Deposition Outline: PMQ – Insurer Duties

The following deposition outline is hyper-technical, exhaustive, and lengthy. Attorneys intending to depo insurance claims personnel or PMQ may want to review this document, but may choose to use other, shorter outlines available here to actually take a depo.

FAIR CLAIM HANDLING – Insurance Code §790.03

(USE NOTE: It is unlawful if the insurer’s failure to perform any of the following duties is “knowingly committed” or are performed with such frequency as to indicate a general business practice . A regulation defines “knowingly committed” to mean: performed with actual, implied or constructive knowledge, including, but not limited to, that which is implied by operation of law. Whenever a response warrants it, follow up with questions: When &InsCo& did &Blank&, was that act knowingly committed? Does&InsCo& act as &Blank&, as a general business practice?)

1.       What written standards has &InsCo& adopted to determine whether it has a duty to defend? Will you produce them?

2.       What written standards has &InsCo& adopted to determine how to investigate a claim? Will you produce them?

3.       What written standards has &InsCo& adopted to determine whether to settle a claim? Will you produce them?

4.       What written standards has &InsCo& adopted to determine whether indemnify a judgment? Will you produce them?

5.       Are you a person authorized by &InsCo& to conduct an investigation of a claim on its behalf? (2695.2(d)) Have you certified each year in writing under penalty of perjury that you have read and understand the California regulations and its amendments? (2695.6(b)(1).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me.

6.       Does &InsCo& have a claim file? Does it contain all documents, notes and work papers which reasonably pertain to the claim? (2695.3(a))? Does the claims manual have a copy of the California regulations? (2695.6(b)(2)(A)) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

7.       Has &InsCo& adopted and implemented standards for the prompt investigation and processing of first party claims? What are they? Are the standards in writing? Where? (790.03(h)(3) Failing to adopt and implement reasonable standards for the prompt investigation and processing of claims arising under insurance policies.) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

8.       Has &InsCo& adopted and implemented standards for the good faith, prompt, efficient and equitable settlement of claims? (2695.1(a)(2)) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

9.       Has &InsCo& disclosed to &Client& all benefits, coverage, and other provisions of each &InsCo& policy that may apply to &Client&’s claim? Did you consider whether any additional benefits might reasonably be payable under each &InsCo& policy? Did &InsCo& need additional proof to process or settle the claim? What was it? Did &InsCo& conduct an investigation to acquire this proof? When? Did &InsCo& immediately communicate to &Client& its need for additional proof. Did &InsCo& immediately cooperate with and assist &Client& in determining the extent of &InsCo&’s additional liability? (2695.4(a)) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

10.     Has &InsCo& adopted and communicate to you written standards for the prompt investigation and processing of claims? (2695.6(a).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

11.     Has &InsCo& adopted and communicate to you written standards for determining whether or not to provide &Client& with a defense of &Plaintiff& action? (2695.6(a).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

12.     Has &InsCo& adopted and communicate to you written standards for determining whether or not to issue a reservation of rights to &Client& regarding the defense of &Plaintiff& action? (2695.6(a).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

13.     Has &InsCo& adopted and communicate to you written standards for determining whether or not to sue &Client&? Do those written standards address when you should sue Client&? Do those written standards address whether suit against Client& should be prosecuted while the &Plaintiff& action is still pending? Do those written standards address whether suit against Client& should be limited in scope? (2695.6(a).) (Montrose 1; Handy) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

14.     Has &InsCo& adopted and communicate to you written standards for determining whether or not to provide independent counsel to &Client& for the defense of &Plaintiff& action? Has &InsCo& adopted and communicated to you written standards for determining whether insurance defense counsel appointed for &Client& to defend the &Plaintiff& action complies with the rules of professional conduct? (2695.6(a).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

15.     Has &InsCo& adopted and communicated to you written standards for determining whether or not to seek reimbursement from &Client& of the costs of defense of &Plaintiff& action? (2695.6(a).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

16.     Has &InsCo& adopted and communicate to you written standards for determining whether or not to seek reimbursement from &Client& of the costs of settling the &Plaintiff& action? (2695.6(a).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

17.     Upon receiving &Client&’s notice of the &Plaintiff& action, did &InsCo& accept or deny the claim, in whole or in part? did &InsCo& do so within forty days? (2695.(7)(b).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

18.     Did &InsCo& deny &Client&’s claim? Did it do so in writing? Did that writing provide to &Client& a statement listing all bases for the denial? Did that writing provide to &Client& a statement listing the factual bases for each reason for the denial? Did that writing provide to &Client& a statement listing the legal bases for each reason for the denial? Did that writing specific each policy provision for the denial, including an explanation of the application of each provision? (2695.(7)(b)(1).)Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

19.     Did &InsCo& delay or deny settlement of &Client&’s claim on the basis that responsibility for payment should be assumed by other insurers? (2695.7(e).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

20.     When &Client& submitted to you ___ documentation did you consider that document to contain any evidence of the claim, or of the magnitude or the amount of the loss? (2695.2(s).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Are they in the claims file? (2695.3(a).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

21.     Did you consider this document to reasonably suggest that a response was expected? Did you furnish &Client& with a complete response based on the facts as then known by &InsCo&? Did you do so within 15 days? (2695.5(b).) Where in the claim files is that noted? (2695.3(a).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

22.     Did you provide &Client& any instructions and reasonable assistance? (2695.5(e)(2).) Did you do so within 15 days? (2695.5(e)(3).) Did you begin any investigation? (2695.5(e).) Did you do so within 15 days? (2695.5(e)(3).) Did &InsCo& provide you with clear written instructions regarding this subject? (2695.6(b)(2)(B).) Please show them to me. Please show them to me. Are they in the claims file? (2695.3(a).) Is that conduct consistent with &InsCo&’s normal business practices? (790.03(h).) When you did that, did you have actual knowledge that you violated the insurance regulations? (2695.2(l)) (knowingly committed.)

23.     During the relevant time period, had &InsCo& adopted any standards for the prompt investigation of claims?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

24.     During the relevant time period, had &InsCo& adopted any standards for the prompt processing of claims?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

25.     During the relevant time period, had &InsCo& implemented any standards for the prompt investigation of claims?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

26.     During the relevant time period, had &InsCo& implemented any standards for the prompt processing of claims?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

27.     During the relevant time period, did &InsCo& accurately represent to &Client& all pertinent facts relating to any coverages at issue?

A. How?

B. Where in the Claims File for the &Plaintiff&’s action are documents relating to the &InsCo&’s representations to &Client& pertinent facts relating to any coverages at issue?

28.     During the relevant time period, did &InsCo& accurately represent to &Client& all pertinent insurance policy provisions relating to any coverages at issue?

A. How?

B. Where in the Claims File for the &Plaintiff&’s action are documents relating to the &InsCo&’s representations to &Client& pertinent insurance policy provisions relating to any coverages at issue?

29.     During the relevant time period, did &InsCo& acknowledge reasonably promptly upon all communications with respect to &Client&’s claims?

A. How?

B. Where in the Claims File for the &Plaintiff&’s action are documents relating to the &InsCo&’s communications with &Client&?

30.     During the relevant time period, did &InsCo& act reasonably promptly upon all communications with respect to &Client&’s claims?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to the &InsCo&’s communications with &Client&?

31.     During the relevant time period, did &InsCo& affirm or deny coverage of &Client&’s claims within a reasonable time?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to the &InsCo&’s affirmation or denial of coverage for &Client&’s claims?

32.     During the relevant time period, did &InsCo& promptly provide to &Client& a reasonable explanation of the basis relied on in the insurance policy, in relation to the facts or applicable law, for the denial of &Client&’s claim for __?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to the &InsCo&’s explanation for denial of coverage for &Client&’s claims?

33.     During the relevant time period, did &InsCo& liability to pay &Client&’s claims became reasonably clear?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to &InsCo&’s liability to pay &Client&’s claims?

34.     During the relevant time period, did &InsCo& attempt in good faith to effectuate prompt, fair, and equitable settlements of &Client&’s claims?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to &InsCo&’s attempt in good faith to effectuate prompt, fair, and equitable settlements of &Client&’s claims?

35.     During the relevant time period, did &InsCo& compel &Client& to institute litigation to recover amounts due from &InsCo&?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to &InsCo& compelling &Client& to institute litigation to recover amounts due from &InsCo&?

36.     During the relevant time period, did &InsCo& attempt to settle &Client&’s claims on the basis of an application which was altered without notice to, or knowledge or consent of &Client&?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to &InsCo&’s attempt to settle &Client&’s claims on the basis of an application which was altered without notice to, or knowledge or consent of &Client&?

37.     During the relevant time period, did &InsCo& respond to &Client&’s request for information as to the coverage under which payment had been made?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to &InsCo&’s respond to &Client&’s request for information as to the coverage under which payment had been made?

38.     During the relevant time period, did &InsCo& liability to pay &Client&’s claims became apparent?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to &InsCo&’s liability to pay &Client&’s claims which became apparent?

39.     During the relevant time period, did &InsCo& misleading &Client& as to the applicable statute of limitations?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to &InsCo& misleading &Client& as to the applicable statute of limitations?

FAIR CLAIM HANDLING – Regulations: Section 2695.1

40.     During the relevant time period, did &InsCo& have a thorough knowledge of the regulations in the California Code of Regulations Section 2695.1 et. seq.?

 

FAIR CLAIM HANDLING – Regulations: Section 2695.2 (Definitions)

41.     During the relevant time period, did &InsCo& consider &Client& to be a Claimant?

42.     During the relevant time period, did &InsCo& consider &Client& to be a First Party Claimant?

43.     During the relevant time period, did &Blank& act as a &ClmAgt& for &InsCo&?

44.     During the relevant time period, was &InsCo& an admitted or non-admitted insurer?

45.     During the relevant time period, did &InsCo& process &Client&’s claims pursuant to each of the following insurance policies? ____

46.     During the relevant time period, describe all activities by &InsCo& or &ClmAgt&s related to the determination of coverage arising from each insurance policy.

47.     During the relevant time period, describe all activities by &InsCo& or &ClmAgt&s related to the determination of liabilities arising from each insurance policy.

48.     During the relevant time period, describe all activities by &InsCo& or &ClmAgt&s related to the determination of the nature and extent of damages arising from each insurance policy.

49.     During the relevant time period, describe all activities by &InsCo& or &ClmAgt&s related to other obligations or duties arising from an insurance policy.

50.     During the relevant time period, did &InsCo& hold a license or Certificate of Authority from the California Insurance Commissioner to transact business in the State of California or with California residents.

51.     During the relevant time period, did &InsCo& receive any notice of claim by &Client&’s against each insurance policy issued by &InsCo&?

A. When?

B. Where in the Claims File for the &Plaintiff&’s action are documents relating to notice of claim?

52.     During the relevant time period, did &InsCo& receive any documentation which provides any evidence of &Client&’s claim and that supports the magnitude or the amount of the claimed loss?

A. When?

B. Where in the Claims File for the &Plaintiff&’s action are documents relating to notice of claim?

FAIR CLAIM HANDLING – Regulations: Section 2695.4. (Representation of Policy Provisions and Benefits)

53.     During the relevant time period, did &InsCo& disclose to &Client& all benefits, coverage, time limits or other provisions of each insurance policy issued by &InsCo& that could possibly apply to &Client&’s claims?

54.     During the relevant time period, did &InsCo& investigate whether any additional benefits might reasonably be payable under each policy if any additional evidence of &Client&’s claims that supports the magnitude or the amount of the claimed loss were submitted to &InsCo&?

55.     During the relevant time period, did &InsCo& were any additional benefits reasonably payable under each policy upon submission of additional evidence of &Client&’s claims?

A. If so, did &InsCo& immediately communicate this fact to &Client&?

B. If so, did &InsCo& cooperate with&Client& in determining the extent of &InsCo&’s additional liability?

C. If so, did &InsCo& assist &Client& in determining the extent of &InsCo&’s additional liability?

D. Where in the Claims File for the &Plaintiff&’s action are documents relating to additional benefits that might reasonably be payable?

56.     During the relevant time period, did &InsCo& deny &Client&’s claim on the basis of the &Client&’s failure to exhibit property?

57.     During the relevant time period, did &InsCo& require &Client& to provide any notice of claim or proof of claim within a specified time?

58.     During the relevant time period, did &InsCo& request that&Client& sign a release?

A. If so, did the release extend beyond the subject matter which gave rise to the claim?

B. If so, did &InsCo& fully explained to &Client& in writing the legal effect of the release?

59.     During the relevant time period, did &InsCo& issue any check or draft in partial settlement of &Client&’s claim with any release language?

60.     During the relevant time period, did &InsCo& require &Client& to submit duplicative evidence to support claims more than one policy issued by &InsCo&?

FAIR CLAIM HANDLING – Regulations: Section 2695.5. (Duties upon Receipt of Communications)

61.     During the relevant time period, did &InsCo& receive any communication from &Client&, regarding a claim?

A. If so, did &InsCo& furnish &Client& with a complete response based on the facts as then known by within 15 calendar days?

62.     During the relevant time period, did &ClmAgt& transmit to &InsCo& &Client&’s notice of claim?

63.     During the relevant time period, did &InsCo& provide to &ClmAgt& with written instructions as to the proper handling of a notice of claim?

64.     Where in the Claims File for the &Plaintiff&’s action are documents relating to written instructions as to the proper handling of a notice of claim?

65.     During the relevant time period, did &InsCo& acknowledge receipt of &Client&’s notice of claim within 15 calendar days?

A. Where in the Claims File for the &Plaintiff&’s action are documents relating to written instructions as to the proper handling of a notice of claim?

66.     During the relevant time period, did &InsCo&’s acknowledge of receipt of &Client&’s notice of claim provide to &Client& necessary forms, instructions, and reasonable assistance, including but not limited to, specifying the information &Client& must provide for proof of claim?

67.     During the relevant time period, did &InsCo&’s acknowledge of receipt of &Client&’s notice of claim begin any investigation of &Client&’s claim within 15 calendar days?

FAIR CLAIM HANDLING – Regulations: Section 2695.6 (Training and Certification)

68.     During the relevant time period, did &InsCo& adopt written standards for the prompt investigation and processing of claims?

A. Where are documents relating to written standards adopt by &InsCo& for the prompt investigation and processing of claims?

69.     During the relevant time period, did &InsCo& communicate to &ClmAgt& written standards for the prompt investigation and processing of claims?

A. Where are documents relating to communications by &InsCo& to &ClmAgt& of written standards adopt by &InsCo& for the prompt investigation and processing of claims?

70.     During the relevant time period, did &InsCo& provide thorough training regarding Code of Regulations section 2695.1 et. seq. to &ClmAgt&”?

A. Where are documents relating to thorough training regarding Code of Regulations section 2695.1 et. seq. by &InsCo& to &ClmAgt&”?

71.     During the relevant time period, did &InsCo& provide adequate training regarding Code of Regulations section 2695.1 et. seq. to &ClmAgt&”?

A. Where are documents relating to adequate training regarding Code of Regulations section 2695.1 et. seq. by &InsCo& to &ClmAgt&”?

72.     During the relevant time period, did &InsCo& certify that &ClmAgt& has been trained regarding Code of Regulations and any revisions thereto?

A. Where are documents relating to certification by &InsCo& that &ClmAgt& has been trained regarding Code of Regulations and any revisions thereto, in writing under penalty of perjury as follows:

(A) that &InsCo&’s claims adjusting manual contains a copy of Code of Regulations ; and,

(B) that clear written instructions regarding the procedures to be followed to effect proper compliance with this subchapter were provided to &ClmAgt&; or,

(C) Independent adjusters retained by &InsCo&, the independent adjuster certified in writing, under penalty of perjury, on an annual basis, that &ClmAgt& has read and understands the Code of Regulations?

DUTY TO DEFEND

Determine Whether Duty To Defend Is Owed

73.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to defend its policyholder in a third party liability action?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTES: “We summarize familiar principles pertaining to an insurer’s duty of defense. An insurer must defend its insured against claims that create a potential for indemnity under the policy. The duty to defend is broader than the duty to indemnify, and it may apply even in an action where no damages are ultimately awarded. Determination of the duty to defend depends, in the first instance, on a comparison between the allegations of the complaint and the terms of the policy. But the duty also exists where extrinsic facts known to the insurer suggest that the claim may be covered. (Citation.) Moreover, that the precise causes of action pled by the third-party complaint may fall outside policy coverage does not excuse the duty to defend where, under the facts alleged, reasonably inferable, or otherwise known, the complaint could fairly be amended to state a covered liability.

“From these premises, the following may be stated: If any facts stated or fairly inferable in the complaint, or otherwise known or discovered by the insurer, suggest a claim potentially covered by the policy, the insurer’s duty to defend arises and is not extinguished until the insurer negates all facts suggesting potential coverage. On the other hand, if, as a matter of law, neither the complaint nor the known extrinsic facts indicate any basis for potential coverage, the duty to defend does not arise in the first instance.

Imposition of an immediate duty to defend is necessary to afford the insured what it is entitled to: the full protection of a defense on its behalf. The insured’s desire to secure the right to call on the insurer’s superior resources for the defense of third party claims is, in all likelihood, typically as significant a motive for the purchase of insurance as is the wish to obtain indemnity for possible liability. Any doubt as to whether the facts establish the existence of the defense duty must be resolved in the insured’s favor.

Scottsdale Ins. Co. v. MV Transp. (2005) 36 Cal.4th 643, 654-655; Montrose Chemical Corp. v. Superior Court (1993) 6 Cal.4th 287, 295-296, 299-300, 304. (citations and quotation marks omitted.))

74.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to defend its policyholder in a third party liability action?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

Determine Whether Duty To Provide Independent Counsel Is Owed

75.     During the relevant time period, did &InsCo& waive any grounds upon which it could deny indemnity coverage to &Client& in the &Plaintiff& action?

A. When?

B. How?

C. Why?

76.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

77.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

78.     During the relevant time period, had &InsCo& adopted any standards to determine whether an attorney appointed by &InsCo& or &ClmAgt& to defend an insured has an attorney client relationship with &InsCo& or &ClmAgt&?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: In State Farm Mutual Automobile Ins. Co. v. Federal Ins. Co. (1999) 72 Cal.App.4th 1422, 1429-30, determined that an attorney appointed by an insurance company to defend an insured does establish an attorney client relationship with the insurance company.)

79.     During the relevant time period, had &InsCo& implemented any standards to determine whether an attorney appointed by &InsCo& or &ClmAgt& to defend an insured has an attorney client relationship with &InsCo& or &ClmAgt&?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

80.     During the relevant time period, had &InsCo& adopted any standards to determine whether an attorney appointed by &InsCo& or &ClmAgt& to defend an insured complied with Rule 3-310 of the Rules of Professional Conduct?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

81.     During the relevant time period, had &InsCo& implemented any standards to determine whether an attorney appointed by &InsCo& or &ClmAgt& to defend an insured complied with Rule 3-310 of the Rules of Professional Conduct?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

82.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved any right to deny indemnity coverage?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

83.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved any right to deny indemnity coverage?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

84.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved all rights to deny indemnity coverage?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

85.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved all rights to deny indemnity coverage?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

86.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage because the insured acted intentionally?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: David Kleis, Inc. v. Superior Court (1995) 37 Cal. App. 4th 1035. Where an insurer reserves rights to deny coverage arguing that the insured acted intentionally is the “classic” situation the insurer should provide independent counsel.)

87.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage because the insured acted intentionally?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

88.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage because &Traitor& had a potential conflict of interest?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “[A] conflict becomes ‘actual’ when an attorney’s duties of loyalty, confidentiality, and zealous advocacy require the attorney to take or to refrain from taking some action to serve the ‘best interests’ of one … client, but the attorney is unable to do so without violating a duty owed by the attorney to another client; or when the attorney is unable independently to evaluate the best interests of each … client because of the [client’s] conflicting interests. (See 1 Hazard & Hodes, The Law of Lawyering (3d ed. 2004 supp.) Conflicts of Interest, § 10.4, p. 10-13 [terms ‘potential’ and ‘actual’ ‘must have reference to the degree of likelihood that the risk-the potentiality-will ripen into adverse effect-the actuality’]; 2 Mallen & Smith, Legal Malpractice (2007 ed.) § 16:2, p. 818 [“An actual conflict exists when an attorney’s professional judgment for one client necessarily will be affected adversely because of the interests of another client’‘].)

In re Zamer G (2007) 153 Cal. App. 4th 1253, 1268)

89.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage because &Traitor& had a potential conflict of interest?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

90.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage because &Traitor& had a actual conflict of interest?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

91.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage because &Traitor& had a actual conflict of interest?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

92.     During the relevant time period, did &InsCo& reserve more than one defense to coverage?

A. As to each defense to coverage, did &InsCo& analyze each defense separately to decide whether &Client& was entitled to independent counsel to defend the &Plaintiff& action?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to &InsCo&’s separate analysis of each defense to decide whether &Client& was entitled to independent counsel to defend the &Plaintiff& action?

93.     During the relevant time period, did &InsCo& whether &Traitor& could possibly prejudice &Client& with respect to each defense to coverage reserved by &InsCo&?

A. As to each defense to coverage, did &InsCo& analyze each defense separately to decide whether &Traitor& could possibly prejudice &Client&?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to &InsCo&’s separate analysis of each defense to decide whether &Traitor& could possibly prejudice &Client&?

94.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage based on any coverage dispute that has nothing to do with the issues being litigated in the &Plaintiff& action?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: Long v. Century Indemnity Co. (2008) 163 Cal.App.4th 1460, 1470-1471.

“Thus, when the reservation of rights is based on coverage disputes that have nothing to do with the issues being litigated in the underlying action… there is no conflict of interest, and no duty to appoint independent counsel. Conversely, when the facts on which resolution of the reserved coverage dispute depends are at issue in the underlying action, independent counsel must be appointed because counsel selected and controlled by the insurer could determine the outcome of those issues in the third party action.)

95.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage based on any coverage dispute that has nothing to do with the issues being litigated in the &Plaintiff& action?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

D. Were any grounds upon which &InsCo& reserved the right to deny indemnity coverage based on a coverage dispute that had nothing to do with the issues being litigated in the &Plaintiff& action?

E. Were all grounds upon which &InsCo& reserved the right to deny indemnity coverage based on a coverage dispute that had nothing to do with the issues being litigated in the &Plaintiff& action?

96.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage based on any coverage dispute that is logically unrelated to the issues of consequence in the &Plaintiff& action?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: No disqualifying conflict arises for insurance defense counsel “when the coverage question is logically unrelated to the issues of consequence in the underlying case.” (Montrose Chemical Corp. v. Superior Court (1993) 6 Cal.4th 287, 301-302.)

97.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide independent counsel to defend its policyholder in a third party liability action when it reserved the right to deny indemnity coverage based on any coverage dispute that is logically unrelated to the issues of consequence in the &Plaintiff& action?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

D. Were any grounds upon which &InsCo& reserved the right to deny indemnity coverage based on a coverage dispute that is logically unrelated to the issues of consequence in the &Plaintiff& action?

E. Were all grounds upon which &InsCo& reserved the right to deny indemnity coverage based on a coverage dispute that is logically unrelated to the issues of consequence in the &Plaintiff& action?

98.     During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to resolve any uncertainty as to whether a duty to defend is owed in favor of the insured?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: Any uncertainty as to whether a duty to defend is owed is resolved in favor of the insured. B & E Convalescent Ctr. v. State Comp. Ins. Fund (1992) 8 Cal.App.4th 78, 99-100. This broad duty to defend is intended to “give the insured the peace of mind and security which the insured has every right to expect.” California Ins. Guar. Ass’n v. Wood (1990) 217 Cal.App.3d 944, 948.)

99.     During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to resolve any uncertainty as to whether a duty to defend is owed in favor of the insured?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

100.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to defend immediately?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “To defend meaningfully, the insurer must defend immediately.” (Montrose Chemical Corp. v. Superior Court (1993) 6 Cal.4th 287, 295.)

101.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to defend immediately?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

102.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to defend entirely?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “To defend immediately, it must defend entirely.” Buss v. Superior Court (1997) 16 Cal.4th 35, 48.)

103.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to defend entirely?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

104. During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide defense counsel with sufficient funds to conduct the defense?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: The insurer must provide the attorneys with sufficient funds to conduct the defense. Aerojet-General Corp. v. Transport Indem. Co. (1997) 17 Cal.4th 38, 58.)

105.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide defense counsel with sufficient funds to conduct the defense?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

106.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide the policyholder of the expertise and resources available to &InsCo&?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: A liability insurer may not force its policyholder to finance his own investigation and defense of the lawsuit, and then to seek reimbursement in a second lawsuit against the insurance company because to do so would deprive the insured “of the expertise and resources available to insurance carriers in making prompt and competent investigations as to the merits of lawsuits filed against their insureds.” Mullen v. Glens Falls Ins. Co. (1977) 73 Cal.App.3d 163, 173-174.)

107.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide the policyholder of the expertise and resources available to &InsCo&?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

108.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to not force its policyholder to finance ones own investigation and defense of a third party liability lawsuit, and then to seek reimbursement in a second lawsuit against &InsCo&?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

109.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to not force its policyholder to finance ones own investigation and defense of a third party liability lawsuit, and then to seek reimbursement in a second lawsuit against &InsCo&?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

110.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to provide competent counsel to represent the insured in a third party liability lawsuit?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: The insurer must provide competent counsel to represent the insured. Merritt v. Reserve Ins. Co. (1973) 34 Cal.App.3d 858, 882; Travelers Ins. Co. v. Lesher (1986) 187 Cal.App.3d 169, 191.)

111.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to provide competent counsel to represent the insured in a third party liability lawsuit?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

112.   During the relevant time period, had &InsCo& adopted any standards to determine whether its duty to defend a policyholder is excused another insurer is obligated to defend?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “[W]here more than one insurer owes a duty to defend, a defense by one constitutes no excuse of the failure of any other insurer to perform.” Wint v. Fidelity & Cas. Co. of New York (1973) 9 Cal.3d 257, 263; Safeco Ins. Co. of America v. Parks (2009) 170 Cal.App.4th 992, 1005.)

113.   During the relevant time period, had &InsCo& implemented any standards to determine whether its duty to defend a policyholder is excused another insurer is obligated to defend?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

114.   During the relevant time period, had &InsCo& adopted any standards to determine whether its duty to defend a policyholder is excused another insurer agrees to defend?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “[W]here more than one insurer owes a duty to defend, a defense by one constitutes no excuse of the failure of any other insurer to perform.” Wint v. Fidelity & Cas. Co. of New York (1973) 9 Cal.3d 257, 263; Safeco Ins. Co. of America v. Parks (2009) 170 Cal.App.4th 992, 1005.)

115.   During the relevant time period, had &InsCo& implemented any standards to determine whether its duty to defend a policyholder is excused another insurer agrees to defend?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

116.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to fully inquire into possible bases that might support a policyholder’s claim?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “For the insurer to fulfill its obligation not to impair the right of the insured to receive the benefits of the agreement … it is essential that an insurer fully inquire into possible bases that might support the insured’s claim.” Egan v. Mutual of Omaha Ins. Co. (1979) 24 Cal.3d 809, 819; Hughes v. Blue Cross of No. Calif. (1989) 215 Cal.App.3d 832, 846.

To protect the insured’s peace of mind and security, “an insurer cannot reasonably and in good faith deny payments to its insured without thoroughly investigating the foundation for its denial.” Egan v. Mutual of Omaha Ins. Co. (1979) 24 Cal.3d 809, 819; Wilson v. 21st Century Ins. Co. (2007) 42 Cal.4th 713, 721; Jordan v. Allstate Ins. Co. (2007) 148 Cal.App.4th 1062, 1072.

“(I)t is essential that an insurer fully inquire into all possible bases that might support the insured’s claim . . . (A)n insurer cannot reasonably and in good faith deny payments to its insured without thoroughly investigating the foundation for its denial.” Egan v. Mutual of Omaha Ins. Co. (1979) 24 Cal.3d 809, 819; Shade Foods, Inc. v. Innovative Products Sales & Marketing, Inc. (2000) 78 Cal.App.4th 847, 879 [adequacy of investigation is “(a)mong the most critical factors bearing on the insurer’s good faith.”]

An insurance company’s duty to conduct a thorough investigation may include the duty to interview witnesses with significant information. Downey Sav. & Loan Ass’n v. Ohio Cas. Ins. Co. (1987) 189 Cal.App.3d 1072, 1084.)

117.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to fully inquire into possible bases that might support a policyholder’s claim?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

118.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to keep abreast of the progress and status of the litigation?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: A liability insurer must “keep abreast of the progress and status of the litigation in order that it may act intelligently and in good faith on settlement offers.” Merritt v. Reserve Ins. Co. (1973) 34 Cal.App.3d 858, 882.)

119.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to keep abreast of the progress and status of the litigation?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

120.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to settle a liability lawsuit filed against its policyholder?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “This implied covenant obligates the insurance company, among other things, to make reasonable efforts to settle a third party’s lawsuit against the insured. If the insurer breaches the implied covenant by unreasonably refusing to settle the third party suit, the insured may sue the insurer in tort to recover damages proximately caused by the insurer’s breach.” PPG Industries, Inc. v. Transamerica Ins. Co. (1999) 20 Cal.4th 310, 312.)

121.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to settle a liability lawsuit filed against its policyholder?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

122.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to do nothing which will injure the right of the policyholder to receive the benefits of an insurance policy?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “Every contract imposes upon each party a duty of good faith and fair dealing in its performance and its enforcement.” Foley v. Interactive Data Corp. (1988) 47 Cal.3d 654, 683. The fundamental principle of the implied covenant of good faith and fair dealing is “that neither party will do anything which will injure the right of the other to receive the benefits of the agreement.” Gruenberg v. Aetna Ins. Co. (1973) 9 Cal.3d 566, 573.

The implied covenant of good faith and fair dealing is breached where an insurer delays or denies payment of policy benefits unreasonably (i.e., without any reasonable basis for its position) or without proper cause. Jordan v. Allstate Ins. Co. (2007) 148 Cal.App.4th 1062, 1072-1073.)

123.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to do nothing which will injure the right of the policyholder to receive the benefits of an insurance policy?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

124.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to consideration to the interests of the policyholder in processing claims?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: The duty of good faith and fair dealing requires an insurer to “careful and serious consideration to the interests and position of the assured…. The carrier cannot exclusively preoccupy itself with its own interests but must also weigh the real interests of the assured.” Merritt v. Reserve Ins. Co. (1973) 34 Cal.App.3d 858, 875. When investigating a claim, an insurance company has a duty to diligently search for evidence which supports its insured’s claim. If it seeks to discover only the evidence that defeats the claim it holds its own interest above that of its insured.” Mariscal v. Old Republic Life Ins. Co. (1996) 42 Cal.App.4th 1617, 1619-1620.)

125.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to consideration to the interests of the policyholder in processing claims?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

126.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to refrain from unreasonable delay in the payment of policy benefits?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “A delay in payment of benefits due under an insurance policy gives rise to tort liability only if the insured can establish the delay was unreasonable” Brehm v. 21st Century Ins. Co. (2008) 166 Cal.App.4th 1225, 1237. Unreasonable delay in the processing of a claim or the payment of benefits may be evidence of bad faith by the insurer. Fleming v. Safeco Ins. Co. of America, Inc. (1984) 160 Cal.App.3d 31, 37.)

127.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to refrain from unreasonable delay in the payment of policy benefits?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

128.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to not delay payment of some claims to coerce a compromise of another claim?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: Insurer may not delay payment of some claims to coerce a compromise of disputed claim. Beck v. State Farm Mut. Auto. Ins. Co. (1976) 54 Cal.App.3d 347, 355.)

129.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to not delay payment of some claims to coerce a compromise of another claim?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

130.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to use objective standards in making its claims decisions?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: An insurer must use objective standards in making its claims decisions and cannot ignore evidence supporting a claim, while focusing on facts justifying denial of the claim. “An insurance company may not ignore evidence which supports coverage. If it does so, it acts unreasonably towards its insured and breaches the covenant of good faith and fair dealing.” Wilson v. 21st Century Ins. Co. (2007) 42 Cal.4th 713, 721.)

131.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to use objective standards in making its claims decisions?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

132.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to interpret its policies to resolve doubts as to meaning against &InsCo&?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: In interpreting an insurance policy we apply the general principle that doubts as to meaning must be resolved against the insurer and that any exception to the performance of the basic underlying obligation must be so stated as clearly to apprise the insured of its effect.” Gray v. Zurich Insurance Co. (1966) 65 Cal.2d 263, 269.)

133.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to interpret its policies to resolve doubts as to meaning against &InsCo&?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

134.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to inform its policyholder of any conflict of interest?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: “[T]he insurer’s fiduciary obligations were consistent with those of the attorney retained to represent the insured, and as a result the insurer should have informed the insured of the conflict of interest and of the opportunity to have independent counsel. (Manzanita Park v. Insurance Co. of North America (9th Cir. 1988) 857 F.2d 549, 555.)” State Farm Fire & Casualty Co. v. Superior Court (1989) 216 Cal.App.3d 1222, 1235-1236.)

135.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to inform its policyholder of any conflict of interest?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

136.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to inform its policyholder of the opportunity to have independent counsel?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

137.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to inform its policyholder of the opportunity to have independent counsel?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

138.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to not sue its own policyholder to defeat coverage in a third party action which is still pending?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: An insurer which sues its own insured to defeat coverage for an third party action which is still pending may be liable for malicious prosecution. Hillenbrand, Inc. v.Insurance Company of North America (2002) 104 Cal App 4th 784.)

139.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to not sue its own policyholder to defeat coverage in a third party action which is still pending?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

140.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to not join forces with the plaintiff in the third party action as a means to defeat coverage?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: Montrose Chemical Corp. v. Superior Court (Canadian Universal Ins. Co.), supra, 25 Cal.App.4th at p. 910 [“[T]he insurer must not be permitted to join forces with the plaintiffs in the underlying actions as a means to defeat coverage”].)

141.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to not join forces with the plaintiff in the third party action as a means to defeat coverage?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

142.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to not compel its policyholder to fight a two-front war – with the plaintiffs and with &InsCo&?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: Montrose Chemical Corp. v. Superior Court (Canadian Universal Ins. Co.), supra, 25 Cal.App.4th at p. 910 [“Another sort of prejudice occurs when the insured is compelled to fight a two-front war, doing battle with the plaintiffs in the third party litigation while at the same time devoting its money and its human resources to litigating coverage issues with its carriers”)

143.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to not compel its policyholder to fight a two-front war – with the plaintiffs and with &InsCo&?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

144.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to not risk inconsistent factual determinations in a coverage lawsuit that could prejudice the insured in the third party lawsuit?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: Montrose Chemical Corp. v. Superior Court, supra, 6 Cal.4th at p. 301 [“To eliminate the risk of inconsistent factual determinations that could prejudice the insured, a stay of the declaratory relief action pending resolution of the third party suit is appropriate when the coverage question turns on facts to be litigated in the underlying action”].)

145.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to not risk inconsistent factual determinations in a coverage lawsuit that could prejudice the insured in the third party lawsuit?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

146.   During the relevant time period, had &InsCo& adopted any standards to determine whether it had a duty to not collateral estop its policyholder from relitigating any adverse factual findings in the third party action?

A. What standards did &InsCo& adopt?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& adopted which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& adopt these standards?

(USE NOTE: Montrose Chemical Corp. v. Superior Court (Canadian Universal Ins. Co.), supra, 25 Cal.App.4th at p. 910 [“[T]he insured may be collaterally estopped from relitigating any adverse factual findings in the third party action, notwithstanding that any fact found in the insured’s favor could not be used to its advantage”].)

147.   During the relevant time period, had &InsCo& implemented any standards to determine whether it had a duty to not collateral estop its policyholder from relitigating any adverse factual findings in the third party action?

A. What standards did &InsCo& implement?

B. Where in the Claims Manual, or Claims File for the &Plaintiff&’s action are documents relating to the standards &InsCo& implemented which reasonably pertain to &Client&’s claims?

C. Why did &InsCo& implement these standards?

148.   Has &InsCo& adopted Standards to protect the interest of its policyholder equally with its own? Implemented that Standard? Describe your search for evidence which supports its insured’s claim? What Factors considered? Make the argument for each side (insurer and policyholder) for the interests to be protected for each claims decision made?

(USE NOTES: “The insurance company breached the covenant of good faith and fair dealing because it did not fulfill its obligation to protect the interest of its insured. When investigating a claim, an insurance company has a duty to diligently search for evidence which supports its insured’s claim. If it seeks to discover only the evidence that defeats the claim it holds its own interest above that of its insured.” Mariscal v. Old Republic Life Ins. Co. (1996) 42 Cal.App.4th 1617, 1620. “Insureds seek protection against calamity and purchase insurance to buy peace of mind and security. The insurer has a duty to protect the insured’s interests as if it were its own, and it may not deny a claim without thoroughly investigating it. “A trier of fact may find that an insurer acted unreasonably if the insurer ignores evidence available to it which supports the claim. The insurer may not just focus on those facts which justify denial of the claim. If an insurer unreasonably refuses a claim, it is liable for breach of the covenant of good faith and fair dealing inherent in every insurance policy.” Mariscal v. Old Republic Life Ins. Co. (1996) 42 Cal.App.4th 1617, 1623. (Citations omitted.) “An insurance company may not ignore evidence which supports coverage. If it does so, it acts unreasonably towards its insured and breaches the covenant of good faith and fair dealing.” Mariscal v. Old Republic Life Ins. Co. (1996) 42 Cal.App.4th 1617, 1624. “[A] duty to deal fairly and in good faith with its assured … amounts to something more than the usual duty of good faith between contracting parties, this for the reason that in limited liability insurance contracts conflicts of interest between assured and carrier remain endemic to their relationship, and whenever a conflict of interest breaks out the carrier becomes obligated to protect the interests of the assured equally with its own.” Merritt v. Reserve Ins. Co. (1973) 34 Cal.App.3d 858, 868. “The carrier cannot exclusively preoccupy itself with its own interests but must also weigh the real interests of the assured.” Merritt v. Reserve Ins. Co. (1973) 34 Cal.App.3d 858, 875.

 

Please enter your email address in order to view this page.
Your email address will not be sold to or shared with third parties.
DutytoDefend.com