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The Restaurant Nobody Will Write

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The Restaurant Nobody Will Write

A Lexington agency is asked to insure a 60-year-old restaurant with three grease fires in five years, a failing roof, and an owner who wants coverage bound by Friday. Every admitted carrier the agency represents declines, and two of those carriers do not write restaurant risks at all. The owner signs a broker-fee disclosure and the agency places the risk with an eligible surplus lines insurer at an $18,000 premium, filing the policy and remitting the surplus lines premium tax on time. In November that carrier is declared insolvent and cannot pay a $95,000 fire claim. The owner calls the agency demanding payment and asking whether the Kentucky insurance guaranty association will step in. The agency's file contains the two declinations and a handwritten note reading "no other markets."

1. Was the diligent effort requirement satisfied before this risk was placed in the surplus lines market?

Read the worked answer

Probably not on this record.

Surplus lines placement is permitted only after a documented, unsuccessful search of the admitted market for the specific class of business. The agency has two declinations, and the facts state both came from carriers that do not write restaurants at all. A declination from an insurer that never could have written the risk proves nothing about market availability; regulators routinely reject those as evidence of diligent effort.

What a defensible file looks like:

  • Declinations from at least three admitted insurers that actively write restaurant or similar hospitality risks in Kentucky.
  • Names, dates, and method of the submission (rating portal, email, underwriter contact), not a summary note.
  • A specific reason for decline (loss history, roof condition, cooking exposure), tied to the risk's actual characteristics.
  • A statement of the class and the coverage limits sought.

"No other markets" is the problem. That note is a conclusion, not evidence. On a market-conduct exam the DOI can read the file and see no proof that any admitted writer of restaurant business was ever asked. The three prior grease fires - a known, class-relevant loss history - should have been disclosed to each market that declined.

Judgment call: the outcome (a legitimate surplus lines placement) can be correct while the documentation is deficient. Diligent effort is judged by the file, not by the result, and the deficiency is a violation even though the coverage the owner bought was real.

2. The owner asks whether the guaranty association will pay the $95,000 claim. Answer him, with reasoning.

Read the worked answer

No - in the ordinary case the guaranty association does not respond to surplus lines insolvencies.

Guaranty associations are funded by assessments on member insurers, and membership is limited to insurers authorized (admitted) in the state. Surplus lines carriers are, by definition, not admitted; they are permitted to write only through licensed surplus lines producers under a separate statutory scheme. They are not members, so their insolvencies fall outside the safety net.

What this means concretely for the owner:

  • The $95,000 claim is an unsecured claim in the insolvency proceeding, likely worth a fraction of face value and paid slowly, if at all.
  • No guaranty association claim form exists for him to file.
  • The owner is now effectively self-insured for a fire loss he believed was insured - and the failing roof and cooking exposure are still there.

Agency exposure. The more dangerous question is whether the agency ever explained, before binding, that (a) the carrier was non-admitted, (b) guaranty fund protection would not apply, and (c) the owner was taking carrier-credit risk. If that conversation is undocumented, the agency's E&O exposure is significant and is measured by what the owner reasonably understood, not by what the agency meant to say.

Best practice: surplus lines disclosures should be in writing and signed, exactly like an UM rejection or a coinsurance-limit acknowledgment.

3. Evaluate the broker fee and the overall adequacy of the agency's disclosure to this client.

Read the worked answer

The broker fee is permissible only if three conditions hold:

  1. It is disclosed in writing and agreed to before the sale - the facts say a disclosure was signed, which is the right starting point.
  2. It is not a disguised commission or a charge for work the agency was already compensated for by the carrier's commission.
  3. It is reasonable in relation to the work actually performed, and it is separately identified on the invoice.

If the $18,000 premium already generated a normal commission, the agency must be able to describe what extra, non-duplicative service the fee purchased. A fee charged routinely on every account is not a fee for extraordinary work.

The larger gap is what was not disclosed. The disclosure covered the fee but evidently not the surplus lines character of the placement. The client needed to understand:

  • the carrier is not admitted in Kentucky and is not a guaranty association member;
  • the policy forms, rates, and terms are not filed or approved by the DOI, so the coverage may differ from an admitted-market form (e.g., stricter protective-safeguards or roof conditions);
  • the diligent-effort search was performed and what it produced.

Judgment: a signed fee disclosure protects the fee. It does not protect the agency on the carrier-insolvency question, which is the exposure that actually materialized. The fix is a single, plain-language surplus lines acknowledgment signed at binding, covering both points.