“Nightmares on Insurance Street” Presented by: The self proclaimed “FAIA Dream Team” David Thompson, CPCU, AAI aka “Dream Team 2” Jay Williams, CIC, AAI aka “Dream Team 1” 1 Housekeeping • Class times – 1:30 p.m. to 4:30 p.m. • Break – One break – 13 minutes • DFS rules – Phones, newspapers, etc 2 Unauthorized Entity Issues Verify with the DFS: – www.myfloridacfo.com – 1-800-342-2762 / 1-877-MY-FL-CFO 3 The Important Stuff The Dream Team Dilemma Is our greatest asset… – Our intelligence – Our fantastic teaching ability – Our amazing good looks – Or…. – Our humility! 5 Our Web Site 6 7 8 9 Stump the Nerds 10 BAP Temporary Substitutes 11 BAP Temporary Substitutes BAP works just like a PAP All the same coverages follow over to a temporary substitute Symbol used isn’t a factor 12 BAP Temporary Substitutes Symbol 1 Symbol 2 Symbol 7 Symbol 8 Symbol 9 Any Auto Owned Autos Specifically Described Autos Hired Autos Non-owned autos 13 From the Policy (Liability) 14 Regardless of symbol, liability coverage for temporary substitutes is provided in the form. 15 From the Policy (Physical Damage) SECTION III – PHYSICAL DAMAGE COVERAGE A. Coverage 1. We will pay for "loss" to a covered "auto" or its equipment… 16 17 Temporary Substitute Problem: – Liability coverage automatically provided – Physical damage coverage not provided Solution? 18 Symbol 8 Always add it to every BAP Is there a limit per vehicle? Solution for: – Temporary substitutes – “Regular” business rentals for traveling employees Also add CA 20 54 – Employee Hired Autos 19 20 Temporary Substitutes 21 Coverage B - Homeowners Short version: – 10% of Coverage A – Covers structures worldwide – The 10% is part of Coverage A, and is not additional insurance 22 Coverage B - Homeowners What is an “Other Structure”? – Set apart by clear space – On “residence premises” – Limit is 10% of Coverage A 23 24 25 Coverage B - Homeowners Important definition: "Residence premises" means: a. The one family dwelling where you reside; b. The two, three or four family dwelling where you reside in at least one of the family units; or c. That part of any other building where you reside; and which is shown as the "residence premises" in the Declarations. "Residence premises" also includes other structures and grounds at that location. 26 Coverage B - Homeowners Important exclusions: We do not cover: a. Land, including land on which the other structures are located; b. Other structures rented or held for rental to any person not a tenant of the dwelling, unless used solely as a private garage; c. Other structures from which any "business" is conducted; or d. Other structures used to store "business" property. However, we do cover a structure that contains "business" property solely owned by an "insured" or a tenant of the dwelling provided that "business" property does not include gaseous or liquid fuel, other than fuel in a permanently installed fuel tank of a vehicle or craft parked or stored in the structure. 27 Coverage B - Homeowners Endorsements: – HO 04 40 Structures Rented to Others Used as a private residence Extends liability and med pay 28 Coverage B - Homeowners Endorsements: – HO 04 42 Permitted Incidental Occupancies Limit applies separately from Coverage B Contents that are described are now covered under Coverage C 29 Coverage B - Homeowners Endorsements: – HO 04 48 Other Structures – Increased Limits Increases the Coverage B limit Applies only to the structure described in the endorsement 30 Coverage B - Homeowners Endorsements: – H0 04 91: Extends coverage to other structures not located on the “residence premises” Cannot be used for a dwelling, rental, business, or business property storage 31 Coverage B - Homeowners Endorsements: – H0 04 92: Similar to HO 04 91 but allows for location schedule/amount of coverage Cannot be used for a dwelling, rental, business, or business property storage 32 Coverage B – Swimming Pools 33 Coverage A or B? 34 Coverage A or B? 35 Coverage A or B? 36 Coverage A or B? 37 Coverage B - Homeowners Flood Insurance Issues: – Coverage for detached garages only – 10% of coverage limit (not an additional amount) – Separate policy needed for other structures 38 Coverage B - Homeowners Questions? 39 Kid’s Cars Best advice: – Title car to kid – Put on kid’s PAP – That way, parents can’t be sued – Saves everyone money 40 “It’s party time!” “The insurance went up HOW much?” 41 QUESTION Who is This? Kid’s Cars No matter how you slice the banana, it’s going to cost you a ton to insure kids. Before we go any further, how will To quote a student: this affect our insurance in 16 – “When my customers complain years? about the cost to insure kids I tell them they should have considered that in the heat of passion 16 years earlier.” 43 Kid’s Cars – The Cost Pre-kid, two cars, high limits: –$750 Kid turns 16: –$1,250 Kid gets boring car: –$1,850 44 Situation Parents: – Assets to protect – PAP with high limits and umbrella Kid: – Excited to drive – Cool car – Low limits Tragedy: Kid hits car, serious injuries 45 Avenues To Mom/Dad’s Wallet 1. Car registered to Mom/Dad 2. Child under age (Statutory, state specific) 3. Vicarious … “On a mission” 46 Avenues To Mom/Dad’s Wallet 1. Car registered to Mom/Dad If your name is here… You’re gonna get sued! 47 2. Child Under Age -Statutory 48 FS 322.09 (1)(a) The application of any person under the age of 18 years for a driver's license must be signed and verified before a person authorized to administer oaths by the father, mother, or guardian…. 49 (2) Any negligence or willful misconduct of a minor under the age of 18 years when driving a motor vehicle upon a highway shall be imputed to the person who has signed the application of such minor for a permit or license, which person shall be jointly and severally liable with such minor for any damages caused by such negligence or willful misconduct. 50 What About Age 18 & Older? Car in Child’s Sole Name Situation: – Child is age 22, in college. Rents apartment. – Mom/Dad support child. Would YOU sue? – Mom/Dad claim child on taxes – Child has bedroom at house, stays there from time to time – Child has no assets; parents have money – Child has wreck, kills someone. Would you try to chase Mom & Dad for the money? 51 3. Vicarious – “On a Mission” Analogy: – Producer uses his car to visit clients. Agency sued. “Respondeat superior.” Situation: – Dad gives kid list of eight places to go; post office, grocery store, Sonny’s, etc – Child has wreck. Parent’s sued: “Child on a mission for parents.” Or, changing tire 52 Discussion Based on ISO Forms Main focus today is on liability coverage. 53 Kid’s Cars – The Options 1. No car – Good risk management 2. Car in parents’ name, driven by kid – Generally the least expensive way; no coverage gaps 3. Car in kid’s name – Disaster waiting to happen 54 1. Kid’s Cars – No Car List the kid as a driver for rating and underwriting reasons – QUESTION: How does listing the kid as a driver affect coverage? 55 1. Kid’s Cars – No Car List the kid as a driver for rating and underwriting reasons – QUESTION: How does listing the kid as a driver affect coverage? As long as the kid is a resident family member, he/she has all policy coverages Separate policy needed once the kid is no longer a resident What is “resident?” 56 57 58 2. Car in Parents’ Name List kid as driver – underwriting & rating Least expensive choice No coverage gaps Kid’s wreck = parents’ problem 59 3. Car in Kid’s Name Huge potential problem What limits do parents often want to carry on the kid’s car? Why? –Cost –“My neighbor said…” –“An attorney said…” –“A guy in the bar told me…” 60 Car in Kid’s Name -- Dangers Exclusion in parents’ policy voids coverage for claims resulting from use of the kid’s car – Liability – Med-pay – Physical damage UM and PIP 61 The Exclusion 3. Any vehicle, other than "your covered auto", which is: a. Owned by any "family member"; or b. Furnished or available for the regular use of any "family member". However, this Exclusion (B.3.) does not apply to you while you are maintaining or "occupying" any vehicle which is: a. Owned by a "family member"; or b. Furnished or available for the regular use of a 62 "family member". Examples – Under Mom/Dad’s PAP Mom/Dad Get Sued Kid driving kid’s car Sibling driving kid’s car Friend driving kid’s car Mom/Dad driving kid’s car 63 Examples – Under Kid’s PAP Mom/Dad Get Sued Kid driving kid’s car Sibling driving kid’s car Friend driving kid’s car Mom/Dad driving kid’s car Limits? $$$$ 64 Car in Kid’s Name QUESTION: If this option is selected what recommendation is there to the parents? 65 Kid’s Cars – Bottom Line If the car and policy are in the kid’s name, assume the parents’ policy is worthless. Parents depend on kid’s limits if they are sued. 66 Other Coverages Med-pay – Same exclusions PIP – If car in kid’s name, kid gets his/her PIP UM – Save the debate…clone limits and stack it Physical damage: – Kid’s policy covers kid’s car 67 Other Thoughts… The moral issue of low limits for the kid Future wage garnishments How would Mom/Dad feel if THEY were hit and hurt bad by a kid with 10/20/10? 68 Kid’s Cars 69 Drive Other Car (DOC) Coverage 70 Drive Other Car (DOC) Coverage Recent change…only liability coverage available under DOC Huge new gap created 71 Drive Other Car (DOC) Coverage Coverages Provided: – Liability – Med Pay – Uninsured Motorist – Physical Damage 72 Drive Other Car (DOC) Coverage Coverage NOT Provided: – Personal Injury Protection Broadened PIP for Named Individuals A MUST in FL and other no-fault states 73 Drive Other Car (DOC) Coverage Who is an Insured: – Med Pay and Uninsured Motorist Named insured and family – Liability and Physical Damage Named insured and resident spouse – Gaps for family members other than the spouse 74 Drive Other Car (DOC) Coverage Comparison to Personal Auto Policy – Who is an insured – Endorsements available 75 Drive Other Car (DOC) Coverage 76 NFIP: RCBAP vs. CPP Residential Condominium Building Association Policy Commercial Property Policy Both policies cover building items the same way Typically, coverages match 77 NFIP: RCBAP vs. CPP RCBAP – Property covered – The whole dang building! Foundations Paint, carpet, tile, cabinets, etc Additions and alterations made at the sole expense of the unit owner Compared to CPP 78 NFIP: RCBAP vs. CPP RCBAP – Unit owners make significant improvements/additions – Is RCBAP now under-insured? – Is there now a potential coinsurance problem? 79 NFIP: RCBAP vs. CPP Replacement cost for flood is greater than replacement cost for property…always! So… 80 NFIP: RCBAP vs. CPP Your answer is: – A. The RCBAP always has more coverage than the CPP – B. The RCBAP and CPP are always equal – C. The CPP always has more coverage than the RCBAP – D. Not enough information to answer 81 Condos – How We Can Help I need: – Copy of RCBAP dec page – Copy of appraisal Must include foundation and all building items – Letter from lender with client name and loan number 83 84 NFIP 85 Employees As Insureds – Business Auto Policy – CA 99 33 Employees are “an insured” under BAP using any auto Employee is covered under BAP using his/her own auto for business BAP is primary in all instances 86 Employees As Insureds – Business Auto Policy – CA 99 33 Who is an Insured in the BAC – Person or entity named – Permissive users – Exceptions/Exclusions 87 Employees As Insureds – Business Auto Policy – CA 99 33 Coverage Provided by Endorsement: – Liability – Physical Damage 88 Employees As Insureds – Business Auto Policy – CA 99 33 Uses: – Employees driving autos owned by them Primary/excess issues PAP/BAP analysis – Traveling employees – rental cars Liability Physical Damage 89 Employees As Insureds – Business Auto Policy – CA 99 33 90 Uninsured Motorists (UM) on Motorcycles 91 Uninsured Motorists (UM) on Motorcycles Cost for UM on cycles is very expensive Remember, the PAP excludes UM on vehicles with less than four wheels UM must be purchased on a cycle policy for coverage to apply 92 93 UM on Motorcycles FS 627.727 (1) No motor vehicle liability insurance policy which provides bodily injury liability coverage shall be delivered or issued for delivery in this state with respect to any specifically insured or identified motor vehicle registered 94 The Statute - 627.727 (1) No motor vehicle liability insurance policy which… – PAP – BAP – Motorhome policy – Motorcycle policy 95 The Policy INSURING AGREEMENT A. We will pay compensatory damages which an "insured" is legally entitled to recover from the owner or operator of an "uninsured motor vehicle" because of "bodily injury": 1. Sustained by an "insured"; and 2. Caused by an accident. 96 Compensatory Damages What are “compensatory damages?” 97 Compensatory Damages Summary: – Whatever the court awards! Medical bills Lost wages Loss of limbs Loss of enjoyment of life Pain & suffering – UM Covers a lot more than medical bills! 98 99 Will PIP, med-pay, or health insurance cover these? 100 Stacked vs. Non-Stacked Stacked Dollar difference – More cars equals more money Also, a coverage difference Non-stacked Dollar difference – Same dollars, regardless of number of cars Coverage difference – Excludes some claims that stacked covers. 101 Stacked Exclusions A. We do not provide Uninsured Motorists Coverage for "bodily injury" sustained by any "insured": 1. If that "insured" or the legal representative settles the "bodily injury" claim and such settlement prejudices our right to recover payment. However, this Exclusion (A.1.) does not apply to a settlement made with the insurer of a vehicle described in Section 2. of the definition of "uninsured motor vehicle". 2. While "occupying" "your covered auto" when it is being used as a public or livery conveyance. This Exclusion (A.2.) does not apply to a share-the-expense car pool. 3. Using a vehicle without a reasonable belief that that "insured" is entitled to do so. This Exclusion (A.3.) does not apply to a "family member" using your "covered auto" which is owned by you. 4. With respect to damages for pain, suffering, mental anguish or inconvenience unless the "bodily injury" consists in whole or in part of: a. Significant and permanent loss of an important bodily function; b. Permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement; c. Significant and permanent scarring or disfigurement; or d. Death. 102 Non-Stacked Exclusions 103 Non-Stacked Exclusions A. We do not provide Uninsured Motorists Coverage for "bodily injury" sustained: 1. By an "insured" while "occupying" any motor vehicle owned by that "insured" which is not insured for this coverage under this policy. This includes a trailer of any type used with that vehicle. 2. By any "family member" while "occupying" any motor vehicle you own which is insured for this coverage on a primary basis under any other policy. B. We do not provide Uninsured Motorists Coverage for "bodily injury" sustained by any "insured": 1. If that "insured" or the legal representative settles the "bodily injury" claim and such settlement prejudices our right to recover payment. However, this Exclusion (B.1.) does not apply to a settlement made with the insurer of a vehicle described in Section 2. of the definition of "uninsured motor vehicle". 2. While "occupying" "your covered auto" when it is being used as a public or livery conveyance. This Exclusion (B.2.) does not apply to a share-the-expense car pool. 3. Using a vehicle without a reasonable belief that that "insured" is entitled to do so. This Exclusion (B.3.) does not apply to a "family member" using "your covered auto" which is owned by you. 4. With respect to damages for pain, suffering, mental anguish or inconvenience unless the "bodily injury" consists in whole or in part of: a. Significant and permanent loss of an important bodily function; b. Permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement; c. Significant and permanent scarring or disfigurement; or d. Death. 104 Non-Stacked Exclusions A. We do not provide Uninsured Motorists Coverage for "bodily injury" sustained: 1. By an "insured" while "occupying" any motor vehicle owned by that "insured" which is not insured for this coverage under this policy. This includes a trailer of any type used with that vehicle. 2. By any "family member" while "occupying" any motor vehicle you own which is insured for this coverage on a primary basis under any other policy. B. We do not provide Uninsured Motorists Coverage for "bodily injury" sustained by any "insured": 1. If that "insured" or the legal representative settles the "bodily injury" claim and such settlement prejudices our right to recover payment. However, this Exclusion (B.1.) does not apply to a settlement made with the insurer of a vehicle described in Section 2. of the definition of "uninsured motor vehicle". 2. While "occupying" "your covered auto" when it is being used as a public or livery conveyance. This Exclusion (B.2.) does not apply to a share-the-expense car pool. 3. Using a vehicle without a reasonable belief that that "insured" is entitled to do so. This Exclusion (B.3.) does not apply to a "family member" using "your covered auto" which is owned by you. 4. With respect to damages for pain, suffering, mental anguish or inconvenience unless the "bodily injury" consists in whole or in part of: a. Significant and permanent loss of an important bodily function; b. Permanent injury within a reasonable degree of medical probability, other than scarring or disfigurement; c. Significant and permanent scarring or disfigurement; or d. Death. 105 So…… This exclusion is in the non-stacked form, It’s the “owned but not insured” exclusion. but not in No thecoverage stacked form: with non-stacked. Coverage does apply with stacked. – A. We do not provide Uninsured Motorists Coverage for "bodily injury" sustained: – 1. By an "insured" while "occupying" any motor vehicle owned by that "insured" which is not insured for this coverage under this policy…” 106 Owned Motorcycle Broward County Zip Code 300/500 Non-Stacked PAP UM $116 for six months (Stacked $155) $300K Cycle UM - $1451/year (Liability $119) Stacked PAP UM will respond on the motorcycle. (300/500) UM REJECTED! 107 Alabama Car One Car UM Rejected! Two Cars 250/500 Non-Stacked Stacked PAP UM will respond on the Alabama car. (500/1,000) 108 109 UM On Motorcycles 110 PEO (Professional Employer Organization) Tricks & Traps When a “client company” uses a PEO: – No need for WC – No need for CGL – No need for any other policies – PEO provides all coverages for client company – Great benefit for client company 111 PEO (Professional Employer Organization) Tricks & Traps Co-employment Relationship: – Primary employer (PEO) Pays employees Pays taxes Pays SUTA & FUTA Offers Benefits 112 PEO (Professional Employer Organization) Tricks & Traps Co-employment Relationship: – Worksite Employer Hires/fires Salary determination Supervises Offers benefits 113 PEO (Professional Employer Organization) Tricks & Traps Co-employment Relationship: – Contractual relationship Client Services Agreement (CSA) Defines the exact relationship and who is responsible for what 114 PEO (Professional Employer Organization) Tricks & Traps Gaps Created by the CSA: – Newly hired employees Client (WSE) must notify the PEO New employee not covered until received AND approved – Uninsured sub-contractors CSA does not recognize these as employees Client is “naked” 115 PEO (Professional Employer Organization) Tricks & Traps Other PEO “tricks”: – Can be “hidden” costs in the CSA Set up and change fees WC claim fees Garnishment fees Other administration fees 116 PEO (Professional Employer Organization) Tricks & Traps Other PEO “tricks”: – State Unemployment Tax (SUTA) Tax “cutoffs” not honored Rates increased without notice – High administration fees Lead with WC – low pricing for high risk Increase admin to cover WC costs Rates for master health plan 117 manipulated PEO (Professional Employer Organization) Tricks & Traps 118 Fair Credit Reporting Act (FCRA) 119 Fair Credit Reporting Act (FCRA) FCRA was renamed FACTA When renamed, there was no longer any impact on insurance agencies and the MVR issue. – Agents can now supply MVRs to commercial customers 120 Fair Credit Reporting Act (FCRA) Key terms – Consumer report – Consumer reporting agency – Permissible purpose – Employment purposes – Adverse action – Insurance underwriting 121 Fair Credit Reporting Act (FCRA) Consumer report: The term “consumer report” means any written, oral, or other communication of any information by a consumer reporting agency bearing on a consumer's credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the consumer's eligibility for: – (A) credit or insurance to be used primarily for personal, family, or household purposes; – (B) employment purposes; or – (C) any other purpose authorized under section 604 [§ 1681b]. 122 Fair Credit Reporting Act (FCRA) Consumer reporting agency: – The term “consumer reporting agency” means any person which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties, and which uses any means or facility of interstate commerce for the purpose of preparing or furnishing consumer reports. 123 Fair Credit Reporting Act (FCRA) Permissible purpose: In general. Subject to subsection (c), any consumer reporting agency may furnish a consumer report under the following circumstances and no other: (2) In accordance with the written instructions of the consumer to whom it relates. (3) To a person which it has reason to believe (A) intends to use the information in connection with a credit transaction involving the consumer on whom the information is to be furnished and involving the extension of credit to, or review or collection of an account of the consumer; or (B) intends to use the information for employment purposes; or (C) intends to use the information in connection with the underwriting of insurance involving the consumer; or 124 Fair Credit Reporting Act (FCRA) Permissible purpose: – Before an employer can get a consumer report for employment purposes, they must notify the individual in writing - in a document consisting solely of this notice - that a report may be used. They must also get the person's written authorization before asking the provider for the report. 125 Fair Credit Reporting Act (FCRA) Employments purposes: – The term “employment purposes” when used in connection with a consumer report means a report used for the purpose of evaluating a consumer for employment, promotion, reassignment or retention as an employee. 126 Fair Credit Reporting Act (FCRA) Adverse action: – Step 1: Before you take the adverse action, the employer must give the individual a pre-adverse action disclosure that includes a copy of the individual's consumer report and a copy of "A Summary of Your Rights Under the Fair Credit Reporting Act." 127 Fair Credit Reporting Act (FCRA) Adverse action: Step 2: After you've taken an adverse action, the employer must give the individual notice that the action has been taken in an adverse action notice. It must include: – The name, address and phone number of the CRA that supplied the report; – A statement that the CRA who supplied the report did not make the decision to take the adverse action and cannot give specific reasons for it; and – A notice of the individual's right to dispute the accuracy or completeness of any information the agency furnished, and his or her right to an additional free consumer report from the agency directly upon request within 60 days. 128 Don’t mess with the feds! 129 130 Fair Credit Reporting Act (FCRA) 131 Business Income and Extra Expense Coverage Options – Monthly limit: 1/3, 1/4, 1/6 Limits to 3, 4, or 6 months – Maximum period of indemnity No time limit on recovery – Agreed value Does not waive coinsurance 132 Business Income and Extra Expense Coverage Options – Business Income WITH Extra Expense – Business Income WITHOUT Extra Expense – Extra Expense Only 133 Business Income and Extra Expense Coverage Options – Business Income WITH Extra Expense – Business Income WITHOUT Extra Expense – Extra Expense Only 134 Business Income and Extra Expense Methods to Provide Coverage: – Coinsurance method Business Income Worksheet needed Long, tedious form Even accountants don’t understand it! 135 Business Income and Extra Expense Methods to Provide Coverage: – Waiving coinsurance: Maximum Period of Indemnity –Pays for a specific period of time –Ends when coverage runs out or $$ runs out…whichever comes FIRST 136 Business Income and Extra Expense Methods to Provide Coverage: – Waiving coinsurance: Monthly Limit of Indemnity –1/3, 1/4, or 1/6 of the limit per month –Limited to the maximum amount per MONTH –Pays until the $$ runs out 137 Business Income and Extra Expense Methods to Provide Coverage: – Waiving coinsurance: Agreed Value –Worksheet needed –Insured and company agree on values –Good for 1 year from the agreement date 138 BBQ Joints 139 140 141 142 143 144 145 And The BBQ Winner Is… 146 147 148 As We Conclude… E-mail me with questions Dthompson@faia.com 149