Download
what to do with the indefensible e o claim n.
Skip this Video
Loading SlideShow in 5 Seconds..
What To Do With The Indefensible E&O Claim PowerPoint Presentation
Download Presentation
What To Do With The Indefensible E&O Claim

What To Do With The Indefensible E&O Claim

65 Vues Download Presentation
Télécharger la présentation

What To Do With The Indefensible E&O Claim

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. What To Do With TheIndefensible E&O Claim

  2. MODERATOR: Peter J. Biging, Esq., Partner, Lewis Brisbois Bisgaard & Smith LLP PANELISTS: Jean Clark Bates, RN, BSN, MPPM, Vice President, Claims, Professional Risk Management Services, Inc. Shauna Martin Ehlert, Esq., Member, Cozen O’Connor William Jackson, MBA, JD, Senior Director, Lancer Claims Services Devina Joiner, Esq., Vice President, Professional Liability Claims, Mutual Marine Office, Inc. What To Do With TheIndefensible E&O Claim

  3. Overview • Identifying and Defining the Indefensible Claim • Strategies to Employ in Responding • Obstacles, Collateral Concerns, Ethical Issues • Marrying Art and Science • Takeaways • Q&A

  4. Identifying and Defining the Indefensible Claim When is a claim “indefensible”? How do you identify it? What can be done to ensure that it is identified as early as possible?

  5. Hopeless? WILL                      (to HENSLOWE)                  We are lost.                             HENSLOWE                  No, it will turn out well.                             WILL                  How will it?                             HENSLOWE                  I don't know, it's a mystery.

  6. Defining Features • Clear – cut, indisputable liability on the facts and the law • There are “smoking gun” documents • The Defendant has confessed liability • The case is theoretically defensible, but: • Defendant’s story simply does not add up • The Defendant has made prior sworn statements compromising his/her defense position • Defendant or Defendant’s principal is thoroughly unlikable and/or lacks personal credibility • Defendant will be unable to assist in his defense (e.g., deceased, mentally incompetent)

  7. Defining Features Cont’d • The legal rationale underpinning the defense is tenuous, at best • Although tangential to critical issues, Defendant or a critical defense witness has engaged in outrageous conduct • The Defendant corporation’s principal is under indictment or criminal investigation and won’t attest to anything or testify under oath

  8. Defining Features Cont’d • Other Factors Raise Red Flags or Pose Substantial Obstacles: • The case is a high profile news story, being portrayed in the media with extraordinary negativity • Defendant is pressing adamantly for settlement at any cost • Attorney’s fees are recoverable, and they could be expected to potentially dwarf any realistic exposure • There is discoverable information with the potential to exponentially increase the exposure faced if discovery proceeds • Your instincts just tell you this case is trouble

  9. Strategies to Employ in Responding • What to do? • What are the options • How do you take a case that walks in the door “indefensible” and deal with it intelligently, creatively, responsibly, ethically and cost-effectively?

  10. Cost - if it’s a guaranteed loser, containing cost of defense is critical - if attorney’s fees are recoverable, this issue is doubly critical Size of Exposure - exposure may exceed policy limits - exposure may be even greater than damages sought Insureds/Defendant’s Interests - concern about protecting reputation - concern about uninsured exposure - concern about business impact Immediate Concerns

  11. Strategic Options • For Insurer, Be Sure, First, to Fully Evaluate Coverage Issues • Consider Existence of Technical Legal Defenses • Maybe there is a slick way to defend even though the facts are awful • Consider Options for Counter-Attack • Are there available counterclaims that can provide offset against anticipated exposure or provide leverage in settlement discussions? • Maybe there is no way to avoid exposure, but exposure can minimized via offset

  12. Strategic Options Cont’d • Settle • Statistically proven to be best option, but may not be possible • Plaintiff’s settlement demand bears no reasonable relationship to actual loss • Plaintiff’s settlement demands include non-monetary relief anathema to Defendant • Defendant obstinately will not consent to settle and/or won’t give up a counterclaim or original claims raised • There are uncovered claims/acts and/or punitives present big part of settlement discussion

  13. Strategic Options Cont’d • Employ Aggressive, Creative Litigation Tactics • Maybe there are opportunities to out-maneuver the Plaintiff to get a better than expected result • Defend, even though it is suicide mission • Losing at trial might be less costly than meeting an outrageous settlement demand • In pre-trial proceedings unrealistic positions of both sides may be moderated by improved information and fatigue

  14. Strategic Options cont’d • Surrender • Sometimes just giving the plaintiff what they want is the least costly option. • Hope for a miracle • an unplanned, unexpected game changing event

  15. Coverage

  16. Evaluate Coverage Promptly and Carefully • Claims made and reported issues • Demand prior to policy period? • Claim not timely reported? • Fraud in policy application? • Material misrepresentation or omission • May be able to rescind • Claim reported under prior policy or expected before policy inception? • Within professional services definition?

  17. Evaluate Coverage Promptly and Carefully • Prior acts coverage issues • Wrongful act prior to fixed retroactive date? • Proof of prior continuous coverage required? • Insured definition • Claim against named insured’s employees, partners, business entity – are they insureds? • Applicable exclusions • Can’t assume allegations are true if denied by insured – e.g. fraud • May not make a difference whether allegations are true or false –e.g. bodily injury exclusion

  18. Evaluate Coverage Promptly and Carefully • Cooperation issues • Insured refuses to cooperate in investigation or give testimony because he is under criminal indictment • Insured admits liability, agrees to unauthorized settlement • Must act promptly on coverage issues • Assuming control of the defense before asserting coverage defenses may be a waiver • Obtaining opinion of coverage counsel may be a good defense against bad faith • But ignoring a coverage opinion you don’t like is dangerous • Consider declaratory relief action

  19. Technical Legal Defenses

  20. Technical Legal Defenses • Jurisdiction • Does insured have sufficient contacts with forum state? • Where statute of limitations is also an issue, was service proper? • Proper Parties? • Standing to sue? • Claim by trust must be brought by trustee, not beneficiaries • Claim of decedent must be brought by executor or administrator of estate, not heirs • Claim by party absolved of liabilities through bankruptcy may belong to trustee in bankruptcy • Claims of children are assertable by their legal guardian, not simply any family member

  21. Technical Legal Defenses Cont’d • Corporate entities generally must be in good standing to enjoy privilege of utilizing state courts (i.e., be up-to-date with corporate tax obligations) • Failure to join indispensible parties? • E.g., others who have a claim to assets in dispute • Plaintiff incompetent? • May need to have court appoint guardian ad litem

  22. Technical Legal Defenses Cont’d • Statute of limitations • Generally run from date claim should have been discovered, not date of wrongful act • When claim should have been discovered may be a triable issue of fact • Look for evidence of early discovery – e.g., complaint letter • NOTE: Depending on jurisdiction and type of claim, statute may begin running from date of negligent act giving rise to claim, regardless of when injury discovered • Some claims are subject to an absolute time limit from the date of the transaction regardless of discovery • Statutory claims • FINRA arbitration claims

  23. Technical Legal Defenses Cont’d • Causation • Some claims essentially require “but for” causation, which may allow for absolute defense even in cases of clear negligence • E.g., insurance broker fails to place requested coverage, but uncovered claim would have fallen outside claims made policy period • E.g., lawyer missed statute of limitations on filing of legally deficient claim

  24. Technical Legal Defenses Cont’d • Ratification • E.g., stockbroker places unauthorized trade. Customer sees on statement but says nothing because stock is up. Later stock goes down and customer complains purchase was not authorized. Customer has ratified the transaction • Unclean hands • E.g., customer and insurance agent conspire to submit fraudulent insurance application. Insurer discovers fraud, refuses to pay loss. Customer can’t sue the agent because their fraudulent scheme did not succeed.

  25. Technical Legal Defenses Cont’d • Failure to comply with pre-suit requirements • Claims under consumer protection statutes may require pre-suit demand letter (e.g. Texas DTPA, Massachusetts Chapter 93A) • In some states a plaintiff must obtain a certificate of merit from a qualified expert prior to bringing an action for professional malpractice • Some statutes require report to governmental enforcement agency before bringing private action (e.g. employment discrimination, elder abuse)

  26. Attacking Damages • Invest in a good damages expert early on • Look to parse concrete from speculative damages • Identify, target and highlight uncertainties, variables, contingencies • Identify mitigating factors • E.g., costs, expenses, taxes that would otherwise have been incurred

  27. Counter-Attacking • Are there opportunities to assert counterclaims? • May provide basis for offsetting liability, and thereby reducing overall exposure • May provide fulcrum to bring plaintiff otherwise expressing little interest in settlement to negotiating table • But Note: If counterclaims are available, question of how to address funding of counterclaims must be considered and resolved early on • Insurer will not want to fund commercial counterclaim costing 3 times as much to litigate as defense

  28. Settlement

  29. Most Cases are Settled

  30. Plaintiff “Win” Rates at Trial • Plaintiff “win” rates vary by case type • Contract: 62.6% • Fraud 61.4% • Personal injury: 60.9% • Employment 51.1.% • Negligence (non-PI): 42.6% • Products liability: 30.2% • Medical malpractice: 19.5%

  31. Settlement Decision Errors • Plaintiff turns down a settlement offer, wins less at trial • Happens in 61.2% of cases • Average cost of error: $43k • Defendant rejects settlement demand, loses more at trial • Happens in 24.3% of cases • Average cost of error: $1.1 million Source: Journal of Empirical Legal Studies, Sept. 2008

  32. Implications for the Indefensible Case • You would like to settle, but you think the demand is unreasonable • Your evaluation of the exposure is probably more accurate than the plaintiff's • If you lose at trial but for less than the settlement demand, you can claim victory • But if you are wrong, the consequences could be painful • You need to make an extra effort to achieve a reasonable settlement – consider mediation

  33. It’s never too late to negotiate • Negotiations can continue during trial • Developments at trial may influence the parties to renew settlement negotiations • During a jury trial, the judge may call the parties into chambers and pressure them to resume settlement negotiations • Negotiations can continue after trial • Losing side may file a motion for new trial or an appeal, so the game is not over • Many “run-away” jury are compromised significantly while post-trial motions or appeals are pending.

  34. Dealing with Exigencies, Obstacles, Collateral Concerns, and Related Ethical Issues

  35. Exigencies • Even limited discovery will reveal disastrous information • Clearly fraudulent and/or criminal behavior is apparently involved. • Exposure goes even beyond plaintiff’s perception in size and/or scope • Case needs to be resolved before class may be certified

  36. Obstacles • Settlement demand bears no reasonable relation to value of claims; Plaintiff’s counsel views case as career-maker • Non-monetary relief is sought, which is anathema to the defendant/insured • Negotiations need time, but court is placing case on rocket trajectory • There is interest in settlement but the co-defendant is being uncooperative • The claims involve uncovered acts with a defense obligation • Plaintiff’s counsel views case as career maker

  37. Ethical Concerns • What information or documents can ethically be withheld while settlement is being negotiated? • When do you pass the point of aggressively advocating for your client/insured and begin to invoke concerns about acting deceptively or deceitfully? • What can and can’t you use as leverage? • Where fraudulent or criminal conduct has been identified, what moral and/or ethical duties are implicated? What duties may exist with regard to alerting the defendant’s/insured’s clients and/or regulatory authorities? • What are the duties of defense counsel in reporting to the insured E & O carrier regarding perceived evidence of conduct that may impact coverage?

  38. Mediation

  39. Mediation as Enhanced Negotiation • Mediation is non-binding negotiation assisted by a neutral third party. • Mediation is remarkably effective • 80%-90% of cases submitted to mediation will settle • Critical, however, to think carefully about what kind of mediator you want • Judge, practicing attorney, non-attorney mediator • Judgmental style vs. facilitative style • Negotiation skills truly make a difference in outcomes • Understanding the mediation process and knowing how to manage it will pay off in better results.

  40. Reluctance to Mediate • Is proposing mediation a sign of weakness? • No; it is a sign you want to settle • It is also a signal you think the plaintiff is over-valuing the case • Plaintiff attorneys sometimes resist • Fear mediator will talk clients into being reasonable when their attorney wants to play hardball • Fear direct communications with their client, exposing client to unfiltered discussion of downside risk • How to get them to the table • In some jurisdictions, the court can order the parties to mediate • In some forums (e.g. FINRA) a mediation service will attempt to persuade the parties to mediate

  41. Other ADR Techniques • Mock trial • Focus group • Neutral evaluation • Informal sit-down • Invite opposing counsel to lunch to just discuss the case generally • Where is this going? • How are we going to get this resolved?

  42. More on Resolution Strategies

  43. Relations Between Counsel • Defense counsel should maintain a cordial relationship with plaintiff’s counsel • You know you will want to talk settlement at some point and you want that discussion to be collegial • Lawyers are competitive. If the relationship between opposing counsel is acrimonious, the desire of each to humiliate the other may eclipse serving their clients’ interests

  44. Unconventional Settlements • Structured settlement • Lifetime annuity rather than lump sum • Protects unsophisticated plaintiff from financial exploitation by friends and family • Can save you a ton of money if plaintiff is in poor health and you can get a rated policy • Non-monetary sweeteners • Apology, walk in the woods, repaired personal relationship • Return of family heirlooms, love letters, other items of symbolic value.

  45. Deception – How Far Can You Go?

  46. Deception – Permissible Puffing • Okay to say the following even if not true: • “We think this case is defensible” • “We are looking forward to taking this case to trial” • “We don’t care how much it will cost or how long it will take to beat you” • No obligation to disclose damaging evidence not yet required to be produced. • No obligation to educate incompetent plaintiff’s counsel who under-values case.

  47. Deception – Over the Line • Destruction of evidence • Perjured testimony • Withholding “smoking gun” document you should have produced • Factual misrepresentation of evidence you claim to possess • Dangers: sanctions, settlement may be set aside for fraud

  48. Employing Aggressive, Creative Litigation Tactics

  49. Make Plaintiff Uncomfortable • Within reasonable limits, it is okay to use discovery and investigation to make the plaintiff uncomfortable with continuing to pursue the case. • Plaintiffs are often reluctant to have to disclose psychiatric records, tax records, bank records, credit card records, phone records and other personal information. • Public record searches, investigation and surveillance may lead to information which will discredit the plaintiff. • Ex-employees and ex-spouses are often a goldmine for information which will make the plaintiff squirm.

  50. More on Discomfort • Make use of Freedom of Information laws • There can often be powerful stuff there that plaintiff doesn’t want re-hashed