“3 Claims Conditions 1) In the event of any loss destruction or damage or event likely to give rise to a claim under this Policy the Insured shall a) notify the Company immediately b) notify the Police Authority immediately if it becomes evident that any loss or damage has been caused by theft or malicious persons c) carry out and permit to be taken any action which may be reasonably practicable to prevent further loss destruction or damage d) deliver to the Company at the Insureds expense i) full information in writing of the property lost destroyed or damaged and of the amount of loss destruction or damage … iii) all such proofs and information relating to the claim as may be reasonably required … 2) No claim under the Policy shall be payable unless the terms of this condition have been complied with … 15 Condition Precedent It is a condition precedent to any liability on the part of the Company under this Policy that a) the terms hereof so far as they relate to anything to be done or complied with by the Insured are duly and faithfully observed and fulfilled by the Insured and by any other person who may be entitled to be indemnified under this Policy (b) the statements made and the answers given in the proposal herein before referred to are true and complete ----------------------------------------------------------------------------- BUSINESS INTERRUPTION Definitions Indemnity Period The period beginning with the occurrence of the Incident and ending not later than the Maximum Indemnity Period thereafter during which the results of the Business shall be affected in consequence thereof Turnover The money paid or payable to the Insured for goods sold and delivered and for services rendered in the course of the Business at the Premises Maximum Indemnity Period as stated in the Schedule Uninsured Working Expenses as stated in the Schedule Gross Profit The amount by which 1) the sum of the amount of the Turnover and the amounts of the closing stock and work in progress shall exceed 2) the sum of the amount of the opening stock and work in progress and the amount of the Uninsured Working Expenses Rate of Gross Profit The rate of Gross Profit earned on the turnover during the financial year immediately before the date of the Incident Annual Turnover The Turnover during the twelve months immediately before the date of the Incident. Standard Turnover The Turnover during the period in the twelve months immediately before the date of the Incident which corresponds with the Indemnity Period …….. to which such adjustments shall be made as may be necessary to provide for the trend of the Business and for variations in or other circumstances affecting the Business either before or after the Incident or which would have affected the business had the Incident not occurred so that the figures thus adjusted shall represent as nearly as may be reasonably practicable the results which but for the Incident would have been obtained during the relative period after the Incident Basis of Loss Settlement The undernoted terms of settlement apply only if the paragraph title appears in the Schedule to this Section Gross Profit/Estimated Gross Profit The insurance under this item is limited to loss of Gross Profit due to a) Reduction in Turnover and b) Increase in Cost of Working and the amount payable as indemnity thereunder shall be a) In respect of Reduction in Turnover: the sum produced by applying the Rate of Gross Profit to the amount by which the Turnover during the Indemnity Period shall fall short of the Standard Turnover in consequence of the Incident a) notify the Company immediately b) notify the Police Authority immediately if it becomes evident that any loss or damage has been caused by theft or malicious persons c) carry out and permit to be taken any action which may be reasonably practicable to prevent further loss destruction or damage d) deliver to the Company at the Insureds expense i) full information in writing of the property lost destroyed or damaged and of the amount of loss destruction or damage … iii) all such proofs and information relating to the claim as may be reasonably required … BUSINESS INTERRUPTION Definitions Indemnity Period Turnover Maximum Indemnity Period as stated in the Schedule Uninsured Working Expenses as stated in the Schedule Gross Profit The amount by which Rate of Gross Profit Annual Turnover Standard Turnover Basis of Loss Settlement Gross Profit/Estimated Gross Profit a) In respect of Reduction in Turnover: the sum produced by applying the Rate of Gross Profit to the amount by which the Turnover during the Indemnity Period shall fall short of the Standard Turnover in consequence of the Incident b) In respect of Increase in Cost of Working: the additional expenditure (subject to the provisions of the Uninsured Working Expenses clause) necessarily and reasonably incurred for the sole purpose of avoiding or diminishing the reduction in Turnover which but for that expenditure would have taken place during the Indemnity Period in consequence of the Incident but not exceeding the sum produced by applying the Rate of Gross Profit to the amount of the reduction thereby avoided ... less any sum saved during the Indemnity Period in respect of such of the charges and expenses of the Business payable out of Gross Profit as may cease or be reduced in consequence of the Incident provided that if the sum insured by the item on Gross Profit be less than the sum produced by applying the Rate of Gross Profit to the Annual Turnover (or to a proportionately increased multiple thereof where the Maximum Indemnity Period exceeds twelve months) the amount payable shall be proportionately reduced… Additional Increased Cost of Working The insurance under this item is limited to such further additional expenditure beyond that recoverable under paragraph (b) of any of the above items insured hereby as the Insured shall necessarily and reasonably incur during the Indemnity Period in consequence of the Incident for the sole purpose of avoiding or diminishing a reduction in Turnover or Gross Revenue. Professional Accountants Clause Any particulars or details contained in the Insured’s books of account or other business books or documents which may be required by the Company under part (b) of Special Condition 2 for the purpose of investigating or verifying any claim hereunder may be produced by professional accountants if at the time they are regularly acting as such for the Insured and their report shall be prima facie evidence of the particulars and details to which such report relates The Company will pay to the Insured the reasonable charges payable by the Insured to their professional accountants for producing such particulars or details or any other proofs information or evidence as may be required by the Company under part (b) of Special Condition 2 of this Section and reporting that such particulars or details are in accordance with the Insured’s books of accounts or other business books or documents provided that the sum of the amount payable under this Clause and the amount otherwise payable under the Section shall in no case exceed the liability of the Company as stated. Special Conditions …………. 2. Claims Conditions a) In the event of any loss destruction or damage in consequence of which a claim is or may be made under this Section the Insured shall - notify the Company immediately - deliver to the Company at the Insureds expense within 7 days of its happening full details of loss destruction or damage caused by riot civil commotion strikers locked-out workers persons taking part in labour disturbances or malicious persons - with due diligence carry out and permit to be taken any action which may be reasonably practicable to minimise or check any interruption of or interference with the Business or to avoid or diminish the loss b) In the event of a claim being made under this Section the Insured at their own expense shall i) - (not later than 30 days after the expiry of the Indemnity Period or within such further time as the Company may allow) deliver to the Company in writing particulars of their claim together with details of all other insurances covering property used by the Insured at the Premises for the purpose of the Business or any part of it or any resulting consequential loss … ii) - deliver to the Company such books of account and other business books vouchers invoices balance sheets and other documents proofs information explanation and other evidence as may be reasonably required by the Company for the purpose of investigating or verifying the claim .. c) If the terms of this condition have not been complied with - no claims under this Section shall be payable ……. BUSINESS INTERRUPTION – ALL RISKS. (Exclusions) CONSEQUENTIAL LOSS [a]rising directly or indirectly from (d) disappearance unexplained or inventory shortage misfiling or misplacing of information …”
“… but bear in mind the latter will not investigate the loss of profit element unless requested as it doesn’t fall within the AIG policy, although they will be able to quantify the stock and client will be able to provide evidence of the profit element on this.”
“Loss – do we need to give details of each item. – yes Do we need to complete 2008 Pi s – yes. Do we need to prove unsatisfied demand for LoP claim – yes.”
“1. Insurer to admit liability – provide non financial information, particularly recovery opportunities. 2. Provide outline quantum indication but park detailed quantum questions until admission of liability forthcoming. …”
“AXA – BI Claim Not intended to cover such events xs£5k each time a BI loss occurred following theft … Overall … If overcome liability hurdles – ‘negotiated’ amount. Claims follows AIG claim – AIG have to admit liability first W&C Shopping list See 29.12.08 email”
“I refer to my e-mail dated29 December 2008 , to which I have not yet received a response. I look forward to hearing from you or your client as soon as possible with the information requested.”
“As explained, the purpose of the meeting is to provide the outstanding information previously requested to enable you to report to your principals with the aim of securing a commitment to provide indemnity. This includes … item 1 on your 29 December e-mail … all items relevant to recovery possibilities will be provided.…. I shall also circulate headline claim details so you have an idea of overall quantum and how it was calculated. … Subsequently Lindsay can produce the more in depth stock and financial information needed to support the claim (John the balance of your shopping list is currently parked here …)”
“Not prepared to do work until liability admitted” and Mr Coonan’s subsequent email dated24 March 2009 . iii) Mrs Stone raised the question of accountant’s charges. She said that TB wanted insurers to pay for KPMG to provide the information listed in items 2 to 7 of Mr Coonan’s “shopping list”
“I would say positions did not change during the meeting as the adjusters had no authority to make decisions on liability or funding.”
“I note that your client is not prepared to undertake the exhaustive reviews and analysis of stock shortage and claim reconciliation information at this stage until such time as agreement in principle that liability is accepted has been provided.”
“... AIG’s position –their decision on liability is promised next week. No doubt it will take a little longer but it would be appreciated if their decision were also available in the near future so that we can agree a methodology that suits both insurers for the financial substantiation required”
“1. … AXA … fully reserves all its rights under the Policy and at law and … AXA’s ongoing conduct of this matter, including but not limited to conduct through its adjusters, Woodgate & Clark, or others instructed by or on behalf of AXA, will be subject to that reservation. 2. … this letter nor any conduct related to this matter shall be construed as a waiver of, nor shall AXA be estopped from asserting in the future, any rights and defences it may have under the Policy or in law. No representations, express or implied, by AXA, or its agents or its employees in respect of coverage under the Policy in respect of the Claim shall be effective unless and until communicated in writing by AXA or by any solicitors that may be instructed on their behalf. …”
“In the meantime, I look forward to receiving any further claim submissionyour client wishes to make at this stage.”
“The insured have updated their stock claim as the results of the anticipated 2008 shortfall are now available. It is down slightly to£1.674m in total, so still exceeds the AIG policy limited. Once AXA has confirmed they are prepared to deal with this claim, I will forward the details on.”
“The Insured is reluctant to carry out necessary quantification works twice and the brokers have advised that they are pressing you and your underwriters for your own admission of liability ... Further, the brokers have asked us to confirm that we will attend a meeting arranged for 16 September at which time quantum matters and the manner in which the Insured will seek to prove its losses will be discussed. I have confirmed to the broker that I shall be pleased to attend and participate in such quantum discussions, although this involvement will be entirely without prejudice to or admission of liability.”
“Sufficient particulars must be given by the assured. It is a question of fact whether particulars are sufficient, which must depend on all the circumstances of the case, such as the means of information open to the assured and, no doubt, the time within which particulars must be delivered. The phrase “full particulars” has been said to mean “the best particulars the assured can reasonably give”, and if the assured has failed to give a detailed account of his loss when he could have done so, he will be unable to recover ... The assured will not be prevented or estopped from recovering for his loss by the fact that his particulars are inaccurate since, unless the policy otherwise provides, he is entitled to deliver further particulars or amend the original ones.”
“... I would myself prefer Professor Malcolm Clarke's formulation in The Law of Insurance Contracts, loose-leaf Ed, para 26–4 d. “Inferences from rejection. If the insurer rejects the claim altogether on another ground, such as lack of cover, the insurer does not thereby waive the possibility of pleading a breach of condition at a later stage, if that breach occurred prior to the rejection of the claim …”
“It is a long established rule of law that a contracting party, who, after he has become entitled to refuse performance of his contractual obligations, gives a wrong reason for his refusal, does not thereby deprive himself of a justification which in fact existed, whether he was aware of it or not ... This rule is, however, subject to a proviso. If the point not taken is one which if taken could have been put right, the principle will not apply.”
“Estoppel by convention may arise where parties to a transaction act on an assumed state of facts or law, the assumption being either shared by them both or made by one and acquiesced in by the other. The effect of an estoppel by convention is to preclude a party from denying the assumed facts or law if it would be unjust to allow him to go back on the assumption … It is not enough that each of the two parties acts on an assumption not communicated to the other.”
“Mysterious disappearance’ clauses, which appear in many forms of property insurance and also in some liability policies, exempt the insurers from liability in the event that the insured subject matter is the subject of “mysterious” or “unexplainable” disappearance. It is unlikely that this type of wording has very much affect. If the policy is one against specific perils, the assured bears the burden of proving that the loss was proximately caused by an insured peril. An assured who is able to do so will by definition defeat the mysterious disappearance exclusion, because the disappearance has been shown not to be unexplained. Conversely an assured who is unable to identify which insured peril has caused the loss will not be able to recover anyway, so the mysterious disappearance clause adds nothing to the insurers’ rights.”
“…Once it can be demonstrated that […] liability does, as a matter of the balance of probabilities, fall within the cover of the policy reinsured (for instance, because the applicable excess has been exceeded), liability would be established; what thereafter remain are questions of quantum. These are questions of fact, sometimes referred to as “jury questions”: see, for example, Municipal Mutual Insurance Ltd v Sea Insurance Co Ltd [1998] Lloyd’s Rep IR 421, at pages 436 and following, per Hobhouse LJ (as he then was). When this stage has been reached, the court must do its best on the available evidence, bearing in mind the burden of proof resting upon Equitas and the applicable standard of proof: see too, Chaplin v Hicks[1911] 2 KB 786 , at pages 792 and 795. But at this stage, there can be no objection in principle to Equitas seeking a recovery in a minimum amount, provided that the minimum amount is established on a balance of probabilities; the effect is simply that Equitas foregoes any attempt to recover additional sums. The extent of losses, once liability has been established, need not be proved with scientific exactitude. As Lord Hoffmann observed, in Gregg v Scott[2005] 2 AC 176 , at para 69, citing from a Scottish decision itself citing a Canadian judgment: The rule against the recovery of uncertain damages is directed against uncertainty as to cause rather than as to extent or measure.”
“22 … Some claims for consequential loss are capable of being established with precision (for example, expenses incurred prior to the date of trial). Other forms of consequential loss are not capable of similarly precise calculation because they involve the attempted measurement of things which would or might have happened (or might not have happened) but for the defendant's wrongful conduct, as distinct from things which have happened. In such a situation the law does not require a claimant to perform the impossible, nor does it apply the balance of probability test to the measurement of the loss. 23. The claimant has first to establish an actionable head of loss. This may in some circumstances consist of the loss of a chance, for example, Chaplin v Hicks[1911] 2 KB 786 and Allied Maples Group Limited v Simmons and Simmons[1995] 1 WLR 1602 , but we are not concerned with that situation in the present case, because the judge found that, but for Mr Bomford's fraud, on a balance of probability Tangent would have traded profitably at stage 1, and would have traded more profitably with a larger fund at stage 2. The next task is to quantify the loss. Where that involves a hypothetical exercise, the court does not apply the same balance of probability approach as it would to the proof of past facts. Rather, it estimates the loss by making the best attempt it can to evaluate the chances, great or small (unless those chances amount to no more than remote speculation), taking all significant factors into account. (See Davis v Taylor[1974] AC 207 , 212 (Lord Reid) and Gregg v Scott[2005] 2 AC 176 , para 17 (Lord Nicholls) and paras 67-69 (Lord Hoffmann)).”
“25…Where the quantification of loss depends upon an assessment of events which did not happen the judge is left to assess the chances of the alternative scenario he is presented with. This has nothing to do with loss of chance as such. It is simply the judge making a realistic and reasoned assessment of a variety of circumstances in order to determine what the level of loss has been.”
“However, without an adjustment mechanism, as provided by the Trends Clause, the application of that standard formula to the facts of a given case may not give proper effect to the indemnity intended to be provided under the Business Interruption section of the Policy, namely in respect of the loss resulting from the business interruption suffered in consequence of property damage which is itself the result of an insured event. The purpose of the Trends Clause is to allow for an appropriate adjustment to be made to the components of the standard formula so as to give effect to the requirement that the insured be indemnified in respect of the loss caused by the insured damage, not more and not less.”