J. NORMAN STARK, ATTORNEY-AT-LAW
Business and Corporate
Counsel, Business and corporate
startup, acquisition, operations, management, facilities, law,
architecture / engineering management.
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Policies of insurance may actually contain provisions for specific exclusions
from coverage, including reservation of rights. Some of these exclusions
may be, among others, for "Acts of God," or "intentional
acts," of the insured. And, under the facts of any claim, where the
insured is sued, if an exclusion clearly applies, the insurer may also
deny coverage and may even refuse to provide any legal defense.
In the complex business chain and commerce, beginning with the basic raw
materials supplier, and extending to the final sale to the end user, where
the facts and evidence point to intentional, or negligent acts of the
insured, resulting in loss, damage, or harm, the insurer may invoke specific
exclusions to coverage. Where the insured is sued, and it is not readily
apparent to the insurer whether or not one or more of the policy exclusions
apply, the insurer may retain and provide legal defense counsel, but must
do so with a "reservation of rights" notification letter, whereby
the insurer may deny coverage and even discontinue the legal defense,
after it becomes apparent that, under the policy terms, an exclusion from
coverage applies, whereby the insurer has no duty to defend or pay the
claim. The insured may be left with little recourse, and all of the liability!
Insurers may, by contract, agree to defend its insured, and may do so
in good faith under the policy, without waiving its right to assert, even
at a later date, the policy defenses it believes it has, provided that
it gives its insured timely, written notice of any reservation of rights
being asserted.
Without timely, written notification to its insured, the insurance company
will have been deemed to have waived its right to deny coverage. The reservation
of rights is a necessary action to avoiding a claim of waiver or estoppel,
i.e., whereby the insured claims reliance upon the insurer’s defense
and its failure to provide coverage, all to his detriment, by failing
to timely advise of the right to retain his own legal counsel.
The failure of the insurer to reserve its right to deny coverage was clearly
dealt with in Socony-Vacuum Oil Co. v. Continental Cas. Co. (App.1944),
45 Ohio Law Abs. 458, where the insurer, without reserving its rights,
provided a defense to its insured for approximately one year before it
denied liability and withdrew its defense. The insured hired an attorney,
and the plaintiff subsequently dismissed its complaint. The insured then
sued the insurer for its attorney fees. The Court of Appeals concluded
that, by representing the insured for a year without a reservation of
rights, the insurer had waived any right under the policy to challenge
coverage. On appeal to the Ohio Supreme Court, the Court noted that estoppel
could operate in proceedings to compel an insurer to pay a judgment recovered
in a damage suit in which the insurer had provided a defense without a
reservation of rights.
Purchasers of insurance coverage must ascertain that all reasonably foreseeable
risks are covered under the terms of their insurance policy. Then, when
a reservation of rights, or denial of coverage is received, the insured
must be prepared to select and retain experienced legal counsel, to mount
a good defense and an aggressive offense, including timely assertion of
all potential claims against the insurer, for bad faith refusal of coverage
and full indemnification of the insured under the policy terms and limits.
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Author: J. NORMAN STARK is an Attorney-at-Law, a
Registered Architect, (AIA, NCARB) Registered Landscape Architect, Interior
Designer, Planner and Senior Appraiser (ASA), admitted to practice law before
the Bar of Ohio, the US District Courts, Ohio and Illinois (Central Dist.),
the US Court of Appeals, and the United States Supreme Court. He has had
experience in business, Construction, Real Property, Litigation and Construction-Legal
Project and Crisis Management.
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