Claim Assistance

The attorneys in LGWM’s Insurance Coverage Practice Group work directly with insurance claims analysts to provide outside claims handling assistance. In this capacity, our attorneys communicate directly with insureds, claimants, and counsel on behalf of the carrier to assist in obtaining full details of insurance claims that are relevant to assessing coverage and evaluating liability and assisting the carrier in setting reserves.

The LGWM coverage team often works closely with loss adjusters to ensure the legitimacy of insurance claims. We regularly interact with the insurance brokers who procured the coverage and the underwriters who underwrote the risk. Our attorneys provide valuable assistance in the resolution of insurance claims by gathering the necessary information to evaluate claim exposure and set indemnity and defense reserves, and then evaluate and negotiate potential settlements to ensure a fair settlement for the insurance company client.

Cases of Note

• Represented excess insurer in response to the reporting of potential claims against an insured investment management firm arising out of the Madoff Ponzi scheme. Analyzed coverage for claims subsequently made against the insured for alleged wrongful acts in failing to notify investors of the risks of investing in Madoff and various feeder funds.
• Advised insurer on coverage available for DOJ investigation of insured contractor for violation of the Fair Housing Act and Americans with Disabilities Act at multiple properties in the southeast U.S. over the course of 25 years. Analyzed multiple coverage issues including claim reporting and notice obligations, application of retroactive dates, insured status issues, and the impact of defense and settlement without insurer consent.
• Represented commercial general liability insurer in connection with a multimillion dollar construction defect claim asserted against insured product manufacturer, additional insured distributor and installer, and multiple other non-insured parties. Representation included analysis of trigger issues under Alabama, North Carolina, and Missouri law, evaluation of batch endorsements and resulting impact on self-insured retention obligations, and analysis of complex additional insured issues. Negotiated on behalf of client with insured and other carriers to ensure proper allocation of any defense or indemnity contribution ultimately made to resolve the claim.
• Advised insurer on coverage for insurance claims reported by insured international manufacturing company in response to SEC investigation of financial reporting practices and subsequent class actions filed against the insured in the U.S. and Canada. Representation involved analysis of the U.S. Securities Exchange Act and its Canadian counterpart, the Ontario Securities Act.
• Advised insurer on coverage implications for lawsuit against insured investment fund based on insured’s alleged involvement in a Ponzi scheme, which defrauded $50M in real estate assets from a single client. Negotiated favorable resolution of claim for insurer with insured contributing 30% of settlement payment to client from its own funds.
• Represented insurer in connection with an underlying lawsuit involving acquisition of a West Virginia coal mining operation. The insured was sued for various securities violations. Our coverage investigation revealed misrepresentations by the insured to the insurer, ultimately resulting in a successful disclaimer of coverage.
• Represented DO insurer in connection with claims resulting from the collapse of a failed casino project. Provided coverage advice to insurer under directors and officers liability and run off insurance policies following insured’s bankruptcy. Successfully negotiated a global settlement with the bankruptcy trustee.
• Advised insurer on complex insurance claim by insured financial services company after multiple claims were asserted against the insured by national banking institutions following the U.S. mortgage crisis. Identified and analyzed significant coverage issues including late reporting, trigger of prior policy years, interrelation, misrepresentation on insurance applications, and prior knowledge defenses. Represented insurer in subsequent coverage litigation and assisted insurer in negotiating favorable settlement.
• Counseled various insurers on commercial property coverage issues associated with hurricanes in the Gulf of Mexico.