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Coverage Question Series – Part 32
Post on December 7th, 2018
This is a continuing series in which we address policy coverage questions that we routinely discuss with you and your colleagues. The answers provided are based on the basic policy form, currently LPLP-1s (effective for all policies new or renewed as of May 1, 2018). Refer to your specific policy and any endorsements attached thereto that may change coverage or the answers provided here.

I went ahead and settled the claim with the client before I reported the claim to OBLIC, am I covered?


You don’t think there is much to dispute, you missed the deadline. Unfortunately, the error occurred for a repeat client that has referred other clients to you. You pay, out of your own pocket, an amount agreeable with the client. You then report the matter to OBLIC seeking to recover the amount you paid over your deductible.

“The Insured shall not, except at his or her own cost, voluntarily make any payment, assume any obligation or incur any expense.” VII. ASSISTANCE AND COOPERATION OF THE INSURED, p.12. The voluntary payment you made to settle the claim was made at your own cost, OBLIC would not reimburse for the amount you paid over the deductible, regardless of merit.

What would have happened if you had reported it prior to settling the case? We would have evaluated the matter and may have reached the exact same conclusion to resolve quickly. We cannot stress it enough: contact us when you first become aware of the act, error or omission as soon as practicable.

As you should expect, these Q&A scenarios are based on simple hypotheticals. Coverage determinations for an actual claim are ultimately based on the unique facts, applicable law, and the Terms, Conditions, Limitations, Exclusions, and Endorsements of your policy.
Please contact me at [email protected] if you have any questions!
Carl Marsh, Esq.
Claims Counsel