Slip and Fall Slipped Insured’s Mind

A restaurant hired a plowing service. One night, before the service plowed the lot, a grandmother exits her car, slips and falls, and breaks her hip. The woman sues, but the restaurant did not report the injured woman’s claim to their insurer for six months.
 
Notable Timestamps

[ 00:26 ] - By the time the insurer learned of the loss, the injured person had already obtained a judgment against the insured. 

[ 01:35 ] - How do you walk on ice?

[ 03:28 ] - A CGL's notice provision likely requires "immediate notice", "notice as soon as practicable", or "prompt notice". Courts interpret these provisions in line with a reasonableness standard.

[ 04:00 ] - Breach of this policy provision can give the insurer the right to deny coverage, so claims are often reported even prior to suit being filed.

[ 05:11 ] - In Illinois, courts examine factors including the wording of the notice provision, the sophistication of the insured, the diligence of the insured, and prejudice.

[ 07:33 ] - Some states (but not IL) require the insured to show prejudice-- in layman's terms, some impact beyond a technality.

[ 10:50 ] - Even if the insured feels that the snow plow company should be at fault, the insured must still comply with the insurance contract.

[ 12:27 ] - There's no universal bright-line rule on the amount of time: cases range from finding breach at three months, to finding no breach at two years.

[ 13:37 ] - Courts would also consider factual situations like difficulties with mail.

[ 14:10 ] - Typically in lawsuits lack of knowledge of a contract is not a defense, but in this case the sophistication of an insured is a factor.

[ 16:14 ] - Michele provides a recap of the scenario and the points above.

Your PLRB Resources

50 State Survey – Late Notice - https://www.plrb.org/documents/table-of-contents-late-notice/?search=late%20notice

Commercial General Liability Policy Annotation Key GL25, Late Notice - https://www.plrb.org/documents/gl25-notice-to-insurer/

Commercial General Liability Policy Annotation Key GL26, Notice Prompt And As Soon As Practicable - https://www.plrb.org/documents/gl26-notice-prompt-as-soon-as-practicable/

PLRB Coverage Reply, Is Prejudice Required to Deny a Claim for Late Notice? - https://www.plrb.org/documents/is-prejudice-required-to-deny-a-claim-for-late-notice-2022-09-30/

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The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

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