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Professional Indemnity Insurance: Aims Learning Outcomes
Professional Indemnity Insurance: Aims Learning Outcomes
Paper 8139V1-0
Contents
Aims
Learning outcomes
Cases
Authors
Sarah Williams MA, Keating Chambers
Ben Sareen MA, Keating Chambers
Professional indemnity insurance Paper 8139 Page 2
Aims
This paper looks at two aspects of insurance that project managers need to be aware
of:
the insurance provisions under the JCT 2005 contracts and, in particular,
insurance against injury to people and property other than the works;
what is meant by joint names insurance and how it works;
the problems caused by joint insurance.
Learning outcomes
After studying this paper you should be able to:
appraise the risks that the project manager needs to be aware of when
obtaining relevant insurance cover.
Professional indemnity insurance Paper 8139 Page 3
The proposal is obviously an important document. The questions and answers will be
crucial to the insurer’s decision as to whether to provide insurance and on what terms.
To reflect the importance of the statements made within the proposal, the proposer is
generally required to make a declaration on the form confirming that the statements
made are true. Such a declaration may typically be in the following terms:
‘I believe the above statement and particulars, together with any other information
supplied, are true and I have not suppressed or misstated any material fact. I agree
this declaration shall be the basis of the contract between the underwriters and
me.’
The proposal form will often be expressly incorporated into the insurance contract.
Even if it is not, the words ‘the basis of this contract’ show that the proposer is
warranting the accuracy of his statements, and the warranty effectively becomes a
term of the insurance policy. A warranty is of great importance in insurance law,
since its breach will discharge the insurer’s liability on the policy from the time of the
breach. As is explained in the next section of this paper, materiality is an important
concept in insurance law. However, materiality is not relevant to breach of warranty.
Hence, if the warranty is in fact untrue, the insurer can repudiate liability on the
policy, even if the untrue or inaccurate facts were not material.
The requirement of the utmost good faith applies to both the insurer and the insured.
It is the requirement on the insured that will be of the most interest to the project
manager and is considered in the following paragraphs.
Professional indemnity insurance Paper 8139 Page 4
In the period leading up to entering into the insurance contract, the requirement of the
utmost good faith includes an obligation to disclose material facts and to refrain from
making untrue statements. This duty of disclosure is dealt with in more detail below.
However, this is not the whole of the duty of good faith. There is also a rather more
limited duty during the currency of the policy to act in good faith. There have not
been many instances in which the courts have held that the duty applies post-contract.
Examples include where a term of the policy requires the insured to provide the
insurer with information during the policy term, and in the making of claims – where
the duty includes the duty not to make dishonest or fraudulent claims.
The third important introductory point is the time at which the duty arises. It exists
during negotiations for the placing of the contract of insurance and continues up to
the date when the contract is formed. It also arises on each renewal of the policy and,
where a variation to the policy is sought by the insured, on that variation. There is no
continuous duty to disclose material facts or facts affecting the risk during the
currency of the policy. Nor is there a duty of disclosure in the making of claims,
although the duty of good faith applies to the making of claims (see above).
actual knowledge
deemed knowledge
the circumstances which are material
any facts which need not be disclosed
the penalty for breach of the duty.
Actual knowledge
The insured must, subject to the test of materiality, disclose facts known to him. He
need not disclose inferences which he has drawn from those facts.
Where the insured is a company, identifying the company’s actual knowledge may be
more difficult. There may, for example, be material facts known to an employee
which are not known to the person placing the insurance. It seems likely that the
actual knowledge of the company would be limited to the directors/managers or the
‘directing minds’ of the company, rather than include knowledge of each individual
employee.
Professional indemnity insurance Paper 8139 Page 5
Deemed knowledge
The insured is deemed to know every circumstance which ought, in the ordinary
course of business, to be known by him. This does not mean that he has to make
specific enquiries. However, ignorance through incompetence or turning a blind eye
will not prevent an insured being deemed to have the relevant knowledge. It may be
that an insured company will be deemed to know facts known to an employee which
would not be within its actual knowledge if the ‘directing minds’ ought to have been
informed of such facts during the ordinary course of business.
Materiality
The principle is straightforward (although application to the facts of an individual
case may be somewhat more difficult). The principle is that every circumstance is
material which would influence the judgement of a prudent insurer in fixing the
premium or determining whether he will take the risk.
The view of the insured at the time as to whether a fact was material is not relevant.
The question is what the notional ‘prudent insurer’ would have thought.
It is not necessary to show that the insurer would have reached a different
conclusion if he had known. It is sufficient that it would have influenced his
thought processes.
It does not matter that there is no connection between the undisclosed fact and
the circumstances of the loss.
The date on which to judge whether a circumstance is material is the date the
insurance contract was made and not the date of the loss.
The questions asked on a proposal form may limit the proposer’s duty of disclosure.
For example, the form may ask how many claims have been brought in the last 10
years against the proposer. It may then be implied that the insurer does not consider
that claims brought outside that period are material. However, it would not be safe to
assume that the insured did not need to disclose any facts other than those which form
the subject of questions on the proposal form.
Insurers obviously cannot rely on a failure to disclose facts of which they were aware,
since the purpose of the duty is to prevent them from being misled or induced to enter
into a policy as a result of not being informed of a material fact. For similar reasons,
it is self-evident that the insurer cannot complain that he was not told of facts which
diminish the risk. The insured, of course, is likely to want to inform the insurer of
facts likely to diminish the risk in the hope of reducing his premium, etc.
Professional indemnity insurance Paper 8139 Page 6
The questions of presumed knowledge and waiver are more difficult. An insurer will
be presumed to be aware of the business which he is insuring (in this case, project
management). Waiver is not likely to be easy to show. However, if an insurer was
told facts which should have put him on enquiry about other facts or circumstances
but he made no enquiry, he may well be held to have waived such information.
As can be seen from the above, the insurer has a choice of whether to avoid the
policy. He may choose not to do so. Alternatively, he may act in such a way that a
court would interpret his conduct as waiver of the right to avoid the policy or
affirmation of the policy. In order to be held to have affirmed the policy, the insurer
must have had actual knowledge of the non-disclosure, and a reasonable time to
decide what to do and communicate (by words or conduct) the choice to affirm to the
insured: see Insurance Corporation of the Channel Islands v. Royal Hotel Ltd. The
last criterion is the most difficult. Mere delay or inaction is unlikely to be sufficient.
On the other hand, acceptance of a premium or payment of a loss is likely to be
enough.
Of more comfort to the insured professional is the fact that it is not uncommon for
insurance policies to contain a provision that the insurer will not avoid if the failure to
disclose was innocent or inadvertent and free from fraudulent intent. In the current
‘hardening’ market such clauses are not as freely available as previously, and in
certain areas cover has been restricted.
an occurrence-based policy
a claims made policy.
If insurance is on an occurrence basis, the policy that will respond to a claim is that
which was in force at the time of the negligent act. If insurance is on a claims made
basis, the policy that will respond is the one in force at the time the claim is made
(which may, of course, be some time after the negligent act occurred). Professional
indemnity policies are almost invariably on a claims made basis. This basis is
therefore considered in more detail in the following paragraphs.
However, claims made policies tend not to cover just situations where a third party
actually makes a claim within the policy period. They usually also cover the situation
where a circumstance which may or is likely to give rise to a loss or claim arises
during that period. The policy may therefore require the insured to give notice not
only of the actual claim, but also if he becomes aware of any circumstance which
‘may give rise to’, ‘might give rise to’ or is ‘likely to give rise to’ a loss or claim. The
policy in force at the date of notification of the circumstance will then be deemed to
be the policy which will respond if the third party subsequently makes a claim against
the insured.
The important question for the insured faced with such a policy term is when a
circumstance may give rise or is likely to give rise to a claim. In this context, the
mere fact that a claim later arises has been held to be insufficient to prove that
circumstances were previously likely to give rise to a claim: see Jacobs v. Coster.
‘Likely’ has been held to mean at least a 50% chance of a claim being made: see
Layher v. Lowe. The word ‘may’, however, involves a lesser degree of probability. It
has been held that this means a claim was ‘at least possible’: see Rothschild v.
Collyear.
There are a number of potential difficulties with a claims made policy of which the
project manager needs to be aware:
Renewing the policy is crucial, otherwise a third party may make a claim in
relation to a negligent act which occurred some years earlier but there will be
no policy to respond. Run-off cover must be maintained when a firm ceases to
trade to cover this very eventuality.
The limits and terms of the policy which will apply to the claim are those that
were in force when the claim or circumstance was first notified.
It is very important to notify circumstances and claims for two reasons: first, to
ensure that cover is accepted under the relevant policy; and secondly, to ensure
that, if a change is made in insurers with whom a policy is placed, the claim
does not fall between policies. Subsequent insurers will be very likely to
exclude liability for claims arising from circumstances of which the insured is
already aware.
Limitations on cover
It is obviously of crucial importance to ensure that adequate professional indemnity
insurance is maintained to reflect the risks of the work undertaken. The last thing with
which a professional wants to be faced is a substantial element of the claim which is
uninsured and has to be met, in the case of a sole practitioner or a partnership, out of
personal assets.
The amount that the insurer will pay in relation to a claim can be limited in three
ways. First, there is likely to be an upper limit on the amount of each claim which the
insurer will pay. Secondly, the policy limit may be for an aggregate amount for all
claims or circumstances notified in the policy period. Thirdly, at the other end, there
may be an excess which is the insured’s responsibility and is the figure below which
the insurer has no responsibility. Policies may also include geographical limitations.
Both the limit on the indemnity and the excess may be expressed as an amount per
claim or for each policy period. If the limit is for the policy period, it may be
expressed as ‘in the aggregate’ or ‘any one claim and in all’. If the limit is for each
claim, it is likely to be described as ‘each and every claim’ or ‘any one claim’ during
the period.
The problem is the reverse where the excess is concerned. If the excess is in the
aggregate rather than for each claim, the insured has only to contribute it once during
the policy period. An insured facing three claims in a policy period will therefore
have to contribute more if the excess is expressed to be per claim.
A further potential difficulty with limitations on the indemnity can occur when a
maximum indemnity is to be paid for ‘any one occurrence’ or a number of claims
arising from one single incident or event. This has been interpreted as being more
restrictive than ‘any one claim’ in that a number of claims may arise out of only one
occurrence. Again, the reverse problem arises with the excess. So if the excess is to
be paid for ‘each and every claim’, the insured may end up having to contribute a
considerable amount from his own pocket.
As to geographical limitations, project managers should be aware that there may well
be a limitation or exclusion in the policy in relation to claims made or suits brought in
the USA and/or Canada or contracts under US and/or Canadian law. This limitation
could be in the form of reduced indemnity limit. Alternatively, no cover at all may be
provided for such claims/contracts.
Costs
Another important issue is whether the policy covers legal costs. A defendant to
proceedings can face two possible types of legal cost:
It is usual for the policy to expressly provide for payment of costs. For example, it
may contain an agreement to indemnify the insured against all costs and expenses of
litigation (a) recovered by any claimant from the insured and (b) incurred with the
written consent of the insurance company. The first item covers the claimant’s costs;
the second covers the costs of defending the claim.
The wording of such clauses needs to be looked at carefully. For example, if the costs
for which the insurer provides an indemnity are expressed to be ‘all costs and
expenses incurred with the insurer’s written consent’, this will only refer to the
defence costs. The words ‘all costs and expenses payable by the insured’ has been
held to mean only the costs of the claimant and not the defence costs.
If there is no express term providing for an indemnity in relation to costs, costs may
be recoverable as part of the general indemnity. However, if the general indemnity
limit is low, the risk is that the claim and costs may exceed it. In such a case, the
insured will have to meet the costs once the limit of indemnity is exceeded.
A halfway house occurs in some policies that provide that when judgment is given
against the insured for more than the limit of the indemnity, the insurer will also
indemnify the insured against the proportion of the costs (determined by the
relationship between the indemnity sum and the judgment amount).
However, professional indemnity policies often contain clauses which mitigate the
harshness of this obligation by providing that the insurers will only be entitled to
avoid the policy for non-disclosure if there was a fraudulent intent or if the failure
could be deemed to be reckless or grossly negligent. Alternatively, it may be possible
to argue that the insurer has waived his right to rely on the notice clause. This may
occur, for example, if the insurer induces the insured to incur further trouble or
expense in relation to the claim in the belief that the insurer was not relying on the
notice provision. On the other hand, the mere carrying out of investigations by the
insurer, without inducing the insured to incur expense, etc., may be insufficient to
amount to a waiver.
‘The insurer will pay any such claim or claims which may arise without requiring
the assured to dispute any claim, unless a Queen’s Counsel (to be mutually agreed
upon by the underwriters and assured) advises that the same could be successfully
contested by the assured and the assured consents to such a claim being contested,
but such consent not to be unreasonably withheld.’
This means that an insured cannot be forced by his insurers to contest a claim.
Defending a claim may have implications for a professional’s reputation which he
may wish to avoid.
Professional indemnity insurance Paper 8139 Page 10
The following paragraphs therefore describe in outline the insurance provisions of the
JCT 2005 standard form of building contract, which contains a typical although not
entirely straightforward insurance regime. Consideration is then given to the potential
problem for the professional team created by joint insurance, and the project
manager’s duty in relation to the insurance provisions in the light of Pozzolanic
Lytag.
Insurance against injury to people and property (other than the works)
Clauses 6.1 to 6.6 cover the first type of insurance. The contractor is obliged, under
Clause 6.1, to indemnify the employer against claims, losses, etc. arising from
personal injury and death except where this is owing to acts of neglect of the
employer or persons for whom the employer is responsible. Under Clause 6.2, the
contractor is obliged to indemnify the employer against losses, claims, etc. in respect
of loss, injury or damage to property (other than the works).
Clause 6.4 then obliges the contractor to take out insurance in relation to his liability
under Clauses 6.1 and 6.2. The amount of the insurance cover (except in relation to
employees where legislation is relevant) is to be set out in the contract particulars.
Clause 6.5 requires further – limited – insurance to be taken out by the contractor if
this is stated to be required in the contract particulars and the architect instructs the
contractor to do so. It is to be taken out in the joint names of the employer and the
contractor. It relates to damage to any property other than the works caused by
collapse, subsidence, heave, vibration, weakening or removal of support of lowering
of groundwater arising out of the works. This insurance is limited by the existence of
nine exceptions, including design errors and reasonably foreseeable inevitable
damage.
Under Options A and B, the cover is to be for all risks, which is defined in Clause 6.8
as ‘any physical loss or damage to work executed and site materials’, subject to a
number of identified exceptions. The insurance is to be taken out in the joint names of
the employer and the contractor. Joint names insurance is defined as a policy of
insurance which includes the employer and the contractor as the composite insured,
and under which the insurers have no right of recourse against any person named or
recognised as an insured. Clause 6.9 provides that subcontractors are to be recognised
as an insured under the joint names policy (or the policy is to include a waiver of the
insurers’ right of subrogation against these subcontractors). The insurance is to be
taken out by either the employer or the contractor, depending on whether Option A or
B is chosen.
Professional indemnity insurance Paper 8139 Page 11
The amount of the insurance is the full reinstatement value of the works plus a
percentage stated in the contract particulars for professional fees.
Under Option C, the insurance is to be taken out by the employer. Again, the
insurance is to be in joint names. It is to cover the ‘specified perils’. These perils are
defined in Clause 6.8 and include fire, lightning, floods, earthquakes, etc. The amount
of the insurance is the full cost of reinstatement, repair or replacement of loss or
damage to the structures and contents for which the employer is responsible.
This means that, for example in the event of a fire, the employer’s insurers cannot sue
the contractor or nominated subcontractor to recover the amounts paid out to the
employer to reinstate the damage. However, if the fire was also caused by negligence
of the professional team, they are not protected from a subrogated claim by the
employer’s insurers. The question which then arises is whether the professional team
can claim a contribution towards the damages it has to pay the employer from the
contractors (who also caused the damage).
This situation was considered by the House of Lords in Co-operative Retail Services
Ltd v. Taylor Young. The property had suffered from a fire during the course of
construction. The employer had sued the architects and engineers (but not the
contractor or subcontractor, who were jointly insured with the employer) for
negligently causing the fire. The professional team sought to claim a contribution
from the contractor and subcontractor under the Civil Liability (Contribution) Act
1978.
For the purposes of the issues heard by the court, it was assumed that the fire was
caused by the breaches of contract of the professional team, the contractor and the
subcontractor. The House of Lords decided that the professional team was not entitled
to a contribution from the contractor or subcontractor since, on the true construction
of the contract, the latter would have had a defence to any claim made by the
employer, namely the existence of the joint insurance. The contractor and
subcontractor would therefore not have been ‘liable for the same damage’ as the
professional team. There can be no claim for a contribution under the Act unless:
This situation is harsh for the professional team, which is then left to bear the claim
alone.
Professional indemnity insurance Paper 8139 Page 12
There are, however, possible alternative methods of insurance which are becoming
more common. For example, latent defects insurance could cover the first 10 or 12
years of the life of a building, usually relating to structural defects and the building
envelope, and in certain instances five years’ cover is available for some aspects of
the building services. The attraction is that it is the building that is being insured
rather than simply certain of the parties involved in the construction. Alternatively,
single project insurance would cover not only the employer, contractor and
subcontractor but also the design team. However, this option is very difficult to insure
in the current market conditions and, even if insurance were available, the period
would be too short to provide adequate protection. These alternatives are not yet
catered for within the JCT schemes.
Cases
Co-operative Retail Services Ltd v. Taylor Young [2002] UKHL 17, [2002] BLR 272.
Insurance Corporation of the Channel Islands v. Royal Hotel Ltd [1998] Lloyd’s Rep
IR 151.