"(1) Every appeal will be limited to a review of the decision of the lower court unless (a) a practice direction makes different provision for a particular category of appeal; or (b) the court considers that in the circumstances of an individual appeal it would be in the interests of justice to hold a re-hearing. (3) The appeal court will allow an appeal where the decision of the lower court was (a) wrong; (4) The appeal court may draw any inference of fact which it considers justified on the evidence." "(1) Every appeal will be limited to a review of the decision of the lower court unless (a) a practice direction makes different provision for a particular category of appeal; or (b) the court considers that in the circumstances of an individual appeal it would be in the interests of justice to hold a re-hearing. (3) The appeal court will allow an appeal where the decision of the lower court was (a) wrong; (4) The appeal court may draw any inference of fact which it considers justified on the evidence."
" The appellate approach: the general rule 30. As a general rule, every appeal will be limited to a review of the decision of the lower court. This general rule will be applied unless a practice direction makes different provision for a particular category of appeal, or the court considers that in the circumstance of an individual appeal it would be in the interests of justice to hold a rehearing:CPR r 52.11 (1). The appeal court will only allow an appeal where the decision of the lower court was wrong, or where it was unjust because of a serious procedural or other irregularity in the proceedings in the lower court:CPR r 52.11 (3). 31. This marks a significant change in practice, in relation to what used to be called "interlocutory appeals" from district judges or masters. Under the old practice, the appeal to a judge was a rehearing in the fullest sense of the word, and the judge exercised his/her discretion afresh, while giving appropriate weight to the way the lower court had exercised its discretion in the matter. Under the new practice, the decision of the lower court will attract much greater significance. The appeal courts duty is now limited to a review of that decision, and it may only interfere in the quite limited circumstances set out inCPR r 52.11 (3). 32. The first ground for interference speaks for itself. The epithet "wrong" is to be applied to the substance of the decision made by the lower court. If the appeal is against the exercise of a discretion by the lower court, the decision of the House of Lords in GvG (Minors: Custody Appeal)[1985] 1 WLR 647 warrants attention. In that case Lord Fraser of Tullybelton said, at p 652: "
"(1) The burden of showing that the trial Judge was wrong lies on the appellant. (2) When questions of the credibility of witnesses who have given oral evidence arise the appellant must establish that the trial Judge was plainly wrong. Once again there is a long line of authority emphasizing the restricted nature of the Court of Appeals power to interfere with a Judges decision in these circumstances though in describing that power different expressions have been used. In SS Hontestroom v SS Sagaporak[1927] AC 37 at p 47 Lord Sumner said: "
"In such a case it is the duty of the Court of Appeal to make up its own mind not disregarding the judgment appealed from and giving special weight to that judgment in cases where the credibility of witnesses comes into question, but with full liability to draw its own inferences from the facts proved or admitted and to decide accordingly. (3) When a party has been acquitted of fraud the decision in his favour should not be displaced except on the clearest grounds. This proposition is not in contest and is supported by the House of Lords in Akerhielm v De Mare[1959] AC 789 at p 806, where the earlier authority of Glasier v Rolb(1889) 42 Ch D 436 is cited." "(1) The burden of showing that the trial Judge was wrong lies on the appellant. (2) When questions of the credibility of witnesses who have given oral evidence arise the appellant must establish that the trial Judge was plainly wrong. Once again there is a long line of authority emphasizing the restricted nature of the Court of Appeals power to interfere with a Judges decision in these circumstances though in describing that power different expressions have been used. In SS Hontestroom v SS Sagaporak[1927] AC 37 at p 47 Lord Sumner said: "
"In such a case it is the duty of the Court of Appeal to make up its own mind not disregarding the judgment appealed from and giving special weight to that judgment in cases where the credibility of witnesses comes into question, but with full liability to draw its own inferences from the facts proved or admitted and to decide accordingly. (3) When a party has been acquitted of fraud the decision in his favour should not be displaced except on the clearest grounds. This proposition is not in contest and is supported by the House of Lords in Akerhielm v De Mare[1959] AC 789 at p 806, where the earlier authority of Glasier v Rolb(1889) 42 Ch D 436 is cited."
"With regard to an appeal to this court (which would never have involved a complete rehearing in that sense), the language of review may be said to fit most easily into the context of an appeal against the exercise of a discretion, or an appeal where the court of appeal is essentially concerned with the correctness of an exercise of evaluation or judgment such as a decision by a lower court whether, weighing all relevant factors, a contract of service existed. However, the references in r 52 11 (3) and (4) to the power of an appellant court to allow an appeal where the decision below was wrong and to draw any inference of fact which it considers justified on the evidence indicate that there are other contexts in which the court of appeal must, as previously, make up its own mind as to the correctness or otherwise of a decision, even on matters of fact, by a lower court. Where the correctness of a finding of primary fact or of inference is in issue, it cannot be a matter of simple discretion how an appellant court approaches the matter. Once the appellant has shown a real prospect (justifying permission to appeal) that a finding or inference is wrong, the role of an appellate court is to determine whether or not this is so, giving full weight of course to the advantages enjoyed by any judge of first instance who has heard oral evidence. In the present case, therefore, I consider that (a) it is for us if necessary to make up our own mind about the correctness or otherwise of any findings of primary fact or inferences from primary fact that the judge made or drew and the claimants challenge, while (b) reminding ourselves that, so far as the appeal raises issues of judgment on unchallenged primary findings and inferences, this court ought not to interfere unless it is satisfied that the judges conclusion lay outside the bounds within which reasonable disagreement is possible. In relation to (a) we must, as stated, bear in mind the important and well-recognised reluctance of this court to interfere with a trail judge on any finding of primary fact based on the credibility or reliability of oral evidence. In the present case, however, while there was oral evidence, its content was largely uncontentious."
"On the other hand, the standards applied by the law in different contexts vary a great deal in precision and generally speaking, the vaguer the standard and the greater the number of factors which the court has to weigh up in deciding whether the standards have been met, the more reluctant an appellate court will be to interfere with the trial judges decision" "
"The question of whether an invention was obvious had been called "a kind of jury question" (see Jenkins LJ in Allmanna Svenska Elektriska A/B v The Burntisland Shipbuilding Co Ltd(1952) 69 RPC 63 , 70) and should be treated with appropriate respect by an appellate court. It is true that in Benmax v Austin Motor Co Ltd[1955] AC 370 (1955) 72 RPC 39 , 42, this House decided that, while the judges findings of primary fact, particularly if founded upon an assessment of the credibility of witnesses, were virtually unassailable, an appellate court would be more ready to differ from the judges evaluation of those facts by reference to some legal standard such as negligence or obviousness. In drawing this distinction, however, Viscount Simonds went on to observe, at page 374, that it was "subject only to the weight which should, as a matter of course, be given to the opinion of the learned judge"
"It is worth reflecting on what judges mean when they speak of inferences in this context. An inference from a number of primary facts may itself be a simple matter of fact. That is an inference from circumstantial evidence, or what might be called the smoking gun kind of inference. (Inferences from a litigants failure to call a particular witness may be in this category.) In the present context, however, the inference is not a simple matter of fact because it involves a process of evaluation. It was put very clearly by Viscount Simonds in Benmax v Austin Motor Co Ltd[1955] AC 370 , 373 (a patent case on obviousness): "
"I cannot help thinking that some confusion may have arisen from a failure to distinguish between a finding of a specific fact and a finding of fact which is really an inference from facts specifically found or, as it has sometimes been said, between the perception and evaluation of facts."
"How reluctant should an appellate court be to interfere with the trial judges evaluation of, and conclusion on, the primary facts? As Hoffmann LJ made clear in Grayan there is no single standard which is appropriate to every case. The most important variables include the nature of the evaluation required, the standing and experience of the fact-finding judge or tribunal, and the extent to which the judge or tribunal had to assess the oral evidence." "
"As you will see these placings are for Contractors involved principally in Residential, Commercial and associated trades coverage is provided on an all jobs basis with no single project being more than$10,000,000 in Contract. The estimated premium income over both placings in the next twelve months is estimated at approximately US$20,000,000 . As respects the Liability coverage, please note that any account with a known products exposure is automatically disqualified and not even submitted to the Underwriters for an indication of terms. Each account is subject to a vigorous pre-qualification procedure in the USA and in London before it is even submitted to Underwriter. This process has contributed to the success of the placing which is demonstrated by the enclosed figures and the premium volume. The leading Insurers in London are the Assicurazioni Generali Spa with support from the Commercial Union and the Munich Re. We believe you will find our submissions self explanatory but if you have any questions pleas contact the undersigned. We now await details of your proposed participation which can be on a reinsurance basis if you wish." "
"He recalls discussing the capacity which was on offer at that time and the split of the forecast premium of US$20 millions for the next year between sections A and B, and between the AH package and the WK Cooper package. He discussed the pre-qualification procedures and was led to believe, accurately, that AH would initially assess the suitability of the proposal and weed out those which they believed would be unacceptable to underwriters and that the Lead Reinsurance underwriters at Generali would carry out their own assessment and quote terms, where the risk was acceptable. He also says that he was led to believe that Munich Re was taking 35%, Generali was taking 40% and Commercial Union 20%. He says he understood, from the fax and the telephone call that these percentages applied to both sections A and B. He says that he formed a very favourable impression of the potential business as the brokers had been able to answer all their questions and give the necessary comfort we were looking for. He recalls a further telephone conversation with AH on9 July 1992 , when he chased them up for the wordings for which he has asked in the earlier call."
"Derek, thanks for your patience and input on this placement in view of which, based on your offer 18-6-92 and faxes 9-7-92, we are prepared to accept a 7.5% line of whole to be signed in full subject the CGL R/I available and total deductions to ARIG 30% in all. Please forward final slip(s) for our signature after finalising all points such as fronting, protection, etc. Pls note that our liability only incepts from inception of this facility for projects to be declared from now; no run off liability is accepted from previous periods or contracts already having incepted and/or completed. Pls confirm. Best rgds." "
" we confirm that we will be using your line of 7.5% on each sections with respect to declarations attaching on or after the 2 nd of July 1992. we confirm that we have arranged excess of loss re-insurance in respect of your 7.5 % line on the CGL section section B. Your re-insurance cover note will be sent shortly. we anticipate that you will be writing as a retrocession of the Generali United Kingdom Branch. Will advise again if this is not the case. Will send copy of our slip in next day or so. we confirm total deductions to ARIG are 30%. Lastly, we confirm that this placing only apples to occurrences under declarations bound during the twelve months @ July 2 nd 1992. Liability from back years is not transferred Trusting all in order and many thanks." " we confirm that we will be using your line of 7.5% on each sections with respect to declarations attaching on or after the 2 nd of July 1992. we confirm that we have arranged excess of loss re-insurance in respect of your 7.5 % line on the CGL section section B. Your re-insurance cover note will be sent shortly. we anticipate that you will be writing as a retrocession of the Generali United Kingdom Branch. Will advise again if this is not the case. Will send copy of our slip in next day or so. we confirm total deductions to ARIG are 30%. Lastly, we confirm that this placing only apples to occurrences under declarations bound during the twelve months @ July 2 nd 1992. Liability from back years is not transferred Trusting all in order and many thanks."
"We believe that you will find these to be in order and would ask you to authorize your line, where shown on each retrocession slip and fax them back to us immediately. We believe you will find everything in order but if you have any questions please contact the undersigned immediately."
"The leading Insurers in London are [Generali] with support from the Commercial Union and the Munich Re."
"Claims Handling Procedure:- as per the attached agreement. Claims settlement authority is US$25,000 per claim"
"(1) The fax of18 June 1992 was an invitation by AH to ARIG to treat. It did not amount to an offer since, amongst other things, it did not specify the respect in which ARIG could participate whether a co-reinsurer of United or as a retrocessionaire of Generali. (2) ARIGs fax of10 July 1992 was not an acceptance of an offer, because no offer had been made and in any case the acceptance of a 7.5% line could have been on the basis of a co-insurance [where the contracting party would include United] or a retrocession [where the contracting party would be Generali]. (3) The reference by ARIG in that fax to the need for AH to send final slips for signature after finalising points on matters such as fronting, protection etc is significant for two reasons: first, it shows that as at that date ARIG did not regard the contract as concluded because there were terms and conditions still to be sorted out and agreed; and second, it shows that ARIG regarded the formal act of scratching the slip as the last step in the contractual chain. (4) The fax from AH saying that we will be using your line of 7.5% still left open the question whether ARIG was contracting as retrocessionaire or as co-insurer. That issue remained to be resolved and, until it was, there could not have been a concluded contract. When AH had decided in which capacity ARIG was to contract they did so at the same time as sending ARIG the final slips to scratch which they asked to be returned signed and stamped as a matter of urgency. It was only when these slips were sent that ARIGs contractual position had been clarified. (5) From an objective analysis of the contractual documents, it seems to me clear that both parties intended the contract to be concluded when the slips were scratched and returned by ARIG to AH. That would be the usual method by which insurance, reinsurance or retrocession was concluded. Thus, in my judgment, the contract was only concluded in September when that step was taken by ARIG. " "(1) The fax of18 June 1992 was an invitation by AH to ARIG to treat. It did not amount to an offer since, amongst other things, it did not specify the respect in which ARIG could participate whether a co-reinsurer of United or as a retrocessionaire of Generali. (2) ARIGs fax of10 July 1992 was not an acceptance of an offer, because no offer had been made and in any case the acceptance of a 7.5% line could have been on the basis of a co-insurance [where the contracting party would include United] or a retrocession [where the contracting party would be Generali]. (3) The reference by ARIG in that fax to the need for AH to send final slips for signature after finalising points on matters such as fronting, protection etc is significant for two reasons: first, it shows that as at that date ARIG did not regard the contract as concluded because there were terms and conditions still to be sorted out and agreed; and second, it shows that ARIG regarded the formal act of scratching the slip as the last step in the contractual chain. (4) The fax from AH saying that we will be using your line of 7.5% still left open the question whether ARIG was contracting as retrocessionaire or as co-insurer. That issue remained to be resolved and, until it was, there could not have been a concluded contract. When AH had decided in which capacity ARIG was to contract they did so at the same time as sending ARIG the final slips to scratch which they asked to be returned signed and stamped as a matter of urgency. It was only when these slips were sent that ARIGs contractual position had been clarified. (5) From an objective analysis of the contractual documents, it seems to me clear that both parties intended the contract to be concluded when the slips were scratched and returned by ARIG to AH. That would be the usual method by which insurance, reinsurance or retrocession was concluded. Thus, in my judgment, the contract was only concluded in September when that step was taken by ARIG. "
"(2) Every circumstance is material which would influence the judgment of a prudent insurer in fixing the premium, or determining whether he will take the risk."
"For these reasons I conclude that there is to be implied in the Act of 1906 a qualification that a material representation will not entitle the underwriter to avoid the policy unless the misrepresentation induced the making of the contract, using "induced" in the sense in which it is used in the general law of contract." "
"Under the general law, a misrepresentation need not be the sole inducement, but must have been a real and substantial cause affecting the decision of the representee to enter into the contract, or to do so on the terms agreed."
"Type B is a representation such that, if the recipient had known the truth, he would still have been willing to make the contract, but only on different terms, notably, but not only as to premium." "
"Type B is a representation such that, if the recipient had known the truth, he would still have been willing to make the contract, but only on different terms, notably, but not only as to premium."
"The existence of such a presumption is recognised in the authorities; see Halsburys Laws vol 31 par 1067 where the law is stated as follows: Inducement cannot be inferred in law from proved materiality, although there may be cases where the materiality is so obvious as to justify an inference of fact that the representee was actually induced, but, even in such exceptional cases, the inference is only a prima facie one and may be rebutted by counter evidence. The authorities cited include Smith v Chadwick(1884) 9 App Cas 187 and in my judgment they justify the above statement of the law. This provides a reminder of the need to distinguish "materiality" from "inducement", although inevitably the two overlap. Here, the evidence of the three underwriters who did give evidence and of the expert witnesses was clear. If the underwriters had been told the true state of the ground conditions, as revealed by the 1982 report, and of the conflicting views expressed by the authors of that report and by Worleys, then they would have called for further information and in all probability either refused the risk or accepted it on different terms. In fact, all four underwriters including Mr Earnshaw accepted it without any relevant enquiries. There is no evidence to displace a presumption that Mr Earnshaw like the other three was induced by the non-disclosure or misrepresentation to give cover on the terms on which he did. In my judgment, these insurers also have discharged their burden of proof."
"I am not prepared to place any great weight on the oral conversation between Mr Wardlaw and Mr Rehman at the beginning of July 1992. Mr Wardlaw had no recollection of the conversation; the witnesses were dealing with something that occurred 9 years ago and for which there are no notes relevant to this issue. Mr Wardlaw says he thinks he would have explained the full position about Munich Res participation. I doubt he did so because Mr Rehman had obviously talked himself into believing that participation could only be across the board. The most obvious explanation for how this issue came to the fore is simply that Mr Rehman has misled himself and thought, through his own ignorance, that support from Munich Re must have involved their participation in both Sections of both packages. The truth was staring at him in the face. It is most improbable that the brokers would have negligently or deliberately misrepresented the position when the true position was there for all to see." iii) In any event the judge did not consider that what was said about Munich Re played any part in the decision taken ARIG to participate in the programme. In reaching that conclusion he placed particular reliance upon the oral evidence of Mr Anderberg to which I refer below. Misrepresentation i) The fax of 18 June did not contain any representation that Munich Re participated in the whole package. The words "with support from the Commercial Union and the Munich Re" in the fax of 18 June could not mean more than that Munich Re were participating in the packages and did not necessarily mean that they were participating in both sections A and B. Mr Rehman misunderstood the position because he wrongly thought that it was not possible to participate in only one of the packages, although (as I read his judgment) the judge expressed considerable scepticism as to whether Mr Rehman was really of that view. ii) As to the telephone conversation on 3 July, the judge said this in paragraph 31: "
"But in any event I do not consider that what was said about Munich Re played any part in the decision taken by ARIG to participate in the programme. Although Mr Anderberg suggested in his witness statement that but for Munich Res participation ARIG would not have participated, his position modified when he gave evidence. Quite rightly, I think, he said that the decision taken by ARIG whether or not to participate was taken on the merits of their appraisal of the risk but that the fact Munich Re was also a participant was a comfort factor after the decision had been taken." "
"A. Am I right in thinking that you are asking me a question -- because it is quite a long question -- that the Munich Re decision did not have any impact on our own decision? Q. On your underwriting judgment, on deciding whether or not to accept this risk, that is what I am asking. A. You know, we are making an independent underwriting. Q. I am sure you are. A. On all risks. All the other factors involved here -- the excellent figures, et cetera -- indicated that this was a very profitable account and I am sure we would have written it without the participation of Munich Re, I am sure. It was a comfort factor but Munich Re is not guiding our underwriter, we are guiding our underwriting ourselves. MR JUSTICE MORISON: The position is that you take an independent underwriting decision, having made the decision to participate, you are feeling comfortable with that decision having regard to the participation of Munich Re in the programme. A. Yes." "
"Q If you had been told that Munich Re was on section A and section B at the time you assessed the risk, and then just before you accepted the line you were told that Munich Re was not, in fact, on section B, what view would you have taken? A I would have been very puzzled, asking "why", because this was a profitable account and I would have gone back to the producer and asked them for a clarification and why Munich Re did not participate in section B, which was actually, as far as I remember, when we were asking for the premium split it generated, on the advice premium volume of 20 million, it actually generated 75 per cent. Why should Munich Re not participate on this 75 per cent of the 20 million if it was a profitable account with good prospects? That would have been my immediate reaction. If I would not have got any clarification which I could buy, I would have declined participation." "
"CONTRACTORS PREMIUM AND LOSS UPDATE SECTIONS A & B FAC NO GROSS PREMIUM PAID OUT-STANDING INCURRED Paid & O/S LOSS RATIO 910989$ 233,991 $ 31,772 $ NIL$ 31,772 13.57% 956090$ 1,666,516 $ 21,833 $ 456,732 $ 478,565 28.70% 956091$ 4,596,397 $ 223,529 $ 249,454 $ 472,983 10.29% 956092$ 3,245,289 $ NIL$ 10,500 $ 10,500 00.32% 957090$ 10,237,000 $ 2,661,930 $ 1,783,384 $ 4,445,314 43.42% 957091$ 13,334,976 $ 330,181 $ 1,162,273 $ 1,492,454 11.20% 957092$ 11,986,078 $ 4,027 $ 160,223 $ 164,250 01.37% TOTAL$ 45,300,347 $ 3,273,272 $ 3,822,566 $ 7,095,838 15.66% Those figures excluded a particular loss in respect of which coverage was not renewed and were stated to be provided by the third party claims administrator ("
"FAC NO GROSS PREMIUM PAID OUT-STANDING INCURRED Paid & O/S LOSS RATIO 956091$ 749,418 $ 96,264 $ 76,633 $ 172,897 23.07% 956092$ 394,640 $ NIL$ 6,000 $ 6,000 01.52% 957091$ 2,332,347 $ 148,970 $ 366,789 $ 515,7594 22.11% 957092$ 2,217,193 $ 4,027 $ 78,223 $ 82,250 03.71% TOTAL$ 5,693,598 $ 249,261 $ 527,645 $ 776,906 13.65% "
"What is complained of is [the figures] misleading character. ARIG say that the figures would have looked quite different had the TPA [ie G&T] not operated an unusual and imprudent reserving policy. Through Mr Simon QC, ARIG put their case on the need to disclose the reserving policy in two separate ways. He submitted that the reserving policy was imprudent and unusual and, ipso facto, should have been disclosed as a material fact as a part of the fair presentation of the risk. Second, he submitted that without disclosure of it, the figures presented in the fax of June 1992 and in March 1993 were materially misleading. I agree with Mr Collins QC on behalf of Generali that there is effectively only one point. The reserving policy is not itself a material fact which requires to be disclosed. The evidence was clear on this point. An underwriter would only be expected to be informed of such a policy if it were unusual and imprudent so that it rendered the figures showing the ratio of losses to premiums unreliable. Was the policy unusual and imprudent so that the figures disclosed were misleading? Mr Simons two points merged into just one." "
"It seemed to me that Appendix A did not provide the particulars which it purported to provide. As he said, "my reserve of$40,000 cannot be compared to the reserve needs on any individual file."
"In my judgment, even when dealing with expert witnesses, a trial judge has an advantage over an appellate court in assessing the value, the reliability and the impressiveness of the evidence of the experts called on either side. There are various aspects of such evidence in respect of which the trial judge can get the feeling of a case in a way in which an appellate court, reading the transcript, cannot. Sometimes expert witnesses display signs of partisanship in the witness box or lack of objectivity. This may or may not be obvious from the transcript, yet it may be quite plain to the trial judge. Sometimes an expert witness may refuse to make what a more wise witness would make, namely, proper concessions to the viewpoint of the other side. Here again this may or may not be apparent from the transcript, although plain to the trial judge. I mention only two aspects of the matter, but there are others."
"I have to say at once that I did not regard Mr Beckermans evidence as particularly helpful or reliable. In the most general terms he tended to advocate ARIGs case, no doubt through considerable experience of advocating claims in the US courts, often, I suspect, before a jury. He did not quite have the presence, authority and balance to be expected of an independent expert. But he was labouring, I think, under the disadvantage of being instructed late. He was adamant that a claims handler MUST post a reserve within 30 days of a claim being made. He went on to say that he did not regard a 90 day delay as acceptable. 30 days was a US industry standard. There was no mention of this standard in his report, nor in the joint memorandum prepared by the experts nor in a book on the subject to which he helpfully drew our attention. He was of the view that there were really no exceptions to this standard. He felt able to make judgments about the adequacy of the reserves in relation to files for which he had only one piece of paper extracted. I consider that he exaggerated the need for a reserve in 30 days and was not prepared to look at the matter from the perspective of a claims handler in 1992/1993. Broadly speaking, I felt unable to rely upon Mr Beckermans evidence unless it was consonant with the evidence of Mr Palange." "
"Mr Palange gave me confidence about the reliability of his evidence. He is well qualified to give his opinion in this case. He has conducted "literally hundreds" of reserve and technical audits of US Insurers claims departments and TPAs. What he did was to carry out a sampling of 144 original files which he selected from Appendix A. He said, and I accept, that he selected samples of large and small incurred losses, large and small paid losses and a sampling of all sizes of loss where Appendix A had used the figure of US$40,000 (repetitively). He reached a number of conclusions, based on his own analysis of complete files chosen at random within the parameters set out, which I accept and find as follows."
"(1) In almost every case, a claim under the programme would be in the form of a law suit. Claims were attended to immediately on receipt. He would look at the claim, as he looked at all of them in the early years. It would be allocated to a claims examiner, of whom there were 33 and entered in the system. (2) A nil reserve was set until Gay & Taylor were in a position "to set a loss reserve that properly represented underwriters most likely financial exposure in the context of coverage provided by the insurance policy"
"Gay & Taylor adopted a form of case reserving. That is, the reserves were applied on a case by case basis. Initially a nil reserve was set when a new file was opened and the claim would be investigated both as to coverage and liability, often through outside attorneys or independent adjusters. Once the likely outcome was capable of being assessed, Gay & Taylor did not adopt a policy of stair step reserving, but pursued a policy of one-time reserving "that is to say, to establish a reasonably accurate reserve for the first time it was set once adequate and accurate investigation information was received." "
" Matters of Market Practice It is the custom, practice and procedure in the United States insurance industry to post reasonably accurate loss and expense reserves for primary construction, liability and construction defect liability claims, in as timely a fashion as the facts and circumstances of each individual claim reasonably allow. Reserving One of the duties of a TPA is the posting (establishment and maintenance) of reserves. Reserves are used to help an insurance carrier predict the amount of money it will have to spend on paying claims and lawsuits. Case reserving is the most common form of reserving practice within the insurance industry in the United States. "
"Expense reserving should be based upon the reasonable likely cost of the investigation and of the defense of the claim. When a new claim is received, there may be times when information is so limited that a determination of the indemnity or expense reserve amount cannot immediately be made. Normally, defence counsel will provide the claims handler with the information obtained from the discovery process. Defense counsel may also suggest a future course of discovery. However, defence counsel will not normally recommend a specific reserve amount, although he or she may be invited to do so by the claims handler. The retention of defence counsel, and the initiation of the discovery process, should result in the prompt receipt of at least some liability and damages information. Information discovered should be transmitted promptly by the defence attorney to the claims handler in writing. No insurer (or TPA) relative to large construction defect claims could establish reserves that would "properly represent[s] its most likely financial exposure in the context of coverage provide by the policy(ies)" until such time as they received adequate investigative data concerning coverage, liability and damages as the facts and circumstances of each individual claim reasonably allowed. Large losses are more likely to involve complex coverage issues and consideration. Once a coverage position is adopted by an insurer that is "adverse" to an insured, and the larger the potential damages exposure, the more likely it is that the insured will contest such a coverage position(s). It is generally accepted within the US Insurance Market that a large loss is so designated when the incurred value of such loss reaches or exceeds a "significant amount"
"(1) Gay & Taylor were reputable and well known TPAs and it was quite reasonable for Generali to have used them. (2) The terms of the agreement between Generali and Gay & Taylor were "reasonable"
"Adopting Mr Beckermans policy would involve some guess work and would put a premium on regular reviews of such reserves thereafter. Delaying setting a reserve until after an investigation of the full circumstances would be likely to lead to more realistic reserves which were less likely to require review but which were less timely. To adopt a policy whereby reserves were only set when the last t had been crossed and the last i dotted would defeat the object of the exercise which was substantially to inform participants in the programme what the relationship was between premium income and losses (actual and anticipated). If Mr Reynaud had adopted this policy then it would have been both unusual and imprudent"
"Mr Palange prepared his first report having had a copy of Mr Reynauds witness statement. His conclusion, based upon that and a study which he had carried out on the sample files led to this conclusion, namely that this form of reserving "was not one uncommon among American Insurers and TPAs in the late 1980s and early 1990s"
"No insurer or TPA relative to large construction defect claims could establish reserves that would "properly represent its most likely financial exposure in the context of coverage provided by the policy(ies)" until such time as they received adequate investigative data concerning coverage, liability and damages as the facts and circumstances of each individual claim reasonably allowed."
"There was a certain amount of debate as to what Mr Reynaud meant in his testimony. Mr Simon would say that "all of the circumstances" meant down to the last detail and that explained delays in making reserves. If "by all the circumstances" one means no more than all of the circumstances relevant to setting a reserve then Mr Reynaud was not describing an unusual reserving policy."
"Based upon Mr Palanges own work, it is clear that the policy described by Mr Reynaud in his witness statement was, in fact, carried out and that Mr Reynaud did not indulge in the unacceptable practice of taking the investigations too far before setting the reserve. Indeed, in many cases a reserve was made very soon after a file was opened. That did not contradict Mr Reynauds evidence since it was not inconsistent with the reserving policy outlined in his witness statement. The line of questioning pursued of Mr Palange was to try and establish that he was denying the policy of Gay & Taylor. Taking his evidence as a whole, I do not see a difference between the evidence of Mr Reynaud (which added little to what he said in his witness statement) and what Mr Palange discovered on a review of the files." "
"Based upon Mr Palanges own work, it is clear that the policy described by Mr Reynaud in his witness statement was, in fact, carried out and that Mr Reynaud did not indulge in the unacceptable practice of taking the investigations too far before setting the reserve. Indeed, in many cases a reserve was made very soon after a file was opened. That did not contradict Mr Reynauds evidence since it was not inconsistent with the reserving policy outlined in his witness statement. The line of questioning pursued of Mr Palange was to try and establish that he was denying the policy of Gay & Taylor. Taking his evidence as a whole, I do not see a difference between the evidence of Mr Reynaud (which added little to what he said in his witness statement) and what Mr Palange discovered on a review of the files."
"There should be?" and he said "
" Investigation 1) The immediate investigation will be sufficient to include the information needed to make a preliminary investigation. We stress good judgment on a case-by-case basis. Evaluation 1) Evaluation based upon sound claims handling practices and investigation is the key to any successful program. Our rudimentary investigation is completed within 21 days from the date of the assignment, provides information required to reasonably evaluate any coverage question, negligence issue, merits of the particular case based on local precedence, and a reasonable estimate of injuries/damages. This permits the claims representative to offer sound recommendations for the ultimate resolution. Reserves 1) Risk Management cannot effectively operate and obtain its proper goals if our reserves are unrealistically established. The setting of proper reserves on files is most important and sometimes the most difficult task to accomplish. We are diligent in our efforts to obtain the necessary information by which a claim can be properly evaluated. Our reserves are an estimate of the probable ultimate total dollar exposure on a claim. 2) Reserve worksheets will be completed within 14 days on all initial and revised reserves. 3) Reserves are continually reviewed for the life of a file and are submitted in all reports except the final. Reporting and Correspondence 2) Our first report will be submitted within thirty (30) days of assignment, unless otherwise specified by the Client, and will include details on any coverage questions. 3) Subsequent reports shall follow 30-day intervals, unless otherwise specified by the Client " "
"Q. . There must be a finite period, must there not, Mr Palange? A. Most insurers would require, for example, a for example, monthly bordereau reporting and prompt handling and reserve establishment. They would not necessarily put a specific time limit on reserving. Some do and some do not. Q. I suggest to you that very few, if any, do not insist on some period within which reserves must be posted; do you disagree with that? A. I would say that the majority would put a timeframe on that subject." "
" INVESTIGATION 1) The immediate investigation shall be sufficient to include the essential information to make our preliminary evaluation. We stress good judgment on a case-by-case basis. EVALUATION 1) Evaluation based upon sound practices and investigation is the key to any successful program. Thus, our rudimentary investigation will be completed within 30 days from date of assignment and will provide the data required to reasonably evaluate any coverage question, negligence issue, merits of the particular case based on local precedence, and a reasonable estimate of damages. This will permit the claims representative to offer sound recommendations for the ultimate resolution. 2) Basis for acceptance or denial of coverage or liability will be documented in the file. RESERVES 1) CCIs philosophy is to set and stabilize realistic reserves on all cases at the earliest time considering the issues of injury/damage, mitigating circumstances, liability, etc. In no event will we "step ladder" reserves. 2) Reserves will be continually reviewed for the life of a file, and will be submitted in all reports except the final. Changes will be adequately explained and promptly reported REPORTING AND CORRESPONDENCE 2) A first report on claims in excess of our TPA Authority will be submitted within forty-five (45) days of the assignment, and will include details on any coverage questions. CONTROL IN HANDLING THE CLAIM 5) The Unit Supervisor will review all files at least every 30 days ." "
"This paragraph or a paragraph similar to it is one goal set by some insurers and claims handlers as a type of goal."
"Q. Most? A. Well, we disagree on that, whether it is most. Q. [Reference was made to paragraph 2), under Reporting and Correspondence quoted above.] You see, I suggest to you that a reserving philosophy or policy in which no time limit is set on the preliminary evaluation is going to get into trouble because there is no discipline; there is nothing to ensure that the claims handlers are doing their job. Do you disagree with that? A. I believe that putting time limits in proposals and agreements of this sort evolved over time and they became quite common. So earlier versions of the same subject might say "prompt" or might say "regular" or "frequent" or might say "periodic"
"Q. Most? A. Well, we disagree on that, whether it is most. Q. [Reference was made to paragraph 2), under Reporting and Correspondence quoted above.] You see, I suggest to you that a reserving philosophy or policy in which no time limit is set on the preliminary evaluation is going to get into trouble because there is no discipline; there is nothing to ensure that the claims handlers are doing their job. Do you disagree with that? A. I believe that putting time limits in proposals and agreements of this sort evolved over time and they became quite common. So earlier versions of the same subject might say "prompt" or might say "regular" or "frequent" or might say "periodic"
"The reserving policy adopted by me for the US Contractors Program meant that I believed it was not possible to set a loss reserve which properly represented underwriters most likely financial exposure in the context of coverage until I had all of the information regarding the circumstances surrounding events that gave rise to the claim."
"Q. That he deferred setting a loss reserve until he had all of the information regarding the circumstances surrounding the events which gave rise to the claim? A. That is also a standard approach to investigation. Q. It is not prudent reserving policy to wait until you know all the circumstances because you are never going to know all the circumstances and you should not be put off setting a reserve until you think you do, should you? A. As the next sentence says, he did not. Q. "
"Q. That he deferred setting a loss reserve until he had all of the information regarding the circumstances surrounding the events which gave rise to the claim? A. That is also a standard approach to investigation. Q. It is not prudent reserving policy to wait until you know all the circumstances because you are never going to know all the circumstances and you should not be put off setting a reserve until you think you do, should you? A. As the next sentence says, he did not. Q. "
"A. Upon receipt of notice of claim, we set a zero reserve. Upon receipt of the adjusters first report, if sufficient information has been developed, we will set the indemnity reserve and expense reserve. B. If suit is our first notice of loss, we will maintain a zero reserve until sufficient discovery reveals our exposure. C. In general, we do not utilize the step reserve theory, and prefer to set a one-time reserve." "
"We have resisted setting reserves on first notice claims, as this method evolves into what we classify as step reserving or stair-step reserving. We prefer to set a zero reserve until we have enough information to set a "one-time" indemnity reserve, sometimes referred to as the loss reserve. The reason(s) for this method, prevents frequent upgrades/downgrades of reserves and presents Underwriters with reasonably sound financial figures. Expense reserves we occasionally will set an immediate estimate. This of course is dependant upon the type(s) of loss(s). Property losses we know from experience as to how much the adjusting fees will be on various types of losses. If the loss is large, we will delay the expense reserve setting. Normally, property loss, indemnity and expense reserves, we will try to post within the first month or thirty (30) days after receipt of the claim. Liability reserving is the most difficult to set. On these we usually wait until some discovery has been completed in order to determine the amount of exposure to the Insured. Serious debilitating injuries reserves, we will evaluate and set a one-time reserve, once we have evaluated the injuries, negligence, venue, policy and case law cases. Liability expense reserves, we will set depending on the cause of action stated in the summons & complaint. All reserves set reflect reserves above Deductibles and/or SIR amounts." "
"Our reserving policy is not unique in the states or in the Insurance Industry." "
"The statistics do not assist either, since a case by case assessment is required. Mr Simon says that as at June 1992 there were 249 open claims files of which just over 40% had had no indemnity reserve for more than 90 days and 32% had had no expense reserve for more than 60 days. But these figures say little without some indication of the nature of the claim, what inquiries were underway, what the issues were and how much was the deductible. Those figures are not inconsistent with Mr Reynauds stated policy. The same is true of the data relating to March 1993. I can well understand arguments in favour of early reserving with a large slice of judgment or guesswork involved. But over-reserving had its own disadvantages. Late but accurate reserving avoided stair stepping and a risk of over-reserving, but was less prompt. There is no reliable evidence before me to say that the one method was unusual or imprudent and the other not." "
"The question was whether [the methodology] was unusual or imprudent as at 1992 and March 1993. Mr Beckerman says it was; Mr Palange says it was not. I have had no difficulty in preferring the latters opinion to that of the former. I suspect that over the passage of time, reserving has become more sophisticated and the needs for guesstimates more compelling. I suspected, though he denied it, that Mr Beckerman was reflecting more modern practice when he expressed his opinions. Ultimately, Mr Reynauds own evidence that his style of reserving was by no means unique or unusual, coupled with an endorsement from Mr Palange resolved this issue in favour of Generali." "
"If ARIG had, as they did, the burden of proving that the claims handling procedure, including the reserving was imprudent and unusual, they have failed to discharge it. Had an exercise been carried out to second guess reserving in relation to each of the claims files open as at June 1992 and March 1993 and it had transpired that on a case by case basis there was a pattern which showed imprudent reserving then the result of the case might have been different. But here ARIG had to prove that the reserving policy which it asserts should have been adopted [namely a prompt reserve after the full circumstances had been established] was not adopted. They have not proved this by their evidence since there has been no attempt to carry out the necessary exercise to show what should have happened had the claims been properly handled, in their opinion. Reserving with hindsight is not a helpful exercise." "
"I do not find the letters referred to by Mr Simon of any assistance to my decision. Gay & Taylors policy is clear and the letter from a third party carries no weight with me, since I do not know the basis for the writers views. I should make clear that whatever Mr Wardlaws misgivings might have been, the reason why Gay & Taylor were replaced in 1995/96 had nothing to do with their reserving policy, but related to some other, irrelevant dispute."
"We have always acknowledged that your past short term experience with this program is inconsistent with the anticipated long term exposure we believe you face. However, what I personally do not understand is your virtual blind loyalty to Gay & Taylor in view of: (1) its acknowledged inability to keep accurate and current financial records; (2) its obvious input and management of the claims files; (3) its unrealistic (or non-existent) reserving practices; and (4) its total abdication of its proper role in favour of two "coverage" attorneys, who, in my opinion, author simplistic, and to some extent, incomplete analysis of problems."
"Firstly 1991/2 and 1992/3 up to September. The various issues of California coverage and Lawyers utilised were discussed at length but it was finally accepted that for better or worse we have taken the route we have taken and we may get away with it only time will tell as to whether some of these cases backfire. In any case whilst United National accept that we are responsible for all issues on those years and they will not intervene further but that they need to be kept informed immediately of any bad faith accusations or litigation which may arise in order that we may deal appropriately with that. In the final analysis on these years it is up to us to indemnify United National. With regard to post-September 1993 we acknowledge that United National wish to be responsible for all claims issues, defence coverage etc. However the reality is that they could not physically take over all these matters now and would have to appoint a TPA. In the circumstances it seems preferably that we continue to use Gay & Taylor but that Gay & Taylor should follow their instructions on these claims. Meanwhile United National will start gearing up to take over all of the post-September 1993 claims themselves within say a period of 12 months. What needs to be clearly agreed are the lines of communications, financial arrangements and controls during this period."
"The last area that we were advised of some concerned happened to be reservings. To fully understand this, I have asked Mr Mark Jones, present manager of the unit, to give me his understanding of the reserving philosophies and practices as instructed by Generali. Mr Jones admittedly cannot completely clarify the reasoning behind the reserving practices since Mr JG Reynaud was managing the unit at its inception. Mark Jones has advised that he had received several inquiries from London requesting detailed explanation for large initial reserves. Mr Reynaud said that his instructions from Generali was not to "stair step" reserves and Generali preferred no indemnity reserves being placed until we had adequate information to set up a final reserve. This reserving policy is as a result of the majority of our cases are involving construction defect matters, which involve questionable coverages, liability and damages throughout their life cycle. Certainly, it is extremely difficult to establish correct reserves on these type of claims, however, most of our clients and certainly the insurance industry does expect reserving to be posted as soon as practical. The instructions by Generali to Mr Reynaud were followed and reserving was not posted until later in the claim file. Again, I must advise that this is contradictory to what we at Thomas Howell/Gay & Taylor feel are proper reserving philosophies within the industry, however, since we were taking instructions from Generali, Mr Reynaud was utilizing Generalis reserving philosophies as instructed to him." "
"But the fact that the losses developed more quickly and thus, the reserves did not correspond to the norms, is neither here nor there unless it can be shown by ARIG what the reasons are for the large loss development. The Montrose decision may have played a part, but there will have been other factors as well, such as an increase in awards by the courts and so on."
"The reason why there have been such heavy losses on this programme is nothing to do with the reserving policy but is to do with the quality of the underwriting decisions. This was business that were better not written save with much larger premiums. But that is not a matter with which the court is concerned."
"The reason why there have been such heavy losses on this programme is nothing to do with the reserving policy but is to do with the quality of the underwriting decisions. This was business that were better not written save with much larger premiums. But that is not a matter with which the court is concerned."
"Why are you telling me that? Does it have an impact on the figures?"
"Q. Mr Anderberg, do you accept that what is material to the risk in this context is not the reserving methodology itself but the accuracy of the figures that it produces? A. Well, one thing depends on the other. If you have a wrong-serving philosophy or guideline or whatever it could be, it would filter through the figures and distort the figures because that is the connection between these two, you know. That is my opinion. Q. The premium and loss figures are what matter to you as an underwriter? A. It is very important, yes. Q. The use of an unusual reserving philosophy or methodology would only be material to an underwriter to know if it resulted in figures that were materially inaccurate? A. Yes." "
"Q. . if you had been told that the reserving policy was unusual and/or imprudent, how would that have affected your underwriting judgment? A. First of all, I would not have believed in the figures we were given initially and if it would have been a very great deviation from normal standards, I am sure we would have declined participation. Because then we did not know what we were doing."
"Q. If the 1990 loss ratio had been over, what, 50 per cent/60 per cent, at what point of time would it have raised a question in your mind as to why the losses were so high in such a short period of time? A. I might have queried about it if we would have touched maybe 50/60 per cent but I cannot tell you now how I would have reacted. I might have reacted and sought clarification and the clarification might have changed my decision or at least this would have had an impact on the overall programme."
"Q: The policy is that he defers setting a loss reserve until he has all of the information regarding the circumstances surrounding the events that gave rise to the claim. If that was his policy... if that was his philosophy... it was an absurd claims handling philosophy, was it not? A: If that was the philosophy of him and Gay & Taylor for all claims reported, up until March 1993, I would not call it absurd, I would call it unacceptable." "
"Q: Unless there is something materially wrong with the figures which needs to be explained, the methodology of which they are arrived at and calculated is not of interest to you; is that correct? A: Correct, yes." "
"The leading insurers in London are the Assicurazioni Generali SpA with support from the Commercial Union and the Munich Re."
"I can categorically state that I would not have authorised Arigs participation if I had known Munich Re only participated in Section A." "
"All the other factors involved here - the excellent figures, et cetera ..... indicated that this was a very profitable account and I am sure we would have written it without the participation of Munich Re, I am sure. It was a comfort factor [but] Munich Re is not guiding our underwriter, we are guiding our underwriting ourselves."
"If I would not have got any clarification which I could buy, I would have declined participation." "
"If I would not have got any clarification which I could buy, I would have declined participation."
"You can then derive as a reinsurer some - to a great or lesser degree - additional satisfaction and comfort from the knowledge that Munich Re now have a large vested interest in this business and they will be monitoring in their incomparable way, and if things start to go awry, they will gently make an approach to the leader... Now, I think that, therefore, the existence and the potential of Munich Re to do that is something that brings a little added comfort to an underwriter." "
"If I would not have got any clarification which I could buy, I would have declined participation."
"Look, there is a change here, the reinsurers you know, are participating in this or that or they are not participating on this"". "
"The figures combined with these names being on this risk"
"I am satisfied having regard to all the evidence that this, that or the next thing is the right result and I am fortified in that conclusion by the fact that X, Y and Z"
"The figures combined with these names being on this risk"
"I am satisfied having regard to all the evidence that this, that or the next thing is the right result and I am fortified in that conclusion by the fact that X, Y and Z"
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