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Expansion of Insurer Claw-Back Initiatives

By Meagan L. DeJohn and Paul A. Rose
July 27, 2010

A question routinely asked about liability insurance claims seems clear and straightforward on its face: “Is the claim covered?” Because “coverage,” however, typically invokes two concepts, rather than one, such a question often is superficial and misleading. Liability insurance policies, particularly at the primary and umbrella levels, usually provide both defense and indemnity coverage. Each coverage is quite valuable to policyholders, and the defense coverage can be the much more valuable of the two, particularly when underlying cases are complex and, accordingly, expensive to defend, but present little or no prospect of policyholder liability.

Of these two types of coverage, defense coverage also is widely understood to be the broader. In other words, a policy may provide defense coverage but, ultimately, no indemnity coverage. Such variances arise from the nature of “notice” pleading and the unpredictability of underlying litigation. Under “notice” pleading utilized in federal courts and most state courts, it often is difficult and sometimes impossible to discern with precision at the outset of litigation the full nature of all underlying claims against the policyholder. Even when such claims can be discerned with precision, it often is impossible to know at the outset which of the claims, if any, will be successful against the policyholder. When these factors all play out, it is common for insurers to have to pay defense costs but not indemnity costs. Hence, it is said that defense coverage is broader than indemnity coverage.

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