disputed finding by an insurer may be relied upon by the SRA as material.

Case Study 1

We acted for two firms in separate investigations arising from large scale employee theft from client account. Early engagement allowed us to present claims to the relevant insurers for an indemnity and rectification of the client account avoiding intervention in circumstances where, given the extent of the shortfalls, the partners had insufficient resources to meet the liability. Frequent and good communication with the SRA helped avoid intervention.

Case Study 2

A month before insurance renewal we were instructed by three of the four partners in a practice. Four civil claims had been received brought by mortgage lenders. Upon our advice the firm investigated and quickly ascertained that the senior partner had turned rogue; there were c.1,000 affected files. They were all notified to the firm’s existing insurer in the weeks left before renewal, with the effect that the current insurer was at risk.

The insurer declined cover for the two equity partners, the other two being salaried, availing it of a Defence in the underlying claims, the reserve for which was understood to be anywhere between £10 million and £30 million.

On instructions we challenged the declinature and which led to arbitral proceedings. The complexity of those proceedings was such that many months would be required before a substantive hearing could be heard.

In the interim, the insurer declined cover for Defence Costs.

We applied to the SRA for an order directing the insurer to conduct the claims and advance Defence Costs.

The insurer instructed a large city outfit and Queens Counsel at 4 New Square to represent them. Appearing for the equity partner at the hearing we successfully argued the case before the SRA Adjudication Panel. The SRA concluded that it was not open to the insurer to decline to indemnify the firm for Defence Costs cover pending resolution of a coverage dispute. Here resolution meant an arbitral award, not the insurer’s decision. The SRA went further directing the insurer to compromise claims.

That decision ultimately led to the settlement of the arbitral proceedings including an indemnity and payment of legal costs.

We understand that at the time we were the only firm to have made a successful application to the SRA for such an award.

Having acted swiftly to place this insurer at risk, the firm crystallised the issue. With a report that we prepared, the firm was able to obtain renewal insurance and continue in business.

Other issues

We can also assist with all other indemnity insurance issues that arise for example :-

  • Successor Practice Advice;
  • Advice on aggregation;
  • Advice on defence costs cover;
  • Issues arising on the failure of an insurer;
  • Claims upon the Financial Services Compensation Scheme;
  • Sham partnership investigations; and
  • Claims by an insurer to recover a run-off premium from fixed share and salaried members of an LLP.

If you want us on your team, e-mail or speak to Robert Forman on 07976 562236.