Claims

What is a “claim”? There are variances from one insurance company to another, as you can see in the following excerpts from several policies. Note that, in only one instance, is there a requirement that it be written. The definition becomes more expansive when we add “potential” claims or “circumstances” that may give rise to a claim.
Claim means:

“A demand for money or services; a civil proceeding commenced by service of a complaint or similar pleading; or a written request to toll or waive a statute of limitations relating to a potential civil or administrative proceeding, against any Insured for a Wrongful Act.”

“Wrongful Act means any actual or alleged act, error, omission, or Personal Injury Offense in the rendering of, or failure to render, Professional Services; or Network and Information Security Offense, by any Insured, or by any person or entity, including any joint venture, for whom the Insured is legally liable.”

Travelers

“A demand received by the Insured for money or services and which alleges a Wrongful Act.
Claim(s) includes but is not limited to lawsuits, petitions, arbitrations or other alternative dispute
resolution requests filed against the Insured.”

“Wrongful Act means a negligent act, error, or omission, in the performance of Professional Services by an Insured or any person or entity for which the Insured is legally liable. Wrongful Act also means an act, error or omission in the performance of Professional Services by an Insured or any person or entity for which the Insured is legally liable and that results in Personal Injury.”

RLI

“A demand for money or services, naming the Insured and alleging a wrongful act or pollution
incident.”

“Wrongful act means an error, omission, or other act that causes liability in the performance of professional services for others by the Insured or by any person or entity, including joint ventures, for whom the Insured is liable. A wrongful act cannot arise from dishonest, fraudulent, malicious, or criminal conduct committed by the Insured or at the Insured’s direction or with the Insured’s prior knowledge.”

CNA

“A written demand or suit you receive alleging a Wrongful Act(s) arising from your professional services.”

“ Wrongful act(s) means any actual or alleged negligent act, error or omission committed in the course of your professional services for others by you or by any other entity or joint venture for which you are legally liable in the course of rendering your professional services.”

Hanover

That is why we suggest that you call or contact us as soon as you are confronted by an actual or suspected claim. We can discuss the required course of action, notify the carrier and follow up to make sure there is a timely response once it is reported.

A formal service of suit leaves no doubt in your mind, but a phone call from a frustrated Owner, Contractor or fellow Design Professional may not be quite as apparent. In the instance of a formal service of suit, it is imperative that the insurance company be notified immediately since there is a specified period of time in which a response it expected before you are judged to be in default. The frustrated phone call may be a warning sign that action must be taken to prevent deterioration of a situation or condition. A timely call or e-mail to a claim representative for pre-claim assistance frequently results in a favorable resolution in lieu of a protracted legal battle. The claim representative can work with you behind the scenes, either directly or through legal counsel paid for by the carrier, to help you document your file or guide you as you respond to inquiries or demands from other parties involved in the project.

The Insurance carrier reserves the right to appoint legal counsel when that becomes necessary; but, if you have a preference, most are willing to honor your request as long as there are no conflicts and the experience level and hourly rates meet their guidelines. Once appointed, the attorney’s legal and ethical obligations are to you, his/her client, not the insurance carrier. In the interest of maintaining attorney/client privilege, once the attorney is assigned, we are not privy to many of the details of the case; but will periodically discuss the general progress with you, the attorney or claims representative, especially as we approach policy renewal time. In order to effectively negotiate favorable renewal terms with underwriters, we must be familiar with the legal theories being advanced against you and the corresponding defenses being constructed on your behalf by legal counsel.