The Law

Legal Spotlight

A look at the latest legal cases impacting the industry.
By: | April 28, 2016 • 4 min read
You Be the Judge

Insurers Must Pay $58 Million

On sept. 12, 2008, a power plant unit owned by TransCanada Energy USA’s subsidiary TC Ravenswood in New York was taken out of service due to excessive vibrations. On Sept. 16, a crack in the unit’s rotor was discovered. The unit was out of action until May 18, 2009.

R5-16p14_LegalSpotlight.inddTransCanada filed a claim for $7 million in property damage and $50.8 million for loss of gross earnings from Factory Mutual Insurance Co., National Union Fire Insurance Co., ACE INA Insurance and Arch Insurance Co.

The insurers denied the claim.

In legal proceedings, the insurers argued the crack that damaged the unit formed before the policy went into effect on Aug. 26, 2008, and that the plant’s loss of sales were not covered because they were incurred after the period of liability ended.

National Union later settled.

TransCanada countered that the all risks policy covered the breakdown because the unit was operating properly when the policy began.

The New York Supreme Court ruled on March 2 that “it is irrelevant here whether the crack existed or could have been discovered before the policy commenced.” It also ruled for TransCanada on the loss of capacity revenue.

The losses, the court ruled, “were neither speculative nor incapable of being linked directly to the period of liability at issue.” &

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Scorecard: The insurance companies must pay TransCanada $58 million to cover its property damage and business interruption costs.

Takeaway: It was immaterial when the cause of the damage began as long as the property damage was sustained during the policy period.

Sophisticated Buyers of Coverage

Templo Fuente De Vida Corp. formed Fuente Properties in 2002 to acquire a property for a church and daycare centers.

Templo and Fuente (collectively Templo) received a funding commitment from Merl Financial Group Inc. (which later restructured and renamed itself First Independent Financial Group).

However, Templo had to terminate its purchase agreement when the funding did not materialize on the closing date. It filed suit against First Independent in February 2006.

On Aug. 28, 2006, First Independent gave notice of the claim to National Union, which had issued the company a $1 million directors, officers and private company liability policy.

Templo and several defendants, including First Independent, reached a settlement exceeding $3 million. First Independent assigned its rights under the National Union policy to Templo.

National Union denied coverage because of the delay in notifying them of the claim. On Feb. 11, the Supreme Court of New Jersey agreed with both a lower court and an appeals court, upholding the insurance company’s decision.

At issue was whether the insurance company had to establish it suffered prejudice by the late notice in a claims-made policy. For occurrence policies, the state has ruled that insurers must show they are prejudiced by late notice because many insureds are unsophisticated consumers.

For insureds under a claims-made policy, such as D&O, however, the court ruled insureds are sophisticated buyers of insurance. &

Scorecard: National Union will not have to contribute a share of a $3 million-plus settlement agreement.

Takeaway: New Jersey insureds with claims-made policies are treated as sophisticated consumers who are expected to comply with policy terms.

Ingredients for Dismissal

In July 2008, Wisconsin Pharmacal Co. placed an order with Nutritional Manufacturing to manufacture its Daily Probiotic Feminine Supplement chewable tablet, sold at a major retailer. The tablet was to contain Lactobacillus rhamnosus (LRA), a probiotic ingredient.

Nutritional Manufacturing ordered a supply of LRA from Nebraska Cultures of California Inc., which in turn ordered the LRA from Jeneil Biotech Inc.

After the tablets were manufactured and sold by Pharmacal, the retailer notified the company in April 2009 that the tablets contained Lactobillus acidophilus (LA) instead of LRA.

R5-16p14_LegalSpotlight.inddNutritional Manufacturing assigned its causes of action against Nebraska Cultures and Jeneil to Pharmacal, which filed suit against those companies on Jan. 14, 2011, along with their respective general liability insurers, Evanston Insurance Co. and The Netherlands Insurance Co.

In October 2011, a Wisconsin circuit court dismissed some of the allegations and held others in abeyance while it decided whether the insurers must defend and indemnify its insureds. The court ultimately granted the insurers’ request for summary judgment.

That decision was reversed by the court of appeals, which ruled the defective ingredient physically injured the other tablet ingredients, and that the claim was covered by the policies.

On March 1, the Supreme Court of Wisconsin reversed that decision, in a 3-2 ruling.

It ruled there was no property damage because the policies covered only products that caused damage to “property other than the product or completed work itself.” Because the LA ingredient was integrated into the tablet, it did not cause damage to “other property,” it ruled.

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In addition, it ruled, there was no “loss of use of tangible property” because a “reduction in value” of the tablets is not the same as “loss of use.” &

Scorecard: The insurance companies do not have to defend or indemnify Nebraska Cultures or Jeneil.

Takeaway: Blending all of the ingredients together into one tablet created one product.

Anne Freedman is managing editor of Risk & Insurance. She can be reached at [email protected]
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You Be the Judge

Did Broken Leg Arise Out of Employment?

An off-the-clock injury in extreme weather conditions raises questions of compensability.
By: | April 18, 2016 • 3 min read
You Be the Judge

A nursing house supervisor for Christus Schumpert Highland Hospital commuted to work from another city. Her duties included coordinating nursing services and taking calls from those who were unable to come to work. Her normal working hours were 4 p.m. until midnight.

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One afternoon while the supervisor was working, an ice storm rolled in. Many nurses were unable to report to work because of hazardous road conditions, and the hospital stopped accepting patients. A second supervisor arrived to relieve the supervisor after midnight but advised her that the parking lot was icy. The supervisor called hospital security but was told that they didn’t have much sand to treat the parking lot.

The supervisor clocked out at 1:40 a.m. but was unable to leave because the police had closed the roads. She decided to stay in the hospital until conditions improved, first lying on a couch in the waiting room and then trying to sleep in an unoccupied patient room, but she never really fell asleep.

The supervisor got up at 5 a.m., went to the nursing director’s office, and started answering the phone, but did not clock in. A third supervisor arrived to start her shift shortly after 8 a.m. and strongly advised the supervisor not to get on the roads.

The second supervisor offered to let the supervisor to stay at her house until the weather conditions improved, and the supervisor agreed. They exited the hospital and walked to the parking lot where they had parked, which was also open to the public. The second supervisor described the parking lot as “completely icy.”

Rather than going straight to the second supervisor’s vehicle, the supervisor detoured to her own car to drop off a bag she was carrying. She put the bag in her car and shut the door, but when she turned to go to the second supervisor’s car, she slipped on the ice and fell, breaking her leg and sustaining other injuries.

The supervisor filed a workers’ compensation claim, which the hospital denied. The workers’ compensation judge found that the injury was not compensable. The supervisor appealed.

Was the WCJ correct denying the supervisor’s claim?

  • A. No. The risk of injury from walking in the parking lot was greater for the supervisor than for other members of the public.
  • B. Yes. The ice storm was not the kind of condition that subjected the supervisor to any greater risk than the general public.
  • C. No. The supervisor’s presence at the hospital benefited her employer.

How the Court Ruled

A is incorrect. The court pointed out that the slip and fall occurred in a parking lot designated for employees but also open to the general public.

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C is incorrect. The court found that the supervisor was not benefiting the hospital’s business operation by placing her bag in her car before leaving with the second supervisor.

B is correct. In Lafitte-Nesom v. Christus Schumpert Highland, No. 50,496-WCA (La. Ct. App. 02/24/16), the Louisiana Court of Appeal held that the supervisor did not establish that her accident arose out of and in the course of her employment.

Although the hazard of slipping on ice was evident, the court found the ice storm was not the kind of condition that subjected an employee like the supervisor to any greater risk than the general public.

Editor’s note: This feature is not intended as instructional material or to replace legal advice.

Christina Lumbreras is a Legal Editor for Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]
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Sponsored: Berkshire Hathaway Specialty Insurance

Searching for Stability in Cyber Space

The dynamic cyber risk landscape demands a stable insurance carrier with a prudent approach and an eye on the long road.
By: | April 18, 2016 • 6 min read

SponsoredContent_BHSICyber risk affects every industry differently, but there’s one common denominator. No sector is safe.

As headline-grabbing breaches crack systems and tarnish reputations of major retail, healthcare and financial companies, the need for cyber insurance has become increasingly apparent.

Given the constantly changing nature of cyber risk and the market landscape, creating a stable, sustainable cyber insurance business demands a prudent approach, with an eye on the long road.

“We’ve seen carriers jump in and out, wanting to take advantage of a new opportunity, but perhaps underestimating the risk,” said Danielle Librizzi, Senior Vice President, Head of Professional Liability, Berkshire Hathaway Specialty Insurance (BHSI).

“As cyber exposure became more tangible to carriers, in-force coverage was tested and many made radical changes to pricing and availability of coverage. BHSI is committed to entering the cyber market in a thoughtful and sustainable way. We want to be there for our customers as the risks continue to evolve.”

Diverse, Evolving Risks

Danielle Librizzi, Senior Vice President, Head of Professional Liability, Berkshire Hathaway Specialty Insurance

Danielle Librizzi, Senior Vice President, Head of Professional Liability, Berkshire Hathaway Specialty Insurance

Cyber exposure – and coverage — have been evolving, posing different risks and underwriting challenges for different industries. The technology, financial services and healthcare industries illustrate the diverse issues that must be considered in order to provide effective, financially sustainable cyber solutions.

The technology sector was the first cyber battleground, and technology E&O forms included some cyber coverage by virtue of the nature of the risk. “There’s inherent cyber coverage for third party liabilities in E&O,” Librizzi said.

While coverage is widely available, tech companies pose challenges to underwriters because of their unique position in the cyber “supply chain.” These companies provide software, hardware and cloud services; virtually every organization in the world is dependent on a tech provider of some stripe. If an insurer is covering both the provider and its clients, the aggregate risk should be monitored closely.

Think of a DOS attack on a cloud provider that prevents all of its clients – which could include anyone from a bank to a retailer or transportation company — from accessing stored customer or corporate data or running cloud-based service apps. That single attack could bring business in multiple industries to a grinding halt, potentially causing business interruption and E&O losses.

SponsoredContent_BHSIThe tech industry hasn’t seen a large scale event like this yet, but it isn’t waiting around for one to strike before addressing the underlying risk. Controlling and accounting for the aggregate exposure will mold the direction that coverage development takes.

“Our combined form, introduced in October, 2015, is a comprehensive solution that includes first and third party cyber coverage as well as traditional E&O coverage,” Librizzi said.

However, that approach may not be appropriate for other industries. Financial Institutions, for example, may seek a dedicated cyber only policy which does not include traditional E&O coverage.

While banks typically have strong protocols for network security and privacy, they also have a much greater exposure in massive stores of customer data. Financial Institutions are looking to address liability in the form of class action lawsuits or heavy regulatory investigations and fines emanating from cyber, and may not want to compromise their traditional E&O limits.

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“Additionally, given the increased reliance on outsourced providers for technology solutions, we have started to see the introduction of sub-limited coverage for dependent business interruption and payment card industry (PCI) fines and assessments as enhancements to coverage,” Librizzi said. “We might see those sub-limits go to full coverage as competition gets heavier.”

Other industries, which may not be as advanced as financial institutions in addressing cyber threats, have suffered more from a lack of robust cyber coverage that can keep up with increasing exposure.

Healthcare, for example, has seen a surge of cyber attacks since hospitals and other health systems went electronic. To a hacker, healthcare providers represent a warehouse of valuable personal identifiable and protected health information.

SponsoredContent_BHSIEmail addresses from healthcare systems typically are white-listed and less likely to get caught in a spam filter, giving hackers incentive to obtain access and gain control of a healthcare provider’s network in order to launch phishing attacks.

After some high-profile breaches in 2015, Human Health Services and the Office for Civil Rights came under scrutiny for not doing enough enforcement of HIPPA. Fines imposed by regulators increased dramatically over the past decade, and seem poised to only get higher.

“They’ll be ramping up enforcement of regulations in 2016, and that’s only a peek of what’s on the horizon,” Librizzi said.

The burgeoning of healthcare’s cyber exposure has challenged the insurance industry to better understand the nature of the risk and how best to secure hospital systems. Coverage for this sector remains the most difficult to write effectively.

BHSI understands the need for different customers to have different solutions. Some customers desire a dedicated cyber policy that does not include traditional E&O coverage. BHSI’s Network Security and Privacy stand-alone policy is designed to address the needs to those customers.

“The cyber exposures and coverages needs of healthcare, financial services and technology are on different timelines and will look very different in the future,” Librizzi said.

Even in more mature markets, the conflation of commercial and personal cyber risk will challenge insurers going forward. Most existing cyber products don’t cover property damage and personal injury; as the risks emerge and the Internet of Things becomes more pervasive, the coverage will have to evolve as well.

“We must always be thinking about what is on the horizon from a risk and coverage perspective – our technology driven society demands it,” Librizzi said.

Anticipating challenges and adapting to each industry’s needs has been a cornerstone of BHSI’s approach to cyber. It’s careful and measured approach has also helped the specialty insurer build an arsenal of experts and ancillary services to help clients better grasp and mitigate their exposure.

“We know the importance of really understanding the risk and communicating it clearly to our customers,” Librizzi said. “We don’t bury our coverage in a pile of definitions, and we provide the expertise to help insureds stay ahead of the next big breach.”

To learn more about BHSI’s professional liability products, visit http://www.bhspecialty.com/.

Berkshire Hathaway Specialty Insurance (www.bhspecialty.com) provides commercial property, casualty, healthcare professional liability, executive and professional lines, surety, travel, programs, medical stop loss and homeowners insurance. The actual and final terms of coverage for all product lines may vary. It underwrites on the paper of Berkshire Hathaway’s National Indemnity group of insurance companies, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor’s. Based in Boston, Berkshire Hathaway Specialty Insurance has offices in Atlanta, Boston, Chicago, Fort Lauderdale, Houston, Los Angeles, New York, San Francisco, San Ramon, Stevens Point, Auckland, Brisbane, Hong Kong, Melbourne, Singapore, Sydney and Toronto. For more information, contact [email protected].

The information contained herein is for general informational purposes only and does not constitute an offer to sell or a solicitation of an offer to buy any product or service. Any description set forth herein does not include all policy terms, conditions and exclusions. Please refer to the actual policy for complete details of coverage and exclusions.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Berkshire Hathaway Specialty Insurance. The editorial staff of Risk & Insurance had no role in its preparation.




Berkshire Hathaway Specialty Insurance (www.bhspecialty.com) provides commercial property, casualty, healthcare professional liability, executive and professional lines, surety, travel, programs, medical stop loss and homeowners insurance.
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