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You are here: BAILII >> Databases >> England and Wales High Court (Queen's Bench Division) Decisions >> Lyons v Fox Williams LLP [2016] EWHC 2427 (QB) (11 October 2016) URL: http://www.bailii.org/ew/cases/EWHC/QB/2016/2427.html Cite as: [2016] EWHC 2427 (QB) |
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QUEEN'S BENCH DIVISION
Strand, London, WC2A 2LL |
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B e f o r e :
____________________
Cathal Anthony Lyons |
Claimant |
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- and - |
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Fox Williams LLP |
Defendant |
____________________
Colin Edelman QC and Ben Lynch (instructed by DAC Beachcroft LLP) for the Defendant
Hearing dates: 24, 25, 26, 29 February 1, 2, 3 March 2016
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Crown Copyright ©
Mr Justice Turner :
Introduction
A Preliminary Observation
"82. A judge's task is not easy. One does often have to spend time absorbing arguments advanced by the parties which in the event turn out not to be central to the decision-making process.
83. However, judges should bear in mind that the primary function of a first instance judgment is to find facts and identify the crucial legal points and to advance reasons for deciding them in a particular way. The longer a judgment is and the more issues with which it deals the greater the likelihood that: (i) the losing party, the Court of Appeal and any future readers of the judgment will not be able to identify the crucial matters which swayed the judge; (ii) the judgment will contain something with which the unsuccessful party can legitimately take issue and attempt to launch an appeal; (iii) citation of the judgment in future cases will lengthen the hearing of those future cases because time will be taken sorting out the precise status of the judicial observation in question; (iv) reading the judgment will occupy a considerable amount of the time of legal advisers to other parties in future cases who again will have to sort out the status of the judicial observation in question. All this adds to the cost of obtaining legal advice".
"84. Our system of full judgments has many advantages but one must also be conscious of the disadvantages".
The Policies
i) Colonial AD&D;
ii) Colonial LTD;
iii) AGF AD&D; and
iv) AGF LTD.
The Colonial Policies were governed by the law of Bermuda. The AGF Policies contained binding arbitration clauses determinable in Paris but subject to English law.
The Accidental Death and Dismemberment Claims
The Long Term Disability Claims
The 2009 Agreement Claim
Lines of Defence
i) issues relating to LDT fell outside the scope of Mr Custance's retainer;
ii) the claimant was not disabled within the meaning of the LTD policies;
iii) the claimant was not, in any event, eligible to claim under the LTD policies.
i) Mr Custance's involvement in the steps leading up to the 2009 agreement was informal and gave rise to no duty with respect to the inclusion of an English law and jurisdiction clause;
ii) Mr Custance was not instructed to prepare a long form agreement;
iii) EY would not have agreed to an English law and jurisdiction clause in any event; and
iv) the outcome of the litigation between EY and the claimant over the terms of the 2009 agreement would have been the same whether or not an English law and jurisdiction clause had been incorporated.
The Background
The Claimant
The Immediate Aftermath of the Accident
i) by establishing that the injuries he had sustained fell within the scope of the policies in force at the time of his accident; or
ii) by showing that he was entitled to claim under the new Ingosstrakh policy which appeared to provide more generous cover; or
iii) by proving that he was entitled to claim against EY for misrepresenting to him that the cover he enjoyed was materially more generous than it had turned out to be.
Mr Custance's Retainer
"Re: insurance cover arranged for you by Ernst & Young ("E&Y")
Following our telephone discussion earlier this week, I confirm that Fox Williams LLP will be very pleased to act for you in connection with the above matter.
The purpose of this letter is to set out the scope of our role …
Scope
You have explained that, following your accident in June 2006, it has become apparent that the insurance cover arranged on your behalf by E&Y does not provide the type or level of 'accidental death and dismemberment' ("ADD") cover which E&Y had previously represented to you was in place. I understand that the shortcomings in the cover in fact in place at the time of your accident can be demonstrated by comparing it with the cover which was arranged by E&Y when the insurance provider was changed with effect from 1 July 2006.
I have suggested that the areas to be considered further are as follows: (1) to check the extent of the cover in fact provided by the insurance in place at the time of your accident to ensure there are no arguments available which E&Y have failed to take up with insurers on your behalf; (2) to compare that cover with the insurance put in place with effect from 1 July 2006; and (3) to obtain further details of the representations made to you by E&Y as to the 'ADD' cover supposedly in place at the time of your accident.
In order to advise on these points, I will need to see the following: (a) copies of the relevant insurance policies; (b) all correspondence or emails between you and E&Y or insurers/brokers relating to the extent of the cover available for your accident, including in particular any emails/correspondence dealing with the meaning/interpretation of that cover; and (c) anything from E&Y which refers to the insurance benefits available to you in the event of death or serious accident. In relation to (c) you have explained that you were not provided with a copy of the presentation given to you by E&Y. However, you may have received at some stage at least a summary of the health / insurance benefits available to you.
Depending on the outcome of my review of this material, the intention would then be to draft a letter to be sent to you to E&Y, in order to put some pressure on them either to extract the fullest cover to which you are entitled under the insurance in place at the time of your accident, and/or to compensate you for the disparity between that cover and the insurance which they represented to you as being in place. …".
i) The dispute over the scope of Mr Custance's retainer did not arise until years after the events to which it relates. Consequently, for the most part, the independent recollections of the parties and witnesses on a considerable number of issues have either been extinguished or, at least, substantially diminished by the passage of time.[3]
ii) Mr Custance took very few attendance notes. Those which he did take tended to be both frugally drafted and Delphic.
iii) Such attendance notes as have been disclosed were unearthed by Mr Custance in or about March or April 2015 following an unrelated spring clean of his office and well after proceedings had been commenced. As a result the parties' respective contentions had, at least in part, already been crystallised in ignorance of their contents.
iv) It is common ground that the scope of Mr Custance's retainer was expanded in some respects after he sent his initial letter of retainer but the extent of such expansion is disputed and was never formally recorded in writing.
v) There is a very considerable volume of relevant email traffic but the evidential value of this is degraded by the fact that, for the most part, it has been drafted in a conversational and informal way.[4] Some of this material is clearly and reliably relevant to the issues which have arisen between the parties. Some is equally obviously not. Yet there remains an extensive and evidentially impressionistic hinterland in which it is not always immediately clear what issues are being referred to without giving careful consideration to the context in which any given email was sent.
The Law
"(i) A solicitor's contractual duty is to carry out the tasks which the client has instructed and the solicitor has agreed to undertake.
(ii) It is implicit in the solicitor's retainer that he/she will proffer advice which is reasonably incidental to the work that he/she is carrying out.
(iii) In determining what advice is reasonably incidental, it is necessary to have regard to all the circumstances of the case, including the character and experience of the client.
(iv) In relation to (iii), it is not possible to give definitive guidance, but one can give fairly bland illustrations. An experienced businessman will not wish to pay for being told that which he/she already knows. An impoverished client will not wish to pay for advice which he/she cannot afford. An inexperienced client will expect to be warned of risks which are (or should be) apparent to the solicitor but not to the client.
(v) The solicitor and client may, by agreement, limit the duties which would otherwise form part of the solicitor's retainer. As a matter of good practice the solicitor should confirm such agreement in writing. If the solicitor does not do so, the court may not accept that any such restriction was agreed".
The Scope of the Retainer
"Firstly, thank you for your engagement letters. I am traveling at the moment so I will sign and fax to you on Wednesday. … With regard to the documentation requested I will be sending you the following:
1. Communication between our Partnership secretary & Kerry/Myself.
2. Communication between Colonial & either EY or me.
3. Communication between Sherwood and EY. Sherwood acted as broker and it would appear facilitator for EY?
4. The original AD&D policy sent to me by our Partnership secretary. It should be noted that the first time I received this was after my accident.
5. Our new AD&D Policy.
6. My local employment contract … I will also send you any other partnership type documentation that I have.
I believe that is everything you require so far, if not please just let me know.
As I mentioned I am hoping for some form of amicable settlement and best case scenario is from Insurance provider but I do not believe this is likely. Although the second operation on my foot was done while the new policy was active. That operation did amputate toes and metatarsal. We also believe that the amputation of shoulder and top of the humerus also constitutes compensation. But this is where I do not see any action from my Employer/Partnership. I have informed them (verbally) that they should get a lawyer so they can put pressure on the Insurance company. As EY represented to me that I was covered I have been very clear with them that I expect compensation and if Insurance does not provide then I will.
Initially, I am looking for a very clear communication from me to EY, I take whatever counsel you give me and will follow but I would like to be clear to EY on following;
- I believe I was covered per their representation in form of presentations to partners.
- I believe they do not seem to be taking any pro-active actions, for example in October it was when I suggested they needed a lawyer.
- I still then there is a good opportunity to get insurance company to pay – as EY is significant client of insurer & it also a good and valid claim.
- I intend to get my compensation if not from insurer then from EY.
Normally I use my yahoo email but I was on a plane when I did this. I am on my mobile if you need me. …".
"Please advise me if you would like me to simply forward on all of these emails so you can go through them or what you would prefer.
As Cathal states below, the information we received in France included a sliding scale of percentages of what the insurance covered in terms of ADD (eg if you lost 1 toe you receive 5% of total, etc.), so we were always under the assumption that he was well covered. His transmetatarsal amputation operation was done in late July, which, technically, is under the new insurance policy. Also, in correspondence we have from December, it is clear that EY was not responding to the insurance company's requests for information and none of that was passed on to us. In fact, in mid-December they sent a final notice that was then forwarded to us that their 45-day claim timeframe had expired and we had not provided them with the information they requested. Of course, we knew nothing about this, so they extended the timeframe for another 30 days. We provided the info and since that time have heard nothing from EY or the insurance company, despite several requests for a response. We believe that nothing was done and the claim timeframe has simply expired. EY has simply not provided us with any further information. …".
"Yes, do you mind sending me all of the emails – I suspect only a proportion will in fact be important, but it will be helpful for me to have the entire picture".
"With regard to Colonial & AGF you… should contact the senior global people for them to put pressure on colonial/AGF. If needed or necessary then you can see if it is better for global/CIS to get lawyer involved. The personal lawyer required by me is only in relations to Ingostrakh as Philipp obviously wants to ensure we/EY do not get in a legal battle with a client".
The Gathering Storm
"… I contacted you several weeks ago … As I mentioned the indications he has received from the companies insuring EY employees for Long Term Disability and AD&D is that they may not honor his claim …".
"2. Insurance ADD – Including
a. $1.5 Million for dismemberment
b. $300K per annum from insurance as according to EY I must not be physically or mentally able to perform my job (see insurance policies)
c. Repayment of non covered injury expenses".
"… Karl can sign a legally binding letter saying that if I resign as partner he will pay 6 million dollars".
"E&Y will maintain or cause to be maintained (at E&Y's expense) life, AD&D, and disability insurances for Mr Lyons until he is 65 years of age, such insurances to be provided on no less favourable terms than those applying to equity partners of E&Y…".
"Based on the email received from your employer, although you are working part-time, you are receiving full pay. In order to be eligible for benefits, you need to earn less than 80% of your pre-disability earnings throughout the 360-day Elimination Period. Since you are not experiencing this earnings loss, no benefits will be paid and your claim is now closed".
"I received this by post today".
"What is completely unclear to me – and I have no documents which shed any light on this – is why EY continued to tell you that your claim would be covered by Generali".
If it really had been the case that Mr Custance had earlier advised that Generali could be pursued then this email would be expected to have been met with a robustly worded demand from the claimant for an explanation. It was not.
"Q. But you say, you see, in paragraph 35 of your witness statement:
"If the letter was not sent, I can be reasonably confident that I would have discussed its contents with Mr Custance the next time I spoke to him."
You are trying, through your witness statement, to imply that you would have had a discussion about LTD with Mr Custance. Is that really your reconstruction of all this, Mr Mandel?
A. As I say, I don't recollect the details of the conversation. It's possible I could have mentioned it in passing or I may not have mentioned it. I just don't know.
Q. So what you say in your witness statement is simply wrong, isn't it?
A. That I believed that Fox Williams was advising –
Q. No. "I can be reasonably confident that I would have discussed its contents ..."
What you have done in the previous paragraph, you see -- or someone has done it for you -- is to highlight in bold the bits that relate to LTD.
A. Right.
Q. You can see what this is trying to imply, isn't it? It's plucking a passage out of the letter which wasn't even sent, putting it in bold, and saying, "Well, although it wasn't sent, I'm reasonably confident I would have discussed it". That's just simply not your reconstruction of events, is it, Mr Mandel? It doesn't fit with the documents.
A. As I say, I don't recall the conversation. Since my discussions with AON or my correspondence with AON covered both LTD and AD&D and since we were concerned about generally lowering the temperature and making people aware that we were aware of all the policies and the situation -- I may have mentioned it, but I do not remember the conversation specifically.
Q. So what you said in your witness statement is wrong, isn't it? You are not reasonably confident that you would have mentioned LTD, are you?
A. I guess I'm not reasonably confident, that's correct".
"Following our conversation on Friday and a subsequent conversation I had with Cathal yesterday:
- Cathal is now working on the Ingosstrakh claim form, and he and I will discuss this later this week.
- Could you arrange to send me a complete copy of your file re the claims on the Colonial/AGF policies. If I am to advise on further arguments potentially available against those insurers, then I need to make sure that I have a complete picture of all the communications there have been with them so far…".
The Parting of the Ways
"I pointed out to Philipp that everyday I walk about with my settlement in my pocket and if EY signs I am more than happy to leave. I did add that they should say that I am physically and mentally not capable of working. That as far as I am concerned is what they are saying & then as this is true according to my employer I should be able to claim $350,000 per annum from my insurance. Should work? While Philipp like the $350,000 paid by insurance company he was taken aback by my $10 million claim".
"Tick tock".
And:
"Jim treats my claim as a joke, he does nothing".
"So you are not going to believe it but Jim did get a response but did not have to balls to let us know".
This observation betrays something of the relationship between the claimant and Mr Mandel. The claimant plainly thought that Mr Mandel was not brave enough to disappoint him with unwelcome news. Having had the opportunity to see both men give evidence, I am satisfied that, of the two of them, the claimant has the dominant personality. I am in no doubt that a reluctance to cross or to disappoint the claimant played its part in rendering Mr Mandel so pliable and favourably disposed towards the claimant both in the wording of his witness statement and the evidence which he gave at the trial.
i) an obligation on EY to maintain the claimant's insurance with CIGNA until the date of his death, such insurance to be maintained on terms no less advantageous than those which currently apply;
ii) an English law and jurisdiction clause; but
iii) no reference to LTD.
i) the claimant was concerned that his allies in EY, Mr Mandel and Mr Turowski, were likely to move on shortly and leave him more exposed to the vindictiveness of Mr Johansson;
ii) the claimant believed that EY CIS was going through serious financial difficulties; and
iii) his medical condition was getting worse.
The Negotiations
"… I have had the 3rd Doctor now admit that I am unable to work so I know we need to thread carefully but maybe we have a good angle to also get that $300K per annum until I am 65. What do you think? We should talk.
Enjoy your holidays, I will not rattle any cages until you get back".
"Tom's way of writing emails and acting is the typical antagonizing lawyer language and I really do not want to react to that. I hope you understand my view as I want to settle this amicably among friends…".
"Sure I understand, I want to keep moving and popped it onto you after only glancing, thought it was easier. & yep he is a lawyer. You and I know where we are trying to get to…".
"Anyway you will be glad to know your email pissed Philipp off so he only wanted to deal with me. …".
"I can start with Jim (I met him today but no details) we briefly spoke about consulting idea etc".
The only reasonable interpretation of this email is that Mr Mandel was not yet fully in the picture even following the meeting on that day. Hence the reference to "no details". Furthermore, on 13 April 2009 the claimant forwarded an email chain between him and Mr Turowski to Mr Mandel in which he says that he has Mr Turowski's consent to disclose the same. If Mr Mandel had been privy to the negotiations then it is difficult to see why such consent would have been needed. On the same day, he forwarded the letter of intent to Mr Mandel. Again, one would be entitled to expect that if Mr Mandel had been involved in the negotiations he would already have had a copy.
"I think that we may want to divide the term sheet into two parts: one part that EMEIA has an interest in and a second part that is of purely local interest reflects matters solely between Cathal and the local practice".
"The terms sheet is divided into two parts. The first part is the true summary of terms. The second part relates to the terms of a future employment agreement. The reason for the second part is that there may be issues not of interest to EMEIA that are best left for local resolution and might be stated in a separate agreement… Secondly, I wanted to repeat the provisions in our existing employment contract that the employer has an obligation to provide support for work permit and visa. Thirdly, I wanted to indicate the basis for termination that exists under Russian law. Please note that the first of these in the attached term sheet, incapacity, is not in accordance with Russian law and should be deleted".
Ingosstrakh Postscript
2010
The Return of Mr Custance
"I THINK he is saying the contract is not legal and they want to cancel insurance!!!! As you know this was the most important part of the deal as nobody else will insure me…. In fact first this lawyer said he was reviewing contracts for cost effectiveness!! What the bloody hell do I do! …".
"Tom, this is unbelievable. EY and Stephen have confirmed that a claim was lodged with them as far back as 2007 maybe even 2006. EY has been in continuous contact with them. Is this some bad joke,
The payment calculated by EY years ago indicated I would be entitled to a yearly payment of $300,000
EY must have had insurance before this, in fact I am sure there are documents where they had ADD cover for us. So did they claim of incorrect policy, if they did it's their fault.… Jim Mandel and Svetlana Kondakova were looking after this and did claims, in fact Jim only gave me some of the paperwork back sometime in 2010. They were working under the supervision of Philip Turowski. Also at the beginning the HR director Anne Ramsay was also assisting. Se has since left and is now working for kelloggs. I will call her.
But please you need to call the EY lawyers and inform me about their error and they need to sort this. Under the rules I should have been paid since may/June 2010 at the latest".
"1/ He thinks he recalls some discussion about UK law or at least he thinks he remembers something. But hes not fully sure…
2/ IF it came up would Philipp have agreed to UK jurisdiction – he said absolutely Phillipp would have agreed as Philipp thought deal was done and nothing else was to be agreed or could be changed. ….. At least something like this!!! I think it is good".
"I hope you have in your files discussing jurisdiction with Jim! He says he will say yes uk was agreed IF our confirm from your notes. But no matter what he says he's pretty sure and he will say so. He also says that no matter what Philipp would have agreed as he was fully sure deal was done! Please look into this and confirm".
"I need you to be able to confirm that you and Jim spoke about UK jurisdiction, we know you both did so it's important that you say so. As Jim has confirmed he vaguely remembers that you did discuss it and is will to say so. Also he will say that philipp turowski would have agreed to this as he assumed that 1 the deal was done and 2 would have given me practically anything. It's hugely important you confirm, will you?"
LTD claims, scope of retainer and the duty to warn
"There is generally a duty to point out any hazards of the kind which should be obvious to the solicitor but which the client, as a layman, may not appreciate. In Boyce v Rendells the Court of Appeal accepted the following as a general proposition:
"if, in the course of taking instructions, a professional man like a land agent or a solicitor learns of facts which reveal to him as a professional man the existence of obvious risks, then he should do more than merely advise within the strict limits of his retainer. He should call attention to and advise upon the risks".
To similar effect Bingham LJ stated in County Personnel (Employment Agency) v Pulver that: "If in the exercise of a reasonable professional judgment a solicitor is or should be alerted to risks which might elude even an intelligent layman, then plainly it is his duty to advise the client of these risks or explore the matter further"".
"A solicitor is not a general insurer against his client's legal problems. His duties are defined by the terms of the agreed retainer. … [T]he solicitor only has to expend time and effort in what he has been engaged to do and for which the client has agreed to pay. He is under no general obligation to expend time and effort on issues outside the retainer. However if, in the course of doing that for which he is retained, he becomes aware of a risk or a potential risk to the client, it is his duty to inform the client. In doing that he is neither going beyond the scope of his instructions nor is he doing "extra" work for which he is not to be paid. He is simply reporting back to the client on issues of concern which he learns of as a result of, and in the course of, carrying out his express instructions. In relation to this I was struck by the analogy drawn by Mr Seitler. If a dentist is asked to treat a patient's tooth and, on looking into the latter's mouth, he notices that an adjacent tooth is in need of treatment, it is his duty to warn the patient accordingly. So too, if in the course of carrying out instructions within his area of competence a lawyer notices or ought to notice a problem or risk for the client of which it is reasonable to assume the client may not be aware, the lawyer must warn him".
i) the claimant was an astute, focussed and commercially minded business man;
ii) the claimant, particularly with Mr Mandel's assistance, was clearly using Mr Custance more as a targeted resource than as a general legal adviser. There was no legitimate expectation at the material times that he would undertake any sort of analysis of the LTD documentation falling outside the scope of his original express retainer;
iii) as the claimant himself went on to say in his witness statement made for the purposes of pursuing a claim against EY, that EY "had been actively leading the claim on the LTD insurance";
iv) the LTD policies were legally distinct from the AD&D policies. Perusal of and advice upon the latter did not require any knowledge of the scope or terms of the former;
v) mere knowledge of the existence of the LTD policies against the limited background context of which Mr Custance was aware would not have put him on the alert that there was a problem or risk which ought to have been pointed out.
The English law and jurisdiction clause
i) The claimant was, as I have already observed, an astute and hard-headed businessman alert to the commercial significance of where any dispute under a contract may fall to be litigated;
ii) The claimant would not need to be told by Mr Custance about the risk of litigating in Russia. He had worked there for many years and would have been fully aware of the prevailing perception of the hazards of resorting to the courts there;
iii) Mr Custance's earlier drafts had provided him with a written crib sheet which would further remind him of the desirability of an English law and jurisdiction clause and act as an aide memoire during negotiations;
iv) It is implausible that both the claimant and Mr Mandel would have failed to spot the omission of such a clause in the draft agreements;
v) The tone and content of the claimant's emails reveals that he is pleased with the deal and anxious to conclude it. Thus he could be expected to have been more ready to accept an agreement without an English law and jurisdiction clause rather than run the risk of putting a spanner in the works.
Causation and the LTD claims
"In order to assess the validity of any claim the Covered Person shall, upon request and at the expense of the Insurer, undergo a medical examination with a medical expert nominated by the Insurer.
As soon as the validity of claim is assessed, the benefits under this policy will be paid to the Covered Person in the currency of the policy.
Payment of any disability benefit will be subject to and depend upon the assessment of the medical expert so nominated…
The Insurer will ask any Covered Person receiving a pension under this policy to undergo medical examinations at intervals of not less than six months".
The claimant was never medically examined and so no disability benefits fell to be paid under this policy.
"If a Covered Person is unable to perform his Own Occupation due to an accident or an illness prior to his 65th birthday, the Insurer will pay the Covered Person a temporary annuity after the Waiting Period. This annuity is paid monthly in arrears while the Covered Person is unable to perform his Own Occupation. This annuity is equal to 70% of a Covered Person's prior Annual Salary, after deduction of an offset equal to US$180,000, at the onset of the date of the Accident or Illness. It is decreased by any remuneration received by the Covered Person. The first and the last instalments are apportioned. It is subject to a maximum of US$120,000 per annum.
The payment of the Short Term Disability annuity stops:
- after the payment of the 25th monthly instalment
- on the attainment of the Covered Person's 65th birthday
- on the disappearance of the Covered Person
- when the Covered Person resumes full time employment in his Own Occupation
Whichever shall first occur".
"A full-time Member who is authorised to return to work on a part-time basis may continue to receive Short Term Disability payments from the Insurer, but they are reduced on a pro rata basis according to the number of hours work compared with a full-time work schedule. Benefits payable by the Insurer are reduced for Members who return to work so that the total income received by the Member (Insurer payments, salary, social security benefits, unemployment benefits etc) does not exceed 100% of the referenced salary".
"If a Covered Person, after payment of the Short-Term Disability pension, is unable to perform any gainful occupation he receives a Long Term Disability pension equal to 70% of the Covered Persons prior Annual Salary after the deduction of an offset equal to US$180,000. It is decreased by any remuneration received by the Covered Person, the payment of Long-Term Disability pension stops:
- on the attainment of the Covered Person's 65th birthday
- on the disappearance of the Covered Person
- if due to natural recovery, surgical operation or medical treatment the Covered Person is able to resume a gainful activity.
whichever shall first occur".
"If a Member, after payment of the Work Incapacitation Benefits by the Insurer, is still unable to resume any gainful occupation in relation to his education, skills, experience, the Insurer considers this state as a Long Term Disability, provided that it occurs before the 65th birthday and is accepted by the Insurers' consultant physician".
"In the event the Policy is cancelled Long Term Disability payments due to an Insured Event which occurred before the effective date of cancellation continue to be paid".
"When the Company receives proof that an insured is disabled due to…injury…the Company will pay the insured a monthly benefit after the end of the elimination period. The benefit will be paid for the period of disability…".
"Elimination period means a period of consecutive days of partial disability for which no benefit is payable. The elimination period is shown in the application and begins on the first day of partial disability".
"PARTIAL DISABILITY or PARTIALLY DISABLED means as a result of the…injury which caused total disability, the insured is:
1 Able to perform one or more but not all, of the material and substantial duties of his own or any other occupation on a full-time or a part-time basis; or
2 Able to perform all of the material and substantial duties of his own or any other occupation on a part time basis.
To qualify for a partial disability benefit the insured must be earning less than 80% of his pre-disability earnings at the time partial disability employment begins".
"TOTAL DISABILITY or TOTALLY DISABLED for an Extensive Own Occupation Benefit means during the elimination period and until the insured reached the end of the maximum benefit period he is:
1. Unable to perform all of the material and substantial duties of his occupation on a full-time basis because of a disability:
a. Caused by injury…;
b. That started while insured under this policy.
TOTAL DISABILITY or TOTALLY DISABLED means during the elimination period and the next 24 months of disability the insured is:
1. Unable to perform all of the material and substantial duties of his occupation on a full-time basis because of a disability:
a. caused by injury…;
b. that started while insured under this policy; and
2. After 24 months of benefits have been paid, the insured is unable to perform with reasonably continuity all of the material and substantial duties of his own or any other occupation for which he is or becomes reasonably fitted by training, education, experience, age and physical and mental capacity".
"The monthly benefit will cease on…
4. The date the insured's current earnings exceed 80% of his pre-disability earnings".
In order to mitigate the potential harshness of this provision in certain circumstances, it is qualified by a note which provides:
"Because the insured's current earnings may fluctuate, the insurance company may average earnings over three (3) consecutive months rather than immediately terminating his/her benefit once 80% of pre-disability earnings has been reached".
i) the initial injuries sustained to the shoulder and foot were serious and likely candidates for significant long term disability. As early as August 2006 Dr Clavert considered that it would be three to six months before the claimant might be able to return to work part-time;
ii) the claimant continued to have unremitting problems with his shoulder and foot;
iii) in 2007 he was continuing to undergo physiotherapy treatment from Dr Churilova involving no fewer than 115 sessions;
iv) the physiotherapy sessions continued in 2008 with the same level of frequency despite which he began to develop adhesive capsulitis of sufficient severity to warrant a further surgical operation. It was not a success;
v) the level of symptoms continued unabated after the 2009 agreement.
"RECURRENT DISABILITY means a disability which is related or due to the same cause(s) as a prior disability for which a monthly benefit was payable.
A recurrent disability will be treated as part of the prior disability if, after receiving disability benefits under this policy, an insured:
1. Returns to his regular occupation on a full-time basis for less than [six] months; and
2. Performs all the material duties of his occupation.
To qualify for a recurrent disability benefit, the insured must experience more than 20% loss of pre-disability earnings.
Benefit payments will be subject to the terms of this policy for the prior disability.
If an insured returns to his regular occupation on a full time basis for [six] months or more, a recurrent disability will be treated as a new period of disability. The insured must complete another elimination period".
I am not satisfied that this provision is relevant to the circumstances of the claimant's disability. He received no benefits under the policy in respect of a "prior disability". He did not return to his regular occupation on a full time basis.
"The monthly benefit will cease on…
4. The date the insured's current earnings exceed 80% of his pre-disability earnings".
However, this term can only take the defendant so far. During the eligibility period the claimant was not entitled to claim monthly benefits. The Colonial rejection letter was sent within the eligibility period and purported to assert that in order to be eligible the claimant would have to have earned less than 80% of his pre-disability earnings throughout the 360 day elimination period. This is simply wrong. A monthly benefit cannot cease even before an entitlement to claim arises.
RUSSIAN LAW AND JURISDICTION - HYPOTHETICAL CAUSATION ISSUES
i) Article 181(2) of the Russian Civil Code provides that a party loses the right to challenge the validity of any transaction after the expiry of one year from its conclusion;
ii) Mr Turowski had a power of attorney binding on all relevant legal entities in the EY group;
iii) the terms of the contract were sufficiently clear by the operation of Article 431 of the Russian Civil Code;
iv) even if the agreement were invalid, the consequence of Article 167 of the Russian Civil Code would be to put the claimant in the same position as he would have been in if the agreement had not been concluded thus entitling him to the benefits of CIGNA healthcare for him and his family.
i) in an email to Mr Custance dated 21 February 2011, the claimant said that Herve Labaude had told him over the telephone that he had received advice from outside Russian lawyers to the effect that they did not believe that the agreement was enforceable under Russian law;
ii) EY's Russian lawyers must have provided sufficiently positive advice to enable the point to have been taken in the Defence;
iii) his wife had taken the agreement to an in-house Russian lawyer at the firm at which she worked and had been advised that it would be unenforceable.
i) Mr Labaude was a deeply unreliable source of second hand information as to what legal advice he had received. He was partisan and hardly likely to be trusted to give either an accurate or an objective account of any such advice. On the claimant's own case, Mr Labaude was a scheming and unscrupulous man responsible for threatening to "crush" Mr Mandel for daring to reopen allegations that EY had been involved in bribing the Russian courts. The claimant's email is conspicuously lacking in any detail as to the basis upon which Mr Labaude was asserting that the Russian lawyers had reached the conclusion he claimed that they had. Indeed the only specific point was that "coverage for life" under Russian law is probably not enforceable. This is a contention conspicuous by its absence from EY's eventual pleaded defence. No written copy of any such advice was ever deployed by EY. I conclude that this evidence is worthless.
ii) The fact that matters purporting to raise issues of Russian law feature in EY's defence fall far short of establishing that these points had any prospect of success. They were pleaded assertions and no more. Furthermore, it is unclear whether and to what extent Russian law would have been any more (or less) favourable to EY than English law.
iii) Finally, the claimant's second hand anonymous hearsay assertion of what his wife's colleague is said to have told her is also devoid of weight. There is no indication of what specific expertise this lawyer had in contractual matters. There is no evidence as to what information, if any, she was given as to the circumstances leading up to the agreement under challenge. There is no particularisation of the basis upon which the lawyer purportedly reached her conclusion. There is no indication as to the level of formality or confidence with which this conclusion was reached. No written note was made of the substance of the advice. Neither the lawyer nor the claimant's wife have given evidence on the point.
CONTRIBUTORY NEGLIGENCE
LIMITATION OF LIABILITY
CONCLUSIONS
i) although the AD&D claim did not come to trial, Mr Custance's advice on the cover provided under the AD&D policies was negligent. He ought to have considered the terms of the policies themselves and he should not have relied exclusively on the contents of the Members' Booklet;
ii) Mr Custance's original retainer did not extend to advising the claimant on issues relating to LTD cover;
iii) subsequent references to LTD in exchanges between the claimant and those acting on his behalf and Mr Custance, were by way of setting the background context and, latterly, to define an element in the claimant's broad negotiating objectives. Mr Custance was not expected to analyse the scope and contents of the LTD policies;
iv) no duty to warn arose on the facts of this case;
v) if, contrary to my primary findings, the claimant had established liability in respect of his LDT claims then the quantum of his loss would have been $2,765,095;
vi) Mr Custance was negligent in failing to point out and strongly recommend to the claimant that the terms of the agreement negotiated with EY should include an English law and jurisdiction clause;
vii) the claimant knew that the 2009 agreement did not contain an English law and jurisdiction clause and chose to proceed in any event;
viii) EY would not have agreed to the inclusion of an English law and jurisdiction clause;
ix) the claimant has not proved that the potential application of Russian law reduced the level of his settlement with EY following the dispute over the 2009 agreement;
x) the assessment of the quantum of the 2009 agreement claim had it been made out; the level, if any, of contributory negligence; and the operation of the defendant's limitation of liability terms do not, in the light of my other findings, fall to be resolved.
Note 1 Where nothing turns on it I will, for the sake of convenience, generically refer in this judgment to any and all companies in the Ernst and Young group as “EY”. [Back] Note 2 All references to dollars in this judgment are, for the avoidance of doubt, to US dollars. [Back] Note 3 By way of salient example, in Mr Custance’s case, by the time he approved the response to the claimant’s letter of claim he had forgotten that he had ever received the Colonial LTD policy and wrongly denied even the existence of the Colonial AD&D policy. He realistically accepted in cross examination that a closer and more thorough examination of the contemporaneous documentation would have shown that his recollection was wrong. [Back] Note 4 Where I have quoted passages from the emails, I have tended not to qualify any substantive inaccuracies or spelling and grammar lapses with “sic”. This is to avoid making this judgment appear to be even more cluttered and pedantic than it already is. [Back] Note 5 Europe, Middle East, India and Africa. [Back] Note 6 As summarised in Jackson and Powell “Professional Liability” 7th Ed at 3-007:
“(i)Where the question is what the claimant would have done, if the defendant had given competent advice or had otherwise acted competently, this is determined by the court on the balance of probabilities. Damages are then assessed on that hypothesis without any discount to reflect the possibility that the claimant might have acted differently.
(ii)Where the question is what some third party would have done, if the defendant had performed competently, damages are assessed on a “loss of a chance” basis. The court must consider what are the chances that the insurers would have paid out; or that the “other side” would have yielded; or that the judge in the original action would have found for the claimant on liability; and so forth. The damages must then reflect the value of this chance which has been lost.”
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