SOME PRINCIPLES OF LAWYER CONDUCT

Michael Sean Quinn, Ph.D, J.D., Etc.

2630 Exposition Blvd  #115

Austin, Texas 78703

(o) 512-296-2594

(c) 512-656-0503

mquinn@msqlaw.com
(Resumes: www.michaelseanquinn.com)

1.     
Lawyers (“Ls”) may not lead or permit their clients
(“Cs”) to believe that they are substantially more experienced or competent
than they are.[1]  For that matter, L may not let C believe that
he has even a moderate amount of experience or knowledge that he does not have.
Leading a client to believe a false proposition is misrepresentation and may be
fraud.  Permitting a client to believe a
false proposition which is important is inconsistent with loyalty and trustworthiness―as
affirmative causation thereof―and therefore a breach of a lawyer’s fiduciary
duty to his client.

2.     
Ls should never represent or assert any relevant and
significant false propositions to Cs.[2]  This proposition applies to all sorts of
representations, including:

                                          i.           
bills and fees.

                                         
ii.           
the probable results in a case.

                                       
iii.           
the probable worth of a case, including the probable
amount of

recoverable
damages, and

                                       
iv.           
so forth.

The less
justification or evidence L has for making an assertion, the less likely it is
that he should make it, although certainly the more important it is that he be
extremely clear about his epistemic uncertainties, lack of evidence,  presence of hopeful guesswork, and so forth.  

3.     
L should never make, cause to be made, or permit to be made
in his name statements about a client or former client which he knows or
believes to be false or falsifiable.

4.     
L may not represent clients with conflicting interests
without obtaining their informed consent after adequate disclosures and
discussions.  

                                           
i.           
This includes situations in which C1 is
financing all or part of L’s representation of C2.

                                         
ii.           
There are other types of conflict, of course, if L has
a business relationship with C, this may create a special conflict.  It would certainly have to be disclosed to a
judge who was to or who had approved the client-attorney relationship.  It would also have to be disclosed to any
other client involved in the same case.

5.   L should
never falsely represent to C1 that it is prudent and    reasonable to represent C2 when it is
not.  This rule is especially powerful
when L has reason to believe that this may not be a good idea.  It has even more power when L knows such to
be the case.

6.   In
litigation, a lead lawyer must rationally evaluate the value of the case.  This requires evaluating or determining to
some reasonable and appropriate degree (i) the probability of winning, (ii) the
probable size of the judgment, (iii) the probability of collecting if there is
a win, (iv) from whom there can be recovery if there is more than one
defendant, and (v) how much can be collected, both individually and
totally.  Informing C of alternative
reasonable and fact-based, if possible, hypotheses (or, points of view)
regarding these kinds of matters is also required to the extent possible, but
there must be some sort of unequivocal recommendation as to what L reasonably
believes is in the best interests of the client (considered by himself
alone)―given the client’s knowledge, economics, finances, budget, view of the
world, preferences, personal (or entity) orientation, and character,  together with the financial situations of
each of the defendants.[3] Significantly, P-6 is
linked closely to P-2.iii.

7.   The
preceding principle (P-6) applies both to actual persons and to organizations,
such as corporations and limited partnerships, which are legal persons.  It also pertains independently to each client
involved in the same dispute.

8.   If no
P-6 type evaluation is possible, L must inform the client that s/he[4]
does not know the answer and cannot come to know it.  Why this inability is true must be reasonably
explained to C.  Obviously, if the
opposing side is concealing or refusing to produce relevant evidence, this fact
in itself can be an important premise in drawing relevant conclusions.  Often, if the opposing side is concealing
economic information, traces of this activity or diagnostic behavior can be
discerned.

9.   L should
never convince C, try to convince a client, or even suggest to C that a case
should be pursued which L believes cannot be won, is unlikely to be won, or
cannot serve the personal interests of the client.[5]  Exit by a party from given litigation is
almost always an option, as is immediate resolution by some settlement or other
means.  This rule applies with enormous
force to high-cost-to-the-client cases. 
(The rule is less forceful in contingency fee cases where L is bearing
the expenses, although it still applies, for various reasons.)  If C wants to spend—what many would call
“squander”—money on a loser case just to illustrate justice or to seek
retribution or vengeance, L should help C understand exactly what he is doing
and what the consequences of his pursuit will and will not be.  This is one of the duties of L, the wise
adviser.

10. As
enormously important as P-9 is, it is even more important that L refrain from
instituting or continuing litigation because it is in L’s interest, when it is
not in the interest of C.

11. Unnecessary
or irrelevant parties should not be sued by Ls representing Cs that are plaintiffs
or counter-plaintiffs, and if such parties have been sued, they should be
dismissed when their lack of involvement becomes clear.  Contrary conduct by L is inconsistent with
L’s duties to C, as well as his legal and professional duties.

12. And, of
course, all the probably necessary plaintiffs should be included in original
pleadings and/or amended pleadings, if possible.  Here L obligation to include X as a plaintiff
results either from X’s voluntary consent or C’s control rights over X.

13. Usually,
all probably blameworthy, responsible, and/or liable parties should be included
as parties by L representing a plaintiff. (There are exceptions, of course).

14. In
litigation, L should proceed upon all appropriate legal theories, avoid all
inappropriate ones, seek all legally appropriate and needed remedies, and avoid
seeking illegitimate or legally unjustifiable remedies.  Here are some examples.

 i.   If recovery
hinges on negligence, it is inappropriate to sue for fraud.

       

ii.     
If recovery hinges on the unlawful diversion and hence
deprivation of corporate asserts, then an action should proceed on that basis.

iii.   
A P-14.ii type action should not be pursued on the
basis of stockholder recovery.  Corporate
assets do not themselves belong to the individual stockholder, who has no
standing to recover them.

iv.   
The same point is true with respect to corporate
opportunities.  They belong to the
corporation, not the shareholders.[6]

v.     
If there are preemptive rights, clients should be
advised about them, and violations of them should be pursued in a timely
manner.

vi.   
If a receiver is needed in an action involving
corporate assets and governance, a receiver should be sought.

15. L may not
charge C unreasonable fees.  Stated fees,
at least for plaintiffs, can be unreasonable because they are unnecessary,
because they are false, because they result from overstaffing, or because they
are substantially out of kilter with the value of a case, the experience and
level of ability of the lawyer (which has been disclosed), the degree of
complexity of the case, the difficulty of the tasks performed at C’s direction
or with C’s antecedent consent, and/or the perceived value of a case.

16. Bills
must be informative and understandable. 
The same point applies to reports designed for clients.

17. P-15
applies to both amounts and structures. 
Thus, if L’s fees must be approved by a judge, L may not charge C in
ways inconsistent with that obligation. 
This duty runs to the bench, the bar, and the client.  See P-20.

18. L may
not factor accounts receivable from clients. 
If L is falsely accused of this by C, L has a duty to C to immediately
deny the “charge” and to try to convince C that his charge is false.

19. L. must
himself or see to it that all legal fees are reasonably explained to every
client who is paying any of those particular fees, absent an explicit,
explained, and informed agreement to the contrary.  (This has not always been true, but it has
been true for a long time).

20. If court
approval is ordered for legal fees, it must be obtained, before the C is
charged.  A violation of this rule leads
to the charging of unapproved fees and that is inconsistent with―for
example―utmost loyalty, fidelity, and good faith.

21. L must
always act reasonably in the rendition of legal services.  Unreasonable and causally significant conduct
(or the unreasonable absence thereof) is shameful to the lawyer who has engaged
in those acts or omissions and to be condemned by all rational observers.[7]  Unreasonable conduct is often generated by unreasonable
beliefs, inattention, overwork, laziness, negative emotions, greed, the need
for more money, and/or prideful narcissism.

22. Reports to clients, including estimates of
recoverable damages, are a form of legal services and so are included within P15
and governed thereby. See P-16.

23. If L
fails to evaluate accurately the potential for recovery and/or actual monetary
loss in a given case, L has very probably been unreasonable in conducting that
case.  All such evaluations must be
communicated clearly, comprehensively, with reasoning to C.

24. Usually,
agreements between opposing counsel should be documented, often by jointly
signed agreed instruments.

25. In
conducting a lawsuit, L must perform (or cause to be performed) adequate
research and must think both clearly and comprehensively—as well as
skeptically, and hence with appropriate and acknowledged uncertainty―about the
course and meaning of the law.  See P-14.

i.       
One on the functions of an associate-level lawyer (La)
is to perform such research and at least begin the process of thinking legal
problems through.

ii.   La is also
expected to know or find out applicable rules of procedure, and the simpler or
more elementary the rule, the truer P-23.ii is.

iii.  Of course,
partner-level lawyers are expected and required to supervise as well as train
associate level associates.

26. If L1 uses
L2 to assist him in litigation, L2 must not only be capable of    reasonable performance under the
circumstances of the case, L1 needs to bring L2 up to speed. The mistakes of L2
are those of L2 and L1. 

27. If La
or L2 come to realize that L1 is mistreating C,
treating C inappropriately (given applicable rules of professional conduct),
treating C illegally, or violating his fiduciary duties to C, La and/or
L1 must notify C.  Given the
fiduciary duties of La and L2 to C, they would even be
required to notify C of L1’s malpractice regarding C.

28. L is
expected to turn over all components of C’s file to C upon C’s request.  L may keep copies, of course, but at L’s
expense (at least if the request occurs at the end of the client-attorney
relationship).  L may never resist or
refuse turning C’s file materials over to C when L has or has access to the
materials.  The mere fact that the papers
in question are poorly done or condemn L does not justify L’s refusal.  (There are exceptions to this rule of course:
hurricanes, tornados, floods, 9/11 type acts of terrorism, and so forth).

29. What L1
considers his file is actually the property of C.  C has an absolute right to the entirety of
this file.  If L2 later
representing C requests the file on behalf of C, L1 must promptly
turn the whole of it over to L2. Of course, these are not all the
principles available for judging and/or evaluating lawyer conduct.  There may even be others relevant to this
case.  However, given what I do and do
not yet know, the above is enough for now.

[1]
See this began as my contribution of a note book for a CLE presentation.

[2]
Indeed, Ls should never lie to Cs about anything.  See Michael Sean
Quinn, The Eleven
Commandments of Professional Responsibility, in THE ETHICS COURSE 54-102 (6th
Ed. 2004).  This textbook was edited
mostly by Beryl Crowley and Mitchel L. Winick and published by The Texas Center
for Legal Ethics and Professionalism.  It
is still distributed (I think) by CD to a course required by the Supreme Court
for new Texas
lawyers.  This is Quinn’s Commandment Two
formulated somewhat narrowly.  It is not
only a principle of professional responsibility; it is also a fiduciary
duty.  (There is also an hour long
lecture on Commandment Two available on the website of the Center. It is part
of a series of 11 or so separate videotaped lectures, given by me, prepared by the
Center, and concerning the 11 different commandments.) Various versions of “The Eleven Commandments” can be found on this blog, on the internet and elsewhere.

[3]
Often, insurance is integral to this last point.  The type of insurance is also relevant.  Thus, cases which should be settled must be
settled more quickly if a malpractice policy is central, since they have
declining limits.

[4]
Henceforth, I shall simply use the pronoun “he,” with the understanding that
its use here is gender neutral.

[5]
Obviously, the idea of personal interest includes
the idea of financial interests, although many other matters are usually also
important.

[6] Of
course, a shareholder derivative action is a different matter, but that is
really a suit on behalf of the corporation.

[7]
See Id. at
141-79.  This principle is one way to
formulate the tort of legal malpractice.             

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Expert Witnesses & Peer Reviews

A Peer Review Problem

Michael Sean Quinn, Ph.D, J.D., Etc.

2630 Exposition Blvd  #115

Austin, Texas 78703

(o) 512-296-2594

(c) 512-656-0503

mquinn@msqlaw.com

Expert witnesses in all sorts of areas, including insurance, as often asks in the opening qualification section whether they have published anything relevant.  If the answer is “Yes,” they are often asked whether any of their work has been “peer reviewed.” I know about this gambit–indeed, I am an expert on this sort of deposition, since I have given a lot of them and taken more than a few.  

The origin of the question is the Daubert case (generally pronounced “Doe-bear,” with the accent on the second syllable) case.  The Supreme Court of the United States case establishing tests for qualifications for a”candidate” for qualified scientific expert witness.  One of the tests was whether the relevant publications of the proposed expert had been “peer reviewed,” i.e., reviewed by anonymous already qualified scientists.  That case was replaced by Kumho Tire, and the centrality of peer review dropped out to some degree, but not quite out. 

Most active judges had already realized that peer review did not exist for many types of proposed experts, such as experts on insurance and insurance bad faith.  Not even law reviews have what is technically known as “peer review,” although some peers might review a proposed writing. 

When I am asked THE question I always answer by saying one of two things. Here

 is

 Answer Strategy #(1)

(1) “What do you mean by “peer review?”

Some lawyers say, 

“What do you think it means? [Often they also say, “This is my deposition so I’ll ask the questions, to which I say something, “Not really. It’s actually mine.”]

My response is expansive: 

“It is a form of editorial review, sort of, used mainly in scientific and mathematical journals (and social science journals, sometime), and much less elsewhere, if at all, in which anonymous groups of similar scientists or mathematicians is are asked to review a submission and evaluate its ‘publish-ability.'”  (I have never seen it used in judging publications on, for example XYZ performance or behavior.)” 

Some lawyers ask, 

“Well, has any of your stuff been “peer reviewed”?

My answer is entirely predictable: 

“Since I have not published scientific, engineering or mathematical papers, the answer is ‘No,’ though many of my peers have read much of my stuff, sometimes at my request before I submit it for publication.  For example, when I publish something in the INSURANCE LITIGATION REPORTER the editor, John di Mugno, a leading authority on insurance law, reads the drafts and comments on them.”

Usually it stops there. 

Answer Strategy #(2)

Here’s the second way of answering. It’s quicker but not quite as good. 

L: “Has any of your stuff been peer reviewed”?

A: “In the technical sense of that term, the one used in Daubert, the answer, of course, is negative, since no one who writes on my kind of stuff is.”

One would expect an objection on the grounds that the question is nonresponsive because of saying too much.  This has never happened to me.  If it did, I’m ready, I revert back to Strategy #(1).

The point of this blog is slightly different, however. I have a a new idea for a Strategy #(3) that can be added into the other two, at least for[of maybe I should be saying, “if only for” amusement.

On Friday July 11, 2014, NYT carries a story on A3 about a scientist who had published 60 or so papers all involving fraudulent experiments and fraudulent peer reviews–conspirators, false mailboxes and more. An on the same day there was an editorial written by a scientist-&-journal-editor, in effect, that there’s more of this sort of thing than one might think. Id at A21.

So, now we get to the addition.

“Besides given what is being reported about fraud in the area of “peer reviews,” I wonder how reliable they are these days.” 

A Bonus, Though Not a Bone to Be Picked

One thing I have never seen is for counsel taking the deposition to go after the peer review files. There is two ways to do this, at least.  One is to seek it from the journal.  This could be done through a simple request, or it could be done by means of a deposition on written questions.  E-discovery or other fancy stuff will not be necessary since the lawyer will be looking only for the copies regarding the witness. There will be resistance from the journal and from the “peer,” since confidentiality has been promised. The other is to seek them, from the witness.  The chances are s/he won’t have any, or will have bits and pieces only.  Even he s/he does, there will be resistance.  

Another & Different Bonus: You Lucky Readers

There is another usage of the phrase “peer review.”  This is to be found in areas of engineering and related disciplines. It is not academic.  It is designed to see to it that the author(s) of a design or a person in change of an activity is doing it well. This could be putting something together, e.g., a jet engine, building something, like a series of networks for an intranet system, or a whole slew of other activities.  It could be an test at a pharmaceutical company or the tuning of one hell of a a piano   This entire idea could be called “a work performance review by one or more peers.”

Of course, there could be expert testimony about the performance of the peers doing the reviews in this sort of case. It is easy to image exactly this happen, e.g., if a big building of complex design tipped over. Indeed, at least in theory, this could happen in the academic case, as well, but it probably hasn’t and probably never will. 

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LEADING QUESTIONS: WORKABILITY AND VALUE–SEVERAL EXAMPLES FOR LEGAL MALPRACTICE CASES

SOME POSSIBLE DEPOSITION QUESTIONS FOR
LAWYER MALPRACTICE CASES

Michael Sean Quinn*

I am a fan of  the use of leading questions, even in
depositions.

Some of the questions are treated
herein as declarative sentences.

That is designed to indicate that a
lot can be done by tone and facial expression.

You
did not do the best that a reasonable lawyer would do in this kind of case?

You don’t
care what the answer is.  If L says No, the next question is, “Tell me
how?”  If the answer is Yes, stop.

         

You
did not do the best you could?

If L says No, ask, “What did you not do?  What did you do poorly?  What did you not do that you should have?”  But, if L says Yes,  let it go.

You
didn’t do all of what a reasonable lawyer in the same or similar case would do,
did you?

If No, ask, “What all did you leave out?  List for me what you did not do which you
think you should done.”  If Yes, leave it.

Your
investigation of the case was not up to snuff, was it?

If Yes, stop.  If No,
ask, “What all did you not do, that you think you should have?  What all did you not do, that you think a
reasonable lawyer would have done?”

C
did not tell you this or that, did she? And so on.

Your
claims file does not report this.  It
does not report that.

          If
Yes, the demand is “Show me”.

         
If No, move to a series of
open questions.

You
believe that C does not lie, don’t you?

If the answer
is Yes, stop.  If the answer is I Do Not, ask for a complete list.

For each
entry on the list, ask, “You don’t really know that, do you?” 

          If
L says I do, then ask “How?”  Ask again for more details about the            

         
basis.

You
believe that C tells the truth, don’t you?

If Yes, stop.  If No,
ask for a list—a compete list.  Ask
about the empirical basis.

That’s
not in your file, is it?

          If
Yes, it’s “Show me.” 

You
leave important stuff out of your file, true?

          If
No, give a list, maybe.

          If
Yes, there a variety of things to
do, and maybe several can be done.

You
know that all attorneys owe every one of its client’s fiduciary duties, true?       

If No, stop.  If Yes,
ask for a definition.

You
did not discharge all of your fiduciary duties to C, did you?

          If
No, stop.  If Yes,
think about stopping.

If
L asks for a definition– “So you don’t know the meaning of the word, do you?”

You don’t
care what the answer is.  It’s clear that
a Yes answer is a wonderful answer.  You may want to stop.  If it’s No,
ask for a list, and then pursue the empirical foundations of the list.

You
did not advise your client in a satisfactory way, true?

If
C says you didn’t advise her as to X, she is lying, true? 

X
was an important issue in the case wasn’t it?

You
didn’t discuss X with her at all, did you?

Again you
don’t care much what the answer is:  (1) YES, I DID. (2) GRANTED I DID NOT. (3) I
DON’T REMEMBER, CHECK MY FILE. (4) I DON’T REMEMBER. ONE REASON IS THAT I DON’T
REALLY KEEP THAT SORT OF THING IN MY CLIENT FILE. (5) WHAT DO YOU MEAN BY
‘ADVISE’?

        

The next set
of questions are sometimes a bit over done. 
Nevertheless, you still often do not care what the answer is.  If who get what the witness takes to be a
base hit for him, (1) always consider asking “How?”  (2) Also consider specifying some act ina
general way—as a hypo if necessary—and then use a leading question to ask, “Is
it not true that failing to do X is below the standard of care?  Or, “Is it not true that doing X is below the
standard of care?

You
did not take the deposition of Quinn, true?

No
one did, true or false?

He
was the expert for the opposite client, true?

You’ve
said in you interrogatories that you thought you could get

him disqualified, true?

Did
you try?

You
did not succeed, did you?

Your
Motion on this matter was not up to snuff was it?

Even
the judge said that, correct? 

You
did not even spell his name correctly did you?

His
last name is not “Quine, true?”

His
middle name is not “Scum,” right?

His
first name is not “Moncoile,” don’t you agree?

You
can spell the English language, isn’t that right?

You
had received Quinn’s report, had you not?

You
are not an “idiot” are you?

You
have a degree from the University of Phoenix, do you not?

And a law degree from the American University of the
Canary Islands, don’t you?

[And
so on and so forth?]

You
would agree, surely that the DRs [Texas Disciplinary Rules] are part of a
manual for competent lawyer   work.

You
would agree that the DR,s are fundamental principles of lawyering morality,
true?

Do
you agree that following the DRs is consistent in every way with providing a
client with a vigorous.

Do
you reject the idea that following the DRs cannot in and of itself constitute
legal malpractice?

You
would also agree that the Texas Lawyers Creed is also a set of guidelines or
acceptable practice, wouldn’t you.

And
the same is true for the ABA Model Rules isn’t is.

         

And so on.

The End.

                  

Michael Sean Quinn, Ph.D, J.D., Etc.

Quinn & Quinn

2630 Exposition Blvd  #115

Austin, Texas 78703

(o) 512-296-2594

(c) 512-656-0503

mquinn@msqlaw.com

(Resumes: www.michaelseanquinn.com)

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INSURANCE: GOOD FAITH AND FAIR DEALING–PHILOSOPHICAL FOUNDATIONS

Michael Sean Quinn, Ph.D, J.D., Etc.

2112 Hartford Rd

Austin, Texas 78703

(O & C) 512-656-0503

mquinn@msqlaw.com

SOME PHILOSOPHICAL FOUNDATONS

An insurer and an insured are parties to a contract, usually
called an insurance policy. Each of them has rights, and each of them have
duties.

If the insurer breaches the contract of insurance by denying
coverage erroneously, then the insured has a suit, and it can win.   Sometimes this is just an action for breach
of the contract, in some situations the insured may have more than just a
breach of contract case.

 

Many jurisdictions have a type of law suit named “negligent
breach of contract”; others do not.  Many
jurisdictions have an action especially for insureds against insurers called
“insurer bad faith.” I am going to talk about bad faith.

INSURANCE BAD FAITH LAW
ACTIONS

 These suits may be
based on the common law, namely, rules created by courts which are often a part
of legal tradition, or they may be based on statutes, viz. laws passed by
legislatures designed to keep insurers on the “straight and narrow.”  Common law actions are more attractive to
some lawyers in some ways than actions based upon statutes.  

The reader should remember that, almost always, insurance bad
faith actions (IBFs) hinge on the existence of a breach of contract in the
determination of coverage and the payment of a claim. No breach, no IBF case.

GENERAL CONCEPT

Now, given the full nickname, “Insurer Violation of Its Duty
of Good Faith and Fair Dealing,” the ideas of good faith and fair
dealing are central, and that is the topic here.  Some of what I say is established truth; some
of it is conjecture; and some of it has its main value in giving lawyers a few
thoughts about how to think when controlling this kind of law suit.

When the law uses two terms or phrases conjoined to each
other, they should be thought of as having at least slightly different meaning.  As a habitual matter, this principle is not
always observed, but it can be used as a way to think and as a way to construct
new ideas.

When that principle is applied to “good faith” and “fair
dealing,” one must begin with the proposition that they have different
meanings, convey different ideas, and can be used in different ways. Thus, what
I shall say here is based on this kind of conceptual separation.

GOOD FAITH

This idea is as old as contract law itself, although it does
not always pop up under that name, and it has a lot of different dimensions.

 Fraud is not thought
of as a breach of the duty of good faith and fair dealing found in contracts,
though it is indicative of a lack of good faith. All swindlers act in bad
faith.  The reason is the theory of
recovery for fraud—the remedy—isn’t usually the enforcement of the contract and
then some. Fraud destroys the very existence of the contract, or prevents it
from ever really existing, and then justifies awarding the defrauded person
appropriate damages, often including punitive or exemplary damages.

A “bad faith” breach of contract involves a breach of
contract of a particular kind, as specified under the applicable law.  This may include doing something to prevent
the other party from performing its obligations under the contract.  It might involve getting a third person to
accomplish this goal. 

In the case of a contract of insurance, it might be trying to
get the insured to give up on its claim because the insurer is being so
obstructionist, dragging its feet for so long, discouraging the insured,
keeping the insured in the dark about the adjustment/settlement process, making
life miserable so that the party to the insurance contract will go away or
settle for less.

This list goes on and on. All of them are examples of a lack
of good faith, or a repudiation of good faith, or something of that ilk. 

An insurer’s setting out to screw the insured in the
settlement process is a paradigm of insurer bad faith. People and companies
have insurance because they will need money in case of a loss.  They are entitled to it. They may need the
money quickly, or relatively quickly, and that can be to the insurer’s
advantage from the point of view of its own self interest, i.e., which is
profit margin.  It must not do any such
thing, ever.  This is exactly the kind of
screw job I’m talking about.

Most insurance companies know this, uniformly usually agree
with what I have just said, and mostly believe they are bound by several
factors to avoid what I have described. 
Among their reasons are these:

·      
Doing
otherwise would violate the purpose of insurance,

·      
It
would be contrary to the spirit of the enterprise,

·     It
would betray the role of insurance as being one of the foundations   of modern
economies,

·      
And
therefore modern civilization,

·      
It
would be dishonest,

·      
It
would be dishonorable,

·      
and
more.

Of course, there are rogue adjusters and rogue claims
managers, and rogues of all sorts when the going for the insurer get tough. (Of
course, this should not happen given the existence and availability of
reinsurance.)

Another set of problems arises from the nature of claims. If
an insured wants more than an amount to which he is entitled, he may fudge the
claim.  The spirit of the insured may be overly
aggressive as to his-her-its entitled amount, and it gets more aggressive, to
the extent he believes that the insurer is trying to avoid payment. 

In addition, of course, there is out-and-out fraud. 

The problem for insurance companies is to suspect that an
inflexible policy holder is being just contrary to the contract, and then tries
and cut it off by blocking recovery or reducing its size.

This can happen even when the insurer is not sure that it is
facing fraud and doesn’t have the evidence to prove its view, even to itself.
The temptation to cut a possible fraudster off “at the pass” can be very
intense, claims executives tend not to be forgiving of their subordinates
missing instances of it.

The idea of good faith is to prevent this sort of
behavior.  One of the key ways it does
this is to say that INSURERS MUST
TREAT THE INTERESTS OF THEIR INSUREDS AT A LEVEL AT LEAST EQUAL TO THEIR OWN.  This is an essence of good faith when it
comes to insurers considered as parties to contracts of insurance.

This is a very dramatic rule. 
It entails that insurer cannot do things ordinary merchants and ordinary
parties to contracts are permitted to do. 
There are sharp limitations on an insurer’s rights as a creature of
commerce.  That results from the kind of “product”
it is selling. At the same time the rule does not make insurers fiduciaries of
insureds.

FAIR DEALING

The idea of a duty of fair dealing is different from the idea
of good faith, though they overlap to some degree. Part of the idea of fair
dealing is that an insurer must treat like cases alike.

          You start from
the idea that some forms of conduct are forbidden completely.  There are some acts and omissions that an
insurer is prohibited from performing in connection with any of its
insureds.  These are criminal conduct,
conduct prohibited by statutes other than criminal codes, e.g., insurance
codes, and those acts which are ruled out by the duty of good faith.

On top of that, an insurer may not treat one insured
different than it treats another.  It may
not treat one insured the way it treat lots of others similarly situated. And
so forth.  This is the very meaning of “fair”
and the very nature of fairness. (Or one of them, anyway.)

AN OVERLAP

In addition, the idea of fairness has another implication. If
insurers are required to treat the interests of their insureds as at least
equal to their own, fairness requires that they view themselves as on the same
level as their insureds, although their roles in the process are in some sense
opposite.  Thus, it becomes unfair for an
insurer to favor itself.  Through this
rule the playing field is thereby leveled. 
No other mass commercial relationship is anything like this.

I sometimes wonder if the “Look for coverage” axiom isn’t actually an axiom, in the sense that it so fundamental that it is not derivative from some other principle–presumably a “real” axiom.  The reasoning for this may be too simplistic.  

If an insurer needed coverage for itself, wouldn’t it insist that its carrier look and see if there were injuries or damages it missed when it reported the claim? If so, then if that insurer must treat the interests of its insured as at least as significant to it as its own, it must look for coverage for its insured. 

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Insurance: A Foundation for Modernity in Civilization

Michael Sean Quinn, Ph.D, J.D., Etc.2630 Exposition Blvd  #115Austin, Texas 78703(o) 512-296-2594mquinn@msqlaw.com (Resumes Found Here.)

Insurance, as we know it, is a key to the financial stability and commercial realm, as well as to personal lives, in the contemporary world.  In fact this is true for the entirety of truly modern civilization.  

What follows is virtually the first paragraph of a history of reinsurance.  This part of the book is written by a now deceased famous historian Harold Jame  
 INSURANCE-the pooling of risk, with reinsurance providing a
further extent of pooling-helps us to lead more predictable lives.  Such enhanced predictability is an essential
element in allowing the establishment of ever more complex social and financial
interactions, involving more people, across longer distances, and with new and
innovative and inherently unforeseeable technologies.  On this basis, the modern world, and the
modern view of the world, has been built. 
One of the reasons that pre-modern farmers and artisans- and those
living today in poor countries-are vulnerable is that they cannot insure
themselves against disasters such as harvest failures which posed and continue
to pose a threat to their means of existence. 
Experimental psychology has produced an increasing amount of evidence
that shows that very poor people under tight resource constraints make poorer
quality decisions, and that momentary poverty depresses measured intelligence
levels.  Well-being and an increased
ability to make rational choices are closely connected with each other, and
with a sense of preparedness and of certainty about the future. The instinct to
insure is linked to and derived from the instinct to organize and to evolve
more and more complex and interlinked structures of mutual support. 

Harold James, Ed., “Introduction: The Insuring Instinct,” THE VALUE OF RISK: Swiss Re and the History of Reinsurance (2013), p. 1, paragraph 1. 

I’m not sure that even I have ever appreciated the  striking, star role insurance has played creating and sustaining the world as we know it.  Of course, this will include the cyber world. 

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Quinn Quotes

Asserting a proposition one believes in a certain situation and asserting its opposition in a substantively different situation, is not necessarily inconsistent. Neither one, taken alone or together, entails advocacy.~Michael Sean Quinn, PhD, JD, CPCU, Etc.Tweet

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Michael Sean Quinn, PhD, JD, CPCU, Etc*., is available as an expert witness in insurance disputes and other litigation matters. Contact