Who s Insured On What Auto? Determining Insured Status on Personal and Business Auto Policies:

Transcription

1 Who s Insured On What Auto? Determining Insured Status on Personal and Business Auto Policies: Presented by: Ted A. Kinney, CIC CPCU ARM AU AAM AAI CPIA Alabama Independent Insurance Agents Birmingham, AL 1

2 Ted A. Kinney, CIC CPCU ARM AU AAM AAI CPIA CRIS Alabama Independent Insurance Agents Birmingham, Alabama Ted Kinney is the Director of Education and Technical Affairs for the Alabama Independent Insurance Agents in Birmingham, Alabama. In this position he is responsible for developing agent education programs and providing technical assistance to association members. He was previously the owner/president of Kinney Training and Consulting, LLC in Columbus, Ohio where he specialized in providing quality insurance training programs to agencies and companies throughout the United States. In addition to training, KTC also offered insurance agency E&O audits and procedural consulting. Ted has been in the insurance business since his graduation from the Ohio State University in During his career, he has worked as an underwriter, field sales manager, department supervisor, marketing specialist and trainer. From 1994 to 2003, Ted was the Director of Curriculum and Faculty Development for PIA of Ohio and Indiana. During that time he developed over 150 training courses covering all aspects of the insurance industry. He has obtained several insurance designations including Certified Insurance Counselor (CIC), Chartered Property Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Underwriting (AU), Associate in Automation Management (AAM), Accredited Advisor in Insurance (AAI), Certified Professional Insurance Agent (CPIA) and Construction Risk & Insurance Specialist (CRIS). He is a member of the national faculty of the Society of Certified Insurance Counselors, the Certified Professional Insurance Agents Society and the Independent Insurance Agents and Brokers of America s ask the expert service. In addition, Ted is a member of the Society of Certified Insurance Counselors and the National Academy of Producer Insurance Studies. 2

3 Disclaimer and Liability Statement The information provided in this course is for educational purposes only. No legal advice is implied or given. If actual legal advice is needed, contact a legal professional. Also, coverage can and does vary from insurer to insurer and from policy to policy. For the exact wording and interpretation of your insurers forms and endorsements, please contact the individual insurer. The instructor s opinions are not necessarily representative of others in the industry. The instructor and Alabama Independent Insurance Agents are not responsible for any liability arising out of reliance upon the information provided in this course. 3

4 DEFINITIONS A. Throughout this policy, "you" and "your" refer to: 1. The "named insured" shown in the Declarations; and 2. The spouse if a resident of the same household. If the spouse ceases to be a resident of the same household during the policy period or prior to the inception of this policy, the spouse will be considered "you" and "your" under this policy but only until the earlier of: 1. The end of 90 days following the spouse's change of residency; 2. The effective date of another policy listing the spouse as a named insured; or 3. The end of the policy period. 4

5 Determining Insured Status on Personal and Business Auto Policies Who s Insured On What Auto? I. INTRODUCTION II. PERSONAL AUTO POLICY (P.A.P.) A. Part A - Liability Coverage 1. You - The named insured a. Shown in the declarations or b. A resident spouse c. A non-resident spouse for up to 90 days or policy expiration, whichever comes first IS THERE EVER A CASE WHEN A SPOUSE IS NOT A RESIDENT? DOES THIS IMPACT COVERAGE? WHAT IS THE SOLUTION? 5

6 DEFINITIONS F. "Family member" means a person related to you by blood, marriage or adoption who is a resident of your household. This includes a ward or foster child. I. "Trailer" means a vehicle designed to be pulled by a: 1. Private passenger auto; or 2. Pickup or van. It also means a farm wagon or farm implement while towed by a vehicle listed in 1. or 2. above. PART A LIABILITY COVERAGE B. "Insured" as used in this Part means: 1. You or any "family member" for the ownership, maintenance or use of any auto or "trailer". 6

7 2. Family member a. Related to you by blood, marriage, or adoption b. Must be a resident of the named insured s household c. Includes a ward or a foster child MY BROTHER LIVES IN TOPEKA AND I LIVE IN WICHITA. WHEN HE VISITS ME ON THE WEEKEND, IS HE A FAMILY MEMBER? What can you or family members drive? - any auto or trailer (unless the usage or vehicle is excluded) WHAT DOES ANY AUTO MEAN? WHAT DOES TRAILER MEAN? 7

8 PART A LIABILITY COVERAGE B. "Insured" as used in this Part means: 2. Any person using "your covered auto". J. "Your covered auto" means: DEFINITIONS 1. Any vehicle shown in the Declarations. 2. A "newly acquired auto". 3. Any "trailer" you own. 4. Any auto or "trailer" you do not own while used as a temporary substitute for any other vehicle described in this definition which is out of normal use because of its: a. Breakdown; b. Repair; c. Servicing; d. Loss; or e. Destruction. This Provision (J.4.) does not apply to Coverage For Damage To Your Auto. 8

9 3. Any person using your covered auto a. Any vehicle shown in the declarations b. A newly acquired auto c. An owned trailer (1) A vehicle designed to be pulled by a private passenger, pickup or van (2) A farm wagon or implement while being towed by a private passenger, pickup or van DOES A TRAILER HAVE TO BE IN THE PROCESS OF BEING TOWED TO HAVE LIABILITY COVERAGE? 9

10 J. "Your covered auto" means: 4. Any auto or "trailer" you do not own while used as a temporary substitute for any other vehicle described in this definition which is out of normal use because of its: a. Breakdown; b. Repair; c. Servicing; d. Loss; or e. Destruction. This Provision (J.4.) does not apply to Coverage For Damage To Your Auto. 10

11 d. A temporary substitute auto (1) Any non-owned auto or trailer (2) Used as a temporary substitute for a covered auto? (3) Covered auto out of use because of: (a) Breakdown (b) Repair (c) Servicing (d) Loss (e) Destruction I GO ON VACATION TO FLORIDA AND RENT A CAR WHILE I M THERE. IS THE RENTAL CAR A TEMPORARY SUBSTITUTE AUTO? I M USING MY NEIGHBOR S 20,000 LB. STAKE TRUCK BECAUSE MY CAR IS IN THE SHOP. IS THIS A TEMPORARY SUBSTITUTE AUTO? IF I RENT A CAR WHILE MY COVERED AUTO IS IN THE SHOP, WOULD ANYONE BE COVERED WHILE THEY ARE DRIVING IT? 11

12 B. "Insured" as used in this Part means: 3. For "your covered auto", any person or organization but only with respect to legal responsibility for acts or omissions of a person for whom coverage is afforded under this Part. 4. For any auto or "trailer", other than "your covered auto", any other person or organization but only with respect to legal responsibility for acts or omissions of you or any "family member" for whom coverage is afforded under this Part. This Provision (B.4.) applies only if the person or organization does not own or hire the auto or "trailer". 12

13 4. For your covered auto a. Any person or organization legally responsible for the acts or omissions of an insured b. This is called vicarious liability I M USING MY PERSONAL AUTO ON BEHALF OF MY EMPLOYER. IF I WERE NEGLIGENT FOR AN AUTO ACCIDENT, WOULD MY EMPLOYER BE AN INSURED ON MY POLICY? AM I COVERED ON THE EMPLOYER S POLICY? 5. For any auto or trailer other than your covered auto a. Any person or organization legally responsible for the named insured or family member b. Except the vehicle owner or renter 13

14 MINI-QUIZ I BORROW A NEIGHBOR S CAR TO USE ON BEHALF OF MY EMPLOYER. IF I AM NEGLIGENT FOR AN AUTO ACCIDENT: WOULD I BE INSURED ON MY NEIGHBOR S POLICY? WOULD MY EMPLOYER BE INSURED ON MY NEIGHBOR S POLICY? WOULD MY NEIGHBOR BE INSURED ON THE NEIGHBOR S POLICY? WOULD I BE INSURED ON MY POLICY? WOULD MY EMPLOYER BE INSURED ON MY POLICY? WOULD MY NEIGHBOR BE INSURED ON MY POLICY? WOULD MY NEIGHBOR OR I BE INSURED ON MY EMPLOYER S POLICY? WHOSE POLICY IS PRIMARY? WHOSE POLICY IS EXCESS? 14

15 Notes Items to Do 15

16 INSURING AGREEMENT PART B MEDICAL PAYMENTS COVERAGE A. We will pay reasonable expenses incurred for necessary medical and funeral services because of "bodily injury": 1. Caused by accident; and 2. Sustained by an "insured". We will pay only those expenses incurred for services rendered within 3 years from the date of the accident. B. "Insured" as used in this Part means: 1. You or any "family member": a. While "occupying"; or b. As a pedestrian when struck by; a motor vehicle designed for use mainly on public roads or a trailer of any type. 2. Any other person while "occupying" "your covered auto". 16

17 B. PART B - MEDICAL PAYMENTS COVERAGE 1. The named insured or family member a. Occupying - in, upon, getting in, on, out, or off b. As a pedestrian when struck by c. A motor vehicle designed for use mainly on public roads or a trailer of any type I M WALKING ON THE STREET IN FRONT OF MY HOUSE AND GET HIT BY A CAR. CAN I COLLECT FROM MY AUTO MED PAY? I M RIDING IN A CITY BUS AND SUSTAIN INJURY IN AN ACCIDENT. CAN I COLLECT FROM MY AUTO MED PAY? I M RIDING ON A FARM TRACTOR AND FALL OFF AND BREAK MY ARM. CAN I COLLECT FROM MY AUTO MED PAY? 2. Any person occupying your covered auto A FRIEND IS RIDING WITH ME IN A RENTED AUTO WHILE I M ON VACATION. IF HE IS INJURED, CAN HE COLLECT FROM MY AUTO MED PAY? 17

18 PART C - UNINSURED MOTORISTS COVERAGE B. "Insured" as used in this Part means: 1. You or any "family member". 2. Any other person "occupying" "your covered auto". 3. Any person for damages that person is entitled to recover because of "bodily injury" to which this coverage applies sustained by a person described in 1. or 2. above. C. "Uninsured motor vehicle" means a land motor vehicle or trailer of any type: 1. To which no bodily injury liability bond or policy applies at the time of the accident. 2. To which a bodily injury liability bond or policy applies at the time of the accident. In this case its limit for bodily injury liability must be less than the minimum limit for bodily injury liability specified by the financial responsibility law of the state in which your covered auto is principally garaged. 3. Which is a hit-and-run vehicle whose operator or owner cannot be identified and which hits: a. You or any "family member"; b. A vehicle which you or any "family member" are "occupying"; or c. "Your covered auto". 4. To which a bodily injury liability bond or policy applies at the time of the accident but the bonding or insuring company: a. Denies coverage; or b. Is or becomes insolvent. 18

19 C. Part C - Uninsured Motorists Coverage 1. The named insured or family member 2. Any person occupying your covered auto 3. Other persons entitled to recover damages because of bodily injury sustained by an insured. AN UNINSURED MOTORIST KILLS A NAMED INSURED IN AN AUTO ACCIDENT. THE DECEASED PARTY S MOTHER, WHO LIVES IN ANOTHER CITY, FILES FOR UM COVERAGE UNDER THE NAMED INSURED S POLICY. IS THE MOTHER AN INSURED? 4. The injuries must arise out of the ownership, maintenance or use of an uninsured motor vehicle a. There is no liability insurance coverage or bond b. Bodily injury liability coverage applies but the limit is below the state s financial responsibility minimum c. Unidentified hit-and-run d. Coverage is denied or the liability insurer or bonding company is insolvent 19

20 However, "uninsured motor vehicle" does not include any vehicle or equipment: 1. Owned by or furnished or available for the regular use of you or any "family member". 2. Owned or operated by a self-insurer under any applicable motor vehicle law, except a self-insurer which is or becomes insolvent. 3. Operated by any governmental unit or agency. 4. Operated on rails or crawler treads. 5. Designed mainly for use off public roads while not on public roads. 6. While located for use as a residence or premises. 20

21 5. Uninsured motor vehicle does not include a. Owned by or furnished or available for the regular use of the named insured or family members b. Owned by a self-insurer (unless insolvent) c. Owned by a governmental unit or agency d. Operated on rails or crawler treads e. Designed for use off public roads while not on public roads f. While located for use as a residence or premises 21

22 D. Endorsements available to change the insured status 1. Company-specific additional insured endorsements (use caution that they don t extend liability beyond what is intended) BASED ON #3 AND #4 OF THE LIABILITY SECTION DEFINITION OF INSURED, IS AN ADDITIONAL INSURED ENDORSEMENT NECESSARY? 2. Loss Payee Endorsements 3. PP Additional Insured - Lessor 4. PP Joint Ownership Coverage 5. PP Extended Non-Owned Coverage Vehicles Furnished or Available for Regular Use 6. PP Named Non-Owner Coverage 7. PP Extended Non-Owned Coverage Vehicles Furnished or Available for Use As Public or Livery Conveyances 8. PP Trust Endorsement 22

23 Notes Items to Do 23

24 Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. 1. Who Is An Insured The following are "insureds": a. You for any covered "auto". A. Description Of Covered Auto Designation Symbols Symbol Description Of Covered Auto Designation Symbols 1 Any "Auto" 2 Owned "Autos" Only Only those "autos" you own (and for Liability Coverage any "trailers" you don't own while attached to power units you own). This includes those "autos" you acquire ownership of after the policy begins. 3 Owned Private Passenger "Autos" Only Only the private passenger "autos" you own. This includes those private passenger "autos" you acquire ownership of after the policy begins. 4 Owned "Autos" Other Than Private Passenger "Autos" Only 5 Owned "Autos" Subject To No- Fault 6 Owned "Autos" Subject To A Compulsory Uninsured Motorists Law 7 Specifically Described "Autos" 8 Hired "Autos" Only 9 Nonowned "Autos" Only Only those "autos" you own that are not of the private passenger type (and for Liability Coverage any "trailers" you don't own while attached to power units you own). This includes those "autos" not of the private passenger type you acquire ownership of after the policy begins. Only those "autos" you own that are required to have No-Fault benefits in the state where they are licensed or principally garaged. This includes those "autos" you acquire ownership of after the policy begins provided they are required to have No-Fault benefits in the state where they are licensed or principally garaged. Only those "autos" you own that because of the law in the state where they are licensed or principally garaged are required to have and cannot reject Uninsured Motorists Coverage. This includes those "autos" you acquire ownership of after the policy begins provided they are subject to the same state uninsured motorists requirement. Only those "autos" described in Item Three of the Declarations for which a premium charge is shown (and for Liability Coverage any "trailers" you don't own while attached to any power unit described in Item Three). Only those "autos" you lease, hire, rent or borrow. This does not include any "auto" you lease, hire, rent, or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. Only those "autos" you do not own, lease, hire, rent or borrow that are used in connection with your business. This includes "autos" owned by your "employees", partners (if you are a partnership), members (if you are a limited liability company), or members of their households but only while used in your business or your personal affairs. 24

25 III. BUSINESS AUTO POLICY A. Who is an insured? 1. The named insured shown in the declarations for a covered auto - covered auto designation symbols are very important a. 1 = Any auto (owned, non-owned, hired, borrowed) b. 2 = Owned autos only - only those autos you own and, for liability coverage, non-owned trailers attached to owned power units c. 3 = Owned private passenger autos only - only private passenger autos you own d. 4 = Owned autos other than private passenger autos only - only autos other than private passenger autos you own and, for liability coverage, non-owned trailers attached to owned power units e. 5 = Owned autos subject to no-fault - autos you own that are subject to no-fault benefits f. 6 = Owned autos subject to a compulsory uninsured motorists law - autos you own that are subject to compulsory UM g. 7 = Specifically described autos - autos described in the declarations and, for liability coverage, nonowned trailers attached to owned power units h. 8 = Hired autos only - only autos you lease, hire, rent or borrow i. 9 = Nonowned autos only - only autos you do not own, lease, hire, rent or borrow 25

26 19 Mobile Equipment Subject to Compulsory or Financial Responsibility or Other Motor Vehicle Insurance Law Only Only those "autos" that are land vehicles and that would qualify under the definition of mobile equipment under this policy if they were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where they are licensed or principally garaged. B. Owned Autos You Acquire After The Policy Begins 1. If Symbols 1, 2, 3, 4, 5,6 or 19 are entered next to a coverage in Item Two of the Declarations, then you have coverage for "autos" that you acquire of the type described for the remainder of the policy period. 2. But, if Symbol 7 is entered next to a coverage in Item Two of the Declarations, an "auto" you acquire will be a covered "auto" for that coverage only if: a. We already cover all "autos" that you own for that coverage or it replaces an "auto" you previously owned that had that coverage; and b. You tell us within 30 days after you acquire it that you want us to cover it for that coverage. C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos If Liability Coverage is provided by this Coverage Form, the following types of vehicles are also covered "autos" for Liability Coverage: 1. "Trailers" with a load capacity of 2,000 pounds or less designed primarily for travel on public roads. 2. "Mobile equipment" while being carried or towed by a covered "auto". 3. Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. "Loss"; or e. Destruction. 26

27 j. 19 = Motor equipment subject to compulsory or financial responsibility or other motor vehicle insurance laws k. Autos acquired during the policy period (1) Coverage for the policy period for coverage symbols 1,2,3,4,5, or 6 (NOTE: the newly acquired vehicle must be of the same type covered by the symbol) (2) Symbol 7 requires that all owned autos be covered (or the new vehicle is a replacement for a covered vehicle) and the company must be notified within 30 days after acquisition l. Liability coverage automatically applies to: (1) Trailers with a load capacity under 2,000 pounds designed for travel on public roads (2) Mobile equipment being carried or towed by a covered auto (3) Temporary substitute autos 27

28 1. Who Is An Insured The following are "insureds": b. Anyone else while using with your permission a covered "auto" you own, hire or borrow except: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household. c. Anyone liable for the conduct of an "insured" described above but only to the extent of that liability. 28

29 2. Anyone else using a covered auto with the named insured s permission is an insured EXCEPT: a. The owner of the hired or borrowed auto (except the owner of a trailer connected to an auto you own) b. An employee using an auto owned by an employee or a member of the household c. Employees of an auto business not owned by the named insured d. Anyone moving property to and from an auto except an employee, partner, lessee, or borrower e. A partner using an auto owned by the partner or a member of the household 3. Anyone liable for the conduct of an insured (but only to the extent of that liability) is also an insured 29

30 Business Auto Policy Quiz Podunk Popsicle Company, Inc. owns five (5) private passenger vehicles and four (4) delivery trucks. Using the covered auto designation symbols, indicated the covered autos for the following coverage: 1. Liability coverage on owned, hired and non-owned vehicles 2. Auto medical payments coverage on all owned private passenger autos 3. Uninsured motorists coverage on all owned vehicles 4. Comprehensive coverage on all owned private passenger autos 5. Specified causes of loss coverage on the delivery trucks 6. Collision coverage on all owned vehicles Casper s Meat Company, Inc. owns three (3) private passenger vehicles, four (4) delivery vans and one (1) refrigerated truck. The company has the following coverage and limits: Liability Symbol 1 (any auto) $500,000 Medical Symbol 3 (owned private $5,000 Payments passenger autos) Comprehensive Symbol 2 (all owned autos) $100 Deductible Uninsured Symbol 2 (all owned autos) $500,000 Motorists Which of the following situations would be covered by the policy? 1. An employee driving a van owned by Casper s ran a red light and struck a pedestrian. A claim is brought against Casper s. 2. The same situation as in 1., but the employee is also sued. 30

31 3. While making a delivery for Casper s, an employee is injured in an accident. 4. The President of Casper s is driving one of the private passenger autos on a personal vacation. He runs a stop sign and injures a pedestrian. Casper s is sued. 5. The same situation as in 5., except the President is sued individually. 6. Jane Smith, an employee, is asked to make a delivery for Casper s using her own auto. The employee does not have any insurance on the auto. She negligently collides with another vehicle. a. A claim is brought against Jane Smith. b. Jane files a claim on Casper s policy for damage to her vehicle. c. A claim is brought against Casper s for damage to the other vehicle. d. The owner of the other auto has to rent a car for two weeks until his auto is repaired. e. Jane has to rent a car for a week until her new auto can be delivered. 31

32 B. Endorsements available to change the insured 1. CA Lessor Additional Insured and Loss Payee - used to extend coverage to lessor s of leased vehicles (don t use this if the vehicle is leased to the insured by an employee) 2. CA Designated Insured restates item 3. of who is an insured to provide proof of insured status 3. CA Employee Hired Autos provides employees coverage when they rent vehicles in their own name for the employer s business 4. CA Fellow Employee Coverage removes the fellow employee exclusion 5. CA Fellow Employee Coverage for Designated Employees/Positions removes the fellow employee exclusion only for named employees or positions 6. CA Truckers - Named Lessee As Insured a. Used for truckers who lease vehicles from the named insured b. The lease must be in writing and contain a holdharmless agreement c. Removes the contractual liability exclusion as it pertains to the lease d. Provides primary liability coverage 32

33 7. CA Drive Other Car Coverage - Broadened Coverage for Named Individuals a. Provides coverage for individuals named while using an auto not owned by the named insured b. Does not apply to a vehicle owned by the named individual or while used in an auto business c. Used when the named individual does not have a PAP (not needed if a PAP is in force) 8. CA Individual Named Insured a. Provides broad drive other car coverage for policies written in the name of an individual b. The policy must insure a private passenger auto c. Provides personal auto coverage for owned autos d. Family members are added for private passenger autos e. Adds coverage for non-owned autos also 9. CA Employees As Insureds - extends coverage to employees using an auto not owned by the named insured in the named insured s business or personal affairs 10. CA Employee As Lessor extends insured status to employees who lease their vehicles to the employer 33

34 IV. SUMMARY 34

35 Notes Items to Do 35

36 This page is intentionally blank (Actually, it s not blank because it has this writing on it!) 36

37 PP Personal Auto Policy Sample Personal Auto Form & Endorsements PP Additional Insured - Lessor PP Joint Ownership Coverage PP Extended Non-Owned Coverage Vehicles Furnished or Available for Regular Use PP Named Non-Owner Coverage PP Extended Non-Owned Coverage Vehicles Furnished or Available for Use As Public or Livery Conveyances Sample Business Auto Form & Endorsements CA Business Auto Coverage Form CA Lessor Additional Insured and Loss Payee CA Designated Insured CA Employee Hired Autos CA Fellow Employee Coverage CA Fellow Employee Coverage for Designated Employees/Positions CA Truckers - Named Lessee As Insured CA Drive Other Car Coverage - Broadened Coverage for Named Individuals CA Individual Named Insured CA Employees As Insureds CA Employee As Lessor 37

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