Before Denying Coverage on Grounds of Late Notice, Insurer Must Prove Prejudice
(March 2011) By Colleen K. O’Brien, Associate
For more information, contact Paul Farquharson.
Sherwood Brands, Inc. v. Great Am. Ins. Co.,
No. 62 (Maryland Court of Appeals, Feb. 24, 2011) |
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In this case, the Maryland Court of Appeals construed Md.
Code Ann., Ins. § 19-110 to hold that in claims-made-and-reported policies,
where an act triggering coverage occurs during the policy period, and the
insured fails to comply with the policy’s notice requirement, the policy is
breached, and the insurer must demonstrate that it was prejudiced by the late
notice.
This appeal involved two underlying cases filed against the
insured. In both cases, the insured failed to notify the insurer of the lawsuits
within the time period mandated by the insurance policies, and the insurer
denied coverage due to the late notice. In response, the insured filed breach of
contract and declaratory judgment actions in circuit court against the insurer.
After the trial court granted summary judgment in favor of the insurer, and
before the Court of Special Appeals could hear the case, the Court of Appeals
granted certiorari sua sponte, to revisit the
notice-prejudice case law that had been dormant since
T.H.E. Insurance Co. v. P.T.P. Inc., 331 Md. 406 (Md. 1993). The Court of
Appeals disagreed with the trial court, vacated the judgment, and remanded the
case.
The Court found that the policy at issue here was a
claims-made-and-reported policy. In claims-made-and-reported policies, the
claim must be made against the insured during the coverage period, and the
insured must notify the insurer of the claim against it during the
applicable reporting period.
The insurer argued that the Court should adopt the rule
of the majority of jurisdictions, which almost universally decline to extend
notice-prejudice rules to claims-made-and-reported policies. The Court of
Appeals resisted this argument, on grounds that most of the other
jurisdictions did not have a legislative notice-prejudice rule like
Maryland, as codified by Md. Code Ann., Ins. § 19-110. Of the two other
states that did have notice-prejudice legislation, their statutes were
distinguishable from Md. Code Ann., Ins. § 19-110. The pertinent part of Md.
Code Ann., Ins. § 19-110 reads: “[a]n insurer may disclaim coverage on a
liability insurance policy on the ground that the insured . . . has breached
the policy . . . by not giving the insurer required notice only if the
insurer establishes . . . that the lack . . . of notice has resulted in
actual prejudice to the insurer.”
The Court reasoned that, Md. Code Ann., Ins. § 19-110
only applies when an insured “breache[s] the policy.” If the notice
provision was a “condition precedent” to coverage, then the insured did not
“breach the policy” by failing to obey it because the non-occurrence of a
condition precedent does not constitute a breach. On the other hand, if the
notice provision was a covenant, the insured’s failure to notify the insurer
would constitute a breach. Despite the fact that the explicit terms of the
policy here stated that providing notice was a “condition precedent,” to the
Court, Md. Code Ann., Ins. § 19-110 “mandate[d] that the notice provisions
of the policy be treated as covenants, not conditions.” Therefore, the
insured breached the policy, and Md. Code Ann., Ins. § 19-110 operated to
require the insurer to demonstrate that it was prejudiced by the late
notice. Because the insurer never demonstrated that it was prejudiced by the
late notice at the trial court level, the Court of Appeals vacated the
judgment in favor of the insurer, and remanded the case.