Have you read your health and life policy to see if your activities are excluded. This travel insurance policy excluded mountaineering and skiing

First this case defines mountaineering, legally! The court carefully picked its way through the language of the policy to keep the injured plaintiff in the lawsuit a little longer. That probably means the insurance company settled the case rather than spend more money fighting, but that is only speculation.

Redmond v. Sirius International Insurance Corporation, 2014 U.S. Dist. LEXIS 5089

Date of the Decision: January 15, 2014

Plaintiff: Ryan M. Redmond

Defendant: Sirius International Insurance Corporation

Plaintiff Claims: breach of contract and insurance bad faith

Defendant Defenses: the contract

Holding: Cross motions for summary judgment denied, case headed for trial

The plaintiff in this case when ski mountaineering in Grand Teton National Park. Half way up Ellingwood Couloir, the plaintiff and a friend stopped climbing and started to ski down. Two other friends proceeded up the couloir. The plaintiff fell, tumbling down the mountain. He was eventually airlifted from the park.

The plaintiff had purchased a travel policy. The insurance company that issued the travel policy, relying upon the exclusions in the policy, denied coverage for the plaintiff’s injuries. The plaintiff and the defendant insurance company filed motions for summary judgment covering multiple issues, including a dismissal of the case due to the policy exclusions.

Summary of the case

The policy exclusions stated:

All charges, costs, expenses and/or claims (collectively “Charges”) incurred by the Insured Person and directly or indirectly relating to or arising from or in connection with any of the following acts …:

* * *

(11) Charges incurred for any surgery, Treatment or supplies relating to, arising from or in connection with, for, or as a result of:

* * *

(d) any Injury or Illness sustained while taking part in mountaineering activities where specialized climbing equipment, ropes or guides are normally or reasonably should have been used, Amateur Athletics, Professional Athletics, aviation (except when traveling solely as a passenger in a commercial aircraft), hang gliding and parachuting, snow skiing except for recreational downhill and/or cross country snow skiing (no cover provided whilst skiing in violation of applicable laws, rules or regulations; away from prepared and marked in-bound territories; and/or against the advice of the local ski school or local authoritative body), racing of any kind including by horse, motor vehicle (of any type) or motorcycle, spelunking, and subaqua pursuits involving underwater breathing apparatus (except as otherwise expressly set forth in Section Q. Recreational Underwater Activities). Practice or training in preparation for any excluded activity which results in injury will be considered as activity while taking part in such activity; and/or

(e) any Illness or Injury sustained while participating in any sporting, recreational or ad-venture activity where such activity is undertaken against the advice or direction of any local authority or any qualified instructor or contrary to the rules, recommendations and procedures of a recognized governing body for the sport or activity….

Basically the policy attempted to exclude recreational activities except skiing at a ski area.

The court first looked at the requirements for either party to win a motion for summary judgment. Similar in most courts in most cases.

“The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” A material fact is one that might affect the outcome of the case, and a nonmoving party’s dispute is “genuine” only if a reasonable finder of fact could find in the nonmoving party’s favor at trial. The court views the facts in the light most favorable to the non-moving party, and likewise it draws all inferences in the non-movant’s favor. The court may not weigh the evidence or make credibility determinations. Thus, the nonmoving party will defeat a motion for summary judgment if it is able to produce admissible evidence that, when viewed in the most favorable light, would be sufficient to enable the finder of fact to return a verdict in its favor.

The court then looked at the requirements on interpreting an insurance policy. Insurance policies are contracts and must meet all contract requirements. Insurance policies in many states also have to meet specific requirements and have different ways of interpreting some specific insurance issues. In Wisconsin policies are interpreted as a contract first.

“An insurance policy is a contract, and as such is subject to the same rules of construction as other contracts.” Because contract interpretation is primarily a question of law, it is a matter that is generally well-suited for summary judgment. “When interpreting an insurance contract courts must look at the contract as a whole.” In construing an insurance contract, the court should do “so as not to render any words, phrases, or terms ineffective or meaningless.” Terms should be given their plain and ordinary meaning. In determining the “plain and ordinary meaning” of a term, courts will frequently turn to dictionaries.

However, if a provision of an insurance contract is ambiguous, it is to be construed strictly against the insurer. An insurance contract is not ambiguous simply because parties each have their own interpretation of a provision. Rather, “[a]n insurance contract is ambiguous when it is susceptible to more than one interpretation and reasonably intelligent persons would honestly differ as to its meaning.”

Construction against the author of a contract is a common occurrence in the law. The party that drafts the contract is the party that loses if the court is faced with a situation where the exact intention of the language is not clear. Instead of tossing a coin, the writer of the contract loses.

The court looked at the exclusion language above to determine if the activity of climbing up a couloir and skiing down is mountain climbing.

First the court determined that mountaineering did not encompass the action of skiing down the mountain. When in doubt in defining words courts use dictionaries.

The Oxford English Dictionary defines “mountaineering” as, “The action or sport of climbing mountains.” Oxford English Dictionary, (January 15, 2014), http://www.oed.com/view/Entry/239554.

Merriam-Webster similarly defines it as “the sport or technique of scaling mountains.” Merriam-Webster, (January 15, 2014), http://www.merriam-webster.com/dictionary/mountaineering.

The definition within the American Heritage Dictionary states, “The climbing of mountains, especially using special equipment and techniques on rock, ice, or snow.

Also called mountain climbing.” American Heritage Dictionary, (January 15, 2014), http://www.ahdictionary.com/word/search.html?q=mountaineering.

The definitions all defined mountaineering as climbing and climbing means going up. However, the court also found that:

Thus, if “mountaineering” is defined by reference to “climbing” and climbing can denote either ascent or descent, then necessarily, “mountaineering” must include both ascent and descent. The court finds this understanding of mountaineering to be the only logical definition. After all, in the context of mountaineering, the proverb “What goes up, must come down,” is generally literally true.

The next issue then if skiing down was not mountaineering and excluded, was the issue, whether the activity which injured the plaintiff violated the ski terms of the policy. The court then had to consider if skiing in a couloir in a national park is skiing out of bounds. The defendant argued that ski mountaineering was encompassed by the term mountaineering. However, the court did not agree. “The court also rejects the defendant’s contention that the mountaineering exclusion encompasses “ski mountaineering,” which the defendant characterizes as a subset of mountaineering.”

The plaintiff argued that ski mountaineering required the use of ropes and other specialized equipment. The court found that the term mountaineering did not encompass ski mountaineering.

Thank heavens for us; the court did not accept either of these definitions.

The next issue was whether or not the acts of the plaintiff fell within the exclusions in the policy concerning skiing. The court reviewed the policy and the skiing exclusion and defined the exclusion this way.

This provision, moving back and forth between coverage and exclusions, is far from a model of clarity. It first excludes coverage for injuries sustained while snow skiing but then immediately excludes from the exclusion (and thus covers) injuries sustained while “recreational downhill and/or cross country snow skiing,” and then adds a parenthetical to now exclude from the exclusion to the exclusion (and thus deny coverage for) injuries sustained while “skiing in violation of applicable laws, rules or regulations; away from prepared and marked in-bound territories; and/or against the advice of the local ski school or local authoritative body.” The net effect of this provision is that injuries sustained as a result of recreational snow skiing are covered provided the skiing was not unlawful, against the advice of certain entities, or “away from prepared and marked in-bound territories.”

(You always wondered what someone learns in law school. You learn to read policy exclusions and then interpret them as explained above. The court found the language in the policy: “This provision, moving back and forth between coverage and exclusions, is far from a model of clarity.”)

The plaintiff argued that he was skiing in an area allowed by the insurance policy because anywhere within Grand Teton National Park was allowed to be skied, and he did not leave the park boundary. Inbounds meaning in the National Park. The court then looked at other aspects of the policy to determine what was meant.

“Recreational” is not ambiguous. It is readily understood as, “An activity or pastime which is pursued for the pleasure or interest it provides.” Oxford English Dictionary, (January 15, 2014), http://www.oed.com/view/Entry/159954.

There is no evidence that Redmond was skiing for any purpose other than the pure pleasure or interest the sport provides, and thus the court concludes that Redmond’s skiing on the day of his injury was recreational.

Thus, competitive or commercial skiing likely would not be covered under the policy.

The net effect of the review was the court could not determine if the actions of the plaintiff were excluded by the policy. The definitions the court used and defined in making this determination do have value.

…Redmond [plaintiff] was skiing away from prepared and marked in-bound territories, this plainly encompasses more than simply skiing in an area where skiing is not barred. Thus, having concluded that “away from” means roughly “outside of,” restating this exclusion as a positive question, the issue before the court becomes, “Was Redmond skiing in a prepared and marked in-bound territory when he was injured?” Only if he was would the policy possibly afford coverage for his injures.

The court then looking at the overview of skiing could not determine what the terms in the skiing exclusion meant.

The court presumes that if a ski area is bordered on the sides by signs and ropes demarcating the boundaries of the permissible skiing area, it is likely “marked” within the scope of the policy. But is this the only kind of identification that will render an area “marked?” What if the area is depicted on a map that includes boundary lines indicating the recommended areas for skiing? If markings on a map are sufficient, who must prepare such a map to render the area marked? Must the map be prepared by the entity in charge of the area, e.g. the National Park Service, or would a map prepared by a person with special knowledge of the area suffice? Or must the markings even relate to the in-bound territories? Would a sign in the vicinity of the mountain stating “Ski at your own risk,” suffice as a marking? Perhaps there are many other plausible understandings of this term.

The court finally determined that the terms “prepared” and “marked” were not defined adequately in the policy. Therefore, the policy was ambiguous. The court could not grant the defendant’s motion for summary judgment. That issue was left for a jury to decide.

The case went on for multiple pages discussing all the motions filed by each side. This issue was the only one of importance.

So Now What?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) created this exclusion in health insurance policies. The exclusion is legal, but up to an insurance company to enact and place its policies. Several attempts have been made since HIPAA was enacted to correct this issue; however, all have died in committee.

Simply put the court worked hard to determine a way the plaintiff would have insurance.  The simple term “ski area,” added to the definition of skiing would have made the purpose of the lawsuit irrelevant. Obviously, the ski area description was solely for skiing inbounds not in a park.

If you enjoy recreating in the outdoors, make sure that you have the insurance coverage you believe you are paying for. Read your policy or find someone who can read it for you. An insurance policy is more than something to read when you can’t get to sleep at night.

What do you think? Leave a comment.

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Redmond v. Sirius International Insurance Corporation, 2014 U.S. Dist. LEXIS 5089

Redmond v. Sirius International Insurance Corporation, 2014 U.S. Dist. LEXIS 5089

Ryan M. Redmond, Plaintiff, v. Sirius International Insurance Corporation, Defendant.

Case No. 12-CV-587

UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF WISCONSIN

2014 U.S. Dist. LEXIS 5089

January 15, 2014, Decided

January 15, 2014, Filed

PRIOR HISTORY: Redmond v. Sirius Int’l Ins. Corp., 2012 U.S. Dist. LEXIS 110594 (E.D. Wis., Aug. 7, 2012)

CORE TERMS: skiing, bad faith claim, coverage, mountaineering, summary judgment, marked, choice of law, ski, territory, in-bound, mountain, insurer, dictionary, insurance contracts, insurance policies, recreational, insured, climbing, ambiguous, snow, forum selection clause, jury trial, deposition, moot, climb, descent, http, www, com, interest of justice

COUNSEL: [*1] For Ryan M Redmond, Plaintiff: Dean P Laing, Douglas P Dehler, LEAD ATTORNEYS, O’Neil Cannon Hollman DeJong & Laing SC, Milwaukee, WI.

For Sirius International Insurance Corporation, Defendant: Barry A Chasnoff, Mary M Pena, LEAD ATTORNEYS, Akin Gump Strauss Hauer & Feld LLP, San Antonio, TX; Jeffrey A Evans, von Briesen & Roper SC, Milwaukee, WI.

JUDGES: AARON E. GOODSTEIN, U.S. Magistrate Judge.

OPINION BY: AARON E. GOODSTEIN

OPINION

DECISION AND ORDER

I. PROCEDURAL HISTORY

Ryan M. Redmond (“Redmond”) was seriously injured while skiing at Grand Teton National Park on July 2, 2011. When his health insurer, Sirius International Insurance Corporation (“Sirius”), [*2] denied coverage for his injuries, Redmond filed the present action, initially in Waukesha County Circuit Court. Sirius removed the action to federal court on June 8, 2012 based upon the diversity of the parties. On June 14, 2012, Sirius filed its answer and a counterclaim along with a motion to transfer the case to the Southern District of Indiana. Redmond responded to the motion and also filed motions asking that the court strike the defendant’s answer and counterclaim and asking the court to require the defendant to post bond in accordance with Wisconsin law.

On August 7, 2012, the court denied the plaintiff’s motions. With respect to Sirius’ motion to transfer the action to the Southern District of Indiana, the court found that the record was insufficient to permit the court to resolve the motion and therefore held the motion in abeyance as the parties engaged in discovery. On March 20, 2013, the court denied without prejudice the motion to transfer.

On September 9, 2013, the parties filed a total of eight separate motions. (Docket Nos. 54, 56, 58, 60, 63, 66, 70, 75.) The plaintiff subsequently filed two additional motions. (Docket Nos. 84, 107.) Of these 10 motions, the court must [*3] first address the defendant’s renewed motion to transfer the case to Southern District of Indiana, (Docket No. 54), and thus decide whether this court or the Southern District of Indiana should resolve the 9 other motions.

II. MOTION TO TRANSFER

The relevant policy contains a forum selection clause providing that venue for any action related to the policy shall be in “the Circuit and/or Superior Courts of Marion County [Indiana] and in the United States District Court for the Southern District of Indiana, Indianapolis Division (assuming that federal jurisdiction is otherwise appropriate and lawful).” (Docket No. 7 at 3-4.) If the forum selection clause is valid, pursuant to 28 U.S.C. § 1404(a), the “court should transfer the case unless extraordinary circumstances unrelated to the convenience of the parties clearly disfavor a transfer.” Atl. Marine Constr. Co. v. United States Dist. Court, 517 U.S. , , 187 L. Ed. 2d 487, 494, 134 S. Ct. 568 (2013).

Wisconsin law bars such forum selection clauses in insurance policies. Wis. Stat. § 631.83(3)(b). But Wisconsin’s prohibition applies to only “insurance policies and group certificates delivered or issued for delivery in this state, on property ordinarily [*4] located in this state, on persons residing in this state when the policy or group certificate is issued, or on business operations in this state.” Wis. Stat. § 631.01(1). The defendant’s argument against the application of this provision is limited to its view that Redmond was not “residing in” Wisconsin at the time the policy was issued. Sirius does not present, and therefore the court shall not consider any other arguments that may be raised as to why this statutory proscription may be inapplicable to the present dispute.

As the court discussed at length in its prior order, Redmond v. Sirius Int’l Ins. Corp., 2012 U.S. Dist. LEXIS 110594 (E.D. Wis. Aug. 7, 2012), there is a dispute as to whether Redmond was “residing in” Wisconsin when the policy was issued. The court concluded that “residing in” “include[s] [*5] not only those who dwell within the state for a long-term or extended period of time, but also, to the extent that the categories are not redundant, those who have Wisconsin as their domicile, i.e. ‘an individual’s true, fixed, and permanent home where the individual intends to remain permanently and indefinitely and to which, whenever absent, the individual intends to return.'” 2012 U.S. Dist. LEXIS 110594 at *21 (quoting Wis. Stat. §§ 71.01(1n), 71.22(1t)).

Redmond traveled frequently. In fact, the insurance policy that is at issue here was designed specifically to serve the needs of such travelers. He lived in his mother’s home in Delafield, Wisconsin until November 5, 2006 when he left for about six months of missionary work in Peru. He returned to Wisconsin and lived in Wisconsin until August 29, 2010, aside from a total of 30 days of missionary work in Peru and a month working on a Canadian dude ranch.

On August 25, 2010, from his home in Wisconsin, Redmond electronically submitted an application for renewal of his health insurance for the period of October 20, 2010 to October 20, 2011. (Docket No. 88, ¶8.) In doing so, he requested that the policy documents be sent to him in Vermont where he would be attending [*6] school. The application was approved the following day and the declaration and certificate were issued. (Docket No. 88, ¶9.) On August 29, 2010, Redmond left Wisconsin to travel to Vermont where he leased an apartment and attended school from August 30, 2010 through May 20, 2011, returning to Wisconsin in the interim for holidays. (Docket No. 88, ¶¶11-12.) Following May 20, 2011, Redmond returned to Wisconsin. (Docket No. 88, ¶13.)

The court finds that notwithstanding his travels and attendance at school in Vermont, Wisconsin remained Redmond’s domicile, and thus he was “residing in” Wisconsin when the policy was issued. This conclusion is further supported by the facts that Redmond filed taxes, had bank accounts, voted, and registered a vehicle in only Wisconsin. (Docket No. 88, ¶¶16-19.) Consequently, the policy’s forum selection clause is unenforceable under Wis. Stat. § 631.83(3)(b).

Having concluded that the forum selection clause is invalid, the court must turn to Sirius’ alternative argument and consider whether, after balancing all relevant factors, transfer to the Southern District of Indiana remains appropriate pursuant to 28 U.S.C. § 1404(a). “For the convenience of parties [*7] and witnesses, in the interest of justice, a district court may transfer any civil action to any other district or division where it might have been brought.” 28 U.S.C. § 1404(a).

Section 1404 (a) reflects an increased desire to have federal civil suits tried in the federal system at the place called for in the particular case by considerations of convenience and justice. Thus, as the Court recognized in Continental Grain Co. v. Barge FBL-585, 364 U.S. 19, 26, 27, 80 S. Ct. 1470, 4 L. Ed. 2d 1540, [(1960)], the purpose of the section is to prevent the waste “of time, energy and money” and “to protect litigants, witnesses and the public against unnecessary inconvenience and expense….”

Van Dusen v. Barrack, 376 U.S. 612, 616, 84 S. Ct. 805, 11 L. Ed. 2d 945 (1964) (footnotes omitted). There is no dispute that this action could have been filed in the Southern District of Indiana. Thus, the court’s analysis is limited to consideration of the convenience of the parties and witnesses and the interest of justice. The movant “has the burden of establishing, by reference to particular circumstances, that the transferee forum is clearly more convenient.” Coffey v. Van Dorn Iron Works, 796 F.2d 217, 219-20 (7th Cir. 1986).

“With respect to the convenience evaluation, [*8] courts generally consider the availability of and access to witnesses, and each party’s access to and distance from resources in each forum. Other related factors include the location of material events and the relative ease of access to sources of proof.” Research Automation, Inc. v. Schrader-Bridgeport Int’l, Inc., 626 F.3d 973, 978 (7th Cir. 2010) (citations omitted). “The ‘interest of justice’ is a separate element of the transfer analysis that relates to the efficient administration of the court system.” Id.

For this element, courts look to factors including docket congestion and likely speed to trial in the transferor and potential transferee forums; each court’s relative familiarity with the relevant law; the respective desirability of resolving controversies in each locale; and the relationship of each community to the controversy. The interest of justice may be determinative, warranting transfer or its denial even where the convenience of the parties and witnesses points toward the opposite result.

Id. (citations omitted).

Neither forum is especially more convenient for the parties or witnesses. Of the witnesses identified by the parties as likely to testify at trial, four live [*9] in Wyoming, one lives in Colorado, two (or three using the defendant’s count of potential witnesses) live in Indiana, one (the plaintiff) lives in Wisconsin (not Vermont as the defendant states), and one lives in Florida but maintains an apartment and office in Wisconsin. (Docket Nos. 87 at 15; 55 at 10.) The plaintiff’s attorneys have offices in Milwaukee, Wisconsin; the defendant’s attorneys are located in San Antonio, Texas, and are assisted by local counsel. Thus, a number of people are going to have to travel for trial. When traveling from Wyoming, Colorado, or Texas, it makes little difference whether the destination is Indianapolis or Milwaukee. The convenience of a trial in Indianapolis for the witnesses in Indiana would be countered by the inconvenience to the plaintiff, his attorneys, as well as his expert.

The defendant also notes that evidence, such as the plaintiff’s insurance documents, is more likely to be found at offices in Indiana. (Docket No. 55 at 10.) The court finds that in the usual case, the location of documentary evidence is generally an inconsequential consideration. Routine discovery in any case will involve digitizing documents and thus whether parties are [*10] separated by city blocks or time zones, the means and ease of exchange will be the same. The court has no reason to believe this would not be the case here. And after all, discovery is complete so this truly is a non-issue.

The court also recognizes that, although it is unenforceable under Wisconsin law, the fact that the parties agreed to a forum selection may be given some weight in the analysis under § 1404(a). See IFC Credit Corp. v. Aliano Bros. Gen. Contrs., Inc., 437 F.3d 606, 608 (7th Cir. 2006) (citing Stewart Org., Inc. v. Ricoh Corp., 487 U.S. 22, 31, 108 S. Ct. 2239, 101 L. Ed. 2d 22 (1988). However, the fact of the parties’ agreement is counterbalanced by Wisconsin’s strong public policy against forum selection clauses in insurance contracts; thus, the interests of justice lead to the conclusion that this fact merits negligible weight. Cf. id.

With further respect to the interests of justice factor, the defendant points to the fact that the policy states, “Indiana law shall govern all rights and claims raised under this Certificate of Insurance.” (Docket No. 55-1 at ¶6.) Whether Indiana law actually governs this case is the subject of a separate motion. (Docket No. 58.) As discussed below, the court finds [*11] that Indiana law does govern the interpretation of the present contract. Nonetheless, the court does not find that this factor is sufficient to overcome the presumption of preference for the plaintiff’s chosen forum. Although a federal court in Indiana will naturally be more familiar with Indiana law, applying laws from other states is a routine task for federal courts. The defendant has not identified any reason for the court to believe that the legal questions in this action will involve especially novel or complex interpretations of Indiana law such that there is a strong reason to have this matter overseen by a court with more intimate familiarity with Indiana law.

Therefore, having concluded that the forum selection clause is not enforceable and consideration of all the § 1404(a) factors fails to show that the Southern District of Indiana is clearly more convenient and/or favored as a result of a consideration of the interests of justice, the defendant’s motion to transfer this action, (Docket No. 54), shall be denied.

III. CHOICE OF LAW

The relevant insurance policy states, “Indiana law shall govern all rights and claims raised under this Certificate of Insurance.” (Docket No. 55-1 [*12] at ¶6.) Relying upon this provision, the defendant asks the court to conclude that Indiana law applies to the claims raised in this case. (Docket Nos. 58, 59.) The plaintiff responds that Wisconsin law should apply because: (1) the defendant waived its opportunity to make a choice of law argument; (2) the choice of law provision is unconscionable; (3) the choice of law provision is contrary to Wisconsin public policy; (4) the choice of law provision would not apply to the plaintiff’s bad faith claim; (5) a common law choice of law analysis indicates that Wisconsin law should govern. (Docket No. 86.) The defendant replies that a common law choice of law analysis would actually favor Indiana, but in any event, the choice of law provision remains enforceable, is applicable to all the plaintiff’s claims, and the defendant did not waive the choice of law argument.

The court finds that Indiana law governs the present action. The court does not find that the defendant waived the choice of law argument. Choice of substantive law was not relevant to the court’s prior decisions and concluding now that Indiana law applies does not require the court to reassess any prior conclusion.

Nor does the [*13] court find the relevant provision unconscionable. Even accepting the plaintiff’s arguments that a reasonable person would not read the entire policy to recognize that it contained this choice of law provision, much less recognize its implications if he did, the court does not find the provision satisfies the high standard of unconscionability. The plaintiff does not point out what is supposedly so unfavorable about Indiana law that it would make it extremely unfair or oppressive to apply it in this case. If a reasonable person in the plaintiff’s position had been fully aware of the presence and consequences of the choice of law clause, the court has no reason to believe he would not have still agreed to the insurance policy he was offered.

The court finds the plaintiff’s argument that the choice of law provision violates Wisconsin public policy, (Docket No. 86 at 7-8), to be novel but misguided. In the plaintiff’s view, only Wisconsin law could ever govern an insurance dispute involving a Wisconsin resident because Wisconsin’s laws embody the public policy of the state and an insurance contract cannot ever be interpreted in a manner that offends the public policy of the state of Wisconsin. [*14] This argument is founded upon an overly-expansive reading of a quote of Couch on Insurance contained in Appleton Papers, Inc. v. Home Indem. Co., 2000 WI App 104, ¶44, 235 Wis. 2d 39, 612 N.W.2d 760:

A provision that a contract of insurance shall be governed by the law of a given state is void where such an express provision violates a statute of the state of the contract or would, if given force, evade statutory provisions declaring a rule of public policy with reference to contracts made within the jurisdiction, or where the contract stipulation would violate the interests and public policy of the state, since these cannot be changed by the contract of the parties.

What the Wisconsin Court of Appeals was actually saying in this quoted passage is that Wisconsin will not enforce a provision of an insurance contract that offends Wisconsin law simply because the contract contained a choice of law provision stating that the law of another state shall govern. It is for this reason that, notwithstanding the presence of the forum selection clause, it is appropriate to apply Wisconsin law to conclude that the forum selection clause was invalid. The plaintiff does not point to any Wisconsin law or public policy similarly barring [*15] choice of law provisions in insurance contracts. The court rejects the plaintiff’s argument that the court of appeals in Appleton Papers effectively found any choice of law provision unlawful.

Thus, the court turns to the plaintiff’s remaining argument that Wisconsin law would still apply to his bad faith claim. (Docket No. 86 at 8-9.) In support of this argument, the plaintiff begins with the terms of the choice of law provision: “Indiana law shall govern all rights and claims raised under this Certificate of Insurance,” (Docket No. 55-1 at ¶6). Redmond reads this provision as being limited to claims for insurance coverage. (Docket No. 86 at 8.) In Redmond’s view, a claim of bad faith is not “raised under” the policy but rather is a wholly distinct claim.

The court disagrees. Although bad faith is a tort and is distinct from breach of contract, in this case, it is the existence of the contract that creates the relationship necessary for a bad faith claim. Anderson v. Cont’l Ins. Co., 85 Wis. 2d 675, 687, 271 N.W.2d 368, 374 (1978) (the court looks to Wisconsin law here because that is the basis for the plaintiff’s argument). If there was no contract, there could be no claim of bad faith. [*16] Any bad faith claim will depend upon the scope and provisions of the contract. Because a bad faith claim is inextricably linked to the contract, in the court’s view, it is appropriately regarded as a “claim raised under this Certificate of Insurance.”

Accordingly, the court concludes that the choice of law provision contained within the policy is enforceable and applies to all of the plaintiff’s claims. Therefore, the defendant’s motion, (Docket No. 58), shall be granted, and Indiana substantive law shall govern this matter. Consequently, the court shall not consider arguments presented by the plaintiff that are founded solely in Wisconsin law or otherwise unsupported by reference to Indiana law.

IV. MOTIONS FOR SUMMARY JUDGMENT

Having concluded that Indiana law applies and this court must decide the present motions, the court turns to the parties’ motions for summary judgment. Sirius seeks summary judgment in its favor on both Redmond’s breach of contract, (Docket No. 70), and bad faith, (Docket No. 75), claims, as well as its cross-claim for breach of contract, (Docket No. 70), and with respect to the issue of future medical expenses, (Docket No. 66). Redmond seeks summary judgment [*17] on the question of coverage. (Docket No. 63.) The issues raised in all of the motions are largely inter-related and therefore the court shall address them together. At the core of the present dispute is the question of whether the relevant insurance policy afforded coverage for the injuries Redmond suffered and thus the court begins there.

A. Facts

On July 2, 2011, 32-year-old Redmond joined three acquaintances on a trip to ski the Ellingwood Couloir, located in Grand Teton National Park in Wyoming. (Docket No. 83, ¶1.) All were experienced skiers and Redmond considered himself an “expert,” having skied since age two and having skied competitively in high school. (Docket No. 83, ¶¶7-8.) Setting out at 1:00 or 2:00 AM, the group hiked up the mountain using crampons and ice axes to assist their assent. (Docket No. 83, ¶17-18.) Photographs of the group’s ascent have been included in the record. (See Docket No. 68-5.) By about 10:00 AM, the group was about two-thirds of the way up the Ellingwood Couloir when they stopped to rest. (Docket No. 83, ¶19.) Two of the group, including Redmond, rested about 30 minutes, removed their climbing gear, and prepared for their descent; two others continued [*18] climbing, intending to reach the top of the couloir before skiing down. (Docket No. 83, ¶¶25-26.) Redmond was first to ski down the mountain but after skiing only a short distance, he lost his balance and fell. (Docket No. 83, ¶28.) When he ceased tumbling down the mountain, he remained motionless, unconscious, and unresponsive. (Docket No. 83, ¶29.) He was eventually airlifted from the park for medical treatment. (Docket No. 83, ¶29.)

The relevant insurance policy that provided coverage for Redmond for the period of October 20, 2010 to October 20, 2011, contains the following exclusions:

All charges, costs, expenses and/or claims (collectively “Charges”) incurred by the Insured Person and directly or indirectly relating to or arising from or in connection with any of the following acts …:

* * *

(11) Charges incurred for any surgery, Treatment or supplies relating to, arising from or in connection with, for, or as a result of:

* * *

(d) any Injury or Illness sustained while taking part in mountaineering activities where specialized climbing equipment, ropes or guides are normally or reasonably should have been used, Amateur Athletics, Professional Athletics, aviation (except when traveling [*19] solely as a passenger in a commercial aircraft), hang gliding and parachuting, snow skiing except for recreational downhill and/or cross country snow skiing (no cover provided whilst skiing in violation of applicable laws, rules or regulations; away from prepared and marked in-bound territories; and/or against the advice of the local ski school or local authoritative body), racing of any kind including by horse, motor vehicle (of any type) or motorcycle, spelunking, and subaqua pursuits involving underwater breathing apparatus (except as otherwise expressly set forth in Section Q. Recreational Underwater Activities). Practice or training in preparation for any excluded activity which results in injury will be considered as activity while taking part in such activity; and/or

(e) any Illness or Injury sustained while participating in any sporting, recreational or adventure activity where such activity is undertaken against the advice or direction of any local authority or any qualified instructor or contrary to the rules, recommendations and procedures of a recognized governing body for the sport or activity….

(Docket No. 83, ¶33 (emphasis added).) Relying upon section (d) quoted above, [*20] Sirius denied Redmond’s claim. (Docket No. 83, ¶¶36, 38.)

B. Summary Judgment Standard

“The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a); see also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248, 106 S. Ct. 2505, 91 L. Ed. 2d 202 (1986); Celotex Corp. v. Catrett, 477 U.S. 317, 324, 106 S. Ct. 2548, 91 L. Ed. 2d 265 (1986). A material fact is one that might affect the outcome of the case, and a nonmoving party’s dispute is “genuine” only if a reasonable finder of fact could find in the nonmoving party’s favor at trial. Anderson, 477 U.S. at 248-49. The court views the facts in the light most favorable to the non-moving party, and likewise it draws all inferences in the non-movant’s favor. Ault v. Speicher, 634 F.3d 942, 945 (7th Cir. 2011). The court may not weigh the evidence or make credibility determinations. Payne v. Pauley, 337 F.3d 767, 770 (7th Cir. 2003). Thus, the nonmoving party will defeat a motion for summary judgment if it is able to produce admissible evidence that, when viewed in the most favorable light, would be sufficient to enable the finder of fact to return a verdict in its favor. Fleishman v. Cont’l Cas. Co., 698 F.3d 598, 603 (7th Cir. 2012).

C. [*21] Analysis

“An insurance policy is a contract, and as such is subject to the same rules of construction as other contracts.” Dunn v. Meridian Mut. Ins. Co., 836 N.E.2d 249, 251 (Ind. 2005) (citing Allstate Ins. Co. v. Dana Corp., 759 N.E.2d 1049, 1054 (Ind. 2001)). Because contract interpretation is primarily a question of law, it is a matter that is generally well-suited for summary judgment. FLM, LLC v. Cincinnati Ins. Co., 973 N.E.2d 1167, 1174 (Ind. Ct. App. 2012) (citing Mahan v. Am. Std. Ins. Co., 862 N.E.2d 669, 676 (Ind. Ct. App. 2007)). “When interpreting an insurance contract courts must look at the contract as a whole.” Dunn, 836 N.E.2d at 252 (citing Meridian Mut. Ins. Co. v. Richie, 540 N.E.2d 27, 29 (Ind. 1989)). In construing an insurance contract, the court should do “so as not to render any words, phrases, or terms ineffective or meaningless.” FLM, 973 N.E.2d at 1174 (citing Mahan, 862 N.E.2d at 676). Terms should be given their plain and ordinary meaning. Id. (citing Mahan, 862 N.E.2d at 676). In determining the “plain and ordinary meaning” of a term, courts will frequently turn to dictionaries. See, e.g., Allgood v. Meridian Sec. Ins. Co., 836 N.E.2d 243, 247 (Ind. 2005); [*22] State Farm Mut. Auto. Ins. Co. v. D’Angelo, 875 N.E.2d 789, 797-98 (Ind. Ct. App. 2007).

However, if a provision of an insurance contract is ambiguous, it is to be construed strictly against the insurer. FLM, 973 N.E.2d at 1174 (quoting Lake States Ins. Co. v. Tech Tools, Inc., 743 N.E.2d 314, 318 (Ind. Ct. App. 2001)). An insurance contract is not ambiguous simply because parties each have their own interpretation of a provision. Id. (citing Mahan, 862 N.E.2d at 676). Rather, “[a]n insurance contract is ambiguous when it is susceptible to more than one interpretation and reasonably intelligent persons would honestly differ as to its meaning.” Id. (quoting Allstate Ins. Co. v. Bradtmueller, 715 N.E.2d 993, 997 (Ind. Ct. App. 1999)).

1. Mountaineering Exclusion

In its motion for summary judgment, the defendant begins with the contention that the plaintiff’s injuries directly or indirectly related to or arose from or were in connection with mountaineering activities “where specialized climbing equipment, ropes or guides are normally or reasonably should have been used.” Mountaineering is not defined in the policy.

There is no dispute between the parties that when he was ascending the mountain, [*23] Redmond was mountaineering. But Redmond was not injured on his ascent, and the parties disagree as to whether his descent on skis constituted mountaineering.

The Oxford English Dictionary defines “mountaineering” as, “The action or sport of climbing mountains.” Oxford English Dictionary, (January 15, 2014), http://www.oed.com/view/Entry/239554. Merriam-Webster similarly defines it as “the sport or technique of scaling mountains.” Merriam-Webster, (January 15, 2014), http://www.merriam-webster.com/dictionary/mountaineering. The definition within the American Heritage Dictionary states, “The climbing of mountains, especially using special equipment and techniques on rock, ice, or snow. Also called mountain climbing.” American Heritage Dictionary, (January 15, 2014), http://www.ahdictionary.com/word/search.html?q=mountaineering.

If a person uses the word “climb” or “climbing” in common conversation, the connotation will generally be of an action involving ascent, e.g. climb a ladder, climbing stairs, or climb a tree. This understanding is reflected in the Oxford English Dictionary’s first definition of “climb,” which states, “To raise oneself by grasping or clinging, or by the aid of hands [*24] and feet; ‘to mount by means of some hold or footing’ (Johnson); to creep up; to ascend, come, or go up, a perpendicular or steep place. Often with up.” Oxford English Dictionary, (December 2, 2013), http://www.oed.com/view/Entry/34342 (emphasis in original).

But as any parent knows from having to frequently call after a rambunctious child, the word “climb” is often used alongside “down,” to denote descent, as in, “Climb down from there before you get hurt!” The Oxford English Dictionary recognizes this usage of “climb” as its second definition of the word “climb” stating, “to descend by the same means.” Oxford English Dictionary, (January 15, 2014), http://www.oed.com/view/Entry/34342.

Thus, if “mountaineering” is defined by reference to “climbing” and climbing can denote either ascent or descent, then necessarily, “mountaineering” must include both ascent and descent. The court finds this understanding of mountaineering to be the only logical definition. After all, in the context of mountaineering, the proverb “What goes up, must come down,” is generally literally true.

But a person is not necessarily “mountaineering” when he is descending a mountain simply because he ascended through [*25] mountaineering. A person who has helicopter waiting for him at a peak or who chooses to parasail off a mountain could not be appropriately regarding as “mountaineering” on his descent, notwithstanding the means of his ascent. Rather, as the Oxford English Dictionary notes in its second definition of “climb,” when used in the context of descent, the action must be “by the same means.” The court understands the “same means” to be referring to the means stated in the first definition of “climb,” i.e. “grasping or clinging, or by the aid of hands and feet.” Thus, whether ascending or descending a mountain by means of “grasping or clinging, or by the aid of hands and feet,” the person is “mountaineering.”

Here, Redmond generally hiked and climbed up and attempted to ski down. Obviously, skiing involves “the aid of hands and feet” but so do countless other obviously distinct activities. Common sense and common usage would not equate skiing with mountaineering; the actions are distinct in both connotation and denotation. Redmond engaged in mountaineering in order to go skiing but that predicate or the fact that the skiing occurred on a mountain (as skiing obviously often will) did not transform [*26] his skiing into mountaineering.

Nor does the court find persuasive the defendant’s argument that the policy’s expansive language barring coverage for injuries “arising from or in connection with, for, or as a result of … mountaineering” operates to bar coverage. Obviously, this provision serves a valuable purpose. Without it, perhaps a person who fell while mountaineering could argue that the mountaineering exclusion should not bar coverage because he was injured when he fell, not when he was mountaineering, which, by definition, would not include an uncontrolled fall. But the defendant’s argument stretches this provision too far. In the view of the defendant, because the causal chain the resulted in Redmond’s injury included a mountaineering link, coverage must be barred. The court disagrees.

The court also rejects the defendant’s contention that the mountaineering exclusion encompasses “ski mountaineering,” which the defendant characterizes as a subset of mountaineering. The plaintiff contends that ski mountaineering requires ropes and other specialized equipment that he was not using on the descent, (Docket No. 64 at 23-24), but even accepting for present discussion that Redmond’s [*27] acts fell within a broad definition of “ski mountaineering,” the court finds that the mountaineering exclusion does not encompass the distinct activity of ski mountaineering. In describing the mountaineering exclusion, the policy states that mountaineering involves activities “where specialized climbing equipment, ropes or guides are normally or reasonably should have been used.” Here, Redmond’s downhill skiing would not have called for specialized climbing equipment, ropes, or guides, and thus, even if it came within a broad general definition of “ski mountaineering,” the activity would not come within the policy’s description of “mountaineering.”

Therefore, the court concludes that the mountaineering exclusion does not apply in this case. Thus, the court turns to whether any of the policy’s skiing exclusions apply.

2. Skiing Exclusions

In the portion of the insurance policy listing its exclusions, it also states:

“any Injury or Illness sustained while taking part in … snow skiing except for recreational downhill and/or cross country snow skiing (no cover provided whilst skiing in violation of applicable laws, rules or regulations; away from prepared and marked in-bound territories; [*28] and/or against the advice of the local ski school or local authoritative body)….”

This provision, moving back and forth between coverage and exclusions, is far from a model of clarity. It first excludes coverage for injuries sustained while snow skiing but then immediately excludes from the exclusion (and thus covers) injuries sustained while “recreational downhill and/or cross country snow skiing,” and then adds a parenthetical to now exclude from the exclusion to the exclusion (and thus deny coverage for) injuries sustained while “skiing in violation of applicable laws, rules or regulations; away from prepared and marked in-bound territories; and/or against the advice of the local ski school or local authoritative body.” The net effect of this provision is that injuries sustained as a result of recreational snow skiing are covered provided the skiing was not unlawful, against the advice of certain entities, or “away from prepared and marked in-bound territories.”

The defendant argues that the plaintiff’s skiing was not “recreational” and points to a case where a court found that a life insurance policy did not provide coverage for an insured who was killed in an avalanche while heli-skiing [*29] (traveling via helicopter to a remote location on a mountain and then skiing down the mountain) because, although the insured listed skiing as one of his “recreational activities” he did not disclose that he engaged in backcountry heli-skiing. (Docket No. 81 at 8-12 (discussing W. Coast Life Ins. Co. v. Hoar, 505 F. Supp. 2d 734 (D. Colo. 2007)).) However, Hoar is distinguishable in that the issue before that court was not whether a policy exclusion applied but rather whether the insurer had adequate notice of the risk it was undertaking when it relied upon his application to issue the policy. Moreover, the court’s conclusion that the insurer was not adequately informed of its risk was not based solely upon the fact that the insured identified simply skiing, as opposed to heli-skiing, as a recreational activity, but also the fact that the insured did not disclose heli-skiing when asked if he engaged in “any hazardous activities.” Id. at 744-49.

“Recreational” is not ambiguous. It is readily understood as, “An activity or pastime which is pursued for the pleasure or interest it provides.” Oxford English Dictionary, (January 15, 2014), http://www.oed.com/view/Entry/159954. Thus, competitive [*30] or commercial skiing likely would not be covered under the policy. There is no evidence that Redmond was skiing for any purpose other than the pure pleasure or interest the sport provides, and thus the court concludes that Redmond’s skiing on the day of his injury was recreational.

Nor is there reason to conclude that his skiing was unlawful or against the advice of any relevant entity. The next question is whether he was skiing “away from prepared and marked in-bound territories” when he was injured.

In Redmond’s view, this phrase, when read alongside the other exclusions, means simply that there is no coverage if he is skiing in an area where he has been told not to ski. (Docket No. 64 at 27.) Thus, the exclusion would not apply here because he was skiing in an area where skiing was permitted; in effect, because skiing was permitted anywhere within Grand Teton National Park, the whole park was a prepared and in-bound territory. (Docket No. 64 at 27.)

Moreover, the term “away from” is ambiguous in the view of the plaintiff. It may be interpreted strictly to suggest the skier’s direction. Thus, there would be no coverage if a skier started on a marked and prepared in-bound area but then [*31] left that area. Or, perhaps, there might be coverage for out-of-bounds skiing provided the skier’s path, at some point, would intersect a marked and prepared in-bound territory and thus he was going towards, rather than away from, the in-bound territory. Therefore, a skier taking a shortcut through an out-of-bounds area would still be covered because he was going towards in-bound territory. Alternatively “away from” might be much broader, meaning generally, “outside,” as in how one might say she is “away from home.”

The court does not find the phrase “away from” to be ambiguous. Simply because a term has more than one denotation does not make it ambiguous; otherwise, the majority of words would probably be ambiguous. The differing understandings must also be reasonable given the context before the court will find a term ambiguous. The latter understanding, i.e. that “away from” means, roughly, “outside,” is the only reasonable understanding of the term given the context in which it is used. There may be some arguable ambiguity as to how far from the prepared and in-bound territory a person must be to be “away from” such territory, e.g. whether the term should be read like the NFL rulebook [*32] where one foot on the line is out of bounds or if there might be a sort of “bubble” around a covered territory so that coverage does not necessarily end at a strict boundary line, see York v. Sterling Ins. Co., 114 A.D.2d 665, 666-67, 494 N.Y.S.2d 243 (N.Y. App. Div. 3d Dep’t 1985) (holding that policy provision excluding coverage for injuries “away from” the insured’s property did not bar coverage for injuries sustained when a person riding a dirt bike on insured’s property lost control, traveled over the insured’s property line, and was injured). The follow-up question as to precisely how far one must be to be “away from” is not an issue presently before this court, although it may be relevant for trial. Thus, the court turns its focus to what is meant by “prepared and marked in-bound territories.”

The court rejects the plaintiff’s contention that the court must lump all the exclusions together and conclude that they mean simply that there is coverage so long as he was not skiing in an area where skiing was not banned. Such an interpretation offends the maxim of contract interpretation that, to the extent possible, every term and provision must be given meaning. In saying that there is no coverage [*33] if Redmond was skiing away from prepared and marked in-bound territories, this plainly encompasses more than simply skiing in an area where skiing is not barred. Thus, having concluded that “away from” means roughly “outside of,” restating this exclusion as a positive question, the issue before the court becomes, “Was Redmond skiing in a prepared and marked in-bound territory when he was injured?” Only if he was would the policy possibly afford coverage for his injures.

The plaintiff’s focus upon “in-bound” overlooks two other essential components to the exclusion–“prepared” and “marked.” The plaintiff refers to these terms in only a single inconsequential footnote, (Docket No. 64 at 31, n. 14).) If the plaintiff does not regard his argument on this point worthy of inclusion of the text of his brief, the court hardly regards it as worthy of much consideration; in fact, the court previously expressed its disapproval of the plaintiff’s efforts to raise arguments in footnotes, (Docket No. 80 at 4).

The court agrees with the defendant that “prepared” and “marked” are words of ordinary use. However, this fact does not necessarily mean that the terms are unambiguous as used in the policy. [*34] The only argument offered by either party that approaches a definition of the term “prepared” is the defendant’s suggestion that it means “groomed.” (Docket Nos. 71 at 23; 103 at 3, 9.) As for “marked” there is only the defendant’s footnote where it notes that Redmond testified he did not observe ropes, signs, fences, or other defined physical boundaries on the mountain that day. (Docket No. 71 at 21-22, fn.78.)

The court finds that both “prepared” and “marked” are subject to different interpretations. Again, simply because there are differing interpretations does not mean that the terms are ambiguous or that the policy affords coverage. Rather, for the term to be ambiguous, the differing interpretations must both be reasonable such that “intelligent persons would honestly differ as to its meaning.” Stevenson by Freeman v. Hamilton Mut. Ins. Co., 672 N.E.2d 467, 471 (Ind. Ct. App. 1996) (citing Harden v. Monroe Guaranty Ins. Co., 626 N.E.2d 814, 817 (Ind. Ct. App. 1993)). There is coverage only if one of those reasonable understandings is consistent with coverage. Thus, the court looks to the various meanings of these terms.

While “marked” is readily understood as having some sort of [*35] visible identification, see Oxford English Dictionary, (January 15, 2014), http://www.oed.com/view/Entry/114174, what is unclear is what sort of mark must be utilized or what these marks must indicate. The court presumes that if a ski area is bordered on the sides by signs and ropes demarcating the boundaries of the permissible skiing area, it is likely “marked” within the scope of the policy. But is this the only kind of identification that will render an area “marked?” What if the area is depicted on a map that includes boundary lines indicating the recommended areas for skiing? If markings on a map are sufficient, who must prepare such a map to render the area marked? Must the map be prepared by the entity in charge of the area, e.g. the National Park Service, or would a map prepared by a person with special knowledge of the area suffice? Or must the markings even relate to the in-bound territories? Would a sign in the vicinity of the mountain stating “Ski at your own risk,” suffice as a marking? Perhaps there are many other plausible understandings of this term.

As for “prepared,” again this term has a readily understandable common meaning, e.g. “To bring into a suitable condition [*36] for some future action or purpose; to make ready in advance; to fit out, equip.” Oxford English Dictionary, (January 15, 2014), http://www.oed.com/view/Entry/150447. This definition is exceptionally broad and thus its application to the context of skiing is unclear. Even the defendant’s own expert testified that he was not familiar with what this might mean in the context of skiing. (Docket No. 68-15 at 32.)

If ground has snow on it, to many persons, it is “prepared” for skiing in that it has been brought into a suitable condition for skiing, and thus the policy may be simply excluding coverage when persons attempt to ski on surfaces not suitable for skiing. Or must there be some sort of human intervention? (See Docket No. 68-12 at 12.) If so, what sort of intervention? In the context of backcountry skiing, would inspection for or the mitigation of avalanche dangers be adequate preparation of the territory? If so, who must do this? Or must there be, as the defendant seems to suggest, formal grooming of the area, using, for example, a snow grooming machine? If the latter definition is appropriate, then would there be coverage under the policy if an insured was making a run after a fresh [*37] snowfall, or must he wait for the snow grooming machine to make a pass over the slopes?

The court finds that neither party has adequately articulated, much less supported, an appropriate conclusive meaning for these terms. While the defendant’s understanding of the terms “prepared” and “marked” is, as discussed below in conjunction with the plaintiff’s bad faith claim, reasonable, this understanding is not necessarily the only reasonable understanding. Therefore, because the court is not satisfied that the terms are unambiguous and support the conclusion that there is no coverage under the policy, the court cannot grant the defendant’s motion for summary judgment. However, nor can the court grant the plaintiff’s motion for summary judgment because the plaintiff has not adequately demonstrated that the terms are, in fact, ambiguous and/or support a finding of coverage. The plaintiff largely asks the court to read the terms out of the policy rather than presenting an alternative reasonable understanding of these terms that is consistent with coverage. Although the court offers here hypothetical interpretations of these terms to demonstrate how they terms are not necessarily un-ambiguous, [*38] absent the defendant’s opportunity to respond to these interpretations, the court is not prepared to conclude that any of these proffered interpretations is reasonable. And in any event, even if reasonable, the court could not conclude that the proffered interpretation would be consistent with coverage because the plaintiff has not presented any such factual support to the court.

Consequently, neither party has succeeded in establishing that summary judgment is warranted on their respective motions relating to coverage. Because the understanding of “in-bound” appears to be at least partially dependent upon the definitions of both “prepared” and “marked,” the court finds itself similarly unable to fix a definition of this term at this time. Therefore, the parties’ motions for summary judgment regarding coverage, (Docket Nos. 63, 70), shall be denied.

3. Future Medical Expenses

Based upon its reading of the plaintiff’s complaint, the defendant understood that the plaintiff was seeking payment for medical expenses related to the accident but not incurred prior to the time the policy terminated. Thus, the defendant filed a motion seeking to foreclose this perceived request for damages. (Docket [*39] No. 66.) In response, the plaintiff states that he is seeking coverage only for medical expenses incurred between the date of the accident, July 2, 2011, and the date his coverage expired, October 19, 2012. The reference in the complaint to “costs of the medical care he will continue to receive in the future,” (Docket No. 1-1 at ¶40), was not a demand for coverage beyond the policy period but rather was necessitated by the fact that the complaint was filed within the policy period. In reply, the defendant asks the court to strike the pertinent portion of the complaint and declare that future medical expenses are not available to the plaintiff.

The court finds that the defendant’s motion, (Docket No. 66), is moot and therefore shall be denied as such. Further, the court finds no reason to strike any portion of the plaintiff’s complaint. The parties agree that the plaintiff is not entitled to payment for medical expenses incurred outside the policy period and the court does not read the complaint as seeking such damages. Thus, there is no controversy on this point that requires action by this court.

4. Bad Faith

It is well-established that insurers have a duty to deal in good faith with [*40] their insureds. Monroe Guar. Ins. Co. v. Magwerks Corp., 829 N.E.2d 968, 975 (Ind. 2005) (citing Freidline v. Shelby Ins. Co., 774 N.E.2d 37, 40 (Ind. 2002). “As a general proposition, ‘[a] finding of bad faith requires evidence of a state of mind reflecting dishonest purpose, moral obliquity, furtive design, or ill will.'” Magwerks, 829 N.E.2d 968, 977 (Ind. 2005) (quoting Colley v. Indiana Farmers Mut. Ins. Group, 691 N.E.2d 1259, 1261 (Ind. Ct. App. 1998)). This may be proven if the plaintiff can establish by clear and convincing evidence “that the insurer had knowledge that there was no legitimate basis for denying liability.” Id. at 976 (quoting Freidline, 774 N.E.2d at 40). “Poor judgment or negligence do not amount to bad faith.” Lumbermens Mut. Cas. Co. v. Combs, 873 N.E.2d 692, 714 (Ind. Ct. App. 2007) (quoting State Farm Mut. Auto Ins. Co. v. Gutierrez, 844 N.E.2d 572, 580 (Ind. Ct. App. 2006). Nor is the lack of a diligent investigation sufficient to support a finding of bad faith. Id. (quoting Gutierrez, 844 N.E.2d at 580). Thus, bad faith is not synonymous with a breach of contract. Even if a denial of coverage was improper, it was not necessarily done in bad faith. Id. [*41] (quoting Erie Ins. Co. v. Hickman, 622 N.E.2d 515 (Ind. 1993)).

Redmond’s claim of bad faith is two-pronged. The first prong is Sirius’ conduct before the suit was filed; the second is Sirius’ conduct in defending this suit and pursuing a counterclaim against Redmond.

With respect to Sirius’ pre-litigation conduct, Redmond contends that Sirius acted in bad faith when it failed to conduct an adequate investigation into his claim and denied his claim. Sirius contends that its investigation was appropriate and its decision reasonable. In support, it points primarily to its “claim log,” which it provided to the court, (Docket No. 73-24). However, absent appropriate foundation to establish that this document is a business record under Fed. R. Evid. 803(6), this document is inadmissible hearsay. The defendant fails to support this document by an affidavit or declaration, nor has the defendant directed the court to any relevant deposition testimony that could provide the necessary foundation.

The defendant also relies upon the deposition testimony of Tammie Peters (“Peters”), the person ultimately responsible for denying Redmond’s claim. However, the defendant has provided the court with only [*42] nine pages of her 154 page deposition (three of the provided pages comprise the cover and certification pages), and not always the pages relied upon by the defendant, (see, e.g., Docket No. 73 at ¶130 (citing “Ex. W, Peters Dep. 10:7-9” which is not included in Docket No. 73-23).) In her deposition, Peters is asked to review Exhibit 11, (see Docket No. 68-10), which the questioner posits consists of articles found on the internet and placed in the claims file of Sirius’ underwriter. (Docket No. 73-23 at 6.) At no point in the deposition excerpts provided to the court by the defendant does Peters authenticate these documents or testify that she relied solely upon them to make her coverage decision. Other documents attached to the defendant’s proposed findings of fact and cited by defendant in its proposed findings of fact and in its briefs are similarly un-authenticated. The only other testimony in the portion of Peters’ deposition provided to the court by the defendant that indicates the basis for Peters’ decision to deny Redmond’s claim is her statement that another employee offered his opinion that the claim was not covered because he reviewed an ambulance report and had done some [*43] internet research regarding where Redmond was skiing. (Docket No. 73-23 at 5.)

In contrast to the defendant’s submissions, the plaintiff has provided the court with the entirety of Peters’ deposition and thus the court turns to this document. (Docket No. 68-12.) Having reviewed this document, the court is able to fill in many of the gaps left by the defendant. In her deposition, Peters discusses Exhibit 7, which she describes as “insured notes” comprised of “notes that were put under the insured, Ryan Redmond.” (Docket No. 68-12 at 15.) Exhibit 7, which was provided to the court by the plaintiff as Docket No. 68-7, is largely the same as the “claim log,” (Docket No. 73-24), provided by the defendant, although the formatting of these documents differs and Docket No. 68-7 includes pages and entries beyond those included in the defendant’s excerpt. Based upon this more complete review, the court concludes that Peters’ testimony regarding this document is sufficient to bring the document within Fed. R. Evid. 803(6), and thus it may be appropriately considered by the court in deciding the present motion.

This document indicates that the decision to deny coverage was made by at least July [*44] 29, 2011. (Docket Nos. 73-24 at 3; 68-12 at 20.) The notes indicate that on July 5, 2011, the underwriter was informed that Redmond was in a “skiing accident with a head injury.” (Docket No. 73-24 at 6.) An hour later, another employer of the underwriter spoke with personnel at the hospital and noted, “Admitted through ER / head trauma / fall from cliff.” (Docket No. 73-24 at 5.) Ten days later, following a conversation with the helicopter ambulance service that assisted in Redmond’s rescue, the notes state, “Appeared scene was Lupine Meadows, but was unsure if that is a ski resort or park.” (Docket No. 73-24 at 4.) Later that day, a follow-up call confirmed that Lupine Meadows was in Grand Teton National Park. (Docket No. 73-24 at 4.) Four days thereafter, the underwriter communicated to the hospital that there might not be coverage because preliminary investigation indicated Redmond’s “injuries were as a result of backcountry skiing.” (Docket No. 73-24 at 4.)

The court is not able to find that the information contained in this document was necessarily sufficient to deny Redmond’s claim. Thus, the court looks to what other information was available to the underwriter. Peters testified [*45] that she also relied upon a report from the helicopter ambulance service that transported Redmond. (Docket No. 68-12 at 20.) This report is included in Exhibit AA to Sirius’ statement of proposed facts, (Docket No. 73-27 at 12-16), and, like many of the defendant’s exhibits, is not authenticated by way of a declaration, affidavit, or deposition testimony. Nonetheless, the court shall consider it because the plaintiff does not dispute that this document is the Omniflight Helicopters-Idaho medical records received by the underwriter. (Docket No. 96, ¶107.) The portion of this report captioned “History of Present Illness” states, in part, “Pt had been backcountry skiing when he fell down steep slope approx. 800 ft. Took approx. 2 hrs before pt could be reached.” (Docket No. 73-27 at 12.)

Taken together, all of this information provided a reasonable basis to deny Redmond’s claim pursuant to the skiing exclusion in the policy. As discussed above, the terms “prepared” and “marked,” as used within the skiing exclusion, can be reasonably understood in different ways. One such reasonable understanding would be the understanding that Peters testified she held, which there is no coverage for skiing [*46] outside of the boundaries of a ski run at a traditional ski resort. One could reasonably understand “backcountry skiing” to mean that Redmond was necessarily not skiing at a traditional ski resort. Subsequent information further corroborated the conclusion that Redmond was skiing in a remote wilderness area. (See Docket No. 73-14 (National Park Service Search & Rescue Report received by the underwriter on Sept. 15, 2011).) Thus, based upon the information provided, the decision to deny coverage was reasonable. This decision might prove incorrect, but it was not done in bad faith. There is simply no evidence that could permit a reasonable finder of fact to conclude by clear and convincing evidence that Peters’ decision to deny the claim was the result of a “dishonest purpose, moral obliquity, furtive design, or ill will.”

Thus, the court turns to the question of whether Sirius’ conduct in this litigation might form the basis for a claim of bad faith. Redmond argues that Sirius acted in bad faith by using tactics to try to get Redmond to concede Sirius’ counterclaim, which Sirius eventually withdrew, and by failing to reconsider the denial of coverage after certain deposition testimony. [*47] (Docket No. 89 at 9.)

On the issue of post-litigation conduct vis-à-vis bad faith, courts across the country have been dealing with two distinct issues. The first is evidentiary: whether an insurer’s conduct in litigation following the filing of a claim alleging bad faith might be used as evidence to support that claim of bad faith. The second is substantive: whether an insurer’s conduct in litigation might itself form the basis for a claim of bad faith. The Court of Appeals of Indiana addressed these issues in Gooch v. State Farm Mut. Auto. Ins. Co., 712 N.E.2d 38 (Ind. Ct. App. 1999), and noted the general reluctance of courts to permit post-litigation conduct as evidence to support a prior claim of bad faith. Id. at 42 (discussing Howard v. State Farm Mut. Auto. Ins. Co., 316 S.C. 445, 450 S.E.2d 582 (1994); Palmer v. Farmers Ins. Exch., 261 Mont. 91, 861 P.2d 895 (1993); Nationwide Mut. Ins. Co. v. Clay, 525 So. 2d 1339 (Ala.1987)). With respect to the second question, however, the Court of Appeals of Indiana concluded that when an insurer is sued, under certain circumstances, its post-litigation conduct might form an independent basis for a new bad faith claim.

In Gooch, the plaintiff [*48] sued her insurer seeking coverage under the uninsured motorist provision of her policy. After the action was filed, the defendant insurer insisted that she also pursue an action against another individual in a foreign jurisdiction, an action the plaintiff believed would be frivolous. Believing that the insurance company was making these demands to frustrate her suit and thus pressure her to settle, the plaintiff amended her complaint to also allege bad faith. The court of appeals concluded that such litigation conduct by an insurer might present a cognizable claim of bad faith, and in doing so the court emphasized that the plaintiff was relying upon conduct that occurred only before she filed her bad faith claim.

What Redmond is attempting to allege here are two distinct bad faith claims. The first related to the denial of his claim; the second related to Sirius’ conduct in the litigation. But as the court addressed in a prior order, (Docket No. 80), Redmond’s complaint raises bad faith only with respect to Sirius’ denial of his claim. Although Gooch involved a case initiated on a wholly distinct coverage claim, an insurer is likely not absolved of its duty of good faith simply because [*49] a plaintiff, like Redmond, initiates a suit alleging bad faith. If a suit is commenced containing a claim of bad faith and an insurer subsequently engages in litigation conduct that itself constitutes a distinct claim of bad faith, in accordance with Gooch, that plaintiff may amend her complaint to state a second distinct claim of bad faith.

Here, Redmond did not seek to amend his complaint to add a claim of post-litigation bad faith. Instead, he has attempted to expand the bad faith claim in his complaint by supplementing his discovery responses. The defendant objected and, as is fully discussed in this court’s prior order, (Docket No. 80), the court rejected this means of constructively amending his complaint. There was no amended complaint and therefore no such claim of post-litigation bad faith is properly before the court. Thus, Redmond necessarily cannot obtain the relief he seeks. Accordingly, the court shall grant the defendant’s motion for summary judgment as to the entirety of Redmond’s bad faith claim.

V. MOTION TO STRIKE PLAINTIFF’S DEMAND FOR A JURY TRIAL

Alongside its choice of law and venue provisions, the insurance policy also states, “All trials regarding disputes under [*50] this insurance shall be exclusively presented to and determined solely by the court as the trier of fact, without a jury.”

The plaintiff contends that this waiver of his right to a jury trial is unenforceable because it was not knowingly and intelligently made and the jury waiver provision is unconscionable. (Docket No. 95.) In reply, the defendant cites IFC Credit Corp. v. United Bus. & Indus. Fed. Credit Un., 512 F.3d 989, 993-94 (7th Cir. 2008), for the proposition that a jury waiver provision need not be knowing, voluntary, or intentional to be enforceable. (Docket No. 102 at 2-3.) However, the contract at issue in IFC was a traditional commercial contract under the Uniform Commercial Code. Although insurance policies are a form of contract and traditional rules of contract interpretation are applied, there is a vast difference between a UCC agreement for the sale of goods and a consumer insurance policy.

In deciding whether a contract provision waiving the right to a jury trial is enforceable, the court looks to the state substantive law that governs the contract. IFC, 512 F.3d at 994. Thus, the court looks to Indiana law. The plaintiff cites only Wisconsin law; the defendant, although [*51] citing Indiana law, does not identify any Indiana case explicitly addressing the question of a jury trial waiver in an insurance contract. The court’s own research has failed to identify any court that has applied Indiana law to directly answer this question.

Notwithstanding, the Court of Appeals for the Seventh Circuit noted that when it comes to the waiver of the right to a jury trial, an agreement to arbitrate a claim (and thus give up not only a jury trial but a judicial forum altogether) is arguably more onerous than an agreement to simply have a claim heard by a court instead of a jury, yet arbitration agreements are regularly enforced in all sorts of contracts without any special requirements. Id. Thus, in the absence of any case law addressing the validity of an insurance contract provision waiving simply the right to a jury trial, the court looks to how Indiana would regard a similar provision waiving the right to present a claim in any judicial forum.

Indiana law does not prohibit the use of arbitration provisions in insurance contracts, see Ind. Code sec. 34-57-2-1; rather, Indiana has a strong policy in favor of enforcing arbitration provisions in all contracts, including [*52] insurance contracts, see, e.g., Pekin Ins. Co. v. Hanquier, 984 N.E.2d 227, 228 (Ind. Ct. App. 2013); HemoCleanse, Inc. v. Phila. Indem. Ins. Co., 831 N.E.2d 259, 262 (Ind. Ct. App. 2005).

If an insurer can include in a standard insurance contract a provision whereby an insured will give up his right to not only a trial by jury but also the right to bring his action in any court, the court has little reason to conclude that a provision waiving the right to a jury trial is inherently unenforceable or any extraordinary means are necessary to render it effective. Thus, the court shall enforce the contract as written.

The plaintiff also raises separate arguments limited to the applicability of the waiver of the right to a jury trial to his bad faith claim. These arguments are basically a restatement of the arguments the plaintiff offered to support his contention that the choice of law provision did not apply to the bad faith claim. For the same reasons set forth above in the discussion of that motion, the court would reject these arguments. But more importantly, having concluded that the defendant is entitled to summary judgment on the plaintiff’s bad faith claim, this aspect of the plaintiff’s [*53] argument is moot.

Finally, the court rejects the plaintiff’s argument that the defendant waived the opportunity to object to the plaintiff’s demand for a jury trial. Under the circumstances of this case, the court finds the present stage of litigation to be an appropriate time for the defendant to raise its objection. Therefore, the defendant’s motion to strike the plaintiff’s demand for a trial by jury, (Docket No. 50), shall be granted.

VI. DEFENDANT’S MOTION TO STRIKE PLAINTIFF’S EXPERT REPORT

The defendant objects to opinions offered by the plaintiff’s expert, Daniel Doucette (“Doucette”), many of which are now moot in light of the court’s decisions on other motions. Thus, having concluded that the defendant is entitled to summary judgment on the plaintiff’s bad faith claim, Doucette’s opinions on this topic are no longer relevant. The only topic on which Doucette opined that remains to be resolved is the question of what the phrase “away from prepared and marked in-bound territories” means.

On this topic, Doucette’s conclusions read more like a legal brief than the opinions of an expert. (See Docket No. 61-1 at 19.) He does not opine as to how this phrase is commonly understood in [*54] the insurance industry, but rather offers general conclusions as to what this phrase might mean in the context of skiing. Although Redmond argues that Doucette is qualified to testify also as a ski expert, (Docket No. 91 at 9-10), the court is not persuaded. Doucette may be an experienced skier, but absent additional knowledge, skill, training, or education, the court finds that Doucette is not qualified to testify as an expert on skiing. The court is not going to open the witness stand to a parade of recreational skiers, each of whom would opine as to the meaning of the relevant phrase. An expert is supposed to assist the trier of fact and Doucette’s opinion on these phrases is not at all helpful.

Therefore, to the extent that his opinions are not moot, the court shall grant the defendant’s motion to exclude Doucette from testifying and strike his expert report, (Docket No. 60).

VII. MOTIONS TO STRIKE

Redmond moved to strike portions of the Sirius’ brief in support of its motion for summary judgment on the plaintiff’s bad faith claim, (Docket No. 84), and to strike Sirius’s reply to its proposed findings of fact, (Docket No. 107.)

The first motion to strike, (Docket No. 84), relates to [*55] the fact that in its brief in support of its motion for summary judgment, Sirius relied upon an email exchange it had not previously disclosed in discovery on the grounds that it was privileged, (see Docket No. 76 at 9-10). In response, Sirius apparently does not oppose the motion to strike, (Docket No. 97 at 4 (“Sirius will withdraw the previously withheld document at issue…”); its opposition is limited to the request for sanctions. Having considered the parties’ briefs on the matter, the court does not find that sanctions are appropriate. Therefore, the motion to strike shall be granted; the request for sanctions shall be denied.

The second motion to strike relates to the fact that Sirius replied to Redmond’s response to Sirius’ proposed findings of fact. Responding to this motion, Sirius’ counsel acknowledges that he misread what was permissible under the relevant local rule, Civ. L.R. 56(b)(3)(B), and agrees to withdraw the pleading. (Docket No. 109.) Therefore, the defendant having withdrawn the relevant pleading, (Docket No. 106), the motion to strike, (Docket No. 107), is moot.

VIII. CONCLUSION

Notwithstanding his travels, Redmond was “residing in” Wisconsin when he renewed his [*56] travel insurance policy with Sirius. Therefore, under Wis. Stat. § 631.83(3)(b), the policy’s forum selection clause is unenforceable. Balancing all other relevant factors, the court does not find that transfer to the Southern District of Indiana pursuant to 28 U.S.C. § 1404(a) is appropriate. Therefore, Sirius’ motion to transfer will be denied.

However, the choice of law provision within the contract shall be given its effect, and therefore Sirius’ motion for an order holding that Indiana law applies to the present case will be granted.

As for the parties’ motions for summary judgment, the court concludes that the mountaineering exclusion is unambiguous and does not exclude coverage for Redmond’s injuries. As for the skiing exclusion, Redmond was engaged in recreational skiing, and there is no evidence that Redmond was skiing “in violation of applicable laws, rules or regulations … and/or against the advice of the local ski school or local authoritative body.” However, the provision excluding coverage for skiing “away from prepared and marked in-bound territories” is subject to varying interpretations and the evidence before the court is insufficient to enable the court to conclude [*57] that either party is entitled to summary judgment on the question of whether the policy provides coverage for Redmond’s injuries.

The court shall grant the defendant’s motion for summary judgment with respect to the plaintiff’s bad faith claim. The evidence is insufficient to permit a reasonable finder of fact to conclude that Sirius acted in bad faith in denying Redmond’s claim. Moreover, Sirius’ litigation conduct cannot form the basis for a bad faith claim because Redmond never amended his complaint to state such a claim.

The defendant’s motion to strike the plaintiff’s demand for a jury trial is granted in accordance with the plain language of the policy, and therefore in any trial in this matter, the court shall serve as the finder of fact.

The report of plaintiff’s expert Daniel Doucette is largely moot in light of other conclusions by the court, but to the extent it is not moot, the defendant’s motion to strike is granted. The plaintiff lacks the qualifications to testify as an expert on skiing and his opinions regarding the meaning of the phrase “away from prepared and marked in-bound territories” are insufficiently supported to come within the appropriate ambit of an expert.

Finally, [*58] with respect to the plaintiff’s motions to strike, the defendant concedes both. Therefore, the plaintiff’s motion to strike portions of the defendant’s brief in support of its motion for summary judgment is granted and its reply to the plaintiff’s response to the defendant’s proposed findings of fact is deemed withdrawn. The court declines to impose sanctions.

IT IS THEREFORE ORDERED that the defendant’s motion to transfer this case to the United States District Court for the Southern District of Indiana, (Docket No. 54), is denied.

IT IS FURTHER ORDERED that the defendant’s motion to strike the plaintiff’s demand for a jury trial, (Docket No. 56), is granted.

IT IS FURTHER ORDERED that the defendant’s motion for an order that Indiana law governs the plaintiff’s claims, (Docket No. 58), is granted.

IT IS FURTHER ORDERED that the defendant’s motion to exclude and strike the expert report of Daniel Doucette, (Docket No. 60), is granted to the extent that the motion is not moot.

IT IS FURTHER ORDERED that the plaintiff’s motion for summary judgment on coverage, (Docket No. 63), is denied.

IT IS FURTHER ORDERED that the defendant’s motion for summary judgment on future medical expenses, (Docket [*59] No. 66), is denied as moot.

IT IS FURTHER ORDERED that the defendant’s motion for summary judgment on the plaintiff’s breach of contract claim and the defendant’s breach of contract counterclaim, (Docket No. 70), is denied

IT IS FURTHER ORDERED that the defendant’s motion for summary judgment on the plaintiff’s bad faith claim, (Docket No. 75), is granted.

IT IS FURTHER ORDERED that the plaintiff’s expedited non-dispositive motion to strike, (Docket No. 84), is granted. The request for sanctions is denied.

IT IS FURTHER ORDERED that the plaintiff’s expedited non-dispositive motion to strike, (Docket No. 107), is denied as moot. The defendant’s reply, (Docket No. 106), is considered withdrawn.

IT IS FURTHER ORDERED that the court shall hold a telephonic conference on January 28, 2014 at 9:00 AM (CST) to discuss scheduling this matter for trial. The court will initiate the call. Not less than 48 hours before the call, counsel participating in the call shall provide to the court via email to GoodsteinPO@wied.uscourts.gov a direct telephone number where counsel may be reached for the call. The court strongly discourages the use of mobile phones for conference calls.

Dated at Milwaukee, Wisconsin [*60] this 15th day of January, 2014.

/s/ Aaron E. Goodstein

AARON E. GOODSTEIN

U.S. Magistrate Judge

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Indemnification agreements? What are you signing?

Suddenly, indemnification agreements are flying around the outdoor industry. Make sure you know what you are signing.

Indemnification agreements, either as part of another document or individually are being tossed around the outdoor industry. So far, they have all been written by non-attorneys. By that I mean they are written badly or by someone who does not understand what they are and how they work. Before you sign an indemnification agreement, you need to understand what you are signing and the ramifications of signing it.

An indemnification agreement is similar, not like, but similar, to an insurance policy. Most times an indemnification agreement says you will pay us (indemnify) for any money we spend because of your actions that have cost us money, including our costs and attorney’s fees.

An insurance policy is slightly different than indemnification policy for two reasons.

1.   An insurance policy is very specific on what if covers. If it is not written in the policy as something that is insured, then you will not get money.

2.   You pay for a policy. The amount of money you pay is based on the risk; the greater the risk, the more money you pay for the policy.

Indemnification agreements in the past have been narrow and focused on specific issues that the parties negotiate. The indemnification agreement said if something you did brings us into a lawsuit, you have to reimburse us for our costs if we are sued because of what you did. Indemnification agreements were written into contracts as part of the overall deal.

An Example would be:

A manufacturer makes a product with a defect, and the retailer is sued because of the defect by the consumer who purchased the product. The liability issues are set forth because the agreement says the retailer must be sued or there must be liability or a claim.

First Problem: Consideration

For a contract to be valid there must be consideration. Consideration is a benefit flowing from one party to the other party. Normally, consideration is money. If a contract and a course of dealing exist between two parties, if one party now wants an indemnification agreement signed, there must be new consideration. You have to pay for the new agreement to be a contract and to be binding. No consideration, no contract.

Second Problem: Overly Broad

The indemnification agreements I am seeing recently have been very broad and cover everything. There are major issues with a document this broad because it is impossible to comply with. By that I mean there are realistic limits to what can be indemnified. The major item controlling indemnification agreements is money. If you don’t have a bank account with enough cash in the account to cover the indemnification bill when it comes due, why sign the agreement to begin with?

1.   You can only sign what you can pay for.

Unless you are dealing with broken products (replacement) or fixed amounts (breach of contract), you can only sign an indemnification agreement that has limits that you can afford. If you sign an indemnification agreement knowing there are no way you can pay for it, you are creating additional problems; misrepresentation and fraud (see below). If you can’t pay the bill when it comes due, you will either file bankruptcy and or go out of business.

Make sure you know how much indemnification will cost you and whether or not you can deal with the bill. If you don’t have the cash, then you better have an insurance policy.

2.   You can only sign what your insurance policy says it will cover.

99% of the time, an indemnification agreement is really based on your insurance company stepping up and writing a check. The insurance company does that because:

A.   There is a legitimate claim covered by the policy.

B.   The claim is within the limits of the policy.

C.  The insurance company knew about the indemnification and agreed to it in advance! (Oh?)

If your policy is not broad enough, does not cover everything covered in the indemnification, you are again on the hook yourself. Your commercial policy is very different from your homeowner’s policy. Your commercial policy says it covers everything on the list of covered items in the policy. If the claim is not on the list, you have no insurance coverage.

Your insurance policy is written to pay claims, not necessarily contracts. If the indemnification is not based on a claim or legal liability, your insurance policy may just ignore the issue. The insurance company is not contractually required to pay what is not covered in the policy.

3.   If your insurance company does not know about the indemnification and agree to it, you still may not have coverage. You are back to writing a check.

Your insurance company in many cases can cover indemnification; however, many policies require knowledge in advance or in some cases need to approve indemnification. Sending an indemnification claim to an insurance company based on a contract you signed without the insurance company knowing about the indemnification agreement in advance is an easy way to get the claim denied or the policy non-renewed the next time it comes up for renewal.

4.   Signing an indemnification agreement without the ability to back it up is a misrepresentation in some states.

Misrepresentation pierces the corporate veil making you personally liable for the claims. (The sole exception to this MAYBE if you are an LLC; however several states have not ruled that an LLC can be pierced for misrepresentation and fraud.) Simply put, you sign a contract knowing you cannot complete the contract that is called misrepresentation and maybe fraud. Misrepresentation and fraud on the part of the owner of a corporation, when dealing with monetary issues, is a way to pierce the corporate veil. Piercing the corporate veil is one way of making your personal assets liable for the claims against your business.

This might be a stretch in some cases, but it is clearly within the realm of possibilities, especially if you have a lot of personal assets. Attorneys and insurance companies work harder if they know there is a payoff.

If you can’t fulfill the indemnification agreement, and you have no insurance to cover it, you better not sign it.

5.   You should not indemnify someone for something that you are not liable for.

This is simple. If you don’t owe the money, why would you say you owe the money? Many of these agreements are asking for indemnification for issues that you have no legal liability for. It is hard to be liable for how a product is used if they do not read the instructions. An example would be an employee of a retailer store is demonstrating your product without reading the instructions, attending the tech clinic or understanding the product. During the demonstration to the consumer, he injures the consumer.

Why would that be your fault and why should you pay for it? Yet a few indemnification agreements I’ve read lately would require the manufacture to pay for the injuries.

As a manufacturer you are not legally liable for that claim. It is not your fault; you were not negligent. However, the indemnification agreement you signed said you would pay for any claim based on your product. The consumer has a claim against the retailer, because of the product, but not because the product was defective. The retailer is solely liable for the claim, and you should not be.

A.  You should only indemnify someone for what you are responsible for.

Conversely, you should agree to indemnify someone for what you are liable for. If it is your fault, you should pay. Many indemnification agreements are being written because the cost of getting a manufacturer or liable party to pay up exceeds the amount owed. I understand that reasoning, and it is sound and smart.

A good example of these is: you are running an event on property owned by a third party. You accept the money for the event, set up the course, review the entrants and totally control the event. The landowner’s sole responsibility in the event was providing the land and pointing out any known or reasonably foreseeable dangers on the land.

If someone is hurt in the event and sues the landowner, the event promoter should protect the landowner.

B.  You should not indemnify someone for what you do not have control over.

If the landowner is told by the event promoter that he cannot tell the event promoter how to run the event, the landowner should not be liable. The landowner has no control over the event. Therefore, the landowner should not be liable.

The manufacturer can only be liable for the product. If the sales person working for the retailer tells the consumer that this product will save their lives and prevent all injuries contrary to the manufacturer’s warnings, manual, instructions and marketing, then the manufacturer should not pick up the tab for the injured consumer. The manufacturer had no control over the salesperson, did not even know the salesperson existed, and therefore, should not be liable for someone they have no control over.

A manufacture could be liable if they have not disclaimed the warranty of merchantability or the warranty of fitness for a particular purpose, but that is for another article.

C.  You should only indemnify someone for what your insurance company agrees to indemnify someone for.

That means you should only indemnify someone for:

a.   What you can control.

b.   What you are liable for.

c.   What insurance policy says it will cover?

But they are my friends; they would never sue me based on the agreement!

They might not, but your friend may not always be in control of that agreement. Anyone who becomes a beneficiary or an owner of the contract can use the indemnification to sue you. The two best examples of this are:

A Bankruptcy Trustee: A bankruptcy trustee is an attorney whose job is to find every dime that may be owed to the bankrupt business. Any contract that has not been fulfilled, any invoice that has not been paid, and any indemnification agreement that may have money tied available, will be fair game. If the Bankruptcy Trustee can determine if the business that signed the indemnification agreement owes the bankrupt business money, the Trustee by law, must get the money back.

The Bankruptcy Trustee will sue in the name of the Bankrupt Company claiming indemnification for an earlier claim. You will think you are free and clear because the company you signed the indemnification agreement with filed bankruptcy. However, the Bankruptcy Trustee will come rowing back to the courtroom and hold you liable to the point of forcing you to file bankruptcy.

The Insurance Company under the Subrogation clause of an insurance policy believing the indemnification agreement allows them to collect from you. Every insurance policy has a subrogation clause. That means that the insurance company has the right to recover from anyone who caused the claim that the insurance company wrote a check for. Insurance companies will spend days looking for anyone who they can recover money from, and an indemnification agreement is a perfect opportunity. I would guess that 30% or more of the lawsuits in the US are insurance company subrogation claims.

Subrogation claims can be filed by worker’s comp accidents, car accidents, general liability or health insurance claims.

Again, the lawsuit will be in the name of the company you signed the indemnification agreement with, and that company has no choice. If the company does not cooperate with the insurance company, the original claim may not get paid. Insurance companies will finance the lawsuit, so there are no legal games to be played; they know what they want, and they understand the cost of getting it.

If you want Indemnification Agreements…. And you should then get them in a way that works for everyone.

Spending time money legal fees on an agreement that won’t be used or cannot be collected on is a waste of time.

1.   Be realistic.

a.   With you asking to indemnify for what

b.   What they can pay or what insurance they can purchase and afford.

c.   With what you need indemnified, with what someone other than you is legally liable for.

2.   Be prepared to offer one in return. Why should I sign yours if you are going to leave me out in the cold for any claim or liability you cause? Besides mutual indemnification, agreements take out the consideration issue if written correctly.

3.   Make sure it is signed by the right person. A corporation has officers. The board of directors of the corporation authorizes the officers to sign agreements for the corporation. An indemnification agreement is a big deal so make sure the person signing it has the authority to sign the agreement. Having a sales person or sales manager sign the agreement is a waste of trees.

4.   An indemnification agreement without a Certificate of Insurance or an Additional Insured document that is tied to the Indemnification Agreement, not just with it, is worthless.

The certificate of insurance must be legally tied to the indemnification agreement or both are worthless. There is no insurance to cover the indemnification and not money to indemnify the problem.

5.   Have an attorney write your indemnification agreement so it works.

One last point

Signing indemnification agreements may increase your insurance rates. Basically, instead of insuring you, your policy is not insuring dozens of other businesses and their employees. Your insurance company, if they continue to renew your policy, may increase your premium because the risk has increased.

(Insurance companies also do this based on the number of Additional Insured’s you issue and the coverage you make available to the Additional insured’s. Again, that is another article for another day.)

Indemnification agreements work, but only if written correctly and written with knowledge of how and why they work.

What do you think? Leave a comment.

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Copyright 2012 Recreation Law (720) Edit Law

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By Recreation Law          Rec-law@recreation-law.com   James H. Moss                  Jim Moss

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Newsletter has good ideas, but also misses the mark a little

Church Mutual newsletter needs a little clarification about allowing groups into your facilities.

The article was a newsletter to insured’s and interested parties to help them reduce their exposure to risk. The issue was a question and answer about how you deal with

English: Charles Simms, March 17, 1796, Fire I...

English: Charles Simms, March 17, 1796, Fire Insurance Policy (Photo credit: Wikipedia)

groups that want to use your facility. There were three issues that I think need clarified.

The first was all groups that want to borrow, rent or use your space should provide the owner with a certificate of insurance. The quote was:

Once approved, all groups must provide a certificate of insurance from either a local or national organization as a condition of using our facility.

1.     The Certificate of Insurance should be from a National Insurance Company.

2.     The certificate of Insurance should name your facility or the owner of the facility as an additional insured on the certificate.

3.     The certificate of insurance should also include a copy of the insurance policy. There are a lot of “fake” certificates of insurance and a copy of a policy allows you to call the issuing company and verify the insurance is in force.

The second issue was:

Small groups without insurance are required to sign a waiver stating that the group and individuals will not hold Presbyterian Church of the Master responsible for any injuries or other losses they might incur while on our property.

1.     When a group signs an agreement that says the group will protect the owner of the property from claims, it is called a hold harmless or an indemnification agreement.

2.     A waiver is a release signed by an individual before an accident releasing the other person from any liability.

3.     A hold harmless or indemnification agreement without an insurance policy behind it is worthless. How many groups of “people” have enough money to reimburse you for a claim?

A better approach would be to have each person coming to the event at the facility to sign a release. Yes, it is a pain in the butt, but it is the only real protection you if cannot get a certificate of insurance and a copy of an insurance policy.

The best thing to do is make sure your facility is as safe as you can make it, any non-safe areas or not accessible and the place is clean. Better to not have an accident then it is to try to defend one. In a building situation, it should be fairly easy to have your facility inspected to make sure it is up to code, standards and the latest and greatest for your guests and others.

The final issue was the group using to facility had to abide by the “standards of use.” Have rules that the group agrees to abide by. Make sure the rules are understood. Do not use acronyms, explain everything. If necessary do a walk-through of the property and make sure the renters understand the rules.

Don’t expect the rules to be followed.

See Risk Reporter talks with Woody Burge about facility rental

What do you think? Leave a comment.

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NPS is chasing a squirrel up a tree and it’s lost in Canyonlands NP.

Outside parties suggest insurance limits of $5 million for concessionaires.

The National Park Service has hired outside firms to determine that concessionaires should have $5 million in liability insurancecoverage. The article does not say how

National Park Service emblem

that number was determined. However, how the limit was determined was wrong.

You determine the amount of insurance you need by determining your insurable interest. How much is your business worth? By that I mean you determine the value of your business, what is worth it, if you were to sell the business.   then buy a little more insurance than that.

Say your business is worth $1 million. Based on all the property, land, income, permits (which allegedly have no value) your CPA has determined that your business valuation is $1 million. You should buy $1.1 million in insurance coverage. Probably, you will end up buying $1.5 or $2 million because polices are rarely written for $1.1 million, usually just big round numbers.

Why? Because you are protecting what you own. That is what insurance is for, to protect an asset. You buy fire insurance to replace a building if it was to burn down. If it cost you $500,000 to rebuild the building, it would be stupid to insure the building for $400,000 and just as stupid to insure it for $600,000. In the first case, you would only have a $400,000 building when you were done, not what you needed. In the second case, you would have a $500,000 building and nothing more. You would have paid a premium on an extra $100,000 of insurance that you will never get.

You can’t insure what you don’t own or for an inflated value.

The same goes for liability insurance. Why insure your business for more than it is worth. All you want to do is keep your business. You don’t want to pay for insurance that you don’t need. All that does with liability insurance provide an incentive to sue and a bigger payoff if they do.  

The last think you want to do is to have less insurance than the value of your business. If your business is worth $1 million, and you have $500,000 in liability insurance, the plaintiff will sue and take your business. That is $500,000 more than your insurance.

You buy the amount of insurance that you need to protect your business from fire, wind, hail and lawsuits.

So what is the NPS going to do?

First, they could bankrupt large business that only buys the minimum to maintain their concession contract. If they are worth more than $5 million, then they will lose their business if a guest has a claim greater than $5 million.

The NPS may also bankrupt businesses if they ask a business with a value of $100,000 to buy a $5 million-dollar policy. They could not afford it.

The only people who will not suffer are those businesses that are worth more than $3.5 million. The $5 million limits are about right.

Based on the article, the NPS will bankrupt a lot of its concessionaires.

The NPS currently has 515 concession contracts in 130 parks, with 60 percent of those contracts generating less than $250,000 in annual revenue.

As stupid as that sounds, this quote from the “insurance professionals” that the NPS hired is even stupider from an insurance standpoint.

Insurance Journal obtained a copy of the Aon Global report dated January 11, 2011. “In our opinion, business operations that potentially could result in serious injury to multiple parties should consider liability limits of at least $5 million,” the Aon report says. “Based on the loss potential, we consider the $5 million limit to be reasonable for most river rafting and guide situations.”

Why is that a stupid statement? Because insurance claims are based on a real value in the end. You total the medical bills, the future medical bills, the lost wages and an amount for pain and suffering and that amount is what a claim amount boils down too. If 99% of your clients make about $50,000, a year and 99% of your injuries are sprained ankles than your claims limits would be $10,000. Someone who can’t work for months and only makes $50,000 a year would after one year out of work, only recover $40,000 or so. The amount earned is discounted because you would not have costs of working and there is a value of getting the money in one lump sum in advance.

To determine the insurance limits an actuary would look at claims. And the claims don’t justify the limits the “experts” are requesting.

Besides insurance is not based on what someone is owed, insurance is based on what you are worth as a business.

Based on the quote above, the value the “experts” came up with is based on a mythical future claim with multiple injured parties.

I’m still waiting for that to happen. Reality and the “experts” have not met. Read the article, the “experts” look pretty bad. Even worse, the NPS admitted that they had no claims like this in testimony before Congress.

Insurance is not determined by guesses or experts, except a business’s CPA. How much is the business worth that is the amount of insurance you need!

See New National Parks’ Insurance Requirements Ignite Controversy or New National Parks Outfitters & Guides Insurance Requirements.

For more articles on the insurance issues see: Insurance 101

What do you think? Leave a comment.

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Auto Service Company to offer Bicycle Insurance, It All ready offers Rides

http://betterworldclub.com/go_forward/index.htm
http://betterworldclub.com/go_forward/index.htm
April 27, 2012
GET MOVING
Better World Club to Offer Bicycle Insurance!New Program to be One of the First in America

The Better World Club will soon be offering one of the nation’s only bike insurance policies. Until this year, cyclists in the U.S. could only obtain protection piecemeal through their auto, homeowner, or health insurance. We are thrilled to announce that we will soon be adding bike-specific insurance to our already-groundbreaking nationwide bicycle roadside assistance program. It will include both medical and liability coverage, with optional coverage available for property damage and theft.
bike.jpg
We could use your help to get this program up and spinning! If you’re a cyclist, please answer a few questions about our bike insurance by clicking here.

If you know other cyclists or local bike organizations who might be interested, spread the word.

forward2.gif

We fight for everyone’s right to use the road, and for their right to be safe while doing so. We’ve supported safe passing laws, opposed the removal of bike and pedestrian infrastructure funding, and worked with the League of American Bicyclists to provide great incentives to our non-driving members. Now that we’ve convinced insurers to give cyclists the same protection as motorists, we’re ready to show the nation that “alternative” transit doesn’t have to mean facing four lanes of traffic with only a helmet to protect you.

 

 

SPECIAL CAMPAIGN
Join Us in the National Bike Challenge!We’re Throwing Down the Gauntlet and Stepping Up to the Plate

Not to mention mixing metaphors. But seriously, folks! An alliance of heavy-hitting bike organizations (including our obvious crush, the League of American Bicyclists) has started a new nation-wide bicycle commute challenge. The program runs May 1 to August 31, and has the goal of uniting 50,000 people to bike 10 million miles. We aren’t sure if they’re ambitious or crazy, but either way, we want in on the action. We’ve signed up a team, and think you should do the same! The user-friendly website helps you track your miles, and participants can win prizes ranging from water bottles to cycling trips through California’s wine country. We have our corkscrew multi-tool all sharpened and ready. Click here to read more!

NatBikeChallenge-header.jpg

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Insurance company release fails, even in the state where the company is located

Sport Underwriters.com release has some good points, but overall it has major flaws.

I received this release, which was provided with a quote for insurance. The quote was great. The quote required the insured to have a Waiver and Release System:

Waiver & Release System:

The insured must maintain a system to regularly secure signed Waiver and Release forms from participants. For minor participants, these waiver/release forms should be signed by a parent or guardian. Unintentional error on your part in securing Waiver and Release forms will not void your coverage in the event of a claim by a participant; however, your failure to maintain an adequate system to regularly secure Waiver and Release forms will void your coverage in the event of a claim. All waivers & medical release forms must be approved by underwriters; if you do not have one, we will provide for you.

Overall, that is a good thing. It is also not so different from what most insurance companies want to achieve. However, very few make it such a mandatory issue.

However, I am curious if their system allows for states to not have a system if they are prohibited by law or where releases have no legal value. (See: States that do not Support the Use of a Release.) Montana not only does not allow the use of a release, if an outfitter is found using one, their state license will be yanked, and they will be prohibited from engaging in any business.

Let’s look at the release itself:

This release came from a Sport Underwriters.com. The release also says it is a division of Sport and Special Event Insurance Agency USA which can be found here. That agency is located in New York, which does not allow the use of a release for commercial activities. (See New York Law Restricting the Use of Releases)

The release in its first paragraph states it covers “traveling to and from activity sites in which I am about to engage.”Some states consider transportation to be defined as a “public policy” which is not covered by a release. Some states allow a release to cover transportation if it is incidental to the activity; however, this release does not go deep enough into the issue, in my opinion, to make it effective to stop a suit over a car or bus accident.

The release also states in bold letters that the signor “…will wear approved protective gear as decreed by the governing body of the sport…” Very few outdoor recreation programs have a governing body that decrees safety gear. Some state or federal regulations may require some gear such as PFDs on whitewater for commercial operators, but very little in the rest of the industry.

The release, midway down the page, has a page for the signor to fill in the name of the company or person the release protecting. This is just plain confusing. What if that is skipped, is the release invalid? What if they spell the name wrong or put the wrong name down?

Then the release starts using the term releasees. Releasees is the term applied to the name in the blank. The language is quite broad, but the people being released are, by nature of the way the release is written, very narrowly defined. I generally, in any document being used with the general consumer, avoid using a legal term. It just becomes confusing for the consumer to understand, if they read the document and can make judges and juries mad.  Use the name of the company so that everyone knows no matter how confusing, at least who is being protected.

The release also says you are indemnifying the releasee. I’ve not read a single decision that allows indemnification to work in a release. There is a major difference between indemnifying against losses and stopping them to begin with, unless the indemnification language is written very specifically for a specific reason.

The release has two areas for signatures. One area is for adults to sign, and one area is for parents to sign. Consequently, either you are going to have a parent sign twice or signature line that is blank. There is no place for the minor to sign the agreement.

The parental signage line is preceded by a clause.

FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I, as a Parent, Guardian, Temporary Guardian with legal responsibility for this participant, do consent and agree not only to his/her release of all Releasees, but also to release and indemnify the Releasees from any and all liability incident o his/her involvement in these programs for myself, my heirs, assigns and next of kin.

First, the paragraph is directed to the participants in the first line then refers to the parent guardian. I’ve never heard of a Temporary Guardian. My concern with this is, volunteer youth leaders (church groups, Scout groups, etc.) probably believe they are temporary guardians and sign the form. The outfitter will probably accept the form, not knowing that the signature of the adult has no legal value.

Then the telltale clause that makes me think the release was not written by an attorney: “…agree not only to his/her release of all Releasees, but also to release and indemnify the Releasees…” This language says you are releasing the outfitter and releasing and indemnifying the outfitter. In effect, whoever wrote this stuttered.

Then hint two: “…for myself, my heirs, assigns and next of kin.” The person signing is signing away their right to sue, their heirs, which may include their child’s right to sue, and the adults next of kin. If the child is a minor, they have not signed away the child’s right to sue or the right to sue of the child’s heirs or next of kin.

None of the language above conforms to the required language in Colorado or Florida or the language that other statutes and court cases suggest. As far as a release against the claims of a minor this release fails miserably.

Finally, there is no jurisdiction and venue clause. See Four releases signed and all of them thrown out because they lacked one simple sentence!

My Legal Stutter

An attorney has to write your release. Your release must meet your state laws. Your release must meet the requirements of your program.

Free releases cost you a fortune. The amount of time you will spend defending a release given to you by an insurance company or created by someone who does not understand the legal ramifications is not worth it. No trial will cost you less than ten days, and if you are making less than $1500 in profit in ten days, you need to get another job. J

What do you think? Leave a comment.

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If I were starting a new outfitting business this is what I would worry about from a Risk Management Perspective.

Here is what I would worry about:

1. Do I have a well written release that will cover what I do for the state I do it in? See:

Wrong release for the activity almost sinks YMCA
States that allow a parent to sign away a minor’s right to sue–Updated 2011
Releases are legal documents and need to be written by an attorney that understands the law and the risks of your program/business/activity and your guests/members/clientele.

What is a Release?

2. Am I providing all the information that I can provide to the participants so they understand and assume the risk? See:

Assumption of the Risk

3. If something happens do I have the ability to deal with the problems? Remembering where you are and what you can really do. Small first aid kit and someone to go get help. See:

Money is important in some lawsuits, but the emotions that starts a lawsuit.
Why do people sue? Not for the money.

It’s Not Money

4. Is my marketing program going to cause problems for my risk management program? See:

If you make a promise to attract participants, you must come through on your promises.
Who You Gonna’ Call, Ghostbusters?

INFLATION AND DEFLATION: A Quick Course in Outdoor Recreation Economics

5. Do I have an insurance policy that is going to cover me? Does my insurance agent or broker understand what I am doing? See:

Insurance 101

What do you think? Leave a comment.

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Markel top Five Camp Claims for 2010

Claims are mixed between general liability and property damage claims, but instructive. 

Markel Insurance has listed their top five (5) claims for the 2010 camp season.

1. Auto-related events. The majority of driver-at-fault accidents involved backing into and hitting parked vehicles, colliding at intersections, rear-ending other vehicles, and striking objects such as deer and trees.
2. Tripping and falling accidents. These events often took place on playground equipment and during open-field game activities.
3. Wind damage. Wind-related damages were primarily caused by trees falling on structures during strong storms.
4. Abuse. Abuse allegations reported during 2010 were primarily camper-to-camper incidents.
5. Lightning damage. Damages occurred to office equipment, such as computers and telephone systems.
Auto, Wind and Lighting are property damage claims. In most cases, these are the real reasons why you have insurance. To pay for damage for things you cannot control, wind and weather.

Tripping and falling accidents are the curious claims listed. Kids fall down. Many of these claims can be avoided if the parents know that kids are going to be hurt when they run, jump and play.

The Markel Risk Management Tips newsletter can be seen here. To sign up for the newsletter go to CampInsurance.com. A complete article about the top five risks can be found at Train Your Staff with Lessons from the Past.

What do you think? Leave a comment.

 
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Why Get Involved in Litigation

Why waste money shooting yourself?

Over the past several years disturbing situations have come to my attention from the fitness and recreation industry; both wasting time and money. Both are identical in their nature. Someone tried to put a competitor else out of business by using the legal system. In short it doesn’t happen, won’t work and only hurts the industry.

In the first case, I was handed press releases by a manufacture touting their president’s work as an expert witness, against competitors. The president of the company issuing the press release had been testifying as an expert witness in lawsuits against his competitors. It seemed that the manufacture’s product claimed to be safer, (and might be). The president of the company had been testifying for plaintiffs injured with products manufactured by competitors that failed. The press release touted that after the president’s testimony the defendant’s quickly settled the case. The press release touted the president as a hero for helping to make the industry safer, or actually by saying his product was better.

In the second case, one trade organization attacked another trade association. One association attempted to eliminate another association’s ability to be “sanctioned” by a third association. The third association by sanctioning the first association had given the first association credibility. The second, aggressive association received the sanctioning also, then attempted to have the first associations sanctioning withdrawn. The first and second associations are competing associations doing essentially similar things for the same industry. The aggressive association spent more than $10,000 in time, attorney fees and costs to try and have the first associations sanctioned and failed.

In the first example, the long term effect will be to drive up insurance costs nationwide for every manufacture including the one testifying against the others. The only real effect will be to put everyone out of business, helping no one. As I have said many times before, the insurance industries represented in the outdoor recreation and fitness industries are small pools of money. So small that it is easier not to offer insurance than it is to raise rates as evidenced earlier this decade in the climbing gym and ropes course industries. By promoting, encouraging and participating in lawsuits against competitors you are doing nothing but economically slitting your own throat.

What insurance company is going to offer insurance to a company whose president promotes litigation and increased costs based on his own testimony? Insurance companies do not look at whether or not the business they are insuring is making money, but whether or not they the insurance company is making money. Insurance companies do not like litigation or anyone who promotes litigation, which may cost them money. More importantly, they do not like anyone in their own insurance pool that is taking money out of the insurance pool.

Trade associations are created, according to the internal revenue service, to promote an industry. To help the members achieve their goals. Associations should not have goals outside those of their membership. Consequently, spending $10,000 or more for one association to fight another for the benefit of the association seems to be another big waste of money and probably not part of the purpose of the association.
The word competition does not include the word litigation. Competition is doing the best in your business to promote your business. Every minute you spend trying to put your competitor out of business are two wasted minutes. You wasted a minute that will accomplish nothing, and you lost a minute you could have spent working on your business.

It is about time that everyone looks around in their industry and promotes the industry for their benefit. Sure, that may give rise to more money for a competitor, but more importantly it will help you. Fighting within an industry is just plain stupid when there are enough people outside of the industry willing to do that for you.

What do you think? Leave a comment.

© 2010 Recreation Law (720) Edit Law, Recreaton.Law@Gmail.com

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Insurance 101

Claims/Deductibles and Costs

Insurance policies are contracts. They are governed by the law of contracts as well as a specific body of law covering insurance policies. As such the contract, the written document you receive upon paying your premium (money) controls the insured (you) and the insurance company. Because it is a contract, there are no exceptions outside of the written contract and any oral statements or promises do not apply to the contract.

Deductibles were introduced to eliminate small claims. A claim for $200 cost the insurance company $1000 whether the claim is paid or not. The insurance company must open a file and keep that file for a long time. The insurance company must investigate the claim, which may include sending out an adjuster out to look at the issues or to interview people. Every claim, large or small, costs the insurance company money. As such, to save money, the insurance companies introduced deductibles. You pay out $200 for your claim, and we will lower your premium by $X dollars and save us $XXX dollars.

Deductibles also eliminate questionable claims. The insurance company does not have to worry about paying a claim they don’t want to because it is lower than your deductible.

To understand this, call your insurance agent and ask for quotes on your homeowner’s insurance (easiest because it is a yearly premium) for Zero deductible, $250 $500 $1000 and $5000 deductibles. Take the savings between the zero deductible policy and the $1000 deductible policy cost and multiple it by 7. That number should be more than the higher deductible. That is because the average homeowners have a claim 1 every seven years (at least that was the average a few years ago. It might have changed because the number of years someone owns a house has dropped over the last 20 years.)

Example. Your premium for a zero deductible policy is $1000 a year. Your premium for a $1000 deductible policy is $800.00 per year. The difference: $200.00 times 7 is $1400.00. If you only have a claim 1 every 7 years you will have saved $400.00 by having a higher deductible. If you have a $2000 claim you pay $1000 and the insurance company pays $1000.00. You saved $400.00 and it cost the insurance company more than $1000.00.

Automobile insurance does not work quite the same way mathematically because the liability part of your insurance premium is the larger portion.

Why the lesson. Because whether your insurance premiums go up are not controlled by large claims. They are controlled by claims. Large claims are actuarially calculated and known to cost and time by the insurance company. Small claims are a pain in the butt for the insurance company. If you have too many small claims, the insurance company will not renew you, or they will increase your deductible and not change your premium. Insurance companies look at small claims made by policy holders as those people they do not want to do business with. They are a pain in the neck; they want to nickel and dime the insurance company.

Large claims only affect cost or renewal if they were totally the fault of the insured and should have been prevented. The insurance company looks at claims that were responsible as much as why the claim occurred. A large claim is usually one where no one had much control, whereas small claims are usually controllable. A small claim or a large claim that should have been controlled/prevented is the insured’s responsibility and something insurance companies do not stick around to deal with after they learn. As such, when the insured is at fault polices are not renewed or premiums go up.

Do the math. Ten $200 small claims can cost more that are not paid cost more than one $1500 claim that is paid? Paid claims cost less because they are easily determined and paid. “Yup we owe, write a check, done.” So now you understand insurance, claims and deductibles for your insurance policies.

What do you think? Leave a comment.

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Money Magazine has a great article “5 Things to Never Say to Your Insurers”

Money Magazine November 2009 has an article 5 Things to Never Say to Your Insurers on page 32. The 5 things to not say are:

  • I think
  • I got whiplash
  • It’s an experimental treatment
  • My basement flooded
  • Just send me a check

I think is an opinion and opinions get everyone in trouble. Only give any law enforcement officer or insurance investigator facts not opinions. Even if asked be hesitant about what you think, it raises warning flats in everyone’s mind and may lead the investigator down the wrong trail.

I got whiplash is key to start a fraud investigation. If you are hurt, just refer the investigator or claims adjuster to your health care provider. Unless you are a physician and can provide the investigator with the correct medical terminology, don’t. If your neck hurts, say your neck hurts or whatever hurts or does not work. But leave the medical diagnose to your physician.

It’s an experimental treatment translates into insurance speak as “then we are going to experiment on not paying you.” Insurance companies are not required to pay for experiments, even if you believe it may keep you alive. The key term is, is the treatment medical necessary. Again experiments are not medically necessary.

My basement flooded talks about an accident that is not covered. Rain is covered, once water hits the ground, it is called surface water and no insurance policy issued by an insurance company covers it. You must buy a flood insurance policy from the federal government if you want to have coverage for flooding. If the flood was caused by a burst pipe, which is covered tell them what happened, not the results in this case.

Just send me a check. Insurance is used to put the policy holder back in the position where they were before the incident. If you want to use the money for something else, which in some cases may be illegal or a breach of the policy, you can’t tell the insurance company. They want the money to go to fix the problem.

Insurance companies may be owned by shareholders or owned by the policyholders, either way they are not supposed to pay fake, fraudulent, experimental claims or pay for things other than what is specifically listed under the policy.


BSA develops successful defense strategy: Train your attorneys

The Boy Scouts of Americawent from a poor win record to almost a perfect record by organizing and training their attorneys. Business Insurance

History of the Boy Scouts of America

Image via Wikipedia

reported in an article Risk Manager of the Year, published April 24, 2006 that the BSA’s risk manager had organized their defense counsel to make these dramatic changes. In doing so the Risk Manager, Debra Griffith, became the Manager of the Year for her success.

The first approach was to create a unified defense strategy. One law firm was hired to coordinate all lawsuits. This took the claims out of the hand of the insurance company who hired good counsel but never provided additional support for the defense attorneys. Information and successfully strategies where then routed to all attorneys handling cases providing solid ideas and information.

A second approach was to make sure all interrogatories where reviewed by the BSA defense team. This made sure that all interrogatories were answered correctly and the same way.

If you did not know, the plaintiff’s bar has been filing documents for years so answers to interrogatories form another case can be searched to find inconsistencies.

The third idea, and to a large extent the most controversial was a unified training program of all defense counsel…..at a Boy Scout Camp. This allows the defense counsel to get a real feel for the BSA and how the program works. These training programs encourage information and idea sharing both at the conference and when the attorneys go back to home.

It is this last idea that I find so exciting and valuable. From studying motions and briefs and talking to other attorneys in cases the only difference between winning and losing is not the facts of the case but how well the attorneys representing the defendant understand what the defendant was trying to accomplish and how. It is one thing to understand the problems when someone is injured on a ropes course. It is another when the defense team understands the physics of the activity as well as the goals of the participants in the activity.

Another way of looking at this is horseback or equine suits. Falling off a horse produces the same type of defenses: release, equine law and assumption of the risk. However the risks can be explained in a much better way when the plaintiff was part of a weeklong camp program versus someone who rented a horse for a day. The education and care that a camp provides is much different and creates a very different atmosphere from a trail ride offered out the back door of a conference center. Knowing why people are riding the horse can be important in defending a case as knowing the legal issues.

Reading between the lines is to not leave this solely to your insurance company. They will not hire the best law firm, they will not assist in training or getting the firm up to speed, they rarely understand your program and they won’t support you if the dollars look better to sette.

My own experience supports this idea. In the outdoor recreation industry we win cases when the defense firm understands what they are defending rather than throwing the case in their pot and following the same old strategy. Outdoor recreation is different from an auto accident, a fuel spill and a breach of contract. The participants and the outfitters/facilitators/guides are working together to accomplish goals. These facts combined with an attorney who understands the goals of the program, the program and the defenses create a win.

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Travel Insurance Issues Outlined

There is a great article on understanding travel insurance at Understanding Travel Insurance For Sports And Hazardous Activities. Most people don’t use it, but when you are spending several thousand dollars for an adventure vacation it can be valuable. As an example, if were planning a trip to the North side of Everest this spring, you just had your trip cancelled by the Chinese as they attempt to put the Olympic torch on the summit. Trip insurance might help recover your costs.

Travel insurance is divided into two different types of travel policies, although both are referred to as travel insurance.

The first is a policy that covers your cost of the travel part of the trip. Your flight, your hotel costs, those things that are about a trip. Some of these policies cover lost luggage, the cost of extra charges on a cancelled flight, those pure travel related issues. This type of policy would help you recover your costs if you had been scheduled to climb Mt Everest from the North this spring. Most of these policies would cover your costs in your flight, hotel and some incidental costs for the cancelled trip.

The other type of policy includes health or medical insurance for injuries that may occur while traveling. These policies may or may not include covering a rescue or evacuation. It is this second type of policy this article addresses. They are great gap fillers if your health insurance policy is geographically limited or limited to the extent of coverage or activities covered.

Some policies can be purchased that combine travel coverage and the medical coverage under one policy. Both policies usually cover the extra cost of getting home earlier than planned on a flight due to an illness or an emergency.

The valuable part of the article discusses the difference between an accident on an excursion or activity that is an adventure which would be covered and an adventure activity which would not be covered. One is incidental to the main trip which most insurance policies cover and the other is an adventure trip that is not covered by most policies. That is a trip where you are doing a five day safari riding elephants would not cover falling off an elephant. However a trip to Africa where one afternoon you ride an elephant and fall off would be covered. Read the fine print before you buy and buy the policy that covers your trip and trip needs.

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Common Mistakes made by Outfitters and Insurance Companies

BACKGROUND

An eastern canoe livery operation was open during high water after Hurricane Floyd. A canoe livery is a hybrid between an Outfitter and a Rental operation. Courts have determined that because the Livery is in charge of the pickup and return of the guest as well as only allowing the rental of the canoe on one river, the livery is not a rental program but more closely aligned to an outfitter. Although customers rent canoes, the livery controls every aspect of the customer’s experience, as such, the livery owner is held to the standard of an outfitter.

At a canoe livery, the customer pays for a canoe, paddles, life jacket and transportation. The customer is fitted with a life jacket, handed a paddle and escorted to his/her canoe. At the end of the specified trip the canoeist pulls over and is driven back to the rental operation by the livery operator. In some cases, a customer is transported up river and floats back to the livery operation. The canoe livery controls where the activity takes place, the time the participant is on the river, and transportation to and from the river. Most liveries operate on class 0 or 1 rivers, rivers with current but no rapids.

Liveries are mainly located in the eastern United States, usually within 2-3 hours of large cities. Church, school and youth groups are a large part of their business. Most are family run businesses that have been in operation for twenty years or more.

Instruction is generally not provided and rarely requested. The rivers are calm. Sitting in the canoe and holding on, will normally allow you to arrive at the takeout unscathed.

Ten years ago, life jackets where an “add on” – provided if the customer requested one. Normally, customers were handed a floating seat cushion. Since then, the standard in the industry has evolved to giving every customer a life jacket which buckles or straps on, even though most states by law do not require them in canoes.

FACTS OF THE CASE

An elderly canoe trailer near Nashville, Michi...

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1. Livery Statement: In this case, a recent storm had increased the river flow. The river was higher than normal but not closed. The customer called the livery the day before to see if the river was open. The customer was informed the river was high, but still open. The customer claims they were told the river was “safe.” Four customers arrived, rented two canoes for $54.00 and paid with a credit card. The livery transported the customers and the equipment upriver to float down to the livery office. The bus driver reiterated to the customers that the water was high.

The customers over-turned their canoes. They came back to the operation, cold, wet and mad. At the livery, the customers claimed they had lost a wallet containing $600.00 in cash, prescription glasses, and other items. They had minor scratches, but refused medical treatment.

Customer Complaint: Soon after the incident, the customers filed a complaint with a State Consumer Agency. In the complaint, they stated they had rented the canoes 2 days after Hurricane Floyd. While they were concerned the river might be too high, too dangerous or obstructed, they assumed the campground would have checked for these things and suspended their trips if the trip was too dangerous for their skill level. The customers informed the livery they were novices. They did not receive instructions or warnings from the livery.

According to the complaint: “In fact they [the livery] broadly proclaimed we could ‘float back’ in 4 hours. The river was so high that we were over our heads and the banks were under water. When we complained to the livery they admitted that no one had checked the river since the storm, yet they sent us out in these canoes…. They refused to refund our money for the rentals or compensate us for our losses…. They took a chance with our lives to make a lousy $54.00! … We could have easily been seriously injured or died as a result of their blatant negligence.”

Over a month later the customer sent a complaint letter to the livery. In the letter they claimed $840.00 in lost cash and one day of lost work because of a physician visit. The lost work was valued at $200.00. The customer also complained that “no advice or instructions were offered by your representative” concerning canoeing. They also claimed that no warning given about the high water conditions.

3. Documents: The livery’s brochure offers no information as to risk or whether a release must be signed. Another brochure advises that “If you are unable to swim – a life jacket will be available.” There is no risk or release information in the second brochure either. The only notice is about failure to return equipment.

The customers did sign a rental contract, which they relied upon in making their compliant. However, a rental contract is in fact and in law not a contract; it is a receipt. A receipt contains information about the renter and the return of the items rented, including life jackets. At the very bottom of this rental contract, there is a statement about returning equipment on time. There is also a line for the customer’s signature below the return policy.

4: Insurance Company: The customer’s complaint was forwarded to the livery’s insurance company. The insurance company wrote the complaining customer. [Starting the lawsuit!] The insurance company letter said in part:

“The insurance available to the Livery is liability insurance. Under this type of insurance payments are made on behalf of the insured for situations in which the insured would be at fault for damages. That is, if the matter were taken to court, they could be found responsible.”
“The duties owed you by the Livery are to: (1) Exercise reasonable care in the maintenance of the premises for your safety; (2) Warn you of any dangerous condition which are not open and obvious and of which the owner has knowledge; (3) Make a reasonable inspections of the premises and remedy any dangerous conditions the inspections reveals.”

The insurance company denied any claim.

5. Complaint: Approximately 2 months after the original rental, the customer filed a complaint in the Small Claims court requesting $1,408.00.

The Plaintiff in the Complaint stated as follows: “XXX Campground operates a canoe rental concession. On XX/XX/XX myself & three others rented a canoe for a pleasure trip. Defendant was asked in advance if the conditions were safe to allow canoeing. The stated condition was safe. All four of us were thrown from our canoes into the river as the result of surging waters well above normal state. I ____ lost of personal goods and work time. They were negligent in not checking conditions on river & allowing anyone to navigate the river.”

LIVERY MISTAKES

Canoes along the Au Sable River (Michigan), USA

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Basic Mistakes: No properly written release. No pre-trip safety talk. No pre-trip National Livery Safety System video. No information in their brochure about risk, loss of property or that a release had to be signed.

Less obvious with respect to defending a lawsuit, but much more critical in preventing a lawsuit: No thorough knowledge of their insurance policy and no understanding of how their insurance company would react; not dealing with the complaint immediately; not dealing with the complaint when a complaint was filed with the state; knowing the customer was lying; and, basing their response on the “customer lied” rather than focusing the bigger problem.

The customer in two documents states they were told the river was safe. This guarantees a lawsuit and a loss for the livery or any outfitter. No river is safe. Life is not safe. By stating that your river, trip or activity is safe you are making a promise you cannot meet. It might have been safe for the previous 1 million people who went down the river, but the next person who goes down and may be injured and will not have a safe trip. Your promise of “safe” makes their suit for negligence golden. The outfitter denies making those claims. However, something was said that induced the people to come to the river, even after they called to confirm the river was open during high water.

A complaint based on the concept that a livery should check river conditions is rare – and relatively new. Some livery owners inspect the river each day; however, the vast majorities do not. There are definitely situations when an inspection is warranted, i.e., when a customer or third party notifies you of a problem, or if your canoes quit coming down river. At the beginning of the season and possibly after high water, you might also require a check. However, checking river conditions each day is probably not necessary.

To alleviate the need to check daily, a statement regarding your policy should be included in the release, along with language about who owns the river and what is and is not within your control. Similarly, a statement that Mother Nature controls the river – not the livery owner – should also be included. You might want to place a similar statement in your brochure and on your website.

Another complaint is the “lack of instruction.” The customer claimed they were not given adequate instruction to navigate the river. No liveries provide instruction except in answering basic questions. However, this area is changing with the use of the National Livery Safety System video. The NLSS video provides several minutes of instruction that would have helped the customer in this case. Possibly guests should be prompted to ask questions or if they have any questions, maybe even a sign at the check in that asks the customer to ask questions.

Another statement that stands out is the one about the water being over the customer’s heads. Either the customer was under the belief the river was shallow or someone had implied this was so. No customer should ever enter a river with the belief they can stand up in the river. Two reasons exist for this: (1) river bottoms change. A river can be six inches deep one day and the next be 20 feet deep; (2) Foot entrapments. Foot entrapments are a major cause of death in canoeing and rafting river deaths. A person walking along the riverbed steps in a hole and the current keeps them from being able to remove their foot. As such, they can be quickly shoved under the water and drowned. Here again, the NLSS video speaks about foot entrapments.

Brochures: Every brochure should do three things to prevent litigation: (1) the brochure should state the livery is not responsible for any injury or death. (2) The brochure should state the livery is not responsible for lost property. (3) The brochure should state the customer will be required to sign a release before undertaking the trip. Failure to inform your guests of the risks and the potential losses they are going to be taking on is weak at best and leads to lawsuits.

Releases: In this day and age, a properly written release is a must for any livery, outfitter or risk operation.

INSURANCE COMPANY MISTAKES

English: Canoeing on the Shenandoah River.

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This is the scariest part of the entire situation. The insurance company in an effort to save a nickel could have cost themselves millions. They took legalese and attempted to use it to stop a lawsuit. A common technique of insurance companies is to deny coverage and provide the upset customers with the information for them to sue.

Fatal Insurance Company Error 1: No one had mentioned a lawsuit until the insurance company brought it up: “That is, if the matter were taken to court, they could be found responsible.” Let’s translate this for the common man: “You can’t get any money from the livery or us unless you sue us.” Small claims court is easy. It is easier still to stay up late and watch TV, make a toll free call in the morning and find an attorney to take on the arrogant insurance company. That is what those late night ads are all about.

Fatal Insurance Company Error 2: “The duties owed you by Livery are to: (1) Exercise reasonable care in the maintenance of the premises for your safety; (2) Warn you of any dangerous condition which are not open and obvious and of which the owner has knowledge; (3) Make reasonable inspections of the premises and remedy any dangerous conditions the inspections reveal.” The insurance company denied any claim. Let’s interpret this as a reasonable man would.

Reasonable Care: It was blatantly obvious to the customer that “reasonable” would have been for the livery to canoe the river and check it out. “Reasonable” legally means what every other outfitter is doing. The customer, however, does not care what every other outfitter is doing. They only care about what the one they paid did as compared to what they believe or were led to believe would happen.

Open and Obvious: To a competent canoeist, a strainer is obvious. To novice canoer’s, strainers may not be obvious until they are caught in one.

Owner has knowledge: The customer believed the livery should have had knowledge of the river conditions.

Reasonable Inspection: It was blatantly obvious that the customer believed it was reasonable to canoe the river.

Premises. The insurance company defined this as the land area being insured, probably only as that land owned by the livery. The customer defined this as everything the customer was upon while paying the livery for the day, the land, the river and the bus.

The legal paragraph quoted above said this to the customer: It was reasonable for the livery to check out the river. Once they did they should have told us more about the river.

The insurance company gave the customer the reason to go to court on a silver platter. While this letter might not afford the customer solid legal grounds in a higher court, in small claims court, they could hold up the insurance company letter and make an augment that will likely win. Because it is small claims court, the insurance company has no liability and will not pay to defend. The insurance company ducked out, costing the livery some money but it could have cost them both thousands.

More importantly, the insurance company told the customer to sue! The insurance company letter stated the only way they customer could recover was if they sued, so the customer did. In fact, they were told to sue by the livery’s insurance company.

Isn’t this the opposite of everything you expect from your insurance company and what your insurance company stands for? Aren’t your insurance companies supposed to assist you in stopping lawsuits, in making sure you do not go to court? Yet the insurance company sent a letter that told the angry customer that they could sue and get money.

INTERESTING LEGAL ISSUES

The customer made a claim for negligence in the complaint. If the judge finds negligence the judge can award more than the damages requested, kick the case to another court, or ignore the negligence claim.

ANALYSIS

The livery dodged a bullet; the insurance company dodged a bullet. Wet, cold angry customers came into the operation after their trip and could have been dealt with then. However, they were sent on their way, still wet, cold and angry. Angry customers, who feel their lives have been put at risk don’t stop complaining and don’t let go of their angry easily. These customers spent six months dealing with the anger. Each time they received an unsatisfactory answer, they kept going till they got an answer.

They never got the answer they wanted, “We’re sorry, here is your money back.” They got a lot more money, but that is the only thing the court could give them. See It’s Not Money.

The livery also got angry. A customer was stupid enough to take valuables down a river and then demanded compensation when they lost then. That anger increased when each time a claim was made, the value of the items lost increased.

Two angry people are now fighting each other. One because they felt they were treated badly, their lives put at risk. The other because they felt someone was trying to cheat them.

SUMMARY

English: A canoe in the BWCA

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This case is a miracle. The customer, if they could prove they were told the trip was safe could sue for negligence, and probably win. This case could have been settled for $54.00 or less, instantly. It could have been settled easily at any stage along the way, until the insurance company became involved. Any settlement of less than $10,000 is probably a good deal.

  • The customer should never be told the river was safe.
  • The customer should have been told to leave their valuables in their car and their keys in the livery office. This should have been confirmed in writing in a release
  • It is better to have no money and somewhat satisfied customers rather than $54.00 and angry customers.
  • The conditions and acknowledgment of the river should have been in writing
  • The customers should have been informed in advance in the brochure or website that instruction is not provided; it is just a rental, not training.
  • The river should have been checked by the livery if not regularly, at least every time the river flow changes to look for problems, strainers and ascertain the river is still runable.
  • The letter sent by the insurance company was an invitation to sue the livery. The livery should have handled the problem because it is their customer. Insurance companies have no empathy and are better at starting lawsuits than they are at stopping them. The insurance company basically told the customers to sue.

Deal with your own problems because no one will deal with them as well as you will.

Videos

I don’t know of anyone making videos you can use to point out the risks and dangers of your sports. Stay in touch with Quietwater Films, who maybe is working on some.

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