A design firm’s insurance claim that was considered too vague by a federal judge may cost the University of Pittsburgh a chance to recover losses under an architects and engineers general liability policy that insured the designer.

In deciding the case in federal district court in New York City, the judge recently rejected the university’s attempt to force Ballinger Co.’s insurance provider, Lexington Insurance Co., Boston, to cover millions in damages stemming from delays that postponed completion for a year on a building addition on the University of Pittsburgh campus.

The university took over the claim from Ballinger after having worked out a separate settlement with the Philadelphia-based architect and engineer.

Siding with Lexington, federal Judge Katherine Forrest argued that Ballinger’s warning of potential trouble with foundations of the $40-million addition to the university’ Salk Hall lacked the details and specifics to qualify as an official insurance claim.

根据匹兹堡大学的说法，萨克·霍尔（Salk Hall）是乔纳斯·萨克（Jonas Salk）进行与小儿麻痹症疫苗有关的工作的地方。现在，它为药学和牙科医学学校提供了空间。

巴林格（Ballinger）于2012年1月31日向其保险公司（即其索赔政策期限到期的前一天）发送了简短的说明。

“You don’t need perfect knowledge in asserting a claim, but you need a certain requisite level of information and you need a level of candor,” said Kenneth E. Rubinstein, an attorney and insurance expert at PretiFlaherty, a law firm. (Rubinstein and PretiFlaherty have no involvement in the case.)

根据福雷斯特（Forrest）的较早决定，巴林格（Ballinger）对列克星敦（Lexington）的注释由一条线组成，拒绝了大学对部分简易判决的要求。

“匹兹堡大学[H]的高级管理层已告知该项目正在遇到问题，并在早期阶段延迟。”

法官在她的裁决中写道，根据合同，巴林格与列克星敦的保险合同阐明了需要什么信息。

其中包括“实际或涉嫌违反专业职责”，并解释了该公司承担的“专业职责”可能触发了索赔，何时发生诉讼以及对损害的描述。

The “entire description of the Claim is that “this project is experiencing problems and delays in its early stages,” Judge Forrest wrote. “This statement is entirely non-specific – it is merely a placeholder … It could mean just about anything.”

保险索赔报告要求

While noting it is “harsh,” under Pennsylvania law, failure to comply with reporting requirements of a “claims-made” policy is enough to preclude coverage, Judge Forrest wrote.

To have ruled in favor of the University of Pittsburgh - and by extension Ballinger - would have effectively converted the design firm’s insurance policy from claims-based to an occurrence policy, which extends coverage for a problem or issue that arises during the coverage period even if the claim is made later, she ruled.

University officials blamed Ballinger and two of its subcontractors for design issues with the foundation and retaining wall of the 81,000-square-foot lab building. Both had to be redone, delaying the opening of the project by a year to 2014, according to the University Times, a faculty newspaper.

Still, one possible factor in Ballinger’s defense may be the timing of the problems that developed on the project.

The design and engineering firm may not simply have had all the information at its finger tips when it sent that one-line warning to Lexington Insurance on the last day of January, just before its policy expired, Rubinstein noted. The university did not come forth with a specific list of alleged damages until October.

如何ever, there is information that Ballinger could have added that might have made it more likely that its brief note would have qualified as an actual claim, said Rubinstein.

例如，巴林格本可以说：“我们相信匹兹堡大学打算声称我们犯下了渎职行为，”鲁宾斯坦说。

“They had the ability to say, they have the duty to say there was an actual or alleged breach of professional duty,” he added.

如何提出保险索赔

One common concern on part of companies making insurance claim is the fear that by acknowledging a mistake or error, it could hurt the firm’s chances in court, Rubinstein said. But Ballinger could have pointed to potential issues, while also making clear it does not agree or disputes them.

Another issue that may have played a role in the court’s decision denying coverage to the University of Pittsburgh and by extension Ballinger was the lack of responsiveness on part of the company.

After Ballinger sent its one-line warning to Lexington of potential problems with the project it was working on at the University of Pittsburgh, the insurance company had an adjustor contact Ballinger but received no response, Judge Forrest noted.

Legally, any ambiguity in coverage is typically interpreted against the insurance company in favor of the insured. But if you fail to follow the guidelines for filing a claim and given the information the insurance company is seeking, you effectively give the insurance company an out, Rubinstein said.

“The key to dealing with the carriers is that you need to be responsive,” he said.