Three Keys to Picking the Best ‘Claims Made’ Form

This is the final post in a 5-part series authored by Fred Fisher. Check out the previous posts in this series here: Part 1  |  Part 2  |  Part 3  |  Part 4.

Three Keys to Picking the Best ‘Claims Made’ Form

Over the last week the “claims made” policy has been dissected, revealing its inner workings. But before moving on to the keys for choosing the best “claims made” policy form, the heart of the “claims made” policy must be explored: the definition of a “claim.”

The Definition of “Claim” Scrambles Everything

Defining a “claim” in the context of a “claims made” policy is the first issue when analyzing coverage. Many Appellate courts have ruled that a “claim” is “a demand for money or services.” Sounds simple enough; yet isn’t the filing of a lawsuit, even if un-served, a “demand for money?”

What if suit is filed in one policy term where the definition of claim is “a written demand” yet served after renewal on a policy written by another insurer whose policy defines “claim” as “a written demand received by the insured,” or” a lawsuit served on the insured?” Under these definitions, two insurers could have coverage for the same “claim,” which is not supposed to happen with “claims made” forms.

More complicated is the scenario where an insured moves coverage from an insurer whose definition of “claim” is “a written demand received by the insured,” to an insurer that applies a Prior and Pending Litigation exclusion using the policy’s inception date. If suit is filed during the expiring policy term but served after the inception of the new policy, the claim will be denied by both – even if reported to the prior insurer within the 30 or 60 day reporting extension (if applicable). The suit does not meet the extended reporting period requirement as it was not “received by the insured” during the policy term. The new insurer will likely deny liability because the litigation commenced (the suit was filed) prior to inception. Thus a gap in coverage is created, which isn’t supposed to happen when the insured has continuous “claims made” coverage.

Playing the “Claim Game”

Agents and brokers who do not work with “claims made” coverages on a regular basis now should have a much deeper understanding of the intricacies and differences each carrier/policy form offers. Successfully navigating through “claims made” policies requires specific attention to detail, particularly to the policy form definitions.

As has been presented in this series, one “claims made” policy is not just as good as another; and if the insured has been covered by an inferior form in the past, changing to a superior form could create coverage gaps. Knowing how the find the potential gaps makes good agents better agents.

Formulate claims scenarios when/if coverage is being moved to another carrier and policy form. Several may need to be created and run – comparing the scenario to the coverage form wording – to assure that there are no gaps or what gaps there might be.

What to Look for in a “Claims Made” Policy

Placing a “claims made” policy requires the agent to look for certain policy characteristics. Following are a few hallmarks of the “best” “claims made” coverage forms:

  • Try to use a company that uses a “claims made” form rather than a “claims made and reported” form. Unfortunately this will prove the most difficult;
  • If the only form available is a “claims made and reporting” form, look for one that automatically provides the insured 30 or 60 unrestricted additional days after expiration to report a claim first made prior to expiration. Make sure the definition of “claim” does not require “receipt by the insured;” and/or
  • Use a form that does not use the inception date as the prior and pending litigation or continuity date when there is prior coverage in force. Or use one that excludes “known litigation.prior to inception” only.

Use of these simple rules will ensure better coverage for clients and fewer chances for errors and omissions claims for the agent. n addition, by asking for endorsements to clean up the language, fewer underwriters will be heard to say, “You’re the only one asking.”


This ends the five-part series on “claims made” coverage forms. Hopefully this has increased awareness of the pitfalls and gaps potentially present in the use of these forms.

REPRINTED WITH THE PERMISSION OF MyNewMarkets.com, An Insurance Journal Company.

‘Claims Made’ Coverage Tripped Up by the Trigger Language

This post is part 4 of a 5-part series authored by Fred Fisher. Check out the previous posts in this series here: Part 1  |  Part 2  |  Part 3.

‘Claims Made’ Coverage Tripped Up by the Trigger Language

The Incident Reporting Provision

Nearly all “claims made” forms allow the insured to report a fact or circumstance that will likely or may give rise to a claim at some point in the future. If the reported act or error does evolve into a claim at a later date, the insurer to whom the incident was first reported will treat the claim as if it were first made during the policy term of the initial report.

Some insureds abused this provision and submitted a laundry list of “potential claims” to the insurer. The most common reasons for such abuses arose from insureds being non-renewed or changing carriers. Because of such attacks on this liberalizing language, and the industry’s attempt to avoid the submission of “possibilities,” insureds are now required to provide:

  1. The specific details of the act, error or omission … that gave rise to the Circumstance;
  2. The injury or damage which may result or has resulted from the Circumstance; and
  3. The facts by which (the Insured)…first became aware of the act, error or omission..

The Incident Reporting Provision is not the same as the claim-reporting extension. An “incident” MUST be reported in sufficient detail prior to the expiration of the policy. The insured, absent language to the contrary, does not have any additional time beyond the policy period to report an incident. In contrast, a “claims made and reported form” allows the insured an additional 30 or 60 days (as discussed in an earlier section) to report a claim “first made during the policy term…” “Claim” and “incident” are not synonymous terms.

The Automatic Claim Reporting Extension and the Claim Reporting Condition

Since the “claims made and reported” wording was first adopted in the early 1990’s, it may have become the most common “claims made” wording used. As a result, most insurance practitioners have come to accept that not only must a claim first be made during the policy term, but to garner coverage, such claim must also be reported during the policy term (or any extension period if provided). Unfortunately some insurers, in their zeal to force insureds to report their claims in a timely manner, have taken a surprising and unconventional approach that may result in the denial of a claim for unsuspecting insureds. Some policy’s Condition sections now state:

“The Insured shall, as a condition precedent to the coverage afforded by this policy, give written notice to the underwriters during the policy period of any claim made against the insured, but in no event shall notice to the underwriters be later than 30 (may be 60 or 90 days depending on the insurer) after any insured becomes aware of said claim.”

Not many would expect to find such an unconventional provision in the conditions section when the insuring agreement has already implied it is a conventional “claims made and reported form.” Thus an unexpected claim denial might result for an otherwise covered claim.

The Automatic Claim Reporting Extension and Renewal

Most brokers expect a “claims made and reported form” to give the insured some limited amount of time following the end of the policy period to report a claim first made during the policy term (most commonly 30 or 60 days). The purpose of this provision was to not penalize an insured who, in good faith, found it next to impossible to comply with the requirement of reporting the claim during the policy period. The preferred language was akin to:

“..the  Insureds  shall,  as  a  condition  precedent  to  their  rights  to  payment  under  this  Policy,  give  to underwriters notice in writing of such Claim as soon as practicable provided all Claims must be reported no  later  than  the  end  of  the  Policy  Period,  in  accordance  the  requirements  of  the  Optional  Extension Period (if applicable}, or sixty (60} days after the expiration date of the Policy Period.”

While the above policy language is preferred and relatively unrestricted, new language is popping up with unusual and restrictive language; some is even illogical. New policy wording will only allow the reporting extension: “In the event of cancellation or non renewal of this Policy, by either the ‘Named Insured’ or the Company.”

If the policy is renewed, no last-minute claims made against the insured are covered unless the claim is reported prior to expiration of policy. Neither will such claim be covered by the renewal policy since the claim wasn’t first made in that policy term. This wording almost behooves the insured to renew elsewhere.

There are still some “claims made and reported” policies in use requiring the claim be first made and reported during the policy term – never allowing for a post-expiration claim report.

The Automatic Claim Reporting Extension and Contradictory Policy Language

Consider a policy’s insuring agreement that reads:

“Provides professional liability coverage for those wrongful acts that occur subsequent to the retroactive date stated in the declarations and which are first made against you and reported to us while this policy is in force. No coverage exists for claims first made against you and reported to us after the end of the policy term unless, and to the extent, an extended reporting period applies.”

The “Notice of ‘Claims'” wording in the conditions section of the above policy reads:

SECTION VII – CONDITIONS

Notice of “Claims”

  • “As a condition precedent to our obligations under this Policy, you shall give written notice to us as soon as practicable, but in no event later than 60 days after the end of the “Policy Period” of any “Claim” made against you  “

In the same form, the Extended Reporting Period language states:

SECTION VIII – EXTENDED REPORTING PERIOD

1} In  the  event  of  cancellation  or  non  renewal  of  this  Policy,  by  either  the  “Named  Insured”  or  the Company,  for  reasons  other  than  non-payment  of  premium  or  material  misrepresentation  in  the Application, you shall have the right to an Extended Reporting Period as follows:

(a}   Automatic Extended Reporting Period

Coverage  as  provided  under  this  Policy  shall  automatically  continue  for  a  period  of  sixty  (60}  days following the effective date of such cancellation or non renewal, but only with respect to “Claims” and “Wrongful Acts” committed before the effective date of such cancellation or non renewal.

Claims received during the prior policy term but reported one day after policy expiration have been denied by the renewal carrier (same insurer) because the claim was not reported in accordance with the Extended Reporting Period” provision since the policy was neither canceled nor non-renewed. Thus, if the policy is renewed, the insured must report even last-minute claims to the insurer prior to expiration. Such interpretation and denial completely ignores Condition VII – “Notice of ‘Claims.””

The Automatic Claim Reporting Extension and Confused Policy Language

Cut and paste” is a quick and expedient way for an insurance carrier to re-draft a policy to its own liking; but it helps to read the finished policy in its entirety once done creating it. A recently reviewed policy”s declaration page states:

  • “Notice of claim must be given no later than 60 days after such claim has been made”

Yet page one of the Coverage Section reads:

  • All coverage sections in Section I – Liability – cover claims first made during the policy period against the Insured alleging a .’wrongful act’ ..” (This is pure claims made wording.)

Going deeper into the form, the policy’s Condition Section requires:

  • “As a condition precedent to coverage under this policy, the insured shall give the Insurer written Notice of any claim as soon as practical after.. Become(ing) aware of such claim, but in no event later than 60 calendar days after the termination of the policy period..”

Such extended reporting language is usually found in a “claims made and reported” form.

This policy form is obviously a mix of “pure claims made” wording and “claims made and reported” form language. The problem created by such amalgamated wording is deciding which takes precedence and exactly when a claim MUST be reported to avoid denial for not meeting reporting requirements.

The Automatic Claim Reporting Extension and Convoluted Policy Language

How long does the insured have to file a claim considering the following policy language?

  1. Notice of “Claims”: As a condition precedent to coverage under this policy, the “Insured” shall provide written notice of any “Claim” made against any “Insured” as soon as practicable, but in no event later than the earlier of:

{a}  Thirty {30} days following receipt of written notice of the “Claim;” or

{b}  The later of the expiration date of this policy, the Automatic Extended Reporting Period or the optional Extended Reporting Period, if elected hereunder.

To answer the question, the policy and the claim-receipt scenario must be analyzed very closely. This is one of those “it depends” moments with the key phrase being “the earlier of…”

Assume, for example sake, that the policy renews January 1 and that the expiring policy has a 30-day automatic extended reporting period (aka “basic extended reporting period” (BERP)) with no Extended Reporting Period. If a claim is received on December 23, what is the date by which the insured must report the claim to avoid denial based on not meeting reporting requirements? January 22!

How is that date deduced? The form states that the insured must report the claim by the EARLIER of:

30 days from receipt or “the latter of” three dates. Looked at in comparison, the relative dates are:

  • 30 days from receipt – January 22; or
  • Expiration date – December 31;
  • Automatic Extended Reporting Period date – January 30; or
  • Extended Reporting Period date – not applicable.

The earlier of these two options is January 22 because the latest of the last three dates is January 30. In no event will the insured ever have more than 30 days to file the claim once it has been received; even if received during the supplemental extended reporting period (SERP).

The Automatic Claim Reporting Extension and Limited Extension Wording

The following  policy wording only gives the insured 60 additional days to report a claim if the claim was first made against the insured during the last 60 days of the policy period.

IX. NOTIFICATION

  1. In the event any Executive Officer becomes aware that a Claim has been made against any of the Insureds, the Insureds shall, as a condition precedent to their rights to payment under this Policy, give to Underwriters notice in writing of such Claim …..no later than the end of the Policy Period, in accordance with the requirements of the Optional Extension Period (if applicable}, or sixty (60} days after the expiration date of the Policy Period in the case of Claims first made against the Insured during the last sixty (60} days of the Policy Period.”

Agents and insureds cannot confuse this with the idea that the insured has a 60-day BERP. This provision avoids the penalization of an insured whose executive officer does not receive notice of a claim until near the end of the policy period.

The Automatic Claim Reporting Extension and Ridiculous Wording  

Some forms don’t give the insured any additional time after expiration to report claims made before expiration unless the policy is canceled or non-renewed.  The wording below really turns the policy into a 14 month policy; but again only if the current policy is canceled or non-renewed:

C. Extended Reporting Period:

  1. If we or you cancel or refuse to renew this policy for reasons other than non-payment of premium; we will provide to you a 60 day Automatic Extension of the coverage granted by this policy, at no additional charge, for any claim first made against you and reported to us during the 60 day extension period but only as respects wrongful acts committed after the Retroactive Date (if any) stated in the Declarations and prior to the date of cancellation or non- renewal.

How can agents and insureds protect themselves from such nonsense?!

It Gets Worse Before it Gets Better

One more problematic definition is left, the definition of a “claim.” Knowing what qualifies as a “claim” is the key for the agent and insured to know when to report an incident to the insurer. The next post provides a chart with eight different definitions of a “claim” to allow the reader to compare and contrast the differences among the carriers.

The series ends with three key recommendations for finding the best “claims made” policy for any client. Don’t miss tomorrow’s final installment.

REPRINTED WITH THE PERMISSION OF MyNewMarkets.com, An Insurance Journal Company.

The Prior and Pending Litigation Exclusion’s Convergence into Professional Liability Policies

This post is part 3 of a 5-part series authored by Fred Fisher. Check out the previous posts in this series here: Part 1  |  Part 2.

The Prior and Pending Litigation Exclusion’s Convergence into Professional Liability Policies

No one knows exactly when, but at some point, some senior executive liability underwriter must have moved to an errors and omissions division and discovered the professional liability policy contained no “continuity date” limitation. Errors and omissions underwriters soon began using the prior and pending litigation exclusion by endorsing the language onto the policy or inserting it into the policy’s exclusion section. The most often used exclusionary language read:

“.arising out of . from any claim, arbitration, mediation, litigation, administrative proceeding (including disciplinary and licensing}, bankruptcy or regulatory proceeding or investigation, pending as of or commenced prior to the inception date ..”

Some policies even went so far as to use language as limiting as:

“..arising out of .. from any claim, arbitration, mediation, litigation, administrative proceeding (including disciplinary and licensing}, bankruptcy or regulatory proceeding or investigation, pending as of or commenced prior to the first inception date ..”

“First inception date” was commonly a defined term in these policies. To clarify the extent of or limitation on coverage, the insured was required to go to the policy’s definition section. The definition may have read:

First inception date means the date set forth in Item “X” of the Declarations as the inception date of the first … Professional Liability Policy that (i} provides or provided the same or essentially the same coverage as this policy, and (ii} was issued by us or any other member company of XXXXXX  to the named insured or its predecessors and was continually renewed by us or any other XXXXX member company through the inception date of this policy; or such other date specified in Item “X” of the Declarations as such.

Some insurers hid similar limitations within their forms without disclosing the prior and pending limitation in the quote. This not only creates claims problems for insureds, it places agents’ and brokers’ errors and omissions policies in danger; possibly having to respond to an excluded claim.

Note also the conspicuous absence of the term “know n” from the prior and pending litigation wording. Even unknown  suits, administrative proceedings or other such matters would be excluded if they predate the prior and pending date. This potential gap is explored below.

Worse, errors and omissions underwriters, unlike executive liability underwriters, almost always made the prior and pending (continuity) date the same as the inception date of the first policy written with that insurer – even if there was prior coverage. Professional liability underwriters would not “back- date” the prior and pending litigation date, creating a potential coverage gap. This additional provision meant that the insured professional now had to satisfy four coverage triggers:

  1. The claim against the insured had to be first made during the policy term;
  2. The wrongful act had to take place subsequent to any retroactive date;
  3. The claim had to be reported to the insurance company during the policy term or any automatic extended reporting period; and
  4. The service of the suit must occur after the prior and pending litigation date; even if the insured had no knowledge that it is coming. If the “P/P date” is the inception date, this could cause problems.

The necessity of meeting all four requirements creates a subtle yet potentially devastating coverage gap. Even if the insured has continuous coverage with a many-year past retroactive date, the prior and pending litigation exclusion is absolute and does not require the insured to have actual knowledge that a suit was filed prior to the current policy’s inception for such action to be excluded from coverage. If a suit were filed the day before renewal, for example, but not received until after renewal, the prior and pending litigation date may act to exclude coverage for such suit even though the claim is made during the policy term, even if the insured was unaware of any act or error that may give rise to such a suit.

Basic extended reporting periods (BERP’s) were created to fill this gap. BERP language in the expiring, non-renewed policy generally allows the insured between 30 and 60 days (most common is 60) to report a “claim.” Such an extension should fill the gaps created by the above scenario, but it depends on the definition of a “claim.” If a “claim” is defined simply as a “demand for money or services,” then the suit might be covered by the prior policy under the BERP provision. If, however, the definition of a “claim” requires the notice of claim or service of suit be received during the policy period, then the claim may be denied by the prior carrier and will likely be denied by the new/current carrier.

Further, there is no chance for coverage from the prior carrier should the claim be submitted after the 30 or 60 days provided by the BERP-allowable extension. This scenario is likely if the insured submits the suit/claim to the current carrier and does not submit it to the prior carrier until denial of liability is received from the new carrier (which may take the entire extension period to receive).

The definition of a “claim” and the basic extended reporting period provisions govern whether or not such a coverage gap exists. A thorough understanding of terms and policy provisions is necessary before coverage is moved from one carrier to another if the prior and pending litigation date is advanced by the new carrier.

Thus far I have seen only three policy forms require the insured to have actual knowledge of a suit or administrative proceeding in order to be considered a “claim;” unlike the above example which only required the filing of a suit or proceeding. This, having actual knowledge, is the solution that would eliminate all potential gaps in coverage and make the form 100 percent consistent with the warranty contained in the application.

As obvious  as it seems to insert the word “known” into the definition, some carriers have taken a different path – backdating the prior and pending litigation date to match the prior acts date. While this fixes the coverage “gap” issue, it exacerbates and further highlights the problem created by not simply inserting the term “known.” There may be unintended consequences of backdating the prior and pending date without inserting the word “known;”including theoretically covering a claim scenario that could not possibly happen in the real world.

More problems are created when the professional liability underwriter and/or the agent is unaware that their policy contains a prior and pending exclusion that automatically advances to the renewal date at subsequent renewals.

Problems A ‘Plenty

Agents are well aware that incidents that may lead to claims should be reported to the carrier once there is knowledge of such incident. “Claims made” policies allow this and certain policy provisions require the reporting of such incidents.

However, the incident reporting provision has developed into a potential trap for the insured; a trap from which a claim denial is possible simply because an incident was not reported in the manner prescribed by the policy.

The next post details common incident reporting provisions and spotlights seven potential problems created by the policy wording. Proof once again that not all “claims made” policies are created equal; and each must be studied to assure there is no coverage gap.

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