Insurance coverage agent negligence instances are not often simple. A current choice gives invaluable perception into how insurance coverage agent negligence claims play out when organizations misunderstand the scope of their insurance coverage protection. 1
This lawsuit arose after the Piatt Lake Bible Convention Affiliation’s “Miracle Constructing,” a multipurpose construction at a distant youth camp in Michigan, collapsed below the load of snow and ice. The nonprofit believed it was absolutely lined below its long-standing insurance coverage coverage with Church Mutual. Nevertheless, after the loss, the Affiliation found that essential parts of the reconstruction prices related to compliance with fashionable constructing codes weren’t included within the substitute price protection.
These extra “code improve” prices exceeded $1 million, however the coverage supplied solely a $100,000 cap for code compliance bills. The Affiliation then sued Church Mutual in a negligence motion. It argued that it had relied on the Church Mutual agent’s representations and {that a} particular relationship existed, giving rise to a authorized responsibility to advise them extra absolutely in regards to the protection being supplied.
The policyholder’s argument centered on the notion that over time, Church Mutual had cultivated a trusted relationship via direct contact, insurance coverage opinions, and promotional supplies suggesting that the insurer was an skilled in non secular establishment protection. The Affiliation claimed that Church Mutual assured them they have been “absolutely lined,” and that this language created an affordable perception amongst board members that they’d be capable to rebuild their constructions fully within the occasion of a loss.
The Affiliation additionally emphasised its repeated inquiries through the years in regards to the adequacy of the coverage’s protection. In line with their argument, the insurer’s failure to clarify the importance of the restricted ordinance or regulation protection and the sensible impact of that cap amounted to negligent misrepresentation.
The court docket, nonetheless, discovered no authorized foundation for the negligence declare. Underneath Michigan regulation, insurance coverage brokers don’t owe a normal responsibility to advise policyholders in regards to the sufficiency of their protection until a slim “particular relationship” exists. That particular relationship arises solely below particular circumstances, resembling when an agent misrepresents protection, fails to make clear an ambiguous query, offers inaccurate recommendation, or expressly agrees to undertake an advisory function.
On this case, the court docket concluded that no such “particular relationship” existed. The board members who interacted with the insurer understood that “substitute price” meant restoring what had existed, not upgrading to new code. One board member even testified that he acknowledged code upgrades, resembling hearth suppression techniques, wouldn’t be included if the unique construction didn’t have them. Consequently, there was no proof of a misstatement, and definitely no indication that Church Mutual had undertaken an obligation to advise the nonprofit about what kinds of endorsements or increased limits it ought to contemplate.
Even assuming an obligation might need existed, the court docket additional dominated that the Affiliation didn’t show reliance. The board president couldn’t recall the specifics of the dialogue with the insurance coverage agent during which she felt assured that the Affiliation was absolutely lined. Moreover, the document lacked any proof that the board took or kept away from taking motion based mostly on a transparent, inaccurate illustration. Within the court docket’s view, any misunderstanding stemmed not from a misrepresentation by the insurer however from assumptions made by the nonprofit’s management about what they believed “full protection” meant.
For officers and leaders of nonprofit organizations, this case carries a number of essential classes. In the beginning, it’s essential to explicitly ask your insurance coverage agent not solely whether or not a coverage contains substitute price protection, but additionally whether or not it offers adequate protection to rebuild in compliance with present constructing codes. Many older buildings, significantly these constructed a long time in the past, is not going to meet fashionable code necessities, and the price of code compliance might be vital. Asking clear, direct questions and requiring particular written explanations of what’s and isn’t lined can assist keep away from surprises after a loss happens.
Second, organizations should be proactive in in search of protection that addresses identified dangers. One important endorsement usually neglected is ordinance or regulation protection, which incorporates three components: loss to the undamaged portion of a constructing, the price of demolition, and the elevated price of building as a consequence of code adjustments.
On this case, the Affiliation had solely $100,000 in ordinance protection. After the loss, when Church Mutual issued a renewal coverage, they elevated that restrict to $2 million. This was an implicit acknowledgment of the chance that had gone unaddressed. Nonprofit boards and policyholders typically ought to view that as a lesson and guarantee they consider the adequacy of such sublimits earlier than a loss, not after.
Leaders ought to do not forget that the responsibility to determine protection gaps could in the end relaxation with the policyholder in lots of jurisdictions. Whereas insurers and brokers could supply recommendation, until they explicitly tackle the function of advisor, courts in lots of jurisdictions is not going to impose an obligation upon them to fill within the blanks. Officers of boards and leaders of entities who assume they’re absolutely protected with out confirming the small print in writing achieve this on the group’s peril.
Board members ought to be certain that they or their designees fastidiously evaluation coverage declarations, endorsements, and exclusions. When unsure, ask the insurance coverage skilled for particular suggestions and recommendation after which doc these conversations. I counsel that the agent be requested if they’ll present recommendation about the very best protection that won’t depart safety gaps within the occasion of a disaster. If the agent refuses, go to a distinct agent.
Hiring a reliable insurance coverage advisor who agrees in writing to be an insurance coverage advisor is a primary step. Asking the precise questions, acquiring the right endorsements, and documenting these discussions and choices are the very best methods to guard the mission and operations earlier than a loss happens.
For these all for Michigan insurance coverage agent negligence regulation, I counsel studying What Are the Duties of An Insurance coverage Agent to the Policyholder—A Michigan Case Instance. For these within the “particular relationship” customary, I counsel studying Florida Insurance coverage Agent Customary of Care and the “Particular Relationship” They Share with the Insured.
Thought For The Day
“The one greatest drawback in communication is the phantasm that it has taken place.”
— George Bernard Shaw
1 Piatt Lake Bible Convention Assoc. v. Church Mut. Ins. Co., No. 2:23-cv-73 (W.D. MI. July 11, 2025).