UNDERSTANDING PROPERTY, LIABILITY & MOTOR VEHICLE INSURANCE

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1 UNDERSTANDING PROPERTY, LIABILITY & MOTOR VEHICLE INSURANCE 07/04 i

2 PUBLISHER S NOTICE IMPORTANT NOTICE EVERY CARE HAS BEEN TAKEN TO ENSURE THAT THE INFORMATION IN THIS GUIDE IS AS ACCURATE AS POSSIBLE AT THE TIME OF PUBLICATION. PLEASE BE ADVISED THAT LAWS AND PROCEDURES ARE CONSTANTLY CHANGING AND ARE ALSO SUBJECT TO DIFFERING INTERPRETATIONS. HOWEVER, NEITHER THE AUTHORS NOR THE PUBLISHERS ACCEPT ANY RESPONSIBILITY FOR ANY LOSS, INJURY, OR INCONVENIENCE SUSTAINED BY ANYONE USING THIS GUIDE. THIS INFORMATION IS INTENDED TO PROVIDE GENERAL INFORMATION AND BACKGROUND AND IS DISTRIBUTED ON THE BASIS THAT THE AUTHORS ARE NOT ENGAGED IN RENDERING LEGAL, ACCOUNTING, OR ANY OTHER PROFESSIONAL SERVICE OR ADVICE. THIS GUIDE WAS DESIGNED TO GIVE YOU AN OVERVIEW OF THE INFORMATION PRESENTED AND IS NOT A SUBSTITUTE FOR PROFESSIONAL CONSULTATION. Cpyright 2003, 2004 AHI Insurance Services All rights reserved. Printed in the United States f America. N part f this publicatin may be used r reprduced in any frm r by any means, transmitted in any frm r by any means, electrnic r mechanical, fr any purpse, withut the express written permissin f AHI Insurance Services, Inc. Making cpies f this bk fr any purpse ther than yur wn persnal use is a vilatin f the United States cpyright laws. AHI CE Services W Grand Av Franklin Park, Il Tll free: (800) (847) Fax: (847) Internet: 07/04 ii

3 TABLE OF CONTENTS PUBLISHER S NOTICE IMPORTANT NOTICE ii ii CHAPTER 1: FIRE INSURANCE 1 FIRE INSURANCE HISTORY...1 DEFINITION OF FIRE...1 BASIC PROVISIONS OF THE STANDARD FIRE POLICY... 1 Limitatins On Recvery... 1 Cvered Perils... 2 Assignment f the Plicy... 2 CONDITIONS, EXCLUSIONS, AND OTHER PROVISIONS...2 Cncealment and Fraud... 2 Excluded Prperty... 2 Excluded Perils... 2 Other Insurance... 2 Other Perils and Added Prvisins... 2 Prtectin f the Mrtgagee's Interest... 2 Prrate Liability Clause... 2 Appraisal Clause... 3 Cmpany's Optin... 3 Other Prvisins:... 3 FIRE INSURANCE RATING...3 SUMMARY...3 CHAPTER 2: DWELLING COVERAGES 4 THE 1984 HOMEOWNERS PROGRAM...4 TYPES OF HOMEOWNERS POLICIES...5 HO-1 (Basic Frm)... 5 HO-2 (Brad Frm)... 5 HO-3 (Special Frm)... 5 HO-4 (Cntents Brad Frm)... 5 HO-6 (Unit-wners Frm)... 5 HO-8 (Mdified Cverage Frm)... 5 POLICY LAYOUT...5 Declaratins... 5 Definitins... 6 ANALYSIS OF HOMEOWNERS (HO-2) POLICY...7 SECTION 1 - PROPERTY COVERAGE... 7 SECTION 1 - PERILS INSURED AGAINST... 8 Sectin 1 - Exclusins Sectin 1 - Cnditins Mrtgage Clause SECTION 2 Liability Cverage Sectin 2 - Exclusins Sectins 1 and 2 - Cnditins CHAPTER 3: PROPERTY INSURANCE COVERAGES 14 DWELLING 77 PROGRAM...14 Eligible Dwellings TYPES OF DWELLING FORMS...14 Dwelling Prperty 1 (Basic Frm) Dwelling Prperty 2 (Brad Frm) Dwelling Prperty (Special Frm) MOBILE HOME INSURANCE...15 Eligibility Cverage OCEAN AND INLAND MARINE INSURANCE...15 Inland Marine Insurance Inland Marine Flaters Persnal Articles Flater Persnal Prperty Flater i

4 Insurance n Pleasure Bats AIRCRAFT PROPERTY INSURANCE...20 FEDERAL PROPERTY INSURANCE PROGRAMS...20 Federal Fld Insurance Eligibility Requirements Amunts f Insurance Definitin f Fld FAIR PLANS...21 FEDERAL CRIME INSURANCE...21 FEDERAL CROP INSURANCE...21 TITLE INSURANCE...22 CHAPTER 4: FEMa 23 Emergency Supprt Functins Emergency Partners Federal-level Partners Disaster Declaratin Prcess And Federal Disaster Assistance...25 The Declaratin Prcess Available Assistance Individual Assistance What Types f Assistance Are Prvided? Hazard Mitigatin Federal Respnse Plan Partners...30 CHAPTER: 5 INVOLUNTARY INSURANCE MARKETS 32 Gals and Purpses Challenges in the Middle Years: Arsn and Brader Cverage FAIR Plans Tday Deppulatin and ther Trends Castal Prblems In Cnclusins CHAPTER 6: DWELLING INSURANCE BITS & PIECES 39 Hmewners Insurance A Brief Synpsis...39 Main Elements f Hmewners Insurance Understanding Dwelling Insurance...42 Renter's Insurance Cndminium Owners Insurance Valuable Items Insurance Excess Liability Insurance Hme Business Prtectin Fld Insurance Hme Insurance Illustratins Cndminium wners insurance example CHAPTER 7: THE BUSINESS OWNERS POLICY PLAN (BOP) 54 Histry f the Plicy Determining the Premium The Rating Prcedure Inspectin f the Site t Determine Insurance Needs Premium Debits and Credits Qualificatins fr Eligibility Businesses That Might Qualify fr a BOP Businesses That D Nt Qualify fr a BOP General Cnditins and Prvisins and Prvisins Specific t the BOP General Cnditins and Prvisins Prvisins Specific t the BOP...56 The Cancellatin Prvisin Calculating the Return Premium The Plicy Perid, the Plicy Territry and Time f Inceptin Prvisins The Other Insurance Prvisin The Duplicatin f Cverage Prvisin Available BOP Plicies...57 Deductibles in the Standard Frm General Prperty Limitatins Under the Standard Frm General Prperty Exclusins Under the Standard Frm Building Cverage (Sectin A)...59 ii

5 Buildings and Fixtures Quarterly Autmatic Insurance Rates Business Persnal Prperty Cverage (Sectin B)...59 Defining Business Persnal Prperty Business Persnal Prperty That Is in Transit r Being Mved Additinal Areas f Cverage Seasnal Autmatic Increases Lss f Incme Cverage (Sectin C)...60 Available Optinal Cverages Accunts Receivable Cverage Biler and Machinery Cverage Burglary and Rbbery Cverage Earthquake Cverage Emplyee Dishnesty Cverage Exterir Grade Flr Glass Cverage Exterir Signs Cverage The Special (All Risk) Plicy General Prperty Limitatins Under the Special Frm General Prperty Exclusins Under the Special Frm Mney and Securities Cverage (Sectin D) Additinal Optinal Cverages Business Liability (Sectin E) Limits f Liability Supplementary Payments Medical Payments (Sectin F) CHAPTER 8: MOTOR VEHICLE INSURANCE 67 THE TORT LIABILITY SYSTEM AND AUTOMOBILE INSURANCE...67 AN OVERVIEW OF THE PERSONAL AUTO POLICY...67 POLICY LAYOUT...68 THE DECLARATIONS PAGE LIMIT OF LIABILITY AGREEMENT DEFINITIONS SUMMARY OF PERSONAL AUTO POLICY COVERAGES...69 LIABILITY COVERAGE INSURING AGREEMENT Insured Persns SUPPLEMENTARY PAYMENTS EXCLUSIONS LIMIT OF LIABILITY OUT OF STATE COVERAGE FINANCIAL RESPONSIBILITY OTHER INSURANCE MEDICAL PAYMENTS COVERAGE...73 INSURING AGREEMENT EXCLUSIONS LIMIT OF LIABILITY OTHER INSURANCE UNINSURED MOTORISTS COVERAGE...74 INSURING AGREEMENT EXCLUSIONS LIMIT OF LIABILITY OTHER INSURANCE UNDERINSURED MOTORIST COVERAGE ARBITRATION PART D COVERAGE FOR DAMAGE TO YOUR AUTO TRANSPORTATION EXPENSES EXCLUSIONS LIMIT OF LIABILITY PAYMENT OF LOSS NO BENEFIT TO BALLEE OTHER INSURANCE APPRAISAL DUTIES AFTER AN ACCIDENT OR LOSS GENERAL PROVISIONS...80 BANKRUPTCY CHANGES FRAUD iii

6 LEGAL ACTION AGAINST US OUR RIGHT TO RECOVER PAYMENT POLICY PERIOD AND TERRITORY TERMINATION TRANSFER OF YOUR INTEREST IN THIS POLICY...82 TWO OR MORE AUTO POLICIES...82 INSURING MOTORCYCLES AND OTHER VEHICLES...82 APPROACHES FOR COMPENSATING AUTOMOBILE ACCIDENT VICTIMS...82 Financial Respnsibility Laws Cmpulsry Insurance Laws Unsatisfied Judgment Funds Uninsured Mtrist Cverage N-Fault Autmbile Insurance Arguments fr n-fault laws Basic characteristics f n-fault laws AUTOMOBILE INSURANCE FOR HIGH-RISK DRIVERS...84 Autmbile Insurance Plans (Assigned Risk Plans) Jint Underwriting Assciatins, (JUA.) Reinsurance Facilities Maryland Autmbile Insurance Fund Specialty Autmbile Insurers COST OF AUTOMOBILE INSURANCE...85 Territry Age, Sex, and Marital Status Use f the Autmbile Driver Educatin Gd Student Discunt Number and Type f Autmbiles Individual Driving Recrd Purchase Higher Deductibles Imprve Yur Driving Recrd MOTOR VEHICLE INSURANCE BITS &PIECES...85 Facts abut Rental Car Insurance Cverage Offered by the Rental Agency Other surces f cverage Aut Insurance Rates On The Rise...86 INDUSTRY FINANCIALS AND OUTLOOK Higher Medical Csts Higher Repair Csts Cst f Jury Awards Aut Theft Fraud & Abuse Factrs Affecting Aut Insurance Pricing AVERAGE EXPENDITURES ON AUTO INSURANCE NONSTANDARD AUTOMOBILE INSURANCE MARKET...88 Autmated Underwriting Tls...88 Insurance Scres Mdel Laws Credit-Related Insurance Scring Hw Credit Scring Helps the Insured Tyipcal Legislatin Regulating Insurers' Use f Credit Infrmatin CLUE and Other Prperty Claims Databases Insurers Use Of Clue Summary...92 CHAPTER 9: THE AGENCY RELATIONSHIP 93 HOW IS AGENCY CREATED?...93 AGENCY BY APPOINTMENT AGENCY BY ESTOPPEL AGENCY BY RATIFICATION...93 HOW THE AUTHORITY OF AN AGENT IS CREATED...93 EXPRESSED CONSENT IMPIED CONSENT APPARENT CONSENT THE AGENT AS A FIDUCIARY...94 LOYALTY SKILL AND CARE iv

7 DISCLOSURE TIMELINESS ACCOUNTABILITY OF FUNDS SOLE INTEREST DELIGENCE IN SOLICITATION OF BUSINESS COMPETATIVE FAIR PLAY CAPTIVE VS INDEPENDENT AGENTS...95 CAPTIVE AGENT INDEPENDENT AGENTS PRINCIPAL S OBLIGATIONS TO THE AGENT...96 THE EMPLOYMENT AGREEMENT...96 THE PRINCIPAL S OBLIGATION OF COMPENSATION...96 INDEMNIFICATION OF AGENT...96 BROKER'S OBLIGATIONS TO THE INSURER...97 v

8 CHAPTER 1: FIRE INSURANCE Fires are an alarming cause f financial insecurity. The destructin f prperty values and the lss f human life can be a traumatic experience t families and businesses alike. FIRE INSURANCE HISTORY Fires and fire insurance have mre than tw hundred years f American histry. The early fire marks f Benjamin Franklin's era still can be seen n sme Philadelphia buildings. Early subscribers wuld pay fire-fighting cmpanies in advance. In return fr the payment they wuld receive a metallic lg t put utside their building. Payments fr fire marks supprted the firefighting cmpanies. If a prtected prperty had a fire, the apprpriate firefighting cmpany was ntified then, nce the lg was identified, the fire was fught. During the early years f fire insurance, insurers drafted their wn plicies, which made the cntracts lack unifrmity. The cntracts were lengthy and restrictive. Numerus mral hazard clauses and ther restrictive prvisins were inserted int the cntracts, which permitted insurers t deny claims. The cntracts were als cumbersme and difficult t understand. In 1873, Massachusetts became the first state t adpt a standard plicy fr the writing f fire insurance. New Yrk passed a similar law in The standard fire plicy was later revised in 1918 and later in The 1943 New Yrk Standard Fire Plicy is nw used in mst states, and minr variatins f it are used in the ther states. Tw majr advantages result frm a standard plicy, such as is demnstrated in a Standard Fire Plicy. First, lss-adjustment prblems are reduced, since the pssibility f tw cntracts with different plicy prvisins is reduced. Secnd, there are fewer legal difficulties, since the curts have interpreted the wrds, phrases, and prvisins f the standard cntract repeatedly, and their meaning is knwn mre precisely. The SFP is an incmplete cntract, and an apprpriate frm must be added t it. A frm must be added because prperty has different characteristics, and the insurance needs f individuals and business firms vary widely. In recent years, the SFP has declined in imprtance. Many states have passed laws that require insurance cntracts t be mre readable. In view f the trend twards readable cntracts and package plicies, the SFP has been eliminated as a separate cntract fr certain types f insurance, and SFP s basic prvisins are nw incrprated int the newer cntracts. Despite its reduced imprtance the SFP remains an imprtant dcument. The basic prvisins f the SFP have been incrprated int the newer readable cntracts. Many basic prperty insurance cncepts were first legally defined in the SFP, fr example, the principles f indemnity, insurable interest, actual cash value, and pr rate sharing f lsses. Finally, the SFP is still used t insure cmmercial buildings and business prperty that d nt qualify fr cverage under the newer cntracts. DEFINITION OF FIRE 'Fire" is never defined in insurance plicies, perhaps because Its meaning is well established by the curts. First, there must be cmbustin r rapid xidatin that causes a flame r at least a glw. Thus, scrching, heating, and charring that ccur withut a flame r glw are nt cvered. Secnd, the fire must be hstile r unfriendly. A hstile fire is ne that is uncnfined and beynd designated bundaries. A friendly fire is ne deliberately ignited and remaining within a desired bundary. It makes n difference if a fire begins as friendly an subsequently becmes hstile, r if a fire begins as hstile, if an insured is t cllect fr a fire lss, the prximate cause, r an intervening cause must be a hstile fire. If water damage was sustained when the fire department put ut a hstile fire, the prximate cause f the water damage wuld be the hstile fire, and this damage wuld be cvered by a fire plicy. Frtunately fr mst prperty wners, fire insurance usually is purchased in packages specifying ther related perils, s the legal issues cnfrnted histrically by insured purchasing nly fire insurance shuld nt be frequently encuntered. BASIC PROVISIONS OF THE STANDARD FIRE POLICY Cnsideratin Plicy Term Persns Insured The SFP cvers the named insured and his r her legal representative. The named insured can be an individual, business assciatin, r crpratin. A party nt specified, as a named insured has n legal right t receive a lss payment directly even thugh that party has an insurable interest in the prperty at the time f lss. Limitatins On Recvery Face amunt f the plicy Actual cash value Amunt t repair r replace the prperty with similar materials N allwance fr increased cst f repair due t sme rdinance r law 1

9 N cverage fr business incme r ther indirect lss Insurable interest f the insured Cvered Perils Only three perils are cvered in the insuring agreement. T have cverage under the SFP, an insured peril must be the prximate cause f the lss. This means there is an unbrken chain f events between the ccurrence f an insured peril and damage r destructin f the prperty. Assignment f the Plicy The SFP cannt be validly assigned t smene else withut the insurers written cnsent. CONDITIONS, EXCLUSIONS, AND OTHER PROVISIONS Cncealment and Fraud If the insured willfully cnceals a material fact r makes a material misrepresentatin, either befre r after a lss, the insurer can vid the plicy. Excluded Prperty This includes accunts, bills, currency, deeds, evidence f debt, mney, and securities. Excluded Perils Enemy attack; Invasin; Insurrectin; Rebellin; Civil war; Usurped pwer; Order f any civil authrity; Neglect f the insured t prtect the prperty; Lss by theft. Other Insurance Suspensin f Insurance Material increase in hazard Vacancy r un-ccupancy beynd sixty days N cverage fr rit r explsin, unless a fire ensues Other Perils and Added Prvisins Prhibitin f Waiver N plicy prvisin can be waived unless it is in writing and attached t the plicy. Cancellatin Either the insured r the insurer can cancel the SFP. In either case, a premium refund based n the shrt-rate table will be made t the insured rather than a pr rate refund based n the unearned premium. Prtectin f the Mrtgagee's Interest The mrtgagee is prtected in a dwelling plicy in the fllwing fashin: Purchase f separate insurance; Assignment f the plicy by the insured Lss payable clause; Standard Mrtgage Clause. Prrate Liability Clause Applies when mre than ne plicy cvers the same insurable interest in the prperty. Requirements If a Lse Occurs The insured must give immediate written ntice f the lss t the cmpany; The insured is required t prtect the prperty frm further damage; 2

10 Unless extended in writing by the cmpany, the insured must file a satisfactry prf f lss within sixty days. Appraisal Clause Appraisal clause is used when the insured and insurer cannt agree n the actual cash value r amunt f the lss. The purpse f the appraisal clause is t reduce litigatin and prvide an equitable and fair prcedure fr reslving any disagreement cncerning the amunt f lss. Cmpany's Optin The cmpany has the ptin f paying the claim in dllars, r it can: Repair, Rebuild, Replace the prperty with materials f like kind and quality. N Abandnment f Prperty The cmpany has the ptin t take salvage at its agreed r appraised value, but the cmpany cannt be frced t take salvage, and the insured cannt abandn the prperty. Other Prvisins: The insurer must pay the lss within sixty days after prf f lss is received. A lawsuit against the cmpany cncerning the lss must be made within twelve mnths after the lss and nly upn cmpliance with all plicy prvisins pertaining t the insured's bligatins at the time f and after the lss. The insurer may require frm the insured an assignment f the right f recvery against any party wh may have caused the lss t the extent f the lss payment. FIRE INSURANCE RATING A fire insurance rate is the cst per hundred dllars f expsure value. The premium is calculated by multiplying the rate times the number f hundreds f dllars f value in the expsure. Fire insurers, t prduce rates, cmmnly use tw different methds: classes rating and schedule rating perates by cmbining cmparable units int a class and then charging a class rate reflecting the lss experience and expenses f the class analyzes each prperty individually and is used primarily in rating cmmercial buildings. SUMMARY Fr mre than sixty years the 1943 New Yrk Standard Fire Insurance Plicy prvided the backbne f American fire insurance cntracts. Cmmercial fire insurance is prvided as ne part f a seven-part cmmercial insurance package. Prperty cverage falls int three categries: buildings, persnal business prperty, and prperty f thers. Fire and ten ther perils are specified causes f lss in the basic frm. Mre extensive cverage is available in the brad and special frms. Indirect lss cverage is available fr incme lst, and extra expenses, fllwing a direct lss. Incme lst because f direct lsses at dependent prperties can als be insured. Fire insurance rates are usually determined n a schedule r a class-rating basis. Schedule rating requires cmparing prperty t a standard expsure and increasing r decreasing the premium fr desirable r undesirable features. Class rating invlves placing prperty in a class with similarly situated expsures. Fcus Pints Firefighting services were riginally built n a subscriptin basis. Subscribers wuld prepay firefighting cmpanies t fight future fires. Original fire insurance cnsisted f insurers drafting their wn plicies. Massachusetts was the first state t adpt a standard fire insurance plicy in In 1886 New Yrk passed a similar laws t establish a standard fire insurance plicy. The 1943 New Yrk Standard Fire Plicy is nw used in mst states. Standard Fire Plicy is als knwn as SFP. The SFP is an incmplete cntract, and apprpriate frms must be added t it. 3

11 SFP s must have additinal frms added t it because prperties have different characteristics. The SFP is n lnger as imprtant as it nce was. Basic prvisins f the SFP have been incrprated int the newer readable cntracts. The term fire is never defined in insurance plicies. A hstile fire is uncnfined and passes beynd designated bundaries. A friendly fire is ne deliberately ignited and remaining within a desired bundary. A fire must be cnsidered hstile fr an insured t cllect n a fire plicy. Water damage ccurring frm fighting a hstile fire wuld be cvered under a fire plicy. Cnsideratin, plicy term and persns insured are the basic prvisins f the SFP. Only three perils are cvered in the insuring agreement. Fr cverage under the SFP, an insured peril must be the prximate cause f the lss. The SFP cannt be assigned t anther party withut the insurers written cnsent. Misrepresentatin r cncealment f material fact either befre r after a lss, can make the plicy vid. There are prperties cnsidered excluded frm cverage. Vacancy r un-ccupancy beynd sixty days results in the suspensin f insurance. N plicy prvisin can be waived unless it is in writing and attached t the plicy. The insured r the insurer can cancel the SFP. Prrate liability applies when multiple plicies cver the same interest in the prperty. Appraisal clause is used when the insured and insurer cannt agree n the actual cash value r amunt f the lss. Insurance cmpanies can repair, rebuild, r replace the prperty r pay the claim in cash. The insurer must pay the lss within sixty days after prf f lss is received. Lawsuits against the cmpany must be made within twelve mnths after the lss. The fire insurance rate is the cst per hundred dllars f expsure value. Calculating premiums: Rate X hundred s f dllars f value in the expsure. T prduce rates fire insurers use classes rating and schedule rating. CHAPTER 2: DWELLING COVERAGES Hmewners insurance is a package plicy that cmbines tw r mre separate cntracts int ne plicy. Prir t the intrductin f hmewners insurance in the 1950s, prperty insurance n a private dwelling and persnal prperty, theft cverage, and persnal liability insurance culd nt be btained in ne plicy. The current hmewners (HO) frmat incrprates the standard fire plicy with ther cverage's including cmprehensive persnal liability insurance, additinal living expense cverage, replacement-cst cverage n the dwelling, and medical expense cverage fr peple ther than the hmewner and family. In 1976 the Insurance Services Office (ISO) made a significant revisin in the language f the HO insurance plicy. The Hmewners 76 Plicy referred t the plicy wner as yu and the insurer as we. The standard fire plicy was eliminated as a separate dcument, and its basic prvisins were incrprated int the hmewner plicy itself. THE 1984 HOMEOWNERS PROGRAM The Hmewners 76 Prgram was nt adpted in several states and the lder frms were used instead. Eliminatin f the standard fire plicy as a separate dcument caused prblems in sme states, since law mandated the standard fire plicy. 4

12 The ISO revised the hmewner s plicy in 1982 and it was initially intrduced n a trial basis in six states in 1982 and early 1983, the mst recent HO frms were intrduced in A hmewner cntract n a private dwelling can be written nly n an wner-ccupied dwelling that des nt cntain mre than tw families (fur in sme states). TYPES OF HOMEOWNERS POLICIES HO-1 (Basic Frm) HO-1 insures the dwelling and ther structures and als cvers the insured's persnal prperty. Hmewner s-1 is a named-perils plicy. Hmewners-1 is nt widely used at the present time and has been withdrawn frm use in many states. HO-2 (Brad Frm) HO-2 expands the cverage under the basic frm and adds several new perils. HO-3 (Special Frm) HO-3 insures the dwelling and ther structures against the risks f direct physical lss t prperty except thse lsses specifically excluded. Persnal prperty is cvered by the same brad named perils listed in HO-2, plus the peril f damage by glass r safety glazing material that is part f a building, strm dr, r strm windw. HO-4 (Cntents Brad Frm) HO-4 is specifically designed fr tenants f rented premises. Hmewner 4 cvers the tenant's persnal prperty against lss r damage, and it als prvides persnal liability insurance as well. HO-6 (Unit-wners Frm) HO-6 is designed fr the wners f cndminium units and cperative apartments. Hmewners 6 cvers the persnal prperty f the insured fr the same named perils listed in Hmewners 2. There is als a minimum f $1 000 f insurance n the cndminium unit that cver the fllwing prperty: a. Alteratins, appliances, fixtures, and imprvements that are part f the residence premises, such as built-in appliances, carpets, additinal kitchen cabinets, and wallpaper. b. Real prperty that pertains exclusively t the residence premises, such as a pati r balcny, r trees r shrubs n the pati. c. Prperty that may be the insured's respnsibility under the cndminium wners agreement, such as fixtures r interir partitins. d. Structures wned slely by the insured, ther than the cndminium unit, which is at the lcatin f the cndminium unit, such as a private garage r fence HO-8 (Mdified Cverage Frm) HO-8 is a mdified HO-1 frm by which lsses t the dwelling and ther structures are paid based n the amunt required t repair r replace the prperty using cmmn cnstructin materials and methds. Payment is nt based n replacement cst. In additin, theft cverage is limited t lsses that ccur n the residence premises up t a maximum f $1000 per ccurrence. The HO-8 frm is designed fr lder hmes in urban neighbrhds where the replacement cst f a huse may substantially exceed its market value. POLICY LAYOUT Declaratins The HO's frnt-page displays descriptive material called the declaratins, which cme frm the insurance applicatin. The declaratins shw: Rating infrmatin the insurer used t calculate the premium, The name and address f the named insured appears, The time when the plicy begins and ends is shwn, The maximum limits f the insurance cmpany's liability fr the different cverage are entered. The Insurers Limit f Liability is Divided Int Tw Sectins 5

13 Sectin 1: prvides prperty insurance prtectin and is divided int fur cverage's (r insuring agreements), each with a separate limit f liability. Sectin 2: prvides liability cverage and is divided int tw cverage s. Hmewner s cverage is that each cverage (A thrugh F) is treated separately. Dllars may nt be transferred amng the varius cverage s. The maximum amunt the insured culd cllect is the sum f all the cverage s. Cverage A cvers the insured's hme. Cverage B applies t such Items as an unattached garage r shed. Cverage C applies t prperty usually fund in hmes such as furniture, clthes, appliances, and ther persnal prperty. Cverage D, lss f use, pays fr extra expenses if a cvered lss prevents the insured frm living in the hme. The limits f liability fr the varius insuring agreements fund in Sectin 1 are determined as a percentage f cverage A. That is, nce the insured chses an amunt fr cverage A, cverage B autmatically equals 10 percent f this amunt. Cverage C equals 50 percent f cverage A. Cverage D equals 20 percent f cverage A. If an insured needs additinal prtectin, cverage's B, C, r D may be increased. Cverage may nt be reduced belw the specified percentages. The insured must pay an additinal charge fr increased cverage. Sectin 2 Prvides Liability Prtectin and is Divided Int Tw Cverage s. Cverage E prvides prtectin frm adverse legal judgments. Cverage F prvides fr medical payments t thse injured by accident arising at the insured's premises r resulting frm the insured's activities. Cverage is available withut establishing the hmewner s legal liability. Definitins Immediately fllwing the insuring agreement is a shrt glssary that determines the meaning f eight imprtant terms that are fund thrughut the plicy in bldface type. Bdily injury means bdily harm, sickness r disease, including required care, lss f services and death that results. Business includes trade, prfessinal r ccupatin. Insured means yu and residents f yur husehld wh are: Yur relatives, Other persns under the age f 21 and in the care f any persn named abve, With respect t animals r watercraft t which this plicy applies, any persn r rganizatin legally respnsible fr these animals r watercraft which are wned by yu r any persn included in r abve. A persn r rganizatin using r having custdy f these animals r watercraft in the curse f business r withut the cnsent f the wner is nt an insured. With respect t any vehicle t which this plicy applies: Persns while engaged in yur emply r that f any persn included in a r b abve, Other persns using the vehicle n an insured lcatin with yur cnsent means, Insured Lcatin means: The residence premises, The part f ther premises, ther structures and grunds used by yu as a residence and: Which is shwn in the Declaratins, Or which is acquired by yur during the plicy perid fr yur use as a residence. 6

14 Any premises used by yu in cnnectin with a premises in a r b abve, Any part f a premise, Vacant land, ther than farmland, wned by r rented t an insured, Land wned by r rented t an insured n which a ne r tw family dwelling is being built as a residence fr and insured. Individual r family cemetery plts r burial vaults f an insured r, Any part f a premise ccasinally rented t an insured fr ther than business use. Occurrence means an accident, including expsure t cnditins, which results, during the plicy perid, in: Bdily injury; Prperty damage. Prperty damage means physical injury t, destructin f, r lss f use f tangible prperty. Residence emplyee means: An emplyee f a persn whse duties are related t the maintenance r use f the including husehld r dmestic services; One wh perfrms similar duties elsewhere nt related t the business f the insured. Residence premises means: The ne family dwelling, ther structures, and grunds, That part f any ther building; where yu reside and which is shwing the 'residence premises' as the in the Declaratins. Residence premises als means a tw family dwelling where yu reside in at least ne f the family units and which is shwn as the residence premises" in the Declaratins. ANALYSIS OF HOMEOWNERS (HO-2) POLICY SECTION 1 - PROPERTY COVERAGE Sectin 1 f the HO cnsists f fur parts. They are labeled A thrugh D and Additinal Cverage s. Sectin 1 infrms the insured what prperty and ther lsses are cvered and what lsses are nt cvered. Cverage A applies t the insured's residence premises shwn n the Declaratins. A secnd hme r summer cttage, which might be cnsidered a temprary residence, is nt cvered, since it des nt appear in the Declaratins. Cverage B applies t ther structures n the residence premises separated frm the hme by a clear space. An unattached garage r tls shed are examples f prperty cvered in this sectin. Cverage C applies t persnal prperty f the insured lcated anywhere in the the plicy. wrld. Special limits n sme prperty are detailed in Smetimes the questin is raised whether a specific item is real r persnal prperty. If it were real prperty, it wuld be cvered under Cverage A. If it were persnal, it wuld be cvered under Cverage C. The English cmmn law rule is land and anything permanently attached t land is real prperty The Special Limits f Liability passage establishes maximum dllar amunts that can be recvered when the specifically identified prperty is lst. In sme cases the limits apply nly t lss by the peril r theft; in ther cases, any lss is subject t the specified limits. Special limits f liability These limits d nt increase the Cverage C limit f liability. The special limit fr each numbered categry belw is the ttal limit fr each lss fr all prperty in that categry. $200 n mney bank ntes, bullin, gld ther than gld ware, silver ther than silverware, platinum, cins and medals, 7

15 $1000 n securities, accunts, deeds, evidences f debt, letters f credit, ntes, ther than bank ntes, manuscripts, passprts, tickets and stamps, $1 000 n watercraft, including their trailers, furnishings, equipment and utbard mtrs, $1000 n trailers nt used with watercraft, $1000 n grave markers, $1000 fr lss by theft f jewelry, watches, furs, precius and semi- precius stnes, $2000 fr lss by theft f firearms, $2500 fr lss by theft f silverware, silver-plated ware, gld ware, gld-plated ware and pewter-ware. This includes flatware, hllwware, tea sets, trays and trphies made f r including silver, gld r pewter. $2500 n prperty, n the residence premises used at any time r in any manner fr any purpse. $250 n prperty, away frm the used at any time r in any manner fr any business purpse. Persnal prperty insured elsewhere, such as in a Persnal Prperty Flater. Mtr vehicles and Equipment Prperty assciated with renting f an apartment was previusly called "Additinal Living Expense." The frmer term seems mre infrmative, because R emphasizes that the insurance cvers nly the necessary increase in living expenses... fr the shrtest time required t repair r replace the damage. Additinal Cverage Debris remval csts are cvered; Expenses incurred t prtect prperty frm further damage are cvered; A limited amunt f cverage is available fr damage t trees and shrubs; Fire department service charges will be reimbursed; Prperty remved frm the residence because it was endangered and that is subsequently damaged r stlen at the remval site is cvered; Credit card fraud and similar frauds are cvered fr a limited amunt; Certain lss assessments in cperative-type buildings are paid up t a $1000 limit; Cllapse - Cllapse had been a specifically named peril in prir versins f the HO insurance plicy. Nw it is given special treatment. Cllapse is difficult t define, because it can be the result f many different causes. Mrever, sme curts have intrduced the dctrine f This rule states, when a lss arises frm tw separately identifiable perils, ne cvered (fr example, negligence r cllapse) and ne excluded (fr exam pie, undergrund water pressure), cverage will be prvided by the HO. Cncurrent causatin curt decisins have led t deliberate treatment f lsses assciated with cllapse as an additinal cverage instead f as a named peril. SECTION 1 - PERILS INSURED AGAINST (HO-2) Prperty insurance plicies take ne f tw basic frmats: (1) they may specify the perils that can prduce an insured lss, r (2) they may prvide cmprehensive r pen perils cverage and specify the exclusins that apply. Insurers are nw aviding using the term, all risks cverage, because n insurance plicy cvers all pssible lsses. The term "cmprehensive cverage" nw is als being avided fr the same reasn. Fire r Lightning Fire means a hstile fire, ne nt cntained in its prper place. Lightning is a pwerful discharge f natural electricity. Direct lsses frm lightning are smetimes hard t prve especially when the nly damage that ccurs is t TV sets and ther appliances. Windstrm r Hail Under this peril, HO-2 prvides prtectin against trnades and all ther surces f vilent wind damage. The cverage excludes damage t the interir f the buildings r cntents if the exterir f the building first sustains n damage. 8

16 Explsin Explsin is a difficult term t define, and the term is nt defined in the plicy. There may be fire r lud nise accmpanying an explsin. There may be cnfinement f gases under pressure. When a cmbinatin f sme r all f these events causes damage-fr instance, when a furnace blws up HO-2 cvers the damage caused by the event. Rit r Civil Cmmtin War, civil war, and insurrectin are nt cvered but lesser hstilities are cvered. The issue f terrrists' acts will prbably have t be addressed by the curts and by insurers. Aircraft and Vehicles Aircraft damage includes damage caused by spacecraft failing n a huse. HO-2 (but nt HO-3) excludes lsses t fences, driveways, and walks caused by vehicles perated by an ccupant f the huse. Sudden and Accidental Smke Damage The smke damage caused by a smldering electric blanket may be cvered under this prvisin, as may damage resulting frm faulty cking appliances. If fire fighters cause water damage putting ut the smldering, this -t wuld be cvered, because the prximate cause f the lss wuld be the smldering blanket r stve. Vandalism r Malicius Mischief If thers willfully and intentinally damage the hmewner s prperty, there is cverage in the HO-2 cntract. The cverage fr these tw perils is suspended if the huse has been vacated fr thirty days befre the lss. Vacant means the insureds and their pssessins are absent frm the huse. When an insured takes a vacatin with plans t return hme, the huse is unccupied rather than vacant, and the cverage remains in effect. Theft Theft means the crime f remving prperty withut the wner's permissin. Theft generally des nt include lsses by fraud r mysterius disappearance f prperty. Three exclusins t theft cverage are in the HO, including the theft cmmitted by an insured. Additinal restrictins apply if the theft ccurs ff the residence premises including in a cllege drm r apartment. Breakage f Glass Breakage f glass is a result and nt a cause f lss. This is cmprehensive cverage. Any peril causing structural glass (part f the building) t break prduces an insured lss. Falling Objects The building must sustain exterir damage befre interir damage is cvered. If a tree limb were t fall and break thrugh the rf, cverage wuld be prvided fr the rf and damaged cntents. Accidental Damage Caused by Plumbing Lss t plumbing, appliances, sprinkler systems, r air cnditiners is nt cvered. Only the lsses resulting frm water leakage by these units are cvered. Damage caused by slw and repeated leaks is excluded, hwever, as is damage sustained if the building is vacant fr mre than thirty cnsecutive days befre a lss. Sudden Destructin f Water Heaters, Heating Systems, Air Cnditiners, r Sprinklers The prvisin cvers the explsin f these units, but lsses resulting frm freezing are cvered separately. Freezing f Plumbing If the building is ccupied, r even if the building is unccupied as lng as a serius attempt is made t heat it, and frzen pipes that burst cause damage, HO-2 prvides cverage. Sudden Damage frm Artificially Generated Electrical Currents Cverage is prvided fr electrical appliances excluding damage t tubes, transistrs, and similar parts. If a surge f pwer were sent thrugh the electric lines and burned ut a mtr, there is cverage. Shrt-circuit damage may als be cvered in sme cases. 9

17 Damage dne by explsin, lava flw, r vlcanic ash wuld be cvered; earthquake damage is specifically excluded The eruptin f Munt St. Helen's raised several questins abut HO insurance cverage. Sectin 1 - Exclusins Eight exclusins apply t the Sectin 1 cverage in HO-2. Each f the eight exclusins eliminates the insurer's liability fr the insured lss. The language f the HO makes this pint as fllws: We d nt insure fr lss caused directly r indirectly by any f the fllwing. Such lss is excluded regardless f any ther cause r event cntributing cncurrently r in any sequence t the lss. Ordinance r Law Meaning enfrcement f any rdinance r law regulating the cnstructin, repair, r demlitin f a building r ther structure, unless specifically prvided under this plicy. Earth Mvement Meaning earthquake including land shck waves r tremrs befre, during r after a vlcanic eruptin; landslide; mudflw; earth sinking, rising, r shifting; unless direct lss by: Fire; Explsin; Breakage f glass r safety glazing material which is part f a building; Strm dr r strm windw; Ensues and ensuing lss; This exclusin des nt apply t lss by theft. Meaning f Water Damage Fld, surface water, waves, tidal water, verflw f a bdy f water, r spray frm any f these, whether r nt driven by wind. Water, which backs up thrugh sewers r drains; Water belw the surface f the grund; Water, which exerts pressure n r seeps r leaks thrugh a building, sidewalk, driveway, fundatin, swimming pl r ther structure; Direct lss by fire, explsin r theft resulting frm water damage is cvered. Pwer Failure Meaning the failure f pwer r ther utility service if the failure takes place ff the But, if a Peril Insured Against ensues n the, we will pay nly fr that ensuing lss. Neglect Meaning neglect f the insured t use all reasnable means t save and preserve prperty at and after the time f a lss. War Undeclared war Civil war Insurrectin Rebellin Revlutin Warlike act by a military frce r military persnnel Destructin r seizure r use fr a military purpse Including any cnsequence f any f these Discharge f a nuclear weapn will be deemed a warlike act even if accidental. Nuclear Hazard T the extent set frth in the Nuclear Hazard Clause f Sectin I - Cnditins. 10

18 Intentinal Lss Meaning any lss arising ut f any act cmmitted by r at the directin with the intent t cause a lss. Sectin 1 - Cnditins Several f the HO-2 cnditins were derived frm the Standard Fire Plicy (SFP). Lss Settlement The lss settlement prvisin presents several alternative paths t determine the amunt f payment made t the insured in the event f lss. Cvered prperty lsses are settled as fllws: Buildings under Cverage A r B at replacement cst withut deductin fr depreciatin, subject t the fllwing: If, at the time f lss, the amunt f insurance in this plicy n the damaged building is 80% r mre f the full placement cst f the building, immediately befre the lss, we will pay the cst t repair r replace, after applicatin f deductible and withut deductin fr depreciatin, but nt mre than the least f the fllwing amunts: The limit f liability under this plicy that applies t the building, The replacement cst f that part f the building damaged fr like cnstructin and use n the same premises, The necessary amunt actually spent t repair r replace the damaged building, If, at the time f lss, the amunt f insurance in this plicy n the damaged building is less than 80% f the full replacement cst f the building immediately befre the lss, we will pay the greater f the fllwing amunts, but nt mre than the limit f liability under this plicy that applies t the building: The actual cash value f that part f the building damaged, That prprtin f the cst t repair r replace, after applicatin f deductible and withut deductin fr depreciatin, that part f the building damaged, which the ttal amunt f insurance in this plicy n the damaged building bears t 80% f the replacement cst f the building. Replacement Cst and Insurance t Value Requirement The lss settlement prvisin f HO-2 cntains a penalty prvisin that applies if the insured has purchased less than 80 percent f replacement cst. The HO penalty prvisin is similar t the cmmnly fund in cmmercial prperty insurance plicies. The purpse f bth the cinsurance clause and the HO lss settlement clause is t make under insurance unattractive t the insured. Bth clauses prvide fr that the insured t pay a penalty based n the amunt f under insurance. Many prperty plicies cntain a clause requiring the insured t purchase sme minimum amunt f insurance if the insured wants full cverage n all lsses. If the insured purchases less than the minimum amunt, there will be nly partial recvery fr lsses. The minimum amunt f insurance the cmpany requires usually is stated as a percentage f the replacement cst f the insured prperty. T determine whether the insured has met the cinsurance requirement n the dwelling, -insurers uses the fllwing frmula: amunt f insurance purchased amunts X f = insurance 80% f replacement cst lss prceeds. If the first term in the equatin is less than 1, the insured will bear a prtin f the lss. The insured is said t be a "cinsurer f the lss." If the fractin is equal t r greater than 1, the insurer will pay the full amunt f the lss, limited t the face amunt f insurance purchased. Reasns fr the Cinsurance Requirement What is the reasn fr the cinsurance requirement? It exists t keep insurance rates fair. If prperty wners, recgnizing mst lsses are partial, purchased insurance equal t nly 50 percent f the value f the cvered prperty, they might think that the mst significant part f the risk had been transferred. Withut the cinsurance penalty, they wuld have an advantageus deal. The cinsurance requirement f prperty insurance plicies prevents insureds frm taking advantage f the insurers average rate structure. If smene purchases insurance equal t 50 percent f the value f the prperty when the insurer requires 80 percent cverage, that insured will receive nly partial recvery fr a lss. 11

19 Mrtgage Clause The HO has prvisins prtecting creditrs making lans secured by the insured prperty. This prtectin is fund in the mrtgage is evidence f a debt. It is the security agreement when a lan is made n real estate. A mrtgage gives the lender (mrtgagee) a legal interest in the prperty mrtgaged. If the brrwer (mrtgagr) defaults n the lan agreement, the mrtgagee may freclse n the mrtgage and sell the prperty t satisfy the debt. Bth the mrtgagr and the mrtgagee have an insurable interest in the prperty. The wrd 'mrtgagee' includes trustee. If a mrtgagee is named in this plicy, any lss payable under Cverage A r B will be paid t the mrtgagee and yu, as interests appear. If mre than ne mrtgagee is named, the rder f payment will be the same as the rder f the mrtgages. If we deny yur claim, that denial will nt apply t a valid claim f the mrtgagee, if the mrtgagee: Ntifies us f any change in wnership, ccupancy, r substantial change in risk f which the mrtgagee is aware; Pays any premium due under this plicy n demand if yu have neglected t pay the premium; Submits a signed, swrn statement f lss within 60 days after receiving ntice frm us f yur failure t d s; Plicy cnditins relating t Appraisal, Suit Against Us and Payment apply t the mrtgagee; If the plicy is cancelled r nt renewed by us, the mrtgagee will be ntified at least IO days befre the date f cancellatin r nn - renewal takes effect. If we pay the mrtgagee fr any lss and deny payment t yu: We are subrgated t all the rights f the mrtgagee granted under the mrtgage n the prperty; At ur ptin, we may pay t the mrtgagee the whle principal n the mrtgage plus any accrued interest. In this event, we will receive a full assignment and transfer f the mrtgage and all securities held as cllateral t the mrtgage debt; Subrgatin will nt impair the right f the mrtgagee t recver the full amunt f the mrtgagee's claim. SECTION 2 Liability Cverage Cverage E Persnal Liability If a claim is made r a suit is brught against and fr damages because f r caused by an t which this cverage applies, we will: Pay up t ur limit f liability fr the damages fr which the is legally liable; Prvide a defense at ur expense by cunsel f ur chice, even if the suit is grundless, false r fraudulent. We may investigate and settle any claim r suit that we decide is apprpriate. Our duty t settle r defend ends when the amunt we pay fr damages resulting frm the ccurrence equals ur limit f liability. Cverage F Medical Payments T Others We will pay the necessary medical expenses that are incurred r medically ascertained within three years frm the date f an accident causing Medical expenses means reasnable charges fr medical, surgical, x-ray, dental, ambulance, hspital, prfessinal nursing, prsthetic devices and funeral services. This cverage des nt apply t yu r regular residents f yur husehld except residence emplyees. As t thers, this cverage applies nly: T a persn n the insured lcatin with the permissin f an insured T a persn ff the insured lcatin, if the bdily injury: Arises ut f a cnditin n the insured lcatin r the ways immediately adjining; Is caused by the activities f an insured; Is caused by a residence emplyee in the curse f the residence emplyee's emplyment by the insured; Is caused by an animal wned by r in the care f an insured. The interpretatin f these clauses is that the insurer agrees t pay fr successful judgments against the insured resulting frm the nnbusiness activities f the named insured and his husehld residents. 12

20 It agrees t prvide the insured with a lawyer t defend lawsuits. The insurer retains the right t make a settlement with a claimant if the insurer thinks a settlement is expedient (advantageus). In prfessinal liability insurance plicies, such as medical liability insurance, the insured, whse prfessinal reputatin may be at issue, can prevent an insurer frm trying t settle a claim withut a curt fight. The insurers duty t make payment n its insured's behalf is nt exactly cincident with its duty t defend its insureds. Payment is required nly fr cvered acts. A legal defense is required even fr false, fraudulent, r grundless lawsuits. Because f the ptential difference between the duty t defend an insured and the duty t pay liability claims, the issue f the insurer's bligatin has been litigated. Sectin 2 - Exclusins Because cverage's E and F are cmprehensive-type cverage, several imprtant exclusins limit the insurer's liability. Amng the claims nt cvered are thse arising frm bdily injury r prperty damage. Which is expected r intended by an insured. The "intent" required t exclude cverage is neither the "Intent t act nr the Intent t cause a specific injury cmplained f. Rather it is the "intent t cause bdily injury." Arising ut f "business pursuits." A review f the litigatin n this pint des nt lead t any general cnclusins. Different curts in different jurisdictins have reached different cnclusins given similar circumstances. Perhaps the safest pint t nte is that if an insured injures smebdy while engaged in an activity dne fr mnetary gain, a pssibility exists that the HO will nt prvide liability cverage. Arising ut f the rendering r failure t render prfessinal services. This clause reinfrces he preceding clause, making it clear that if an insured is sued fr actins as an accuntant, attrney, r physician, the HO will nt prvide cverage. Arising frm the wnership, maintenance, and use f mtr vehicles, aircraft, r watercraft. There are sme exceptins t these exclusins, s the HO prvides sme cverage in limited circumstances. Arising frm the transmissin f cmmunicable diseases. An increasing amunt f litigatin during the later half f the 1980s alleged injury resulting frm transmissin f cmmunicable disease, especially sexually transmitted diseases. The purpse f this exclusin is t relieve the insurer f respnsibility fr paying such claims r defending such lawsuits. This exclusin is recent and may nt appear in all cmpanies' plicy frms yet. Sectin 2, like Sectin 1 f HO-2, cntains sme additinal cverage and sme cnditins. They fllw the pattern develped in Sectin 1. Sectins 1 and 2 - Cnditins The final sectin f HO-2 cntains cnditins applicable t bth Sectins 1 and 2. Cncealment and fraud Waiver prvisins Cancellatin by insurer and insured Assignment (nt valid unless insurer has given written cnsent). Subrgatin Death f an insured (the legal representative f the insured cntinue t receive cverage after the insured's death) Liability insurance plicies generally prvide fr the full limit f liability fr each ccurrence. In additin, there usually is n additinal premium t be paid. The HO is a cmbinatin f fire, persnal liability, and additinal expense prtectin. The majr divisins f HO-2 include the fllwing-definitins. Sectin 1 -Prperty Cverage Sectin 1-Perils Insured Against Sectin 1-Exclusins Sectin 1-Cnditins Sectin 2-Liability Cverage Sectin 2-Exclusins We will cntinue this sessin with a lk at ther persnal prperty insurance cverage's that can be used by individuals and families. Fcus Pints Hmewner s plicies were intrduced in the 1950 s. Hmewners insurance is a package plicy cmbining tw r mre separate cntracts int ne plicy. Current hmewners insurance blends the standard fire plicy with ther cverage's. The ISO revised the hmewner s plicy in HO-1 cvers structures and the insureds persnal prperty. HO-2 cvers HO-1 and additinal perils. 13

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