The policy
11 The primary indemnity was as I have set out above. The terms "Personal Injury", "Property Damage" and "Occurrence" were defined as follows:
2. "Personal Injury" means:
(a) bodily injury, death, sickness, disease, disability, shock, fright, mental anguish and mental health;
(b) false arrest, false imprisonment, wrongful eviction, wrongful detention, malicious prosecution and humiliation;
(c) libel, slander, defamation of character or invasion of right of privacy; and
(d) assault and battery not committed by or at the direction of the Insured unless committed for the purpose of preventing or eliminating danger to persons or property,
In the event of Personal Injury claims arising from latent injury, latent disease, latent sickness, or latent disability, such injury disease, sickness or disability in respect of each claim shall be deemed to have occurred on the day such injury, disease, sickness, or disability was first medically diagnosed.
3. "Property Damage" means:
(a) physical injury to or destruction of tangible property which occurs during the policy period, including the loss of use thereof at any time resulting therefrom; or
(b) loss of use of tangible property which has not been physically injured or destroyed provided such loss of use is caused by physical injury to or destruction of other tangible property which occurs during the policy period.
4. "Occurrence" means an event, including Continuous or repeated exposure to substantially the same general conditions, which result in Personal Injury or Property Damage neither expected nor intended from the standpoint of the Insured.
12 As can be seen when one reads in these definitions into the indemnity clause, the precise relationship between occurrence, damage and indemnity is not expressly clear for personal injury. The definition of property damage appears to locate the nexus as the physical injury to or destruction of the tangible property within the policy period. As to personal injury, it would appear that the injury must occur or be manifested within the policy period: see the last paragraph of the definition of personal injury dealing with latent injury. AIGA also put the submission that the relevant occurrence was required to have occurred within the policy period also. That proposition is not self-evident. That is not a question that I have to decide at the moment.
13 Exclusion (k) was in the following terms:
Liability arising directly or indirectly out of or caused by, through or in connection with any medical treatment, nursing, examination or first aid conducted, prescribed or administered by Medical persons of the Insured or any one acting on their behalf.
14 The policy provided a separately expressed head of cover called "Supplementary Payments". It dealt with the important issue of the conduct of the defence and the expenses thereof.
15 The primary liability in the insuring clause to indemnify for "all amounts which the Insured shall become legally liable to pay" is to be interpreted as indemnity for legal liability ascertained by judgment, award or settlement: Distillers Co Biochemicals (Aust) Pty Ltd v Ajax Insurance Co Ltd (1974) 130 CLR 1 at 25-26; Post Office v Norwich Union Fire Insurance Society Ltd [1967] 2 QB 363 at 373-74 and 377-78; Vero Insurance Ltd v Baycorp Advantage Ltd [2004] NSWCA 390; 13 ANZ Insurance Cases 61-630 at [1], [48] and [89]; Allianz Australia Insurance Ltd v Bluescope Steel Ltd [2014] NSWCA 276; 87 NSWLR 332 at 349 [78], 381 [267]-[270].
16 In policies of this character the nature of that primary liability can give rise to practical difficulties for insureds. Given that the legal liability of the insurer is not engaged until there is an event of liability by judgment, award or settlement, the insured may be left, in the meantime, to fund a defence or to settle the case, without the involvement of the insurer. Different policies deal with this difficulty, and related problems, differently. Some solutions are more favourable to insured, some more favourable to insurer. Such, no doubt, is reflected in the premium.
17 The terms of a policy can be structured by the parties; benefits of terms are paid for. Thus, statements of commerciality or not of a construction of a policy in a debate about its terms and reach of cover must be carefully assessed. A lack of commerciality, so-called, may simply be the extent of the possible operation of the policy in respect of a claim that has in fact been paid for, by a higher or lower premium.
18 One solution of the above difficulties has been to give the insurer the right, but not the duty, to take over the defence of a claim. Another has been to have a clause requiring the insurer to pay defence costs expended by the insured with its consent, which clause may be linked to the claims for which indemnity is provided, or it may be linked to the suit in which such claims are made. Another solution has been to require the insurer to undertake the defence of the suit in which the relevant claims are made.
19 In the instant policy the solution was the last of these. The "Supplementary Payments" clauses were as follows:
With respect to the indemnity afforded by this policy the Company will:
(a) Defend in their name and on their behalf any suit against the Insured alleging such Personal Injury or Property Damage and seeking damages on account thereof, even if such suit is groundless, false or fraudulent; and the Company may make such investigation, negotiation, and settlement of any claim or suit as it deems expedient; but the Company shall not be obligated to pay any claim or judgement or to defend any suit after the applicable limit of the Company's liability has been exhausted by payment of judgements or settlements.
(b) Pay all expenses incurred by the Company, all costs taxed against the Insured in any such suit and all interest accruing after entry of judgement until the Company has paid, tendered or deposited in court such part of such judgement as does not exceed the limit of the Company's liability thereon;
Provided that if a payment exceeding the Company's Limits of Liability has to be made to dispose of a claim, the Company's liability to pay Supplementary Payments in connection therewith shall be limited to such proportion of the paid Supplementary Payments as the Limits of Liability bear to the amount paid to dispose of the claim.
Provided further that the amounts thus incurred, except payments in settlement of claims and suits, are payable by the Company in addition to the applicable limit of liability of this Policy but in no event shall the Company's liability in respect of these payments exceed 50% of the Limits of Liability Stated in the Schedule.
20 The limit of liability of the policy was $5 million (any one occurrence). The limits of liability were affected by an aggregate clause relevantly in the following terms:
The limit of the Company's liability in respect of any one occurrence shall not exceed the limit of liability stated in the Schedule. All Personal Injury and Property Damage arising out of Continuous or repeated exposure to substantially the same general conditions shall be construed as arising out of one occurrence.
21 The deductible was said in the policy schedule to be:
$200,000 Each and Every Claim
22 This was elaborated upon in exclusion (s) as follows:
The Insured shall bear the first $200,000 of each and every claim inclusive of costs associated with the settlement of such claims.