CIC Commercial Casualty Institute Study Notes Notes by Cliff J. Ravenscraft May18-20, 2005 Questions: Call Butch Harris What is the definition of Casualty? Casualty is a type of insurance that protects your legal responsibility for damage to other people's property or injury to another person. Essentials of Legal Liability (Section 1) 2 questions from this section Learning Objective #1 To explain the types of torts and be able to describe under what situation each type of liability might apply. (Section 1, Pages 2-5) What is a tort? A private wrong or harm (other than a breach of contract) committed against another, resulting in legal liability. A tort is either intentional or accidental (unintentional carelessness) (negligent). Torts: You are responsible for your actions, for the actions of others associated with you, and for your things. Torts are largely based on Common Law: Decided by court decisions. A lot of interpretation is involved. Examples of Torts: Negligence (Non-Intentional) Intentional Tort Strict Liability Absolute Liability Let’s look at these torts… Negligence: Negligence is the basis of most torts and liability insurance claims There are FOUR elements of Negligence. All four elements must be present for a tort to be considered “Negligence.” 1. Duty Owed (Legal Obligation) 2. Breach of Duty 3. Proximate Cause 4. Damages Intentional Torts: There are Five types of Intentional Torts 1. Defamation of Character a. Libel – written form b. Slander – spoken form 2. Wrongful Entry 3. Wrongful Conviction 4. False arrest or unlawful detention 5. Assault & Battery Assault is the intentional making of a threatening gesture which causes another person to become reasonably apprehensive of an anticipated immediate bodily contact. Battery is the intentional and unpermitted touching of the person of another. Strict Liability: (ONLY ABOUT PRODUCT LIABILITY) A manufacturer is strictly liable in tort when an article he places on the market, knowing it is to be used without inspection for defects, proves to have a defect that causes injury to a human being. (1963 Supreme Court of California) Three Elements of Strict Liability 1. Defective when it left custody of manufacturer or supplier 2. Defective condition made the product unreasonably dangerous. 3. Defective product was the proximate cause of injury. Type of defect: 1. Defective due to faulty manufacture or assembly 2. Defective in design 3. Failure to give warning. Unlike most torts, there is no need to prove specific negligence. Negligence is Assumed! Example: Ford Explorer & Firestone Tires Absolute Liability: (No Question of Negligence) (Inherently dangerous) A person who commits certain torts will be liable for ensuing injury to another regardless of willful wrongdoing or negligence on the part of the individual. Dangerous Instrumentality Doctrine: Anyone who possesses, stores, maintains, or transports a dangerous instrument is absolutely liable for injury or damage caused by the instrument, regardless of the presence of due care. Application of Absolute Liability a. Explosive or highly flammable material b. Firearms c. Animals (Mostly Wild Animals) Learning Objective #4 To be able to explain the concept of vicarious liability and describe important relationships that create this liability. (Section 1, Pages 9-11) Vicarious Liability: Liability of one person based upon the conduct of another. This liability is imputed (transferred) from one person to another. This type of liability is based upon the relationship of the two parties involved in the transfer of liability. FOUR Important Relationships Applicable to Vicarious Liability: 1. Agency: Agency is fiduciary relationship in which one person (principal) authorizes another (agent) to act on his or her behalf in business dealings with third parties. The agent owes a duty to act primarily for the benefit of the principal and to deal fairly with the principal in every way. Two Important Characteristics: 1. There must be AUTHORITY to act for the principal 2. There must be CONTROL by the principal 2. Employee/Employer Relationship: The employer (master) is held vicariously liable to the third parties for physical harm or other wrongdoing by the employee (servant), committed while the employee was acting within the scope of employment. An EMPLOYEE is a person who is employed with or without pay to perform personal services for another, and who, in respect to the physical movements in the performance of such service, is subject to the employer’s right or power of control. Rules of Negligence: 1. The employee must commit a wrong for which the employer can be held liable. 2. The employer must retain the right to control the physical conduct of the employee. 3. The wrong must be committed within the scope of employment. 4. Deviation from scope of employment or instructions can be a defense against vicarious liability. 3. Independent Contractor: The independent contractor is one with whom the employer has contracted for an end result that is to be brought about by the independent contractor. The employer usually has no control over the details of the physical performance by the contractor. Rules of Negligence: The “General Rule” is that the employer is not liable for physical harm caused to a third person by the negligent act of the contractor in the performance of the contract, because the employer has no legal right to control the details of the physical performance of the contract. 4. Partnerships and Joint Ventures: Partnership: An association of two or more persons to carry on, as co-owners, a business for profit. Joint Venture: An association established to conduct a single transaction or a series of related transactions, as contrasted to an ongoing business that involves many transactions. Rules of Negligence: If a partner, by some act or omission, causes loss or injury to a third person while in the ordinary course of business of the partnership, Then the partnership, that partner, and each of the other partners is held liable and the private property of a partner can be used to satisfy the judgment. Note: Due to the fact that individuals, that are in a Sole Proprietorship, Partnership, or Joint Venture, can be held liable even after their business ceases to exist and that their private property can be used to satisfy any judgment against them, it is important to sell them a “Discontinued Operations Policy.” Note: Members of Corporations and Limited Liability Companies (LLC) are not in the same danger of their private property being used to satisfy judgments. Commercial General Liability Policy (Section 2) 6 questions from this section General Study Notes for General Liability Know Who is Insured? What is Insured? What is Not Insured? Study Exclusions Closely / Remember exceptions to exclusions. Study “In coverage Territory” & Must be in Policy Period General Liability policy makes two promises. First, it promises to Pay… Second it promises to defend an insured. Know about Care Custody & Control… Remember example about where car stereo being installed and employee hits another car that is in the care custody and control of the store and also injuries someone in the parking lot. Why are the two veh’s not covered and why is the person covered? (Example of how to watch exclusions) KNOW ABOUT MOBILE EQUIPMENT Remember that Aircraft/Auto/Watercraft are not covered EXCEPT FOR certain circumstances they are. Example, if not owned and less than 26’ and if owned but stored on owned premises. Learning Objective #1 To demonstrate an understanding of “Who is an Insured” by identifying whether a party is afforded coverage in a particular loss situation. (Section 2, Pages 7-18) Who Is Insured? THERE ARE THREE TYPES OF INSUREDS ON A CGL POLICY: 1. Named Insureds: Incl. Spouse for Individuals, Partners, & Joint Ventures 2. Automatic Insureds: Employees & Volunteers: TEMPS ARE NOT COVERED! Not Covered When: -Injury to co-worker or volunteer (Work Comp) -Medical Profession Acts or Omissions (Prof. Liability) -PD to named insured or any employee or volunteer property OTHERS If a CURRENT or PAST Partnership, Joint Venture or LLC is not listed as NAMED INSURED, they are not covered by this policy! The problem is loss of completed operations and products liability coverage. If they bought DISCONTINUED OPERATIONS Coverage for that prior entity, it provides the coverage. 3. Additional Insureds Learning Objective #2 Identify the three major coverages of the CGL form and describe the General Liability exposure areas included within each coverage. (Section 2, Pages 19-25) There are 3 major coverages on the CGL form. 1. Coverage “A” Bodily Injury & Property Damage Premises: Happens on Insured’s Property Operations: As a result of installation Products: Coverage OFF PREMISES caused by defect Completed Operations: Done Deal, Turned over for intended purpose. 2. Coverage “B” Personal & Advertising Injury 3. Coverage “C” Medical Payments Policy Period and Coverage Territory: Occurs during the policy period and in coverage territory! Policy Period- Stated in the dec page Coverage Territory: a) b) c) d) e) f) USA It’s territories & possessions Puerto Rico Canada (only foreign country) International area but only when in the course of travel between the above places Worldwide— i. Goods must be made or sold in territory, ii. Insured out of territory for short time, or iii. Personal and advertising injury offenses that take place through the internet. However, damages awarded by foreign court not covered. Learning Objective #3 To apply the various exclusions of the CGL by properly identifying coverage in a loss situation and in some cases identifying endorsements that modify the exclusions to add or restrict coverage. (Section 2, Pages 25-41) Pollution Exclusion: EXCLUDES: Premises (Except for HVAC & water heater equipment fumes) (Except for work site with additional insured (Except for Smoke from hostile Fire) ** The above would be covered on premises! Waste Operations if you or others working for you brought the pollutant to the site (Excluded) Except for Mobile Equipment fluids Except for Fumes from operations inside of building Except for Smoke from a hostile fire. Operations on pollutants IT DOES COVER THE FOLLOWING: 1. Operations if you or others working for you did not bring the pollutant to the site. 2. Products 3. Completed Operations *** Cleanup is not covered, except for Property Damage Aircraft, Auto, or Watercraft Exclusion These three are excluded except for: 1. Boat stored ashore at your premises 2. Non-owned, less than 26ft., boat no being used to carry people or property for a charge. 3. Parking customer’s cars on or next to your premises. 4. Insured Contract – Aircraft and Watercraft 5. Operated certain mobile equipment. Mobile Equipment is not covered for transportation and Prearranged Stunting Activity. There is no coverage for Damage to the following Property: 1. Owned or occupied property (There is coverage for fire) 2. Any property loaned to you (Put on Inland Marine) 3. Personal Property of others in your care (Need Garage Keepers) Business Automobile Coverages (Section 3) 4 questions from this section Learning Objective #2: To Identify a covered auto when given the appropriate symbol information and other descriptions, and explain how the policy provides coverage for newly acquired autos. Note: Study page 19 in the Business Auto Section for Symbol Descriptions Symbols 1-6… If newly acquired, coverage is AUTOMATICALLY provided up through the end of the policy period. If Symbol 7, there is coverage only IF: All owned autos have that coverage OR Replaces an auto with that coverage. Must notify company within 30 days Note on Mobile Equipment: If injury or damage is caused to others by “mobile equipment”: While operated… it is covered by the GL Policy While being Transported by auto, it is covered under the CA Policy. Learning Objective #3: To explain the coverage afforded in the Liability Section of the business auto policy by applying the information to specific loss a situation. Including exclusions and endorsements that add or restrict coverage. There are 1. 2. 3. three important aspects of the coverage: “Insured” must be legally responsible to pay damages of “BI” or “PD” Damages must be the result of an “accident.” The accident must result from the ownership, maintenance or use of a “Covered Auto.” Note: Accident is defined much broader than “collision.” Remember the story of the quarry trucks that caused cracking in the walls of the home it drove by on a regular ongoing basis. Truck never hit the home, but did caused damage by shaking the ground repeatedly. Business Auto Liability Section will also pay all sums an “Insured” legally must pay as a covered pollution cost or expense, caused by an accident involving a covered auto. However, it will only pay for this if there is either BI or PD to which the insurance applies that is caused by the same accident. Learning Objective #4: To identify those persons and/or organizations found in the “Who is an insured” section of the business auto coverage form and identify endorsements that add or restrict coverage. Who Is An Insured? Three Types of People 1. Named Insured 2. Permissive User 3. Anyone Liable Vicariously There are a few exceptions on Permissive Users. The following are not covered if the policy is left unendorsed... 1. The owner of hired “auto” would not apply in the case of a trailer. - Can Add Lessor-Additional Insured Loss Payee Endorsement 2. Your “employee” if the covered “autos” is own by the employee. -Can Add Employee As Insured’s Endorsement 3. Garage Exposure. 4. Other than your “employees”, partners, Members etc. while moving property to and from a covered auto. (Loading/Unloading for NON EMPLOYEES) 5. A partner, or member for a covered “auto” owned by him or her or a member of his or her household. Endorsements that Can Broaden Coverage in regards to “Who is Insured.” What If a car is titled in an individual’s name? Individual Named Insured endorsement: When an owner or partner, add the individual as named insured and attach this endorsement. Employee As Lessor Endorsement: This is used when the vehicle is leased to the company by an owner, partner, or employee. What if you have any owners, partners, or employees who do not personally own any autos and DO NOT HAVE A PERSONAL AUTO POLICY? DOC Drive Other Car Coverage Endorsement: This will extend coverage for Named Individuals… 1. Spouse Automatically Covered. 2. Endorsement has a premium charge. 3. If Applicable, must name children on endorsement. Employee Hired Auto Endorsement: This provides coverage for renting a vehicle in personal name but allows for the business auto to cover it ONLY WHILE USING IT FOR BUSIENESS PURPOSES. Exclusions on the Business Auto Policy: 1. Expected or Intended Injury 2. Contractual: except liability assumed under contract or agreement. 3. Workers Compensation 4. Employee Indemnification and Employer’s Liability Covered under Part Two of Work Comp 5. Fellow Employee 6. Care Custody or Control -Property owned or transported by the “insured” - BETTER HAVE CARGO COVERAGE 7. Handling of Property (LOADING AND UNLOADING) NOT COVERD However, this exclusion does not apply to a hand truck or device attached to the covered “auto”. Coming to rest- Auto policy will cover until the object comes to rest. Completed Operations- All operations required to effect a complete delivery. Examples: Food broker delivery guy didn’t put food in cooler Beer distributor uses hand truck to unload building display. Fuel Hauler gas station and lady trips over hose. 8. Movement of property by Mechanical Device, other than hand truck, unless the device is attached to the covered auto. 9. Operations- BI or PD arising out of the operation of any equipment listed in the definition of mobile equipment. 10. Completed Operations- BI or PD arising out of your work after that work as been completed or abandoned. 11. Pollution-except for those that escape or are discharged from an “Auto” part designed to hold such pollutant. Example transmission or radiator fluids. -except the insured damages property that contain pollutants away from the insured’s premise. 12. War 13. Racing Learning Objective #5: To explain the coverage afforded in the coverage section II physical damage by applying information to specific loss situations, including exclusions and endorsements that add or restrict coverage. Coverage for Physical Damage: 1. Comprehensive 2. Specified Causes of Loss: Like comp only without GLASS and ANIMAL STRIKING. 3. Collision 4. Towing & Labor 5. Glass Breakage & Hitting Bird or Animal 6. Rental Reimbursement Physical Damage Exclusions! 1. Direct / Indirect / concurrent NUCLEAR HAZARD OR WAR/MILITARY ACTION 2. Racing, including stunting activity. 3. Warranty Work 4. Wear & Tear Maintenance such as road damage to tires, etc. 5. Electronic equipment and media 6. Diminution in Value Limit of Insurance is paid in the lesser of the following. 1. ACV of damaged property at the time of the loss 2. Cost of repairing or replacing the damaged or stolen property with other property of Like Kind and Quality. You can get Loan/Lease Gap which will pay for difference minus things like late payment fees, excessive use lease fees, cost of extended warranties, and carry-over balances. Workers Compensation (Section 4) 4 questions from this section Maritime Exposures associated with Work Comp Longshoremen’s and Harbor Workers Compensation Act Coverage: This federal act enacted in 1927 provides uniform and scheduled benefits to any employee who is not a seaman, for injuries sustained on navigable waters or adjoining piers, wharves, dry docks, terminal buildings, marine railways, or other adjoining areas. Does not apply to Master or member of crew Nobody loading or unloading or repairing a small vessel smaller than 18 tons. Employed exclusively to form duties on board. Some other stuff. Know Third Party Action Over… Employee sues third party and third party throws suit back on to employer… KNOW THAT PART 1 COVERS FOUR THINGS… 1. Medical 2. Disability 3. Death 4. Rehabilitation. Excess Liability/Commercial Umbrella (Section 5) 2 questions from this section Three PURPOSES of the Excess Liability / Commercial Umbrella Coverage 1. Increases Liability Limits over the limits provided by other policies. 2. May afford broader coverage for claims made not covered by underlying policies. 3. Provides Drop-Down Coverage (Becomes Primary) coverage over exhausted aggregate or when loss is covered by Excess and not underlying. Three Types of coverage for increased liability limits/excess liability 1. Stand Alone Excess: (Worst) This coverage form does not rely on the Underlying Policy. It has its own Named Insured, Insuring Agreement, Exclusions, etc. Gives coverage without regard to other policies. 2. Following Form Excess: (Next Best) This form relies on the Underlying policy for Insuring Agreement, Exclusions, etc. Provides coverage only in excess of Underlying Policy. Usually NOT broader than primary policy Provides Additional Limits of Liability. May be broader or narrower at the same time. 3. Umbrella: (Best) A “True” Umbrella Policy provides the following: Increased liability limits in excess of primary following forms. BROADER COVERAGE than Underlying Policies Subject to a Self-Insured Retention (Deductible) Stand alone for certain coverages. (Where SIR comes in) Drops Down coverage with SIR if no coverage exists on underlying but is provided in the Umbrella. Replaces Underlying coverage when underlying limits are exhausted.. Professional Liability (Section 6) 2 questions from this section Know the difference between Malpractice Vs. Errors and Omissions Malpractice Insurance: Protection for a service provided by a person or organization in the healing arts against exposure that arise usually from bodily injury. (They put hands on your body to perform their service) Errors & Omissions: Protection for a claim arising from a service on a non-medical nature provided and typically causing damage to property of others. (Service of a non-medical nature usually resulting in damage to property.) *Know that they are both normally Claims Made Policies but are not standard forms so you must read each and every policy. Know the exclusions to the professional liability policy as they are different from other commercial liability policies. 1. Dishonest, criminal or fraudulent acts 2. Contractual Liability 3. Insured v/s Insured 4. NO PAYMENT FOR BODILY INJURY OR PROPERTY DAMAGE. pay a “Monetary” judgment. Instead, they 5. Punitive Damages 6. Activities outside of usual profession. 7. Intentional acts 8. Employment Related Practices – most common: Discrimination 9. Intentional Acts 10. Illegal personal profit 11. Securities Acts and Antitrust Acts Violations.