Insurance Broker/Agent Negligence or Fraud Results
Representative Cases Involving Insurance Agent Fraud or Negligence
The following are examples of actual verdicts and settlements obtained by Pillsbury & Coleman in cases involving problems with insurance agents, such as fraud or negligence. Additional results can be reviewed when you speak with an attorney at our firm. If the plaintiff or insurance company names do not appear it is because confidentiality agreements are in place restricting that information.
The Regents of the University of California v. Stop Loss Insurance Brokers
|Case Issue||Broker negligence|
|Result||Hundreds of thousands of dollars in damages in a jury verdict, plus 100 percent recovery of case costs|
|Summary||The Regents sued their broker (“Stop Loss”) for professional negligence in failing to obtain the proper kind of insurance.
The Regents argued that Stop Loss pitched itself as an expert full-service broker who would not only place the Regents with a reinsurer but also obtain claim information, prepare claim forms and request reimbursements directly from the reinsurer. However, in a particularly severe health care claim − that of patient Doe − the Regents claimed that Stop Loss failed to live up to its agreement. Doe suffered acute renal failure and incurred hundreds of thousands of dollars in health care costs. The Regents filed a claim for reinsurance of this amount and was shocked to learn that the claim was denied. The reinsurer denied the claim on the grounds that it had not been disclosed during the application process.
The Regents contended that Stop Loss breached its contract and committed professional negligence by agreeing to, but then failing to, properly transmit the claim of patient Doe to the Regents’ re-insurer in a timely fashion. Second, the Regents contended that Stop Loss failed to procure the proper amount of reinsurance. At trial, the Regents contended it was entitled to reimbursement of the amounts it paid on the Doe claim.
After a two-week trial in San Francisco Superior Court, the jury found that Stop Loss had breached its contract and fallen below the standard of care and awarded the Regents over hundreds of thousands of dollars in damages. The Regents also recovered 100 percent of its case costs from Stop Loss.
Tough Negotiators, Passionate Litigators
To discuss your insurance-related concern, contact Pillsbury & Coleman, LLP. From our law offices in San Francisco, we represent clients throughout California and across the nation.