Patricia B. Santelle, Dean of the College
Claims professionals will benefit from this presentation by learning about potentially covered risks created by artificial intelligence, the types of coverages implicated by these risks, and the coverage issues involved with these risks. The presentation will also identify potential exposures that may arise when insurance companies utilize artificial intelligence in their underwriting and claim processes. It will close with practical pointers and best practices when handling novel AI-driven risks.
1. AI is creating new types of losses, but coverage will often be determined by old policy language and how that language is interpreted.
AI-driven claims are emerging across multiple areas, including professional liability, bodily injury, intellectual property, cybercrime, fraud, discrimination, privacy, and defamation. The challenge is that insurers are frequently applying traditional policy forms to novel AI fact patterns, making causation, attribution, exclusions, and policy wording critical.
2. The greater risk for insurers may be extra-contractual exposure, not just coverage exposure.
AI can transform an isolated claims mistake into evidence of institutional misconduct and may justify broad discovery. If an AI system repeatedly produces unreasonable outcomes, and the insurer knows (or should know) of the pattern but fails to intervene, plaintiffs may use that evidence to support bad-faith, punitive-damages, or institutional-unfairness theories. The delegation to AI, vendors, or TPAs does not break the chain of responsibility.
3. Governance, documentation, and human oversight are the best defenses.
Organizations should not treat AI governance as a compliance exercise but as a risk-management and litigation-defense function. Key protections include maintaining human decision authority, documenting claim-specific reasons, monitoring for patterns and bias, governing vendor and TPA relationships, preserving records, and implementing formal AI governance structures. Strong governance helps defend against both regulatory scrutiny and bad-faith allegations.
Christopher P. Ferragamo, Marie L. VanDam
As in other areas of the law, the insurance field has important coverage concepts that are referred to by their seminal case names. It is important for claims handlers and insurance professionals to be familiar with these concepts. This presentation will provide insurance claims professionals and counsel with practical guidance on not only the names of the cases but the significant concepts that accompany them and their impact on day-to-day claims handling and coverage assessment.
1. The insurance industry has many well-known legal concepts that arose from landmark cases.
2. These key concepts include popular allocation cases such as Carter Wallace and Boston Gas, as well as cases governing policy limit demands or demands within limits, such as Stowers, Holt, and Tyger River.
3. Certain concepts such as Cumis counsel have become part of the lexicon of insurance professionals. It’s important for all claims professionals and claims counsel to be familiar with these names.
A panel of technical experts will provide both a look back and a look ahead at the trends that drive mass tort claims. Claims professionals and attorneys will benefit from this presentation by learning about the impact of these trends on underlying claims handling, defense strategy and coverage determinations. The presentation also will provide insight on how claims professionals and their counsel can assess current and future risks of exposure for mass tort claims.
1. The aggregation of mass tort claims through the growth of attorney advertising has put more pressure on defendants and insurers to manage claims, model future claims, eliminate non-meritorious claims and reach appropriate settlements/dismissals.
2. Data and analytics show that many of the policies that are being impacted today are not pre-1986 GL policies but include many claims-made policies that are in place for non-legacy and more contemporary claims.
3. Emerging contaminants and regulatory shifts across the federal and state governments create uncertainty about how potential claims will ultimately be adjudicated and tested for scientific and evidentiary causation.
Claims professionals will benefit from this presentation by learning about recent national decisions in both coverage and underlying lawsuits and how those rulings impact both coverage issues and claim handling. The presentation also will provide an overview of whether policyholders or insurers have been prevailing in mass tort coverage litigation, and an analysis of how rulings in mass tort lawsuits impact claim handling issues.
1. Developments in mass tort litigation impact claims handling because they: (1) can be determinative of ultimate coverage decisions; (2) assist coverage investigations; (3) reflect multi-jurisdictional trends affecting scope of exposure; and (4) may inform a course of action (e.g., whether to commence a declaratory judgment action in favorable jurisdiction).
2. While no decision has yet been rendered in the Zantac MDL, the Second Circuit decision on general causation for the APAP MDL may have a national impact – limiting how stringent trial courts apply the evidentiary rules on general causation and opting for a more plaintiff-friendly approach.
Difficult adversaries, whether claimants or counsel, can turn routine matters into costly, time-consuming disputes. This practical session will cover strategies for handling threats, unreasonable conduct, challenging adversaries, AI-generated filings, and effective file documentation. Attendees will learn how to stay strategic, control costs, and protect the claim without becoming part of the problem.
1. Do not personalize your relationship with a difficult adversary. The claim is your problem to solve – the adversary’s demeanor and personality is not.
2. Do not let behavior dictate your strategy with a difficult adversary. Threats, without substance behind them, do not create leverage.
3. Always assume your file is going to be read by the adversary or a third party (Judge, mediator, etc.). Professionalism, proportionality and documentation create protection.
This presentation will provide insurance claims professionals and their attorneys with practical guidance on effectively using engineering experts in property claims. The program will examine best practices for engaging engineers, developing focused assignments, conducting efficient investigations, evaluating causation issues, and obtaining engineering reports that support accurate and defensible claim decisions.
Through discussion of real-world claim scenarios and lessons learned from litigation, attendees will gain insight into how engineers approach property damage investigations, what information they need to render reliable opinions, and how claims professionals can improve collaboration throughout the claim process. The presentation will also address common challenges encountered in property investigations and emerging trends affecting engineering evaluations.
1. Engage the right expertise early.
Retain an engineer when causation is unclear, multiple causes are plausible, or specialized analysis is needed—before repairs, removal, or disposal compromise meaningful evidence. Coordinate preservation with necessary repairs and protection of the property.
2. Ask neutral questions and keep roles clear.
Frame assignments around what the physical evidence supports, not a preferred outcome. Engineers evaluate technical causation; adjusters evaluate the findings within the policy and claim file; counsel addresses legal and evidentiary concerns without directing the science.
3. Expect a transparent path from evidence to conclusion.
A useful report connects observations → data and principles → analysis → opinion. It answers the assignment questions, addresses competing causes and contrary evidence, and clearly states assumptions, limitations, and recommended follow-up.
This presentation will provide insurance claims professionals and their attorneys with practical guidance on effectively using engineering experts in property claims. The program will examine best practices for engaging engineers, developing focused assignments, conducting efficient investigations, evaluating causation issues, and obtaining engineering reports that support accurate and defensible claim decisions.
1. The majority of states do not require excess insurers to drop-down to provide coverage in place of insolvent primary insurers. However, policy language controls the outcome and states interpret such language differently. Be aware of how your policies define or describe exhaustion and underlying insurance.
2. In states applying pro-rata allocation, the insured generally bears the burden of covering amounts allocated to insolvent periods. Courts have not meaningfully analyzed the issue in “all sums” jurisdictions so be prepared to advocate for your own proposed solution in such cases.
3. Even where case law is unclear or even unfavorable, there are steps insurers can take to mitigate the risks of insolvency exposure. Identify periods of insolvency early as the impact on exposure may make early settlement a prudent option. Excess insurers sitting above insolvent carriers may benefit from associating in the defense and/or monitoring of claims within the primary layer even where there is no drop-down obligation as doing so can prevent collusive settlements and/or weak defense efforts.
Claims professionals will benefit from this presentation by learning about key coverage decisions over the past year, and ongoing coverage litigation, involving issues implicated by long-tail and environmental claims, as well as developments in the bankruptcy/insolvency context. The presentation will provide an issue-by-issue overview of recent developments across jurisdictions so as to bring claims professionals up to date and keep them apprised of the status of the legal landscape.
1. A series of recent decisions, including several rulings finding ambiguity in pertinent policy language, reflect different approaches to determining the number of “occurrences.”
2. Even after decades, courts continue to grapple with litigation over the application of various forms of pollution exclusions in a variety of contexts. This includes but is not limited to claims involving emerging liabilities like PFAS.
3. Across a range of other coverage issues, including the exhaustion of self-insured retentions and allocation of loss, courts continue to focus on the operative policy language in resolving disputes.4. Policyholder bankruptcies and receiverships continue to present challenges for insurers.
In this entertaining presentation, Randy Maniloff will look back at the past 14 years of his Coverage Opinions newsletter and share some of his favorite cases and articles.
