Insurance and Risk
A policy should be read in conjunction with the actual activity performed and the risk it is intended to cover. We assist businesses, professionals, and industry operators with issues related to coverage, claims, and disputes, distinguishing liability toward the injured party from the relationship with the insurer.
Read the policy in the context of the business
Insurance coverage depends on the actual contract signed and the risk the company carries. We examine general conditions, specific conditions, appendices, declarations, and the coverage period. Maximum limits, deductibles, excesses, and exclusions can impact the claim response.
The legal review coordinates, when necessary, with the intermediary and technical consultants. It clarifies obligations, clauses, and legal consequences, so that the company can ask specific questions before signing or renewing the contract.
Corporate and product liability
Coverages must be compared with actual activities, products, and contractual relationships. A company may assume liability through terms of sale, indemnities, procurement, distribution, or supply agreements. We examine these commitments along with the policy terms to identify any discrepancies between the company's promises and the insured risk.
When a dispute arises, we reconstruct the facts, individuals, and documents: the product or service involved, relationships with customers and suppliers, requests received, damages claimed, and communications with the insurance company. Our work coordinates the third-party position and the insurance relationship.
Directors and D&O coverage
A request addressed to a director may also involve the company and other parties. It is necessary to identify who is insured, for what role, and during the relevant period, what facts are disputed, and which interests require separate representation. We examine requests, resolutions, assignments, and policies, coordinating the insurance issue with corporate governance and liability.
Cyber incidents and cyber coverage
A cyber incident can generate response costs, business interruptions, and third-party claims. Legal assessments consider coverage conditions, expected communications, relationships with suppliers, and decisions to be made during the incident. Gathering facts and coordinating with technical experts helps maintain a reliable history and manage various responsibilities.
When an insured event occurs
The first phase consists of preserving documents and reconstructing the chronology: event, knowledge, request received, complaint, responses, and actions already taken. We review contractual terms and obligations before communicating, acknowledging, or reaching agreements with the injured party.
We assist in the legal management of the claim and relations with the insurance company, responding to requests for clarification, and examining disputes. When technical or forensic investigations are required, our assistance is coordinated with the case strategy.
Coverage and Liability
The injured party's claim and the insurer's obligation require independent verification. A policy dispute alone does not prove the company's liability; similarly, a defense based on the facts does not automatically resolve every warranty issue.
We evaluate how to coordinate defense, relationships with the company, potential indemnity claims, and negotiations, also considering potential conflicts of interest. Decisions on settlements and awards must be consistent with the clauses and the procedural position.
Renewals and changes of insurer
Before renewing or switching to another insurer, it's a good idea to check declared activities, claims already received, known circumstances, and the temporal continuity of coverage. With claims-made coverage, contractual dates and definitions can impact the assessment. The review considers both the old and new contract, appendices, and communications together.
An example: a request after renewal
A company receives a request for a service performed years earlier, after switching insurers. It's necessary to examine both policies, their dates, previous communications, and the contractual claim definition. The choice of which coverage to activate cannot be based solely on the date of the event.
This is an illustrative example. The conclusion depends on the contractual text and the documented circumstances.
The initial review
The initial review highlights issues to be clarified, missing documents, initiatives to consider, and points to coordinate with the intermediary or technical consultants. The subsequent process may involve contract review, dispute management, discussions with the company, or litigation.
Prepare the complete policies and endorsements, receipts, questionnaires, incident reports, compensation claims, correspondence with insurers and documents relating to the event. Include deadlines and actions already taken.
Frequently Asked Questions
The insurer has refused cover. Does that end the matter?
The denial must be examined in its reasons, comparing facts, communications and contractual conditions.
Can I agree on compensation directly with the third party?
Before the agreement, the powers, clauses and consequences of the guarantee must be examined.
Is the policy limit the amount that will be paid?
Compensation also depends on the coverage's operation, damage, deductibles, and policy terms.
Does the policy cover all signed indemnities?
The commitments undertaken in commercial contracts must be compared with the risk actually insured.
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