Prejudice Not Required for Claims Made Policy

Published: May 5, 2023, 4:40 p.m.

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Two Years Is Not "As Soon as Practical"\\n\\nPlaintiff appealed the trial court order granting summary disposition in\\n defendant\'s favor (no genuine issue of material fact) and the trial \\ncourt order granting in part and denying in part defendant\'s motion for \\ncosts and attorney fees. Defendant cross appeals the trial court order \\ngranting in part and denying in part its motion for costs and attorney \\nfees.\\n\\nIn Maple Manor Rehabilitation Center, LLC v. Evanston Insurance Company,\\n No. 359147, Court of Appeals of Michigan (April 27, 2023) resolved the \\ndisputes.\\n\\nFACTS\\n\\nDorothy Irvine, 88 years old, was admitted to plaintiff, Maple Manor \\nRehabilitation Center ("Maple Manor"), on November 25, 2014, after a \\nhospital stay. On or about December 11, 2014, she was found lying on the\\n floor at the rehabilitation center.\\n\\nShe passed away at the Hospital on December 16, 2014. \\n\\nOn June 7, 2019, Maple Manor reported the Irvine lawsuit to it broker. \\nOn June 12, 2019, defendant denied the request, stating it was not \\nnotified of the claim in a timely manner as required by the insurance \\npolicy.\\n\\nMaple Manor then filed a complaint against the defendant for breach of \\ncontract.\\n\\nDefendant thereafter moved for attorney fees in the amount of $26,581.60\\n plus costs in the amount of $491.20, based primarily on its assertion \\nthat Maple Manor\'s lawsuit was frivolous. T\\n\\nSUMMARY DISPOSITION\\n\\nMaple Manor made a conscious, deliberate decision not to inform \\ndefendant of the Irvine lawsuit until June 7, 2019. It was not by \\naccident, oversight, mistake, inadvertence, or belief that it did not \\nhave coverage.\\n\\nPrejudice to the insurer is a material element in determining whether \\nnotice is reasonably given, and the burden is on the insurer to \\ndemonstrate prejudice. However, that principle developed in the context \\nof "occurrence" insurance policies not a claims made policy.\\n\\nThe delay in giving notice here was approximately two years and delays \\nof far less have been found to be prima facie failure to give notice as \\nsoon as practicable. \\n\\nCONCLUSION\\n\\nThe Court of \\nAppeals concluded that the trial court did not err in finding that there\\n was no material questions of fact on these issues and that the \\ndefendant was thus entitled to summary disposition.\\n\\nThe purpose of imposing sanctions for asserting frivolous claims is to \\ndeter parties and attorneys from filing documents or asserting claims \\nand defenses that have not been sufficiently investigated and researched\\n or that are intended to serve an improper purpose.\\n\\nThe grant of summary disposition was affirmed. The trial court\'s order \\nawarding only part of defendant\'s requested attorney fees was reversed \\nand the case was remanded for entry of an order awarding defendant all \\nof its requested attorney fees.\\n\\nZALMA OPINION\\n\\nMaple Manor was its own worst enemy. It paid for insurance to cover the \\nIrvine lawsuit but decided to retain its own lawyers to defend the suit \\nwithout advising its insurer that the lawsuit existed. It then lied when\\n trying, belatedly, to get coverage although its first report to the \\ninsurer was almost two years after the suit was served and almost a year\\n after they cancelled the claims made policy. The report was not made \\nduring the effective dates of the policy, not as soon as reasonably \\npractical, and the suit it filed was frivolous requiring it to pay the \\ninsurer\'s legal fees.\\n\\n(c) 2023 Barry Zalma & ClaimSchool, Inc.\\n\\nSubscribe and receive videos limited to subscribers of Excellence in \\nClaims Handling at locals.com https://zalmaoninsurance.locals.com/subscribe.\\n\\nConsider subscribing to my publications at substack at https://barryzalma.substack.com/publish/post/107007808\\n\\nBarry Zalma, Esq is available at\\xa0http://www.zalma.com \\nand\\xa0zalma@zalma.com\\n\\nFollow me on LinkedIn: \\nwww.linkedin.com/comm/mynetwork/discovery-see-all?usecase=PEOPLE_FOLLOWS&followMember=barry-zalma-esq-cfe-a6b5257

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