All Terms and Subject Flashcards

1
Q

What is HO-5 Comprehensive Form

A

Open peril for structures and personal property

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2
Q

What is HO-3 Special Form

A

Open peril coverage for dwelling and other structures.

Named Peril coverage for personal property.

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3
Q

Open Peril Approach

A

Covers damages caused by all perils except those specifically excluded.

HO-3 and HO-5

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4
Q

HO-8 Modified Coverage Form

A
Named Peril Coverage
Covers fewer perils
Covers at ACV
Considers fair market value of home
Cheaper
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5
Q

HO-6 Unit Owners Form

A

“Condo Form”
Covers owner’s belongings
Covers all finished surfaces of the individual condominium unit.

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6
Q

HO-4 Contents Broad Form

A

“Renter’s Insurance”
Against all broad form perils
Only covers personal property.

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7
Q

HO-2 Broad Form

A

Named Peril Policy

Insures against all 17 broad form perils

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8
Q

Broad Form Endorsement

A

Vandalism or malicious mischief
Theft
Falling objects
Weight of ice, snow, or sleet
Damage from steam or hot water system
Accidental discharge or overflow of water or freezing
Artificially generated electrical current

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9
Q

Extended Coverage

A

Covered: Windstorm, hail, explosion, riot or civil commotion, vehicles, aircraft, smoke

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10
Q

Named-Peril Approach

A

Covers losses caused only by perils named in policy.

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11
Q

Commercial Lines

A

For possessions included for business or corporate use.

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12
Q

Personal Lines

A

For possessions included for personal use.

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13
Q

Monoline Policy

A

An insurance policy that covers only one risk or type of risks

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14
Q

Line of Coverage

A

A particular risk or groups of risks covered by an insurance policy.

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15
Q

Negotiation Techniques

A

Humor, questions, demonstration, pleasant surprise, diversion, silence, have a back-up offer ready, flexibility.

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16
Q

Prior to Negotiations

A

Complete investigations
Complete estimate
Know circumstances
Be clear about objectives
Understand possible obstacles
Know maximum about insurer willing to pay
Have an idea of minimum amount claimant will accept

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17
Q

Settlement Options

A
Full release
Scheduled Release
Partial Release
Advanced Payment
No Release
Structured Settlement
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18
Q

Dispute Resolution

A
Arbitration
Mediation
Appraisal
Declaratory Judgement Action
Litigation
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19
Q

Recorded Statements must include

A
Introduction Statement (including convo recorded)
State names and locations of everyone
Age and address of interviewee
Body
Where, when, how loss occurred
Description of injuries
Where started where headed
What happened after
Explain interruptions
Stay objective
Avoid excessive empathy
Don't discuss insurance or settlements

Conclusion
Interviewee must verify he understood all questions. Interviewee states again convo is recorded.

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20
Q

Written statements should include

A

Introduction
Identify interviewer and interviewee
Date, time, and place of interview

Body
Where, when, and how loss occurred
Description of injuries

Conclusion
Interviewee verifies in own handwriting
Signature below on right side
Witness signs left

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21
Q

Claims Investigation

A
Liability Claims
Critical Evidence
Official Reports
Other Evidence
Written Statements
Recorded Statements
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22
Q

Investigation: Property Claims

A
Inspect damages
Take photos
Interview claimant and witnesses
Review police report
Consult w/ professionals
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23
Q

Determine Insurer’s Liability

A

Was policy active at time of loss?
Does claimant have insurable interest?
Does policy cover type of damage or injury being claimed?
Is there a history of similar claims?
Will any other policies cover loss?
Has insured met all requirements of the contract?

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24
Q

Claims Process Steps

A
Acknowledge claim
Establish commmunication
Prepare necessary paperwork
Determine insurer's liability
Investigate the losses
Determine time and cost of repairs
Apply all policy coverages and provisions
Negotiate Settlement
Prepare final report.
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25
Q

General Damages

A

Compensatory damages are determined by the court and awarded for intangible, emotional losses that are not quantifiable.

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26
Q

Special Damages

A

Compensatory damages awarded for tangible losses with a quantifiable value.

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27
Q

Diminution of Value

A

Total amount of all damages resulting from an occurence.

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28
Q

Compensatory Damages

A

Money awarded for tangible and intangible economic loss.

2 types:
Special and General

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29
Q

Categories of Harm

A

Physical
Financial
Physical and Financial
Emotional and/or Reputational

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30
Q

Types of Liability Policy Limits

A

Single
Split
Aggregate

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31
Q

Dangerous Instrumentality Doctrine

A

Holds a party strictly liable for damages caused during inherently dangerous activity.

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32
Q

Strict Liability

A

Holds a party 100% liable for damages when the activity or instrument they are performing is inherently dangerous.

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33
Q

Res Ipsa Loquitor

A

Circumstances of the injury make it obvious that the defendant is negligent, no proof is needed.

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34
Q

Defense to Claim of Negligence

A

Assumption of Risks
Contributory Negligence
Comparative Negligence

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35
Q

Vicarious Liability

A

The transfer of negligence from one party to another

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36
Q

Liable

A

Obligated according to law, responsible

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37
Q

Coinsurance Penalty

A

Actual Insurance / Coinsurance Requirement = Penalty

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38
Q

Coinsurance

A

Encourages the insured to purchase an adequate amount of coverage, typically at least 80% of a property’s value.

Requires 80% of property’s value

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39
Q

Types of Deductibles

A

Fixed
Percentage
Franchise

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40
Q

Constructive Total Loss

A

When the cost of repairing damaged property is higher than the property’s current value.

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41
Q

Actual Total Loss

A

When property is completely destroyed and unrepairable

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42
Q

Total Loss

A

When insured property is damaged so badly that it is not worth repairing.

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43
Q

Partial Loss

A

When insured property is only partly damaged, and repair cost fall within the policy limit.

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44
Q

Valued Policy

A

Agreed Value or Guaranteed Value

Valuation method that assigns a set value to each insured item.

Value determined prior to insurance policy.

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45
Q

Obsolescence

A

When something is no longer used or wanted, despite being in good working order.

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46
Q

Characteristics of Replacement Cost

A

No depreciation

Based on replacement cost at the time of loss

Higher premiums

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47
Q

Broad Evidence Rule

A

Takes into consideration any evidence available to determine value

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48
Q

Accumulated Depreciation

A

Annual Depreciation x Age =

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49
Q

Annual Depreciation

A

Replacement Cost / Item’s Useful LIfe

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49
Q

Actual Cash Value

A

Valuation method that takes into account and item’s depreciation

Replacement Cost - Depreciation =

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50
Q

Methods of Valuation

A

Actual Cash Value
Replacement Cost
Stated Amount
Agreed Value

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51
Q

Subrogation

A

The transfer of rights that allows the insurer to recover its losses after it has indemnified a policyholder.

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52
Q

Insurance Adjuster

A

Represents insurer responsible for evaluating the circumstance of a claim.

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53
Q

Claims Process

A
Filing a claim
Acknowledgement
Investigation
Evaluation
Adjustment
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54
Q

Claim

A

A demand for payment in accordance with the terms of an insurance policy.

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55
Q

Indirect Loss

A

An economic loss that results from a direct loss.

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56
Q

Direct Loss

A

Physical harm to tangible property.

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57
Q

Damages are covered:

Proximate Clause

A

If caused by a covered peril.

If their proximate cause was a covered peril.

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58
Q

Original Occurrence

A

Causes damage that then leads to more damage.

The proximate cause of all resulting losses.

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59
Q

Proximate Cause

A

When there is an unbroken chain of events between an occurrence and a loss, then the occurrence is the proximate cause of the loss.

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60
Q

Legal Hazard

A

Increased chance of loss due to legal action.

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61
Q

Physical Hazard

A

Physical conditions that increases the chance of a loss.

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62
Q

Morale Hazard

A

Takes place when insured acts differently because of the comfort that insurance protection provides.

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63
Q

Moral Hazard

A

Results from policy holder’s deliberate decision.

Involves reckless behavior because of financial security offered by insurance.

“Behavioral Hazard”

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64
Q

Estoppel

A

Legal principle that prevents an insurer from denying coverage if the insured has reasonably come to believe that he has such coverage, based on insurer’s practices.

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65
Q

Concealment

A

Deliberately withholding relevant information.

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66
Q

Warranties

A

Promises or guarantees that certain conditions will be met.

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67
Q

Specific Limits

A

Limits that apply to one specific type of property.

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68
Q

Blanket Coverage

A

“Blankets” more than one property, type of property, or coverage under a single limit.

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69
Q

Binder

A

Temporary coverage for an insurance applicant until the policy is issued.

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70
Q

Risk Retention

A

Acknowledging the risks and preparing to handle unexpected losses that may occur.

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71
Q

Risk Management Techniques

A

Avoidance

Reduction

Transference

Retention

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72
Q

Coverage D

A

Loss of Use

For indirect losses that result from direct losses.

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73
Q

Coverages for Loss of Use

A

Additional Living Expenses (ALE)
Fair Rental Value (FRV)
Prohibited Use (a.k.a Civil Authority)

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74
Q

Additional Living Expenses

A

Pays increase in expenses needed for the insured to maintain normal standard of living after a covered loss.

Only covers costs that exceed the insured’s normal living expenses.

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75
Q

Fair Rental Value

A

Indemnifies insured for lost rent if a tenant has to move out due to covered damages.

Pays lost rental income until unit is habitable.

Only pays net loss: subtracts any expenses that do not continue while the tenant is gone.

Coverage does not include losses due to cancelled lease or agreement.

Only pays up until the unit is repaired, not until the insured finds a new tenant, if applicable.

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76
Q

Civil Authority Coverage

A

Pays for ALE and FRV when a civil authority prevents the insured from using the home.

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77
Q

Coverage D - Limits

A

Measured in time rather than dollars.

ALE paid until premises is repaired or replaced, or until the insured’s household can settle elsewhere.

FRV is paid for the shortest amount of time needed to restore the rented area to rentable condition.

Civil Authority pays until access to the home is restored up to a maximum of two weeks.

Allow ALE and FRV to extend beyond the policy expiration date if needed.

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78
Q

Loss of Use Deductibles

A

ALE and FRV subject to the policy deductible.

Civil Authority NOT subject to any deductible.

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79
Q

Debris Removal

A

Additional 5% of policy/coverage limit.

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80
Q

Reasonable Repairs

A

Coverage reimburses homeowner for expenses to protect property from further damage.

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81
Q

Loss Assessment

A

For condo owners under HO-6

Pays when condo association charges an assessment after a loss.

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82
Q

Ordinance or Law

A

Pays up to 10% of the Coverage A limit as additional insurance.

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83
Q

Building Additions and Alterations

A

For HO-4 and HO-6 only.

Covers structural alterations made at renter’s or unit owner’s own expense.

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84
Q

Exclusions to HO Property Coverage:

A

Ordinance or law, earth movement, water damage, off-premises power failure, neglect, war, nuclear hazard, intentional acts, mechanical breakdown.

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85
Q

Deductible

A

If there are two or more deductibles under a policy, the highest deductible amount applies.

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86
Q

Suit Against Us

A

Insured cannot take action against an insurer unless the insured has fully complied with all terms of the policy and starts the action within two years of the date of loss.

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87
Q

Our Option

A

Insurer can repair or replace any part of a damaged property with material or property of like kind and quantity, as long as they give written notice within 30 days of receiving proof of loss.

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88
Q

Loss Payment

A

Clarifies how, when, and to whom a claim will be paid.

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89
Q

No Benefit to Bailee

A

Policy will not pay a third party who has custody or control of the insured’s property, even if it is with the insured’s granted permission.

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90
Q

Recovered Property

A

After the claimant has been indemnified, if either party recovers any property involved in the claim, they must tell the other party about it.

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91
Q

Volcanic Eruption Period

A

One or more volcanic eruptions that occur within a 72-hour period are considered one volcanic eruption.

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92
Q

Section 1 Conditions

A

Interest, deductible, duties, concealment, loss settlement, pair or set, appraisal, other insurance, suit against us, our option, loss payment, abandonment, mortgage, no benefit to bailee, nuclear hazard, recovered property, volcano, policy period.

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93
Q

Section II Conditions

A

Limit of Liability, Severability, Duties After “Occurrence,” Duties of an Injured Person, Claim Payment, Suit Against Us, other insurance, policy period, concealment or fraud

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94
Q

Section I and II Conditions

A

Subrogation, cancellation, nonrenewal, liberalization, waiver or change, assignment, death

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95
Q

Insurance to Value Requirement

A

If home is insured at 80% of value or more:
Replacement Cost

If home is insured at less than 80%: policy pays the higher of:
ACV
or
Replacement Cost minus the insurance to value requirement.
(Insurance Limit / 80% of property value) x Covered Damage

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96
Q

Coverage A

A

Dwelling, attached structures, material located near it

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97
Q

Coverage B

A

Other detached structures

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98
Q

Coverage C

A

Personal Property (Contents)

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99
Q

Coverage D

A

Loss of Use

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100
Q

Liability Coverage can pay for:

A
Medical Bills
Lost Wages
Pain and Suffering
Inconvenience 
Property Damage
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101
Q

Coverage E - Personal Liability

A

Pays for bodily injury and property damage to third party if insured is found negligent.

Applies even if the insured’s property causes a third party damages.

Never pays the insured.

$100.000 minimum coverage

Pays for insured’s legal defense fees

Insurer pays fees all the way to the end of a lawsuit, even if limit is exceeded.

Insurer has the right to settle damages with the claimant however it wants.

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102
Q

Coverage F - Medical Payments

A

No fault coverage.

For medical expenses incurred by third party due to an accident on insured’s premises.

Only necessary, reasonable medical charges.

$1,000 minimum limit

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103
Q

Section II - Additional Coverages

A

Property of Others

First Aid

Claims Expenses

Loss Assessment

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104
Q

Coverage E Exclusions:

A

Bodily injury and property damage to the insured

Bodily injury to persons covered by Workers Compensation Insurance

Damage to property rented by insured, occupied or used by insured, or held in insured’s custody and care

Liability for contracts

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105
Q

Coverage F Exclusions:

A

The insured person

Anyone who lives on residence premises regularly

Anyone eligible for Workers Comp or Disability for the occurrence.

Harm to a resident employee who is not in the course of employment, or is not at premises at time of occurrence.

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106
Q

Coverages E and F Exclusions:

A

Intentional or malicious harm to third party by insured

Harm from war

Disease transmitted from insured to third party

Sexual molestation or abuse by insured

Drug, use, sale, manufacture, possession

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107
Q

Exclusion relating to vehicle use:

A

Harm or damage caused by insured’s automobile use
Exceptions: vehicles for property maintenance, handicapped persons, or those in storage. Recreational vehicles are covered under certain conditions.

Aircraft

Watercraft

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108
Q

Excluded from HO Liability Coverage:

A

Third party losses due to insured’s business

Third party losses from insured’s failure to render business services

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109
Q

Liberalization

A

Applies to changes made up to 60 days before the policy inception

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110
Q

Payment of Claim - Coverage F - Medical Payments to Others

A

Coverage F is voluntary coverage: if a claim is paid, it is not admission of insurer’s liability.

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111
Q

Lawsuit Against Insurer:

A

All Section II terms must be met

No one can join insurer in suit against insured

No suit pertaining to Coverage E can be brought until obligation of insured is agreed to

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112
Q

Homeowners Endorsements (typically):

A
Sinkhole Collapse
Sewer Backup
Earthquake
Hurricane (coverage can be removed)
Ordinance or Law
Personal Property Replacement Cost
Inflation Guard
Scheduled Personal Property
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113
Q

Changing Limits and Valuation

A

For increased premium, endorsements can add:

Replacement Cost valuation rather than ACV

Inflation Guard to automatically increase limits

Scheduled Personal Property, such as jewelry, furs, collectibles

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114
Q

Georgia Notice of Cancellation or Non-renewal

A

During the first 60 days of policy: at least 10 days prior to cancellation.

After 60days: at least 30 days prior to cancellation

For non-payment of premiums: at least 10 days prior to cancellation

Notice of Non-renewal: at least 30 days before policy expires

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115
Q

(Georgia) When cancelling or non-renewing:

A

Insurer must:

Deliver notice in person or by first class mail

Refund any unearned premiums

Provide information about the Georgia FAIR Plan

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116
Q

Georgia Cancellation / Non-renewal

A

Must be for specific, approved reasons:

Non-payment of premiums
Fraud or misrepresentation
Violation of the terms or conditions of the policy
A significant change in the level of risk which increases the likelihood of a loss

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117
Q

Georgia Personal Liability

A

Covers the insured for any liability to someone else on or off the premises

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118
Q

Georgia Premises Liability

A

Only covers the insured for liability to someone else on the property’s premises

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119
Q

Georgia Mobile Home Coverage

A

Can be covered by endorsement or stand-alone policy

Must be used primarily as a residence

Endorsement covers: mobile home and any additions, items permanently installed or attached to the home

Mobile home policy (MHP): HO-7

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120
Q

Georgia Watercraft Policy

A

in addition to HO policy:

Covers physical damage and liability exposure

Eligible property: owned watercraft, trailers, outboard motors, watercraft accessories

Covered craft must stay within the US, its territories, Puerto Rico, or Canada, and within 12 miles of the coast.

Personal use only

Excludes: air-propelled crafts, modified crafts, experimental crafts, hovercraft, submarines

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121
Q

Georgia Watercraft Policy Structure

A

Part A - Liability
Part B - Medical Payments
Part C - Uninsured Boaters
Part D - Coverage for damage to your watercraft

Additional coverages under Part D:
Salvage expense, towing and assistance expense, personal effects

Part E - Insured’s duties after an accident or loss
Part F - General provisions

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122
Q

Georgia Watercraft Policy Conditions

A

Lay-up Period : No coverage if the watercraft is used during the lay-up period specified in policy; unless: the insurer consents in writing, the insured uses it in an emergency and reports the situation within 10 days.
Reduces premium

Total Loss Settlement
In case of total loss, the insurer considers the property’s physical condition and depreciation to determine ACV
Insured pays the difference if the replacement property has a higher value than the original property.

When more than one policy can cover the insured’s liability, the watercraft policy:
pays amount equal to its share of the total amount of insurance available
pays on an excess if: the insured is operating a non-owned watercraft ,the watercraft is being transported on land

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123
Q

Dwelling POlicy

A

For persons not eligible for homeowners insurance

Corporation not eligible for homeowners insurance

Persons or corporations who do not need HO options

Property only, not liability (unless an endorsement is added)

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124
Q

Dwelling Policy Property Types

A

Single-family homes

1-4 unit dwellings (duplexes, four-plexes, etc.)

No more than 5 occupants

Mobile homes, if permanently installed

Incidental business risks, if insurer allows

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125
Q

DP-1 “Basic Form”

A

Named-peril coverage

Covers only fire, lightning, internal explosions

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126
Q

DP-2 “Broad Form”

A

Same perils as the Basic Form, plus many more

+Extended Form Perils
+Broad Form Perils

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127
Q

DP-3 “Special Form”

A

If a peril is not excluded, it is covered

Named-peril coverage to personal property.
Includes all the perils that the DP-2 “Broad Form” covers

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128
Q

DP-3 Exclusions

A

General exclusions
Settling, cracking, shrinking, bulging of patios, foundations, etc.
Damage from birds, insects, vermin, domestic animals
Wind or hail damage to antennas, lawns, trees
Ice or snow damage to awning, fences, outdoor structures, foundations
theft of anything not part of structure
Pollutant damage
Gradual or expected loss from wear and tear, marring, or deterioration
Mechanical breakdown
Inherent vice: a characteristic of an item that causes it to damage or destroy itself
smoke form agricultural or industrial operations

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129
Q

Dwelling Policy Sections

A
Coverage A
B
C
D
E
Additional Coverages
Exclusions
Conditions
Endorsements (If any)
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130
Q

Coverage A - Dwelling

A

Principal dwelling
Attached structures: garages, apartments, etc.
Service machinery: furnace, A/C compressor, etc.

Not included: construction tools, damage to land itself

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131
Q

Coverage B - Other Structures (Dwelling policy)

A

Limit: 10% of Coverage A limit (per claim)

Under DP-1, the 10% is included as part of Coverage A limit

In DP-2 and DP-3, the 10% is added to the Coverage A limit

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132
Q

Coverage D - Fair Rental Value - Dwelling

A

Pays rental income lost due to damage

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133
Q

Coverage E - Additional Living Expenses - Dwelling

A

For the increase in the insured’s living expenses when a covered peril makes the dwelling uninhabitable.

Automatically included in DP-2 and DP-3

Not included in DP-1

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134
Q

Personal Auto Policy (PAP)

A

A policy that combines liability insurance with other optional coverages.

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135
Q

PAP - What is covered?

A

Will indemnify for:
Property damage
bodily injury
legal defense

Will not pay punitive damages

Insurer must defend policyholder against liability claims, in or out of court

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136
Q

PAP Sections

A
Declarations
Part A - Liability
Part B - Medical Payments
Part C - Uninsured Motorist
Part D - Coverage for Damage to Auto
Part E - Duties after an Accident or Loss
Part F - General Provisions
Endorsements
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137
Q

Auto Insurance Deductible

A

Fixed on per claim basis

Typically only applies to collision and comprehensive coverages

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138
Q

Bodily Injury (Auto Insurance)

A

Does not include mental distress or psychological trauma

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139
Q

Covered Auto

A

Car specified on declarations page

Newly acquired auto

Trailer the insured owns

A temporary substitute for car or trailer listed on dec page due to:
breakdown, repair, servicing, loss, destruction

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140
Q

Newly Acquired Auto

A

my not be covered under another insurance

may not be sued for the transport of goods and materials

automatically get the broadest coverage provided to any one car listed in policy

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141
Q

Adding Newly Acquired Autos

A

Reporting (according to the standard PAP)
insured has 14 days to report newly acquired auto

Most states and insurers actually require that your report any new auto within 10 - 30 days.

Comprehensive and Collision coverage:
Can be added within 4 days of getting new car
Automatically applies for first 4 days with $500 deductible

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142
Q

Auto Insurance Medical Payments

A

Pays for covered medical expenses for up to three years from the date of an accident.

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143
Q

Part A - Auto Liability

A

Establishes

Pay liability costs, up to policy limits

Covers injury or damage caused by covered auto or any car the insured drives with permission

Settle or defend liability lawsuits

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144
Q

Part A - Auto Liability Limits

A

One Person’s Injury/Max for all Injuries/Property Damage

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145
Q

Primary and Secondary Coverage

A

Coverage is “primary” if it involves a car the insured owns

“Secondary” if it involves a car the insured does not own.

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146
Q

Part A - Auto Supplementary Payments

A

Assist policyholder with a variety of accident-related expenses.

Not subject to liability limits

May include:
Lost wages - up to 250/day
Expenses due to requests for documents
Bail bonds - up to 250
Accrued interest after a judgement
Premiums on appeal bonds and attachment bonds
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147
Q

Part A - Auto Exclusions

A

Does not include:
intentional damage or injuries
property owned or being transported by the insured
damages incurred under the scope of employment; except domestic employees ineligible for worker’s comp.
properties rented to or used by insured
hired vehicles
company-owned business vehicles
damages or injuries caused while repairing, servicing, parking, or storing vehicles
vehicles taken without permission
damages or injuries arising from or related to a flying car

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148
Q

Auto No-Fault Insurance

A

Designed to indemnify the insured for his own injuries, regardless of fault.

Covers bodily injury only

Mandatory in some states

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149
Q

Part B - Medial Payments Exclusions

A

Accidents where an insured is occupying a vehicle with fewer than four wheels

Autos rented or leased for hire

Autos used without permission
Commercial vehicles covered by a Business Auto Policy

Vehicles located for use as a residence

Injuries sustained under scope of employment (if covered by worker’s comp)

Begin only after Personal Injury Protection (PIP) coverage is fully exhausted.

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150
Q

Part C - Uninsured/Underinsured Motorist Coverage

A

Covers bodily injuries caused by people with insufficient or no insurance

Coverage for physical damage can be added by endorsement

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151
Q

Uninsured Motorist (UM)

A

Driver w/no liability insurance
Driver whose insurer won’t pay
Hit-and-run driver

Driver who does not have enough insurance to pay for all damages

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152
Q

Exclusions to UM/UIM Coverage

A

Insured’s own auto that is not listed in the policy
Government vehicles
Off-road vehicles (but only while not on public roads)
Vehicles used as a premises
Covered autos that are rented or used for hire
Cars used without reasonable belief that permission was granted

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153
Q

Part D - Collision Coverage

A

Pays for damage to insured’s vehicle caused by collision or rollover

Applies even when insured is at-fault

Included “your covered auto” and any “non-owned” car the insured is driving.
(unless the insured borrows it frequently: then it is not covered)

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154
Q

Auto Comprehensive Coverag

A

Theft
hail, water, or flood
Windstorm, fire, vandalism, explosion, earthquake, riot/civil unrest, missiles or falling objects, contact with birds or animals

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155
Q

Part D - Auto Exclusions

A

Normal wear and tear
Freezing
Mechanical or electrical breakdown
Tire damage
Government or civil confiscation
Losses to non-owned autos taken without permission
Losses involving any racing or speed event or facility
Stereo equipment and electronics (unless permanently installed, then subject to limits)

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156
Q

Personal Injury Protection (PIP)

A

Covers injuries to the insured et al caused by an accident , no matter who was at fault.

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157
Q

Farm Insurance

A

Combines both homeowners coverage for personal property and commercial coverage for business assets.

Rancher needs all and additional protection for livestock.

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158
Q

Farm Insurance Policy

A

Property insurance for dwelling and contents

Scheduled and unscheduled farm personal property insurance

Mobile agricultural machinery and livestock coverage

Farm liability insurance

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159
Q

Eligibility for Farm Insurance

A

Farmers must live and conduct business on the insured property

Properties not eligible:
Farms that manufacture or process goods
Farms raising race or show animals
Some vacant farm properties

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160
Q

Farm Property Coverage Forms

A

Cover direct losses to physical property on the insured’s farm.

List the types of property covered

Use attached Causes of Loss Forms to list covered perils

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161
Q

Coverage A - Dwelling Farm

A

For main dwelling, attached structures, and necessary materials

Not covered: trees, shrubs, plants, or lawns (except with endorsement)

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162
Q

Coverage B - Other Private Detached Structures Farm

A

Covers private structures not attached to main dwelling

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163
Q

Coverage C - Household Personal Property Farm

A

Covers theft or damage of personal property

Includes personal property of family and guests staying on the premises

Has a limit of 50% of Coverage A

Sets special limits for some items.

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164
Q

Cover G - Commercial Coverage Farm

A

Barns, outbuildings, and other farm structures covers:
Barns, silos, and granaries
Pens and Fencing (except for fields and pastures)
Corrals and livestock chutes
Feeding structures
Outdoor masts, towers, and antennae
Farming storage structures
Construction or repair materials kept on or adjacent to these structures

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165
Q

Inland Marine Forms

A

Two commonly added to farm policies:

Mobile agricultural machinery and equipment form
Livestock Floater

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166
Q

Mobile Agricultural Machinery and Equipment Form

A

Covers agricultural machines and their tools and equipment
Allows higher limits of insurance than other forms
Scheduled or unscheduled coverage
Requires coinsurance for full coverage to apply

Not covered:
Equipment for sale or on consignment
Machinery used in logging or forestry

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167
Q

Livestock Floater

A

Covers horses, mules, cattle, swine, sheep, and goats.

Scheduled or unscheduled

Includes animal injured or killed while in transit

Provides named-peril coverage.

Requires coinsurance

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168
Q

Farm Property - Causes of Loss Basic Form

A

Fire, theft, lightning, aircraft, smoke, vehicles, wind, sinkhole collapse, hail, volcanic activity, explosions, loss of livestock by flood, riot, vandalism, loss of livestock by earthquake, civil commotion

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169
Q

Farm Property - Causes of Loss Broad Form

A
Basic form plus: 
Falling objects
weight of ice, sleet, or snow
glass breakage
sudden and accidental tearing apart
accidental discharge or leakage of water or steam
sudden and accidental discharges of electricity
collapse
electrocution of covered livestock
attack of covered livestock (excluding sheep) by wild animal
drowning of covered livestock
loading and unloading accidents
accidental shooting of covered livestock
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170
Q

Farm Property - Causes of Loss Special Form

A

Exclusions:
Normal wear and tear, or purposeful neglect
rust, corrosion or decay
settling, cracking or shrinking of structures
infestation by rodents, vermin, or birds
mechanical breakdown
disappearance of farm property, unless stolen
voluntary, fraudulent parting of farm property
unauthorized instructions to transport property
vandalism or glass breakage, if vacant 30 days
dishonest or criminal acts by the insured

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171
Q

Farm Liability Insurance

A

protects the farmer against liability for harm caused to others

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172
Q

Coverage H - Farm LIability

A

Bodily injury and property damage liability

Covers damage or injury caused by normal business operations

Applies to damages that occur on insured premises

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173
Q

Coverage I - Farm Liability

A

Personal and advertising injury:

Pays for claims not involving property damage or personal injury

Includes malicious prosecution, wrongful entry or eviction, and libel or slander

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174
Q

Coverage J - Farm Liabilty

A

Medical payments coverage

Covers medical injuries suffered on farm property or because of farmer’s activities.

Includes medical, dental, hospital, and funeral costs

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175
Q

Farm product Liability

A

Covers injury or illness caused by eating the farmer’s products

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176
Q

Farm Pollution Liability

A

Covers pollution damage caused by farm property and operations.

Includes animal waste overflow, chemical spill

Does NOT include chemical over-spray from aircraft (separate endorsement required)

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177
Q

Custom Farming Liability

A

Covers farmers doing contract work.

Will not apply if a farmer makes more than 5,000 a year as a contractor.

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178
Q

Farm Employees Liability

A

Available via endorsement

Covers employee injuries not allowed under Workers’ Comp

179
Q

Agritainment

A

Refers to farm-based entertainment

Excluded from farm form

Endorsements can add this coverage back in:
Agritainment - Property: adds coverage for damage to the farmer’s property caused by agritainment

Agritainment - Liability: covers the farmer’s liability for injuries that occur during agritainment activities on his farm.

180
Q

Agricultural producer

A

A business that grows and sells crops for a profit

181
Q

Crop Insurance

A

Insurance that covers losses to a crop’s profitability

Two Types:
Crop-yield insures against losses to actual crops
Crop-revenue insures against losses to crop value when prices change or the crop is damaged

182
Q

Crop-Yield Insurance

A

Covers physical losses to the insured crop

2 common forms:
Crop-Hail Insurance
Multi-Peril Crop Insurance (MPCI)

183
Q

Crop-Hail Insurance

A

Covers more perils than just hail.

Typically available through private insurers.

Not reinsured or government subsidized

Rated on an acreage basis

Coverage can be a percentage of expected crop value

Policies sometimes have a minimum amount of losses required before they will pay anything.

184
Q

Crop-Hail Insurance

Perils Covered

A
Hail
Fire
Lightning
Wind (by endorsement)
Transit to storage after harvest
Wildfire
185
Q

Crop-Hail Insurance Exclusions:

A

Failure to harvest a mature crop
“Unit normal visible stand” (crop must be up to be covered)
Before effective hour (damage prior to start of policy)
Crops that can be recovered by harvesting
Crop not owned by the insured (shared drops)
Damage to trees, bushes, fruit, or nut crops
Damage to leaves or plants, unless affecting the actual crop

186
Q

Multi-Peril Crop Insurance (MPCI)

A

Covered Perils: wind, drought, excessive moisture, frost, flood, lightning, tornado, hurricane, hail (by endorsement), volcano, earthquake, disease, insects and wildlife, insect infestation (if unavoidable), irrigation failure (if unavoidable), low/poor quality yields, prevented planting, late planting/replanting.

Government subsidizes it with the Federal Crop Insurance Corporation and regulates it through the U.S. Department of Agriculture

187
Q

MPCI Rules for Policy Changes

A

Policy changes and increases only allowed before sales closing date

Requires planting to be done by set planting dates

No changes during growing season: must remain in effect for an entire crop year

After the first crop year, a farmer may change or cancel policy, but only before the cancellation date

188
Q

MPCI Exclusions

A

Neglect or malfeasance
Failure to reseed
Failure to follow good farming practices

189
Q

Federal Jurisdiction of Crop Insurance

A

All crop insurance is supervised by the National Crop Insurance Services

190
Q

Risk Management Agency (RMA)

A

Promotes sound risk management practices

Subsidizes the premiums of crop growers for federal crop insurance policies

Sets critical production dates

Assigns commodity market prices to protect the producer’s revenue

191
Q

Crop Policy Changes and Pilots

A

Pilot program lets the RMA test policies in small areas before releasing o the rest of the country

New policies are typically pilots for several years

192
Q

MPCI: APH Policy

A

Actual Production History (APH): history of a farm’s crop yield over several years (requires at least 4 years of records)

Protects against low yield.
Guarantees the crop will produce a set percentage of its APH
Crops typically insured at 50% to 85% of the APH

Yield Guarantee:
Minimum amount of yield that the policy guarantees for the insured crop
Coverage kicks in if the crop produces less than this amount.

Yield Guarantee Formula:
APH Yield per Acre x Percentage of Coverage =

Percentage of Projected Price: Insured chooses a percentage of the expected price of insured crop
Expected price is determined by the RMA
How much the insurer pays regardless of how much the crop is actually worth at harvest time

How to calculate indemnity: 
(Yield Guarantee - Actual Production)
x
Percentage of crop price
x
Crop price (set by RMA)
x
Insured's share in the crop
=Total Indemnity
193
Q

Crop Revenue Insurance

A

Insurance that protects against loss of crop value

Includes losses from:
Decline in prices during the growing season
Low crop yields
A combination of both

194
Q

Crop Revenue Insurance Guarantee

A

Sample Formula:
(corn yield guarantee) x (expected sell price at harvest-time)

Policy establishes a guaranteed dollar amount

Farmer gets indemnity if crop-yield and selling price combined are less than guarantee

195
Q

MPCI Policies

A

APH Policy - Crop yield policy

Actual Revenue History - Pilot Policy, guarantees a percentage of average revenue not yield
covers lost revenue due to low yield, falling prices, bad quality, or any combination of these

Yield Protection

Revenue Protection: covers revenue losses due to low yield, low prices, or a combination of both.
Uses two prices: projected price to set coverage; harvest price to determine if indemnity is due
Calculated Revenue = actual production x harvest market price

Revenue Protection with Harvest Price Exclusion - Same as RP, but revenue guarantee does not go up if the harvest price goes up

Whole Farm Revenue Protection (WFRP) - Insures entire farm revenue, not individual crops.
Uses info from Schedule F tax forms and yearly reports to establish approved farm revenue
Farmer sets coverage at a percentage of this number (50% - 85%)
Policy pays indemnity if farm’s actual revenue falls below the insured revenue

Area Risk Protection Insurance (ARPI) - Area-based coverage. Triggered if entire county experience a loss.
Three option: area revenue protection, area revenue protection with harvest price exclusion, area yield protection

Dollar Plan - Covers loss in value caused by damaged crops. RMA sets maximum dollar amount of insurance per acre. Insured chooses a percentage.
Policy pays an indemnity if actual value per acre is lower than dollar amount of insurance

Margin Protection (MP) - Pilot policy that insures farmer’s operating margin.
Expected Margin = Expected Revenue - Expected Costs
Area based plan
Coverage set according to how much margin the country as a whole expects
Policy pays indemnity if the county’s margin is lower than expected.

Livestock Policies - Available for swine, cattle, lambs, and milk.
Protect against declining market prices
Uses prices from the Chicago Mercantile Exchange Group
Two Types: Livestock Risk Protection and Livestock Gross Margin

Rainfall Index (R) Policies - pay an indemnity if the area gets less rainfall than usual.

Vegetation Index (VI) Policies - pay an indemnity if there is less vegetation growth in the area than usual.

Pasture, Rangeland, Forage (PRF) - Currently pilot policy.
Covers acres used as pasture, rangeland, or forage.
Based on the area’s average precipitation
Triggered when there is less rainfall than usual.
Helps offset costs of buying feed and other risk management measures.

Small and Corse Grains Provisions - Cover both crop yield and reduction in crop value Grains must be grown on “insurable acreage”
Small grains: wheat, barley, oats, flax, rye, buckwheat
Coarse grains: corn, grain, sorghum, soybeans

Catastrophic Risk Protection Endorsement (CAT Coverage) - covers losses exceeding 50%
Pays 55% of the price of the crop (according to RMA)
Premiums paid by government
Administrative fee paid by farmer for insured crops

High-Risk Alternate Endorsement (HR-ACE) - For farmers with some crops on high-risk land and some crops on non-high-risk land
Adds coverage for high-risk land that is lower than coverage for the rest of his crops.

Supplemental Coverage Option (SCO) - Area-based coverage that can help pay deductibles on underlying policy.
Follows coverage of underlying policy, except in what triggers coverage:
triggered by county-wide losses; premiums are 65% subsidized

196
Q

Small/Course Grains - Covered Perils

A
Hail
Drought
Excessive Moisture
Fire
Wildlife
Failure of irrigation (if unavoidable)
Insect damage and plant diseases (assuming good farming practices)
197
Q

Small/Course Grains - Insurance Period

A

The period between when the crop is planted to when it’s harvested.

Other events that can set end of insurance period: 
end of crop's season
complete destruction of crop
final adjustment of a claim
abandonment of the crop
198
Q

Crop Policy Provisions - Duties of Insured

A

File a claim within 72 hours
Protect crops from further damage
Leave samples of the damaged crop intact in each field, so adjuster can inspect item

Acreage Reporting:
every crop year, farmer must submit acreage report, due by the acreage reporting date.

Insured must:
plant correctly
maintain the crop correctly
Use required fertilizers, pesticides, soil additives, etc. (does not apply to organic farming)

199
Q

Crop Policy Provisions - Site Assessment

A

During claims site assessment, the adjuster records:
location: latitude and longitude
plant samples
soil samples
normal yields for the region
comparison with similar crops in the same area

200
Q

Crop Policy Provisions - Loss Payments

A

Usually made at actual cash value

Can be made in multiple payments

201
Q

Crop Policy Provisions - Cancellation/Nonrenewal

A

Insurance applications must be signed before the closing date specified by the NCIS.

Policies may not be canceled during the first crop year.

Insurance coverage:
continuous
cancellation only allowed in writing and before the cancellation date specified in the policy

202
Q

Crop Policy - Important Dates

A
Sales closing
Production Reporting
Final Planting
Acreage Reporting
Notice of Crop Damage
Payment Due
Cancellation
Debt Termination
End of Insurance
203
Q

Crop Insurance

A

Usually does not have deductibles

Crop insurance uses thresholds instead of deductibles
threshold is a percentage of insured crops
Losses above threshold have full policy coverage.

204
Q

Crop Insurance Notes

A

Forms are “non-standard

Coverage usually limited to the growing season

Annual policy form is the most common.

Also available are three-season, five-season, and continuous-until-cancelled forms

205
Q

Commercial Property Insurance

A

Covers direct and indirect losses related to business property

Does not include farms and 1-4 family dwellings

Insures on a ACV basis

Replacement Cost is available as an endorsement

206
Q

Commercial Property Policy Sections

A
  1. Declarations Page
  2. Conditions
  3. Coverage Forms
  4. Causes of Loss Forms
207
Q

Commercial Policy Conditions

A
Cancellation/Non-Renewal
Changes to Policy
Concealment, Misrepresentation, and Fraud
Control of Property
(breach in policy conditions only affects the property where the actual breach occurred)
Other Insurance
(usually the two policies will split the loss based on how much coverage each policy provides.)
Liberalization
Legal Action Against Insurer
Subrogation
No Benefit to Bailee
Vacancy
208
Q

Commercial Property Coverage Forms

A
Building and Personal Property Coverage
Business Income Coverage
Contingent Business Interruption Coverage
Builders Risk Coverage
Condominium Coverage
Leasehold Interest Coverage
Legal Liability Coverage
Difference in Conditions Coverage
Other Coverage Forms and Endorsements
209
Q

Building and Personal Property Forms - Commercial

A

The basis for all commercial property policies

Coverage A - Buildings and Structures
Coverage B - Business Personal Property
Coverage C - Personal Property of Others

210
Q

Commercial Coverage A

A

Covers building and structures listed on the “Dec Page” as well as:
additions, additions under construction, any construction equipment within 100ft of insured property, machinery and equipment inside the building, maintenance property.

211
Q

Commercial Coverage B

A

Covers property of the business that is not affixed to the structure, such as:

Business owned personal property used for business purposes

Labor, services, and material furnished on the personal property of others

Inventory or products held for sale

Leased business personal property

Property within 100ft of the business premises

212
Q

Commercial Coverage C

A

Applies to property owned by another party when it is in the care of the insured business.

Commonly $2,500 of coverage

Applies to locations listed on the “Dec Page”

213
Q

Common Additional Commercial Coverages:

A
Debris Removal
Pollution Clean-up and Removal
Preservation of Property
Fire Department Service Charge
Increased Construction Costs
Electronic Data
214
Q

Commercial Debris Removal

A

Limit: 25% of total claim for property damage

Additional $25,000 of coverage is available if:
property damage plus debris removal exceeds policy limit
Debris removal expense exceeds 25% limit

215
Q

Commercial Pollution Clean-Up and Removal

A

Pays up to $10,000 for pollution damages caused by a covered peril.

Insured must report the loss within 180 days

216
Q

Commercial Preservation of Property (Removal Coverage)

A

Applies when the insured removes property to protect it from a covered peril.

Property is covered for any cause of loss during removal and storage at another location.

Coverage lasts up to 30 days.

217
Q

Commercial Construction Costs

A

Applies when insured has to pay extra in order to conform to new building ordinances when repairing or replacing a covered loss

Limit is the small of two amounts:
$10,000
5% of Coverage A limit

Only applies to building insured on RC basis

218
Q

Commercial Electronic Data

A

Covers costs of replacing or restoring electronic data lost or damaged by a covered loss

Includes losses caused by viruses or malicious code, unless introduced by employees of the insured

Limit: $2,500 per year

Limit does not apply to data used to operate:
elevator, lighting, heating, ventilation, air conditioning, security system

219
Q

Commercial Coverage Extensions:

A

Only for insureds who maintain the coinsurance requirement of 80% of the property’s value

Not subject to policy limits

220
Q

Commercial Coverage Extensions

A

Newly Acquired Property
includes new buildings under construction on insured premises and newly acquired properties off premises
30 days of coverage
$250,000 coverage for building and structures

Property Off-Premises:
$10,000 for covered property that is temporarily located off the premises
Excludes property off-premises if it’s being sold

Personal Effects and Property of Others:
up to $2,500 in coverage for damage or destruction of personal belongings
loss must occur on the insured premises

Valuable Papers and Records:
up to $2,500 towards the recovery or replacement of valuable papers and computer records
does not cover money and securities

Outdoor Property:
covers damage to television and radio antennae, detached signs, and trees, plants or shrubs
limit: $1,000
limit for trees, plants, and shrubs: $250 per unit
covered perils: fire, lightning, explosion, riot, civil commotion, and damage by aircraft

Non-Owned Detached Trailers:
covers damage to non-owned trailers being used on the premises
limit: $500
only applies if trailer is not attached to a vehicle
only if insured is contractually responsible for damages to the non-owned trailers

221
Q

Commercial - Business and Personal Property Conditions

A
Abandonment
Appraisal
Duties in the Event of a Loss
Loss Payment
Recovered Property
Vacancy
Valuation
Coinsurance
Mortgagee Clause
222
Q

Commercial Property: Optional Coverages and Endorsement

A

Agreed Value Coverage
Inflation Guard
Replacement Cost
Value Reporting

223
Q

Commercial Optional Coverage - Agreed Value Coverage Option

A

Policyholder and insurer agree on a specific value for the property before the policy is written

Coinsurance requirement is waived

Often applies to rare property or high-value collector items

224
Q

Commercial Optional Coverages - Inflation Guard

A

Policyholder can increase the limit of insurance by a specified percentage periodically throughout the policy term

Keeps the amount of coverage consistent with rising prices

225
Q

Commercial Optional Coverages - Replacement Cost

A

Changes loss settlement terms from ACV to RC

Requires coinsurance minimum

Does not apply to property of others on the insured premises

When covered damages occur:
pays ACV up front
pays the remaining difference between ACV and RC once property has been repaired.

226
Q

Commercial Optional Coverages - Value Reporting

A

For businesses whose property values fluctuate or who buy and sell multiple properties throughout the year:

Insured purchases a limit of insurance to cover the highest property value expected that year

Every month, insured submits “value report” of the actual property value

If insured fails to submit a report, insurer uses the numbers from the previous month

There is a percentage penalty for under-reporting the value of a property

227
Q

Commercial Optional Coverages - Other Coverage Forms

A
Business Income 
Contingent Business Interruption
Builders Risk
Condominium
Leasehold Interest
Legal Liability
Difference in Conditions
228
Q

Commercial Business Income Coverage Form

A

“Business Interruption Form”

Provides protection for loss of income due to a covered loss

Period of Restoration:
time frame within which business income coverage indemnifies the policyholder for loss of income
begins exactly 72 hours after damage occurs
ends the date that either the damaged property is restored or that business resumes at a new location

What does it pay for?
Loss of net income on a Profit and Loss statement
Any continuing operating expense incurred during the period of restoration (rent, salaries, payments to the bank, utilities, taxes, administrative costs)

229
Q

Business Income Coverage Form

A

provides protection for loss of income due to a covered loss

Period of Restoration: time frame within which Business Income Coverage indemnifies the policyholder for loss of income.
begins exactly 72 hours after damage occurs

Pays for loss of net income on a profit and loss statement
any continuing operating expenses incurred during the period of restoration

230
Q

Business Income: Profit and Loss Statement

A

Determines loss of Net income

Relies on: total revenue, cost of goods sold, operating expenses

Equation: Total Revenue - Cost of Goods Sold = Gross Income
Gross Income - Operating Expenses: Net Income from Operations

231
Q

Business Income Coverage Exclusion

A

Excludes Cost of Goods Sold

Means any expenses that go into making or selling a product, including:
inventory, labor, material, supervision

232
Q

Business Income: Extra Expense Coverage

A

Covers the costs of getting a business running again after a covered loss.

Must be:
necessary
incurred during the period of restoration
type of expense that would not have been incurred had there been no loss to the covered property.

233
Q

Extra Expenses: Two Categories

A

“Ture Extra Expenses”: necessary to avoid or minimize the halt in business operations

“Expediting Expenses”: the cost of repairing or replacing property in order to get the business going again.

234
Q

Business Income: Extra Expense Coverage

A

Period of Restoration:
Begins immediately after damage occurs (no 72 hour waiting period before coverage begins)
Ends when damaged property is repaired or replaced

Period of Restoration never subject to the policy period.

235
Q

Business Income Coverage with Extra Expense

A

Loss of business income

Costs associated with getting the business running again

236
Q

Business Income Coverage without Extra Expenses

A

Loss of business income

“expenses to reduce loss” - but only to the extent that the extra expenses reduce the original loss

237
Q

Extra Expense Coverage without Business Income Coverage

A

For companies that must continue business regardless of loss of income, such as: banks, hospitals, newspapers, utilities

“Limit of Loss Payment”: limits the total amount of recovery available to the insured based on 30-day increments

238
Q

Business Income and Extra Expense: Additional Coverages (Order of Civil Authority)

A

Order of CIvil Authority
Provides coverage when a civil authority restricts a business from being occupied due to a pending covered loss.
Coverage lasts for up to 4 consecutive weeks
72-hour window before benefits apply

239
Q

Business Income: Coinsurance

A

Businesses have the option of establishing a level of coinsurance at 50, 60, 70, 80, 90, 100, or even 125% of the business’s normal income

240
Q

Business Income: Maximum Period of Indemnity

A

Takes away coinsurance requirement and the Period of Restoration lasts up to 120 days after the 72hr window. If the policy maxes out, coverage will end before 120 days.

241
Q

Business Income: Monthly LImit of Indemnity

A

Removes coinsurance requirement, but the policyholder parcels his stated limit of coverage. into a fractional maximum available each month (i.e. 1/3, 1/4, 1/6)

242
Q

Business Income: Agreed Value

A

Waives coinsurance requirement

Insured submits two reports:
Financial data from the previous year
Financial data for the upcoming year

Insured and insurer set an Agreed Value of coverage.

Losses are paid in full

243
Q

Contingent Business Interruption Form

A

Covers a business for loss of income caused by damages to a key supplier or key customer.

Indemnifies the dependent company, not the key supplier

Has nothing to do with the supplier’s insurance

244
Q

Builders Risk Coverage FOrm

A

Provides protection for buildings, materials, and equipment under construction or renovation

100% coinsurance is required on the building

245
Q

Builders Risk Extensions

A
Debris Removal
Fire Department Service Charges
Pollutant Cleanup and Removal
Preservation of Property
Scaffolding, Construction Forms, and Temporary Structures (Only while property is on the insured premises)
Property at other locations (10,000 limit)
Property in Transit (25,000 limit)
Sewage Backup (5,000)
246
Q

Condominium Coverage Form

A

Condo Buildings and complexes

Common areas of the condo building

Infrastructure essential to function of the condo as a whole (piping, ductwork, electrical and wiring units, etc)

Business personal property used y the condo as a whole

247
Q

Leasehold Interest Coverage Form

A

Favorable Lease
A lease that is acquired below market value

Leasehold Interest Coverage Form
Pays for the difference in cost between the old rental and the new

248
Q

Legal Liability Coverage Form

A

Property damage to personal property of others caused by negligence

Expenses for legal defense when claims are brought against the business

Theft of other’s personal property

249
Q

Differences in Conditions “All-Risks” Form

A

Bridge coverage gaps left by typical policies

Only covers perils that could lead to catastrophic losses

Excludes risks that are already covered under a different policy

Does not require coinsurance

Usually requires a very large deductible

Can be purchased as a separate policy or added as an endorsement to an existing policy.

250
Q

Commercial Property Endorsements

A

Earthquake and Volcanic Eruption
(Percentage deductible at limit of liability)
(Single Occurrence = Within a single 168hr or 1 week period)
(Excludes tidal waves and tsunamis)

Ordinance

Peek Season
(Temporarily increases coverage limits at specified intervals over the course of the year in order to account for increased inventories)

Protective Safeguard
(Insurer offers lower premiums if the insured agrees to use certain safety precautions)

Spoilage
(Adds perishable stock to covered property, so if it spoils, the insurer will purchase the stock based on the following formula:)
(indemnification = market selling price - any discounts the insured would expect)

251
Q

Causes of Loss Forms: Exclusions

A

Loss due to enforcement of building ordinances

Earthquakes or Land Movements

Seizure or destruction by government authority

Nuclear reaction, radiation

Loss resulting from utility service failure

War

Flood, rising water, mudslides, and the backup of water through sewage pipes

Damages to wiring or devices caused by artificially generated electrical currents

Explosion of boilers, steamers, pipes, and engines

252
Q

Commercial Basic Cause of Loss Form

A

Covers only named perils:

fire, lightning, explosions, windstorm or hail damage, smoke damage, aircraft or vehicles, riot and civil commotion, vandalism and malicious mischief, sprinkler leakage, volcanic events and shock waves, sinkhole collapse.

253
Q

Commercial Basic Cause of Loss Form

A

Covers only named perils:

fire, lightning, explosions, windstorm or hail damage, smoke damage, aircraft or vehicles, riot and civil commotion, vandalism and malicious mischief, sprinkler leakage, volcanic events and shock waves, sinkhole collapse.

254
Q

Commercial Broad Cause of Loss Form

A

Named peril policy, covers Basic Form perils, plus:

breakage of glass, falling objects, weight of ice snow and skeet, water damage from sources other than sprinkler,

additional coverage for collapse, if cause by: any covered perils, hidden decay, hidden insect or vermin damage, weight of people personal property or rain collecting on rooftop, use of defective materials or construction methods.

255
Q

Commercial Special Cause of Loss Form

A

Open peril policy that covers all known perils except for those listed in the exclusions sections, such as:

256
Q

Commercial Property Insurance

A

Provides coverage against direct and indirect losses resulting from damage to business property.

257
Q

Commercial Property Policy Sectins

A
  1. Declarations Page
  2. Conditions
  3. Coverage Forms
  4. Causes of Loss
258
Q

Commercial Property Coverage Forms Available:

A

Building and Personal Property Coverage Form
Business Income Coverage Form
Contingent Business Interruption Coverage Form
Builders Risk Coverage Form
Condominium Coverage Form
Leasehold Interest Coverage Form
Legal Liability Coverage Form
Differences in Conditions Coverage Form
Other Coverage Forms and Popular Endorsements

259
Q

Building and Personal Property Coverage Form (Commercial)

A

Coverage A - Buildings and Structures

Coverage B - Business Personal Property

Coverage C - Personal Property of Others

260
Q

Commercial General Liability (CGL) Insurance

A

Protects a business from a wide variety of financial hazards associated with normal business operations

261
Q

CGL Covers

A

Bodily injury/property damage

Damage to a premises

Products and completed operations

Acts of others

Contracted responsibilities

Personal and advertising injury

262
Q

2 Different Forms of CGL

A

Occurrence

Claims-made

263
Q

Occurrence Form (CGL)

A

Coverage triggered by occurrence or accident

264
Q

Claims-Made (CGL)

A

Coverage triggered by claim

265
Q

Occurrence Form (CGL)

A

Triggered by when the actual injury or damage occurred.

Covers events that happened during policy period, no matter when the claim is made.

266
Q

Claims-Made Form (CGL)

A

Triggered when the claim is filed.

Covers any claim filed during the policy period, no matter when the damage or injury occurred.

Insurers can price premiums to reflect current risks of lawsuit awards.

Insurers will specify a retroactive date which says how far back an occurrence will be covered.

Claims-Made and Reported: insured must report claim or possibility of a claim within the policy period.

Pure Claims-Made: Insured must inform insurer of a claim as quickly as possible (not necessarily within the policy period.)

267
Q

Pros and Cons of Each Coverage Form:

A

Occurrence Form: lower risk for businesses, higher risk for insurer, higher premiums

Claims-Made Form: higher risk for businesses, lower risk for insurer

268
Q

Tail Coverage Overview (Claims-Made)

A

Claims-made coverage can be extended by tails, or tail cover.

Occurrence coverage last forever for damage or injury during the policy period. Tails last only for a relatively short period.

Tails require premiums from the insured as long as the policy is extended.

2 Kinds of Tails: basic extended and supplemental extended

269
Q

Basic Extended Tail - Claims-Made

A

Automatically applies to every canceled or expired claims-made policy. Extends coverage for occurrences 60 days past policy period.

Extends window for making a claim for 5 years past occurrence.

270
Q

Supplemental Extended - Claims-Made

A

Extends coverage for occurrences 60 days past policy period.

Extends window for making a claim forever

Insured must request coverage and pay the premium within 60 days of the policy period.

271
Q

CGL Coverage Forms:

A

Coverage A: Bodily Injury and Property Damage, Premises and Operations Liability, Products and Completed Operations Liability, Contractual Liability for Insured Contracts

Coverage B: Personal and Advertising Injury Liability

Coverage C: Medical Payments to Others

Damage to Premises Rented by You

272
Q

CGL Coverage A

A

Protects the insured from liability for bodily injury and property damage.

Covers 3 Kinds of Hazards:
Premises and Operations
Products and Completed Operations
Contractual Liability for Insured Contracts

273
Q

CGL Premises Liability

A

Covers bodily injury and property damage on premises owned, rented, or leased by insured including the ways immediately adjoining.

274
Q

CGL Operations Liability

A

Covers bodily injury and property damage when working outside premises

275
Q

CGL Product Liability

A

Insured’s liability for bodily injury and property damage caused by the use of products made or sold by insured.

3 Types of Product Liability Claim:

  1. Strict Liability: any defect in safety is manufacturer’s fault.
  2. Negligence: manufacturer did not exercise a reasonable amount of caution.
  3. Breach of Warranty: Insured failed to notify public of a known safety hazard, or failed to deliver the quality of item advertised.
276
Q

CGL Completed Operations Liability

A

The insured’s liability for work completed away from the insured premises.

Work is “completed” the moment that:
the insured has fulfilled the terms of an agreement, or
any portion of the work is used for its intended purpose.
(whichever is earlier)

277
Q

CGL Insured Contracts

A

Lease of premises
Sidetrack agreements
An obligation to indemnify a municipality
Elevator maintenance contracts
Any contract in which the policyholder assumes the tort liability of another party for bodily injury or property damage

278
Q

CGL Libel and Slander (Personal and Advertising Injury)

A

Coverage protects insured against claims of personal injury.

Libel: written words that falsely damage another’s reputation.

Slander: spoken words that falsely damage another’s reputation.

279
Q

CGL False Arrest (Personal and Advertising Injury)

A

False arrest, detention, or imprisonment

Malicious prosecution

280
Q

CGL Wrongful Entry or Eviction (Personal and Advertising Injury)

A

Wrongful Entry: when a landlord uses improper means to repossess real estate or rented space. May also involve invasion of privacy.

Wrongful Eviction: when a landlord or shop-owner evicts a person from public space without cause.

281
Q

CGL Advertising Injury (Personal and Advertising Injury)

A

protects insured against claims of advertising injury.

Advertising Injury means a third party suffered damages as the result of the insured party advertising their good and/or services in a public arena.

May take the form of: libel and slander, copyright infringement, stealing and advertising ideas.

282
Q

Supplementary Payments

A

Supplementary Payments - Coverages A and B
Assist policyholder with a variety of claim or lawsuit expenses.
Not subject to liability limits.
Covers litigation expenses for a third party named in the same suit as the insured. (insured must have assumed liability for the other party through an insured contract; liability is covered under the policy; there is no conflict of interest; third party must agree in writing to cooperate with the insurer)

May include:
lost wages; expenses due to insurer’s request such as retrieving official reports or record, copy fees; bail bonds (up to $250); accrued interest after a judgement is entered; premiums on appeal bonds and attachment bonds

283
Q

CGL Coverage C: Medical Payments

A

No-fault coverage that pays: medical, dental, hospital, nursing, funeral costs

Resulting form an occurrence on insured’s premises or form its business operation.

284
Q

CGL Damage to Premises Rented by You

A

Coverage A usually excludes loaned or rented properties.

Damage to Premises Rented by You lifts this exclusion (adds coverage)

Applies to properties that the insured rents for 7 or fewer consecutive days.

285
Q

CGL Conditions Page

A

Contains provisions the policyholder must meet as a condition of coverage.

Highlights the rights and duties of insured and insurer.

States the rights of each regarding cancellation, changes, lawsuits, etc.

286
Q

CGL Conditions

A

Policies cover occurrences in US, Puerto Rico, and Canada.

Products Liability is worldwide, as long as the product was made or sold in US, Puerto Rico, or Canada.

287
Q

Limits of CGL Insurance - Aggregate Limits

A

Maximum amount a policy will pay for certain specified types of claims over the course of the policy period.

Products-Completed Operations Aggregate: maximum amount the policy will pay to satisfy claims regarding Products and Completed operations only.

General Aggregate: maximum amount the policy will pay out over the policy period for Coverage A, B, and C except for Products and Completed Operation.

Products and Completed Operations has separate aggregate limit from all other coverages.

288
Q

Limit of CGL Insurance - General Aggregate Limit

A

Payments under these coverages are all under one aggregate:

Coverage A: Premises and Operations Liability only

Coverage B: Personal and Advertising Injury Liability

Coverage C: Medical Payments to Others

Damage to Premises Rented by You

289
Q

Limits of CGL - Per Occurrence Limit

A

How much an insurer will pay for any one occurrence.

Always subject to aggregate limits

290
Q

Limits of CGL - Per Occurrence Sub-Limits

A

General Aggregate Limit

Per Occurrence Limit

Personal and Advertising Injury Limit: the maximum amount the insurer will pay for personal and advertising injury to any one person or organization.

Medical Payments Limit: maximum amount the insurer will pay for bodily injury sustained by any one person.

Damages to Premises Rented by You

291
Q

Limits of CGL - Legal Defense

A

No limit on Legal Defense

CGL covers all legal expenses, without limit, up until judgement or settlement.

292
Q

CGL Endorsement: Owners and Contractors Protective Liability

A

Responds to all liability claims filed against the hiring business arising out of work performed by the independent contractor.

protects the hiring business from losses due to contractor’s work.

Vicarious Liability: a company can be held responsible for the actions of a hired contractor.

Purchased by the contractor, but the hiring business is the insured.

Specific to a single project and place.

Expires when project is completed.

293
Q

CGL Laser Beam Endorsement

A

Allows an insurer to exclude specific types of accidents, products, work, or locations from CGL coverage.

294
Q

CGL Liquor Liability Coverage Form (or Endorsement)

A

Alcohol-related occurrences are excluded in regular CGL policy.

And added liquor liability coverage endorsement fills this gap.

Coverage includes cases involving over-service or illegal service to minors.

295
Q

CGL Pollution Liability Coverage

A

Covers bodily injury or property damage caused by pollutants released into air, water, or land.

Covers pollution normally excluded by CGL.

“Pollution Incidents” include release of pollutants at insured site, off-site due to pollutant emanating from site, during transportation, at non-owned disposal sites.

Pollution Liability Coverage Broad Form: Bodily Injury and Property Damage and Clean-up Costs

Pollution Liability Limited Coverage Form: Bodily injury and property damage only

296
Q

Professional Liability Coverage

A

Covers lawsuit and settlement costs when a claim is made because of alleged wrongful acts.

297
Q

Professional Liability Coverage: Malpractice Insurance

A

Medical Professional Liability
Lawyers’ Professional Liability

Both covers claims of act or omission if professional service differs from accepted standard.

298
Q

Professional Liability Coverage: Errors and Omissions (E & O)

A

Protects the insured form consequences of failure to perform.

Excludes coverage for libel, slander, punitive damages.

Protects persons and organizations

Exclusions: Bodily injury, property damage, fraudulent or criminal acts

299
Q

Professional Liability Coverage: Claims Made Policy

A

covers claims made during policy period

does not cover a claim filed after policy period expires.

can apply retroactive dates to policy period.

300
Q

Professional Liability Coverage: Occurrence Policy

A

covers liability for occurrences happening during policy period.

covers after term expires if occurrence was during policy period.

301
Q

Professional Liability Coverage: Unique Provision “Consent to Settle”

A

clause protects the insurer if the insured does not approve a recommended settlement.

insurer pays expenses up to the date the insured refuses, but is not required to continue lawsuit expenses afterward.

Defense cost not included in policy limits

302
Q

Professional Liability Coverage: Other Specialty Liability Coverages

A

Directors and Officers; Fiduciary; Employment Practices; Cyber; Liquor

303
Q

Professional Liability Coverage: Directors and Officers Liability

A

Available to: private companies, educational institutions, non-profit organizations; corporate officials

Pays for: legal defense, damages awarded in lawsuits

Excludes: criminal/fraudulent acts

304
Q

Professional Liability Coverage: Fiduciary Liability

A

protects fiduciary from: mistakes in handling funds, omissions in communicating plan information to employees

305
Q

Professional Liability Coverage: Employment Practices Liability Insurance (EPLI)

A

Provides legal defense for businesses and pays for damages awarded in court when employees claim violations

306
Q

Professional Liability Coverage: Cyber and Privacy Insurance

A

Coverage for losses in the event of a data breach.

Can be written to include costs related to privacy breach

307
Q

Professional Liability Coverage: Liquor Liability

A

covers cost of alcohol-related: bodily injury and property damage.

Includes protection for losses related to serving minors.

308
Q

Surety Bonds

A

Not insurance
May be sold by insurance companies

Suretyship: An arrangement between three parties, in which one party promises to perform for another party, and a third party guarantees that they will fulfill that promise.

Principle: agrees to fulfill on obligation
Obligee: party to whom the principal owes the obligation.
Surety (Guarantor): guarantees to pay obligee if principal defaults.

309
Q

Surety Bond: Indemnitor

A

Fourth party to a surety bond who agrees to reimburse the surety for losses sustained if the principal defaults.

310
Q

Terms related to Surety Bonds

A

Penal Sum: specified amount that a surety might have to pay if the principal fails to perform as promised.

Collateral: surety usually requires, which is a principal’s cash or valuable property kept in reserve by the surety. In a case of default it is forfeit to the surety.

Joint Control: The surety may reserve the right to regularly audit all disbursements, or even co-manage actual work.

311
Q

Types of Surety Bonds

A

Contract Bonds

Judicial Bonds:
fiduciary bond: guarantees work of someone appointed to take financial responsibility for others
court bond: often required of litigants in civil suits to protect opposing parties
bail bond: court bond that guarantees appearance of a defendant in court

Public Official Bonds:
protects the public form a public official’s lack of performance

Customs Bond:
guarantees that an importer/exporter will pay all customs taxes and fees, and obey all regulations and laws.

Financial Guarantee Bond:
guarantees that principal and interest will be paid per the terms of the contract or promissory note.

Lost Instrument Bond:
guarantees that an insurer of a copy of a lost financial instrument will not suffer and economic loss if the owner of the instrument later finds and transacts the original.

Reclamation Bond:
Guarantees the health, safety, and welfare of the public during and after mining operations, and guarantees land will be restored to original condition.

Self-Insurance Worker’s Compensation Bond:
Pays workers’ comp claims filed by the self-insurer’s employees when the self-insurer itself cannot meet this obligation

Faithful Performance of Duty Bond:
Guarantees a principal will faithfully perform his duties as prescribed by law or the bylaws of the obligee

312
Q

Fidelity Bonds

A

Guarantee the principal (employee) will not do something

Principal = employee
Obligee = employer
Surety = insurer

Cover all dishonest acts committed by a covered employee, including: larceny, theft, embezzlement, forgery, misappropriation, wrongful abstraction, willful misapplication

Scheduled or blanket basis

313
Q

Public Employee Dishonest Coverage

A

covers losses resulting from government employee dishonesty.

Coverage Form O = per occurrence
Coverage Form P = per employee

314
Q

Commercial Package Policies

A

Benefits to policyholders: simplicity (one policy for all needs, interline endorsements); elimination of gaps in coverage, reduced premiums

Benefits to Insurers: less diverse selection of lines, customer loyalty strengthened

315
Q

Commercial Package: Representative Lines of Coverage

A
Commercial Property
Commercial General Liability
Employment Related Liability
Professional Liability 
Commercial Crime and Employee Dishonesty
Commercial Inland marine
Business Auto
Boiler and Machinery
Equipment Breakdown
316
Q

Business Owner Package Policy (BOP)

A

Bundles property, liability, and income protection in a single package

Insurance to value requirement, works in the same way as coinsurance.

Policy pays RC if coverage is at least 80% of property’s value

If coverage is less than 80% of property's value policy pays the higher of: ACV or
RCV x (Amount of Insurance/80% Property Value
317
Q

Features of Typical BOP

A

12 months business income coverage
12 months extra expense coverage
inflation guard for buildings and structures
liability protection for lawsuits from accidents or products
slander and copyright protection
deductibles on most claims
RC valuation (ACV endorsement option)
Open-peril coverage (named-peril endorsement option)

Not typically covered: coverage for company owned vehicles; professional liability coverage; malpractice coverage

318
Q

BOP Eligibility

A

wholesaler and Distributors: Retail sales account for 25% or less of gross income; 25% or less of floor space is available to the general public

Processing and Servicing: Annual sales under $3 million; no more than 25% of sales occur off-premises

Limited Cooking and Fast Food Restaurants: 7,500 sf or fewer; max seating: limited cooking - 75, fast food - 150; beer and wine sales no more than 25% annual income; no liquor sales; maintenance of fire extinguishing equipment.

Convenience Store: Gasoline sales less than 75% annual income; no auto repair or car wash; no propane or kerosene sales

Self Storage Facilities: maximum of two stories (floor space not limited); no storage of pollutants, waste, chemicals, or industrial materials.

Specialty Contractors: annual payroll no more than $300,000; annual sales no more than $3 million; subcontracted work no more than 10% total sales; no heavy construction; no working on buildings over 3 stories

Motels: maximum of 3 floors; no bars or cocktail lounges; not seasonal; not closed more than 30 days per year

Apartment Building and Condominium: occupancy must be residential or office; incidental occupancy no more than 25,000 sf; incidental occupancy by contractors not exceeding 7,500 sf or 15%;

Office Buildings: less than 100,000 sf; no higher than 6 stories; tenants occupy no more 25,000 sf; contractors occupy no more than 7,500 sf or 15% of total sf

319
Q

Businesses CANNOT Qualify for a BOP

A

car dealerships, service stations, repair shops: parking lots, garages; amusement parks; bars, nightclubs, and the like; banks and similar financial institutions; manufacturing, processing, servicing businesses (except those eligible); condominium associations (except residential and office)

320
Q

National Flood Insurance Program (NFIP) Dwelling Form

A

Coverage A:
1 to 4 family dwellings
Attached additions

Coverage B:
Personal Property

Coverage C:
Debris Removal
Loss Avoidance Measures
Property Removed to Safety

Coverage D:
Increased Cost of Compliance

321
Q

Three Loss Settlement Options

A

Actual Cash Value:
2, 3, or 4 family dwellings; units NOT used solely as single-family dwellings; detached garages; personal property; appliances, carpets, and carpet pads; outdoor awnings, outdoor antennas or aerials, and other outdoor equipment attached to dwelling; abandoned property that, after a loss, remains as debris at the described location.

Replacement Cost:
single family dwelling; owner occupied; insured’s principal residence; insured at 80% of replacement value

Special Loss Settlement:
for mobile homes or travel trailer: at least 16 feet wide; at least 600 sq. feet inside; insured’s principal residence
policy pays the lowest of two amounts: replacement cost of dwelling (or 1.5 x ACV0; coverage limit

322
Q

Mechanical Breakdown: Coverage

A

Covers losses due to breakdown of motor vehicles

Cover: engines; transmissions; drive trains; steering mechanisms; electrical and electronic systems; a/c systems; front suspension

Require:
proof of regular maintenance
full inspection before the policy is issued
repair costs cannot exceed the car’s ACV.

Exclusions:
due to neglect or delay in maintenance; covered by regular auto insurance; due to racing or reckless driving; on vehicles with altered odometers; occurring while towing with or overloading the vehicle.

Common Conditions:
owner must take reasonable care to minimize repair costs
vehicle may be subject to inspection before repairs are done
subject to subrogation

323
Q

Excess Liability

A

Coverage comes into effect only after limits of base policy are reached.

324
Q

Excess Liability and the Base Policy

A

Follow Form and Stand Alone excess liability policies rely on the base policy.

Operate only after liability limit of base policy is exhausted.
Cover only what is also covered by base policy.

325
Q

Excess Liability: Follow Form

A

Follows base insurance policy to the letter.

Uses all the same provisions, exclusions, and coverages as the base policy; easier to underwrite and less expensive than other Excess Liability policies; claims tend to be simpler

326
Q

Excess Liability: Stand Alone

A

Covers what base policy covers, but sets own exclusions and limitations to coverage.

Adjuster must carefully review policy provisions to ensure a loss is covered.

327
Q

Umbrella Policies

A

May cover risk and exposures NOT included in underlying policy.
(non-owned aircraft; marine craft; property in insured’s custody; personal injury; pollution; professional liability, product recall)

Umbrella policy can operate in several ways: can operate like stand alone; also works as primary policy; provides broadest coverage

328
Q

Umbrella Policies: Self-Insured Retention (SIR)

A

A type of deductible.

Equal to the limits on base policy.

If limit of base policy is paid, this pays the SIR

329
Q

Nationwide Marine Definition

A

Model regulation that defines six categories of eligible marine risks

Ocean Marine: imports and exports

Inland Marine: domestic shipments; instrumentalities of transportation or communication; personal property floater risks; commercial property floater risks

330
Q

Ocean Marine Insurance

A

Ocean Marine Policies are “Utmost Good Faith” contracts: difficult to investigate all the risks involved; ships are required to adhere to certain Implied Warranties in order to receive coverage.

331
Q

Implied Warranties of Ocean Marine Contract

A

Seaworthiness

Condition of Cargo: owner must guarantee cargo is sound and everything is properly loaded.

Legality: voyage must be legal

No Deviation in Voyage: rout of the voyage must be clearly stated prior to departure; captain must adhere to this route throughout voyage, with no change in destination or unnecessary delays.

332
Q

Ocean Marine Premiums

A

Policyholder has 45 days to pay the premium in full or develop a payment option that is acceptable to the insured and the insurer.

Upon cancellation premium will be paid on a pro-rata basis

333
Q

Ocean Marine Insurance Policies

A

Types: Hull Coverage; Cargo Coverage; Freight Insurance; Protection and Indemnity

Coverage: Loss of Vessel; Loss of Cargo; May extend to property stored on docks and piers

Policy Valuation:
valued basis - full amount of policy is paid in the vent of a total loss
unvalued basis - amount of payment is determined after the loss
agreed value basis (valued policy); value of the vessel is determined when policy is issued

334
Q

Hull Policy: Coverage

A

Covers damages to, and loss of, a marine vessel
Policy period: 1 year
Establishes a defined geographic area

335
Q

Hull Policy: Deductibles

A

Average: standard, flat-rate deductible

Franchise:
if damage amount exceeds deductible, the insurer pays the full cost for damages
if damage is less than deductible, the policyholder pays for all damages

336
Q

Cargo Policy

A

The good or property being moved in a shipment

Cargo Coverage: Insures good in transport

3 Types of Cargo Coverage:
Single Risk Form - insures the cargo on a single shipment only
Floating, Open, or Long Term - insures multiple trips over a specific period of time
Warehouse-to-Warehouse - insures cargo from point of origin to point of destination

337
Q

Freight Insurance

A

the charge for transporting goods, paid to the owner of the vessel

Freight Insurance:
protects the vessel owner in the event that the freight costs are not paid
often combined with Hull coverage

338
Q

Protection and Indemnity Insurance

A

Liability insurance that protects the ship owner in the event that the ship causes damages or injuries to a third party.

Often included as part of hull coverage

Covers carrier’s liability for bodily injury or property damage to crew, passengers, and sometimes cargo.

Does not cover claims that fall under state or federal compensation acts

339
Q

Actual Total Loss

A

Insured items that have disappeared or are not salvageable

340
Q

Constructive Total Loss

A

Insured items that have been damaged beyond repair, or the cost to repair exceeds the cost to replace

341
Q

Cost, Insurance, and Freight (CIF)

A

Term of sale in which the seller or exporter is responsible for the cargo throughout shipment

Seller must insure the cargo until it reaches its destination.

342
Q

Cost and Freight ( C&F)

A

Term of sale in which the buyer or importer is responsible for the cargo throughout the shipment.

343
Q

Free on Board (FOB)

A

Term of sale in which the seller is responsible for the cargo until it reaches a certain point, such as a specific ship or port.

If followed by a city name, means the seller is only responsible for the cargo until it arrives in that city.

At this point, the buyer becomes responsible for the goods.

344
Q

Ocean Marine Provisions

A

Sue and Labor: the insured party is required to attempt to prevent further losses once damage occurs

General Average: when the captain of a vessel decides to make a voluntary sacrifice of a part of the ship or its cargo in order to save the whole, all insurers for that ship must participate in the indemnification process

Particular Average Clause: appropriates the loss to a particular company rather than each cargo owner sharing the loss

Free of Particular Average Clause: excludes coverage for all partial or accidental losses, except those caused by stranding, sinking, burning, or collision;
acts like a deductible - insurer is only liable for losses that exceed a set percentage of the value
percentage is usually 10%

345
Q

Inland Marine Insurance

A

Covers property in transport (other than ocean transport)
Covers property involved in transportation
Policies typically known as “floaters”

Eligible Property:
movable; in transit; instrumentalities of transportation or communication, including - roads, bridges, tunnels, radio towers, power lines
Actual means of transport NOT eligible

346
Q

Inland Marine Categories

A

Domestic Shipments
Instrumentalities of Transportation or Communication
Personal Property Floater Risks
Commercial Property Floater Risks

347
Q

Domestic Shipments

A

Transportation Forms: protect against losses occurring during shipment or transport of goods; includes travel by truck, train, ship mail, or plane

Annual Transit: uncontrolled forms that covers loss of goods in transit; applies to all of the insured’s shipments during the year; choice of open-peril or named-peril coverages against fire, windstorm, or theft.

Trip Transit: uncontrolled similar to annual transit, but which only insures a single shipment; coverage applies from the trip origination point to destination.

Motor Truck Cargo: uncontrolled form; protects carrier of shipped goods while the shipment is in transit.
common carrier legal liability: free on board shipping point (ownership of/responsibility for cargo transfers to buyer as soon as cargo leaves shipper); free on board destination point (ownership of/responsibility for cargo transfers to buyer after buyer accepts cargo when it arrive sat the buyer’s destination)

Mail Coverage: controlled form; provides open peril coverage for property sent by registered mail; shipper must report property value accurately

348
Q

Instrumentalities of Transportation and Communication

A

uncontrolled form

pays for direct damage or loss of revenue due to covered loss

covers property directly related to transportation and communication

349
Q

Personal Property Floater Risks

A

Personal Articles Floater: open-peril coverage; coverage is worldwide; no deductible; valuation is determined using the lease of the following (actual cash value, cost to repair or replace, coverage limits); subject to “pair and set” provision

Exclusions: war; nuclear hazards; wear and tear; insects and vermin; spoilage; gradual deterioration

350
Q

Specific Personal Articles Floater Coverages

A

Jewelry Coverage: eligible items include items of personal adornment containing precious metals or jewels; pens; flasks; smoking equipment; trophies
each item must be individually scheduled
newly acquired property automatically covered for 30 days at 25% of coverage limit, up to $10,000

Furs Coverage: includes both genuine and imitation fur; each must be individually scheduled; newly acquired covered for 30 days

Cameras Coverage: eligible items include photography equipment; binoculars; telescopes; microscopes
each item individually scheduled, but blanket coverage available for accessories
30 day automatic coverage for new items

Musical Instruments: each item individually scheduled, but blanket coverage available for accessories
30 day automatic coverage for new items

Silverware Coverage: includes silver; silver plate items; gold; gold plate items
items may get blanket or scheduled coverage

Golfer’s Equipment Coverage: items include clubs, equipment, and clothing
blanket coverage

Fine Arts Coverage: individual items must be scheduled, but blanket coverage available for small items or collections
agreed value coverage
newly acquired property automatically covered for 90 days at 25% of total limit of scheduled items
no coverage for property on exhibit away from insured premises
unique application of pair and set provision (insurer pays full scheduled amount for pair or set; insured must surrender any remaining pieces of set to insurer.

Stamps and Coin Collection Coverage: items include postage stamps; rare and current coins; paper money; banknotes
can provide blanket or scheduled coverage
special limits - ($1,000 for any unscheduled coin collection; $250 for any individual item)

351
Q

Commercial Inland Marine Policies

A

include: domestic shipment; instrumentalities of transportation and communication; commercial property floater risks

two types of conditions: general and loss

Can be written on controlled or uncontrolled forms; includes:
bailee forms; equipment floaters; business floaters; dealer policies

352
Q

Commercial Property Floater Risks: Bailees

A

Bailee: individual who holds someone else’s property for a specific purpose and then returns it to the owner.

Bailee Coverage:
reimburses a bailee’s customer for damage to the customer’s property while in the bailee’s control
provides coverage for Confusion of Goods (a loss makes it impossible to identify damaged property)

353
Q

Commercial Property Floater Risks: Equipment Floaters

A

Uncontrolled Form

May be open peril or named peril

Covers heavy machinery and equipment

(Physicians and Surgeons Equipment; Theatrical Property; Contractors Equipment; Commercial Articles)

354
Q

Commercial Property Floater Risks: Business Floaters

A

Accounts Receivable:
controlled; open peril; reimburses insured for money that cannot be collected because company records have been destroyed.

Valuable Papers and Records:
controlled; covers losses to important documents, manuscripts, or records; does NOT cover money and securities

Installation:
controlled; often open peril; covers items that have been sold while they are being moved or installed, being accepted by the buyer

Electronic Data Processing:
covers hardware, data, media, recorded information, software
liability coverage also available

Signs:
controlled; covers all types of signs owned by insured and those belonging to others that are in the insured’s care

355
Q

Commercial Property Floater Risks: Dealer’s Policies

A

Open peril

Versatile Coverage:
reporting or non-reporting; property covered while on or off premises; property covered while controlled by employees or in transit; covers property of others in insured’s custody

Covers dealers of:
jewelry; stamps; art; coins; furs; cameras; musical instruments; equipment

356
Q

Jewelers Block

A

Bailee Form

For jewelers with up to $250,000 in stock

Covers:
insured’s merchandise; property of others in insured’s care; property in transit and in showcases

Covers: insured’s stock in trade; jewelry sold, but not yet delivered; similar property of others in the insured’s care (if such property is in jewelry trade, it is only covered up to the insured’s financial interest in the property); damage to building housing merchandise when damage is caused by theft, attempted theft, and collapse

Optional Coverages:
(Show Windows: covers theft from a show window by cutting or smashing glass)
(Money: covers theft of money from a vault or safe on insured premises)

Exclusions:
on exhibition in showcases not on the premises
at exhibition that is promoted by a trade association or public authority
sold on a payment plan after its leaves the premises
being worn by the insured or an employee (or a family member either)
in the mail, in express carriers, or motor carriers

357
Q

Jewelers Block: Loss Settlement

A

Determining Value:
value is determined at the time of loss
historical or antique value have no bearing on valuation

Policy Pays the Least of:
actual cash value
cost to restore damaged property to pre-loss condition
cost to replace damaged property
lowest dollar value listed on the company’s books

358
Q

Jewelers Block: Insured’s Duties

A

Insured Must:
maintain safeguards in place at policy inception
take yearly inventory
keep records for 3 years of: purchases, inventory, sales, property off premises, property of others on premises

359
Q

Inland Marine Insurance Review

A

indemnifies an insured party for losses to property in transport or property that is involved in the transportation of goods.

Controlled Line Floaters:
standardized forms filed with the state

Uncontrolled Line Floaters:
non-standard forms tailored to meet needs of each insured

4 Categories: 
Personal Property Floater Risks (personal articles floater)
Domestic Shipments (annual transit, trip transit, motor truck cargo, mail coverage)
Instrumentalities of Transportation and Communication (bridges, tunnels, roads, dams, piers and docks, pipelines, power lines, antennas and towers for radio and TV)
Commercial Property Floater Risks (bailees, equipment floaters, business floaters, dealer's policies)
360
Q

Aviation Insurance

A

Involves:
huge potential for losses

The Problem with Risk Pool in Aviation:
insurance pool is small
potential risk is huge
Insurers and re-insurers often pool risk with underwriting groups specializing in aviation.

361
Q

Aviation Insurance Policies

A

No standard policies

In general, all policies contain Hull Coverage and Liability Coverage

362
Q

Aviation Insurance: Hull Coverage

A

Insurance for the aircraft itself.

2 Types of Coverage:
All Risks- Ground and Flight: this is the broadest aircraft coverage
All Risks - Not in Motion: covers physical damage to the aircraft while the aircraft is not moving by its own power.

Deductibles:
usually percentage or fixed deductible
separate deductibles for “in motion” and “not in motion”
deductible does not apply to losses from (fire, lightning, explosion, theft, robbery, vandalism, transportation of aircraft)

Exclusions:
wear and tear
freezing
mechanical or electrical breakdown
war risks
losses to tires, unless caused by theft, vandalism, or malicious mischief
embezzlement by someone who is legally in possession of the aircraft

363
Q

Aviation Insurance: Aircraft Liability Coverage

A

3 Types of Aircraft Liability Coverage=

Bodily Injury Excluding Passengers:
covers anyone injured by the use, maintenance, or ownership of the aircraft who is not a passenger on the place
includes bodily injury, sickness, disease, mental anguish, death

Passenger Bodily Injury:
applies only to passengers

Property Damage Liability:
covers damage to property (or loss of use of property) caused by the use, ownership, or maintenance of the aircraft
has a single, per occurrence limit

364
Q

Aviation Insurance: Aircraft Liability Coverage

A

Limits of Liability

passenger bodily injury liability and bodily injury excluding passenger are subject to per person and per accident liability limits

property damage liability has a single, per occurrence limit

or, an insured could choose a single limit liability policy

365
Q

Aviation Insurance: Aircraft Liability Coverage

A

Medical Payments Coverage:
no-fault coverage
covers injuries that occur on, or while boarding or exiting aircraft
pays for medical and even funeral costs

366
Q

Admitted Aircraft Liability (Guest Voluntary Settlement)

A

Guest signs release form that:
allows a payment of predetermined amount for bodily injury
releases insured from further liability

Helps avoid lawsuits

Insured can choose when to rely on this coverage

367
Q

Hangarkeepers Liability Coverage:

A

form of bailee insurance

covers damage to planes in custody of insured

368
Q

War, Hi-Jacking and Other Perils Coverage:

A

Adds by endorsement coverage for perils typically excluded

369
Q

Airport Liability Coverage:

A

for those who own, operate, lease, or use space in airports

Available coverages include:
personal injury, contractual, premises, products and completed operations, premises medical payments

370
Q

Cargo Liability Coverage:

A

Indemnifies for lost or damaged: baggage and/or cargo

371
Q

Worker’s Compensation

A

covers work-related injuries and protects employers from their liability when injury occurs.

Covers an employee’s medical bills and lost wages following a work-related injury.

purchased by the employer
primary coverage: pays before other policies
“exclusive remedy” keeps employee from suing employer for covered injuries
“no-fault” policy: applies no matter who is at fault for the injury

Always primary coverage.

372
Q

Worker’s Compensation State Specific Laws

A

Most states require WC

Monopolistic: the state provides WC coverage
Competitive: state has fund in direct competition with private insurers, employers choose which they prefer

Georgia: no state fund
only private companies offer WC
all WC insurers must follow the same state laws

373
Q

Worker’s Compensation: Compulsory vs. Elective

A

Compulsory: WC is required
Elective: employers and employees may opt out of workers’ comp

374
Q

Worker’s Compensation: Georgia - Compulsory

A

All employment relationships must be covered.

Some Exceptions:
companies with fewer than 3 employees
independent contractors
taxicab drivers
prison inmates doing community service
farm laborers
domestic servants
real estate agents
amateur sports officials
375
Q

Worker’s Compensation: Employer Benefits

A

the sole responsibility of the employer is to pay premiums or, in the case of self-insurance, pay benefits to an injured employee

376
Q

Worker’s Compensation Coverage

A

Injuries and death occurring in a normal course of work

Infections or diseases caused by work-related injury

Occupational diseases caused by hazardous jobs

Workers’ Comp only covers injuries and death when: work performed is major contributing cause of injury

377
Q

Worker’s Compensation Exclusions

A

injuries inflicted by a third party for personal reasons

alcoholism or disability arising from alcoholism

drug addiction or disability arising from drug addiction

heart disease, heart attack, failure of coronary blood vessels, stroke, thrombosis

378
Q

Workers’ Compensation Policy

A

Part One describes the benefits available to an injured employee.

Benefits fall into 3 categories: disability and impairment benefits; medical expenses; and death benefits

3 Kinds of Disability/Impairment Benefits:
total disability; temporary partial disability; and permanent partial disability

379
Q

Worker’s Compensation: Average Weekly Wage

A

the employee’s average weekly income in the 13 weeks leading up to the injury

Maximum Medical Improvement:
in cases of permanent injury, the point in which doctors determine that a worker has made as much medical progress as possible.

380
Q

Worker’s Compensation: Disability and Impairment Benefits

A

Income Benefits:
based on the employee’s Average Weekly Wage
subject to certain limits
waiting period: 7 days (covered if the disability lasts over 21 days)

Maximum Benefit Amounts:
total disability: 2/3 of AWW for 400 weeks
permanent partial disability: 2/3 of AWW according to rating schedule
temporary partial disability: wage loss formula for 350 weeks

381
Q

Worker’s Compensation: Temporary Total Disability Benefits (TTD)

A

Pay 66 2/3% of employees AWW

Time Limit: 400 weeks

382
Q

Worker’s Compensation: Catastrophic Injuries

A

includes the following:

Spinal cord injuring involving severe paralysis of arm, leg, or trunk

Amputation of arm, hand, foot, leg

Severe brain or close-head injury

Secord or third degree burns to 25% of body or third degree burns to 5% of face and hands

Total blindness or industrial blindness

Any other injury that prevents employee from being bale to perform available work

383
Q

Worker’s Compensation: Change in Condition

A

For Catastrophic Injuries:

TTD are paid unless there is a change in condition of the injured worker

Change in condition could be:
change in wage-earning capability
change in physical condition
change in status

Only the WC board has the authority to determine that an injury is no longer catastrophic and only after holding a hearing

384
Q

Worker’s Compensation: Temporary Partial Disability Benefits (TPD)

A

Amount: 2/3 the difference between pre- and post-injury AWW

Limit: $350

Time Limit: 350 Weeks

385
Q

Worker’s Compensation: Permanent Partial Diasbility

A

Loss of function of a member or members of the body, or of the body as a whole

Benefits:
for permanent disability due to work-related injury
paid regardless of wage loss
pay 2/3 of employee's AWW
amount of time depends on injury
386
Q

Worker’s Compensation: Schedule of PPD Benefits

A

Paid according to disability schedule listed in GA workers’ compensation law
Duration of benefits based on severity of impairment
Benefits expire at the earlier of the following: completion of scheduled payment period; death of impaired person

387
Q

WC Policy: Medical Benefits

A

Pay for all medical expenses incurred because of work-related injury:
doctors visits; surgery; emergency room visits; x-rays; medicine; necessary medical equipment (e.g. crutches, leg braces); rehabilitation services (for catastrophic injuries)

Time Limits:
for injuries that occurred on or before June 30, 2013, and for all catastrophic injuries: no time limit
for injuries occurring on or after July 01, 2013: 400 weeks

388
Q

WC Policy: Death Benefits:

A

66 2/3% of the employee’s AWW for up to 400 weeks
Paid upon employee’s death from injury arising out of or in the course of employment
Maximum of $230,000 to a single dependent
Funeral expenses up to $7,500

389
Q

WC Policy: Liability

A

Covers employers in the event of:
suits by employees claiming negligence
claims by others for liability of employees
claims by relatives of injured employees

390
Q

WC Policy: Employer’s Liability Exclusions

A

liability assumed under contract
damages for employment that is unlawful
injuries to employees knowingly working in violation of the law
obligations under any compensation law
injuries intentionally caused or aggravated by insured
injuries outside US or Canada
claims arising from unlawful discrimination, coercion, or discharge
obligations under federal acts
penalties imposed for breaking state or federal law

391
Q

Georgia Employers: 3 WC Options

A

Option 1: Purchase WC

Option 2: Self-Insure
employer must get authorization from State Board of WC and Georgia Self-Insurers Guaranty Trust Fund
requires proof of ability to pay benefits

Option 3: Join a Self-Insurance Group
employers pool resources to insure their collective risks

392
Q

WC Policy - Georgia Employers: Out of State Coverage

A

Conditions:
employer must let insurer know about out of state work
state where work is taking place must be listed on policy

393
Q

WOC Policy: Employer’s Duties

A

Provide necessary medical care for injured employee

Report injury to insurer and cooperate with insurer’s investigations

Utmost integrity is expected of all parties, including employer

394
Q

WOC Policy Risk Classification

A

Premiums

Employee Rate Classification:
“High-risk” and “Low-risk”

Factors that Affect Premiums:
size of payroll
risk level of work done
location, safety records, etc.

395
Q

WOC Policy: National Council on Compensation Insurance (NCCI)

A

Rating bureau that develops the rules for setting worker’s compensation premiums that are used by most states

396
Q

WOC Policy: Conditions

A

Outline the rights of the insurer

Insurer has right to inspect workplace at any time

Insured cannot transfer rights or duties without written consent of insurer

Explain how a policy may be cancelled

Require first-named insured to act on behalf of all insureds with respect to policy transactions

397
Q

WOC Policy: Federal Programs

A

Federal programs can provide coverage outside of state WC programs.

Some circumstances where state WC doesn’t apply, because the workers are protected under a different law. Workers usually protected by one of several federal laws or WC programs.

398
Q

WOC Policy: Federal Employees Compensation Act (FECA)

A

Provides WC benefits for civilian federal employees

Pays medical expenses, plus 2/3 of normal monthly salary

Additional payments available for permanent injuries or to dependents

Includes compensation for survivors in the event of death

399
Q

WOC Policy: Federal Employers Liability Act (FELA)

A

Covers interstate railroad workers and their families

FELA Provisions:
railroad workers not covered by state WC laws may sue employers
worker must show legal negligence of employer

400
Q

WOC Policy: Jones Act

A

“Merchant Marine Act”

Allows injured seamen to sue before a jury

insurers usually require maritime coverage endorsement under liability section to protect employer
some employers choose Voluntary Compensation Maritime endorsement to provide workers’ compensation benefits without requiring a lawsuit.

401
Q

WOC Policy: Longshore and Harbor Workers’ Compensation Act

A

Protects employees working on navigable waters or on shore in navigation-related industries

Covered employees receive medical expenses and 2/3 weekly salary while injury continues

Injury includes occupation-related illness

Employers have 2 options:
buy insurance form licensed insurer, or
self-insure with permission of US Dept. of Labor

402
Q

WOC Policy: Black Lung Benefits Act

A

Provides monthly payments and medical treatments to coal miners who become totally disabled from black lung disease

Employers must secure funding for benefits one of 2 ways:
qualify as self-insured
buy insurance from state or commercial insurer

Payments must begin within 30 days of determination of liability

403
Q

Health Insurance

A

A plan that covers and shares expenses associated with health care.

Health Insurance Contract = Evidence of Coverage

404
Q

Deductible

A

the amount the policyholder pays before insurance policy benefits activate

405
Q

Copayment

A

the amount the policyholder pays each time she accesses the benefits of a health insurance policy

406
Q

coinsurance payment

A

a percentage of the total health care expenses that the insured must pay

407
Q

out-of-pocket expenses

A

any deductibles, copayments, and coinsurance that a policyholder pays

408
Q

network provider

A

member physicians and healthcare facilities contracted to treat an insurer’s policyholders

409
Q

capitation

A

an insurer’s practice of paying a healthcare provider up front in return for the agreement to treat all members of the insurer

410
Q

Group Health Insurance

A

lower health insurance costs for the employer and employee

all employees included, regardless of current health status

helps eliminate or reduce policy waiting periods

coverage often continues even after employee leaves the group

Typically managed by:
HMO-Health Maintenance Organization
PPO-Preferred Provider Organization

411
Q

Individual Health Insurance

A

Comprehensive and/or Catastrophic Insurance:

purchase directly from an insurance provider
purchase through HMO, PPO, or POS

412
Q

Insurance Health Insurance Drawbacks

A

individual health insurance can be extremely expensive.

413
Q

Health Maintenance Organization (HMO)

A

managed care insurer providing health insurance through a provider network

broad range of comprehensive medical care

few exclusions and minimal deductibles

restricts members from choosing care providers outside of the network

promotes health programs in hopes of minimizing their healthcare costs

414
Q

Preferred Provider Organization (PPO)

A

members may choose healthcare outside of the Network Provider

members pay the difference between network coverage cost and non-network costs

Access to PPO network care at a very low cost

flexibility of choosing own medical care

415
Q

Point of Service Plans (POS)

A

combines qualities of HMO and PPO plans:

plan can cover visits in or out of network, based on the primary physicians recommendation

416
Q

Major Medical Plans

A

high medical coverage limits

does not restrict the insurer to a network

risk of major out-of-pocket costs

high deductible, and significant coinsurance percentage requirement

417
Q

Surgical and Hospital Insurances

A

Surgical Expense Insurance:
compensation for physician costs associated with surgical procedures

Hospital Indemnity Insurance:
coverage providing a flat amount of indemnification per day for hospitalization

Hospitalization Expense Insurance:
coverage for various hospital expenses (room and board, medical supplies, lab fees, nursing care, etc.)

418
Q

Accident Insurance

A

can pay expenses caused by a covered accident, including:

medical care for injuries
ambulance fees
hospital costs, including emergency room/intensive care
loss of income
death benefit

exclusions: self-inflicted injuries; injuries occurring while under the influence; injuries received in commission of a crime; disease and bacterial infections

419
Q

waiting periods

A

prevents applicants and insured’s from seeking health insurance only after they become ill

420
Q

non-cancelable policies

A

guarantees continuous health coverage, at a set premium price for as long as the policyholder desires

421
Q

Renewable Policies

A

Conditionally Renewable:
insurer may cancel under specific, stated conditions

Optionally Renewable:
insurer chooses whether to renew the policy when the policy period expires
insurer may cancel coverage on the expiration date for any reason

Guaranteed Renewable
insurer guarantees coverage until the insured is a certain age
insurer may increase the premiums over the life of the policy

422
Q

Residual Market Programs

A

state-run programs that provide insurance to high-risk individuals who cannot qualify for private insurance

also known as “shared markets” or “involuntary markets”

usually operate at a loss - meaning payouts exceed premiums collected

state-licensed insurance companies fund shortfalls by “sharing their pool” of premiums with Residual Market

423
Q

Residual Market Programs: Consumer’s Last Resort

A

last-resort option for consumers

consumer must prove rejection by a certain number of private insurers

minimal and highly restrictive coverage at expensive rates

424
Q

Residual Market Programs: Georgia

A

The Georgia Automobile Insurance Plan

Workers’ Compensation Assigned Risk Plan

The Georgia FAIR Plan (Fair Access to Insurance Requirements)

425
Q

Georgia Automobile Insurance Plan (GAAIP)

A

administered by governing committee and regional manager

policyholders and insurers can appeal rulings to commissioner

sold by an agent with property and casualty license in Georgia

426
Q

Georgia Assigned Risk Reinsurance Pool

A

Georgia WC Insurance Plan

also called the “assigned Risk Plan”

provides high-risk WC coverage for Georgia businesses

operates by spreading costs between all WC insurers in the state

427
Q

Georgia FAIR Plan

A

Administered by Georgia Underwriting Association

Coverages Available:

personal lines (homeowner, ho-8; dwelling, dp-1; wind and hail only; residential crime)

commercial lines (commercial fire; wind and hail only; commercial crime)

Coverage Limits:

maximum coverage limits set by commissioner
for any building (personal or commercial): $2,000,000
for a set of buildings: $20,000,000
homeowners section 2: personal liability: $100,000 per occurrence; medical payments: $1,000 per person

Policies effective 1 year

428
Q

Adjusting Code of Ethics: Disclosure

A

Adjusters shall disclose all direct or indirect financial interest they have in adjusting a claim

429
Q

Adjusting Code of Ethics: Equal Treatment

A

adjuster shall treat all claimants equally:
do not favor nice clients
do not disfavor your rude clients

430
Q

Adjusting Code of Ethics: Avoid Prejudice

A

must never be prejudiced in their investigations, adjustments, or settlements

431
Q

Adjusting Code of Ethics: Truthfulness

A

adjuster shall make truthful and unbiased reports of the facts after making a complete investigation

432
Q

Adjusting Code of Ethics: Integrity

A

shall handle every adjustment and settlement with honesty and integrity

433
Q

Adjusting Code of Ethics: Diligence

A

should act with speed and care in completing the adjusting process

every claim is important

failure to settle a claim in a timely manner can result in disciplinary action by the insurance commissioner

434
Q

Adjusting Code of Ethics: Reporting Violations

A

shall promptly report licensed insurance representatives whose conduct violates any insurance laws, rule, or order

435
Q

Adjusting Code of Ethics: Elderly Claimants

A

shall exercise extraordinary care when dealing with elderly clients:

take extra precautions to ensure an elderly claimant gets a complete and fair settlement

do not let failing memory or impaired cognitive processes disadvantage the claimant

436
Q

Adjusting Code of Ethics: Attorneys

A

Claimant has the right to representation by an attorney

Adjusters strictly prohibited from dealing directly with a claimant who has hired an attorney, in order to circumvent the advice of that attorney.

437
Q

Adjusting Code of Ethics: Witnesses

A

adjuster is permitted to interview any witness, or prospective witness, without the consent of opposing counsel or party

must avoid any attempt to influence witnesses

witnesses have the right to a copy of any signed or recorded statements

438
Q

Adjusting Code of Ethics: Right to Attorney

A

adjuster shall not advise a claimant to refrain from seeking legal advice, nor advise against the retention of counsel to protect the claimant’s interest

439
Q

Adjusting Code of Ethics: Traumatized Claimants

A

shall not attempt to negotiate with, or obtain any statements from, claimants or witnesses who appear to be in shock or under severe emotional distress

440
Q

Adjusting Code of Ethics: Advising of Rights

A

adjuster must advise claimants of all their claim rights in accordance with the terms and conditions of the contract and of applicable laws.

must make it clear to the claimant what losses are covered in a particular situation

441
Q

Adjusting Code of Ethics: Release Forms

A

adjuster shall not draft any form of release, unless approved in writing in advance by the insurer.

442
Q

Adjusting Code of Ethics: Competence

A

adjuster should not deal with a claim that he is not trained to take on

443
Q

Unfair Claims Settlement Practices

A

Forbidden by State Law

Misrepresenting Policy Coverage

Failing to acknowledge communications regarding claims promptly
adjuster often responsible for promptly contacting claimant
in Georgia, an insurer has 15 days to respond to a claim

Failing to implement procedures for claims investigation and settlement
insurer responsible for adopting and implementing procedures for proper investigation of claims

Failing to pay legitimate, undisputed claims

Low-balling claim estimates

Refusing to pay claims without having conducted reasonable investigation

Failing to affirm or deny coverage of claim within reasonable time frame
insurer must make decision within reasonable amount of time after receiving all information needed for investigation
insurer must notify claimant if extra time is needed
if insurer rejects claim, must provide a written statement explaining why

Making claims payments without explanation of coverage providing for them
all claims payments should be accompanied by a statement specifying which coverage was used to make payment

Delaying settlement process by requiring both formal proof of loss form and subsequent verification

Failing to provide prompt, reasonable, and accurate explanation for claim denial, when requested by insured in writing

Failing to provide claims forms promptly to claimant
insurers must provide all necessary paperwork to claimant within 15 days of claim being filed, along with clear explanation of their use

Failing to implement standards assuring good workmanship in company repair shops

Indicating payment is final or releases insurer form claim unless:
policy limit has been reached
compromise settlement has been agreed to by first-party claimant and insurer

Issuing payment under one coverage that includes language releasing insurer from its entire liability

444
Q

State Commissioners and Departments of Insurance

A

responsible for maintaining insurer solvency
regulating rates
protecting consumers
making insurance available for all individuals