Insurance Coverage Disputes

Businesses and individuals purchase insurance policies with the expectation that, in the event of property damage or injury to either the policy holder or another, they will be protected from the obligation and cost of defending and possibly paying a claim. However, all too frequently insurance companies assert that either the claim is not covered under the policy or that coverage had been forfeited by the conduct of the insured.

It can be understandably frustrating to learn that an insurer has denied a claim – often an insurer will deny coverage even where an insured has paid premiums for years without a claim. We have significant experience in insurance coverage matters, both helping our clients set up advance procedures to handle a claim or occurrence, and to vigorously protect their rights to insurance coverage after an insurer has sought to deny a claim.

How can we help?

When an incident occurs (whether property damage; an accident; or a claim being commenced), it is absolutely essential that notice be provided to all insurance carriers as soon as possible.

Even if an insurer has denied coverage, all is not lost. We have successfully challenged denials of coverage, both through discussions with the insurers and, where necessary, through litigation.

When Insurance Coverage Disputes arise, you will need someone who can help achieve a satisfactory, speedy and cost-effective outcome. The sooner advice is sought from experts, the better.

We can offer you a specialist advice that combines detailed technical analysis with a pragmatic understanding of insurance practices.

Common areas for coverage issues to arise include:

  • Notification
  • Breach of conditions precedent
  • Non-disclosure, Non-disclosure, materiality, misrepresentation and avoidance.
  • Mistake
  • Misrepresentation
  • Breach of policy terms and conditions, Breach of claims behaviour conditions.
  • Waiver, affirmation, estoppel and reservations of rights.
  • All Risks – Fortuity
  • Validity and scope of ‘blanket’ circumstantial notifications.
  • EL compulsory insurance and restrictions on policy wording.
  • Scope and meaning of policy exclusions.
  • Impact of various professional indemnity ‘Minimum Terms’ regimes (e.g. SRA, ICAEW and RICS).
  • Motor insurance issues – including, Road Traffic Act, declarations, and Article 75.

We advise on the following types of policies.

  • EL compulsory insurance and restrictions on policy wording.
  • Scope and meaning of policy exclusions.
  • Impact of various professional indemnity ‘Minimum Terms’ regimes (e.g. SRA, ICAEW and RICS).
  • Motor insurance issues – including, Road Traffic Act, declarations, and Article 75.
  • Household cover following flood, subsidence, theft and fire to name a few
  • Critical illness cover – where insurers have tried to walk away when serious illnesses such as stroke and cancer were diagnosed.
  • Health insurance – again where insurers sought to suggest that there was no cover when serious operations such as heart surgery or major knee surgery were required.
  • Life insurance following unexpected deaths.
  • Travel insurance to advise on the insured’s obligations following a claim.
  • Caravan insurance where insurers tried to invalidate the policy after a claim was made.

Insurance Coverage Disputes over coverage can have serious consequences for both insurer and insured. Whether it is delay in notification, failure to disclose, or breaches of warranty, it is always advisable to seek assistance as early as possible once the dispute has arisen. Since the issue will normally only arise when an insured seeks to rely on the cover – why not seek coverage advice before an issue arises?