National Assisted Living Risk Retention Group v. Henry Walton Bishop, III, individually and as Personal Representative of the Estate of Henry Walton Bishop, Jr.; J&S Assisted Living and Consultant LLC; Richard Marshall; and Sabrina Marshall
The First District reversed a judgment holding a claims-made insurer liable for denying coverage, holding that neither the insured's notice call reporting the underlying death and regulatory investigations nor the agencies' requests for proof of insurance constituted a 'claim' as the policy defined it. Because the only demand for damages on behalf of the decedent came in 2014 — long after the 2012 policy expired — no claim was ever made within the policy period, and the insurer owed no coverage or defense. The court also held that improper cancellation would not have changed the result, since the policy expired on its own terms in January 2013.
Key facts
- In July 2012, 87-year-old Henry Walton Bishop, Jr., a court-declared vulnerable adult placed by DCF in J&S Assisted Living's facility, wandered away unsupervised and was struck and killed by a logging truck while crossing a busy intersection.
- J&S's manager Richard Marshall called the insurance agent, Carmona, to report Bishop's death and the ensuing FHP, DCF, and AHCA investigations; at that time no one had threatened suit or sought damages, and the agent told him to call back if a lawsuit or charges followed.
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Holdings
- Under a claims-made policy, notice of an injury or occurrence that may later lead to a claim is legally distinct from a claim; a 'claim' is a suit or demand for monetary damages or services…
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Why it matters
This decision is a clean statement of the notice-versus-claim distinction that decides many claims-made coverage disputes, and it will be cited by carriers defending late-reported long-tail exposures. The practical… — full analysis with a trial
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