Washington Federal Judge says adjusters need a baseline understanding of Washington law

According to a new opinion out of the U.S. Court for the Eastern District of Washington, insurers have a duty to ensure that adjusters know enough about applicable case law in order to make reasonable coverage and defense decisions. In Security National Ins. Co. v. Construction Associates of Spokane, Inc., 2022 WL 884911 (E.D. Wash. 3/24/2022), the Court suggested that insurance companies could meet this duty by teaching adjusters to run case searches, purchasing subscriptions to legal newsletters, or consulting legal professionals.

The case involved a Certificate of Insurance issued in 2019 in connection with a construction site injury that occurred in 2016. The injured worker, who was employed by a subcontractor, sued the general contractor. The general contractor tendered its defense to the subcontractor’s insurer, Security National.

In preparing the tender, the general contractor searched its records for a Certificate of Insurance that confirmed its status as an additional insured under the subcontractor’s insurance policy. When it was unable to locate a Certificate for 2016, it contacted the subcontractor’s insurance broker and asked it to issue a Certificate confirming that the subcontractor was insured for the policy period during which the accident occurred and that the general contractor was an additional insured.

While Security National was investigating the tender, the Washington Supreme Court issued its opinion in T-Mobile USA, Inc. v. Selective Ins. Co. of Am., 194 Wn.2d 413, 450 P.3d 150 (2019), which held that the insurer was bound by the representation of its authorized agent in a Certificate of Insurance that an organization was an additional insured even though the Certificate said that it could not be used to expand coverage beyond that provided in the insurance policy. Previous cases had held that a Certificate of Insurance could not expand coverage provided by the insurance policy.

Although the adjuster reviewed the Insurance Commissioner’s regulation on Certificates of Insurance, he was not aware of the T-Mobile opinion. He sent a letter denying the tender almost two months after the opinion had been issued. After the general contractor’s attorney called Security National’s attention to the T-Mobile opinion, it reinvestigated the tender, eventually affirming its denial.

Judge Mendoza, Jr. granted the general contractor’s motion for summary judgment, holding that Security National was bound by its authorized agent’s representation in the 2019 Certificate that the general contractor was an additional insured on the date of the accident. He also held that the insurer acted in bad faith as a matter of law when it denied the tender of defense, rejecting Security National’s argument that claims adjusters cannot be expected to know the law and perform legal research, especially when a new case is decided during an investigation. After noting that the file included notes about sending the tender out for review by coverage counsel and making suggestions about training adjusters to know the law, he held that ignorance of the law does not excuse the conduct of adjusters who deny claims for defense or indemnification. “Adjustors must equip themselves or else seek out those with the requisite tools and knowledge.”