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Directors and Officers Insurance and COVID-19: Future Exclusions with Retroactive Application

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Covid-19 and Insurance

Part of the book series: AIDA Europe Research Series on Insurance Law and Regulation ((ERSILR,volume 7))

  • 188 Accesses

Abstract

The claims-made clause is often not understood by policyholders in general and consumers in particular. Aggravating this situation is the fact that some insurance companies have incorporated an exclusion of future coverage with retroactive application. We understand that said clauses are abusive and absolutely null and void since they violate fundamental legal principles and—among others—reasonable expectations, transparency, and good faith.

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Notes

  1. 1.

    Sobrino (2018), pp. 1675–1795.

  2. 2.

    Muñoz Paredes (2021), p. 167.

  3. 3.

    Sobrino-Gava-Cerda (2021a), pp. 647–691.

  4. 4.

    Sobrino (2020b), pp. 397–439.

  5. 5.

    Guertin (2020).

  6. 6.

    Welch and McDonald (2020).

  7. 7.

    Sobrino (2018), pp. 1235–1304.

  8. 8.

    Sobrino-Gava-Cerda (2021a), pp. 674–691.

  9. 9.

    Yzquierdo Tolsada (1999), p. 229, noted: the “claims-made” clause is about “a legal outrage,” adding that it is “a trap created by insurers that endangers the civil liability insurance institution itself”.

  10. 10.

    Sobrino (2020b), pp. 397–439.

  11. 11.

    Keeton and Widiss (1988) noted: “this insurance applies to ‘bodily injury’ and ‘property damage’ only if a claim for damages because of the ‘bodily injury’ or ‘property damage’ is first made against any insured during the policy period”.

  12. 12.

    Jerry II (1987), p. 287, explains: “claims made policies provide coverage if the act or neglect is discovered and brought to the insurer's attention during the policy's term, regardless of when the act occurred”.

  13. 13.

    Sobrino (2018), p. 1255.

  14. 14.

    Sobrino (2018), p. 1257.

  15. 15.

    Kafka (2001).

  16. 16.

    Sobrino (2009), p. 1.

  17. 17.

    Passannante and Gold (2015) explains that it is essential that the Directors & Officers Insurance Policy have the highest possible retroactivity, highlighting that the insurance “may have a ‘retroactive date’ or a ‘prior and pending litigation “date”.

  18. 18.

    Sobrino-Gava-Cerda (2021a), p. 654.

  19. 19.

    Hans (2015) explains: where, taking into account the experience and the problems of these issues, regarding the doubts regarding whether to make the Preventive Complaint, the suggestion is “when doubt … notify”.

  20. 20.

    Gauntlett (2017), p. 26, who states that “sometimes risk and insurance professionals are reluctant to give notice to insurers of potential business litigation lawsuit when it isn’t clear that the event is covered under their policies or in fear that future premiums will be adversely affected”. But, despite this, it explains the great importance of notifying the loss or an event that may lead to a claim, as soon as possible.

  21. 21.

    Sobrino-Gava-Cerda (2021a), p. 658.

  22. 22.

    Sobrino-Gava-Cerda (2021a), p. 660.

  23. 23.

    Sobrino (2018), p. 1759.

  24. 24.

    Miranda Serrano (2017), p. 49.

  25. 25.

    Sobrino-Gava-Cerda (2021a), p. 656.

  26. 26.

    Sobrino (2018), p. 1759.

  27. 27.

    See: https://www.weforum.org/reports/the-global-risks-report-2020.

  28. 28.

    See: https://www3.weforum.org/docs/WEF%20HGHI_Outbreak_Readiness_Business_Impact.pdf.

  29. 29.

    Taleb (2016).

  30. 30.

    Preve (2020).

  31. 31.

    Harckham (2020).

  32. 32.

    Reuhs (2020).

  33. 33.

    Moraes Miranda et al. (2021), p. 143.

  34. 34.

    Veiga Copo (2020a), p. 484.

  35. 35.

    Lacroix (2020).

  36. 36.

    Healy et al. (2020).

  37. 37.

    Regarding Malpractice Insurance, it should be noted that some Argentine Insurance Companies (such as S.M.G.; Sancor, etc.) issued separate statements indicating that the damages related to the coronavirus had insurance coverage.

  38. 38.

    Muñoz Paredes (2021), p. 167.

  39. 39.

    Dobbyn and French (2016), p. 228.

  40. 40.

    Sobrino-Gava-Cerda (2021b), p. 8.

  41. 41.

    Sobrino (2018), pp. 1691–1795.

  42. 42.

    Stiglitz (2008) p. 253.

  43. 43.

    Keeton and Widiss (1988), p. 46.

  44. 44.

    Browne (1961).

  45. 45.

    Tabares Cortez (2020), pp. 145–170.

  46. 46.

    See Dictionary of Insurance Terms (2000), “All Risk” page 24, where it is explained that “All Risk insurance that covers each and every loss except for those specifically excluded. If the insurance company does not specifically exclude a particular loss, it is automatically covered”.

  47. 47.

    Sobrino-Gava-Cerda (2021b), pp. 461–467.

  48. 48.

    Bataller Grau (2017), pp. 109–129.

  49. 49.

    See Conference by Waldo Sobrino, dated November 17, 1999, on the topic: “Medical Liability Insurance. Coverages. The ‘Claims Made’ Clause: analysis of its validity. The discussion on the exclusion clauses derived from the ‘Y2K’ (‘Millennium Bug’)”, in the Postgraduate Training Conference “Malpractice and Medical Responsibility”, organized by the ‘Master Group Argentina’, at the Argenta Convention Center Tower Buenos Aires, Argentina.

  50. 50.

    Sobrino (1999).

  51. 51.

    Sobrino (2003), p. 48.

  52. 52.

    Sobrino (2018), p. 1703.

  53. 53.

    Guertin (2020).

  54. 54.

    Sun Tzu (2012).

  55. 55.

    Wolf (2020) consider providing “Notice of Circumstance”, where it states that “businesses should be aware that in similar contexts, where the prior claims-made policy (without an exclusion) generally covers only claims ‘made’ and noticed to the insurer before the policy expires, the newly purchased policy expressly excludes certain claims, and such claims are filed against the business during the new policy period, insurers often deny coverage under both the old and new policies”.

  56. 56.

    Sobrino-Gava-Cerda (2021a), pp. 647–691.

  57. 57.

    Welch and McDonald (2020).

  58. 58.

    Fuller (1991).

  59. 59.

    Sobrino (2018), pp. 1691–1795.

  60. 60.

    Sanchez Calero (2001).

  61. 61.

    Sobrino (2018), p 1703.

  62. 62.

    Shina (2019), p. 76.

  63. 63.

    Harari (2018), p. 258.

  64. 64.

    Kahneman (2018).

  65. 65.

    Akerlof and Shiller (2016).

  66. 66.

    Thaler and Sunstein (2018), p. 21.

  67. 67.

    Thaler (2017).

  68. 68.

    Kahneman (2018).

  69. 69.

    Shina (2021).

  70. 70.

    Nader (2016), p. 70, who teaches that “… even law Professors have admitted they often do not read the fine print of some contracts when they purchase goods and services, because it is futile to try to make any changes…”.

  71. 71.

    French (2016), pp. 537–538 where it explains that insurance policies are received long after they have started to be paid, adding “then, if and when the purchaser receive a copy, most do not read it , and even if they did, they could not understand it due to its length, structure, and complexity” (so if the buyer receives a copy, most don’t read it, and even if they did, they couldn’t understand it due to its length, structure and complexity).

  72. 72.

    Sobrino (2018), p. 1703.

  73. 73.

    Radin (2013), p. 12.

  74. 74.

    Sobrino (2020a), p. 41.

  75. 75.

    Nietzsche (2020).

  76. 76.

    Sobrino (2017), p. 1.

  77. 77.

    Émérigon (1828), p. 53.

  78. 78.

    Veiga Copo (2020b), pp. 130–149.

  79. 79.

    Muñoz Paredes (2020a).

  80. 80.

    Sobrino (2021c), p. 45.

  81. 81.

    Sobrino (2021d), p. 1.

  82. 82.

    Lopez Oneto (2021), p. 105.

  83. 83.

    Sobrino (2021d), p. 1.

  84. 84.

    Muñoz Paredes (2020b), p. 141.

  85. 85.

    Veiga Copo (2020b), pp. 130–149.

  86. 86.

    Sobrino (2021e).

  87. 87.

    Sobrino (2021e), pp. 419–441.

  88. 88.

    Sobrino-Gava-Cerda (2021a), pp. 90–151.

  89. 89.

    Sobrino-Gava-Cerda (2021a), p. 344.

  90. 90.

    Halperin (1970), p. 9, where the brilliant creator of the Insurance Law, more than fifty years ago already highlighted the importance of the “reasonable beliefs” (that is, what we now call “reasonable expectations”) of the insured.

  91. 91.

    Veiga Copo (2012), p. 136 where it explains that it is essential that the “clauses respond to the legitimate expectations” of the insured.

  92. 92.

    Sobrino (2020a), p. 51.

  93. 93.

    Keeton and Widiss (1988), p. 627. Jerry II (1987), p. 106.

    Donnelly and Brown (2014), p. 177, where the judgment is cited “Brissette vs. Westbury Life Insurance Company” , where it is established “generally, the aim of that doctrine is to make certain that insurance policies provide the coverage which the insured can reasonably expect to receive.

  94. 94.

    Sobrino (2018), p. 65.

  95. 95.

    Anderson et al. (2015), pp. 2–19, where in relation to the doctrine of “Reasonable Expectations” it is stated that “In 1970, Professor Keeton formulated that doctrine as follows: ‘the objectively reasonable expectations of applicants and intended beneficiaries regarding the terms of insurance contracts will be honored even though painstacking study of the policy provisions would have negated those expectations’”.

    Jordan (2007), p. 324, where it is held that when the doctrine of reasonable expectations of the insured is applied, the Courts must honor and follow the guidelines of the objective that the insured had, according to their reasonable expectations, beyond of the terms of the insurance contract, despite a careful study of the pressures of the policy denying said expectations.

    Dobbyn (1993), p. 96.

    Swedloff (2020), p. 2051.

  96. 96.

    Kafka (2001).

  97. 97.

    Sobrino (2009), p. 1.

  98. 98.

    Miranda Serrano (2017), pp. 45–48.

  99. 99.

    Martinez Muñoz (2020), p. 570.

  100. 100.

    Veiga Copo (2012), p. 234.

  101. 101.

    Medina Magallanes (2011), p. 22, where the outstanding Mexican doctrinaire teaches, which should be called “exquisite good faith -uberrimae bona fidei-”.

  102. 102.

    Emerson (2015), who teaches that “Insurers must act in good faith. Failure to do so (e.g. denying a legitimate claim) is an act of ‘bad faith’, that must lead a liability for compensatory and punitive damages”.

  103. 103.

    Downs and Murphy (2007), pp. 6–7.

  104. 104.

    Borges (2000), p. 141.

  105. 105.

    Novetsky and Schiffer (2014), p. 11 where they determine that “the duty of utmost good faith goes beyond the traditional duty of good faith and fair dealing implicit in every contract”, published at irmi.com, 2014.

  106. 106.

    Sobrino-Gava-Cerda (2021a), pp. 647–691.

  107. 107.

    Guertin (2020).

  108. 108.

    In Argentina, the “Retroactive Coverage Exclusion Clause” is an abusive clause for violating Art. 42 of the National Constitution; International Human Rights Treaties (Art. 75, subsection 22 of the Magna Carta), Arts. 1094, 1118, 1119, 1743, 9, 10 and concordant with the Civil and Commercial Code of the Nation; Article 37 of the Consumer Defense Law; the Arts. 109, 59, 118, 158 and complementary to the Insurance Law; Art. 25 of Law 20.091, etc.

  109. 109.

    We recall that Resolution No. 585/17 of the Superintendency of Insurance of the Nation (Argentina), ordered the mandatory application of an Extended Period of Notifications of three (3) years, automatically, without conditions and without additional premium cost, in such a way that the insured, with all logic and foundation, may successfully require that the text of the 2020 Policy be applied (which did not have the Covid-19 exclusion), as a consequence of the Extended Period of Notifications (Resolution No. 585), which is fully current and applicable (requiring that the text of the Policy for the year 2021 not be applied, in the event that it includes the ‘Retroactive Coverage Exclusion Clause’).

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  1. Facultad de Derecho, Universidad de Buenos Aires, Buenos Aires, Argentina

    Waldo Sobrino

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  1. Waldo Sobrino
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Correspondence to Waldo Sobrino .

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Editors and Affiliations

  1. Department of Private and Commercial Law, University of Oviedo, Oviedo, Spain

    María Luisa Muñoz Paredes

  2. Łyszkiewicz Tarasiuk Kancelaria Radców Prawnych sp.p., Warsaw, Poland

    Anna Tarasiuk

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  • In Argentina, the “Retroactive Coverage Exclusion Clause” is an abusive clause for violating Art. 42 of the National Constitution; International Human Rights Treaties (Art. 75, subsection 22 of the Magna Carta), Arts. 1094, 1118, 1119, 1743, 9, 10 and concordant with the Civil and Commercial Code of the Nation; Article 37 of the Consumer Defense Law; the Arts. 109, 59, 118, 158 and complementary to the Insurance Law; Art. 25 of Law 20.091, etc.

  • We recall that Resolution No. 585/17 of the Superintendency of Insurance of the Nation (Argentina), ordered the mandatory application of an Extended Period of Notification of three (3) years, automatically, without conditions and without additional premium cost, in such a way that the insured, with all logic and foundation, may successfully require that the text of the 2020 Policy be applied (which did not have the Covid-19 exclusion), as a consequence of the Extended Period of Notification (Resolution No. 585), which is fully current and applicable (requiring that the text of the Policy for the year 2021 not be applied, in the event that it includes the ‘Retroactive Coverage Exclusion Clause’)

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Sobrino, W. (2023). Directors and Officers Insurance and COVID-19: Future Exclusions with Retroactive Application. In: Muñoz Paredes, M.L., Tarasiuk, A. (eds) Covid-19 and Insurance. AIDA Europe Research Series on Insurance Law and Regulation, vol 7. Springer, Cham. https://doi.org/10.1007/978-3-031-13753-2_12

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  • DOI: https://doi.org/10.1007/978-3-031-13753-2_12

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  • Online ISBN: 978-3-031-13753-2

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