CAIB 3 - Chapter 2 - New Slides

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Questions and Answers

Who is covered under the coverage for key individuals while performing business-related duties?

Only Owners and Partners

Employees and Volunteer Workers

Spouses, Directors, and Officers

All of the above (correct)

New partnerships and joint ventures automatically receive coverage under the policy.

False

What is the maximum amount the policy will pay for all claims during the policy period called?

Aggregate Limit

Coverage for ________ applies when the Named Insured purchases a majority interest in a new corporation.

New Corporations Signup and view all the answers

Match the following terms with their definitions:

Aggregate Limit = Total amount payable for all claims during the policy period Each Occurrence Limit = Maximum amount payable per individual occurrence Temporary Custodians = Insured following the death of the Named Insured for property maintenance Legal Representatives = Appointed representatives covered after the Named Insured's death Signup and view all the answers

What happens if a fire causes damages totaling $1,105,000 and the Each Occurrence Limit is $1,000,000?

The insured has to cover $105,000 out-of-pocket Signup and view all the answers

The insolvency or bankruptcy of the insured relieves the insurer from liability.

False Signup and view all the answers

What is the duration of automatic coverage for new businesses formed during the policy period?

90 days or until policy expiry Signup and view all the answers

What is the primary currency for claims payments under the Canadian Currency Clause?

Canadian dollars Signup and view all the answers

Insured individuals are required to promptly notify the insurer of any incidents.

True Signup and view all the answers

How long can insurers inspect the insured's records after policy expiration?

three years Signup and view all the answers

The first named insured is responsible for ___ and refunds.

premium payments Signup and view all the answers

Match the following clauses with their descriptions:

Canadian Currency Clause = Claims are paid in Canadian dollars unless otherwise agreed Other Insurance Clause = Policy is primary unless stated otherwise Premium Audit = Final premium is based on actual sales/work Representations Clause = False material representations may void the policy Signup and view all the answers

What must claimants do to pursue legal action against the insurer?

File lawsuits within one year of the right to action Signup and view all the answers

Insurers can assure safety and compliance through inspections.

False Signup and view all the answers

What must insured individuals avoid assuming unless related to first aid?

voluntary assumptions of liability Signup and view all the answers

What does Personal and Advertising Injury Coverage extend to?

Internet-based activities outside the coverage territory Signup and view all the answers

The insurer has a duty to defend any claim that is outside the policy coverage.

False Signup and view all the answers

What must occur for the insurer's duty to defend to end?

Once coverage limits are exhausted Signup and view all the answers

The insurer can investigate any claim for ______.

firsthand information Signup and view all the answers

Match the following coverage features with their descriptions:

Coverage A = Covers only compensatory damages Policy Period Requirement = Losses must occur during active policy Occurrence Requirement = Injury must result from an occurrence Territorial Limits = Applies within Canada and specified territories Signup and view all the answers

What is the insurer's right regarding claims?

Insurer can investigate claims for firsthand information Signup and view all the answers

Compensatory damages are covered under Coverage A.

True Signup and view all the answers

What is one of the benefits of the insurer's right to settle claims?

Reduces legal expenses Signup and view all the answers

What is required from the insured for cancellation of the policy?

A signed request Signup and view all the answers

The scope of 'Your Product' includes real property.

False Signup and view all the answers

What is meant by 'Completed Operations Exposure'?

Liability arising from defects in completed work. Signup and view all the answers

Insurers provide notice to the first Named Insured for ______.

cancellation Signup and view all the answers

Which of the following statements about warranties in product liability coverage is true?

Warranties include statements about quality and performance. Signup and view all the answers

Consumers have the right to sue for damages caused by defective products.

True Signup and view all the answers

What does 'Your Work' cover in the context of liability?

Work done by the insured and subcontractors. Signup and view all the answers

Which of the following is NOT a coverage option within the IBC 2100 CGL Policy?

Environmental Damage Liability Signup and view all the answers

Coverage A protects against legal obligations to pay for bodily injury or property damage.

True Signup and view all the answers

What types of damages are excluded from the CGL policy's coverage?

Punitive damages Signup and view all the answers

The CGL policy applies to losses occurring within __________ and the United States.

Canada Signup and view all the answers

Match the following coverages to their descriptions:

Coverage A = Bodily Injury and Property Damage Liability Coverage B = Personal Injury and Advertising Injury Liability Coverage C = Medical Payments Coverage D = Tenants' Legal Liability Signup and view all the answers

Which of the following conditions is covered under the loss of use provision?

Power outages Signup and view all the answers

The insured's moral obligations are covered by the CGL policy.

False Signup and view all the answers

What does Coverage C refer to in the CGL Policy?

Medical Payments Signup and view all the answers

An __________ includes sudden, unexpected events leading to injury or damage.

occurrence Signup and view all the answers

Match the types of liabilities covered by the CGL policy.

Tort Liability = Includes negligence and other civil wrongs Contractual Liability = Covers obligations assumed through contracts Statutory Liability = Liability imposed by law Criminal Acts = Excluded from coverage Signup and view all the answers

Which of the following is a coverage exclusion under the CAIB 3 CGL Policy?

Civil actions following criminal acts Signup and view all the answers

Coverage includes protection for intangible assets such as goodwill.

False Signup and view all the answers

What type of damages does the policy cover in tort liability?

Compensatory damages Signup and view all the answers

The CGL policy covers only __________ damages for actual injury or damage.

compensatory Signup and view all the answers

Which of the following sectors is mentioned as facing substantial liabilities?

Aerospace Signup and view all the answers

The 'Deep Pocket Theory' suggests that businesses with fewer resources should pay more in liability claims.

False Signup and view all the answers

What is the primary purpose of the Claims Made Policy?

To address the long tail effect and control costs associated with latent injury claims. Signup and view all the answers

Higher awards for liability insurance are necessary due to reduced purchasing power from _____ .

inflation Signup and view all the answers

Match the following terms related to liability insurance with their descriptions:

Defensive Costs = Expenses included in liability policies to manage claims Self-Insurance = When large corporations absorb their own risks Fraudulent Claims = False claims made to secure unwarranted compensation Claims Made Policy = Policy designed to limit exposure to long-term claims Signup and view all the answers

Which factor impacts the adequacy of insurance limits in high litigation areas?

Territory of operations Signup and view all the answers

Insurance companies consider the defendant's ability to pay when awarding damages in court.

False Signup and view all the answers

What common issue do liability insurance policies help businesses manage?

Fraudulent claims Signup and view all the answers

In cases of insufficient insurance, bankruptcy may not absolve a defendant from _____ .

judgment Signup and view all the answers

What theory states that injury begins at exposure to a harmful substance?

Exposure Theory Signup and view all the answers

Study Notes

Commercial General Liability Policy (CGL)

CAIB 3: Chapter 2 provides detailed information about the Commercial General Liability Policy.
The 1980s marked a period of significant challenges for liability insurers due to claims exceeding premiums. High court awards and environmental/aviation disasters added to the strain. Insurers also faced issues of inadequate risk assessment.

Section 1: Developing the Policy Form

This section focuses on the development of the policy form.
Key elements driving insurer losses included environmental disasters (e.g., Bhopal gas leak), aviation disasters (e.g., Air India crash), inadequate risk assessments, and latent bodily injury claims (e.g., asbestos, medical devices).

Major Factors Driving Insurer Losses

Environmental disasters played a major role, as did inadequate risk assessments where premiums were set too low for high-risk industries.

Insurer Response and Development of Commercial General Liability Policy (CGL)

Insurers responded to the crisis by implementing premium hikes for high-risk sectors (e.g., daycare, hospitals) and evaluating policy forms for commercial liability.
The Commercial General Liability Policy (CGL) was developed in the U.S. and adopted in Canada in 1986.
The CGL policy has a shared structure and intent with the U.S. version.

Overview of the Commercial General Liability Policy (IBC 2100)

IBC 2100, a commonly used CGL policy in Canada, does not have a legislated standard form but is widely adopted.
It addresses liability exposures for various entities (individuals, corporations, partnerships, societies, and government bodies).
Key policy components include Declarations (insured's information, policy period, coverage limits, and business description) and additional details within the policy structure covering different liability types and conditions.

Structure of the CGL Policy (IBC 2100)

The IBC 2100 policy has five sections:
- Section I - Coverages: Details four coverages with their insuring agreements and exclusions.
- Section II - Defines "Who Is An Insured."
- Section III - Outlines the Limits of Insurance.
- Section IV - Discusses Commercial General Liability Conditions.
- Section V - Provides Definitions.

Section I - Coverages

Section I details the four main coverages (A-D) along with their corresponding insuring agreements and exclusions.
- Coverage A: Bodily Injury and Property Damage Liability.
- Coverage B: Personal Injury and Advertising Injury Liability.
- Coverage C: Medical Payments.
- Coverage D: Tenants' Legal Liability.

Coverage A: Bodily Injury and Property Damage Liability

Coverage A protects against legal obligations for bodily injury or property damage.
Key features include the coverage's definition of bodily injury (physical harm, sickness or disease) and property damage.

Bodily Injury Coverage Details

Bodily injury coverage is limited to physical harm (excluding things like mental anguish) from minor ailments to severe illnesses
Includes coverage for death due to bodily injury, sickness, or disease.

Property Damage Coverage and Loss of Use

Coverage deals only with tangible property, excluding intangible assets such as goodwill.
Loss of use is covered even without direct physical damage, (e.g., power outages) and encompasses various related business losses (e.g., consequential losses).

Payment Obligations

Policy coverage responds to situations where the insured is lawfully obligated to pay damages.
Coverage defines legal obligations (defined by court decisions) from covered obligations that aren't covered.

Types of Liabilities Covered by the Insuring Agreement

Tort Liability: Coverage extends beyond negligence to include other civil wrongs (e.g., nuisance, trespass).
Contractual Liability: Covers specific obligations assumed through contracts.
Statutory Liability: Covers liability imposed by law (like compliance with safety standards).

Criminal Acts Exclusion

Policy excludes liability related to criminal actions by the insured.
Civil actions following criminal acts are outside the policy's coverage (although victims might pursue civil claims against the offender).

Insurer's Liability Limited to Compensatory Damages

Coverage covers only monetary compensation for actual injury or damage.
Excludes punitive damages (e.g., fines or exemplary damages).

Coverage Limited to Losses During the Policy Period

The policy's coverage is limited to incidents occurring within the policy period or occurrence date.
Challenges and recommendations for recording keeping on all claims are part of maintaining compliance.

Requirement for Injury or Damage to Result from an Occurrence

The policy defines an occurrence as an accident or continuous exposure to harmful conditions.
This policy excludes damages or injuries that predate the policy period, even if those damages or injuries are ongoing

Territorial Limits of Coverage

Coverage applies to losses within Canada and the United States, including territories and some international waters/airspace when travelling between those locations.
Limited world-wide coverage for products liability can protect against out-of-territory claims.

Conditions for International Claims and Coverage

Product liability coverage is for products made or sold in Canada or the US, and legal action must be filed in either location.
Coverage ensures consistency with Canadian/American legal standards.

Additional Coverage for Overseas Business Activities

Coverage extends to short-term overseas business trips for employees.
Encompasses liability arising from personal and advertising injuries overseas if they are connected to internet-based business activities

Insurer's Right and Duty to Defend

Insurers defend actions leading to payouts, protecting their interests.
It is their duty to defend against legitimate claims (even if false or groundless) that are within the scope of the policy.
The insurer's duty to defend ends once coverage limits are spent or when the action is clearly outside the policy's coverage (e.g. intentional acts).
The insurer is not required to defend if the potential damages exceed the policy limits.

Insurer's Right to Investigate and Settle Claims

Investigating a claim with an experienced adjuster allows accurate liability assessment.
Insurer has the right to settle claims outside the courtroom when liability is apparent, reducing costs and time.

Key Features of Coverage A: Bodily Injury and Property Damage Liability

The coverage scope of A is limited to bodily injury or property damage.
Covers only obligations for damages the insured is legally obligated to pay. Compensatory, not punitive damages are covered.
Losses must occur during the policy period.
The occurrence must be caused by an accident (not intentional acts).
Territorial covers within Canada, the U.S., and specified territories.
The insurer has a duty to defend against covered claims.
Insurers can investigate and settle claims.

Exclusions – Intentional Acts and Expected Consequences

Intentional harm exclusions apply for bodily injury or property damage intentionally caused by the insured.
Examples include deliberate assault or arson.
Expected consequences often exclude injuries or damages related to the insured's actions.
Some exceptions exist: reasonable force to protect people or property is not considered intentional.

Exclusions - Contractual Liability

Excludes bodily injury or property damage if the insured assumes liability under a contract or agreement, except when liability results from a contract or after contract execution.

Liability Assumed Under Contract - Overview

Voluntary assumption of liability refers to instances where one party transfers liability to another party by contract (e.g., in building ownership or construction).
The purpose of the exclusion is to protect the insurer from unexpected increases to risk without corresponding premium adjustments.

Exceptions to Contractual Liability Exclusion

Standard insured contracts like leases and easements might be automatically covered but other factors must be considered for additional liability (e.g. municipal work or maintenance agreements).

Assumption of Tort Liability for Business Operations

General business contracts often cover tort liability if the liability arises because of the insured's conduct or negligence and was assumed before a claim arose.
The policy excludes cover if the liability springs solely from a third party's negligence or breach of contract.

Professional Liability Exclusion

The policy generally excludes professional liability assumed through contracts for architects, engineers, and surveyors
The exclusion maintains focus on general liability by excluding specialized categories of liability that often necessitate separate insurance coverage.

Exclusion for Statutory Obligations (e.g., Workers' Compensation)

Statutory obligations (e.g., workers' compensation, unemployment, or employment compensation) are excluded from the coverage.
The insured is still responsible for fulfilling statutory requirements (but coverage isn't provided).

Employee Injury Exclusion and Recommendations

Policy excludes coverage for employee bodily injuries during their employment.
A possible exception is if the liability arises from an insured contract or is covered by employees' compensation plans.
For businesses, options include liability coverage or voluntary compensation endorsements. Workers' compensation is another option, and coverage should be investigated.

Contingent Employer's Liability Coverage

This coverage protects employers when an employee's injury claim is denied by workers' compensation.
Coverage applies when assumed under an insured contract or needed by workers' compensation law.

Automobile Liability Exclusion

(1) policy excludes liability for injury or damage that arises from the use, maintenance, or operation of automobiles (requiring their own policy), (2) motorized snow vehicles (that require their own policy), or (3) vehicles used in races or stunts.)

Exceptions to Automobile Liability Exclusion

Attached equipment (e.g., loading/unloading and machinery) that is attached to vehicles. In these instances, coverage extends to the vehicle with machinery if it is employed only at the job site,
Loading/Unloading coverage occurs when the activities do not operate under provincial motor regulations.

Key Takeaways for Contingent and Automobile Liability

Contingent employer's liability coverage protects employers when worker's compensation denies a claim and liability is shared.
Automobile liability exclusion prevents insurance for typical automobiles, while certain job-site situations are covered.
Multiple policies may be needed to cover certain liability exposures for businesses.

Automobile Exclusion - Owned and Non-Owned Vehicles

Excludes liability for any automobile owned or not owned by the insured.
Businesses have potential liability from rented/leased vehicles or from employees using personal vehicles for business

Types of Automobiles and Heavy Machinery

Non-automobile vehicles, including certain machinery and equipment (e.g., front-end loaders, forklifts) are typically covered under general liability.
Jurisdictional licensing requirements may apply for machinery used on public roads.
Verification of licensing is necessary.

Watercraft Exclusion and Exceptions

Excludes liability for watercraft-related activities (e.g., operation) unless the watercraft is not used commercially and/or is less than 8 meters long, and remains ashore.
Exceptions exist for watercraft on owned/rented premises.

Non-Owned Watercraft Liability

Automatically includes liability for non-owned watercraft under 8 meters in length, limited to pleasure use, not commercial activities.
Insured's occasional use is covered, not commercial activities such as renting boats.
Brokers should inform customers of these limitations.

Exclusion for Damage to Property in Insured's Possession

Coverage does not cover damage to property owned, rented or occupied by the insured.
No coverage for damage to property in the insured's care custody or control.
Exceptions may be purchased with extra premium, including for Tenant's Legal Liability.

Exclusion for Damage to Sold, Loaned, or Abandoned Property

Excludes property damage claims arising after the insured sells, loans or abandons the properties.

Exclusion for Damage from Defective or Faulty Work

Excludes coverage for damage to specific or surrounding parts of property from operations performed when the damage arises from faulty operations.
Defective work exclusions cover damage repair costs for properties needing restoration.
Resultant damage is covered for repairs outside of the areas the work was on

Exclusion for Damage to Products and Work

Product defects in the covered product that is sold to other are excluded.
Workmanship is excluded for defects during the work itself.
The broader exclusions on completed operations may be an optional endorsement.

Exclusion for Work by Subcontractors

Damage to insured work done by a subcontractor is excluded.
Coverage on the work of subcontractors remains contingent on specific exclusions, but the insured is often protected.
Claims process might cover and pursue subrogation against the subcontractor.

Exclusion for "Impaired Property"

Excludes coverage for loss of use from damage to undamaged property due to a defect in the insured's product or work.
Restorable property is not considered impaired, as repairs can still be made without permanent damage.
Loss due to sudden and accidental physical damage to insured's product/work may be covered.

Recall and Withdrawal Exclusion

Coverage for costs associated with recalling, inspecting, repairing, or replacing defective products and work is excluded by the policy and may require separate recall insurance.
Examples include recalling faulty product, repairs and inspections, or disposal of defective merchandise.

Additional Key Exclusions

Electronic data is not covered for digital damage
Personal or advertising injuries excluded
Professionals services (e.g., consulting and medical service) exclusions
Coverage does not automatically extend to abuse claims

Coverage B: Personal and Advertising Injury Liability

Coverages typically include personal and advertising injury liabilities
Typically covered at no extra premium.
Coverage limits commonly match those for other liability.
Covers offenses against personal rights or reputation resulting from defamation, invasion of privacy, or misleading advertising.

Key Offenses Covered under Personal Injury Liability

False arrest, detention, or imprisonment, includes store workers wrongfully accusing customers of theft, are covered by policies.
Malicious prosecution is protected for wrongful accusations when no probable cause existed.
Claims dealing with wrongful entry or eviction extend to wrongful eviction or unauthorised entry onto leased premises.

Additional Offenses Covered: Defamation and Privacy Violations

Covers defamation (slander and libel): damages caused by false statements (spoken or written).
Offers coverage to protect individuals from the publication of material violating their right to privacy, including cases of the published discussion of debt.

Exclusions and Limitations under Coverage B: Personal and Advertising Injury Liability

False publication, intentional legal violations, and contractually assumed liability are excluded, and additional exclusions apply for issues related to advertising, broadcasting or publishing.

Coverage C: Medical Payments

Covers no-fault medical expenses for third parties injured on the insured's property.
First aid, ambulance costs, medical/dental services, and funeral expenses are considered.
Coverage generally remains in effect for 1 year from the accident's date.

Exclusions in Coverage C: Medical Payments

Coverage limits are restricted primarily to accidents.
Medical expenses for the insured, employees covered under workers' compensation or participating in athletic events are not covered.

Key Benefits and Legal Advantages of Coverage C

Paying immediate medical expenses can reduce future legal issues for a company, leading to less substantial claims that can arise.
Court sympathies are often in favor of quick payments.

Coverage D: Tenants' Legal Liability

Covers tenants from legal liability for damages to rented premises
Coverage applies to long term and short term rentals (e.g., hotel rooms, event spaces).
Covers both tort liability (negligence) and contractual liability (contractual agreements).

Why Tenants' Legal Liability Coverage is Necessary

Coverage gaps exist for property damage that is not specifically excluded (e.g negligence leading to damages to covered areas).
Insurers can purchase optional coverage to address specific risks or exposures outside of standard coverage.

Selecting Coverage Limits for Tenants' Legal Liability

Coverage limits for coverage D: Tenants Legal Liability must be at least equal to the value of the portion of the rented area occupied by the insured
Coverage is based on location, occurrences and negligence on an all-risks basis

Common Exclusions for Coverages A, C, and D

Asbestos exposure related exclusions will not be covered.
Fungi/Spore exclusions do not cover the costs associated with fungi or spores for products intended for human or animal use.
Pollution liability excludes specific pollutants and related incidents

Common Exclusions for Coverages A, C, and D (Part 2)

Nuclear energy, often included in the Nuclear Insurance Association of Canada coverage policy, is excluded.
Pollution exclusions broaden to encompass pollutants at a variety of locations (on-site, during transportation, at worksites, related to fires)

Additional Exclusions: Terrorism and War Risks

Coverage does not extend to any expenses resulting from terrorism or warlike actions.

Supplementary Payments for Coverages A, B, and D

Payments cover additional costs from legal defense (including witness fees), bonds, and insured's reasonable court expenses).

Additional Supplementary Payments and Limitations

Legal fees and interest (post-judgment) are covered up to the policy's liability limits.

Determination of Premium – Factors Affecting Rates

Premiums depend on various factors including industry, claims history, and location (geography).
Higher-risk locations or industries typically have higher premiums.
Insurers use factors like sales and payroll data to assess liability risk.

Coverage A: Bodily Injury and Property Damage Liability

Premiums are based on limits, exposure, risks, and factors specific to business operations and location.

Premises and Operations Liability

Premiums depend on square footage, occupancy type, payroll count, and location/geography.

Products Liability

Premiums are based on product type, potential risk, sales volume, and distribution territories.

Completed Operations Liability

Premiums depend on work type, gross receipts, and project scale.

Determining Liability Insurance Coverage — Factor 1: Previous Court Awards

Previous court awards for claims involving similar industries influence coverage recommendations.
Case examples, like a Las Vegas hotel fire exceeding $20 million, demonstrate the necessity for substantial coverage.

Determining Liability Insurance Coverage — Factor 2: Inflation

Courts factor in inflation to ensure adequate compensation for damages, even with rising costs.
Higher awards are reflected based on reduced purchasing power.

Determining Liability Insurance Coverage—Factor 3: Existence of Insurance and the "Deep Pocket" Theory

Courts often consider the existence of insurance and a business's financial resources when setting damages.
The "deep pocket" theory suggests businesses with stronger financial positions may face higher awards.

Determining Liability Insurance Coverage — Factor 4: Territory of Operations

Operating in areas with high litigation frequency (e.g. regions like the U.S.) requires more substantial coverage.
International operations require consideration of currency fluctuations and local legal climates.

Determining Liability Insurance Coverage—Factor 5: Business's Ability to Absorb Losses

Larger corporations often self-insure due to capacity to absorb losses
Small-to-medium sized businesses may struggle to absorb loss and thus gain the benefit of insurance.
Coverage may account for the ability to absorb losses

Effect of Judgment for Damages on Business

Courts do not factor in the ability to pay damages when awarding them.
Bankruptcy may not relieve a defendant from judgment obligations.
Judgments may require liquidation of assets, potentially leading to significant consequences
Insurers might manage these possible consequences.

Fraudulent Claims in Liability Insurance

Fraudulent claims are common, especially in liability and auto insurance.
Liability policies contain tools, like access to adjusters, for managing fraudulent claims (which often results in expenses).
Companies may pay fraudulent claims to prevent added expenses of litigation.

Section 3: Miscellaneous Policy Forms

Section 3 discusses various other policies like the Commercial General Liability Policy / Claims Made Form.

Commercial General Liability Policy (Claims Made Form) - IBC 2200

Traditional CGL (IBC 2100) policies face challenges with long-term bodily injury claims over multiple years.
Claims Made Forms (IBC 2200) were developed to solve this problem by managing escalating claims costs arising from older claims.

Latent Bodily Injury: The History of the Problem

Occurrence-based coverage allows claims any time, but insurers must pay if the risk was insured.
Determining the exact date of injury can be complex, leading to differing opinions about the correct court theory on liability.
Exposure theory, exposure in Residence theory, and Manifestation Theory are different court theories on liability occurrences.

The Solution: The Claims Made Policy

The Claims Made Policy addresses the "long tail" effect of latent injury claims, which are often costly, by reducing exposure to prior claims.
Key features include Triggered coverage when claims arise, limits based on the retrospective date to limit coverage, and extended reporting periods to capture a broader range of exposures..

Professional Liability Insurance

Covers damages stemming from professional services (either performed or not performed).
Defines a professional as someone with specialized knowledge and skills.
Addresses healthcare professionals, advisors and counselors, and others.
Claims Made Basis, due to underwriting challenges, are used.

Basis of Legal Action in Professional Liability

Includes legal grounds for claims (Tort and Contract), which depend on the duty (or lack thereof) of care.
Covers standards of care, performance, and potential breaches in contract.

Directors' and Officers' (D&O) Liability Insurance

Policies protect directors/officers by covering liability when they fail to fulfill duties and obligations.

Addressing Limitations in Liability Coverage Through Umbrella Policies

Inadequate coverage limits are addressed with umbrella policies.
Policies extend broader coverage, filling gaps, and covering additional exposures

How the Umbrella Policy Works

Provides excess liability coverage over the limits in primary insurance on a claims-made basis
This coverage extends to situations involving excluded losses in the primary policy

Underwriting Umbrella Liability Coverage

Comprehensive application forms, which insurers require approval, account for high-risk situations.
Underwriters evaluate existing coverage limits/gaps from primary policies.
Brokers may also offer coverage discounts on broader primary policies, potentially reducing SIR amount.

Other Insurance Clause

Other insurance clauses are often written to establish policy prioritiisation and how liability is shared.

Premium Audit

Insurers make premium deposits and then adjust to the actual sales/work.
Audits ensure correct premiums for actual exposures.

Premiums Clause

The first named insured is responsible for premium payments and refunds in the policy unless noted otherwise.
Management for policy payments from multi-insured entities may also be affected depending on the clause.

Representations Clause

Requires accurate, factual statements about the covered party; false material statements usually void insurance.

Separation of Insureds (Cross Liability)

Insured policies are separate for each separate insured.
Breaches for any single insured do not materially impact the coverage for other insureds..

Termination Clause

Insureds must provide a signed request for cancellation of policy that also involves insurer notice to the named insured.

Transfer of Rights and Subrogation

Insurers have the right to subrogate from covered losses to responsible third parties
Transfer of rights for the policy is dependent on the policy's consent.

Definitions in the CGL Policy

Provides essential definitions, which clarify coverage/responsibilities..

Products Liability - Definition and Scope

Defines your products in a CGL policy.

Examples of Products Liability Coverage

Product Components/Containers/Equipment are examples of covered liabilities.
Warranties are included, ensuring the coverage of all product liabilities.

Completed Operations Exposure

Liability exposure may arise from defects in completed work (as defined) by either the insured or subcontractors.
Definition of "Your Work" typically includes materials and work completed.

Key Elements and Example

Direct/Subtracted work are elements that clarify work scope
Materials supplied would also be included in coverage.
Examples for liability in specific situations (e.g., contractor work includes defects) clarify how liability would be covered.

Determining Liability Insurance Coverage—Factor 1: Previous Court Awards

Previous or similar court awarded situations inform insurance coverage for comparable situations and liability factors.
Case examples for specific situations (e.g., a Las Vegas hotel fire) may be included to demonstrate policy requirements

Determining Liability Insurance Coverage—Factor 2: Inflation

Courts increase award compensation to adjust to the current value of damages when factoring in inflation..
Ensures that compensation is not reduced by inflation

Determining Liability Coverage—Factor 3: Existence of Insurance and the "Deep Pocket" Theory

Courts may award higher damages if they believe a business has financial resources.

Determining Liability Coverage—Factor 4: Territory of Operations

Operating in regions with high litigation frequency (e.g. higher litigation regions like the U.S) will often need more extensive/higher coverage
International operations and currency fluctuations would require specific analysis for these operations and locations.

Determining Liability Coverage Factor 5: Business's Ability to Absorb Losses

Larger corporations often consider self-insurance to absorb loss (especially those with the capacity to do so)
Small to mid-sized businesses are often dependent on insurance and its ability to cover loss.

Effect of Judgment for Damages on Business

Courts do not consider defendants' ability to pay damages when awarding them.
Filing for bankruptcy may not absolve defendants of their liability obligations.

Fraudulent Claims in Liability Insurance

Insurers and policy holders might deal with these situations.
Policies often have costs for defense cases relating to specific situations and potentially fraudulent claims

Section 3: Miscellaneous Policy Forms

Section 3 includes traditional and claims made forms of policy coverage.

Commercial General Liability Policy (Claims Made Form) - IBC 2200

Traditional CGL may face issues in multi-year bodily injury claims for businesses.
Claims Made Form (IBC 2200) was designed to solve this with an added feature to better manage costs for older claims.

Latent Bodily Injury: The History of the Problem

-Occurrence-based coverage may allow claims any time, as long as the risk was insured at the time of occurrence.

Courts may interpret different theories (exposure, exposure in Residence Theory, Manifestation Theory) on what constitutes the time of injury.

Solution: The Claims Made Policy

Policies are triggered when claims arise (inception, retro-date).
Policies maintain consistency across renewals (due to changing exposure risks to the insured).
Extended reporting periods may be available to capture a broader range of exposures.

Professional Liability Insurance

Covers damages from failures of professional services (performed or not).
Professionals are defined as individuals with specialist knowledge and skills.
Includes professional categories like healthcare providers, advisors and counselors, etc.
A claim-made basis is often used for professional liability policies.

Basis of Legal Action in Professional Liability

Legal grounds include professional duty (Tort) and promises or agreements (Contract).
Considerations include the performance of duty (complete, substantial, or breach), the standards within a profession or sector, and any damages or issues that might arise.

Directors' and Officers' (D&O) Liability Insurance

Protects company directors and officers from legal claims of failure to meet their legal duties.
Insurance covers cases if a director or officer is negligent or makes a mistake at work, and/or when fulfilling duties in corporate affairs.
Covers liability to shareholders and creditors.

Addressing Limitations in Liability Coverage Through Umbrella Policies

-Inadequate limits and risks are typically addressed with supplemental liability policies.

Umbrella policies often provide broader coverage and fill the gaps in primary policies by increasing coverage amounts for high-risk areas

How the Umbrella Policy Works

Umbrella policies can cover losses exceeding primary limits on a claims-made basis.
Policies may include exclusions in their provisions which are similar to those in primary policies and may require a deductible
Deductibles can encourage the purchase of adequate primary insurance.

Underwriting Umbrella Liability Coverage

In order to underwrite policies, comprehensive application forms are required.
Policies include broader criteria for primary policies, in addition to coverage and limitations.
Approval by insurers is required for policies.

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Description

Test your understanding of business insurance policies with this quiz. Questions cover key individuals' coverage, automatic policy provisions for new partnerships, and the implications of claims limits. Challenge yourself on topics such as coverage definitions and insurer responsibilities.

CAIB 3 - Chapter 2 - New Slides

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Questions and Answers

Who is covered under the coverage for key individuals while performing business-related duties?

New partnerships and joint ventures automatically receive coverage under the policy.

What is the maximum amount the policy will pay for all claims during the policy period called?

Coverage for ________ applies when the Named Insured purchases a majority interest in a new corporation.

Match the following terms with their definitions:

What happens if a fire causes damages totaling $1,105,000 and the Each Occurrence Limit is $1,000,000?

The insolvency or bankruptcy of the insured relieves the insurer from liability.

What is the duration of automatic coverage for new businesses formed during the policy period?

What is the primary currency for claims payments under the Canadian Currency Clause?

Insured individuals are required to promptly notify the insurer of any incidents.

How long can insurers inspect the insured's records after policy expiration?

The first named insured is responsible for ___ and refunds.

Match the following clauses with their descriptions:

What must claimants do to pursue legal action against the insurer?

Insurers can assure safety and compliance through inspections.

What must insured individuals avoid assuming unless related to first aid?

What does Personal and Advertising Injury Coverage extend to?

The insurer has a duty to defend any claim that is outside the policy coverage.

What must occur for the insurer's duty to defend to end?

The insurer can investigate any claim for ______.

Match the following coverage features with their descriptions:

What is the insurer's right regarding claims?

Compensatory damages are covered under Coverage A.

What is one of the benefits of the insurer's right to settle claims?

What is required from the insured for cancellation of the policy?

The scope of 'Your Product' includes real property.

What is meant by 'Completed Operations Exposure'?

Insurers provide notice to the first Named Insured for ______.

Which of the following statements about warranties in product liability coverage is true?

Consumers have the right to sue for damages caused by defective products.

What does 'Your Work' cover in the context of liability?

Which of the following is NOT a coverage option within the IBC 2100 CGL Policy?

Coverage A protects against legal obligations to pay for bodily injury or property damage.

What types of damages are excluded from the CGL policy's coverage?

The CGL policy applies to losses occurring within __________ and the United States.

Match the following coverages to their descriptions:

Which of the following conditions is covered under the loss of use provision?

The insured's moral obligations are covered by the CGL policy.

What does Coverage C refer to in the CGL Policy?

An __________ includes sudden, unexpected events leading to injury or damage.

Match the types of liabilities covered by the CGL policy.

Which of the following is a coverage exclusion under the CAIB 3 CGL Policy?

Coverage includes protection for intangible assets such as goodwill.

What type of damages does the policy cover in tort liability?

The CGL policy covers only __________ damages for actual injury or damage.

Which of the following sectors is mentioned as facing substantial liabilities?

The 'Deep Pocket Theory' suggests that businesses with fewer resources should pay more in liability claims.

What is the primary purpose of the Claims Made Policy?

Higher awards for liability insurance are necessary due to reduced purchasing power from _____ .

Match the following terms related to liability insurance with their descriptions:

Which factor impacts the adequacy of insurance limits in high litigation areas?

Insurance companies consider the defendant's ability to pay when awarding damages in court.

What common issue do liability insurance policies help businesses manage?

In cases of insufficient insurance, bankruptcy may not absolve a defendant from _____ .

What theory states that injury begins at exposure to a harmful substance?

Study Notes

Commercial General Liability Policy (CGL)

Section 1: Developing the Policy Form

Major Factors Driving Insurer Losses

Insurer Response and Development of Commercial General Liability Policy (CGL)

Overview of the Commercial General Liability Policy (IBC 2100)

Structure of the CGL Policy (IBC 2100)

Section I - Coverages

Coverage A: Bodily Injury and Property Damage Liability

Bodily Injury Coverage Details

Property Damage Coverage and Loss of Use

Payment Obligations

Types of Liabilities Covered by the Insuring Agreement

Criminal Acts Exclusion

Insurer's Liability Limited to Compensatory Damages

Coverage Limited to Losses During the Policy Period

Requirement for Injury or Damage to Result from an Occurrence

Territorial Limits of Coverage

Conditions for International Claims and Coverage

Additional Coverage for Overseas Business Activities

Insurer's Right and Duty to Defend