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Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) The Art, Science and Law The Art, Science and Law Of Underwriting” Of Underwriting” Thanks to our Continuing Education Providers Wednesday, September 6, 2007 Sierra Specialty Insurance Services Thanks to our Hosts

Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

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Page 1: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

• Laura S. Danoff Educational Enterprises (#30885)• Wilson Elser Moskowitz Edelman & Dicker LLP (#1760)

““The Art, Science and LawThe Art, Science and LawOf Underwriting”Of Underwriting”

Thanks to our Continuing Education Providers

Wednesday, September 6, 2007

Sierra Specialty Insurance ServicesThanks to our Hosts

Page 2: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Opening and WelcomeOpening and Welcome

Statement of compliance – anti trustStatement of compliance – anti trust CE/MCLE CreditCE/MCLE Credit PLUS Membership BenefitsPLUS Membership Benefits

Makes programs like this possibleMakes programs like this possible Discounts at PLUS national eventsDiscounts at PLUS national events

Resources through Resources through www.plusweb.org Local and International networkingLocal and International networking RPLU and other recognition n the industryRPLU and other recognition n the industry We have a good time!We have a good time!

WELCOME

Page 3: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Today’s Speakers

Diana GranilloUnited Valley Insurance Services

Nick TaubeMaxim Insurance Group

Louie CastoriaWilson Elser Moskowitz Edelman & Dicker LLP

and You

Page 4: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Our AgendaOur Agenda• Underwriting is an Underwriting is an Artistic Act – Diana Act – Diana

• Underwriting is a Underwriting is a Scientific Act – Nick Act – Nick

• Underwriting is a Underwriting is a Legal Act – Louie Act – Louie

<Ten-Minute Break><Ten-Minute Break>• Three Difficult Placement Situations, Three Difficult Placement Situations,

featuring audience reactions and panelists’ featuring audience reactions and panelists’ comments.comments.

Feel free to ask questions and contribute comments throughout.

Page 5: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Underwriting is an Underwriting is an Artistic ActAct

Page 6: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Underwriting is a Underwriting is a ScientificScientific Act Act

Page 7: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Underwriting is a Underwriting is a Legal Act Act

Page 8: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

What results from Underwriting?

(Hint: it’s a Contract)

Page 9: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

What do those words mean?

Do they mean what they say in the contract?

Do they mean what you or I intended?

Do they mean what a judge says they mean?

Page 10: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

When do we look beyondthe policy itself?

• AmbiguityAmbiguity• Rescission/ReformationRescission/Reformation• Public policyPublic policy

Page 11: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Ambiguity

• General Rule: read the contract, all of it.

• If still unclear, look at the context

• If still unclear, look at the insured’s objectively reasonable expectations

Page 12: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Rescission/Reformation

Reformation: The parties’ mutual intent isn’t reflected in the policy.

Rescission: The applicant concealed or misrepresented facts that were objectively material to the risk, and which the insurer didn’t have reason to know.

Page 13: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Public Policy

Page 14: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

“Time for a short break”

Page 15: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

• Laura S. Danoff Educational Enterprises (#30885)• Wilson Elser Moskowitz Edelman & Dicker LLP (#1760)

““The Art, Science and LawThe Art, Science and LawOf Underwriting”Of Underwriting”

Thanks to our Continuing Education Providers

Wednesday, September 6, 2007

Sierra Specialty Insurance ServicesThanks to our Hosts

Page 16: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Difficult Placement #1

A mortgage banking firm, Owl Lending, has been through some tough times.

Owl is a small company, with less than $2 million in capital. They have had an operating loss for the last two fiscal years, and restated their financial statements once during that time frame.

Page 17: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Owl has only a small percent of subprime loans, and no prior E&O claims. To satisfy contract commitments, Owl must maintain both Mortgage Banker E&O and D&O coverage.

Would you underwrite this risk, and if so on what terms?

Page 18: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

The current negative publicity about subprime mortgages make Owl an unacceptable

risk.

Page 19: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

Owl is too small a company to find a market.

Page 20: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

An insurer can’t cover Owl without stepping into its shoes

under its mortgage loans if Owl goes belly-up.

Page 21: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

Owl sounds like one of those fly-by-night mortgage

companies

Page 22: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Difficult Placement #2

MediHazards, a medical malpractice insurer (rated B++) has a wholly-owned subsidiary, RiskiHazards Insurance Agency. RiskiHazards used to sell Business Package Policies to Doctors who were insured by MediHazards for their medical E&O risks.

Page 23: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

However, MediHazards has now decided to sell the Business Package Policy book of business to an unrelated insurer, Massive Market, which will underwrite the program through its own MGA, MeGaAgency. RiskiHazards will still be the producer.

Page 24: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Up to now, RiskiHazards has not carried its own Insurance Agent & Broker E&O coverage, since all its placements have been with its parent company, but MeGaAgency requires all producers to carry E&O coverage.

If you’re the broker E&O underwriter, would you insure RiskiHazards?

Page 25: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

I would not underwrite RiskiHazards at all because it

had no prior coverage.

Page 26: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?There’s a big difference

between an agency that only writes coverage issued by its parent company and one that

writes through a different carrier’s MGA.

Page 27: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

Business Package Policies present greater risk when

issued to a lot of doctors than to other kinds of businesses.

Page 28: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

I’d never insure anything called “RiskiHazards.”

Page 29: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Difficult Placement #3

The owner of “Auto U,” a driver’s education company, approaches you to buy a Miscellaneous E&O Policy. Auto U has never had that coverage before, though it has broad-form CGL coverage and insures the cars it uses in training and its instructors under a comprehensive Auto policy.

Page 30: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

Auto U has no need to buy Miscellaneous E&O coverage,

because Driver’s Ed isn’t a “profession.”

Page 31: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

Auto U shouldn’t buy the new coverage because it’s already

covered for all the risks inherent in its business.

Page 32: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

AGREE OR DISAGREE?

I’d need to know more facts.

Page 33: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

A month later a recent graduate of Auto U, Ariel Ditz, buys a new hybrid car and

insures it for the $15/$30K minimum limits.

On her first trip in the car, she comes to a stop light and her engine shuts off, which

hybrids do. Surprised by the lack of engine sounds, she thinks that she has stalled the car and that it can’t move.

OK, here are more facts:

Page 34: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

She looks for the owner’s manual, and takes her foot off the brake pedal. The car rolls forward under battery power, colliding with a pedestrian in

the crosswalk.

Page 35: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Unfortunately, he is Mark Splatz, world-famous Olympic swimming gold-medalist. His

swimming career and lucrative endorsements are ruined.

Page 36: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Mr. Splatz sues Ms. Ditz for $10,000,000.

She cross-complains against Auto U for failing to teach her

that hybrid cars can move forward when their engines

turn off. Do these facts change your

answers?

Page 37: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

Questions/Comments

Page 38: Laura S. Danoff Educational Enterprises (#30885) Wilson Elser Moskowitz Edelman & Dicker LLP (#1760) “The Art, Science and Law Of Underwriting” Thanks

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