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2013 COMMERCIAL LINES OOPS! - PDF
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1 2013 COMMERCIAL LINES OOPS! (OFTEN OVERLOOKED POLICY SECTIONS) SPONSORED BY
2 The policy says WHAT???!!! The OOPS!!! Commercial Lines OOPS Often Overlooked Policy Sections Michael C. D Orlando, CIC, LIA, CPIA Insurance Training & Consulting Services 11 Lake Shore Drive Amesbury, MA (978)
3 (b) Conduct and control the defense of the indemnitee in such "suit". So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 2.b.(2) of Section I Coverage A Bodily Injury And Property Damage Liability, such payments will not be deemed to be damages for "bodily injury" and "property damage" and will not reduce the limits of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litigation expenses as Supplementary Payments ends when we have used up the applicable limit of insurance in the payment of judgments or settlements or the conditions set forth above, or the terms of the agreement described in Paragraph f. above, are no longer met. SECTION II WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. c. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. 2. Each of the following is also an insured: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (2) "Property damage" to property: (a) Owned, occupied or used by, (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). CG ISO Properties, Inc., 2006 Page 9 of 16 Michael C. D'Orlando, CIC, LIA, CPIA Page 1 Comm'l Lines "OOPS". 11/13
4 Commercial Lines OOPS! I. Commercial General Liability A. Who is an Insured? 1. The you or named insured options a. Individual includes spouse working in the business b. Partnership or joint venture includes (1) Partners (2) Members (3) Spouses working in the business c. Limited Liability Corporation (LLC) (1) Members (2) Managers d. Organizations other than partnerships, joint ventures or LLCs (1) Executive officers and directors in their duties as such (2) Stockholders for their liability as such e. Trust including trustees acting as such 2. Automatic Insureds a. Employees & volunteer workers Michael C. D'Orlando, CIC, LIA, CPIA Page 2 Comm'l Lines "OOPS". 11/13
5 b. Any person (other than your "employee" or "volunteer worker"), or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Coverage Part. 3. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III LIMITS OF INSURANCE 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; and c. Damages under Coverage B. 3. The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products-completed operations hazard". 4. Subject to Paragraph 2. above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5. Subject to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all "bodily injury" and "property damage" arising out of any one "occurrence". 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and Page 10 of 16 ISO Properties, Inc., 2006 CG Michael C. D'Orlando, CIC, LIA, CPIA Page 3 Comm'l Lines "OOPS". 11/13
6 b. Real Estate managers c. Persons with temporary custody if named insured dies d. Legal representative if named insured dies 3. Newly acquired organizations are automatically covered a. If no other similar insurance b. Until end of policy period or 90 th day c. Excludes prior Personal & Advertising Injury Note: No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. B. Completed Operations and Discontinued Operations 1. What are they? 2. What policy would respond? Michael C. D'Orlando, CIC, LIA, CPIA Page 4 Comm'l Lines "OOPS". 11/13
7 II. Miscellaneous Commercial Property & Time Element Issues A. My business is located on the 10 th floor, so I don t need coverage for backup of sewers & drains or flood or do I??? B. What does do your best to maintain heat in the building mean and why should I care? g. Water, other liquids, powder or molten material that leaks or flows from plumbing, heating, air conditioning or other equipment (except fire protective systems) caused by or resulting from freezing, unless: (1) You do your best to maintain heat in the building or structure; or (2) You drain the equipment and shut off the supply if the heat is not maintained. Michael C. D'Orlando, CIC, LIA, CPIA Page 5 Comm'l Lines "OOPS". 11/13
8 III. Business Auto Policy A. Symbol 1 If we can t get it, can we create it??? 1. Does Symbol 7 + Symbol 8 + Symbol 9 = Symbol 1? 2. How About ?? Symbol 1 Any "Auto" 2 Owned "Autos" Only 3 Owned Private Passenger "Autos" Only 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 Non-owned "Autos" Only Description Of Covered Auto Designation Symbols 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. Only the private passenger "autos" you own. This includes those private passenger "autos" you acquire ownership of after the policy begins. 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 nofault 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. Michael C. D'Orlando, CIC, LIA, CPIA Page 6 Comm'l Lines "OOPS". 11/13
9 B. Some Personal Auto Considerations When Dealing With Business Auto Customers 1. Drive Other Car Coverage 2. Individual Named Insured Endorsement 3. Use of Other Autos Endorsement on the Personal Auto Policy 4. The Fellow Employee Exclusion Michael C. D'Orlando, CIC, LIA, CPIA Page 7 Comm'l Lines "OOPS". 11/13
10 MM THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DRIVE OTHER CAR COVERAGE BROADENED COVERAGE FOR NAMED INDIVIDUALS - MASSACHUSETTS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date or as of the date indicated below. Endorsement effective Named Insured Policy No. Countersigned by (Authorized Representative) This endorsement changes only those coverages listed below for which a charge is shown below. Each of those coverages is changed as follows: Premium Name of Individual BI PD MED UM UIM COMP $ Ded. COLL $ Ded. A. Changes In Liability Coverage 1. Any auto you hire, borrow or don t own is a covered auto for Liability Coverage while being used by any individual named in this endorsement or by his or her spouse while a resident of the same household except: a. Any auto owned by that individual or by any household member of that individual. b. Any auto used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking autos. MM Copyright, Automobile Insurers Bureau, 1998 Page 1 of 2 Michael C. D'Orlando, CIC, LIA, CPIA Page 8 Comm'l Lines "OOPS". 11/13
11 MM The following is added to Who Is An Insured: Any individual named in this endorsement and his or her spouse, while a resident of the same household, are insureds while using any covered auto described in paragraph A.1 of this endorsement. B. Changes In Auto Medical Payments The following is added to Who Is An Insured: Any individual named in this endorsement and his or her family members are insureds while occupying or while a pedestrian when being struck by any auto you hire, borrow or don t own except: Any auto owned by that individual or by any family member. C. Changes In Physical Damage Insurance Any private passenger-type auto you hire, borrow or don t own is a covered auto while in the care, custody or control of any individual named in this endorsement or his or her spouse while a resident of the same household except: 1. Any auto owned by that individual or by any family member. 2. Any auto used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking autos. D. Changes In Uninsured And Underinsured Motorists Insurance The following is added to Who Is An Insured: Any individual named in this endorsement and family members are insured while occupying or while a pedestrian when being struck by any auto you, such named individual and family members hire, borrow or don t own, unless such named individual, or family member, has a Massachusetts auto policy of his or her own providing similar coverage or is covered by a Massachusetts auto policy of another family member providing similar coverage. E. Additional Definitions As used in this endorsement: Family member means a person related to the individual named in this endorsement by blood, marriage or adoption who is a resident of the individual s household, including a ward or foster child. Occupying means in, upon, getting in, on, out or off. cae/98endors/mm9922.doc MM Copyright, Automobile Insurers Bureau, 1998 Page 2 of 2 Michael C. D'Orlando, CIC, LIA, CPIA Page 9 Comm'l Lines "OOPS". 11/13
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14 MASSACHUSETTS ENDORSEMENT M-0051-S Use of Other Autos Vehicles Furnished or Available For Regular Use With respect to the individual(s) and coverages indicated in the Schedule, the provisions of the policy apply unless modified by this endorsement. 1. Any coverage provided under Damage to Someone Else s Property, Optional Bodily Injury to Others, Medical Payments, Collision, Limited Collision, and Comprehensive (Parts 4, 5, 6, 7, 8, and 9) also applies to any vehicle which is furnished or available for the regular use of the named individual on the schedule. 2. We will not pay under this endorsement if: a. The auto is: 1. owned by you or any household member, or 2. a temporary substitute for an auto owned by you or a household member. b. The auto is being used by anyone in the course of his or her employment in the business of selling, servicing, repairing, or parking autos. c. The auto is being used in the business or occupation of the named individual unless the auto is being operated or occupied by named individual, private chauffeur or domestic employee. 3. Under Damage to Someone Else s Property (Part 4) and Optional Bodily Injury to Others (Part 5), the following are not covered: a. The Commonwealth of Massachusetts and any of its agencies and authorities. b. The United States of America and any of its agencies. c. Any person while using an auto in the course of his employment by the United States government if the Federal Tort Claim Act requires the Attorney General of the United States to defend that person in any civil action or proceeding for bodily injury or property damage, whether or not the accident has been reported to the United States or the Attorney General. 4. If someone covered under this endorsement is using an auto he or she does not own at the time of the accident, the owner s auto insurance pays up to its limits before we pay. AIB Manual Rule 50 Michael C. D'Orlando, CIC, LIA, CPIA Page 12 Comm'l Lines "OOPS". 11/13
15 Use of Other Automobiles Vehicles Furnished or Available For Regular Use (cont.) 5. The coverage purchased for the named individual is shown in the schedule. If no premium charge is shown, the coverage does not apply. Unless otherwise indicated below, Use of Other Autos coverage is applicable only to the individual named in the Schedule or in the Coverage Selections Page. Name of Individual: If indicated below, Use of Other Autos coverage applies to: Named Individual and Household Members. Schedule Coverages Premium Part 4 Part 5 Part 6 Part 7 Part 8 Part 9 Limits of Liability: Comprehensive Actual Cash Value less $ deductible Collision Actual Cash Value less $ deductible Limited Collision Actual Cash Value less $ deductible [Ed ] AIB Manual Rule 50 Michael C. D'Orlando, CIC, LIA, CPIA Page 13 Comm'l Lines "OOPS". 11/13
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