“As a matter of general approach the courts strive to uphold arbitration awards. They do not approach them with a meticulous legal eye endeavouring to pick holes, inconsistencies and faults in awards and with the objective of upsetting or frustrating the process of arbitration. Far from it. The approach is to read an arbitration award in a reasonable and commercial way expecting, as is usually the case, that there will be no substantial fault that can be found with it.”
“(a) To what standard of proof is it necessary for a reinsured to prove his case under a “double proviso” follow settlements clause of the type described in Hill v Mercantile[1996] 1 AC 1239 and Equitas v R & Q[2009] EWHC 2787 : “balance of probability” or “arguability”? (b) In considering the question of proof of loss under such a follow settlements clause what is the correct approach to the facts as a matter of law: is it appropriate to look to the underlying facts of the original claim, or to the basis of the claim as compromised?”
“All loss settlements made by the Reinsured, including compromise settlements, shall be unconditionally binding upon Reinsurers provided such settlements are within the conditions of the original policies and/or contracts and within the terms of this reinsurance, and amounts falling to the share of the Reinsurers shall be payable by them upon reasonable evidence of the amount paid being given by the Reinsured.”
“PERIOD This reinsurance covers all losses as herein defined occurring during the period commencing with … and ending with …, both days inclusive, local standard time at the place where the loss occurs.”
“For the purpose of this reinsurance, the term “each and every loss” shall be understood to mean each and every loss and/or occurrence and/or catastrophe and/or disaster and/or calamity and/or series of losses and/or occurrences and/or catastrophes and/or disasters and/or calamities arising out of one event.”
“There are only two rules, both obvious. First, that the reinsurer cannot be held liable unless the loss falls within the cover of the policy reinsured and within the cover created by the reinsurer. Second, that the parties are free to agree on ways of proving whether these requirements are satisfied.” ii) Guidance in respect of satisfaction of the first proviso can and should be drawn from the ‘single proviso’ cases, particularly where (as here, but not in Hill) the settlements by the insurer were pursuant to a compromise agreement. Both Counsel referred to Hiscox v Outhwaite (No 3)[1991] 1 Lloyd’s Rep 524 (“Hiscox”), which was referred to by the Arbitrators in their Award (paragraphs 27 and 29) and in any event was a decision of which at least one of the arbitrators would have been acutely aware. As will be discussed later, the claim in that case was held to fall outside the terms of the reinsurance, but Evans J concluded that “the reinsurer may well be bound to follow the insurer’s settlement of the claim which arguably, as a matter of law, is within the scope of the original insurance, regardless of whether the court might hold, if the issue were fully argued before it, that as a matter of law the claim would fail.”
“39. When one is examining the claim recognised by the insurers when they settle it by admission or compromise, one is examining the real basis on which the claim has been settled. That may not equate with what the assured might have claimed to have happened and to fall within the contract of insurance, nor with what the insurers might advertise as the basis of the settlement … 40. In examining the real basis on which a claim has been settled, one is looking to identify the factual and legal ingredients of the claim embodied and thus recognised in the settlement.”
“The reinsurer cannot require the insurer to prove that the assured’s claim was in fact covered by the original policy, but requires him to show the basis upon which he settled it was one which fell within the terms of the reinsurance as a matter of law or arguably did so.”
“(1) whether it was reasonable for the original insureds and London Market insurers or reinsurers (including [the Respondent]) to accept the factual basis upon which the claim against them was compromised; and (2) whether, on the basis of the accepted facts underlying such compromise settlements, the compromise settlements fell properly within the provisos.”
“it may be suggested by [the Claimant] … that the Tribunal did not apply the wrong test, and that the reference to “arguability” merely refers to the question of whether it was reasonable for original insureds and London Market insurers or reinsurers to accept the factual basis upon which the claim was compromised”: but she submits though this would have (impliedly) been permissible, that it is not in fact what the Arbitrators were doing. iii) Lord Mustill in Hill did not address what the burden of proof was upon the insurer to establish compliance with the first and second provisos, and Gross J in Equitas Ltd v R & Q Reinsurance Co (UK) Ltd[2009] EWHC 2787 , again in a passage accepted by both Counsel and by the Arbitrators (by citation in paragraph 17 of the Award) as correctly stating the law, concluded that compliance with both provisos had to be proved on the balance of probabilities: “65. … Hill v Mercantile essentially stands as authority for the proposition that the Settlements Clause requires the insurer/reinsured to satisfy both provisos … or, in other words, to satisfy Lord Mustill’s “first rule”
“It is perhaps not to be forgotten that the Settlements Clause remains … a follow the settlements clause, designed to avoid the need to investigate the same issues twice, subject of course to the requirements of [the first and second] provisos. Both provisos … and Lord Mustill’s first rule, it is to be underlined, deal with the legal extent of the contracts in question, in the context of losses arguably occurring outsidethe period of cover – not the facts which generate the claims.”
“25. As is well known, many women had problems with the implants: some ruptured, some provoked allergic reactions and some caused (or were alleged to cause) various other disorders. Consequently, many claims were filed against Baxter and other implant manufacturers in the US, Canada, and elsewhere: most of the US cases were consolidated in a class action (“Dow Corning v Lindsey”) which was settled in September 1994. The settlement terms were revised and approved by the presiding court on the22 December 1995 (the Revised Settlement Program – “RSP”), The RSP involved the setting up of a fund by the manufacturers, each contributing according to their market share: Baxter’s share being some 20%. Individual claimants were paid on an agreed scale of compensation (as approved by the court) from the RSP fund. In addition to the class action, some claimants pursued individual actions against specific manufactures, including Baxter. We understand that most of these “opt-out” claims have been settled.”
“50. Most of the US cases were consolidated in a class action, with the four producers as joint defendants. A settlement was agreed and approved on the8th May 1997 by Judge Grady: the four producers (known as the “Fractionators”) would be responsible for payments under the global settlement in proportion to their market share. Claimants would receive compensation according to an agreed schedule. [Baxter’s] share of the “pool” was 20%. The dispute in this arbitration was in respect of this class action settlement.”
“52. The first problem was dealt with by the four manufacturers in concert (no doubt they were all faced with the same questions from their insurers). Mendes and Mount, in their report to the London underwriters of4th February 1999 , explained: “As Underwriters and Companies are aware, the four settling manufacturers have retained the services of Keith Rayment and Associates in order to develop a methodology to make certain that the reimbursement requests for the United States class action settlements were only for claimants who named the manufacturer as being potentially liable. Representatives of Baxter conducted an intensive review of each class action participant’s claim form and supporting medical documentation to determine the alleged product usage history of each claimant. Baxter has requested reimbursement only for claimants who actually alleged usage of contaminated blood factor concentrate manufactured by Baxter.” 53. Mr Rayment was a well known and respected London market figure (he had been the claims manager for one of the largest Lloyd’s syndicates). 54. Mendes and Mount also made it clear that no claims would be presented to underwriters until paid by Baxter.” “As Underwriters and Companies are aware, the four settling manufacturers have retained the services of Keith Rayment and Associates in order to develop a methodology to make certain that the reimbursement requests for the United States class action settlements were only for claimants who named the manufacturer as being potentially liable. Representatives of Baxter conducted an intensive review of each class action participant’s claim form and supporting medical documentation to determine the alleged product usage history of each claimant. Baxter has requested reimbursement only for claimants who actually alleged usage of contaminated blood factor concentrate manufactured by Baxter.”
“55. IRB argued as follows: “Because of the terms of the CAS, CX Re in settling with Baxter accepted certain elements of claim which were not covered by the insurance. These are those elements consequent upon the Settlement sharing formula: … (b) CX Re’s evidence (see the detailed evidence of Miss Comiter …) is that each fractionator contributed its percentage to each individual claim, and that the sums paid were then “reallocated” (to use a neutral term) to lend verisimilitude to the reinsurance presentation, which would require losses to be in relation to insured risks. (c) It follows that each fractionator can recover only their insured percentage (20%) of each of the claims in which they were names. As with the breast implant claims, this is equivalent to the position in [Hiscox]. The claims of other fractionators are not insuredby CXRe and cannot be recovered. The elements of the claims for which BT/Revlon has not paid are not losses for which an indemnity can be claimed.” 56. CX Re replied: (1) Payment was made by the fractionators into a settlement fund, from which fixed sums of US$100,000 were paid to each claimant who satisfied the eligibility criteria (proof of use of product, medical records, etc). (2) Each claim was carefully vetted for eligibility. (3) For the purpose of presenting claims to reinsurers, the product liability claims were then allocated only to those fractionators who had been confirmed as one of the suppliers of product which the HIV/AIDS-positive haemophiliac had used over the years. This painstaking procedure was commissioned and put into operation in order to avoid problems of [Hiscox] and thus allow the spread of the burden of claims through reinsurance market for the benefit of all.”
“34. … Miss Cockerill in her closing summary pointed out that the Claimants accepted certain elements of claim which were not covered by the original insurance as follows: “Claims which would not have arisen but for the broad approach to compensation adopted by the RSP: (i) The underlying RSP settlement allowed for: (1) payment which bore no relation to any evidence of any complaint – such as the advance payment – which was not refundable if a claimant did not evidence anything else. These were payments made without any liability; (2) complaints (eg lupus) which were never causally linked to the produce or in relation to which liability was never established; (3) the settlement allowed for payment of, and payments were made in relation to, explants where there was no established bodily injury.”” “Claims which would not have arisen but for the broad approach to compensation adopted by the RSP: (i) The underlying RSP settlement allowed for: (1) payment which bore no relation to any evidence of any complaint – such as the advance payment – which was not refundable if a claimant did not evidence anything else. These were payments made without any liability; (2) complaints (eg lupus) which were never causally linked to the produce or in relation to which liability was never established; (3) the settlement allowed for payment of, and payments were made in relation to, explants where there was no established bodily injury.””
“32. With most class actions and indeed with most claims for damages for bodily injury and/or property damage caused to a third party the dispute is resolved by a compromise settlement between the parties. It is then difficult or even impossible for the first party to prove absolutely that he was, in fact, liable for the damages compromised. In the initial action, he is defending the position and denying liability; then he must do a complete volte-face and argue with his insurers that he was liable, whilst they use his own defences to defeat the claim on the policies. There is, in the present case, something of this tendency apparent in IRB’s arguments. 33. The dichotomy pointed out by IRB between the payments made into the RSP by Baxter and the claims paid by the insurers is, in our opinion, more apparent than real. Baxter subscribed to the fund on the basis that, at the end of the day, their share of the liabilities would be roughly equivalent to their market share of implants supplied. The claims under their insurance policies were in respect of specific payments made to those original claimants who had AHS/Heyer-Schulte implants: AHS’s liability in those cases was incontrovertible and the insurers recognised their potential liabilities accordingly. According to Ms Comiter, the amount paid out by Baxter into the fund was significantly larger than claimed from their insurers.” ii) Implants: specific points: “35. In a class action with hundreds or thousands of plaintiffs there is likely to be a very wide variation of degree of bodily injury: the object is to include as many people with a complaint, or who might have a complaint, as possible. It may well be that certain individual plaintiffs receive an award which they do not deserve or more than they deserve, but that is the price to be paid for dealing with the problem on this inclusive basis. The commercial advantages for the defendant company and their insurers (and their reinsurers) are (usually) substantial. Ms Cockerill may well be right in that some of these compensation payments, if taken to Court and a legal decision obtained, may not have been paid. That is arguable. It is not right, however, to say: “Whether or not AHS might have been found liable in a trial (which IRB say is unlikely in itself, for the reasons given in the attorney reports), there is no evidence that CX Re would under the terms of the insurances have been likely to be held liable for these sort of payments.” 36. Had AHS been found liable in a trial, however unlikely their attorneys thought that result might be, that would have been conclusive evidence of their liability and their insurers would have to indemnity them (subject to any terms or exclusions in the policy). On the basis of the settlement, these were valid claims and we are satisfied that it was arguable that they are within the terms of the insurance and the reinsurance.” “Whether or not AHS might have been found liable in a trial (which IRB say is unlikely in itself, for the reasons given in the attorney reports), there is no evidence that CX Re would under the terms of the insurances have been likely to be held liable for these sort of payments.” iii) Implants: general conclusion: “38. Under these circumstances, CX Re would have no reasonable grounds for disagreeing with all the other underwriters in the London market. They had no reason to disagree with Mendes and Mount and the leading underwriters and it would have been uncommercial to do so. We find that the settlement was one that was on its terms in respect of liabilities that were within the terms of the reinsurance and therefore, under the terms of the Notice of Loss Clause “unconditionally binding upon Reinsurers”.” iv) Blood: general conclusion: “57. In our opinion the correct questions for us are, first, were [Baxter] liable for bodily injury to patients who used their products – or rather, had the patients’ claims been pursued to a judgment in court and damages awarded would that result (on the balance of probabilities) in a claim on their insurance policies? We have no hesitation in answering yes. Therefore, we find that [Baxter’s] liability is established and is within the conditions of their insurance policies and their reinsurance. Second, does the method of funding the class action settlement affect those liabilities? It does not: this was merely a mechanical means of funding the payouts to the individual claimants. [Baxter’s] liability to claimants who had used their product remains: the fact that, when established, the payment in practice comes from a central “pot” is of no consequence. Third, was the settlement with [Baxter] reasonable and businesslike? It was negotiated by the London underwriters’ representatives, and the whole London market accepted it. We find it was both reasonable and businesslike.”
“26. London underwriters participated in many of Baxter’s (and AHS’s) insurance policies covering products liabilities over a period of many years. If Baxter were held liable for bodily injury caused by its products, the question would arise as to which of Baxter’s policies would pay the claims, bearing in mind previous decisions of US courts (notably Keene, an asbestos case where it was held that all policies, from the time of first exposure through incubation to manifestation, were liable, known as the “triple trigger” theory). Underwriters were represented and advised in this matter by Mendes and Mount, a well-known firm of New York lawyers. In September 1995 an agreement was reached between London Market underwriters and Baxter on a “coverage in place” (“CIP”) basis: this proportioned losses (those which are the subject of this action) over the years 1974 to 1986, being the years when policies had been issued to AHS. We should point out that Baxter used the years 1974 to 1991: on the basis of CIP 1974 to 1986 covered 63.5% of the losses; and 1987 to 1991, 36.5%. However, the 1987 to 1991 policies were on a “claims made” basis and there was some argument as to whether they were liable to pay any of the losses. Suffice it to say the two sets of underwriters agreed to pay 70% and 30% of the losses respectively: this was raised as a separate issue by IRB (the “allocation” point) which we deal with below.”
“39. What was referred to as the “allocation” point was raised by IRB as demonstrating that CX Re was paying claims for which it was not liable and therefore should not be paid by their reinsurers. This argument was misconceived: if it could be shown that, whilst it was reasonable for the insurers to pay 63.5% of the overall loss it was unreasonable for them to pay 70%, there could be some tangential grounds for questioning the settlement. IRB was unable to show any evidence to that end: indeed, such evidence as was available (though largely circumstantial) was that the settlement of 70% of Baxter’s proven liabilities was reasonable and businesslike.”
“74. [Corning] manufactured and installed many products containing asbestos, including an insulation material called Kaylo, for many years, back as far as the 1950s. They faced a substantial number of claims as a result of their operations (318,000 by 1998, many unresolved). Two US insurers, … North River and … ISLIC, provided excess liability cover to Owens on policies effective from 1978 to 1983. They in turn were reinsured, partly by London Underwriters, including CX Re. 75. Up to 1998 these claims against [Corning] were considered as products liability claims: in that year [Corning] began to advise asbestos-related claims as premises or operations liabilities, i.e. not as products liabilities. Accordingly, the claims would not be subject to an aggregate, but an “any one event” limit and [Corning] maintained that there was a single event being “the determination of the company to engage in the insulation business and to install Kaylo insulation products over a twenty year period”
“82. Stauffer was a manufacturer of chemical and agricultural products: they faced environmental pollution claims from about 100 sites which they owned, or had owned in the past. One site in particular, a 400-acre mine at Iron Mountain in Shasta County, California, carried by far the greatest exposure. Stauffer owned this site between 1967 and 1976: Copper, Zinc and Cadmium leachates were contaminating the water system and the surrounding land. Clean-up costs were likely to be huge. 83. The leading London Underwriters and their US Attorney (Lord Bissell & Brook) negotiated a settlement of all outstanding claims: an agreement was reached in September 2000 in the sum of$46.5 million (this included$1.85m defence costs). This amount was allocated over several years’ policies, as explained by Lord Bissell & Brook in their letter dated26 January 2001 : “The$1.85 million for costs was allocated equally to each policy named in the California declaratory judgment actions. The indemnity figure was allocated pro rata to those policies previously allocated a portion of our suggested reserve potentials. The indemnity reserve potentials treated each site as a separate occurrence, and after application of underlying limits, spread the loss from the beginning of Stauffer’s operations through the date when Stauffer received a PRP notice or similar correspondence indicating it had an obligation to perform investigation or remedial actions. We assumed that the law of the site would apply to each claim and applied coverage discounts to each claim based on the known facts and that state’s particular law on the various coverage issues. The per policy allocation detail previously was provided by LMCS.” 84. Claims were presented to IRB on contracts protecting the 1976 to 1978 policy years. IRB disputes their liability on the grounds that the allocation over the policy years was artificial. As Ms Cockerill put it: “The sole issue on this loss is allocation. It appears that allocation was done by a simple split of the settlement over all policy years referred to in the US litigation, and the presentation to IRB consists of CX Re passing this amount on under the 1976 policies. IRB say that what was done does not comprise evidence of any loss occurring during the policy period at all, still less evidence justifying the amount of the claim put forward. As such the claim fails as not being, as a matter of law, a claim on a loss occurring during the policy period and hence being outwith the terms of the reinsurance.” 85. There was no dispute that Stauffer were liable to pay clean-up costs or that these were covered under their insurance policies, but simply a question as to which policies should pay. It seems to us that there is little doubt that, if disputed, insurers would be liable for the whole period from start to discovery, as Lord Bissell & Brook assumed, so the problem, in coming to a compromise settle with Stauffer, was how it should be allocated over the policy years. No doubt spreading it equally over all the relevant years is in a sense artificial. It seems to us, however, that it would have been even more artificial to ascribe a larger portion of the loss to one year rather than another. On the terms by which it was settled, the claim fell within the terms of the insurance and the reinsurance. Was the settlement reasonable and businesslike? In our opinion it was, therefore IRB are liable to pay the claims as presented.” “The$1.85 million for costs was allocated equally to each policy named in the California declaratory judgment actions. The indemnity figure was allocated pro rata to those policies previously allocated a portion of our suggested reserve potentials. The indemnity reserve potentials treated each site as a separate occurrence, and after application of underlying limits, spread the loss from the beginning of Stauffer’s operations through the date when Stauffer received a PRP notice or similar correspondence indicating it had an obligation to perform investigation or remedial actions. We assumed that the law of the site would apply to each claim and applied coverage discounts to each claim based on the known facts and that state’s particular law on the various coverage issues. The per policy allocation detail previously was provided by LMCS.” “The sole issue on this loss is allocation. It appears that allocation was done by a simple split of the settlement over all policy years referred to in the US litigation, and the presentation to IRB consists of CX Re passing this amount on under the 1976 policies. IRB say that what was done does not comprise evidence of any loss occurring during the policy period at all, still less evidence justifying the amount of the claim put forward. As such the claim fails as not being, as a matter of law, a claim on a loss occurring during the policy period and hence being outwith the terms of the reinsurance.”
“80. On the occurrence issue, several English cases were cited. In all of those cases, the circumstances involved a number of different and distinct losses on different policies, the question being was there sufficient connection between them to establish that they were arising out of one occurrence or one event. In the present case we have insurers making a single payment to their insured (although in respect of a large number of potential claims). The insurers make a series of annual (but single) claims on their reinsurance policies which are settled on that basis. We do not think that the cited cases are helpful, but we bear in mind Rix, J in [Kuwait]. They then cite the passage at 684 Col 2 (set out in paragraph 13(vi) above) as to event or occurrence taking colour from the context. 81. We respectfully agree: in the present context, being excess of loss reinsurances, the “perils insured against” are the reinsured suffering a claim (from the portfolio of business protected) in excess of the priority. As to being causally relevant to the loss or losses in question, the loss each year stemmed from a single cause, being [Corning’s] liability arising from their installation activities. In the context of the excess of loss reinsurance contract written by IRB the claim was settled by CX Re as a single loss: the question of whether it was in fact a series of losses arising out of one event (or not) does not arise.”
“In other words, the question as to whether a particular reinsured can discharge the burden on it to prove its claims under a particular Notice of Loss provision is a question of law but the evidence necessary to discharge that burden will depend on the actual facts of the case. Where there has been a settlement, the relevant facts are the facts on which the loss was compromised as opposed to the facts of the loss as it happened (if different).”
“17. As Lord Mustill emphasised, we are not required to make any findings in respect of the facts embodied in the settlement but should only appraise the legal implications of those facts and whether the claim or claims (as compromised) fall arguably within the underlying and reinsurance cover granted. It simply cannot have been intended by the parties to a reinsurance contract (containing the double provisos) that the “provided such settlements are within the conditions of the original policies and/or contracts” language meant that the Reinsured had to prove to an absolute standard that the underlying policy would respond to the claim or claims at issue. Such an interpretation would undermine a reasonable interpretation of the follow the settlements clause when read as a whole in the context of the reinsurance agreement per se.”
“18. The fundamental question for this Tribunal is whether the 8 losses (all involving compromise settlements) claimed by CX Re satisfy the requirements of the follow the settlements language and, as such, are payable by IRB. The Tribunal has no hesitation in determining that all 8 “loss settlements … including compromise settlements” have been proven on the balance of probabilities[my underlining] to fall within the follow the settlements clause including the two provisos. The Tribunal rejects IRB’s arguments as speculative, highly technical, and consistent only with a flawed interpretation of the follow the settlements clause that neither party could possible have intended at the time of contracting. IRB’s position on the provisos essentially ignores the primary provision in this clause which provides that all loss settlements made by CX Re, including compromise settlements, are to be unconditionally binding on IRB.”
“19. As to whether the compromises made by CX Re fall within the conditions of the original policies and the conditions of the reinsurance, CX Re is entitled to discharge the legal burden of satisfying the provisos by adducing the best factual evidence available to it. The recent [Equitas] Judgment made this clear. In order to determine this issue, it is permissible to consider whether CX Re was arguably liable to the insureds/reinsureds on the basis of the loss as compromised. Any further enquiry into the underlying dispute between producers and product liability claimants is not contemplated or required by the terms of the follow the settlements clause or market practice.”
“20. … From the factual evidence presented in this arbitration, the Tribunal saw no reason to doubt that the compromise settlements were predicated on actual or arguable liability in law, based on legal advice, and were settlements that accordingly satisfied the first proviso of the follow settlement clause.”
“21. … This is not to say that all compromise settlements are automatically payable by a reinsurer, as this would have the effect of neutralising the proviso. However, on the facts of this matter and on the basis of the evidence present, the Tribunal is satisfied that these losses should be paid.”
“IRB disputes that the class action settlement was in respect of liabilities which would on the balance of probabilities result in a valid claim under the original insurance policies”
“On the basis of the settlement, these were valid claims and we are satisfied that it was arguable that they are within the terms of the insurance and the reinsurance.”
“38. … We find that the settlement was one that was on its terms in respect of liabilities that were within the terms of the reinsurance and therefore … “unconditionally binding upon Reinsurers.”
“… if there was no evidence to support the allocation across the years, CX Re cannot establish that the losses fell within the terms of the reinsurances.”