In the latest Weekly Wright Report:
Can’t We All Just Get Along – Cooperation Clauses in Insurance Policies
Many insurance policies have what is commonly known in the industry as a “cooperation clause.” A typical clause might provide that the insured must “cooperate with the insurer in the investigation or settlement of the claim or defense against the suit.” The cooperation clause is designed to both aid in making every legitimate defense to the claimed liability and to render assistance in the trial. Under such a clause, the insured is obligated to assist in good faith in making every legitimate defense to a suit for damages. This includes a fair, frank and truthful disclosure of information requested by the insurer for the purpose of enabling it to determine whether or not there is a genuine defense. It has been held that such clauses should be construed and applied by the courts to effectuate their purpose.
However, under Maryland law, when an insurer seeks to disclaim coverage on any policy of liability insurance on the ground that the insured, or anyone claiming the benefits of the policy through the insured, has breached the policy by failing to cooperate with the insurer or by not giving requisite notice to the insurer, such disclaimer of coverage shall be effective only if the insurer establishes, by a preponderance of affirmative evidence that such lack of cooperation or notice has resulted in actual prejudice to the insurer.
Moreover, when insurance companies try to use the cooperation clause for reasons other than its intended purpose, policyholders may not be compelled to cooperate. So, for example, the cooperation clause is not designed to allow the insurance company to bargain with the policyholder’s rights against others. Similarly, an insurance company cannot use the cooperation clause to force a policyholder to assist it in litigation challenging whether there is coverage for the claim.
In a recent case, a court held that the cooperation clause could not be used by an insurer to force the insured to give up its rights against a third party. As one court observed, “[w]hile the Cooperation Clause surely precludes an insured from sabotaging the insurance company’s interests, the clause does not require the insured to subjugate its own best interests.”
The best practice is to fully and timely cooperate and assist your insurance company in defending claims asserted against you, so as to avoid prejudicing the insurance company in its defense and possibly jeopardize your coverage. But, there are limits on what the insurance company can require an insured to do under the cooperation clause. We can assist you in understanding your obligations under your insurance policies so that you can avoid potentially losing coverage.
A Single Person’s Thoughts About the Unthinkable
I recently met with an elderly client (my age?) whose main concern was having a will. She equated having a will with having an estate plan. Once we began speaking, she began to understand that an estate plan involves much more than a will dealing with your assets after death and that much more stress would have to be applied to thinking about the unthinkable while she was still alive. The unthinkable, in this case, is temporary or lifetime disability from whatever cause and how one will deal with it.
When we discuss disability concerns, we have to think about both financial stability and proper care for the person.
In what some consider the “normal” family situation, we think in terms of reliance upon our spouse and/or children. The mature person who has neither a spouse nor children has a tendency to put off decision making regarding their own possible requirements for lifetime help.
In preparing an estate plan, we discuss with clients the concept of a power of attorney for both financial and medical purposes and related documents. These concerns may be met with a living trust, a power of attorney, a medical advanced directive and a medical power of attorney. While these are four separate documents, there may be a good deal of overlap between them.
The biggest question to be addressed with regard to any of these is, who will perform the needed service should it become necessary? With married or even divorced people who have children, the natural tendency is to utilize family members if they are considered trustworthy and competent. For single people, siblings are often the first consideration. The person I was speaking with had been married but was divorced and had never had children. Nor did she have any surviving siblings or even friends with whom she was comfortable.
The question she raised was, what happens if I do nothing, which she saw as her easiest way out. Simply ignore the situation. I explained to her that, should she become physically disabled, at some point some caregiver such as a nursing home or a hospital will turn to the courts for help. After a proper, but costly and successful court process, it is likely that some stranger or strangers will be named to make decisions for this person whom they do not know; not the best choice for the client’s finances and future health care. The problem is addressed in this manner, but it is done in a manner which is most likely the least acceptable to the client who would not have imagined such an arrangement for himself or herself.
The bottom line of these musings is that, if you identify your situation with that of my client whom I am describing, there is most likely a better scenario for you which can be identified through proper discussion with a qualified estate planning attorney. Hopefully, if this scenario applies to you, this article will have made you start thinking AND will make you act.
If you have questions, I will be happy to take your call.
Previously published in Estate Planning Quick Reads.
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