Presented to: PAMIC – APRIL 5, 2006 Krista F. Fiore, Esquire Michael S. Saltzman, Esquire FINEMAN, KREKSTEIN & HARRI

1. Coverage Issues:Pennsylvania Unfair Insurance Practices Act, Unfair Claims Settlement Practices Regulations, Reservation of Rights Letters and Non-Waiver Agreements and Excess Verdict Issues Presented to: PAMIC – APRIL 5, 2006 Krista F. Fiore, Esquire Michael S. Saltzman, Esquire FINEMAN, KREKSTEIN & HARRIS, P.C. www.finemanlawfirm.com

2. PART 1: UNFAIR CLAIMS SETTLEMENT PRACTICES (REGULATIONS) • Section 146.1 Scope Of The Act • Section 146.2 Definitions • Section 146.3 File And Record Documentation • Section 146.4 MisrepresentationOf Policy Provision

3. TIME LIMITATIONSUNDER THE REGULATIONS Section 146.5 Failure To Acknowledge Pertinent Communications - Time Limits • Ten working days - notification of claim • Fifteen working days - insurance department inquiry • Ten working days - reply period • Ten working days - reply period for first-party claims

4. TIME LIMITATIONS UNDERTHE REGULATIONS Section 146.6 Standards For Prompt Investigation Of Claims - Time Limits Investigation complete within 30 days, or if not complete, report to insured every 45 days thereafter

5. TIME LIMITATIONS UNDERTHE REGULATIONS Section 146.7 Standards For Prompt, Fair And Equitable Settlements Applicable To Insurers • Acceptance or denial of claim - first-party claims • Fifteen working days • Fraud exception - reasonable time • The forty-five day cycle - first-party claims • Unrepresented claimants - Statute of Limitations

6. OTHER CONSIDERATIONS • Section 146.8 Standards For Prompt, Fair And Equitable Settlements Applicable To Automobile Insurance • Section 146.9 Comparative Negligence

7. PART 2: Unfair Insurance Practices Act 40 P.S. § 1171.1 (2005) Regulation of insurance business and definitions of unfair methods of competition and unfair or deceptive acts

8. UNFAIR METHOD OF COMPETITION OR UNFAIR OR DECEPTIVE ACTS OR PRACTICES • Connection with Unfair Insurance Practices Act Regulations • Investigation • Determination of coverage • Settlements • Failure to settle • Inducement to settle

9. PROCEDURES • Investigation by commissioner • Administrative hearing • Administrative penalty • Injunction • Civil penalties

10. PART 3: Examples Of How The Unfair Insurance Practices Act And Unfair Claims Settlement Practices Regulations Have Been Used In Bad Faith Litigation

11. BAD FAITH ISSUES • No private cause of action under the UIPA or UCSP • Insurance Commissioner, exclusive jurisdiction • Allegations of violations do not amount to bad faith • Violations will be considered in determining bad faith, and breaches of covenant of good and fair dealing

12. BAD FAITH ISSUES • An insurer can be liable for bad faith if it fails to conduct a good faith investigation and/or neglects to communicate promptly with the insured • Cases have held that technical violations do not constitute bad faith • Better to be safe than sorry

13. THE IMPACT OF UIPA ANDUCSP ON DISCOVERY • Plaintiffs can ascertain procedures for implementing standards of UIPA and UCSP • Can an expert testify to standards?

14. IMPACT OF UIPA AND UCSPON DAMAGES CLOSING THOUGHTS

15. PART 4: Non-waiver Agreements And Reservation Of Rights Letters Notifying the insured of coverage issues

16. REQUIREMENTS • Communicated to the insured • Fairly inform the insured of the insurer's position • Timeliness

17. COMMUNICATED TO THE INSURED • Send to individual insured or president of corporation • Trustee in bankruptcy also effective

18. FAIRLY INFORM THE INSUREDOF THE INSURER'S POSITION • Identify the potential coverage disputes • Inform the insured that there is the potential that it could incur liability for any non-covered claim • Acknowledge that the company is investigating and/or defending the claim without surrendering its right to disclaim coverage for any non-covered claim

19. TIMELINESS • Insurers should issue letter promptly • Insured must establish prejudice by failing to timely issue letter • Test of timeliness is reasonableness

20. CONCLUSION • Reservation of rights and non-waiver agreements are useful tools • Permits insurer to investigate while underlying case proceeds • Courts will enforce them

21. PART 5: EXCESS VERDICT ISSUES

22. AVOIDING BAD FAITH • Risk of liability • Range of adverse verdict • Strengths and weaknesses of evidence • History of cases in geographic area • Appearances of all parties

23. RELATIONSHIP BETWEEN EXCESS INSURER AND PRIMARY INSURER • No direct contract with each other • Doctrine of equitable subrogation

24. DUTIES OF PRIMARY CARRIERIN EXCESS CASES • Notify insured • Notify excess carrier • Notify both insured and excess carrier of underlying case