In its recent decision in Navigators
Specialty Ins. Co. v. Med. Benefits Administrators of Maryland, 2014 U.S.
Dist. LEXIS 22631 (D. Md. Feb. 21, 2014), the United States District Court for
the District of Maryland had occasion to consider whether Maryland Code §
19-110, which establishes a prejudice requirement for late notice disclaimers,
applies to claims made and reported policies.
Navigators insured Medical Benefits Administrators of
Maryland (“MBA”) under successive claims made and reported professional
liability policies for periods October 31, 2009 to October 31, 2010 and October
31, 2010 to October 31, 2011. MBA was a
claims administrator for Brit Insurance with respect to employer benefit
plans. A dispute arose between Brit and
MBA concerning funds that MBA allegedly failed to repay or reconcile, and
litigation ultimately followed.
While the parties disputed when Brit first asserted its claim
against MBA – prior to the first of the two policies or during the term of one
of the policies – the court ultimately determined that the claim was first made
while the 09-10 Navigators’ policy was in effect. MBA, however, did not report the claim to
Navigators until July 2011. Navigators
thus contended that MBA’s failure to have reported the claim prior to the
October 31, 2010 expiration of the 09-10 policy vitiated any right that MBA had
to coverage under that policy. MBA countered
that under Maryland law, its failure to have reported the claim while the 09-10
policy was still in effect would only serve as a bar to coverage if Navigators
was actually prejudiced as a result.
In support of its assertion, MBA relied on Maryland Code §
19-110, which states:
An insurer may disclaim coverage on a
liability insurance policy on the ground that the insured . . . has breached
the policy by failing to cooperate with the insurer or by not giving the
insurer required notice only if the insurer establishes by a preponderance of
the evidence that the lack of cooperation or notice has resulted in actual
prejudice to the insurer.
While this rule has been applied routinely to
occurrence-based policies, the court noted that there were only a handful of
Maryland cases that considered it in the context of claims made and reported
policies. In Sherwood Brands, Inc. v. Great Am. Ins. Co., 13 A.3d 1268 (Md. 2011),
Maryland’s Supreme Court applied in the rule in the context of a claims-made
policy. Two subsequent Maryland federal
district courts distinguished the holding in Sherwood when considering claims made and reported policies. The court also noted the recent decision in McDowell Bldg., LLC v. Zurich Am. Ins. Co.,
2013 U.S. Dist. LEXIS 132854 (D. Md. Sept. 17, 2013), where Maryland’s federal
district court applied the rule in the context of a claims made and reported
policy.
In considering these cases, the court focused heavily on the
reasoning in Sherwood, in particular
the Sherwood Court’s determination
that the purpose of § 19-110 was to make “policy provisions requiring notice
to, and cooperation with, the insurer covenants and not conditions.” Accordingly, the court agreed that the rule
articulated in Sherwood applies to
all policies, including claims made and reported policies. As such, the court determined that Navigators
was required to demonstrate actual prejudice, by a preponderance of the
evidence, in order to disclaim coverage under the 09-10 policy.