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C110 Essentials of Loss Adjusting > Study 11 - Liability Claims > Flashcards

Study 11 - Liability Claims Flashcards

1
Q

What are the various types of personal liability coverage?

A
  • Legal liability
  • Voluntary medical payments
  • Voluntary payment for damage to property
  • Voluntary compensation for residence employees
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2
Q

What is typically specified under the premises covered?

A
  • All premises where the named insured or his or her spouse maintains a residence
  • Other residential premises specified in the policy (on coverage summary page) but not business property or farms
  • Individual or family cemetary plots or burial vaults
  • Vacant land in Canada that the insured owns or rents, excluding farmland
  • Land in Canada on which a one-, two-, or three- family residence is being built that will be occupied
  • Premises the insured is using or where the insured is temporarily residing if such premises are not owned
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3
Q

What are insureds covered for from liability?

A

Personal
Premises
Tenants legal
Employers

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4
Q

When is there no coverage for personal liability?

A
  • Personal actions of any named insured who does not live on the described premises
  • Ownership use, or operation of any motorized vehicle, trailer, or watercraft except those for which coverage is shown in this form
  • Damage to property the insured owns, uses, occupies or leases
  • Damage to property in the insured’s care, custody or control
  • Damage to personal property or fixtures as a result of work done on them by the insured or anyone on his or her behalf
  • Bodily injury to the insured or to any person residing in his or her household other than a residence employee
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5
Q

When is there no coverage for premises liability?

A
  • Damage to property the insured owns, uses, occupies or leases
  • Damage to property in the insured’s care, custody, or control
  • Damage to personal property or fixtures as a result of work done on them by the insured or anyone on the insured’s behalf
  • Bodily injury to the insured or to any person residing in his or her household other than a residence employee
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6
Q

What perils are under tenants legal liability?

A

Fire, explosion, water, smoke

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7
Q

In addition to the policy limit, what else will coverage E cover?

A
  • All expense the insurer incurs
  • All costs charged against the insured in any suit insured under coverage E
  • Any interest accruing after judgment on that part of the judgment within the amount of insurance in coverage E
  • Premiums for appeal bonds required in any insured lawsuit involving the insured and bonds to release any property that is being held as security up to the amount of insurance
  • Expenses that the insured incurs for emergency medical or surgical treatment to others following the accident or occurence
  • Reasonable expenses, including loss of earnings up to a specified dollar amount per day, which the insured incurs at the request of the insurer
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8
Q

What is included in the schedule of benefits for voluntary compensation for residence employees?

A
  • Loss of life, limb, sight or hearing
  • Weekly indemnity or disability
  • Medical expenses
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9
Q

What coverages have limitations under personal liability?

A
  • Watercraft
  • Motorized vehicles
  • Trailers
  • Business and business property
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10
Q

When is there no coverage from use of watercraft or motorized vehicles?

A
  • Carrying passengers for compensation
  • Business
  • Racing
  • Rental
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11
Q

What types of vehicles are insured under a personal liability policy?

A

Lawn mowers, snow blowers, small garden tractors and golf carts

Motorized equipment such as wheelchairs and scooters are also insured

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12
Q

What are the common exclusions of personal liability?

A
  • Invasion, war or civil war, insurrection, rebellion, revolution, terrorism, military or armed forces engaged in hostiles, whether war or not
  • BI or PD which is required to be insured by Nuclear
  • Business pursuits or business use of premises except otherwise specified in policy
  • Rendering of or failure to render professional service
  • Liability imposed by any workers comp
  • BI or PD caused by intentional criminal act or failure to act by anyone insured or at direction of insured
  • Any type of abuse
  • Transmission of communicable diseases
  • Ownership or use of any motorized except as provided in policy
  • Ownership or use or operation of any aircraft or airport/landing facility
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13
Q

What must the insured comply with in the event of a claim?

A

Notice of Accident/Occurrence - prompt, w/ details

Cooperation - help obtain witnesses, info, evidence

Unauthorized Settlement Cov E - not voluntarily make payment or assume obligation

Action Against Insurer Cov E - no action against insurer until policy has been met or until about of insurer’s obligation is determined

Action Against Insurer Cov F & G - suit not bring suit against insurer until insured has complied or until 60 days after proof of loss

Insurance Under More Than One Policy - If there is other insurance, this will be excess

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14
Q

What are the three categories of liability?

A

Negligence, nuisance & breach of contract

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15
Q

What are the four forms of tortfeasor negligence?

A
  • An unintentional act
  • Unintentional carelessness
  • A failure to act
  • An explicit act
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16
Q

What are the three elements of an actionable tort?

A

1) A legal duty of care must be owed
2) There must be a breach of duty
3) The breach must have caused the damage

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17
Q

Which case study was the precedent of ‘our neighbour’?

A

Donoghue v. Stevenson

18
Q

What happened in R. in Right of Canada v, Saskatchewan Wheat Pool?

A
  • Civil consequence of breach of statute should fall under law of negligence
  • Breach of statutory requirements is not in itself a tort that entitles a plaintiff to recover damages by simply proving the breach and damages
  • A breach of statutory requirements is not negligence in itself but proof of statutory breach and resulting damages may be evidence of negligence
  • Statutory formulation of the duty of care may afford a specific and useful standard of reasonable conduct
19
Q

What are the main three types of damages?

A

Compensatory - what someone is entitled to, making amends for the loss

Special - medical bills, etc

General - awarded by court for pain and suffering

Punitive/exemplary - to punish a defendant

20
Q

What was established in Veinot v. Kerr-Addison Mines Ltd?

A

A trespasser should be treated with common humanity

21
Q

What are the factors that should be considered in duty owed to a trespasser?

A
  • Gravity and likelihood of probable injury
  • Character of the intrusion
  • Nature of the premises
  • Knowledge the occupier had of the trespasser’s presence
  • Cost to the occupier of preventing harm
22
Q

What are the three other entrants beyond trespasser?

A

Licensee ; enters w/ consent of occupier, protect from known traps and dangers

Invitee ; enters w/ consent of occupier when occupier has financial or material interest, greatest duty, ie. customers

Contractual Entrant; enters premises due to contract with the occupier

23
Q

What was the relevance of Carriss v. Buxton?

A
  • Implied term that the premises are safe
24
Q

Who does the burden of proof usually lie with?

A

Person who sustained damage and wants to recover

25
Q

What is res ipsa loquitur?

A

The thing speaks for itself

26
Q

When does strict liability apply and what case was the basis for it?

A

Proof of negligence is not required as something was inherently dangerous; ie. industrial use of fire/water, commercial gas & electricity, domestic use of herbicides and wild or vicious animals

Rylands v. Fletcher; water reservoir caused damage on neighbouring property

27
Q

What are the only defences against strict liability?

A
  • Act of god
  • Escape was caused by third party’s actions
  • Escape was deliberate act of outside party
  • Dangerous thing was there with implied consent
  • Dangerous thing was authorized by statute
28
Q

When does absolute liability apply?

A

There is no defence for this; ie. control of spilled substances

29
Q

What is scienter (scienti non fit injuria)?

A

Actual or presumed degree of knowledge that makes a person legally responsible for his or her actions

30
Q

What are the three situations in which a parent would not be held liable?

A
  • Child was acting on parents instructions or under authority
  • Child was employed by the parent and acting within the scope of the employment
  • Damaged was caused by a dangerous thing or animal that the parents had allowed child to control
31
Q

What are the major defences of liability?

A
  • Proving that the elements required for an actionable tort are absent
  • Dental, emergencies, act of god and statutes
  • Voluntary assumption of risk
  • Contractual transfer of liability
32
Q

What was Scott v. Shepherd?

A

The squib case
Proximate cause
Emergency situation

33
Q

What is volenti non fit injuria?

A

Waives his or her right to pursue recovery due to something being dangerous but agreeing to do it

34
Q

When do people willingly accept risk?

A
  • Rural premises used for agriculture
  • Vacant or underdeveloped premises
  • Forested or wilderness premises
  • Golfcourse not open for playing
  • Utility rights of way and corridors
  • Unopened road allowances
  • Private roads that are reasonably identified by notices
  • Recreational trails that are reasonable identified by notices
35
Q

What three points must be proven for a liability claim to succeed in Quebec?

A
  • Duty of care existed
  • Breach of that duty
  • Damage was caused by that breach
36
Q

At what age in Quebec are children usually not deemed to be able to differ right from wrong?

A

Seven

37
Q

What are the six aspects of an investigation of a liability claim?

A
  • Understanding human behaviour
  • Determining scope of investigation
  • Determining who is responsible
  • Investigating slip and fall claims
  • Dealing with costs of litigation
  • Researching case law
38
Q

What is asked to determine the scope of the investigation?

A
  • What are the facts of the case?
  • What documentary evidence is available?
  • What other information must be obtained?
  • What is the legal liability of the insured for the occurrence?
  • Is there any other party who bears any responsibility for the action?
  • Is there any other insurance policy that might come into play?
  • Is there a need to retain an expert?

Why was the claimant there?
What is the claimaint’s relationship?
Location and type of building?

39
Q

What would you ask about the shoes of a claimant in a slip and fall situation?

A
  • Sole characteristics
  • Height of the heel
  • Comfort status for the claimant
  • Any other characteristic that may impact walking
40
Q

What should be reviewed regarding the waxing of floors?

A
  • How the wax was applied
  • Whether the manufacturer’s directions were followed
  • Whether the usual product was used
  • Whether any specific instructions were given by the insured
  • Whether any inspection of the completed job occurred
  • Whether any defects were noted, such as unpolished spots
41
Q

Explain personal liability coverage

A
  • Personal liability coverage under homeowners policies is a form of insurance meant to protect individuals and their families against the liability imposed upon them by law arising out of their daily activities that result in bodily injury or property damage to others.
  • They are also covered for liability they assume under a written agreement relating to their dwelling premises.
  • Applies only to accidents or occurrences that take place during the policy period.
  • The amount of insurance applies to each occurrence, regardless of how many insureds are covered or how many claims are made.
  • It is liability insurance for an individual’s personal liability exposures such as premises, personal activities, some contracts, and certain incidental coverages.
42
Q

Define legal liability

A
  • Legal liability is imposed by law on individuals or corporations to pay for harm done to others.
  • Such law may be the common law, statute law, or customs that over a period of time have taken on the same status as law.
  • Legal liability may also be assumed under the terms of a contract.
  • The policy states that the insurer will pay only compensatory damages for which the insured is legally liable.
  • The amount of insurance stated in the policy is the maximum amount that is available to pay losses in respect of one accident or occurrence.
  • Certain costs and expenses associated with defending an action will be paid in excess of the limit of insurance.

C110 Essentials of Loss Adjusting (11 decks)

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