GROUP PERSONAL EXCESS & UMBRELLA LIABILITY POLICY

Transcription

1 GROUP PERSONAL EXCESS & UMBRELLA LIABILITY POLICY Various provisions of this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout the policy the words you and your refer to the member insured. The words we, us and our refer to the company providing this insurance. The word insured means any other person or organization qualifying as such under SECTION II WHO IS AN INSURED. Other words and phrases that appear in quotations in this policy have special meanings. Refer to SECTION IV DEFINITIONS of this policy for such meanings. SECTION I COVERAGES 1. INSURING AGREEMENT A. Coverage A Personal Excess Liability 1. We will pay on behalf of the insured and in excess of underlying limits those sums the insured becomes legally obligated to pay as damages for loss to which this insurance applies. This insurance only applies if: a. the loss is caused by an event that takes place in the coverage territory ; b. the loss occurs during the coverage term ; and c. the loss is covered by required underlying insurance for the full underlying limits. 2. We have the right, but not the duty, to participate in the investigation or settlement of any claim or the defense of any suit against any insured. 3. We have the right, at our discretion, to settle any claim to which this insurance applies. 4. Defense expenses we incur in the investigation of any claim or defense of any suit will be paid in addition to the Limits of Insurance except when defense expenses paid under the terms of required underlying insurance reduce the limits of required underlying insurance, in which case defense expenses will reduce our Limits of Insurance. 5. The amount we pay is limited. Refer to Condition 1. LIMITS OF INSURANCE under SECTION III CONDITIONS. B. Coverage B Personal Umbrella Liability 1. When Coverage A Personal Excess Liability does not apply, we will pay on your behalf and in excess of the retained amount, those sums you become legally obligated to pay as damages because of: a. bodily injury or property damage to which this insurance applies. This insurance only applies if the bodily injury or property damage : i. is caused by an occurrence in the coverage territory ; and occurs during the coverage term ; or b. personal injury to which this insurance applies. This insurance only applies if the FP Page 1 of 12

2 personal injury is caused by an offense first committed in the coverage territory during the coverage term. 2. We have the right, but not the duty, to investigate any claim or defend any suit against you which seeks damages to which this insurance applies. 3. We have the right, at our discretion, to settle any claim to which this insurance applies. If, when settling a claim, we pay amounts within the retained amount you will promptly reimburse us for those amounts. 4. Defense expenses we incur in the investigation of any claim or defense of any suit will be paid in addition to the Limits of Insurance. 5. The amount we pay is limited. Refer to Condition 1. LIMITS OF INSURANCE under SECTION III - CONDITIONS. C. Coverage C Identity Theft 1. We will reimburse you for reparation expenses which you incur to repair or restore your credit rating when damaged by an identity theft. 2. The amount we will reimburse will be the least of: a. the Reparation Expense Amount shown in Item 6. of the Declarations; b. the amount of your actual reparation expenses ; or c. an amount equal to the limit of your underlying reparation insurance that is applicable to the identity theft. 3. This insurance only applies in excess of reparation expenses paid by underlying reparation insurance. 2. EXCLUSIONS The EXCLUSIONS section of the required underlying insurance are made part of this policy and apply to Coverage A Personal Excess Liability and Coverage B Personal Umbrella Liability. If an inconsistency or contradiction exists between an exclusion in this policy and an exclusion in the required underlying insurance, the exclusion or combination of exclusions which restrict coverage more will prevail. A. Under Coverage B Personal Umbrella Liability, this insurance does not apply to: 1. any liability or damages covered by Coverage A Personal Excess Liability or required underlying insurance or which would have been covered but for: a. the exhaustion or erosion of an aggregate limit of insurance; or b. any failure to maintain required underlying insurance in accordance with Condition 9. MAINTENANCE OF REQUIRED UNDERLYING INSURANCE under SECTION III CONDITIONS. 2. any liability arising out of the ownership, maintenance, operation or use, including loading or unloading of any automobile or aircraft. This exclusion does not apply to bodily injury or property damage arising out of: FP Page 2 of 12

3 a. an aircraft you hire with a crew; b. an automobile of the type that is typically insured under a personal lines automobile policy and that you hire for less than 30 days; or c. an automobile of the type that is typically insured under a personal lines automobile policy and that you own or hire while operated outside of the United States of America, its territories, possessions or Canada; 3. any liability arising out of the ownership, maintenance, operation or use, including loading or unloading of any watercraft or recreational vehicle. This exclusion does not apply to bodily injury or property damage arising out of a watercraft or recreational vehicles you have owned or hired for less than 30 days; 4. any liability arising out of the participation in or preparation for any aircraft, automobile, recreational vehicle or watercraft race. This exclusion does not apply to bodily injury or property damage arising out of a race involving a sailboat you own or rent; 5. property damage to the property of others in your care, custody or control. This exclusion only applies if you were obligated by contract to purchase insurance on the property; 6. any liability arising out of the performance of duties as a director or officer of any organization. This exclusion does not apply to bodily injury, personal injury or property damage arising from an actual or alleged breach of duty by you in your capacity as a director or officer of a not-for-profit organization, including a condominium, cooperative or homeowners association; 7. any liability arising out of the conduct of a business or investment or for-profit activities. This exclusion does not apply to bodily injury or property damage arising out of: a. tenant property ; or b. farms or any other legal business you own and operate from your residence which generate less than $25,000 in gross annual revenue; 8. any liability assumed in a contract or agreement other than an indemnity agreement ; 9. any liability arising out of a trampoline, diving board or other rebounding device; 10. bodily injury, personal injury or property damage to an employee or prospective employee of any insured or to the spouse, child, parent, brother or sister of any such employee; 11. bodily injury, personal injury or property damage expected or intended from the standpoint of the insured or any reasonable person; 12. any liability arising out of the actual, alleged, suspected or threatened discharge, dispersal, seepage, migration, escape or release of pollutants ; 13. any liability arising out of any act of terrorism. B. Under Coverage A Personal Excess Liability and Coverage B Personal Umbrella Liability, this insurance does not apply to: 1. any liability for which coverage is excluded by the required underlying insurance ; FP Page 3 of 12

4 2. any liability for which coverage is provided by required underlying insurance at limits less than the limits of insurance applicable to other coverage provided by the required underlying insurance ; 3. any liability for damage to property you own, rent or occupy, including any costs or expenses incurred by you or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including the prevention of injury to a person or damage to another s property; 4. any liability arising out of day care business; 5. any liability arising out of the rendering or failure to render any professional service ; 6. any liability arising out of a construction defect ; 7. any liability arising out of the actual, alleged, suspected or threatened transmission of a communicable disease; 8. any liability arising out of actual, alleged, suspected or threatened sexual misconduct, sexual molestation, or sexual, physical or mental abuse of any person; 9. any liability arising out of the taking or publishing, in any manner, of photographs or videos without the subjects permission; 10. any liability arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of or presence of lead ; 11. any liability arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of or presence of any fungi or bacteria; 12. any liability arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of or presence of asbestos ; 13. any liability for damages claimed by one insured from another insured; 14. any liability arising out of the actual, alleged, suspected or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of silica or silica-related dust ; 15. any liability imposed under: a. an uninsured or underinsured motorist, uninsured or underinsured boater, Medical Payments, Personal Injury Protection, No-Fault or any similar law; b. a workers compensation, disability benefits, unemployment compensation or any similar law; c. the Employee Retirement Income Security Act of 1974, any amendments thereto or any similar law. C. Under Coverage C Identity Theft, we will not reimburse you when: 1. any other person or organization is liable to reimburse you for the full amount of your reparation expenses ; 2. any other person or organization has declined to reimburse you; FP Page 4 of 12

5 3. any insured is complicit in the identity theft ; or 4. you have not filed, or attempted to file, a police report within 7 days of the identity theft. SECTION II WHO IS AN INSURED 1. Under Coverage A Personal Excess Liability, the member insured is an insured, and any other person who qualifies as an insured under the required underlying insurance is an insured, however, coverage provided such insureds will not be broader than coverage provided by required underlying insurance. 2. Under Coverage B Personal Umbrella Liability, the member insured is the only insured. SECTION III CONDITIONS The CONDITIONS section of the required underlying insurance are made part of this policy and apply to Coverage A Personal Excess Liability and Coverage B Personal Umbrella Liability and Coverage C Identity Theft. If an inconsistency or contradiction exists between a condition of this policy and a condition of the required underlying insurance,, the condition of this policy will apply. 1. LIMITS OF INSURANCE a. This insurance applies separately to each event, occurrence or offense. b. The Each Occurrence Limit shown in the Declarations or the certificate of coverage is the most we will pay for the sum of all damages arising out of an event, occurrence or offense. c. If an Aggregate Limit applies to any required underlying insurance, this insurance will aggregate in the same manner; and d. The number of insureds, claims made, suits brought or persons or organizations making claims or bringing suits will not increase our liability. e. The most we will pay for reparations expenses is the lesser of: i. the Reparation Expense Amount shown in Item 6. of the Declarations; or an amount equal to the limit of your underlying reparation insurance. 2. APPEALS At our discretion we may appeal any judgment which would result in a payment under this policy. When we do appeal, we will pay all costs associated with the appeal in addition to the Limits of Insurance. Any such appeal will not increase our Limits of Insurance. 3. BANKRUPTCY OR INSOLVENCY Bankruptcy or insolvency of the insured or the insured s estate will not relieve us of our obligations under this policy. Bankruptcy or insolvency of any company providing required underlying insurance will not reduce the underlying limits or increase our obligations under this policy. However, if any underlying limits of required underlying insurance are not available or collectible because of the bankruptcy, insolvency or inability of any company providing required underlying insurance to fully discharge its policy obligations, or you are unable to pay or reimburse us for any retained amount due to your bankruptcy, insolvency or inability to pay or reimburse us, this policy will apply as though the full underlying limits of such required underlying insurance and the full retained amount were FP Page 5 of 12

6 available and collectible. We will not be required to drop down or replace required underlying insurance or any retained amount. 4. CANCELLATION a. The Sponsoring Organization may cancel: i. this policy at any time by returning it to us and providing advanced written notice of the termination date; any certificate of coverage by providing 10 days advanced written notice to the member insured. b. A member insured may cancel their certificate of coverage at any time by providing us with advanced written notice. c. We may cancel this policy or any certificate of coverage : i. in the event of non-payment of premium, by providing 10 days notice to the sponsoring organization ; or for any other reason, by providing 60 days notice to the sponsoring organization. d. The sponsoring organization will have the sole responsibility to notify member insureds of any cancellation. e. The sponsoring organization will receive any return premium. Such premium will be calculated in accordance with Condition 12. PREMIUM under SECTION III CONDITIONS. f. Proof of mailing will be proof of notice. This cancellation section will be conformed to comply with the cancellation law in any state that applies to surplus lines insurers. 5. NON-RENEWAL Except as required by statute in the member insured s state, we are not obligated to renew this policy or any certificate of coverage. The sponsoring organization will have the sole responsibility to notify member insureds of any non-renewal. This non-renewal section will be conformed to comply with the non-renewal law in any state that applies to surplus lines insurers. 6. CHANGES This policy and the certificate of coverage contain all of the agreements between you and us. This policy and certificate of coverage may only be changed by endorsements issued by us. 7. DUTIES WHEN THERE IS AN EVENT, OCCURRENCE, OFFENSE, CLAIM OR SUIT a. You must see to it that we, and any other insurers who could provide coverage, are notified as soon as practicable of any event, occurrence or offense which may be reasonably expected to result in a claim under this policy. To the extent possible, notice should include: i. how, when and where the event, occurrence or offense took place; the names and addresses of any injured persons and witnesses; and FP Page 6 of 12

7 i the nature and location of any injury or damage arising out of the event, occurrence or offense. b. If a claim is made or suit is brought against any insured which may be reasonably expected to result in a claim under this policy, you must: i. immediately record the specifics of the claim or suit and the date received; and notify us, and any other insurers who could provide coverage, as soon as practicable. c. You and any other involved insured must: i. immediately send us, and any other insurers who could provide coverage, copies of any demands, notices, summonses or legal papers received in connection with a claim or suit which may be reasonably expected to result in a claim under this policy; authorize us to obtain records and other information; i cooperate with us in the investigation or settlement of the claim, issues relating to coverage under this policy or defense against the suit ; and iv. assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of the injury or damage to which this insurance may apply. d. No insured will, except at that insured s own cost, voluntarily make a payment, assume any obligation or incur any expense, other than first aid, without our consent. Notice to us may be sent to our address shown in the Declarations. 8. LEGAL ACTION AGAINST US No person or organization has a right under this insurance: a. to join us as a party or otherwise bring us into a suit asking for damages from an insured; or b. to sue us on this insurance unless all of its terms have been fully complied with. 9. MAINTENANCE OF REQUIRED UNDERLYING INSURANCE During the coverage term, you must maintain required underlying insurance with underlying limits at least equal to the amounts shown in your certificate of coverage. If you fail to maintain such underlying limits, we will only be liable to the extent we would have been liable had you maintained them. Reduction of underlying limits by the payment of judgments or settlements for loss to which this insurance applies, or would have applied but for the amount of the damages, will not be considered a failure to maintain underlying limits. 10. OTHER INSURANCE This insurance is excess over any other insurance, including any insurance purchased by the insured to apply in excess of the required underlying insurance, available to the insured except insurance purchased specifically to apply in excess of this insurance. 11. PAYMENT OF DAMAGES When the amount of damages payable under this policy has been determined by final judgment or a FP Page 7 of 12

8 written settlement agreement between the claimant and us, we will pay that amount, up to our applicable Limits of Insurance, after the required underlying insurance or the insured has paid the full amount of the underlying limits or, if it applies, the retained amount. 12. PREMIUM The Premium shown in the Declarations is the premium for the coverage we provide for the coverage term. The sponsoring organization is responsible for the payment of premium for this policy. If this policy is cancelled by the sponsoring organization or by any insured prior to its expiration date, or by us because of the failure to pay premium, we may elect to impose a short rate penalty on the return premium which means that we will calculate the return premium as 90% of the pro rata return premium. 13. SEPARATION OF INSUREDS Except with respect to the Limits of Insurance, and any rights or duties specifically assigned to the sponsoring organization, this insurance applies: a. as if each member insured were the only member insured ; and b. separately to each insured against whom a claim is made or suit is brought. 14. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS If an insured has rights to recover all or part of any payment we have made under this insurance, the insured must preserve those rights and, at our request, pursue or transfer those rights to us. The insured must do nothing after the event, occurrence or offense to impair them. 15. COVERAGE TRANSFER A certificate of coverage may not be transferred to any other person or organization without our consent, except that, in the event of your death, coverage will be transferred, until the end of the coverage term, to your legal representative or other person having proper custody of your property until a legal representative is appointed. 16. REFORMATION OF UNDERLYING If the required underlying insurance is reformed after an event to provide coverage for a loss, the terms of such reformation do not apply to this policy. 17. CLAIMS OUTSIDE OF THE UNITED STATES OF AMERICA, ITS TERRITORIES, POSSESSIONS OR CANADA If the insured becomes legally obligated to pay damages to which this insurance applies and we are prevented by law from paying such damages on behalf of the insured, we will reimburse the insured, in U.S currency at the prevailing exchange rate at the time the damages were paid, for such damages. SECTION IV DEFINITIONS The DEFINITIONS section of the required underlying insurance are made part of this policy and apply to words or phrases used in this policy, provided always that words or phrases in quotations in this policy will have the meaning given them in this policy. Asbestos means the mineral in any form. FP Page 8 of 12

9 Automobile means a land motor vehicle: a. subject to a motor vehicle registration law; and b. designed for use principally on public roads. Automobile includes trailers, motorcycles and motor homes but does not include recreational vehicles. Bodily Injury means bodily injury, sickness or disease sustained by a person, including mental injury, mental anguish or death resulting from any of these. Certificate of Coverage means the document we provide to the member insured which establishes the coverage term, Limits of Insurance, required underlying insurance, Minimum Required Underlying Limits and the retained amount. Construction defect means actual, alleged, suspected or potential damage which results from or could result from a known or suspected defect, deficiency, inadequacy or dangerous condition in any products or practices used in the construction, maintenance, repair, remodeling or renovation of any structure. Coverage term means the time between the effective date shown in the certificate of coverage and the earlier of: a. the expiration date shown on the certificate of coverage ; or b. any cancellation date endorsed to the policy or certificate of coverage. Coverage territory means anywhere in the world with the exception of any country or jurisdiction which is subject to trade or other economic sanctions or embargo by the United States of America. Defense expenses means expenses we incur to investigate a claim or defend a suit. Defense expenses include interest which accrues on our portion of a judgment, after entry of that judgment and after the insured or any underlying insurer has paid the full amount of their portion of a judgment but before we have paid, offered to pay or deposited in the court the part of the judgment that is within our applicable Limits of Insurance. Defined Group means the group of persons who, in accordance with the rules established by the sponsoring organization, qualify as member insured. Electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. Domestic partner means a person in a legal or personal relationship with you and shares a common domestic life with you, and who meets all of the insurance eligibility criteria of the sponsoring organization. Event means an accident, incident, occurrence, offense, wrongful act or other loss causing event defined by and to which the required underlying insurance applies. Fungi means any type or form of fungus, including any species of mold, yeast, mildew or mushrooms. Identity theft means the unauthorized use of your personal information, which first commences during the policy period, by unknown persons for the purpose of fraudulently taking your money. As used in FP Page 9 of 12

10 this definition, money includes cash, credit, credit cards, goods, merchandise, loans and valuable papers. Indemnity agreement means that part of a contract or agreement, other than in connection with a business or profession, under which you assume the tort liability of another party to pay for loss, bodily injury, personal injury or property damage to a third party. Tort liability means liability that would be imposed by law in the absence of a contract or agreement. In order for the exception to this exclusion to apply, the indemnity agreement must be executed prior to the loss, injury or damage. Lead means the element in any form. Loss means bodily injury, property damage, personal injury or other loss defined by and to which the required underlying insurance applies. Member insured means the member of the defined group shown in the Declarations or the certificate of coverage. Member insured includes your spouse or domestic partner, if a resident of your household at the time of the event, occurrence or offense. Occurrence means an accident including continuous or repeated exposure to substantially the same general harmful conditions. Offense means any of the offenses shown in the definition of personal injury. Personal Injury means injury, other than bodily injury, arising out of one or more of the following offenses : a. false arrest, detention or imprisonment; b. malicious prosecution; c. wrongful entry into, or wrongful eviction of a person from, a room, dwelling or premises; d. oral or written publication, in any manner, of material that slanders or libels a person or organization or disparages a person s or organization s goods, products or services; e. oral or written publication, in any manner, of material that violates a person s right of privacy; Pollutants mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. Professional services includes but is not limited to: a. real estate, travel, legal, accounting or advertising services; b. preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs, drawings or specifications; c. engineering, architectural or surveying services, including related supervisory or inspection services; d. medical, surgical, dental, x-ray or nursing, services treatment, advice or instruction; e. any health, physical fitness, dietary, rehabilitative or therapeutic services, treatment, advice or instruction; FP Page 10 of 12

11 f. any service, treatment, advice or instruction for the purpose of appearance or skin enhancement, hair removal or replacement or personal grooming; g. optometry or optical or hearing aid services including the prescribing, preparation, fitting, demonstration or distribution of ophthalmic lenses or similar products or hearing aid devices; h. body piercing or tattooing services; i. services in the practice of pharmacy; j. services, collection or distribution of blood or blood products; k. law enforcement or firefighting services; and l. handling, embalming, disposal, burial, cremation, interment or disinterment of dead bodies. Property Damage means: a. physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the occurrence that caused it. For the purpose of this insurance, electronic data is not tangible property. Recreational vehicle means a motorized conveyance, not subject to motor vehicle registration, designed for use on land, off public roads, including but not limited to all terrain vehicles, golf carts, minibikes, mini-motorcycles, mopeds and scooters and snowmobiles. Recreational vehicles do not include automobiles. Required underlying insurance means insurance policies which provide the coverage shown in the Schedule of Required Underlying Insurance, which apply to the loss. Reparation expenses mean costs you incur as a result of an identity theft for: a. loan or credit re-application fees when your original application is rejected due to adverse and erroneous information; b. filing necessary documents and reports with lending or financial institutions, law enforcement or credit rating agencies; or c. reasonable attorney fees, incurred with our prior consent, and as a result of an identity theft to: i. defend or arbitrate a suit by a merchant or collection agency; remove a civil or criminal judgment against you; or i correct inaccurate information in your credit report. Reparation expenses include your lost income, up to $250 per day to a maximum of $10,000, as a result of time off from work to complete any item described in paragraphs a., b. or c. above. This payment for lost income is included within and not in addition to the Reparation Expense Amount shown in Item 6. of the Declarations. FP Page 11 of 12

12 Retained amount means the amount, shown in the Declarations or certificate of coverage, which you must pay for each claim when Coverage B Personal Umbrella Liability applies. The retained amount does not include and is not reduced by any expenses you incur in the investigation or defense of any claim or suit. Silica means silicon dioxide occurring in crystalline, amorphous or impure forms, silica particles, silica dust or silica compounds. Silica-related dust means a mixture or combination of silica and other dust particles. Sponsoring Organization means the person or organization shown as such in the Declarations. The sponsoring organization establishes the rules for membership in the defined group. Suit means a civil proceeding in which damages, to which this insurance applies, are alleged. Suit includes: a. an arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or b. any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. Tenant Property means a one, two, three or four family dwelling, including a condominium or cooperative in which you hold full legal title either as an individual or as a joint or common tenant with your spouse or domestic partner or hold in a trust you created for the purpose of transferring ownership to a family member, while rented to others. Underlying reparation insurance means any insurance available to you for reparation expenses. Underlying limits means the amount shown in the Declarations and the certificate of coverage as the Minimum Required Underlying Limit for each coverage provided by the required underlying insurance. IN WITNESS WHEREOF, THE ISSUING COMPANY HAS CAUSED THIS POLICY TO BE SIGNED OFFICIALLY BELOW AND ON THE DECLARATIONS PAGE BY A DULY AUTHORIZED REPRESENTATIVE OF SAID COMPANY. SIGNATURE SIGNATURE Mary Jane Robertson President James Kraus Secretary FP Page 12 of 12