“Rights against insurer of insolvent person etc (1) This section applies if— (a) a relevant person incurs a liability against which that person is insured under a contract of insurance, or (b) a person who is subject to such a liability becomes a relevant person. (2) The rights of the relevant person under the contract against the insurer in respect of the liability are transferred to and vest in the person to whom the liability is or was incurred (the “third party”). (3) The third party may bring proceedings to enforce the rights against the insurer without having established the relevant person’s liability; but the third party may not enforce those rights without having established that liability. (4) For the purposes of this Act, a liability is established only if its existence and amount are established; and, for that purpose, “establish” means establish— (a) by virtue of a declaration under section 2 or a declarator under section 3, (b) by a judgment or decree, (c) by an award in arbitral proceedings or by an arbitration, or (d) by an enforceable agreement. (5) In this Act— (a) references to an “insured” are to a person who incurs or who is subject to a liability to a third party against which that person is insured under a contract of insurance; (b) references to a “relevant person” are to a person within sections 4 to 7 [(and see also paragraph 1A of Schedule 3)]; (c) references to a “third party” are to be construed in accordance with subsection (2); (d) references to “transferred rights” are to rights under a contract of insurance which are transferred under this section.”
“SECTION B PUBLIC AND PRODUCTS (including inefficacy) LIABILITY DEFINITIONS to Section B … 8 Liability Liability means legal liability to pay damages including interest and claimant costs recoverable from you in respect of or as a result of: 8.1 accidental bodily injury to any person other than an employee 8.2 accidental damage caused by you or your employees or sub-contractors to property other than property belonging to you or in your custody, possession or control 8.3 accidental damage or bodily injury caused by deliberate acts of your employees or sub-contractors 8.4 accidental personal injury, 8.5 accidental advertising injury 8.6 accidental denial of access occurring during the period of insurance in connection with any occurrence which is or may be the subject of indemnity under this Section. … 19 Criminal acts We will indemnify you for your liability to pay damages including interest and claimants costs recoverable from you as a result of bodily injury or damage in respect of criminal acts of arson, theft, malicious damage, assault, fraud, dishonesty or embezzlement by your employees provided that the events insured by this clause: 19.1 were committed during the period of insurance, and 19.2 arose in connection with a contract with a customer. … COVER We will indemnify you up to the limit of indemnity against liability incurred by you during the period of insurance arising out of and in the course of business within the territorial limits. … CLAIMS CONDITIONS The following Conditions 1-10 must be complied with after an incident that may give rise to a claim under your policy. Breach of these conditions will entitle us to refuse to deal with the relevant claim. … 2 Writ, summons, etc You must not respond to any letter, writ or summons or other document sent to you in connection with any accident, incident or occurrence that may relate to any claim under your policy or which may give rise to a claim under any Section of your policy. You must immediately send them to Sutton Specialist Risks Ltd unanswered by return of post, or to us or legal representatives as may otherwise be advised by us. 3 Notification of claims You or any other party insured by your policy must inform Sutton Specialist Risks Ltd Sutton Specialist Risks Ltd, hereafter, referred to as “SSR,” acted as agent for the ThirdDefendantin receiving notice of potential claims or other notifiable circumstances. : 3.1 immediately you have knowledge of any impending prosecution, inquest or inquiry in connection with any accident or disease, which may be the subject of claim, give notice in writing and give us any further information and assistance we may require, … 3.5 within as soon as practical but in any event within thirty (30) days in the case of any other damage, bodily injury, incident, accident or occurrence, that may give rise to a claim under any your policy but not separate specified above.”
“Hi Elvin Is it possible to get the following sent across from the alleged incident cheers. Please ensure that you provide our adjuster with the following documents: 1) Incident book entry 2) Witness Statement(s) 3) Internal investigation report i.e. what went wrong? What measures have been out in place to prevent a reoccurrence? 4) A copy of the contract between yourselves and Protec 5) pre and post-accident risk assessment for assaults 6) CCTV 7) Any other relevant documents … Kind regards, Rob Norbury.”
“With reference to the claim we have had presented to us on behalf of Mr. Daniel Makin for an incident which occurred in August 2017, Muse Bar Oldham. The police fully investigated the incident at the time, and they were provided with all CCTV footage from 2 public houses, witness statements and statements from the two guards in question at the time of the incident, they were provided with the sign in book, all other relevant information and held all communications between Protec Security and the officers on duty. The Police took all the evidence away at the time and after a full investigation they had declared that our guards operated correctly within the guidelines of their employment and the law, the claimant was reported to be under the influence of alcohol and drugs, but we cannot confirm this as this was in the police report. The police retained all the evidence and reported that there was no further action to be taken and the case was closed. No evidence has been returned to Protec Security and is still held with the Police with this in mind, we have no records kept with Protec Security. As far as Protec Security was concerned with the conclusion of the police report we did not report this to the insurance as there was no case to answer, so no claim or further action was identified at the time. We have not heard anything from the claimant in the last 3 years and the first we have been aware of anything following from the closed case was the letter from the claimant's solicitors June 2020. We have recently been informed that the claimant had tried to make a claim directly the Muse, but they hadn't responded so the claimant is now trying to proceed the claim with Protec Security. The two guards in question have since left our employment as the incident occurred 3 years ago, we have tried to contact the two guards but they are refusing to co-operate with us, should you need to contact them, we have provided as much detail as possible below, please feel free to contact them directly should you need to. … Both guards had been instructed in their duties as door supervisors and had received adequate training via their SIA application in the delivery of their duties when on duty. …”
“Mr. Lucas was on annual leave at the time of the incident. The guards on Duty had called for the police to attend as Mr. Makin was the aggressor in the situation. The Police who attended (crime reference and Police Numbers have already been supplied to you - crime reference number 110362E/17 and the Officers at the time of the incident were PC14019 Dawson and PC5630 Cullen) ceased all the evidence at the time of the incident to investigate. They closed the incident and acknowledged that our Officers on duty had acted according to their duties and no further action was to be taken. You can contact GMP to request this information to be provided to you. We have not seen this form you have attached, this has not been sent from this office. This is a new format which was only released in May 2019, a copy of our old form format has been sent to you. The form has not been signed by our guards and the date is incorrect. The Manager that has signed the form "A.Toft" is not a member of our staff we have no knowledge of who this person is. Therefore we believe this has been filled in more recently by the venue in order to assist. We have already provided all the information we have on file for Mr. Diallo and Mr. Coupe. We have tried to contact them but they are not being cooperative. There was no Riddor reported as at the time there was no reason to believe this was a Riddor notification as Mr. Makin did not have any injuries of this nature at the time. The original letter we received forwarded to us from the Muse - was addressed to the Muse and in no way was this in connection to our Company, therefore we had no reason to believe we had to send to our insurers, the information we provided to the Muse at the time was only to assist them. We had no further contact regarding this incident from the Muse after they had emailed us to say they were having a meeting with their insurers (copy of this has been sent to you), of which we were not privy to this meeting. We did not know Mr. Makin before the incident and we were not aware of any injuries suffered at the time or subsequently after the incident. We have only been informed of this on receipt of the letter from Mr. Makins solicitors sent to us June 2020, three years after the incident. As we have instructed previous all evidence at the time, including reports, CCTV footage etc was / and still is held by the Police. We have some information held with our solicitors in archive, due to the lockdown and limited staff they have not been able to retrieve this as yet, but we are working on this. We are not trying to be difficult, obstructive or hide any information, but after 3 years and changes to staff we are trying our best to locate as much information as we can, and as we retrieve more we will forward this on to you.”
“The incident involving Mr Makin took place on6 August 2017 . From a redacted copy of the Police report which has been provided to QBE by Mr Makin's solicitors, it can be established that the matter was first reported to the police on12 August 2017 and that the police investigation was finalised on22 September 2017 . Whilst we understand that Mr Elvin Lucas was on annual leave at the time of the incident, we understand that he was contacted by the police and provided incident reports to them, as well as witness statements, the sign in book and all communications between Protec and the officers on duty. It is not presently known the date or dates upon which this information was provided to the police by Protec but it is likely to have been towards the start of the investigation and before17 August 2017 when we understand the first of the doormen was interviewed by the police. It is plain that an incident which resulted in a complaint being made to the police as to the conduct of your employees and which was alleged to have caused a serious injury to Mr Makin was one which "may give rise to a claim" under the policy. In the circumstances, you had a duty to inform Sutton as soon as practical but in any event within 30 days from when you were informed of the police's investigation into the incident.”
“[17] An event may occur which gives rise to a claim which is brought against the insured well over a year or more later. The insured may know of the event at the time it occurs or in the immediate aftermath and that it is likely to give rise to a claim against him. If so, he must give notice to the insurer. But he may not know of the event, or the details of the event, until some considerable time after the event occurred; and when he knows about it, or something about it, he may or may not appreciate that it is likely to give rise to a claim against him. What then is his obligation under the clause? Mr Robert Moxon Browne QC for Zurich submitted to the judge, as he did to us, that the meaning of the words used in condition 2 is that, when the insured learns of the event and realises that it is likely to give rise to a claim he must, then, give notice to the insurer, even if this is well after the event occurred. He must also do so as soon as he could with reasonable diligence have discovered that an event which was likely to give rise to a claim had occurred. The judge rejected this submission…. [32] I do not accept Zurich’s construction of the condition. This is a condition introduced by Zurich into its policy which has the potential effect of completely excluding liability in respect of an otherwise valid claim for indemnity. If Zurich wished to exclude liability it was for it to ensure that clear wording was used to secure that result. It has not done so. It is possible to construe the use of the phrase ‘as soon as possible’ as meaning that even if, when the event occurred, it was not likely to give rise to a claim, the obligation to notify would arise whenever thereafter the insured knew or should have known that an event which had occurred in the past was likely to give rise to a claim. But I regard this as a strained interpretation and erroneous. [33] It is, in any event, far from clear that that is the right interpretation and given the nature of the clause the ambiguity must be resolved in favour of Maccaferri. Clauses such as these need to be clear if they are to have effect: Royal and Sun Alliance Insurance plc v Dornoch Ltd[2005] EWCA Civ 238 , [2005] 1 All ER (Comm) 590, [2005] Lloyd’s Rep IR 544. That is particularly so in circumstances where the context in which the clause was agreed was that Layher and Jacobs A reference to Layher Ltd v Lowe (1996) 58 ConLR42, [2000] Lloyd’s IR 510 and Jacobs v Coster[2000] EWCA Civ 3042 , [2000] Lloyd’s Rep IR 506. had been decided as they had. Although the wording in the present case is not identical to the wording in those cases, the two cases indicate that prima facie whether there is an obligation to notify an occurrence as one likely to give rise to a claim is to be determined by reference to the position immediately after it occurs. Further, Zurich’s construction imposes an obligation to carry out something of a rolling assessment as to whether a past event is likely to give rise to a claim (and possibly as to whether an event has happened at all) as circumstances develop. There are clauses which have that effect, particularly in claims made policies insuring against professional liability, but they are not in this form. If that was what was intended, the insurers could be expected to have spelt it out. [34] The question therefore is whether, when the event occurred (an occasion not limited to the exact moment) it was likely to give rise to a claim. That will depend on whether in the light of the actual knowledge that the insured then possessed a reasonable person in his position would have thought that it at least 50% likely that a claim would be made.”
“You must not respond to any letter, writ or summons or other document sent to you in connection with any accident, incident or occurrence (a) that may relate to any claim under your policy (b) which may give rise to a claim under any Section of your policy.”: This is problematic because it is difficult to conceive of an “accident, incident or occurrence” which relates to a claim under the policy. It is only an accident etc. which might itself give rise to a claim to which the policy might respond that would be of interest. The idea of notifying an accident etc. that “relates” to a claim is either meaningless or irrelevant. (iii) The Claimant suggests that this condition may in fact have been intended to read: “You must not respond to any letter, writ or summons or other document sent to you (a) that may relate to any claim under your policy or (b) in connection with any accident, incident or occurrence which may give rise to a claim under any Section of your policy.” (iv) This third reading For the avoidance of doubt, in calling this the Claimant’s third “reading” or “construction” of the words at this point and hereafter in this judgment, I do not mean to imply that the Claimant was saying that this was a permissibleconstruction that was less good than the first or second; the Claimant considers the third readingnot to be a permissible reading of the words at all since it contends that itdoes injustice to the language used. would avoid the infelicities identified in readings (i) and (ii) above. However, to interpret the policy in this way would involve a redrawing of the policy that goes beyond what it permissible. The limits of the use of construction to correct drafting errors without a formal order of rectification was said by Brightman LJ in East v Pantiles(1982) 2 EGLR 111 to arise where two conditions are satisfied: “first, there must be a clear mistake on the face of the instrument; secondly, it must be clear what correction ought to be made in order to cure the mistake. If those conditions are satisfied, then the correction is made as a matter of construction. If they are not satisfied then either the claimant must pursue an action for rectification or he must leave it to a court of construction to reach what answer it can on the basis that the uncorrected wording represents the manner in which the parties decided to express their intention.”
“You must not respond to any letter, writ or summons or other document sent to you (a) that may relate to any claim under your policy or (b) in connection with any accident, incident or occurrence which may give rise to a claim under any Section of your policy. You must immediately send them to Sutton Specialist Risks Ltd unanswered by return of post, or to us or legal representatives as may otherwise be advised by us.”
“It is not always easy to decide whether clauses requiring notice of a claim are conditions precedent to the liability of the insurer under the policy, or merely terms of the policy for breach of which the insurer’s only remedy is to claim damages for the extra expense flowing from the insured’s failure to give notice within the proper time. Little more can be said than that it is a matter of construing the policy as a whole.”
“It is a well-established and salutary principle that a party who relies on a clause exempting him from liability can only do so if the words of the clause are clear on a fair construction of the clause.”
“The modern drafting technique is to include a general clause which declares that the due observance and fulfilment by the insured of all the obligations cast upon him by the policy terms shall be conditions precedent to any liability of the insurers to make any payment under the policy. Breach by the insured of a term of the kind described above then provides the insurer with a defence to payment, regardless of whether it was either remedied before or causally connected with the loss.”
“103. The Conditions were written under the heading ‘Policy Conditions.’ MGL was warned that if it did not comply MGL “may lose all right to recover under your policy.”
“Policy Conditions “These are conditions of the cover and apply throughout your policy…. If you do not comply with a condition you may lose all right to cover under your policy or to receive payment for a claim. … Claims Notification Condition You must Claims Notification Condition You must 1 as soon as practical a. … b. give us all information we request … If you do not comply with this condition we have the right to refuse to pay your claim. Claims Procedures Condition … 2 At your expense you must provide us with a. full details in writing of any injury, loss or damage and any further information we may reasonably require b. any assistance to enable us to settle or defend a claim … If you do not comply with this condition we have the right to refuse to pay your claim.”
“13. Observance The liability of Underwriters shall be conditional on: (i) the Assured paying in full the premium demanded and observing the terms and conditions of this insurance …”
“[62] It is well established that a general clause in an insurance policy purporting to make compliance with obligations in the policy a condition precedent to the underwriters being liable in respect of a claim can indeed have that effect. The effect of such a general clause is that which the clause would have if it had been set out at the commencement of each particular clause which imposes an obligation upon the assured. This is the ‘modern drafting technique’ (see MacGillivray on Insurance Law (10th edn, 2003) pp 227–228 (para 10–11)). Whilst the words ‘condition precedent’ are often used in such clauses, other words can have the same effect so long as the clause is apt to make that effect the clear intention of the parties. What has to be found is a ‘conditional link’ between the assured’s obligation to give notice and the underwriters’ obligation to pay the claim. [63] Condition 13 states that the ‘liability of Underwriters shall be conditional on the Assured paying in full the premium demanded and observing the terms and conditions of this insurance’. In my judgment this provision, when read in conjunction with condition 4(a), is apt to make clear that the parties intended there to be a conditional link between the assured’s obligation to comply with condition 4(a) and the underwriters’ obligation to pay the claim in question. References omitted. ”
“Certainty is naturally considered to be of great importance in dealing with commercial documents such as insurance policies. Consequently, as a matter of principle, when once the meaning of a word has been established by judicial decision, later courts will follow that interpretation, even when not strictly bound to do so under the doctrine of precedent.”
“First, where the wording differs in important respects from that used in earlier formulations, it is dangerous to construe it by analogy with the earlier provisions, since it may well be that the wording has deliberately been altered for the purpose of overcoming the original decision. Secondly, the original decision is binding only as to the use of a particular word in a particular context – it should not be assumed that a word must mean the same in every insurance policy in which it appears if the surrounding circumstances are different.”
“It is clear that the principle, if it still has any validity, can only apply if there is genuine ambiguity, which cannot otherwise be resolved by applying the ordinary principles of construction. In other words, it should not be relied on to create ambiguity where there is none.”
“i. In exercising a discretion under an insurance policy, an insurer is obliged to act towards the insured in the assessment and determination of its claim with the utmost good faith. The obligation is no different from that owed by a trustee to act in good faith in relation to the exercise of a discretion. ii. The obligation is, at least, to exercise the discretion in good faith, upon real and genuine considerations and in accordance with the purposes for which the discretion was conferred. iii. The obligation imposed on an insurer is consistent with the duty imposed upon a person who, by contract, is required to carry out a quasi judicial function: that person must “act honestly, bona fide and reasonably.” iv. An insurer is obliged to exercise its discretion upon “real and genuine consideration” and on sound reasons. v. Where a decision made by an insurer is essentially in the nature of a discretionary judgment, that decision may be attacked on the basis that it was unreasonable on the material then before the insurer. vi. In the absence of a reason put forward in support of the exercise of the discretion, the Court may infer that the discretion miscarried: see, for example, the evidentiary significance of a trustee to providing reasons for a decision in respect to the exercise of a discretion. vii. An insurer’s “power of restraining settlement by the insured must be exercised in good faith having regard to the interests of the insured as well as to its own interests and in the exercise of its power to withhold consent the insurer must not have regard to considerations extraneous to the policy of indemnity.”
"16. Under English law a liability policy is, generally speaking and in the absence of wording to the contrary, a policy which indemnifies the insured in respect of actual liability. That means that, in order to recover from his insurer the insured must show that he was liable to the person who claimed against him. Liability cannot be determined in a legal vacuum. Hence the need to assume, for this purpose, a correct application of the law governing the claim in question to the facts properly found. 17. In the event of dispute the existence of liability has to be established to the satisfaction of the insurer, or, failing that, by the judge or arbitrator who has jurisdiction to decide such a dispute. It is not, therefore, necessarily sufficient for the insured to show that he has been held liable to a claimant by some court or tribunal or that he has agreed to settle with him. In practice the fact that this has occurred may cause or persuade the insurer to pay, but, if it does not, the insured must prove that he was actually liable…"