Duty to defend, duty to indemnify, and the notice provisions that decide both.
Esshaki Legal Media TeamCurrent as of June 2024
When a claim arrives, the first question is whether an insurer must defend, and
that question is answered differently from whether it must ultimately pay.
Duty to defend is broader. It is generally triggered where the allegations,
compared with the policy, raise the potential for coverage — the eight corners
of the complaint and the policy in many states, with some permitting extrinsic
evidence. Ambiguity is resolved in favor of a defense.
Reservation of rights. An insurer defending while disputing coverage must
reserve rights specifically. Where the reservation creates a conflict, the
insured may be entitled to independent counsel at the insurer’s expense in many
states.
Duty to indemnify depends on the facts ultimately established, and may be
resolved in a declaratory action, sometimes stayed pending the underlying case.
Notice. Occurrence policies generally require notice as soon as practicable,
with late notice a defense only on a showing of prejudice in most states.
Claims-made policies require notice within the policy period or an extended
reporting period, and there late notice is usually fatal without any prejudice
requirement.
Allocation among policies and periods for long-tail claims, and exhaustion
of underlying layers before excess coverage responds.
Bad faith. An insurer’s unreasonable refusal to defend, or failure to settle
within limits when it should, exposes it beyond the policy limits.