Global Insurance Services

While most insurance litigation concerns issues of contract law, insurers at times face claims in tort or statute alleging bad faith in terms of improper claims handling, delays in providing insurance proceeds, and/or inadequate investigation.

At Goldberg Segalla, we believe that defending these claims requires a proactive approach from the onset. This includes early motion practice to dismiss these claims shortly after they are filed.

Our insurance litigation attorneys represent primary and excess carriers in defending these disputes across the country. This practice and our attorneys have learned from one of the foremost bad faith expert witnesses in the industry, Thomas F. Segalla. Mr. Segalla, editor of Couch on Insurance, has testified in more than 40 different jurisdictions as an expert witness on bad faith.

The Insurance Regulatory team can handle any insurance or reinsurance regulatory issue or transaction. Our extensive experience in insurance corporate and regulatory matters – from property-casualty to life, accident, and health and annuities – includes inbound public and private insurance company mergers and acquisitions, and other transactions.

As a go-to firm for several leading insurers and reinsurers, Goldberg Segalla provides invaluable insight into day-to-day regulatory issues facing the industry and effective methods to address even the most complex regulatory challenges.

Our insurance and reinsurance regulatory attorneys have a proven track record helping clients implement successful regulatory strategies and navigate this highly nuanced environment. As widely recognized thought leaders in the global insurance and reinsurance arena, we regularly advise on emerging trends, legal issues, and the activities of state and federal insurance regulators, the National Association of Insurance Commissioners (NAIC), surplus lines stamping offices, the International Association of Insurance Supervisors (IAIS), and other bodies that shape insurance regulatory policies.

Insurers and Reinsurers

• Formation, structuring, sale, mergers, acquisitions, restructuring, reorganization, and dissolution of insurance and reinsurance companies, and the required filings
• Licensing matters, from company formation to admission, expansion, and redomestication
• Guidance regarding the creation, approval, and marketing of insurance products
• Representation in market conduct and regulatory examinations, compliance audits, consumer complaints, administrative hearings, and governmental inquiries developing claims handling procedures
• Representation in solvency and other modernization initiatives, such as such the NAIC Initiatives, the effects of the Nonadmitted and Reinsurance Reform Act and other sections of the Dodd-Frank Act, the effects of Brexit on the U.S. excess and surplus lines industry, the impact and nuances of the Patient Protection and Affordable Care Act
• Advising on compliance with the NAIC’s Model Insurance Holding Company Systems Act and Corporate Governance Annual Disclosure Model Law, the Foreign Corrupt Practices Act, the UK Bribery Act, the Sarbanes-Oxley Act, Own Risk and Solvency Assessment (ORSA), statutory investment regulations, federal and state privacy and anti-bribery statutes and New York’s groundbreaking Cybersecurity Regulation Protecting Consumers and Financial Institutions from Cyber-Attacks
• Advice on regulatory issues concerning the use of social media and usage-based big data in insurance underwriting
• Representation and counsel on transactions including portfolio transfers, assumption reinsurance, public and private financing, offshore structures, insurance-linked securities, etc.

Producers and Other Insurance Intermediaries

• Guidance on entity formation, licensing, mergers, and acquisitions for insurance agents and brokers, managing general agents, reinsurance brokers, independent adjusters, third party administrators and excess and surplus lines brokers
• Compliance advice about referral arrangements, commission sharing limits, fiduciary requirements, and anti-rebating laws
• Representation in consumer complaints
• Defending broker-dealers and registered representatives in Financial Industry Regulatory Authority (FINRA) arbitrations and disciplinary actions.

Captive Insurance Companies

• Developing creative risk-retention/transfer solutions and risk-management programs
• Advising on industry developments and pertinent legislation such as the Nonadmitted and Reinsurance Reform Act component of the Dodd Frank Act, the Liability Risk Retention Act, the Terrorism Risk Insurance Act, and others
• Drafting policy language and developing claims handling procedures

Goldberg Segalla clients trust the firm’s insurance coverage lawyers to act as national or regional counsel on their behalf across the country, on a wide range of high-complexity and high-exposure coverage matters. Decades of results and partnership give the firm’s clients the confidence to know that the coverage team will proudly and zealously represent their interests, no matter the issue, location, or exposure.

Several of the world’s largest insurers and law firms have selected us to serve in capacities such as:

• Regional coverage counsel for multiple insurers – in some cases covering more than a dozen states, and in another spanning more than 20
• National bad faith coverage counsel
• National reinsurance counsel
• National fidelity/crime coverage counsel
• National coordinating counsel for weather-related catastrophes such as Superstorm Sandy
• One of only a select few firms handling 9/11 coverage litigation
• Regulatory counsel for a Japan-based insurer in the $5 billion acquisition of a NYSE-traded U.S. insurance holding company
• National regulatory counsel for one of the largest providers of vehicle service contracts
• A go-to resource for large, cross-border law firms without regulatory capacity to serve the U.S. regulatory needs of their multinational financial and other service-provider clients

This constantly growing and increasingly diverse list of assignments reflects the exceptional degree of trust and confidence we have earned in the insurance market.

Attorneys in our Global Insurance Services group have been on the leading edge of revising existing policy forms and developing new insurance agreements to address emerging risks and changing laws across the country. We have drafted and refined policies insuring first-party risks for numerous lines of insurance, including commercial and personal property policies, cyber and data breach insurance, boiler and machinery insurance, environmental and pollution policies, as well as construction and builder’s risk insurance, among others. Goldberg Segalla attorneys have also co-authored multiple innovative environmental liability insurance products widely used in the excess and surplus lines insurance market to address environmental pollution and environmental professional risks.

At Goldberg Segalla, our seasoned lawyers have a thorough understanding of the business of reinsurance and the needs of our reinsurance clients. While we are zealous advocates for our clients, some of our representative achievements have come via settlements or commutations that not only resolve the instant dispute, but also preserve the business relationship and avoid the cost of prolonged arbitration or litigation.

We are on the front line of significant reinsurance claims involving reinsurers, ceding companies, managing general agents, brokers, intermediaries, and reinsurance pool managers. Our mediation, arbitration, and litigation practice spans across all types of reinsurance agreements, both facultative and treaty.

We regularly team with cedents and reinsurers to resolve disputes involving the full range of reinsurance issues. We have experience with all classes of business, including property and casualty, life and health, and workers’ compensation. Several of our attorneys are also ARIAS·U.S. certified arbitrators.

Some of our recent engagements have involved:

• Division of responsibility for actions of a managing general agent
• Representations made by a managing general agent
• Compliance with underwriting guidelines
• Calculation of attachment points for aggregate protections
• A reinsurer’s duty of inquiry
• Pre-hearing security
• Various concerns arising from workers’ compensation carve-out business
• The follow-the-fortunes doctrine
• Application of inuring reinsurance
• Various points arising between and among pool member, pool manager, and pool agents
• Choice of law concerning the issue of late notice
• Reformation/rescission/the duty of utmost good faith
• Claims administration
• Enforceability of arbitration clauses
• Audits and due diligence

Goldberg Segalla’s national insurance coverage lawyers help insurer clients reduce their risk by providing coverage analysis and recommendations tailored to their specific industry.

We have guided policyholders and self-insured entities in analyzing risks and assisting them with the procurement/placement of insurance coverage. We have also advised policyholders on a wide range of complex risk management issues and provided them with counsel in selecting and implementing proactive risk management programs.

Our experience includes:

• Developing proactive internal protocols to monitor insurance compliance and implement risk transfer mechanisms
• Assessing whether current insurance and contracts adequately protect a company for all foreseeable risks in its specific industry
• Assessing insurance issues related to strategic business sales and acquisitions
• Advising companies on their entire insurance portfolio, including EPLI, liability, property, directors and officers, and other coverage
• Assessing overall insurance portfolio and impact of class actions, antitrust and securities claims
• Assisting in structuring captive insurance programs and reinsurance placement issues
• Partnering with brokers for proactive solutions to risk management

Parties to merger, acquisition, and divestiture transactions are increasingly using insurance products to close deals. Remaining at the forefront of the transactional liability insurance market, Goldberg Segalla is positioned to assist clients with these customized products. Attorneys in our Global Insurance Services group have comprehensive knowledge and experience with a suite of insurance solutions ranging from representations and warranties insurance to contingent liability and tax opinion liability insurance.

Goldberg Segalla’s unique ability to synergize our complex insurance coverage practice with our corporate and transactional acumen allows us to efficiently assist our clients with both the fast-paced underwriting and policy drafting, as well as provide effective counsel throughout the claims process. Whether we are assisting in the due diligence review before closing, or evaluating coverage triggers or damages valuations once a claim is submitted, we offer practical advice to support our clients’ objectives.

When coverage disputes turn adversarial, our experienced insurance coverage lawyers provide counsel on matters of policy interpretation and advocate on our clients’ behalf. Often representing insurers in state and federal courts, our lawyers bring their legal acumen and team of subject matter experts to advocate on our clients’ behalf to effectively resolve claims.

With a deep bench of veteran insurance attorneys experienced in advising on general liability, product liability, and foodborne illness policies, as well as a vast array of complex coverages, endorsements, and exclusions, our team is uniquely positioned to counsel insurers in the agribusiness market, regarding both traditional farm policies and commercial agribusiness.

Insurers that issue Commercial General Liability (CGL) and commercial excess/umbrella liability policies must be adept at handling a wide range of insurance coverage issues when policyholders submit requests for coverage for accidents and lawsuits. The attorneys in our Global Insurance Services group have decades of experience handling matters involving CGL and excess/umbrella coverage ranging from catastrophic construction site accidents, class action products alleging toxic products, actions against institutions alleging failure to prevent sexual abuse, and premises liability claims. Insurers must proactively identify and address a myriad of coverage issues including:

• Whether the claim constitutes “bodily injury” or “property damage” caused by “occurrence” as defined by the policy
• Whether an exclusion to coverage applies
• The issuance of prompt and effective reservation of rights or disclaimer of coverage letters compliant with applicable statutes and regulations
• Whether losses can be transferred to downstream insurers through additional insured coverage claims or contractual indemnification claims, and the need for prompt tender letters
• Whether the insured may be entitled to choice of counsel
• Potential erosion of a policy’s aggregate limits by multiple claims
• Handling time-limited policy limit demands and other bad faith “set-ups”
• Issues involving coverage allocation for defense and indemnity costs under multiple policies
• Should a declaratory judgement action be brought against the insured or co-insurers to obtain a declaration of rights under the policies

Our insurance coverage attorneys have the experience and talent to handle the wide range of issues that are raised when accidents and lawsuits implicate CGL and excess/umbrella coverage. The services that we regularly provide include:

• Insurance coverage opinions concerning issues such as whether the insuring agreement is triggered and whether a duty to defend and potentially indemnify is owed
• The interpretation of policy exclusions and whether a disclaimer of coverage should be issued
• Whether a defense should be afforded subject to a reservation of rights
• Whether a matter involves a single or multiple occurrences
• Whether the loss should be tendered to a co-insurer or indemnitee

When clients are presented with CGL and excess/ umbrella coverage issues, our attorneys provide critical guidance to claims professionals by drafting coverage opinions, disclaimers of coverage, and reservation of rights letters.

The Global Insurance Services practice group includes nationally recognized insurance coverage litigators who regularly represent insurers in venues across the United States in high stakes insurance coverage litigation involving CGL and excess/umbrella coverage.

Our attorneys are experienced in representing insurers in complex, multi-party coverage disputes arising from construction-related activities and losses and are well-versed in the coverage issues prevalent in claims between owners, trade contractors, architects, engineers, and trade subcontractors. We have litigated these issues at the trial court level and in appellate courts and tried construction defect-related coverage issues to juries.

Our knowledge and experience span all construction related insurance including commercial general liability policies, professional liability insurance, and owner’s protective liability policies as well as Owner Controlled Insurance Programs, Contractor Controlled Insurance Programs and other wrap-up policies.

Our insurance coverage lawyers frequently assist in preparing coverage opinions addressing construction defects, architects and engineers’ alleged malfeasance and related issues. We investigate these claims, prepare reservation-of-rights letters on behalf of clients, address tenders by or on behalf of insureds and additional insureds, litigate and try these types of cases.

Whether the insurer has a bona fide coverage dispute, additional-insured dispute, a claim for coverage for contractual defense and indemnity, or other construction-related coverage issues, we are well positioned to provide our clients guidance on issues such as:

• An insurer’s duty to defend
• Additional insured issues
• Coverage for tenders of defense and indemnification
• Evaluating whether the actions complained of constitute an “occurrence” and “property damage”
• Coverage for known losses or loss in progress
• Coverage for completed operations
• Coverage for pollution events and pollution cleanup costs under construction policies
• The scope of various business risk exclusions contained in commercial general liability policies
• Allocation of losses spanning multiple policy periods
• Allocation of coverage and uncovered losses

Because claims under the Coverage B of standard CGL policies encompass such a broad range of subject matter, providing effective counsel requires a collaborative legal team with a range of knowledge and experience equally broad. Our insurance coverage attorneys are armed with a robust understanding of the nuances of insurance relating to Coverage B claims, and they bring that historical knowledge and deep experience to bear on every assignment with the goal of providing cost-effective, sophisticated advocacy. Our services include defending insurers in litigation, providing pre-suit analysis, assisting with claim strategy, and prosecuting affirmative declaratory judgment and contribution actions.

As the threat and potential consequences of data breaches continue to rise, cyber risk coverage is becoming a must-have for companies large and small. We help our clients navigate this booming market with the unique training and experience of a dedicated cyber risk team integrated with our Global Insurance Services practice group to provide a broad range of services for insurers and reinsurers.

• Policy wordings and negotiations – Our experienced coverage attorneys can partner with you to develop, draft, review, or modify policy language to appropriately allocate the risk stemming from data breaches and privacy issues.
• Underwriting guidelines and coverage counsel – We are regularly called upon to provide coverage advice regarding claims made under cyber, privacy, and social media policies, and are well-equipped to develop applications and underwriting guidelines.
• Reputational risk coverage – Traditional first- and third-party policies do not account for the cost of repairing a company’s reputation after a data breach. Goldberg Segalla lawyers worked with insurers to develop some of the first policies that address reputational risk.
• Coverage dispute defense – Many leading insurers and reinsurers trust our insurance coverage litigators to represent them in their highest-exposure coverage disputes involving first- and third-party claims.
• Auto insurance telematics – Through our participation in automobile telematics and insurance analytics conferences we are well equipped to keep insurance carriers, automobile manufacturers, telematics system vendors, technology providers, and operational and risk executives updated on the evolving legal issues surrounding data privacy and ownership in auto insurance telematics.

IR²:  Incident Response and Indemnity Recovery

When a cyber event strikes, your priority is guiding your insured through the crisis and ensuring they’re compensated for their loss. At Goldberg Segalla, experience tells us that swift incident response must be followed by a strategic plan for indemnity recovery.

Our cyber subrogation team moves quickly to help identify third-party responsibility – whether it’s vendors, partners, or service providers – and pursue those accountable. We build strong claims and drive recovery of cyber-related indemnity payments efficiently and economically.

Key Considerations

Our attorneys are pioneers that have navigated the complexities of cyber subrogation. We help clients address:

• Subrogation when the party at fault is also your insured
• Subrogation in the face of an ongoing relationship between the insured and the party at fault
• Partnering with insureds with large retentions or deductibles
• Contractual issues (limitation of liability/choice of law, etc.)
• Evaluating venue and forum
• The amount at issue versus cost of recovery
• Bundling claims for strategic advantage and economic viability

Supporting Your Claim

We conduct a thorough investigation grounded in the insurance policy and any relevant contracts between the insured and the party responsible for the loss. Our process includes:

• Establishing liability based on cybersecurity and data privacy obligations
• Connecting liability to the cause of loss
• Quantifying damages using incident response expense documentation and payment records
• Mining lawsuits, enforcement actions, and public filings concerning the responsible party to strengthen your claim and anticipate defenses

This comprehensive approach ensures your claim is well-substantiated and positioned for recovery through early resolution or after defeating a motion to dismiss.

Proven Resolution Options

Our team helps insurers pursue responsible parties with proven strategies that maximize subrogation outcomes, including:

• Strategically selecting the venue and forum
• Crafting pleadings that get past the motion to dismiss
• Negotiating with the party at fault and their insurance carrier
• Developing a simple, compelling narrative
• Being prepared to take the case to trial

Collaborative Financial Partnership

At Goldberg Segalla, we believe that being a trusted business partner means aligning on a financial framework that that is mutually beneficial. We commit to:

• Exploring flexible fee structures, including fee plus contingency-based arrangements
• Setting realistic budgets and hold to them
• Maintaining prompt reporting and transparency throughout the process

Experience That Counts

With the average cost of a cyberattack exceeding almost $4 million, the financial impact is significant. Insurers call upon Goldberg Segalla as the law firm with the experience and insight to protect their interests.

Goldberg Segalla’s Global Insurance Services practice group is one of the largest in the U.S., representing insurers, reinsurers, and others across the insurance landscape. Our trial attorneys are recognized for excellence in cybersecurity litigation, deep subrogation experience, and the ability to preserve critical business relationships while pursuing successful recovery.

D&O insurance has become a more sophisticated tool for public and private companies to protect key executives and minimize corporate exposures. While these specialized products have increased, our national team of insurance coverage lawyers has routinely counseled our clients in understanding the merits, potential damages, and coverage issues presented by a variety of underlying exposures.

Global Insurance Services attorneys represent insurance carriers under D&O policies issued to policyholders ranging from Fortune 500 companies to smaller and privately held companies, as well as investment advisors, mutual funds, hedge funds, and private equity firms. Our team has experience in the US, Bermuda, and London markets.

We work aggressively toward an effective end for claims resolution while all our legal tactics and choices are informed by a comprehensive but flexible strategy tailored to the client’s needs and long-range objectives.

Our national coverage lawyers provide our clients with a broad perspective and deliver value and superior service from the first notice of claim through final disposition. Our capabilities include:

• Evaluation, monitoring, and resolution of complex D&O claims—Many of the world’s leading insurers turn to our Global Insurance Services team to analyze, litigate, and resolve claims presenting cutting-edge coverage issues and complex claims. We leverage our globally recognized team’s broad knowledge base and experience to assist in evaluating the merit and value of claims, monitor the progression of litigation, and provide innovative and practical solutions to resolve claims through negotiation, alternative dispute resolution, or if necessary, litigation. When litigation is necessary, our attorneys have vast experience representing D&O insurers in coverage disputes in state and federal courts throughout the nation.

• Policy wordings and negotiations—To help minimize the risk of a potentially costly coverage dispute, our team can partner with clients to develop, draft, review, or modify policy language in order to tailor a public or private D&O policy to the unique risks of a policyholder. On behalf of insurers and reinsurers, we regularly negotiate policies, endorsements, and treaties with policyholders, brokers, and cedents.

• Risk assessment—Through the underwriting process, our attorneys can work with insurers to evaluate risks presented by a potential policyholder, and assist insurance companies through their underwriting decisions—providing valuable insight into the specialized exposure faced by corporations in various fields. This includes guidance on emerging risks such as data breaches and other cyber risks. We harness the broader knowledge of Goldberg Segalla’s spectrum of lawyers in our diverse range of practice groups to identify risks for our clients before they quote or bind.

Goldberg Segalla defends insurers against claims brought by financial institutions and other corporate policyholders involving financial institution bonds, fidelity bonds, and crime policies. Our fidelity attorneys bring to each engagement the comprehensive understanding of financial operations necessary to handle immensely complex cases involving insider trading, foreign exchange trading, securities and commodities markets, credit and lending activities, money laundering, computer and telecommunications fraud, and other operations.

We leverage our extensive network of prominent accountants, international investigators, and financial and banking professionals to assist with examination and analysis of claims. In addition,  our insurance litigation attorneys have decades of experience counseling insurers, conducting investigations, and handling first-party coverage litigation in matters involving:

• Fraudulent acts
• Fund misdirection and misappropriation
• Embezzlement
• Account manipulation
• Employee dishonesty
• Improper wire transfers
• Check-kiting
• ERISA fraud
• Lending losses
• Computer fraud
• Social engineering losses
• Forgery
• Ponzi schemes and other financial scams
• Mortgage fraud
• Securities fraud
• Safe-deposit box burglary
• Catastrophe-related safe deposit box claims
• Precious metal loss

Goldberg Segalla insurance litigation lawyers have successfully represented insurance agents and brokers in hundreds of errors and omissions claims and lawsuits on a regional and national basis.

Our experience includes the representation of insurance agents and brokers in errors and omissions claims arising out of both first-party and third-party claims, in connection with placements in the excess and surplus lines market, as well as personal lines, commercial lines, professional liability, umbrella excess, and workers’ compensation coverage.

Our attorneys are highly skilled in the specialized law, strategies, and techniques required to achieve outstanding, cost-effective results in the defense of insurance agents and brokers. In addition, they draw on the extensive experience of other Global Insurance Services attorneys to identify any relevant coverage issues and arguments, and any alternative sources of coverage for the underlying claim. Moreover, when an E&O lawsuit is brought due to an underlying liability claim, such as a labor law claim in the construction industry, Goldberg Segalla attorneys in other practice areas are available to lend their expertise to resolve the underlying liability claim.

In addition to E&O defense, we help clients to be proactive about preventing lawsuits. We are committed to providing insurance agents and brokers and their E&O insurers with cutting-edge, practical loss control advice and helping them implement those strategies. In the event of a claim or lawsuit, Goldberg Segalla attorneys work closely with the agents and brokers as well as claims representatives and claims counsel to develop and implement a winning strategy while keeping down both indemnity and defense dollars.

Goldberg Segalla is also available to represent agents and brokers outside of an insured claim, including insurance regulatory and licensing matters, employment concerns, non-competes and non-solicitation agreements, business contracts, agency and MGA agreements, as well as E&O loss control and prevention seminars and audits.

Leadership in Insurance Agents and Brokers Defense

Committed to sharing our knowledge and experience in defending insurance agents and brokers in professional liability matters—and to working with other attorneys, claims-handlers, policy writers, and other insurance industry professionals to further the interests of the industry and the defense bar—attorneys in our Global Insurance Services group have served in leadership roles in numerous legal and professional organizations, including:

• American Bar Association (ABA)
  • Tort Trial and Insurance Practice Section: Professional Liability Insurance Committee (PLIC) past chair and current chair-elect
  • Section of Litigation: Insurance Coverage Litigation Committee and Professional Liability Litigation Committee members
• Claims and Litigation Management Alliance (CLM)
  • Professional Liability Committee member and former chair
• Defense Research Institute (DRI)
  • Professional Liability Committee members, including the industry chair and a past chair
• Federation of Defense and Corporate Counsel (FDCC)
  • Professional Liability Section member and former vice-chair
• Professional Liability Defense Federation (PLDF)
  • Multiple members, including the president of the Board of Directors, multiple past presidents, committee chairs
• Professional Liability Underwriting Society (PLUS)
  • Multiple members, including chair and former chair of the Mid-Atlantic Chapter

Goldberg Segalla’s Global Insurance Services practice has an experienced group of insurance lawyers and litigators focused on life and health insurance, disability benefits, and Employee Retirement and Income Security Act (ERISA) matters. We serve the comprehensive needs of insurers, plan administrators, and others operating in the LHD and ERISA space regarding both benefits claims and other insurance regulatory issues. We handle matters such as:

Life Insurance

• Claims involving questions whether a death was “accidental”
• Contestability, fraud, and material misrepresentation (including foreign death schemes)
• Lapsed or canceled policy issues
• Beneficiary concerns and disputes, including those involving beneficiary changes and unique slayer statute scenarios
• Policy rescission
• Premium disputes and policy administration
• Stranger-originated life insurance (STOLI) and corporate-owned life insurance (COLI)

Health Insurance

• Disputes over payor submission deadlines and third-party billing
• Health insurance and provider audits
• Health Insurance Portability and Accountability Act (HIPAA) compliance and litigation
• Health care subrogation and third-party lien disputes
• Billing agent errors and omissions
• Mandatory insurance reporting to Centers for Medicare and Medicaid Services (CMS)
• Affordable Care Act compliance
• Guidance regarding health insurance exchanges

Disability Benefits

• Defeating challenges to discretionary clause language
• Benefits limitation determinations, such as limits to an “own occupation” period as opposed to “any occupation”
• Resolving disputes among overlapping disability policies
• Litigation over plan conflicts of interest affecting the standard of review
• Heightening efficiency by limiting discovery to the administrative record
• Fraud investigations
• Policy rescission

Employee Retirement and Income Security Act (ERISA)

• Proactive and prompt removal of ERISA cases to the federal courts
• Evolving issues concerning ERISA preemption, including preventing claims of estoppel, waiver, bad faith, fraud, etc.
• Discretionary standards
• Interference and retaliation claims under ERISA Section 510

Insurance Regulatory Guidance

• Organization and licensing of life insurance companies
• Guidance with life insurance and group disability insurance policy form filings
• Compliance with state insurance laws regarding corporate governance and disclosure rules
• Compliance with New York Insurance Law requirements for first-year agent compensation
• Filings submitted to demonstrate compliance with Section 4228 of the New York Insurance Law (agent compensation limitations)
• Compliance with replacement rules for life and annuity contracts, including notifications and disclosures
• Compliance with rules governing advertisement of life insurance and annuity contracts
• Representation in market conduct examinations and agent disciplinary proceedings

Our property and business interruption attorneys understand that to best serve our clients, we need to do more than understand first-party property law. We understand the pitfalls and dangers that can abound in these complex claims and the special challenges that natural disasters such as hurricanes, tornados, and floods can present.

Whether our clients are confronted with a suspicious fire or thousandfold residential and commercial claims from a “CAT” event, we have the experience and commitment to provide proactive, cost-efficient and goal-oriented assistance.

Our experience as lead counsel and coordinating counsel for several insurers with respect to, for example, Superstorm Sandy and Hurricane Matthew affords us the opportunity to cull the collective wisdom of our nationally recognized coverage, extra contractual, and fraud attorneys who handle matters across the country. Our approach is always driven by one over-arching value: to understand our clients’ goals and work together to accomplish them.

The scope of services we provide, which leads to exceptional value for our clients, includes:

• Attention to public relations and other strategic values; alignment of claim-handling processes and other company business units
• Identification of regulatory standards, with constant monitoring and updates
• Identification and recommendation of key experts in “real time” for claim-handling purposes and for litigation purposes
• Coordination of onsite activities where appropriate
• Analysis of coverage issues; drafting coverage analyses and reservation of rights letters
• Examinations under oath and use of various investigative resources
• Development of claim-review protocols to avoid extra-contractual risk
• Litigation, where necessary, including high-stakes cases
• Appraisal and alternative dispute resolution

The Global Insurance Services group has a team focused on counseling insurers concerning claims arising under professional liability policies issued to a wide variety of professionals, including architects and engineers, insurance agents and producers, lawyers, accountants, doctors and other healthcare providers, and representing our clients in some of the most complex and high-exposure errors and omissions coverage matters nationwide.

Our insurance coverage lawyers advise insurers on their rights and obligations under E&O policies and assist in communicating their coverage positions clearly and precisely. Since most E&O policies are written on a “claims made” or on a “claims made and reported” basis, our attorneys help evaluate whether a given matter qualifies as a “claim” under the subject policy, whether any such “claim” was properly made (or made and reported) within the policy period, and whether any other limitations or defenses apply. We also advise insurers of their options for handling other coverage issues, including when and how to negotiate, litigate, and raise legitimate coverage defenses without creating extracontractual exposure.

When disputes cannot or should not be resolved, our insurance litigation attorneys regularly handle coverage issues in both state and federal court and other forums. We have significant experience litigating whether a matter qualifies as a “claim,” whether “claims” are “interrelated,” issues around retroactive date limitations, whether a matter involves “professional services,” policy rescission and cancellation matters, allocation issues, bad faith litigation, and appellate matters after an adverse ruling at trial.

We also provide policy underwriting and drafting advice and have helped clients develop policy forms and endorsements for a range of professional liability policies, including media and technology policies, environmental professional policies, architects and engineers, and other miscellaneous professionals.

In any transportation coverage analysis, it is imperative to understand the relationship of the parties involved (vehicle/truck owner, lessor, lessee, trailer owner), as well as the contractual relationship and additional insured status of various parties. Often there are issues regarding property damage, underinsured motorist coverage, excess/primary insurance obligations, worker’s compensation, permissive use, and scope of employment.

All of this must be examined in conjunction with the extensive statutory and regulatory scheme governing commercial and personal transportation. If one thing is key, it is an understanding that a few key facts, technical knowledge, or statutory twist may mean the difference between success and failure when it comes to transportation insurance coverage issues.

Goldberg Segalla’s transportation coverage team draws from a deep bench of highly experienced lawyers handling some of the most complex coverage matters across the country. Our firm’s clients include national and regional insurers, trucking and logistics companies, and other commercial companies with a dedicated fleet. We help transportation industry clients achieve a seamless blanket of risk protection for their operations through coverage analysis and recommendations tailored to the industry. For our insurer clients, we work collaboratively to draft policy language and mitigate their business risks.

We provide litigated and non-litigated guidance on virtually every coverage issue arising from significant trucking and transportation accidents, including permissive use, covered “auto” issues, insured status and related limitations, and “other insurance” clauses. Goldberg Segalla attorneys represent clients on these and other issues in civil courts and various forums nationwide, and regularly work as national or lead counsel depending on the venue and matter.

A major element of our transportation coverage is helping clients manage so-called “time-limited” settlement demands, under which a third-party claimant or plaintiff demands payment of the insurer’s limits by a unilaterally-set deadline to settle claims against the insured. We guide clients in evaluating and responding to such demands, and in identifying potential pitfalls or “set ups” to avoid.

The insurance coverage team also has deep experience with the federally-required MCS-90 endorsement, which provides a financial safety net to motorists injured or damaged in accidents involving motor carriers of property. We have advised clients regarding this endorsement and the many issues that arise from its interpretation and application, including motor carrier status, issuance and replacement of an endorsement, and potential fraud.

Goldberg Segalla attorneys are nationally recognized leaders in environmental and mass tort coverage and have co-authored multiple innovative environmental liability insurance products widely used in the excess and surplus lines insurance market to address environmental pollution and environmental professional risks.

Our insurance litigation attorneys regularly represent insurers in complex, multi-party coverage disputes arising out of environmental contamination and pollution, toxic tort, or product liability claims – often involving potential exposure in the hundreds of millions of dollars.

By partnering with the foremost industry consultants at all stages of a claim and throughout the course of coverage litigation, we work to ensure that the technical aspects of each case are properly addressed. Our collective experience with the full spectrum of federal, state, and local environmental laws and regulations enhances our ability to provide proactive solutions for our clients’ insurance challenges.

We have handled a wide variety of coverage disputes arising from contaminated property and bodily injury issues, including exposure to:

• Hazardous materials
• Leaking underground storage tanks
• PFAS, mold, lead, benzene, silica, glyphosate
• Legionnaires’ disease
• Natural gas fracking
• Occupational health and safety issues
• Oil and gas spills
• Sick building syndrome
• Storage and transport of hazardous chemicals
• Professional negligence claims concerning environmental consultants
• Soil and groundwater cleanup

Our Global Insurance Services attorneys have also litigated cases dealing with the release of hazardous substances from landfills; the discharge of hazardous materials from manufacturing operations; and the analysis of claims for contamination of navigable waters, aquifers, drinking water sources, and groundwater.

In addition, our attorneys have successfully litigated in state and federal courts on issues such as:

• Proper interpretation of the pollution, asbestos, and occupational disease exclusions
• Negotiation of cost-share and commutations of policies
• Number of occurrences
• What constitutes a “suit“
• Allocation of costs
• Successor liability
• Self-insured retentions
• Insolvency
• Waiver and estoppel
• Trigger of coverage and exhaustion

The excess and surplus market represents an important segment of the overall insurance industry, filling a key gap in the availability of coverage. With this type of insurance, the risks are often atypical of what standard carriers are comfortable writing or require payment of an unacceptably high premium.

The insurance litigation lawyers at Goldberg Segalla look both inside and outside the box to successfully resolve disputes arising out of excess and surplus lines coverage. We have extensive experience as monitoring counsel for excess and surplus lines insurers (both foreign and domestic), and we have successfully handled disputes over language in the Bermuda Form and other specialty risk policies. In addition, we have handled the regulatory needs of these carriers as well.

Some of our recent engagements involved:

• Risks that were materially misrepresented during the underwriting process, such as location, loss history, and prior cancellation
• Litigating the scope of “Ultimate Net Loss” as defined under a policy
• Equitable contribution claims
• Successfully defending claims for third-party coverage that were, in fact, policyholder capital improvements
• Assisting E&S carriers to become eligible nationwide
• Advising the E&S market of significant changes in the rules of the various surplus lines stamping offices
• Successfully defending surplus lines carriers in upholding policy wording that limits or excludes coverage for sexual abuse claims and assault and battery claims

Insurance fraud may occur across various lines of coverage, and it may extend from rate evasion in the underwriting of coverage, misrepresentations in the application process, suppression of exposures on audit, fabricated losses, and post-loss claim enhancement. Our Global Insurance Services group combines a broad knowledge base of our client’s insurance products with up-to-the-minute knowledge of the latest schemes fraudsters are employing to take advantage of our clients. The synergies created between that knowledge base and our experienced and savvy litigators give Goldberg Segalla clients a competitive edge against fraud.

Our insurance fraud team of attorneys works closely and cooperatively with Special Investigation Units (SIU) as well as claims and auditing departments to investigate cases involving insurance fraud. We work collaboratively to help hone investigations, analyze data, and formulate cost-effective litigation plans that allow insurers to quantify the results of their anti-fraud activities.

Our experience includes combating all types of dishonest conduct aimed at harming our clients:

• Application and premium fraud
• Discovery of hidden payroll in computer business records
• Recovery of unpaid insurance premiums
• Policy rescission
• Staged motor vehicle accident rings and thefts
• Unlicensed medical providers
• Medical provider billing eligibility and fraud
• Business interruption losses
• Identity fraud
• Fraudulent employment discrimination claims
• Exaggerated property loss claims
• Enhanced personal injury claims

Goldberg Segalla’s coverage practice includes a number of attorneys with extensive experience representing and counseling insurers that issue or underwrite policies to skilled nursing facilities and other long term care facilities. This group of lawyers advises the firm’s insurer partners on claims arising under these products, which often involve sensitive and high exposure matters.

The claims most often arise under “claim-made” policies, and Goldberg Segalla’s insurance coverage attorneys have deep experience analyzing, and as necessary litigating, even the most complex coverage issue in this context, whether it involves the making or reporting of claims, retroactive-date concerns, or other defenses or limitations to coverage. The team is also familiar with the state and federal regulations applicable to this segment of the firm’s clients, as well as with the state business and commercial laws impacting the clients’ facilities and business practices.

This coverage group regularly provides coverage opinions and coverage correspondence on behalf of its clients, to adequately preserve their rights under the applicable policy and law. Issuing coverage correspondence on a national basis has required the group to become familiar with state laws relating to timing and substance of such correspondence, independent counsel issues raised by the correspondence, and requirements relating to commencing a declaratory judgment action depending on the insurer’s coverage position.

Given the often sensitive or high-exposure nature of claims involving patients or residents of a long-term care facility, a key component of the group’s practice is recognizing, avoiding, and/or mitigating potential extra-contractual exposures for the firm’s clients in this space. Most often, this exposure comes in the alleged bad faith failure-to-settle context, often in the form of time-limited settlement demands. Goldberg Segalla’s lawyers are familiar with the most common bad faith “set ups” employed against insurers across the country, and they have a deep understanding of the judicial standards applicable to insurers in the context of third-party settlement negotiations.

Goldberg Segalla attorneys are nationally recognized product impairment and product recall coverage litigators. Our attorneys regularly represent insurers in complex coverage disputes involving claims presented by manufacturers of a wide variety of products, including food and beverage, cosmetics, energy, electronics, industrial, medical, pharmaceutical, transportation, and other consumer goods, seeking to address the costs of defective or contaminated products either before or after the impaired products have entered the marketplace. Goldberg Segalla attorneys have successfully counseled clients involving all aspects of these claims, which frequently require an analysis of the impact of expert evaluation concerning the cause of the loss and forensic accounting on coverage.

Goldberg Segalla’s national insurance coverage lawyers represent insurer and commercial clients against civil claims of abuse, negligent supervision, harassment, and emotional distress. We are involved in numerous high-exposure, high-visibility Child Victims Act and Adult Survivor Act claims.

Our experience as national coordinating counsel for insurers impacted by these claims has Goldberg Segalla specially equipped to handle the complex and sensitive issues that inevitably arise. This includes issue spotting from the onset of the claim, assisting in securing lost or outdated policies, coordinating responses to a mass influx of claims, and litigating coverage disputes that may arise. Our attorneys also have experience guiding insurers through an insured’s bankruptcy that may result from such claims to best ensure our client’s rights are protected through the process.

Along with claims for sexual abuse, Goldberg Segalla insurance defense attorneys have significant experience litigating coverage issues arising from claims for human trafficking under the Trafficking Victims Reauthorization Act and similar state statutes. We help insurers analyze their duties to defend and indemnify, and address whether the occurrence or aggregate limit applies, exclusions that may bar coverage and separation of insureds interests. These matters often include hospitality industry insureds that have sold or outsourced management operations and our effort to identify risk transfer opportunities through indemnification or additional insured coverage. We assist insurers in responding to time-limited demands and making sure any potential damages are allocated amongst all applicable policy periods.