(July 2018)
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Insurance Services
Office (ISO) CG 00 37–Products/Completed Operations Liability Coverage Form
(Occurrence Basis) is analyzed first. This analysis is based on the 04 13 edition
and differences between the 12 07 and the 04 13 editions will be in bold.
At the end of this
article is a discussion on the differences between the CG 00 37 and the CG 00
38–Products/Completed Operations Liability Coverage Form (Claims-Made Basis).
CG 00 37 begins by stating that certain provisions in the form restrict coverage. It encourages the insured to carefully read the entire policy to determine its rights and duties and to determine what is covered and not covered. It also points out that the insurance company uses the terms you and your to refer to the named insured and that an insured is any person or entity qualifying as such under Section II–Who Is An Insured. The terms we, us and our refer to the insurance company providing the coverage. It also directs attention to Section V–Definitions because understanding the definitions is critical to understanding the coverage form.
a. The insurance company agrees to pay amounts
for which the insured is legally obligated to pay as damages for bodily injury
and property damage covered by this insurance. This expansive statement is then
limited by stating that only bodily injury and property damage that fits within
the defined products-completed operations hazard is covered.
The insurance company has not only the right but also the duty to defend
the insured when suits are brought that demand damages. However, this duty and
right applies only when those suits apply to damages that might be covered by
this insurance.
Once the insurance company is involved, it takes control and decides
when and how to investigate and/or settle any claim or suit. The settlement
amount is limited as described in Section III–Limits of Insurance. The duty of
the insurance company to defend ends when the applicable limit of insurance is
used up by actual payment of judgments and settlements.
It is very important to review the Supplementary Payment Sections in
this coverage form because it lists important sums that are paid in addition to
the obligations described in this insuring agreement.
b. Coverage applies to bodily injury and property damage caused by an occurrence that takes place in the coverage territory. The bodily injury and property damage must occur during the policy period.
Note: The occurrence is not required to take place during the policy period and the bodily injury and property damage are not required to take place within the coverage territory.
Example: Hedgehog Industries manufactures hedge clippers in Indiana. On 1/1/18 a box of clippers are shipped to London without having the required warning labels attached. Millicent buys one of the hedge clippers on 7/1/18. She cuts her hand with the clippers on 7/15/18 and, due to complications for the injury, dies on 8/15/18. Hedgehogs PCO policy runs from 7/1/18-7/1/19 and the next is from 7/1/19-7/1/20. If a claim is presented, the 7/1/19-7/1/20 policy would respond because the bodily injury occurred during that policy period. |
Bodily injury or property damage that occurs before the policy period may be covered under the current policy period but only if no one was aware that it had occurred during a prior policy period. This means that no insured knew of the injury or damage and also that no employee authorized by the named insured to give or receive notice of an occurrence or a claim knew of it. On the other hand, when there is such knowledge, any continuation, change or resumption of that prior policy bodily injury or property damage is considered having been known before the policy period and is therefore not covered.
Note: This is only discussing the bodily injury and property damage, not the occurrence. The insured could be aware of any occurrence without any consequences. It is only knowledge of either bodily injury or property damage that impacts coverage.
c. When bodily injury or property damage occurs during the policy period all continuation, change or resumption of that particular bodily injury or property damage is covered as part of that specific policy period even if the resumption, change or continuation takes place in one or more following policy periods.
d. The policy explains exactly when bodily injury or property damage is considered to have become known. It is the earliest of the following times when any insured or employee authorized by the named insured to provide notice of a claim:
· Reports the bodily injury or property damage to any insurance company
· Receives a damage demand that alleges either bodily injury or property damage
· Becomes aware that bodily injury or property damage has occurred or has begun to occur
Note: The means by which the named insured or its authorized employee becomes aware of a loss is not limited. It could be an Internet report, an observation, or any other manner or means.
e. Bodily injury damages are not limited to only the injured party’s claims.
It includes damages for care, loss of services or death resulting at any time
from the claimed bodily injury submitted by any party.
The very broad coverage provided in the insuring agreement above is
limited by this exclusion section. The coverage does not apply to the following:
Note: There are many exceptions within the exclusions so it is very important to read the entire
exclusion in order to determine what is covered.
a. Expected or Intended Injury
Coverage does not apply to bodily injury or property damage which the
insured either expected or intended. An exception to this exclusion covers
bodily injury resulting from the insured using reasonable force to protect
persons or property.
Note: This exclusion must be viewed from the
eyes and mind of the insured not that of the witness or the person injured.
Related Article: Expected Or Intended Injury Exclusion
b. Contractual Liability
There is no coverage for bodily injury or
property damage in cases where
the insured must pay damages based on contractually assumed obligations. There
are two exceptions to this exclusion.
·
One is
if liability would have existed without a contact or agreement. This ensures
that the mere presence of a contract does not void coverage included in the
coverage form.
·
The
second is just as simple. Coverage applies if the liability assumed is within an
insured contract, as defined in the coverage form that went into effect prior
to the bodily injury or property damage.
Attorney fees and other litigation expenses are considered damages, and
therefore covered, but only if they were also assumed in the insured contract
and then only for allegations of damages covered by this coverage form.
Note: The Supplementary Payments section of this
coverage form clarifies that the defense expenses of an indemnitee are
Supplementary Payments and not included in the limits of insurance under
certain circumstances. However, under other circumstances, they are.
c. Liquor Liability (04 13
change)
The insurance company does not pay for bodily injury or property damage for which any insured may be liable because of any of the following:
·
Causing
or contributing to the intoxication of any person
·
Furnishing
alcoholic beverages to a person under the legal drinking age
·
Furnishing
alcoholic beverages to a person already under the influence of alcohol
·
Any law
relating to the sale, gift, distribution or use of alcoholic beverages.
The
following significant changes are in the 04 13 edition:
Any of
the actions described above may result in an occurrence. In that case, there is
also no coverage if any of the following claims related to that occurrence are
brought against the insured:
·
Hiring, employing, monitoring,
or training others
·
Noting that a person
is intoxicated and either providing transportation to that person or failing to
provide such transportation
This exclusion does not apply if the named
insured is not in the business of manufacturing, distributing, selling,
serving, or furnishing alcoholic beverages.
The named insured may not serve
alcoholic beverages but does allow others to bring such beverages onto its
premises. In that case, this exclusion does not apply even if a license is
required to operate this way. It is not treated as a liquor-related business
even if it charges a fee to consume the beverages on the premises.
This could be a very important exclusion for online or mail order
sellers of alcoholic beverages because of the difficulty of verifying the legal
age and identity of prospective purchasers. In cases such as these, the named
insured should purchase Liquor Liability Coverage.
Related Article: Liquor Liability Occurrence and Claims-Made
Coverage Forms Overview
d. Workers Compensation and
Similar Laws
There is no coverage for requirements or obligations of the insured
imposed by any workers compensation, disability benefits, unemployment
compensation or similar law. The intent of this exclusion and the Employers
Liability exclusion is to eliminate the possibility of the insured being
indemnified under this coverage form for an injury covered by workers
compensation or employer’s liability coverage forms and policies.
e. Employers Liability
Bodily injury to an employee of the insured as a
result of his or her employment by the insured is not covered. Such
injury to an employee during performance of duties that are in conjunction with
the conduct of the insured’s business is also excluded. Bodily injury to the
spouse, children, parents, brothers or sisters of that employee that occurs
because of the bodily injury of the employee is also not covered.
This exclusion applies whether the insured is liable as an employer or
in any other capacity, or whether the insured must share damages with or repay
someone else who must pay damages because of the injury.
An important exception to this exclusion is that it does not apply to
liability the insured assumes under an insured contract.
Note: This
clarification is particularly important because of the widespread use of
contractors, subcontractors, independent contractors or leased employees and
much of the uncertainty with respect to who is responsible for injuries to
those workers.
f. War
There is no coverage for bodily injury or property
damage caused directly or indirectly in any way by war, undeclared war and
civil war. There is also no coverage if the injury or damage is from warlike
action by a military force. This exclusion also applies to actions taken by a
government to prevent or defend against an expected or actual attack by any
government or other authority using military personnel or agents. It also
applies to rebellion, revolution, insurrection or unlawful seizure of power and
the action taken by the government to prevent or defend against any of these.
g. Damage to Property
The insurance company does not pay for property damage to:
(1) Property the named insured owns, rents or occupies. Costs or expenses
the named insured or any other party incurs to repair, replace, enhance,
restore or maintain such property for any reason are not covered even if they
are incurred in order to prevent injury to persons or
damage to property of others.
(2) Premises the named insured sold gave away or abandoned. This
exclusion applies when the property damage arises out of any part of those
premises
(3) Property loaned to the named insured
(4) Personal property in the insured's care, custody or control
There are two exceptions:
· Paragraph (2) above does not apply if the location is the named insured's work and the named insured never occupied or rented the location or held it for rent.
Note: This is particularly important to homebuilders that build and sell homes. Without this exception, there would be no coverage once the home was sold. However, this exclusion does apply if the named insured used the home as an office or rented it out prior to selling it.
|
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Coverage applies because it is a model home and never rented or occupied. |
Coverage does not apply because it has been occupied as an office. |
·
Paragraphs
(3) and (4) above do not apply to any liability assumed under a sidetrack
agreement.
Note: Railroad sidetrack agreements are covered
contracts under the PCO Coverage Form.
h. Damage to Your Product
Coverage does not apply to property damage to the named insured's product
arising out of it or any part of it.
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Example: The named insured
manufactures gas water heaters. A water heater malfunctions, explodes and
destroys the furnace next to it and other items in the utility room. Coverage
does not apply to the destroyed water heater but it but would apply to the
furnace and other property damaged by the explosion. |
i. Damage to Your Work
There is no coverage for property damage to the named insured's work that
arises out of it or any part of it included in the products/completed
operations hazard.
There is an exception to this exclusion that
applies to work performed by a subcontractor that the insured hired. Coverage
applies if the damage to property is the result of the subcontractor’s
completed work.
Example: The named insured is building a house. The electrical wiring in the house causes a fire. The property damage as a result of the fire is not covered. However, coverage does apply if a subcontractor installed the wiring for the named insured. |
Related Court Cases:
Work Project Exclusion Held Applicable to Control of Project by Construction Manager
j. Damage to Impaired Property or Property Not Physically Injured
If a defect, inadequacy or dangerous condition in the named insured’s
work or product impairs property but does not physically damage it, there is no
coverage. There is also no coverage when the named insured or its subcontractor
either is late in fulfilling or fails to perform items required in its contract,
and that lack of action results in property being impaired. However, this
exclusion does not apply to loss of use of other property arising out of the
sudden and accidental physical injury to the named insured completed work or
product.
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Example: Peckin
Switch, Inc. manufactures assembly line switches. Peckin sold a batch of
defective switches to be installed as replacements during routine assembly
line maintenance. After the switches were installed, the assembly lines could
not be restarted, resulting in additional downtime. Assembly lines were
impaired because of Peckin’s defective switches but were otherwise undamaged.
All claims made against Peckin are excluded. |
Note: There is no standard ISO endorsement currently available to buy back this coverage or to delete this exclusion.
k. Recall of Products, Work or Impaired Property
There is no coverage
for any incurred loss, cost, or expense when the named insured’s product, work,
or any impaired property is recalled or withdrawn from the market or from any
use. There is also no coverage for costs and expenses the named insured or
others incur because they can no longer use the recalled or withdrawn item.
This exclusion also applies to withdrawal, recall, inspection, repair,
replacement, adjustment, removal, and disposal expenses.
This exclusion applies
when the recall or withdrawal is due to a defect, deficiency, inadequacy, or
dangerous condition in the item recalled.
Note: CG 00 66–Product Withdrawal Coverage Form reimburses the named insured's product withdrawal expenses because of a product withdrawal to which the coverage provided applies.
l. Electronic Data (04 13 change)
Coverage does not apply to damages arising out of the loss of, loss of
use of, damage to, corruption of, inability to access or inability to
manipulate electronic data.
This exclusion does not apply to bodily injury. (04 13
addition)
Electronic data is defined as information, facts or programs used with
computer software or any other media used with electronically controlled
equipment.
Note: Payments made under this section do not
reduce the limits of insurance.
1. Only when the insurance company investigates or settles a claim or defends a suit against an insured, will
the insurance company pay the following amounts.
a. All expenses
incurred that relate to the claim.
Note: This provision is
important because these expenses can be substantial and could reduce the
available limits if they were included in the limits of insurance that apply.
b. The cost of bonds
to release attachments. This is limited to only the cost of bond amounts that
are within the limit of insurance that applies. The cost of the excess amount
of the bond is at the insured’s expense. The insurance company is not required
to furnish the bonds.
c. Reasonable
expenses the insured incurs at the request of the insurance company to assist
it in investigating or defending a claim or suit. This includes up to $250 per
day in lost earnings if the insured is required to be away from work.
d. A suit’s court costs that
are the insured’s responsibility. These
costs do not include attorney fees or expenses for which the insured is
responsible.
Note: This attorney’s fee
restriction can be very costly to the insured, especially if the insured loses
the law suit and the court assesses the other party’s attorney’s fees against
the insured.
e. Prejudgment
interest, for which the insured is responsible, on the part of any judgment the
insurance company pays. However, if the company offers to pay full policy
limits, it does not pay any prejudgment interest that accrues during the period of time after it makes the offer.
f. Interest that
accrues on the full amount of any judgment in the period between the entering
of the judgement and the insurance company paying, offering to pay or
depositing with the court its portion of that judgment.
2. If an indemnitee
of the insured is named in a suit brought against the insured and the insurance
company defends the insured, the company will also defend the indemnitee but only if the following
conditions are met:
a. The suit against
the indemnitee must meet the following two criteria:
b. The insurance
provided by this coverage form must apply to the assumed liability
c. The insured
assumed the obligation to defend or the cost of defense in the same contract or
agreement where the liability was assumed
d. Based on what the
insurance company knows about the occurrence and the allegations contained in
the suit, there appears to be no conflict between the respective interests of
the insured and the indemnitee
e. Both the insured
and the indemnitee ask the insurance company to handle the defense of the
indemnitee in the suit and agree to have the same legal representative handling
the interests of both parties
f. The indemnitee has
its own set of conditions. The following must be in writing:
·
Agree
to cooperate with the insurance company while they investigate, defend or settle
the suit.
·
An
agreement to immediately send copies to the insurance company of suit-related demands,
notices, summonses or legal documents.
·
Agree
to provide notification to any other insurer who provides coverage for the
indemnitee.
·
A cooperation
agreement with the insurance company as it coordinates other insurance
available to the indemnitee.
·
Provide
authorization so that the insurance company can obtain records and other
information related to the suit.
·
Authorize
the insurance company to conduct and control the defense of the indemnitee in
the suit.
Subject to all criteria in this item 2. being met, attorney fees and all litigation expenses are paid without
reducing the limits of insurance. The insurance company's obligation to defend
the indemnitee ends when the applicable limit of insurance is exhausted by
payment of judgments or settlements or when the conditions and agreements in
this item 2. above are not met.
Example: Gregory manufactures tea pots. Endorsement CG 20 15–Additional
Insured Vendors is attached so all of Gregory’s vendors are considered
additional insureds for Gregory’s tea pots. Marge is badly burnt when the
handle of her tea pot, which had been purchased from Cozy Tea, breaks. She
sues Cozy Tea and Gregory. Gregory’s insurance coverage agrees to represent
both Cozy Tea and Gregory and pay all defense expenses. However, Cozy Tea is
not satisfied with the handling of the case and refuses to honor the
conditions as outlined. Cozy Tea’s owner demands separate representation
because she believes her case is being compromised by being tied to Gregory.
Once this occurs, her defense costs are no longer outside limits. The case continues and Cozy Tea has separate representation, but
all expenses incurred reduce the limit of insurance available to pay for the
loss. |
1. This section identifies
insureds with respect to this insurance. This applies based on the type of entity or entities selected on the
declarations:
a. If the named insured is an individual, the individual is the named
insured as well as the named insured's spouse. However, this situation is not
all-inclusive. Their status as named insureds is limited to operations of the
business for which the named insured is the sole owner.
Example: Katie Fram, a sole proprietor,
sells bird houses. Both she and her husband, Patrick, are insureds. In
addition, Katie is the sole proprietor in another venture in which she sells
birdseed. Here again, both she and Patrick are insureds. However, if she and her
sister owned the birdseed business as a partnership, coverage would not apply
to the partnership. |
b. If the named
insured is a partnership or joint venture, the partnership or joint venture is
an insured. In addition, the members and partners of the named insured along
with their spouses are insureds but subject to a condition. The condition is
that their status as insureds is limited to operations of the named insured's
business.
Example: Jasper and |
c. If the named
insured is a limited liability company, the limited liability company is an
insured. In addition, members of the company are insureds
but their status is limited to their conducting the named insured's business.
The named insured's managers are also insureds but their
limited status is only while performing their specific duties as managers.
d. If the named
insured is any other organization, it is an insured. In addition, the executive
officers and directors are insureds but the insured
status is limited to their performance of their duties as officer or directors.
Stockholders are also insureds but their status is very
limited to only liability imposed as stockholders.
2. The following are also insureds:
a. Employees, excluding executive officers and managers of a limited
liability company, are insureds within the narrow range of activities within
the scope of their employment or while conducting the named insured's business.
(1) Employees are not insureds for bodily
injury:
·
To the
named insured, its partners or members.
·
To
other employees. However, this limitation applies only while the other employees
are in the course of their employment or performance
of duties related to the conduct of the named insured's business
·
To a
relative of any co-employee as a consequence of the
paragraph above
·
Where
an obligation exists to share damages with or repay others for damages because
of injury described in the two bulleted items above
·
When an
employee provides or fails to provide professional health care services
(2) Employees are also not insureds for
property damage to property owned, occupied, used by, and rented to, in the
care, custody or control of any of the following:
·
The
named insured
·
Employees
of the named insured
·
Partners
or members of the named insured.
This property damage restriction also
extends to property over which any of the above exercise physical control.
b. Any party other than an employee acting as the named insured's real
estate manager.
c. If the named insured dies, the temporary legal
custodian of the named insured’s property. This status applies only until a
legal representative is appointed. The status is limited to only the liability
resulting from maintenance of the property.
d. If the insured dies, the properly appointed legal representative but
only while carrying out its duties as the legal representative.
Note: The legal representative assumes all of the
deceased named insured's rights and duties. This goes beyond the standard
insured status and extends to rights to cancellation, conditions and other
elements assigned only to named insureds.
3. Any newly formed or acquired organization qualifies as a named insured
if no other similar coverage is available to it. This does not include
partnerships, joint ventures or limited liability companies the named insured
owns or over which it has majority interest. This provision applies for only 90
days after the organization is formed or acquired, or until the end of the
policy period, whichever comes first. In addition, coverage does not apply to bodily
injury or property damage that occurred before acquisition or formation of the
organization.
No party is an insured concerning conduct of any current or previous
partnership, joint venture or limited liability company not shown on the
declarations as an insured.
Note: In addition to the parties included as insureds as outlined above, ISO has produced numerous endorsements used to add a variety of additional insureds under certain circumstances or limited to specific purposes.
Related Article: ISO Products/Completed Operations Liability Coverage Forms Available Endorsements and Their Uses
1. The most the
insurance company pays are the Limits of Insurance on the declarations, subject
to the rest of this section. This is regardless of the number of insureds,
claims made or suits brought and number of parties
making claims or bringing suits.
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Example:
Parrott and Keet are partners in the Birds R Us pet store. Keri is attacked
by a purchased parrot and sues Parrott and Keet individually as well as the
Birds R Us partnership. Although there are three claims presented, only one
occurrence limit will be available for the loss. |
2. The Aggregate
Limit is the most paid for damages because of bodily injury and property damage
included in the products/completed operations hazard.
Example: Listening Ears, Inc.’s Products/Completed Operations Liability Coverage Form has a $3,000,000 aggregate limit. Ten products claims for ten separate customer injury claims are presented during a single policy year. All the losses are covered, the injuries occur during the policy period, and the total amount of the ten claims is $4,000,000. This coverage form responds only up to the $3,000,000 aggregate limit. |
3. The Each
Occurrence Limit is the most paid for the total of damages arising out of a
single occurrence. This is subject to the Aggregate Limit.
The final part of this section clarifies how the limits of insurance
apply in a policy period. They apply separately to each consecutive annual
period and to any remaining period of less than 12 months. The period begins
with the coverage inception date on the declarations. A policy period may be
extended for an additional period of less than 12 months. When that occurs the additional extended period is treated as part of
the last preceding period for the purpose of determining the limits of
insurance.
Example: Purple Punch’s policy has a policy inception date of 1/1/18. A decision is made to rewrite all policies in order to gain a common expiration date of 7/1. Purple Punch can either cancel on 7/1/18 and have a new policy on that date or extend the existing policy to 7/1/19. Unless there is a reduction in coverage because of a policy edition change, Purple should be advised to replace the policy on 7/1/18. |
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Option 1: |
Limits |
Option 2: |
Limits |
1/1/18 – 7/1/18 |
$1,000,000 |
1/1/18-7/1/19 |
$1,000,000 |
7/1/18-7/1/19 |
$1,000,000 |
||
Using option one, Purple Punch would have a unique
$1,000,000 aggregate available for the first six months of coverage and then
a separate $1,000,000 available for the next 12-month policy period. |
In option two, Purple Punch would have only $1,000,000
aggregate for the entire 18 months. |
1. Bankruptcy
If the insured or the insured's estate becomes bankrupt or insolvent,
the insurance company is not relieved of its obligations under the
Products/Completed Operations Coverage Form.
2. Duties in the Event of Occurrence, Claim or Suit
The named insured has a
number of duties to perform when a situation that might result in a
claim occurs and also if a claim or demand for coverage is presented:
a. The named insured must inform the insurance company when there is an occurrence
that may result in a claim or demand. The notice must be as soon as practicable
and provide information concerning how, when and where the event took place.
The notice should also include the names and addresses of all injured parties
and any witnesses along with a description of the nature and location of any
injury or damage that are a result of the occurrence.
b. Concerning claims made or suits brought, the named insured must
immediately record the details of the claim or suit and the date on which it
was received. The insurance company must be notified of the claim or suit as
soon as practicable. A verbal notification is not sufficient. It must be
followed up by timely written notice.
c. Every insured involved in or with the claim must:
·
Provide copies of demands, notices, summonses and
legal documents received in conjunction with the claim or suit immediately to
the insurance company
·
Authorize and grant approval for the insurance
company to obtain records and other needed information
·
Cooperate with the insurance company as it investigates
and/or settles the claim or defends the suit
·
Only when requested by the insurance company, assist
it in enforcing rights against a person or organization that may be liable to
the insured for injury or damage covered by this insurance
d. No insured may voluntarily make any payments, assume any obligations or
incur any expenses other than first aid without the insurance company's consent.
The insured does have permission to do any of the above but only at its own cost
or expense.
Related Court Case: Ten Year Delay of Claim Relieved Insurer
of Defense and Indemnification of Housing Authority is an example of the
potential impact of improperly notifying the insurance company of a claim.
3. Legal Action Against Us
No party has the
right to join the insurance company in any manner, bring the company into a
suit claiming damages from an insured or sue the insurance company unless all of the policy terms and conditions have been completely
met and complied with.
The insurance
company can be sued to recover on an agreed settlement or on a final judgment
against the insured. However, the insurance company is not liable for damages that
would not be covered by this coverage form. It is also not liable for amounts in excess of the limit of insurance.
The term “agreed
settlement” is a settlement where a release of liability is signed by the
insured, the insurance company and the claimant or the claimant's legal
representative. This settlement would have been reached out of court.
4. Other Insurance
The insurance company's obligations to pay are limited if other valid
and collectible insurance is available that applies to the loss, as follows:
a. Primary Insurance
The insurance provided under this coverage form is primary. The
insurance company has the first obligation to pay unless any other insurance available
is also primary. When there is other primary coverage, refer to b. Method of Sharing, below.
b. Method
of Sharing
Equal sharing is
the preferred method but it is used only if all of the
other primary coverage forms permit it. Equal shares contribution means that each
insurance company contributes an equal amount until it uses up its limit of
insurance or the loss is paid, whichever occurs first.
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Example: The insured has three separate
Products/Completed Operations Liability Coverage Forms, all written in the
same name. When a loss occurs for which the insured is liable for damages,
all three respond. Policy A's each occurrence limit
is $1,000,000, Policy B's is $2,000,000 and Policy C's is $3,000,000. The
total amount of the judgment for which the insured is liable is $300,000.
Under contribution by equal shares, each of the three policies contributes
$100,000 for a total payment of $300,000. |
Contribution by proportional limits is used
when equal sharing cannot be used. Proportional limits contribution requires
the development of a ratio which is then applied to the loss. Ratios are determined based on each
insurer’s limit as a percentage of the total applicable limits. The loss is
then multiplied by the computed ratio to determine how much each company must
pay.
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Example: Using
the previous example, Policy A's each occurrence limit is $1,000,000, Policy
B's is $2,000,000 and Policy C's is $3,000,000. The total of all limits
available to pay claims is $6,000,000. Company A has 1/6 of the obligation.
Company B has 1/3 of the obligation. Company C has 1/2. The total amount of
the insured's liability is $300,000. As a result, Company A pays $50,000,
Company B pays $100,000, and Company C pays the remaining $150,000. |
5. Premium Audit
a. All premiums are calculated according to
the insurance company's rules and rates.
b. The premium shown on the declarations as
an advance premium is only a deposit premium. At the end of each audit period,
the insurance company determines the actual earned premium for the period and
notifies the first named insured. The due date for the company to receive the
premium billed is the due date shown on the billing notice. However, when
advance and other premiums paid throughout the policy year are more than the computed
premium, the insurance company refunds the excess to the first named insured.
c. The first named insured is required to keep
the records and information the insurance company needs to do the premium
calculations. It must send copies of such records and information to the
company when requested to do so.
Example: Fernando’s Meats policy is issued effective 1/1/18 as follows: |
||
Rate: |
Sales |
Advance premium |
1.25 |
$2,000,000 |
$2,500 |
Fernando provides
his records to the insurance company in February, 2019
and his premium is calculated as follows: |
||
Rate: |
Sales |
Earned premium |
1.25 |
$3,000,000 |
$3,750 |
Fernando is sent
a bill for $1,250 ($3,750 - $2,500). The bill is due upon receipt. |
6. Representations
When the named insured accepts this coverage form as issued, it agrees
that the statements on the declarations are complete and accurate. It also
agrees that the policy is based on representations it made to the insurance
company. Furthermore, the named insured agrees that the policy was issued based
on those representations.
Note: This condition is important because it sets
the stage for rescission of the policy if it is determined that the named
insured misrepresented material information.
Related Court Cases:
Contractor Paints Itself into a Corner
Split Decision on False Statements in Application
7. Separation of Insureds
Each named insured is treated as though it is the only named insured.
There are two exceptions. The first is that limits of insurance apply over the
entire coverage form so each named insured does not
have access to its own set of limits. The other exception is that the first
named insured has certain extra policy-related responsibilities which are
described within the applicable conditions.
When insureds are faced with a claim or suit, each one is treated
separately. The only exception is that the limits of insurance apply over the
entire form so each insured does not have its own set
of limits.
8. Transfer of Rights of Recovery Against
Others to Us
Any rights the
insured has against others to recover all or part of any payment made by the
insurance company are transferred to the insurance company. The insured must
preserve those rights and do nothing after the loss occurs to impair them. The
insurance company can request that the insured bring suit
or transfer those rights to it. The insurance company also has the right to
request that the insured assist it in enforcing those rights.
Note: The enforcement can be very difficult on
insureds as they may be required to be the party to any lawsuits filed which
can result in lost friendships and adverse publicity.
Example: Marty’s Jewels, Inc. manufactures and sells earrings to a number of local retailers. All necklaces are required to be hypoallergenic. Paula sues Gina’s Jewels because she had a severe allergic reaction to an earring. Gina’s insurance company, Heartly Insurance, files a claim against Marty’s Jewel’s, Inc. because it manufactured the contaminated earring. Marty’s insurance carrier, Friendly Insurance, pays the retailer’s claim and then uses Marty’s rights of recovery to subrogate against Precise Metals who had supplied the contaminated metal used in the earrings. Marty is devastated when his close friend, the owner of Precise Metals, is forced into bankruptcy due to the lawsuit. |
9. When We Do Not Renew
The insurance
company must mail or deliver written notice if a decision is made to not renew.
The notice must be mailed to the first named insured at the address listed on
the declaration. The notice must be mailed at least 30 days prior to the
expiration date. The only evidence required that the notice has been mailed out
is a proof of mailing.
Note: This paragraph
is modified by specific endorsements in many states as to the number of days of
advance notice of non-renewal required, what is
considered acceptable as proof of mailing and the valid reasons to terminate or
not renew coverage. The requirements of each state must be evaluated carefully
when considering any changes or modifications of this condition.
Defined words are
used throughout the policy. Restricting their meaning to the definition in the
policy provides the means for all parties involved with the policy to have a
clearer understanding of the coverage intended.
1. Auto (04 13 change)
A land motor vehicle, trailer or semi-trailer designed for travel on
public roads. Machinery and equipment attached to that land motor vehicle,
trailer or semi-trailer is also considered auto. A land vehicle that is subject
to compulsory or financial responsibility laws or motor vehicle laws where it
is garaged is also considered an auto.
The term does not include mobile equipment.
Note: The 04 13 edition removes the words “in the state” after “motor vehicle
laws” in the prior edition with respect to auto licensing or garaging
locations.
2. Bodily injury
Sickness or disease when it is sustained by a person is considered bodily
injury. Bodily injury that is sustained by a person is also bodily injury.
Death that results from bodily injury, sickness or disease is bodily
injury no matter when that death results.
Example: A machine
exploded. Jerry was struck by one of the flying parts. It lodged in his head
and could not safely be removed. Many years later he fell off a ladder,
dislodged the part and died. Even though the death was many years after the
initial injury, the death is considered bodily injury from that initial
bodily injury. |
3. Coverage territory
The United States of America, its territories and
possessions, Puerto Rico, and Canada. International waters or airspace are also
part of the coverage territory but only for injury or damage that occurs during
travel or transportation between points in the first sentence.
Coverage territory includes other parts of the world, if the injury or
damage arises out of the goods or products the named insured manufactures or
sells in the territory described above. However, this worldwide coverage is
limited because payment is made only when the damages are determined either by
trial in the territory described above or in a settlement agreed upon with the
insurance company.
4. Employee
This expands to include leased workers but not to temporary workers.
5. Executive officer
A person occupying any officer position. The named insured's charter,
constitution, by-laws or similar governing documents are the only documents
that can describe what an officer position is.
6. Impaired property
Tangible property that either cannot be used or is less useful than it
could be. It cannot be the insured’s work or product.
The reason for the loss of usefulness can be because the named insured's
product or work that is a part of the tangible property is dangerous ,
inadequate, defective or deficient or is alleged to be so.
Example: Jerry’s stamping machine was working well but a recent recall notice
states that any machine with a Ready Start switch could accidentally activate.
Jerry takes the machine out of service until the replacement switch is
delivered. That machine is impaired property. |
The reason for the loss of usefulness can also be the result of the named
insured not satisfactorily completing the terms of a contract or agreement.
Example: Gordon Millwrights have installed a luggage carrousel at the local
airport. All work is complete but the carrousel
cannot be used until all safety testing has been completed. The time period between the final installation and the safety
inspection is when the carrousel is impaired property. |
An important part of this definition is that the property must be capable
of being restored to use.
7. Insured contract
Consists of six types of
documents:
a. Lease of premises. This does not include a
part of any agreement that indemnifies others for fire to a
premises that is either rented to or occupied temporarily by the named
insured with the owner’s permission.
b. Sidetrack agreement
Note: A sidetrack
agreement is a contract between the owners of a premises and a railroad with
respect to a railroad transfer or access track on the insured property owner's
premises. The railroad agrees to let the insured use the sidetrack as long as the railroad is guaranteed access to it and the
owner agrees to certain conditions concerning maintenance of the property.
These agreements may also contain specific hold harmless agreements between the
property owner and the railroad.
c. An easement or license agreement. However,
those contracts connected with construction or demolition operations on or
within 50 feet of a railroad are not insured contracts.
d. Obligations to indemnify a municipality as required
by ordinance. However, those connected with actual work for that municipality
are not insured contracts.
e. Elevator maintenance agreements
f. A business-related contract or agreement in which the named insured
assumes the tort liability of another party and under which it must be pay for
bodily injury or property damage to a third person or organization. Contracts
or agreements that indemnify a municipality in conjunction with work done for
the municipality are included within this type of contract. However, the
following contracts and agreements in part or in whole are not insured
contracts:
·
Ones that indemnify a railroad for bodily injury or
property damage but only for such injury or damage that is due to construction
or demolition operations conducted within 50 feet of any railroad property.
That property must have to do with railroad bridges, trestles, tracks,
roadbeds, tunnels, overpasses or crossings
·
Ones that indemnify architects, engineers or
surveyors for injury or damage. The primary cause of the injury or damage must arise
from the preparation, map approval process, shop drawings, opinions, reports,
surveys, field orders, change orders, drawings and specifications, or the giving
or failure to give instructions or directions.
·
When an architect, engineer or surveyor insured
assumes liability for injury or damage arising out of its rendering or failing
to render professional services as described in the above paragraph or from supervisory,
inspection, architectural or engineering activities
Note: Tort liability is
liability imposed by law.
8. Leased worker
A person leased to the named insured by a labor-leasing firm. There must
be a written contract or agreement between the named insured and the
labor-leasing firm. The leased worker performs duties related to the conduct of
the named insured's business. Leased workers are not the same as temporary
workers.
9. Loading or unloading
The handling of property. It starts when the property is moved
from a place of acceptance onto an
aircraft, watercraft or auto. It continues while it is on the aircraft,
watercraft or auto and does not end until the property is at its final delivery
location. Movement of property by means of a mechanical device not attached to
the aircraft, watercraft or auto is not considered loading and unloaded unless
the device is a hand truck.
10. Mobile equipment
The following land
vehicles and the machinery attached to them.
a. Bulldozers, farm machinery, forklifts, and other
vehicles designed primarily for off-road use
b. Vehicles intended to be used only on or next to
the owned or rented premises
c. Vehicles that use crawler treads to travel
d. Vehicles used to provide mobility for the
described permanently mounted equipment. The equipment must be power cranes,
shovels, loaders, diggers or drills, or road construction or resurfacing
equipment such as graders, scrapers, or rollers. The vehicle is not required to
be self-propelled but it may be.
e. Vehicles not described in a., b., c., or d. above
and that are not self-propelled. They must be used to provide mobility for
permanently attached equipment. The equipment can be devices used to raise or
lower workers, such as cherry pickers. It can also be air compressors, pumps,
and generators, including spraying, welding, building cleaning, geophysical
exploration, lighting, and well servicing equipment.
f. Vehicles not described in a., b., c., or d. above
and used for purposes other than transporting persons or cargo.
Vehicles that are self-propelled with the
following permanently attached equipment are autos, not mobile equipment:
Mobile equipment does
not include any vehicle subject to compulsory or financial responsibility laws
or motor vehicle insurance laws where it is licensed or garaged. These vehicles
are treated as autos. The 04 13 edition
removes the words “in the state” after “motor vehicle laws” in the prior
edition with respect to auto licensing or garaging locations.
11. Occurrence
An accident. It includes continuous or repeated exposure to essentially
the same harmful conditions.
12. Products/completed operations hazard
Bodily injury and property damage that occurs away from premises or
locations the named insured owns or rents and arising out of its products or
work. It does not mean:
Work
is considered completed when the work called for in the named insured’s
contract has been completed. When there is a contract for work at multiple
sites, the work at one site is considered completed even if there is still work to be done at other sites. Whenever part of work done
at a site is put to its intended use by any party, other than a contractor or
subcontractor still working on the same project, that part of the work is
considered complete. Work is considered completed, even if it may still need
service, maintenance, correction, repair, or replacement.
This definition does not include bodily injury or
property damage that arises from any of the following:
Example: Massive Art Supplies hires Good Hauls, Inc. to
transport various paints to its clients from Indiana to California. The
product arrives and is sold at local outlets. Artists buy the paints and
notice the paint does not adhere or have true color resulting in multiple
claims because of work having to be redone. An investigation reveals that
Good Hauls, Inc. neglected to activate its refrigerating unit during the long
trip. Massive Art Supplies is covered for the products losses because of the
exception to this definition. |
13. Property damage
Electronic date is not considered tangible property. Electronic data is
information, facts or programs stored as or on, created or used on or
transmitted to or from computer software or any other media used with
electronically controlled equipment.
Note: This is extremely important and limiting! Its importance cannot be
overemphasized. If the named insured passes a computer virus to another party's
computer in any way, and that virus destroys important data on that computer,
previous editions might have covered it. That is no longer the case with this
definition.
14. Suit
A civil proceeding alleging damages resulting from bodily injury or
property damage covered by this insurance. Arbitration proceedings or any other
alternative dispute resolution proceeding in which such damages are claimed are
considered suit only if submitted to by the insured with the insurance
company's consent.
15. Temporary worker
Any person furnished to the named insured as a substitute for a
permanent employee who is temporarily away from the business. Also a person furnished to meet seasonal or short-term
workload conditions.
16. Your product
Any goods or products
manufactured, sold, handled, distributed or disposed of by the named insured,
by others that trade under the named insured’s name, or by any party whose
business or assets the named insured acquired. Your Product includes containers
(excluding vehicles), materials, parts, or equipment furnished in connection
with such goods or products.
Your product does not include
real property.
Your product is also
warranties or representations made concerning the fitness, quality, durability,
performance, or use of the product and providing (or failing to provide)
adequate warnings or instructions.
Your product is not
vending machines or other property rented to or located for the use of others
but not sold.
17. Your work
Work or operations done by the named insured or on behalf of the named insured, and the materials, parts or equipment furnished in connection with such work or operations.
Warranties or representations made at any time concerning the fitness, quality, durability, performance or use of the named insured's work are considered your work. The providing or failing to provide warnings or instructions is also considered your work.
The header section of this coverage form states in bold letters that Coverage A and Coverage B provide claims-made coverage with the admonition to read the entire form carefully. This statement is intended to alert the named insured to the fact that certain parts of this coverage form are different than in the occurrence coverage form.
This analysis addresses only the five parts of the claims-made form that differ from the occurrence form.
Note: The WHO, WHAT, WHERE, and HOW aspects
of coverage are unchanged. The differences are based on WHEN.
1. Insuring Agreement summary:
Example: The policy period is 01/01/18 to 01/01/19 when coverage is written on a claims-made basis for the first time. It subsequently renews twice, each time on a claims-made form. Three claims are reported during the time period. Claim #1 is a 12/01/017 bodily injury reported on 01/15/18. Claim #2 is a 05/01/18 property damage reported on 12/01/18. Claim #3 is a 02/01/18 bodily injury reported on 06/01/16. |
Scenario 1: The retroactive date changes to match the effective date of each policy term:
|
Scenario 2: The retroactive date is the effective date of the first claims-made policy.
|
Scenario 3: The retroactive date indicated on the declarations is "None."
|
All claims for damages because of bodily injury to the same person are treated as having been made at the time that the first of those claims was made against any insured.
Example: Brian is unloading a semitrailer when the lift on the truck malfunctions and crushes his foot. A claim for his medical bills is presented to Sims Truck Lifts, Inc. on 07/01/17. Brian’s wife sends notification of her claim for loss of consortium to Sims’ insurance company. On 03/01/18, Brian dies due to complications from the foot surgery so his family files a wrongful death claim against Sims. On 09/01/18, Brian’s workers compensation carrier subrogates against the insured for the costs of the injuries he sustained that it paid. Each of these claims is treated as having the initial claims-made date of 07/01/17. |
All claims for damages because of
property damage causing loss to the same person or organization are treated as
having been made at the time that the first of those claims was made against
any insured.
The CG 00 38, Condition 2. Duties In The Event Of
Occurrence, Claim or Suit, subparagraph a. has an entry not found in the
occurrence form. It states that notice of an occurrence is not notice of a
claim. Subparagraph b. in the CG 00 38 states that if a claim is received by
any insured, the named insured must immediately record the specifics of the
claim and the date received and notify the insurance company as soon as
practicable. The named insured must also ensure that the insurance company
receives written notice of the claim as soon as practicable.
Note: The term suit does not appear in the
claims-made form.
Example: On 08/01/17, Pamela witnesses one of her restaurant’s customers choking on her food and expressing concerns about her food allergies. After the customer’s breathing improves, Pamela questions her cook about the ingredients in that customer’s meal. Meanwhile, the customer and the rest of the table leave. Pamela notifies the insurance company of the occurrence on the same day. On 06/15/18 Pamela receives papers informing her that the family of the customer is suing because she died as a result of the food she ingested at the restaurant. If Pam had claims-made coverage in force during the time period, the claims-made date is 06/15/18, not 08/01/17, and the coverage in force as of 06/15/18 responds, provided the retroactive date is prior to 08/01/17. |
Condition 4. Other Insurance, subparagraph b. Excess Insurance is an
addition. The occurrence form coverage is always primary so there is no excess
provision. This excess provision states that this insurance is excess over any
other insurance that is not written as claims-made. That other insurance must
be effective prior to the inception date of this policy and apply to bodily
injury or property damage. Furthermore, this policy is excess only if either of
the following is true:
Example: Continuing the restaurant example above, if occurrence coverage was in effect on 08/01/17 and claims-made coverage was in effect on 06/15/18 with a retroactive date prior to 08/01/14, the occurrence coverage is primary and the claims-made coverage is excess. |
Condition 10. Your Right to Claim and
Occurrence Information in
the CG 00 38 does not appear in the occurrence form. This condition details the
claims-made claim information the insurance company is required to release. The
detailed analysis follows.
10. Your Right to
Claim and Occurrence Information
The insurance
company provides the first named insured information relating to any
claims-made products/completed operations coverage issued to it during the
previous three years. The information that must be released is:
Note: The named insured’s reporting will
determine the type of reports it can expect. If its initial notices are skimpy,
this report will also be skimpy.
Reserve amounts are
based on the insurance company's judgment, are subject to change at any time
and without notice, and should not be considered as
final settlement amounts.
The released
information could compromise claim negotiations, so the policy prevents the
named insured from disclosing or providing it to claimants and/or their
representatives without its prior consent.
If the insurance
company decides to cancel or not renew the coverage provided, this claim
information must be provided 30 days or more prior to the cancellation or
non-renewal date. In all other cases, it will provide this information only if
a written request for such is received from the first named insured within the 60
days following the expiration date. The insurance company must provide the
requested information within 45 days of the request date.
The insurance
company provides a disclaimer. It makes no representations or warranties as to
the accuracy of the information. Cancellation or non-renewal is still
effective, even if the information provided is not accurate.
Example: Pelican, Inc. has been insured on a claims-made Products/Completed Operations Liability Coverage Form written by Creative Insurance Company for the past three years. Creative notifies Pelican that it is not renewing coverage and provides Pelican with two different reports. The first report reads as follows: |
||
Date of loss |
Loss description |
Remarks |
12/8/15 |
Property struck claim |
10 storefronts |
5/5/16 |
Child injury claim |
1 child – under 5 years old |
8/7/17 |
Property struck claim |
Bridge |
This report does not include ten other occurrences included on a similar report received from its previous carrier. The second report reads as follows: |
||
Policy period |
Amounts paid |
Amounts reserved |
01/01/15-01/01/16 |
$35,000 |
$0 |
01/01/16-01/01/17 |
$25,000 |
$400,000 |
01/01/17-01/01/18 |
$15,000 |
$150,000 |
This section is
found only in the claims-made coverage form. It does not appear at all in the
occurrence coverage form. This section explains how the extended reporting
periods work.
1. The insurance
company provides one or more described Extended Reporting Periods. It is provided
if this coverage is cancelled or is not renewed by either the named insured or
the insurance company. It also applies if the insurance company replaces or
renews the current policy with insurance that has a later retroactive date than
the one shown on this declarations or with coverage
provided is on other than a claims-made basis.
2. Extended
Reporting Periods do not change the nature of the coverage provided or extend
the coverage period. These periods apply only to claims for bodily injury or
property damage that actually occur before the end of
the coverage period and after any retroactive date on the declarations.
3. A Basic Extended
Reporting Period is included automatically and without any additional premium
charge. It begins at the end of the coverage period. It lasts for:
Claims covered under any subsequent insurance coverage the named insured
purchases or that would be covered except for the limit of insurance applying
to such claims being used up are not eligible for coverage under this Basic
Extended Period.
4. The Basic
Extended Reporting Period uses the same limits available to the rest of the
insurance policy.
Example: Major Insurance Company non renewed Realistic’s P/CO coverage, triggering the Basic Extended Reporting Period. Realistic's P/CO coverage had been on a claims-made basis for the past four years. The retroactive date was the date of the first claims-made policy and had never changed. The first claims-made coverage was effective 01/01/16 and the last claims-made P/CO coverage form expired 01/01/18.
|
5. A Supplemental
Extended Reporting Period is available by endorsement and for an additional
premium charge. It is of unlimited duration and begins when the Basic Extended
Reporting Period ends. The onus is on the named insured to request the
endorsement. It must do so quickly because if the named insured has not
requested this endorsement within 60 days following the policy expiration date,
the endorsement is no longer available at any cost. The premium is due promptly
and coverage does not go into effect until after it is paid. The premium will
be expensive but is capped at no more than 200% of the annual premium of this particular policy. The insurance company is required to
consider exposures, insurance limits and types of insurance, limits available
to pay for future claims and other relevant factors when setting the price. CG
28 34–Supplemental Extended Reporting Period Endorsement or CG 28
35–Supplemental Extended Reporting Period Endorsement for Special Accident,
Products, Work or Locations must be attached to explain the terms and
conditions specific to this reporting period.
6. A supplemental aggregate limit of insurance becomes available when the Supplemental Extended Reporting Period is in effect. The limit applies only for claims first received and recorded during the Supplemental Extended Reporting Period and is equal to the dollar amount on the declarations in effect at the end of the policy period.