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69 Cards in this Set
- Front
- Back
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3rd party
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A person or a business who is not a party to the insurance contract but who asserts a claim against the insd |
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Coverage E - Personal Liability
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provides coverage if a claim is made or a suit is brought against an insured because of bodily injury or property damage to a 3rd party for a covered occurrence. Defense costs pd in addition to limit of liability. Coverage is worldwide. Basic limit is $100,000 per occurrence, but can be higher. |
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occurrence
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an accident, including continuous or repeated exposure to substantially the same general condition. Can be sudden or gradual series of incidents |
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Residence Employee |
includes domestic workers whose duties relate to maintaining or using the household premises or performing domestic or household services. (med pay applies) |
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Employee |
an employee of an insd who is not a residence employee (med pay does not apply) |
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Coverage F - Med Pay to others
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covers medical payments incurred within 3 yrs of an injury. automatically included at a limit of $1,000 per person per single accident. may overlap with coverage E, but Cov. E only applies when insd is legally responsible. Cov F can be pd when insd feels moral obligation even when not negligent |
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Section II - Additional Coverages (4)
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1. Claim Expenses 2. First Aid Expenses 3. Damage to Property of Others 4. Loss Assessment |
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Claim Expenses
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1. Expenses we incur 2. Premiums on bonds 3. Reasonable expenses 4. Post judgment interest |
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First Aid Expenses
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-states that insurer will reimburse an insd for expenses the insd has incurred while delivering first aid |
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Damage to Property of Others |
-pays up to $1,000 for damage to the property of others cause by an insd, regardless of fault or legal liability |
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Loss Assessment
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-homeowners are sometimes billed with an assessment by their HOA when the organization sustains a loss for which their officers failed to secure a sufficient amt of insurance. provides up to $1,000, regardless of the number of assessments. |
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motor vehicle and other motorized craft exclusions
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-watercraft liability (small, low powered is included) -aircraft liability -hovercraft liability |
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Expected or Intended Injury Exclusion (Applies to E&F)
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applied to any BI or PD cause by an insd when the BI or PD is intentional or expected even if the actual injury or damage resulting from the action was unintended when the action took place |
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Business Exclusion (Applies to E&F) |
excludes coverage for BI or PD arising out of business activities, but provides coverage for occasional or part time activities ie mowing lawns, selling lemonade. also covers: -activities where insd rcvd less than $2,000 per year -volunteer activities -home daycare services not involving compensation -home daycare for a relative |
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Rental Situation exceptions
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Considered a business, unless: 1. rental is occasional and used only as a residence 2. rental of part of the location as a residence, as long as no more than 2 boarders are in the same family unit 3. rental of part of an insd location if only used as an office or a school, studio or private garage |
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Professional Services Exclusions (Applies to E&F)
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-coverage excluded for the insd rendering or failure to render professional services |
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Insd Premises not on an insd location (Applies to E&F) |
-exclude BI or PD arising out of any premises that is owned by or rented to an insd, or is owned and rented to others by and insd, but is not an insd location |
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War Exclusion (Applies to E&F) |
excludes any BI or PD that results from war
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Communicable Disease Exclusion (Applies to E&F)
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excludes any coverage for BI or PD that arises from the transmission of a communicable disease by an insd |
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Sexual Molestation/Corporal Punishment/Physical or Mental Abuse Exclusion (Applies to E&F)
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any losses arising from these events are excluded
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Controlled Substance Exclusion (Applies to E&F)
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exclude any loss that results from the use, sale, manufacture, delivery, transfer, or possession of controlled substances |
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Loss Assessment and Contractual Liability (Applies to E Only) |
does not provide coverage for liability from any loss assessment charged against an insd as a member of a homeowners or condo association |
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Cov. E applies to these types of written contracts
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2. Liability of others assumed by the NI before an accident occurs |
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Damage to Insd Property Exclusion (Applies to E Only) |
Cov E does not apply to damage to property owner by an insd. Cannot be used to repair, replace or otherwise modify |
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Damage to Property in the insd Care Exclusion (Applies to E Only) |
no coverage to property rented to, occupied by, or in the care of the insd. |
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BI to Workers Eligible for WC Exclusion (Applies to E Only) |
Should be covered under a WC policy |
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Nuclear Liability Exclusion (Applies to E Only)
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excludes BI or PD that would normally be covered under a nuclear energy policy |
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BI to an Insd Exclusion (Applies to E Only)
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does not apply to NI, resident relatives and other residents under the age of 21 in the insd's care for BI, even if the injury is caused by another insd |
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residence employee off premises exclusion (Applies to F Only)
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does not apply to a residence employee's injury if injured off premises and does not arise from the employees work, unless: 1. the resident employee is working off premises 2. the resident employee is injured while on premises but not working |
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bodily injury eligible for WC benefits exclusion (Applies to F Only)
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any person eligible to receive payment for BI under any WC law, non-occupational disability law or occupational disease law is excluded |
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Nuclear reaction Exclusion (Applies to F Only)
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excludes BI for any nuclear reaction, nuclear radiation or radioactive contamination regardless of cause.
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Injury to Residents Exclusion (Applies to F Only) |
Cov F excludes BI to any person who regularly resides at the insured location (other than residence employee) |
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3 Sets of Conditions |
1. Section I - Conditions that apply to property coverage 2. Section I & II - conditions applies to both property and liability coverage 3. Section II - Conditions that apply specifically to Cov E and F |
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Section II Conditions - Limit of Liability |
-stipulates that the coverage in Cov E is the limit of coverage for any one occurrence. -does not increase regardless of the # of insd, claims made, or people injured -states that all BI & PD that result from continuous or repeated exposure to the same harmful conditions are considered to be one occurence -Cov F limit is available per person in a single accident |
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Section II Conditions - Severability of Insurance |
-claim can involve several insds -under this condition, each insd seeking protection is treated as if they have separate coverage in the policy. Still will only pay up to policy limit for any one occurence |
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Section II Conditions - Duties After an Occurence |
-give written notice -cooperate with insurer -forward legal documents -provide claims assistance -submit evidence for damage to property of others -not make voluntary payments |
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Section II Conditions - Duties of an Injured Person (Cov F) |
-give the insurer written proof of the claim as soon as possible -authorize the insurer to obtain copies of medical reports and records -submit to a physical exam |
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Section II Conditions - Payment of a Claim (Cov F) |
-stipulates that a payment of this claim is not an admission of liability by insd or insurer -purpose of this coverage is to prevent suits or possible damages resulting from claims by providing prompt payment |
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Section II Conditions - Suits against us |
-states that the insurer cannot be sued unless certain provisions are met 1. insd must meet all obligations 2. no one can join insurer as a party in any action against insd 3. no action with respect to cov E can be brought against the insurer until the obligation of the insd has been determined by a final judgement or agreement signed by insurer |
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Section II Conditions - Bankruptcy of Insd |
-if insd becomes bankrupt, insurer must still handle as they normally would |
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Other Insurance |
-Section I - applicable on a pro rata basis -Section II - paid as excess |
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Section I & II Conditions - Liberalization Clause |
-specifies how broadened coverage applies to the policy -stipulates that any change is effective on the date the insurer makes the coverage change as long as within 60 days before effective date |
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Section I & II Conditions - Waiver or changes of provisions condition |
-waiver of a right or change of a policy provision is only valid if the insurer makes it in writing -insurer does not waive rights by asking for an appraisal or examination |
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Waiver |
the intentional relinquishment of a known right |
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Apparent Authority |
a 3rd party's reasonable belief that an agent has authority to act on it's principle's behalf. |
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Binding authority |
insurance agent's authority to effect coverage on behalf of the insurer |
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Section I & II Conditions -Cancellation condition |
-specifies the requirements for a valid termination of the policy by either the insd or insurer -policy holder can cancel at any time with written notice. -insurer can cancel only for certain reasons by delivering cancellation notice to insd within a certain number of days |
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Section I & II Conditions -Nonrenewal Condition |
-insurer has a right to nonrenew a policy when it expires -must provide at least 30 days written notice to the insd. - |
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Section I & II Conditions - Assignment Condition |
states that any assignment of the policy without the insurer's written consent in invalid. -if property sold, policy cannot be transferred. |
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Section I & II Conditions - Subrogation condition |
-refers to the insd right to recover claim payment from the party responsible for the loss -insd cannot waive rights of recovery after a loss has occurred |
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Hold Harmless agreement |
contractual provision that obligates one of the parties to assume legal liability of another |
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Section I & II Conditions - Death Condition |
-if the named insured or his/her spouse should die, decedents representative is covered as an insd as long as they have financial responsibility in the property |
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HO-2 Broad Form |
-designed for owner-occupant -has a lower premium because it covers dwelling and other structures against fewer causes of loss. named perils only. -named perils for covs A, B,C. Cov D is triggered by a loss under previous coverages that makes the building unusable -burden of proof for loss being covered is on the insd |
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HO-5 Comprehensive Form |
-broadest property form -essential an HO-3 modified to provide special form coverage also for Cov C -covers water damage -special limits of $1500 for jewelry and furs, $2500 for firearms and $2500 for silverware |
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HO-4 Contents Broad Form |
-renter's policy, no cov A or B -Cov C written on amt selected by insd -Cov D is 30% of Cov C -provides additional coverage for bldg additions and alterations with a limit of 10% of cov c -Does not include coverage for furnishings provided by landlord |
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HO-6 Unit Owners Form |
-covers the exposures faced by owners of condos or cooperative units -defines residence premise as only the unit where the insd resides -Cov A includes appliances, alterations fixtures and improvements that are part of the bldg, items of real property that pertain exclusively to the insd unit, property that is the unit owner's responsibility under condo owners agreement and structures owned solely by insd. $5000 limit -No Cov B -Insd selects Cov C limit -Cov D is 50% of cov A -named perils coverage -Cov A losses settled at RC as long as repaired in a reasonable time -trees, shrubs plants covered for 10% of cov C |
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HO-8 Modified Coverage Form |
-designed for use when the RC of an owner occupied dwelling significantly exceeds it's market value. used to avoid moral hazard. |
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Personal Property replacement cost loss settlement endorsement |
-provides replacement cost coverage on personal property instead of ACV -some property like antiques and fine art is not eligible -when replacement value is more than $500, insd must repair or replace before insurer will pay. Make ACV claim first than RC within 180 days -insurers may require increased Cov C limit with this |
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Scheduled Personal Property Endorsement |
-provides scheduled coverage for specific items. Cov C limits do not apply. Section I deductible does not apply. Covers more causes of loss |
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Inflation Gaurd Endorsement |
Designed to help prevent underinsurance cause by economic inflation and rising replacement costs. gradually and automatically increases limits throughout policy period. Each year insd and insurer agree on a percentage increase |
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Earthquake Coverage |
covers earth movement which is excluded normally. Mandatory deductible of 5% of the limit that applies to either coverage A or C, whichever is greater but not less than $5000 |
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Assisted Living Care Coverage |
-provides personal property coverage and personal liability coverage to a relative of the insd who is a resident at a facility that provides assisted living services. -limits like $250 for hearing aids and $500 for medical alert devices apply |
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Credit Card, Electronic Fund Transfer Card or Access Device, Forgery and Counterfeit Money Coverage - Increased Limit Endorsement |
-normally, coverage of up to $500 for losses resulting from the unauthorized use of insd cc, bank card check forgery, or acceptance of counterfeit money -Endorsement provides additional coverage up to $10,000 |
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Home Business Insurance Cov |
-business package policy only when attached to the home. -must be owned by insd -must be operated from residence premises -max of 3 employees |
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Ordinance or Law - INcrease amt of coverage |
repairs could have to be made to a dwelling after a loss in order to comply with current ordinances or laws can endorse in increments of 25% to unlimited |
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Water Backup and Sump Discharge or Overflow Coverage |
-normally excluded, this endorsement adds back |
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Supplemental Loss assessment coverage |
supplement what is provided normally for loss assessment coverage that can be assessed by a HOA |
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Additional residence rented to others |
1-4 families rental property not at the insd location |
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Personal INjury Coverage |
expands liability coverage by adding personal injury arising from -false arrest, detention or imprisonment -malicious prosecution -invasion of privacy, wrongful eviction or wrongful entry |
