COURT OF APPEAL (CIVIL DIVISION)
ON APPEAL FROM QUEEN'S BENCH DIVISION
Mr Justice Moore-Bick
Strand, London, WC2A 2LL |
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B e f o r e :
LORD JUSTICE MANCE
and
SIR WILLIAM ALDOUS
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Friends Provident Life & Pensions Ltd |
Appellant |
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- and - |
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Sirius International Insurance |
Respondent |
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Smith Bernal Wordwave Limited, 190 Fleet Street
London EC4A 2AG
Tel No: 020 7421 4040, Fax No: 020 7831 8838
Official Shorthand Writers to the Court)
Mr Tom Weitzman QC (instructed by Messrs Herbert Smith Llp) for the Respondent
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Crown Copyright ©
Lord Justice Mance :
"2. LMA's professional indemnity insurance for the 1993-94 year took the form of a primary layer providing cover in respect of losses of up to £1 million any one claim and in the aggregate (subject to various deductibles) and an excess layer providing cover of £4 million in excess of £1 million any one claim and in the aggregate. The primary layer was underwritten by Syndicate No. 657 at Lloyd's through an agent, Resource Underwriting Ltd. The first excess layer was underwritten in part by a group of Lloyd's Syndicates, including Syndicate 657, and in part by the defendants, all of whom were members of the London companies' market. Both layers were placed by the brokers Bowring Marsh & McLennan Ltd ("Bowrings") and were written on a "claims made" basis, that is, the policies were expressed to provide an indemnity against losses arising from claims made against the insured during the period of the policy.
3. The business of LMA included giving financial advice to individuals in relation to personal pension plans. On 28th January 1994 in the context of negotiations for the renewal of cover for the year beginning 1st February 1994 Mr. Harvey, the Legal Services Manager of LMA, wrote to Lloyd's underwriters at the address of Bowrings in Exeter in the following terms:
"I confirm that after due enquiry I know of no circumstances likely to give rise to a claim under the Group's Professional Indemnity Policy save as follows:-
1. Matters which are currently under investigation but are not likely to exceed the deductible under the policy.
2. Pensions Transfers and Opt Outs which are a matter of public record and relate to all pensions providers. Detailed investigation will be conducted into pensions related transactions in accordance with any SIB/LAUTRO guidelines and notification of any potential claims given to underwriters in the usual way."
4. The reference to "pensions transfers and opt-outs" was a general reference to LMA's involvement in giving financial advice to employees who were considering whether to transfer from, (or, in the case of new employees, opt out of), private pension schemes run by their employers in favour of personal pension plans available in the market. By the latter part of 1993 the regulatory bodies had expressed concern that the advice given to many clients by their financial advisers was inadequate and had led to what was later to become known as "pension mis-selling". They had already indicated their intention to conduct an investigation, but its precise nature and scope had yet to be determined. In the event, as a result of those investigations LMA was required to pay sums totalling over £9 million to various clients by way of compensation.
5. Clause 2 of the General Conditions forming part of the primary layer policy obliged the insured to notify the underwriters as soon as possible of any circumstances that might give rise to a claim. It also provided that any claim arising from circumstances notified to the insurers in accordance with that clause should be deemed to have been made during the period of the policy. Accordingly, the claimant sought to recover its loss from the underwriters for the 1993-94 year on the grounds that, although the claims themselves had not been made during that year, they arose out of the circumstances described in Mr. Harvey's letter of 28th January 1994 and were therefore to be treated as having occurred during the period of cover. The Lloyd's Syndicates have accepted liability in respect of those claims, both under the primary and excess layer policies, but the defendants have declined to do so on the grounds (among others) that their policies only cover claims actually made within the policy period and that even if they do extend to claims arising out of circumstances notified during the policy period, LMA failed to notify them of any such circumstances within that time.
6. By orders made on 25th February 2004 and 30th April 2004 directions were given for the trial of a number of preliminary issues relating to the construction and effect of the excess layer policies. Before identifying those issues, however, it is necessary to set out the material terms of the various policies.
The policies
7. The material parts of the primary layer policy provided as follows:
"Now we, the underwriters, to the extent and in the manner hereinafter provided, hereby agree:-
1. To indemnify THE ASSURED against any claim or claims first made against them during the period of insurance set forth in the First Schedule in respect of any Civil Liability whatsoever or whensoever arising . . . . . . .
. . . . . . . . . . . . . . . . . . . .
EXCLUSIONS
The Policy shall not indemnify THE ASSURED against any claim or loss:-
. . . . . . . . . . . . . . . . . . . .
2. Arising out of any circumstances or occurrence . . . . . . . . which were known to THE ASSURED prior to the inception of this Policy
. . . . . . . . . . . . . . . . . . . .
GENERAL CONDITIONS
. . . . . . . . . . . . . . . . . . . .
2. THE ASSURED shall as a CONDITION PRECEDENT to their right to be indemnified under this Policy give to the Underwriters notice as soon as possible during the period of this policy as set forth in the Schedule:-
2.1 Of any circumstance of which THE ASSURED shall become aware which may give rise to a claim or loss against them or any of them.
2.2 Of the receipt of notice from any person whether written or oral of an intention to make a claim against them or any of them.
. . . . . . . . . . . . . . . . . . . .
Such notice having been given to Underwriters THE ASSURED shall give to the Underwriters as soon as possible full details in writing of the circumstances which may give rise to a claim or loss against them or any of them. Any claim or loss to which that circumstance has given rise which is subsequently made after the expiration of the period specified in the First Schedule shall be deemed for the purposes of this Policy to have been made during the subsistence hereof."
8. The leading excess layer policy was underwritten by the Lloyd's Syndicates and was known as the 'Co-insurance policy' because it was referred to by that name in each of the other excess layer policies. It incorporated a set of clauses known as the A W G S Excess Wording which provided as follows:
"To indemnify the Assured for claim or claims which may be made against the Assured during the period of insurance . . . . ."
and contained the following clauses:
"1. Liability to pay under this Policy shall not attach unless and until the Underwriters of the Underlying Policy/ies shall have paid or have admitted liability or have been held liable to pay, the full amount of their indemnity.
2. It is a condition of this Policy that the Underlying Policy/ies shall be maintained in full effect during the currency of this Policy.
3. If by reason of the payment of any claim or claims by the Underwriters of the Underlying Policy/ies during the period of this Insurance the amount of indemnity provided by such Underlying Policy/ies is:-
(a) Partially reduced, then this Policy shall apply in excess of the reduced amount of the Underlying Policy/ies for the remainder of the period of insurance;
(b) Totally exhausted, then this Policy shall continue in force as Underlying Policy until expiry hereof.
. . . . . . . . . . . . . . . . . . . .
5. Any claim(s) made against the Assured or the discovery by the Assured of any loss(es), or any circumstances of which the Assured becomes aware during the subsistence hereof which are likely to give rise to such a claim or loss, shall, if it appears likely that such claim(s) or loss(es) may exceed the indemnity available under the Policy/ies of the primary and Underlying excess Insurers, be notified immediately by the Assured in writing to the Underwriters hereon.
. . . . . . . . . . . . . . . . . . . .
7. Except as otherwise provided herein this policy is subject to the same terms, exclusions, conditions and definitions as the Policy of the primary Insurers. No amendment to the Policy of the primary during the period of this Policy in respect of which the primary Insurers require an additional premium or a deductible shall be effective in extending the scope of this Policy until agreed in writing by the Underwriters."
9. The first to fourth defendants' proportions of the excess layer cover was written on the policy form issued by the London Insurance & Reinsurance Market Association Ltd ("LIRMA"). It described the interest insured as
"Excess Professional Indemnity Insurance in accordance with the Policy referred to in the Coinsurance Clause below."
The Coinsurance Clause provided as follows:
"It is warranted that this Policy shall run concurrently with and be subject to the same terms, provisions and limitations as are contained in Policy No. 509/QF404093 issued by certain Lloyd's underwriters covering the identical subject matter and risk."
10. The fifth defendant issued its own policy by which it agreed to indemnify the claimant against
"Loss as more fully set forth in the Policy detailed in the said Schedule covering the identical subject matter and risk (hereinafter called the "Co-insuring Policy") . . . . . . Provided that:-
(1) . . . . . . . . .
(2) the Policy shall be subject to the same terms, provisions, conditions and limitations as are contained in the Co-insuring Policy."
The Co-insuring Policy was identified in the schedule as Lloyd's Policy No. 509/QF404093.
11. Thus each of the defendants' policies purported to incorporate the terms of the Co-insurance policy which, by virtue of clause 7 of the A W G S Excess Wording, purported in turn to incorporate the terms of the primary layer policy.
The Issues
Issue 1: "Whether the cover provided under the excess policies:-
(1) included the extension of cover contained in General Condition 2 of the primary policy in respect of claims made after the policy period arising out of circumstances notified within the policy period; or(2) Only provided cover in respect of claims made within the policy period."
The judge's answer was that the cover provided by the excess policies extends to claims arising out of circumstances notified during the policy period.
Issue 2: "Whether, in the event that cover provided under the excess policies included the extension of cover referred to above:-
(1) The notice required in order to extend cover to the claims arising out of the circumstances thus notified had only to be given to the insurers subscribing to the primary policy; or(2) It was necessary for such notice to be given to the insurer on the particular policy in the excess layer in question."
The judge's answer was that it is sufficient that notice of the circumstances giving rise to the claim was given to the primary layer insurers.
Issue 3: "Whether the provision of Schedule 1 to the primary policy identifying Bowring as the person to whom claims were to be notified was incorporated, expressly or by implication, into the excess policies with the result that, in the event that the excess policies incorporated the extension of cover referred to above but that the relevant notice needed to be given within the policy period to the insurers subscribing to the excess policies, this requirement was satisfied by the giving of notice to Bowring."
The judge's answer was that notice to Bowrings was not sufficient to constitute notice to the appellants..
Issue 4: "Whether LMA's letter of 28th January 1994 constituted notice of the circumstances identified therein to
(1) the insurers subscribing to the primary policy; and(2) the insurers subscribing to the excess policies."
The judge's answer was that the letter was sufficient to constitute notice to the Lloyd's underwriters on both the primary and excess layers, but did not constitute notice to the appellants.
Issue 5: "In the event that cover provided under the excess policies included the extension of cover referred to above and the requisite notice of the relevant circumstances was given within the policy period, what (if any) further requirements as to the giving of notice were imposed on LMA by
(1) General Condition 2 of the primary policy (to the extent that it was incorporated into the excess policy); and/or(2) Clause 5 of the Co-insuring policy."
The judge's answer was that the respondents were obliged to give notice to the appellants of claims and circumstances in accordance with clause 5.
Issue 6: "Whether any such further requirements [sic] as to the giving of notice as may be identified in answer to question 5 above was
(1) a condition precedent to liability under the excess policies;(2) an innominate term, breach of which might if sufficiently serious excuse the insurers subscribing to the excess policies from liability; or
(3) a term breach of which gives rise to a right to damages only."
The judge's answer was that the obligation to give notice to the excess layer underwriters is an innominate term breach of which, if sufficiently serious, entitles the defendants to reject liability for the relevant claim.
Issue 7: "Without prejudice to the above, whether, on the true construction of the excess policies, the provisions of the excess policies extend to claims in respect of which the claimant seeks an indemnity."
The judge said that no separate answer was required.
Issue 8: "Whether, in the event that clause 5 of the Co-insuring policy is an innominate term and assuming that LMA (or the claimant) has committed a repudiatory breach of clause 5 by failing to notify claims to the defendants in accordance with its provisions
(1) the defendants have a defence to the claims the subject of such repudiatory breach irrespective of whether or not they have accepted such breach; or(2) the defendants have a defence to the claims the subject of such repudiatory breach provided that they have accepted such breach; or
(3) the defendants have a defence to the claims the subject of such repudiatory breach provided that they have accepted such breach and that the losses the subject of such claims occurred after such acceptance"
The judge's answer was that if the respondents have committed a serious breach of clause 5, the appellants are entitled to treat it as equivalent to a failure to comply with a condition precedent and have a defence to the claim without the need for any formal "acceptance" of the breach and regardless of when the claim was made or the loss occurred.
"38. I think Mr. Hancock was right in saying that this letter was addressed to the prospective insurers for the 1994-95 policy year, but I do not think that prevented it from providing adequate notice of the matters to which it refers for the purposes of the current policy to the extent that the same underwriters were involved. What the insurers required was prompt notification of any circumstances that might give rise to a claim. Provided they were given the information required by General Condition 2 in a form that made it clear that they were being notified of circumstances that the insured thought might give rise to a claim, it was immaterial that the information was contained in a letter directed to renewal of cover. Since the prospective insurers at Lloyd's for the ensuing year were the same as for the expiring year, this letter was in my view capable of constituting notice to them of the circumstances described in it.
39. Finally Mr. Hancock submitted that the letter was not a warning that claims might be forthcoming but an assurance that they would not and so did not amount to notification of circumstances that might give rise to a claim. The fact that the letter was addressed to the prospective insurers for the ensuing year inevitably meant that it was directed as much to the risk of claims being made during the period of that policy as to the notification of circumstances that might give rise to claims that would fall under the current policy. The two were directly related. I see no reason, therefore, why the same letter should not be capable of satisfying both objects where the same underwriters are involved. In my view the letter was both notification of circumstances that might give rise to a loss and an assurance that the insured was not aware of any other circumstances that might do so. The underwriters could therefore proceed on the basis that any claims arising out of those circumstances would fall within the expiring policy and could be excluded from the ensuing policy."
"it was, however, bound to fail unless BAI could demonstrate that there was a serious breach of condition 1(a) which had serious consequences and that in reliance on such a breach the claim had been rejected."
In his view the breach of the claims notification clause, condition 1(a), "was very limited in that BAI had sufficient details to enable them to investigate the claim" and that "Furthermore, by that time BAI had at least some details of the claim they had not suffered any irremediable prejudice". Waller LJ was also doubtful whether BAI's conduct could be said to amount to a final rejection of the claim, but, if it did, he said, it was not justified. Any defence which was open to BAI was therefore not available. It follows from these passages that Waller LJ's statements about the possible nature and effect of a claims notification clause were obiter.
"26 I do not myself think that the choice should necessarily lie between a construction which would involve condition 1(a) being a condition precedent, and condition 1(a) simply giving rise to a claim for damages. It seems to me that once a condition such as condition 1(a) is construed as something less than a condition precedent, it will still be important to ascertain precisely what its contractual effect is intended to be and what the effect of a breach of that term will be. For example, if no details of the incident in relation to which RCCL was making its claim were ever supplied, despite the insurers' requests for them, would BAI still be bound to pay, and simply be left with a remedy in damages for breach of the condition? Certainly if the consequences for BAI were that they had been seriously prejudiced, it seems to me unreasonable that that should be so. Accordingly it seems to me one should consider the possibility that a breach of condition 1(a) might in some circumstances be so serious as to give a right to reject the claim albeit it was not repudiatory in the sense of enabling BAI to accept a repudiation of the whole contract. The very fact that condition 1(a) is aimed at imposing obligations in relation to individual claims which BAI might be obliged to pay, ought logically to allow for the possibility of a "repudiatory" breach leading simply to a rejection of a claim.
27. I accept, I should say, that it is possible for the terms of a policy by express language to be clearer than this term as to what its intended effect should be. …."
"32. I see no reason however why condition 1(a) should not be construed as an "innominate" term as per Hongkong Fir Shipping Co Ltd (supra) where the consequences of a breach may be so serious as to entitle BAI to reject the claim albeit the breach is not so serious as to amount to a repudiation of the whole contract. Mr Lynagh submits there is no support in the judgment of Giles J for the proposition that the consequences may be so serious as to give a right to reject the claim. I accept that Giles J took the view that there was a separate contract of reinsurance in relation to the risk the subject matter of that case, and thus did not decide the point. But I do think the inference to be drawn from the passage quoted at 702F - 703A of the judgment of Giles J supports the view that I take. I accept Mr Walker's submission in this regard. It seems to me that the payment of individual claims are severable obligations and that where an insured is bound to carry out one obligation in order to receive the benefit of the insurer's obligation by implication the insured is accepting that if he fails in a serious way to carry out his part of that bargain he will not receive what he has bargained for.
33. Thus the correct analysis of condition 1(a) I would suggest should be as follows. Compliance with condition 1(a) is not by the policy made a condition precedent to liability, thus it is not enough for BAI to establish a failure to supply full details as soon as possible in order to resist the claim. That much is conceded.
34. Condition 1(a) is however an innominate term. Breach of it, however serious, would be unlikely to amount to a repudiation of the whole contract of insurance. Furthermore, it is not a term the breach of which, or any breach of which, would entitle the insured not to pay the claim because that would simply make it a condition precedent. But, in my view, a breach which demonstrated an intention not to continue to make a claim, or which has very serious consequences for BAI, should be such as to entitle BAI to defeat the claim. If a term is a condition precedent to liability, any breach defeats liability but does not lead to a repudiation of the whole contract. I see no reason why although a term is not a condition precedent so that any breach defeats liability, it cannot be construed as a term where a serious breach defeats liability."
"If underwriters had felt that the commercial considerations which Mr Saloman has referred to were so important to them, they could easily have made the making of declarations a condition of the cover."
Applying the reasoning in BAI, HHJ Hallgarten and this court then considered whether the breach was so serious that underwriters were "entitled to avoid liability, not for the whole cover, but for that risk". Both held that it was not. Whether the reasoning in BAI was or is binding or correct was evidently not argued and was not considered or decided.
"In my view Mr. Hancock was right in saying that the principles relating to discharge by breach are not directly applicable to a situation of the kind that arises in this case. As I understand the passages from his judgment quoted earlier, Waller L.J. was drawing on those principles by analogy to explain how the breach of a term such as that contained in clause 1(a) could have different consequences depending on its gravity. I do not understand him to be importing from the law on repudiation the necessity for the insurer to "accept" the breach as terminating his liability to pay, much less the principles governing accrued rights. If, as paragraphs 33 and 34 suggest, a serious breach of clause 1(a) has the same consequences as a failure to comply with a condition precedent, no "acceptance" is necessary; the insurer is simply entitled to reject the claim on that ground. Moreover, there is another reason why I am unable to accept Mr. Weitzman's argument. The submission that in the present case the claimant already had an accrued right to be indemnified by the defendants at the time when they decided to reject the claim for failure to comply with the notification requirements proceeds on the assumption that that right was unconditional. In fact, however, it was conditional on its complying, at least substantially, with the requirements of clause 5. If the claimant failed to comply with clause 5 in a manner that was sufficiently serious to entitle the defendants to reject the claim, its right to be indemnified remained at best conditional until the underwriters elected not to rely on their rights or in some other way lost their right to reject the claim on those grounds. However, neither of those events occurred."
Sir William Aldous:
Lord Justice Waller: