LAW ENFORCEMENT LIABILITY COVERAGE FORM ANALYSIS

LAW ENFORCEMENT LIABILITY COVERAGE FORM ANALYSIS

(July 2019)

 

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Since Law Enforcement Liability (LEL) Coverage is not standardized, care has to be taken when using a particular insurance company’s form. The following analysis is of a form that is representative of such coverage.

This particular form advises that “you” and “your” references the law enforcement entity that is the named insured under the policy and the “we,” “us” and “our” is the company providing the insurance protection. The introduction also specifically refers to Section II – Who is an Insured for an explanation as to who is meant when the term insured is used in the policy. A final recommendation is made to refer to Section VI–Definitions in order to understand terms in the policy that have special meanings.

SECTION I - COVERAGE

1. Insuring Agreement

a. This portion of the policy obligates the insurer to pay on behalf of an insured that has to pay another party who has been harmed by the insured. The payment obligation is only created by the named insured committing a wrongful act which is defined by the policy.

The insurer uses this section to establish both a duty to defend the named insured against wrongful act claims as well as reserve its right to investigate and, if necessary, settle such claims and incidents. It also points out that any payment obligation is subject to the policy’s applicable deductible and the listed policy limits. Paying either a judgment or settlement ends the insurer’s obligation to provide the named insured a legal defense.

The only other, valid payment obligation under this policy exists only within the policy’s supplementary payment section.

b. Coverage under this policy is triggered by qualifying wrongful acts. Such acts that have eligible coverage are those that happen somewhere in the policy’s coverage territory and that happen during the applicable policy period.

Related Court Case: Taser Use Determined To Be Excessive Force

2. Exclusions

This section is precisely where one needs to go in order to determine what occurrences are covered. Typical Law Enforcement Liability forms bar coverage for the following:

a. Claims covered under the insured’s workers compensation, unemployment compensation, disability benefits, or similar insurance policies

b. Loss or injury to any of a named insured’s law enforcement officers, employees, or auxiliary or voluntary personnel. However, this exclusion only applies when the loss or injury is tied to duties they perform for the named insured.

c. Claims arising out of ownership, maintenance, management, operation, use, control, loading or unloading of autos or motor or propelled vehicles of any kind, including watercraft or aircraft if owned or operated by, rented or loaned to any insured, or operated by any person on an insured's behalf

Note: These should be covered on the insured’s business auto, watercraft, or aviation coverage form or policy.

An interesting point is the trend of local law enforcement making use of drones in their activities. Policies may bear revising as such use becomes more popular.

 

Example: Officer Landon had just begun training several cadets in operating a small fleet of drones that were donated to the department. Initially they are to be used for surveillance and missing person searches. During one training session, a cadet loses control over a drone which falls and strikes a civilian. This loss is not eligible for coverage under the LEL policy.

 

Related Article: Aircraft Insurance Coverage Analysis

d. Losses related to the named insured voluntarily taking on liability by way of any contract or agreement. There is an important exception. The exclusion exempts losses involving political subdivisions that make mutual law enforcement assistance agreements.

 

Example: After a major traffic accident occurs on a road located in Stressed County, several deputies from Helperly County respond. A motorcyclist sues, alleging that he was seriously injured when a Helperly deputy pushed him off his bike as he attempted to get around the accident site. The Helperly deputy is eligible for protection under Stressed County’s LEL policy due to their mutual law enforcement assistance agreement.

 

e. Losses stemming from occurrences involving parties other than the named insured, except for acts that are approved by a named insured. Once again, an exemption applies to incidents involving political subdivisions that make mutual law enforcement assistance agreements.

f. Claims that arise from the insured’s employment policies or practices, including refusal to employ, termination of employment, coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination or violation of civil rights.

Related Court Case: Sheriff’s Office May Control Moonlighting Activities

Note: These should be covered on the insured’s employment practices liability coverage form or policy.

Related Article: Employment-Related Practices Liability Coverage Analysis

g. Claims arising out of any criminal, dishonest, bad faith, fraudulent or malicious act, error or omission as well as any deliberate violation of, or knowledge of any deliberate violation of, a federal, state or local statute, ordinance, rule or regulation. However, the named insured’s intent regarding these actions must be legally determined. Further, other persons who are insureds under this policy, if they are judged not to be complicit or aware of such acts, are still eligible for coverage.

Related Article: Innocent Insureds

h. Property damage to property the insured owns occupies or rents. Neither does coverage under this policy extend to loss to property in the insured’s care, custody or control. There is an important exception. It does not apply to property held by persons when they are arrested or detained

i. Any type of nuclear exposure. Specifically, coverage is barred for losses where an insured has provided equipment, parts or services to efforts to plan, build, run or even facilitate a nuclear reactors, nuclear devices or waste storage. Any handling or transportation of nuclear materials or byproducts is also excluded.

j. Claims seeking relief or redress in any form other than monetary damages the form references injunctive (terminating an activity), mandamus (ordered to perform a specific duty), declamatory (ordered to make a specific statement) or equitable relief. Further, damages that, in any manner, involve employee pay are ineligible for coverage. The latter instance is barred even when the liability exists in the form of liquidated damages and even when created due to any laws, regulations or collective bargaining situations.

k. Claims made against an insured by another insured

l. Claims involving pollution. Pollutants are any solid, liquid, gaseous, or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. The terms also applies to any forms of radiation or ionization as well as genetically engineered, teratogenic (agents that harm embryo development), carcinogenic and mutagenic (agents that cause or increase the chance of mutation) materials. Waste also includes materials intended for recycling, reconditioning or reclamation.

 

Example: The Yellingtown Police Department responds to a hostage situation. The situation is resolved when the hostage-taker is subdued after tear gas canisters are lobbed into the building. Later, several rubber-necking citizens who are hospitalized due to escaping fumes sue the department. The claims are denied under the policy’s pollution exclusion.

 

Neither does coverage extend to losses related to pollution clean-up, monitoring, and testing or assessment activity, even when mandated by authorities.

This policy also bars coverage or payment for any investigation, settlement or other expenses related to pollution claims (includes suits, allegations or proceedings).

Related article: Pollution Exclusion and Limited Coverage

If additional pollution liability coverage is needed, a separate pollution policy should be considered.

Related Court Cases: Environmental Cleanup Costs Held Not Covered By CGL Insurance

m. Liability arising out of a member of the medical profession rendering or failing to render professional services

n. Civil or criminal fines or penalties levied by any federal, state or local governmental regulatory agency or court. Damages that, by law, are classified as ineligible for reimbursement or indemnification are also excluded.

o. A claim for damages relating to a communicable disease. There is no coverage if the allegations are that there was actual transmission of or merely exposure to a communicable disease. An example of such a disease is Acquired Immune Deficiency Syndrome (AIDS). Damages claimed because of negligent training, supervision, recruitment, policies or procedures are also not covered.

Again, exclusions do differ among insurers offering the coverage. For instance, carriers may also exclude losses involving the following (or similar activities):

·         Misuse of the named insured’s funds

·         Any form of moonlighting

·         Acts outside of described job duties

SUPPLEMENTARY PAYMENTS

Under this policy the insurance carrier pays all of the following costs in addition to the protection provided by this policy’s applicable liability limit.

Note: Read each item carefully because there are exceptions.

1. All expenses the insurance company incurs to investigate, defend and settle claims

Note: This category of expense is subject to the policy deductible that applies to a given wrongful act.

2. Cost of bail bonds required because of a covered injury. The maximum amount payable is $250.

3. Cost of bonds to release attached assets. The costs are limited to those needed to supply a bond within the policy limits. However, it is NOT the insurance company’s responsibility to secure release bonds.

4. Expenses caused to an insured while attending hearings, trials or other claim-related activities in which the insurer requests participation. This coverage includes up to $100 per day for an insured’s loss of earnings.

5. The costs that are taxed by the court against an insured. However, eligibility for such expense only applies to lawsuits that the insurance company chooses to defend.

6. Pre-judgment interest awarded against the insured on the part of the judgment the insurance company pays. The insurance company’s pre-judgment payment obligation does not extend to such interest that accumulates after the date it offers to pay the policy’s applicable limit.

Related Court Case: "WYO" Insurer Liable for Prejudgment Interest – demonstrates that this obligation can be broadly applied.

7. Subject to the policy’s limit, the insurance company will pay interest that mounts on a judgment that is made from the date the award is announced until the day the amount is paid, offered or deposited.

8. Premiums on appeal bonds, but only for lawsuits in which the insurer provides a defense.

9. First aid expense for bodily injury to others that occurs when and where a covered loss takes place.

SECTION II - WHO IS AN INSURED

1. The entity or organization named on the declarations is an insured.

2. All of the following are insureds but they are insureds only while acting on behalf of the named insured and within the scope of assigned duties:

a. The named insured’s law enforcement officers. It also refers to estates, heirs, legal representatives or assigns of such law enforcement officers if deceased, bankrupt or incapacitated.

b. The political entity or subdivision to which the named insured law enforcement agency belongs including that entity’s public (elected or appointed) officials. However, the entity or subdivision must have been in existence at the inception date of the applicable policy period.

c. Other law enforcement agency employees and any volunteers who are actually authorized as such by the law enforcement agency.

 

Examples:

  • Dispatchers, fleet maintenance personnel, janitors, office clerks, criminologists, and forensic specialists of the law enforcement agency are insureds.
  • Volunteer chaplains trained and authorized by the law enforcement agencies are insureds.
  • An individual who directs traffic around a vehicle accident before law enforcement arrives is NOT an insured because that individual has not been authorized.

 

Notes:

Coverage does not apply to any entity not listed. As a result, entities to be covered must be named, such as current and past partnerships and joint ventures.

Some carriers may specifically list other entities that have insured status such as authorized commissions, boards (such as discipline or inquiry), or administrative departments. However, as is the case with other insured parties, such status usually exists only when entities are acting within their permitted duties.

 

Example: The Upper Hinterland Sheriff Department’s Discipline Board is sued by an employee and arbitration results in an award of $15,000 in damages. However, the department’s insurer rejects the claim for paying the damages. The dispute was over wages lost while the employee was suspended for failing to comply with procedures in running the department’s evidence room. It did not involve an eligible loss.

 

SECTION III - LIMITS OF INSURANCE AND DEDUCTIBLE

1. The most the insurance company pays as a result of wrongful acts is the limit of insurance on the declarations. This limit is not affected by the number of insureds, the number of claims filed, suits brought or by the number of persons or organizations that file claims or bring suits.

 

Example: The Aberdeen Police Department and its Regulatory Commission have Law Enforcement Liability coverage. Officer Sandra Smith arrests an armed robbery suspect witnesses identify in a police line-up. The suspect is later cleared of wrongdoing based on DNA evidence. The suspect sues Smith, the Aberdeen Police Department and the Regulatory Commission separately. The Law Enforcement Liability coverage responds and defends each insured separately but the maximum payout on this claim is limited to a single limit of Insurance. The limit does not apply separately to each insured. This instance is treated as a single, wrongful act.

 

2. The Aggregate Limit is, during a given policy period, the maximum amount of coverage available to pay for eligible losses that occur in that period.

 

Example: The Aberdeen Police Department purchased Law Enforcement Liability coverage with a $1,000,000 Wrongful Act Limit and a $3,000,000 Aggregate Limit. Twenty-two separate claims were filed on 22 separate alleged incidents of civil rights abuse, with damages ranging from $100,000 to $2,000,000 per claim. Since the limit for any one covered claim is the $1,000,000 Wrongful Act Limit, coverage applies only to any liability award made against the insured up to $1,000,000. Awards in excess of $1,000,000 during the policy period are Aberdeen's responsibility. The total amount for all covered losses combined during the policy period is the $3,000,000 Aggregate Limit, regardless of the number of claims the insured was liable for and the total amount of damages assessed. Awards in excess of $3,000,000 during the policy period are Aberdeen's responsibility.

 

3. The policy’s Wrongful Act Limit is the maximum amount available to pay a single claim but is always subject to the Aggregate Limit. Therefore, regardless what appears as the Wrongful Act Limit, it is subject to an Aggregate Limit that is reduced by payment of other, eligible claims.

 

Example: The Kursed County Sheriff’s Department had horrendous losses during the LEL policy year of 1/13/18 - 1/3/19. Their policy had a $750,000 Wrongful Act Limit and a $2,000,000 Aggregate Limit. As of:

3/20/18 the policy paid out $750,000 in an $800,000 judgment on a loss involving a settlement of an improper high-speed pursuit involving a crime that fell outside of department’s pursuit guidelines.

7/8/18 a judgement awarded $950,000 in a class action loss involving excessive forced used during multiple arrests at a wedding reception fight. The policy paid out $750,000.

9/8/18 a settlement resulted in a a $600,000 payment for a loss involving false arrest and false imprisonment. The policy paid out $500,000 because aggregate limit had been reached.

Wrongful Act Limit = $750,000

Wrongful Act Limit = $750,000

Wrongful Act Limit = $750,000

Policy Payments to date:

$750,000 (capped by wrongful act limit)

Policy Payments to date: $1,500,000 (2nd loss ALSO capped by wrongful act limit)

Policy Payments to date: $2,000,000

Aggregate Limit remaining  = $1,250,000

Aggregate Limit remaining = $500,000

Aggregate Limit = $0

Department’s out of pocket cost, year-to-date $50,000

Department’s out of pocket cost, year-to-date $250,000:

$50,000 from 3/18 Loss

$200,000 from 7/18 loss

Department’s out of pocket cost, year-to-date $350,000:

$50,000 from 3/18 Loss

$$200,000 from 7/18 Loss

$100,000 from 9/18 Loss

Note: After payment of 9/18 Loss, the policy’s Aggregate Limit is exhausted and no coverage is available for losses for the remainder of the policy period.

 

4. Deductible

a. The Wrongful Act Limit, as described in item 3 above, is paid only when in excess of the policy’s applicable deductible. The policy specifically advises that the deductible represents an uninsured financial threshold that is the named insured’s responsibility for any loss paid within the Wrongful Act limit. An unusual twist in this form is that the deductible is warranted to not be covered by any other type of insurance. The deductible amount must be the responsibility of only the law enforcement agency

b. No other terms or policy provisions affect the application of the stated deductible. Regardless the situation, the deductible applies.

c. For various reasons, the insurance company may decide to pay the deductible either in part or in total. However, the insured is obligated to reimburse the insurance company as soon as requested to do so.

5. Multiple claims that arise out of a given, wrongful act, related wrongful acts or from a single, official declaration, are treated as a single occurrence. This is good news for the named insured because that means only one deductible applies. The downside is that only a single Wrongful Act Limit applies in those same circumstances.

An official declaration must be triggered by rioting or similar activity. The declaration is used to declare one or more of the following:

·         States of emergency

·         Curfews

·         Martial law

Both the Wrongful Act and Aggregate Limits apply, in full, to each, applicable annual policy period. They also apply separately to any period of less than 12 month that may remain (usually due to a policy cancellation or termination). However, if after a policy has been issued, the coverage period is extended, then both limits apply over that extended length of time.

 

Example: Provemtowne’s Police Dept. has an LEL policy with an effective date of 2/1/18 to 2/1/19. and Wrongful Act/Aggregate Limits of $2,000,000/$4,000,000

Scenario 1: The policy is cancelled on 4/1/15 to establish a different policy period. The policy is rewritten to 4/1/18-4/11/19.

One set of  $2,000,000/$4,000,000 limits apply from 2/1/18 through 4/1/18

A new set of $2,000,000/$4,000,000 limits apply from 4/1/18-4/1/19

Scenario 2: The policy is extended to 4/1/19 in order to have coverage track with Provemtowne’s fiscal year. The $2,000,000/$4,000,000 limits apply from 2/1/18 through 4/1/19

SECTION IV - CONDITIONS

1. Bankruptcy

The insurance company’s obligation to provide coverage and defend the insured is not affected if the insured becomes bankrupt or insolvent.

2. Cancellation

a. The first named insured on the declarations can cancel at any time by providing the insurance company with advance written notice of its intent to do so.

b. The insurance company can cancel at any time by providing the first named insured with written notice of the cancellation. Cancellations because of non-payment must give at least 10 days advance notice. At least 60 days advance notice is required for any other reason.

c. The insurance company must mail or deliver its notice to the mailing address of the first named insured. The address used is the one that is last known to the insurance company.

Note: This makes it critical that the address on the coverage form be kept current.

d. The notice of cancellation states the cancellation date. This is the date that the policy period and coverage both end.

e. In case of cancellation, the insurance company sends the return premium due to the first named insured. If the company cancels, the refund is calculated on a pro rata basis. If the named insured cancels, the refund may be calculated on a different basis. In any case, the cancellation is effective even if a refund has not been made or offered.

f. The only documentation that is needed to show that the cancellation was sent to the first named insured is a proof of mailing.

Note: Most states have different periods that replace the ones in this condition.

3. Changes

The coverage form contains all agreements between the insurance company and the named insured. The first named insured is the only insured authorized to request changes and such changes are not effective until and unless the insurance company actually adds it to the policy by endorsement.

4. Duties In The Event Of Incident, Wrongful Act, Claim or Suit

The named insured has a number of duties to perform if a claim or demand for coverage occurs:

a. The named insured must inform the insurance company of any wrongful act that may result in a claim as soon as possible. As a minimum, the notice should include information concerning how, when and where the event took place and the names and addresses of all injured parties and any witnesses. It should also indicate the types of claim that may result from the particular wrongful act.

Note: If a claim or lawsuit related to a reported incident is later filed, the named insured has a separate obligation to also report that development to the insurance company.

b. Concerning claims made or suits brought, the named insured or any insured must immediately record its details, the date it was received, and notify the insurance company as soon as possible. This is in addition to providing the company with timely written notice of the claim or suit.

c. Every insured involved in or with the claim must:

·         Immediately send the insurance company copies of demands, notices, summonses and legal documents it receives in conjunction with the claim or suit

·         Authorize and grant approval for the insurance company to obtain records and other needed information

·         Cooperate with the insurance company in investigating or settling the claim or defending against the suit

·         When the insurance company requests, assist it in enforcing any right against any person or organization that may be liable to the insured for injury or damage covered by this insurance.

·         Take care not to proceed in a manner that endangers the insurance company’s rights with  regard to the applicable incident or act

d. No insured may voluntarily make any payments, assume any obligations, or incur any expenses other than first aid without the insurance company's written consent, unless it does so at its own cost or expense.

Related Court Case: Ten Year Delay of Claim Relieved Insurer of Defense And Indemnification Of Housing Authority

5. Examination of Your Books And Records

The insurance company may examine, audit, and copy the named insured’s books and records. However, the insurance company is limited to only those which actually relate to the coverage provided. This right applies during the policy period and for up to three years after expiration.

6. Governmental Immunity

Law enforcement agencies may be entitled to governmental immunity as public institutions. The coverage provided does not constitute a waiver of any governmental immunity available to the named insured.

 

Example: A Harmville police officer hears an emergency dispatch for a fire department to an address that is only a couple minutes away from his location. He arrives on the scene. A child and mother who fled the burning home tell him that the father is in the home with a garden hose, trying to extinguish the flames. The officer enters the home and forces the father out. The fire department was delayed by a minor traffic accident. By the time they arrive, the flames have spread substantially. The home’s a total loss by the time the fire is extinguished. The homeowner later sues the police officer claiming that he could have put out the fire earlier and saved most of the home. The police department opens a file and begins to provide a defense against the lawsuit even though the insurer is aware that Harmville has a law that will shield the officer from the lawsuit.

 

7. Inspections and Surveys

The insurance company has the right to make inspections and surveys at any time, report its findings to the named insured, and recommend changes it feels should be made. However, it is not obligated to do so. Anything it does in this regard relates only to its findings of the risk's insurability and the premiums to charge. It does not make safety inspections or attempt to perform duties of parties that provide for the health or safety of workers or the public. It does not warrant that conditions are safe or healthful or comply with any law, regulation, code or standard.

This condition applies to the insurance company as well as to any rating, advisory, rate service or other organization that also makes insurance inspections, surveys, reports, or recommendations for insurance purposes.

8. Legal Action Against Us

Legal action cannot be brought against the insurance company until the insured has performed its duties as required within the policy.

A person or organization cannot name the insurance company as a party in any type of suit or action that is requesting damages from any insured. They can also not sue the insurance company unless terms and conditions of the policy have been satisfied.

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 are not subject to payment under the terms of this policy or that are for more than the limit of insurance that applies.

Note: For a settlement to be considered, agreed upon, and include a valid release of liability, all interested parties plus the insurance company must sign.

9. Other Insurance

This condition explains how this coverage applies if other insurance also applies to a claim

a. This policy applies on an excess basis, except when the other source of coverage was bought specifically as excess coverage over this policy’s protection. Otherwise, coverage does not apply until the other insurance is exhausted. The excess application is operational over all other collectible sources, including deductibles and self-insured retentions. No other programs affect the application of this policy’s stated deductible.

b. When this policy acts as an excess source of protection, the insurance company has no obligation to provide a defense against the applicable claim or suit that is another insurance company’s responsibility. However, this insurance company has an option to provide a defense if none is provided by another insurer. In such instances, the insurance company takes over the named insured’s rights of action against any other insurance company.

c. When this policy acts as an excess source of protection, the insurance company only pays the share it owes that exceeds the total amount that would be paid by all other sources of coverage if this protection did not exist. The excess payment obligation includes all deductible and self-insured amounts contained in all other sources.

Note: This part of the other insurance provision is to prevent expectations that this policy respond on anything but an excess basis when primary sources of coverage exists. Deductibles and retentions are legal parts of primary levels of protection, so this provision keeps those financial obligations intact.

d. This subpart takes effect when coverage is NOT provided on an excess basis. The insurance company’s response depends on how the other source of coverage responds.

(1) If the other insurance permits contribution by equal shares, this insurance does as well. Each insurance company contributes equal amounts until it exhausts its limit of insurance or the loss is paid, whichever occurs first.

(2) If the other insurance does not include contribution by equal shares, contribution is by limits. With this approach, each company's share is the ratio of its applicable limit of insurance to the total applicable limits of insurance by all companies.

 

Example: The Aberdeen Police Department has its primary coverage under Policy A with limits of $500,000 and also coverage under Policy B with limits of $1,000,000. A bystander hurt during a raid sues the department and is awarded a $750,000 judgment.

·         If Policy B applies on an excess basis, Policy A pays $500,000 and Policy B pays $250,000.

·         If Policy B applies on a pro-rata equal shares basis, Policy A pays $375,000 and Policy B pays $375,000.

·         If Policy B applies on a pro-rata ratio method, Policy A pays $250,000 (1/3 of the total limits available) and Policy B pays $500,000 (2/3 of the total limits available).

 

10. Premium Audit

This provision applies only when the Declarations Page indicates that the policy is auditable.

a. The advance premium on the declarations is only a deposit premium. At the end of each audit period, the insurance company determines the actual earned premium for the period.

b. The date on the billing notice is the date the company expects to receive the premium billed. However, if the advance and audit premiums are more than the earned premium, the insurance company refunds the excess to the Named Insured that is listed first on the policy.

c. The Named Insured that is first listed on the policy is responsible for keeping the records and information the insurance company needs to do the premium calculations and must send copies of them to the company when it requests.

Note: Audit period is not clearly defined or explained. It can be monthly, quarterly, annually or any reasonable period that’s agreed upon by the Named Insured and the insurance company.

 

Example: Harmville’s LEL policy is subject to a quarterly audit and the deposit premium charged at inception is estimated to approximate the final annual earned premium. An audit is performed at the end of each quarter to determine that period’s exposure. The actual earned premium for that quarter is deducted from the deposit premium and a statement is sent to the Named Insured. After the policy’s last audit is completed, it’s determined that the actual earned premium exceeds the deposit. The policy year’s final quarterly statement includes a bill for the additional premium owed. Once notified by the statement, Harmville is obligated to make the additional payment.

 

11. Premiums

The First Named Insured pays the premium and also receives any return premiums the insurance company pays.

12. Representations

This condition states that the insurance company relies on the insured's complete and accurate representations, statements, information, and other material stated in the insurance application. It also states that, based on being supplied with both true and complete information, the policy was issued by the insurance company.

Note: The effect is that, for all intents, the application may be treated as part of the policy and, if information proves to be either materially incomplete or false, the insurance company has greater justification for taking adverse underwriting action. The company may also have the right to void coverage and deny claims because of information that is inaccurate or fraudulent.

13. Separation of Insureds

Other than the limits of insurance and any rights and duties that apply to only the first named insured, this policy treats and responds to each  named insured as though it is the only named insured on the policy. In addition, each insured is treated on a separate basis with respect to eligible claims and lawsuits.

14. Settlement

The named insured can refuse to consent to a negotiated settlement with the insurance company. They can insist that the claim be contested or that legal proceedings continue. However, there is a potential penalty. The insurance company will pay no more in any action or settlement than the amount it could have settled the claim for plus the cost of defense it incurred up to the date the insured refused to settle.

Note: This provision is also referred, unofficially, as a hammer clause and is usually seen in professional liability policies for physicians and lawyers.

Related Court Case: Physicians Professional Liability Insurer Had Sole Discretion to Settle Malpractice Suit

15. Transfer of Rights of Recovery Against Others to Us

Any rights the insured has against others to recover all or part of any payment the insurance company made transfer to the company. The insured must preserve those rights and not do anything after the loss occurs to impair them. If and when a request is made by the insurance company, the applicable insured is obligated to either file a lawsuit on its behalf or transfer the policy rights over to the insurance company.

16. Your Authority and Duties

In certain instances, such as with handling premiums, filing reports and receiving termination notices, it would be inefficient and prone to error for all of the insureds under a policy to share policy obligations. Therefore, as a stipulation for providing this insurance, it is the First Named Insured’s duty to act as proxy for all other insureds. Further, this provision both obligates the policy’s other insureds to accept the status of the first Named Insured and to notify the same party of any incidents or acts which may trigger coverage. The notification to the first Named Insured has to be in writing.

SECTION V - DEFINITIONS

Defined words are used throughout the coverage form. Restricting the meanings of certain terms provides a way for everyone to have a clearer understanding of the policy’s coverage intent.

1. Auto is a land motor vehicle, trailer or semi-trailer. It must be designed for travel on public roads. This does not mean that it is used on public roads – the statement is that it is designed for such travel.

Note: This definition makes no consideration for various state laws that deem other types of vehicles as motor vehicles nor does it address mobile equipment.

2. Bodily injury is bodily injury, sickness or disease sustained by a person. It includes death as well as mental injury that is directly related to any physical injury.

3. Coverage territory is generally limited to the United States of America, its territories and possessions, Puerto Rico, and Canada. However, coverage extends to any point on the globe if both of the following apply:

  • An insured, whose home is in the described territory, commits a wrongful act outside of the described territory. This applies only if that insured is conducting the named insured’s business and is outside the territory for only a short amount of time.
  • The named insured is found to be responsible for injury that occurred elsewhere in the world in a lawsuit brought in the described territory or the insurance company reaches a settlement outside of legal proceedings.

4. Defense expenses are legal fees and expenses incurred in investigating, defending, arbitrating, mediating or appealing a claim, or in any alternative dispute resolution process.

5. First aid refers to providing emergency medical treatment by an officer or employee of the named insured’s law enforcement agency. This applies only if a licensed medical professional is not immediately available.

6. Injury refers collectively to bodily injury, personal injury or property damage that is related to law enforcement and similar activities the named insured approved. However, such injury or damage only qualifies as injury if such instances were not intended or expected from the standpoint of the named insured.

Note: An exception exists for intended acts that involve reasonable force use in defending either persons or property.

Related Court Case: Law Enforcement Liability Insurance Held Not To Cover Injuries Resulting From High Speed Chase

7. Personal injury. This term applies to any injury, with the exception of bodily harm, that arises out of one or more of the following offenses.

  • False arrest, detention, or imprisonment, when such imprisonment was unjustified
  • Prosecution considered malicious or harassing
  • Bodily injury to others related to efforts to defend persons or property
  • Acts of discrimination. Acts that are not legally allowed to be insured are not included.
  • Humiliation
  • False or improper service of process
  • Violation of property rights
  • Violation of civil rights. Violations that are not legally allowed to be insured are not included.
  • Offenses typically committed on behalf of the owner, landlord, or lessor of a room, dwelling, or premises such as wrongful entry into, wrongful eviction from, or invasion of the right of private occupancy of residential space
  • Publication of material that slanders or libels a person or organization, disparages a person's or organization's goods, products, or services, or violates a person's right of privacy. The publication can be written or verbal.

Related Court Case: Releasing Accident Victim Photos Invaded Privacy

8. Property damage is physical injury to tangible property. This term also applies to loss suffered due to the property being inaccessible. The inaccessibility could be due to the property being damaged or to it being stolen.

9. Suit is a civil proceeding that alleges damages covered under by this insurance. It includes arbitration or any other alternative method of dispute resolution in which the insurance company agrees to be a participant.

10. Wrongful act applies to both allegations as well as confirmed acts involving misstatements, errors, omissions (nonfeasance), neglect, and breach of duty. Such acts performed by parties other than the named insured qualifies if the acts were performed while working or acting on the named insured’s behalf.

Wrongdoing by a public official (malfeasance) is covered only when such an act is an allegation. Once malfeasance is determined to have occurred, it no longer qualifies as a wrongful act.

Note: At least one other carrier used defined term, “law enforcement wrongful act” to more narrowly control how coverage form responded to eligible losses.