Section 8.4 Claim

• Library: Insurance Practice 2015

A claim is typically defined in the policy. Frequently it is defined as a demand for money or services. It is generally an assertion of a legal right.

In Hill v. Physicians & Surgeons Exchange of California, 225 Cal. App. 3d 1 (Cal. Ct. App. 1990), the term “claim” was not defined in the policy. The doctor argued that it was a “claim” when he was asked about complications and the patient stopped seeing him. The court did not agree. The court held that a claim requires that the party ask the insured for some services or to pay a sum of money.

See also Winkler v. Nat’l Union Fire Ins. Co. of Pittsburgh, Pa., 930 F.2d 1364 (9^th Cir. 1991). In Winkler, the directors of the corporation had a claims-made policy with effective dates of April 27, 1981, through April 27, 1984. In September 1983, the directors were informed that the corporation was overdrawn by $3.2 million. When the directors informed the shareholders of the overdraft, the shareholders “announced their...