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Coverages

 
Here is the rule, begin at the beginning. Before reviewing the exclusions, exceptions and exceptions to exceptions, you must confirm the loss even qualifies for coverage based upon the grant of coverage found in the insuring agreement. A policy’s or coverage part’s insuring agreement is the broadest coverage is ever going to be – the top of the funnel you might say. If the loss or damage falls outside the coverage provided by the insuring agreement – you don’t have to look any further into the policy – there is no coverage. This article analyzes the insuring agreement found in Coverage Part A of the CGL as our example.
An insured who is leasing a building or space in a building is being required by the landlord to carry $1M in “fire legal” coverage. The insured’s CGL insurer will not provide more than $300K in FDLL limits. What can the insured do? Better, what SHOULD the insured do?
A commercial prospect rents space at a warehouse and his current agent tells him that the fire damage legal liability coverage on his CGL policy covers him there. The prospective agent believes that the CP 00 40 Legal Liability Coverage Form is superior. Who is right…or are both wrong?
Most general liability coverage cases, that address whether “property damage” has taken place, focus on the “physical injury to tangible property” aspect of the definition. You can see that a building is no longer standing or that water intrusion has caused damage. On the other hand, whether there has been a “loss of use” of property can be more esoteric. So, between “physical injury” cases being more common, thereby providing more guidance, as well as involving a more easily identifiable injury, it is not surprising that “loss of use”-based “property damage” cases can be challenging.
In the world of insurance coverage, the word “claim” is one of the most frequently spoken. It is used by an injured party to describe its pursuit of relief against the wrongdoer and the wrongdoer uses the term to describe its pursuit of coverage from its insurer. Obviously, the term “claim” is not immune from disputes when it appears in an insurance policy.
Proprietary coverage forms are not always better than Insurance Services Office (ISO) forms. Careful comparison is required to confirm the insured is not harmed by non-ISO language. A recent Illinois district court ruling highlights an incidence where ISO’s Personal and Advertising Injury wording may be broader and better for the insured.
In 1999, ISO, following the lead of a number of companies, introduced a series of new and revised 'Montrose' endorsements for the CGL program. This filing was prompted by a California Supreme Court decision, Montrose Chemical Corp. v. Admiral Ins. Co., that adopted the 'continuous trigger' of coverage under third-party liability claims and abdicated the 'loss-in-progress' or 'known loss' rule that was at the foundation of insurance. The information below examines the background, coverage changes and implications of the Montrose decision.
The named insured is a corporation. The sole stockholder personally owns a piece of land on which the corporation parks its vehicles. A pedestrian tripped on the premises and is suing the insured corporation. The location of this land was not specifically scheduled as a location on the policy. The insurer of seven years is denying the claim on the basis of misrepresentation, that the insured didn't declare the location. Is this correct?
Many years ago, leases typically made the tenant responsible for negligence that resulted in fire damage to the occupied premises. Today, leases more commonly make the tenant responsible for a much broader spectrum of losses and often without regard to fault. This article examines two recent examples of claims not covered by FDLL or by contractual liability under the lease.
The insured negligently caused a fire to his own rented area. It was paid under the landlord's property policy and now they are subrogating against the insured tenant. The insured's carrier is saying that, even though 'fire legal' is part of the CGL policy (now referred to in the CGL forms as 'Damage to Premises Rented to You'), the Other Insurance clause states it is excess over other insurance and they will not defend the insured in the lawsuit nor indeminify the landlord. Is fire legal liability coverage primary or excess?
As we all know, the issue of '1 vs. 2' occurrences in the WTC disaster is currently front-page news. However, this issue has been debated for years. In this special article, we'll examine the WTC situation, along with several others, and give you our opinion along with that of the courts here and abroad.
Picking up where we left off in Part 1 of this article, the issue of one vs. multiple occurrences has arisen in claims for many years. In Part 2, we'll take a look at several 'Ask an Expert' claims that examine related issues when it is unclear as to how many occurrences have happened.
A restaurant was insured under a CGL with the CG 24 07 attached. A customer broke a crown eating a BBQ sandwich. The adjuster denied the $285 medical payments claim due to the CG 24 07. Subsequently, they denied the liability claim on the basis that, once the product has been turned over to the consumer, it is no longer the insured's product. What's going on here and where is Rod Serling when you need him?
Recently our 'Ask an Expert' service received two questions from agents in different states who had experienced the same claim. A restaurant customer broke a tooth on an olive pit in a salad and the restaurant's insurer denied liability. Read the full article to get our slant on this denial, as well as learn something important about the 'Ask an Expert' service.
There has been an increasingly disturbing trend of courts upholding claim denials based on property damage not arising from an 'occurrence' in the CGL policy. Typically, these claims involve contractors and damage to 'your work.' While I'm not saying the claims are covered, I do question whether the 'no occurrence' basis for the denial is proper and in keeping with the policy language.
The CGL policy has several exclusions that apply to faulty workmanship. However, a number of courts have ruled that these exclusions are meaningless because damage to your own work (even if caused by a subcontractor) is not an 'occurrence,' so the insuring agreement isn't even triggered. We are now seeing legislation and CGL endorsements in response to these rulings.
If you recall the old Flip Wilson TV show, he had a recurring sketch with the theme 'The devil made me do it!' In the routine, his alter-ego, Geraldine, would get into trouble, then disclaim responsibility, blaming it on the devil. Too often, this happens in our business when liability is denied by the carrier. In this article, we'll take a look at a claim where there was clearly coverage under the policy...however, the carrier denied the claim, taking the position that the insured was not liable.
One of the most often misunderstood insurance issues involves what event triggers coverage under a liability policy? Is it when the negligence occurs or when, possibly years later, the BI or PD occurs? Is there a difference in the coverage trigger between an occurrence and a claims-made policy? How does this issue affect discontinued operations and products exposures? In this article, we'll attempt to solve these mysteries.