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California Insurance Law
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CAIL15
Geared towards attorneys who represent policyholders or insurers, insurance claims personnel, and other attorneys whose work may be affected by
insurance coverage issues.
California insurance coverage issues that can arise in connection with the most commonly-issued insurance contracts. The handbook is organized by types of property and casualty insurance policies, encompassing both personal and commercial lines. Includes typical provisions, issues raised by those provisions, treatment of those provisions by California courts. The handbook is geared towards attorneys who represent policyholders or insurers, Insurance claims personnel, and other attorneys whose work may be affected by insurance coverage issues.
| SKU | CAIL15 |
|---|---|
| Product Types | Books |
| Brand | The Recorder (CA) |
| Publication Date | February 19, 2015 |
| Jurisdiction | California |
| ISBN | 978-1-57625-904-7 |
| Page Count | 0 |
| Edition | 1st |
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Chapter 1: Introduction to Insurance Policies...........................................1
1-1 TYPES OF POLICIES......................................................................1
1-1:1 Personal Lines Versus Commercial Lines Policies.................1
1-1:2 Property Versus Liability Policies...........................................2
1-1:3 Occurrence Versus Claims-Made Policies..............................3
1-1:4 Primary Versus Excess Versus Umbrella Policies...................4
1-2 DIFFERENT TYPES OF PROPERTY POLICIES........................5
1-2:1 All Risk Versus Specified Peril Policies.................................5
1-2:2 Automobile ............................................................................5
1-2:3 Homeowners ..........................................................................5
1-2:4 Commercial Property .............................................................6
1-2:5 Builder’s Risk.........................................................................6
1-3 DIFFERENT TYPES OF LIABILITY POLICIES........................6
1-3:1 Automobile ............................................................................6
1-3:2 Homeowners ..........................................................................7
1-3:3 Personal Lines Umbrella ........................................................7
1-3:4 Commercial General Liability................................................8
1-3:5 Errors and Omissions..............................................................8
1-3:6 Directors and Officers Liability..............................................8
1-3:7 Employment Practices Liability..............................................9
1-3:8 Commercial Lines Excess/Umbrella.......................................9
1-4 THE CONCEPT OF FORTUITY IN INSURANCE POLICIES..9
1-5 STANDARDIZED FORMS...........................................................10
Chapter 2: Interpretation of Insurance Policies...................................... 11
2-1 CONTRACT INTERPRETATION GENERALLY...................... 11
2-2 CONTRACT INTERPRETATION AS TO INSURANCE
POLICIES........................................................................................12
2-3 HOW TO READ A POLICY..........................................................14
2-3:1 Policy Declarations Pages.....................................................14
2-3:2 The Insuring Agreement.......................................................14
2-3:4 Exclusions.............................................................................15
2-3:5 Give Backs............................................................................15
2-3:6 Conditions.............................................................................15
2-4 EFFECT OF ENDORSEMENTS..................................................16
2-5 BURDENS OF PROOF..................................................................16
2-5:1 Insured Must Prove Loss Falls Within Insuring Agreement.16
2-5:2 Insurer Must Prove Exclusion or Limitation Removes
Coverage...............................................................................16
2-5:3 Insured Must Prove Loss Falls Within Exception to
Exclusion...............................................................................17
2-5:4 Burden of Proof Regarding Failure to Perform Conditions
Precedent...............................................................................17
Chapter 3: Commercial Property Coverage.............................................19
3-1 PURPOSE OF PROPERTY COVERAGE....................................19
3-2 VALUED POLICIES......................................................................19
3-2:1 Requirements........................................................................19
3-2:2 Agreed Value Policies Are Disfavored.................................20
3-3 KEY PROVISIONS IN PROPERTY DECLARATIONS
PAGES.............................................................................................20
3-4 THE PROPERTY INSURING AGREEMENT............................20
3-4:1 Covered Property..................................................................21
3-4:2 Covered Cause of Loss—Specified or Named Peril.............21
3-4:3 Covered Cause of Loss—All Risks......................................22
3-4:4 The Concept of Fortuity in a Property Policy.......................22
3-4:5 Indemnification Under a Property Policy.............................23
3-4:6 Direct Physical Loss.............................................................23
3-4:6.1 What Constitutes a Direct Physical Loss.........23
3-4:6.2 What Is Not a Direct Physical Loss.................24
3-4:7 Property Not Covered...........................................................25
3-5 DOES THE LOSS FALL WITHIN THE POLICY PERIOD......26
3-5:1 Discrete Loss.........................................................................26
3-5:2 Continuous and Progressive Loss.........................................27
3-5:3 Manifestation Rule................................................................27
3-5:4 Delayed Discovery Rule.......................................................27
3-6 LIMITATIONS ON COVERAGE.................................................28
3-6:1 Property That Is Missing, Where Only Evidence of Loss Is
Inventory Shortage................................................................28
3-6:2 Damage to the Interior of Any Building Caused by or
Resulting from Rain, Snow, Sleet, Ice, Sand or Dust...........28
3-7 ADDITIONAL COVERAGES......................................................29
3-7:1 Collapse.................................................................................29
3-7:2 Water Damage, Other Liquids, Powder or Molten Material
Damage.................................................................................30
3-7:3 Business Income...................................................................30
3-7:3.1 Definition of Business Income.........................31
3-7:3.2 Requirement That Operations Be Suspended..31
3-7:3.3 Suspension Caused By Covered Cause of
Loss..................................................................32
3-7:3.4 Period of Restoration.......................................32
3-7:3.5 Extended Business Income..............................32
3-7:4 Extra Expense.......................................................................32
3-7:5 Civil Authority......................................................................33
3-7:6 Forgery or Alteration.............................................................34
3-7:7 Increased Cost of Construction.............................................34
3-8 COVERAGE EXTENSIONS.........................................................35
3-8:1 Newly Acquired or Constructed Property.............................35
3-8:2 Personal Effects (and Property of Others)............................35
3-8:3 Valuable Papers and Records................................................35
3-9 EXCLUSIONS ...............................................................................35
3-9:1 Application of Exclusions.....................................................35
3-9:1.1 Loss Resulting from Single Cause or Peril......36
3-9:1.2 Efficient Proximate Cause Doctrine................37
3-9:2 Property Policy Exclusions...................................................38
3-9:2.1 Section B.1 Exclusions....................................38
3-9:2.1a Ordinance or Law...........................38
3-9:2.1b Earth Movement.............................39
3-9:2.1c Governmental Action.....................39
3-9:2.1d War and Military Action.................40
3-9:2.1e Water..............................................41
3-9:2.1e(1) Flood, Surface Water...........41
3-9:2.1e(2) Water Backing Up from
Sewer or Drain....................42
3-9:2.2 Section B.2 Exclusions....................................42
3-9:2.2a Dishonesty......................................42
3-9:2.2b False Pretense.................................42
3-9:2.2c Collapse..........................................43
3-9:2.2d Pollution.........................................43
3-9:2.2e Neglect...........................................44
3-9:2.2f Other Types of Losses....................45
3-8:2.2f(1) Wear and Tear......................45
3-9:2.2f(2) Rust, Corrosion, Fungus,
Decay, Deterioration, Hidden
or Latent Defect or Quality
in Property that Causes It to
Destroy Itself.......................45
3-9:2-2f(3) Settling, Cracking, Shrinking
or Expansion........................45
3-9:2-2f(4) Nesting or Infestations .......46
3-9:2.2g Repeated Seepage or Leakage of
Water..............................................46
3-9:2.3 Section B.3 Exclusions....................................46
3-9:2.3a Weather Conditions........................46
3-9:2.3b Acts or Decisions...........................47
3-9:2.3c Negligent Work..............................47
3-9:2.4 Ensuing Loss Provisions..................................47
3-10 LIMITS OF INSURANCE.............................................................49
3-11 DEDUCTIBLES..............................................................................49
3-12 PROPERTY LOSS CONDITIONS...............................................49
3-12:1 Appraisal...............................................................................49
3-12:2 Duties in the Event of Loss or Damage................................49
3-12:2.1 Notice of Loss ...................................................................50
3-12:2.2 Protection of Property from Further Loss........51
3-12:2.3 Production of Books, Records or Other
Evidence Supporting the Loss.........................51
3-12:2.4 Proof of Loss....................................................52
3-12:2.5 Examination Under Oath ................................52
3-12:3 Legal Action Against Us.......................................................54
3-12:4 Loss Payment........................................................................54
3-12:5 Vacancy.................................................................................55
3-12:6 Co-Insurance ........................................................................57
3-13 PROPERTY--GENERAL CONDITIONS.....................................57
3-13:1 Mortgageholders...................................................................57
3-13:2 Policy Period/Coverage Territory.........................................57
3-13:3 Concealment or Fraud...........................................................57
3:14 OPTIONAL COVERAGES...........................................................58
3-14:1 Employment Dishonesty.......................................................58
3-14:2 Inflation Guard......................................................................59
3-14:3 Replacement Cost.................................................................59
3-15 PROPERTY DEFINITIONS..........................................................60
Chapter 4: Commercial General Liability Policies..................................61
4-1 PURPOSE OF LIABILITY COVERAGE....................................61
4-2 DUTY TO DEFEND VERSUS DUTY TO INDEMNIFY..........61
4-2:1 How to Determine Duty to Defend.......................................61
4-2:1.1 An Insured’s Right to Independent Counsel....62
4-2:2 How to Determine Duty to Indemnify..................................63
4-3 HOW TO READ A LIABILITY POLICY....................................64
4-4 KEY PROVISIONS IN LIABILITY DECLARATIONS
PAGES.............................................................................................64
4-5 THE LIABILITY INSURING AGREEMENT.............................64
4-5:1 Types of Liability Insuring Agreements...............................64
4-5:1.1 Coverage A.......................................................64
4-5:1.2 Coverage B......................................................65
4-5:1.3 Combination (Business Liability Insuring
Agreement)......................................................65
4-5:2 Who Is an Insured.................................................................65
4-5:2.1 Named Insured.................................................65
4-5:2.2 Effect of Joint Venture Exclusion....................66
4-5:2.3 Additional Insureds..........................................67
4-5:2.3a Omnibus Provisions.......................67
4-5:2.3b Additional Insured Endorsements..68
4-5:3 Damages................................................................................69
4-5:3.1 What Constitutes Damages..............................69
4-5:3.2 What Does Not Constitute Damages...............69
4-5:3.3 Prohibition on Indemnification of Punitive
Damages..........................................................70
4-5:4 Bodily Injury and Property Damage Coverage.....................70
4-5:4.1 Bodily Injury...................................................70
4-5:4.1a What Constitutes “Bodily Injury”..70
4-5:4.1b What Does Not Constitute “Bodily
Injury”............................................70
4-5:4.2 Property Damage.............................................71
4-5:4.2a Tangible Property Requirement.....71
4-5:4.2b What Constitutes “Property
Damage”.........................................71
4-5:4.2c What Does Not Constitute “Property
Damage”.........................................72
4-5:4.3 Occurrence.......................................................73
4-5:4.3a Accident Requirement....................73
4-5:4.3b What Does Not Constitute an
Occurrence.....................................73
4-5:4.4 Trigger of Coverage.........................................76
4-5:5 Personal and Advertising Injury Coverage...........................76
4-5:5.1 What Is Personal and Advertising Injury.........76
4-5:5.2 Offense Based..................................................76
4-5:5.2a False Arrest, Detention or
Imprisonment.................................77
4-5:5.2b Malicious Prosecution....................77
4-5:5.2c Wrongful Eviction, Entry, or
Invasion of the Right of Private
Occupancy......................................78
4-5:5.2d Defamation or Disparagement.......79
4-5:5.2e Violation of Right of Privacy.........79
4-5:5.2f Use of Another’s Advertising Idea.80
4-5:5.2g Infringement of Copyright, Trade
Dress or Slogan..............................81
4-5:6 Suit........................................................................................81
4-5:6.1 What Constitutes a Suit...................................81
4-5:6.1a Where Term Is Undefined..............81
4-5:6.1b Where Term Is Defined..................82
4-5:6.2 What Does Not Constitute a Suit.....................82
4-6 MEDICAL EXPENSES PROVISION..........................................82
4-7 SUPPLEMENTARY PAYMENTS PROVISION.........................83
4-6:1 What Is Covered...................................................................83
4-6:2 When Is the Provision Inapplicable......................................84
4-8 EXCLUSIONS AND LIMITATIONS...........................................84
4-8:1 Application of Exclusions.....................................................84
4-8:1.1 Concurrent Cause Analysis..............................84
4-8:2 Standard Liability Policy Exclusions and Limitations..........85
4-8:2.1 Expected or Intended Acts..............................85
4-8:2.1a Insurance Code Section 533...........86
4-8:2.2 Contractual Liability........................................86
4-8:2.3 Workers’ Compensation and Similar Laws.....87
4-8:2.4 Employer’s Liability.......................................87
4-8:2.5 Pollution...........................................................88
4-8:2.5a Absolute Pollution Exclusion.........88
4-8:2.5b Sudden and Accidental...................89
4-8:2.6 Aircraft, Auto, Watercraft................................89
4-8:2.7 Damage to Property.........................................90
4-8:2.8 Damage to “Your Product” and “Your Work”.91
4-8:2.10 Damage to Impaired Property..........................92
4-8:2.11 Sistership Exclusion.........................................93
4-8:2.12 Classification Limitations................................93
4-8:2.13 Personal and Advertising Injury Exclusions....93
4-8:2.13a Exclusions Based on Insured’s
Knowledge.....................................93
4-8:2.13b Prior Publication Exclusion...........94
4-8:2.13c Breach of Contract Exclusion........94
4-8:2.13d Failure of Goods, Products, Services
to Conform.....................................95
4-8:2.13e Infringement Exclusion..................95
4-8:2.13f Employment-Related Practices......95
4-8:2.14 Medical Expenses Exclusions..........................96
4-9 LIMITS OF LIABILITY................................................................97
4-10 POLICY CONDITIONS.................................................................97
4-10:1 Bankruptcy............................................................................97
4-10:2 Duties in the Event of Occurrence, Offense, Claim or Suit..98
4-10:2.1 Ramifications of Insured’s Breach...................98
4-10:3 Suit Limitation Clause..........................................................99
4-10:4 Other Insurance Clause.......................................................100
4-10:4a Escape Clauses Disfavored............................100
4-10:5 Concealment/Fraud.............................................................100
4-10:6 Separation of Insureds Clause.............................................101
4-10:7 Transfer of Rights of Recovery Against Others..................101
4-11 OTHER ENDORSEMENTS TO LIABILITY POLICIES........102
4-12:1 Professional Services Exclusion.........................................102
4-12:2 Insured vs. Insured Exclusion.............................................102
4-12:3 Residential Construction Exclusion....................................103
4-12:4 Special Conditions Endorsement........................................103
Chapter 5: Commercial Automobile Policies.........................................105
5-1 PURPOSE OF COMMERCIAL AUTOMOBILE POLICY......105
5-2 TYPES OF COVERAGE INCLUDED.......................................105
5-2:1 Liability Coverage (Third Party)........................................105
5-2:2 Physical Damage Coverage (First Party)............................106
5-2:3 Medical Payments Coverage...............................................106
5-2:4 Uninsured Motorist Coverage.............................................106
5-3 COVERED AUTOS......................................................................106
5-3:1 Description of Covered Auto Designation Symbols...........106
5-3:2 Owned Autos Acquired After Inception of Policy..............107
5-3:3 Trailers, Mobile Equipment, and Temporary Substitute
Autos...................................................................................107
5-4 LIABILITY COVERAGE............................................................107
5-4:1 Insuring Agreement.............................................................107
5-4:1.1 Who Is an Insured..........................................107
5-4:1.1a Named Insured.............................108
5-4:1.1b Permissive Users..........................108
5-4:1.1c Anyone Liable for the Conduct of an
Insured..........................................108
5-4:1.2 Bodily Injury and Property Damage..............108
5-4:1.3 Covered Pollution Cost or Expense...............108
5-4:1.4 Accident Requirement...................................109
5-4:1.5 Resulting from Ownership, Maintenance or Use
of a Covered Auto..........................................109
5-4:2 Coverage Extensions...........................................................109
5-4:2.1 Supplementary Payments............................... 110
5-4:2.2 Out of State Coverage Extensions................. 110
5-4:3 Typical Liability Exclusions............................................... 110
5-4:3.1 Expected or Intended Injury Exclusion......... 111
5-4:3.2 Contractual Liability Exclusion..................... 111
5-4:3.3 Workers’ Compensation Exclusion................ 111
5-4:3.4 Employer’s Liability Exclusion..................... 111
5-4:3.5 Bodily Injury to a Fellow Employee
Exclusion ..................................................... 112
5-4:3.6 Care, Custody or Control Exclusion ............ 112
5-4:3.7 Handling of Property Exclusion.................... 112
5-4:3.8 Movement of Property by Mechanical Device
Exclusion ..................................................... 112
5-4:3.9 Completed Operations Exclusion ................ 112
5-4:3.10 Pollution Exclusion ...................................... 113
5-4:3.11 War Exclusion................................................ 113
5-4:3.12 Racing Exclusion .......................................... 113
5-4:4 Limit of Insurance............................................................... 113
5-4:4.1 One Accident................................................. 113
5-4:4.2 Other Coverages............................................ 114
5-5 PHYSICAL DAMAGE COVERAGE......................................... 114
5-5:1 Insuring Agreement............................................................. 114
5-5:1.1 Loss to Covered Auto ................................... 114
5-5:1.1a Comprehensive Coverage .......... 114
5-5:1.1b Specified Causes of Loss
Coverage...................................... 114
5-5:1.1c Collision Coverage ..................... 115
5-5:2 Typical Exclusions.............................................................. 115
5-5:2.1 Nuclear Hazard Exclusion ........................... 115
5-5:2.2 War or Military Action Exclusion ................. 115
5-5:2.3 Racing Exclusion ......................................... 115
5-5:2.4 Wear and Tear Exclusion ............................. 115
5-5:2.5 Exclusion for Loss to Specified Devices and
Equipment .................................................... 115
5-5:3 Limit of Insurance............................................................... 116
5-5:4 Deductible........................................................................... 116
5-6 MEDICAL PAYMENTS COVERAGE....................................... 116
5-6:1 Purpose of Coverage........................................................... 116
5-6:2 Insuring Agreement............................................................. 116
5-6:2.1 Payment for Reasonable Expenses for
Necessary Medical and Funeral Services to or
for an Insured................................................. 116
5-6:2.2 Who Is an Insured ........................................ 117
5-6:3 Typical Exclusions.............................................................. 117
5-6:3.1 Vehicle Used as Premises.............................. 117
5-6:3.2 Non-Covered Autos Owned by Named
Insured ......................................................... 117
5-6:3.3 Non-Covered Autos Owned by Family
Member.......................................................... 117
5-6:3.4 Injury to Employee ...................................... 117
5-6:3.5 Auto Business Other Than Named Insured’s
Business ........................................................ 117
5-6:3.6 War................................................................. 118
5-6:3.7 Use Without Reasonable Belief of Entitlement
to Do So ........................................................ 118
5-6:3.8 Racing .......................................................... 118
5-6:4 Limits of Insurance............................................................. 118
5-7 UNINSURED MOTORISTS COVERAGE............................... 118
5-7:1 Purpose of Coverage........................................................... 118
5-7:2 Insuring Agreement ........................................................... 119
5-7:2.1 Uninsured Motor Vehicle Requirement ........ 119
5-7:2.1a Includes Underinsured Motor
Vehicle.......................................... 119
5-7:2.1b Physical Contact Requirement for
Hit and Run.................................. 119
5-7:2.1c What Does Not Constitute an
Uninsured Motor Vehicle ...........120
5-7:2.2 Who Is an Insured .........................................120
5-7:3 Typical Exclusions..............................................................120
5-7:3.1 Punitive Damages..........................................120
5-7:3.2 Settlement Without Insurer’s Consent...........121
5-7:3.3 Workers’ Compensation or Similar Law.......121
5-7:3.4 Non-Covered Autos .....................................121
5-7:3.5 Non-Covered Leased Autos...........................121
5-7:3.6 Use Without Reasonable Belief of Entitlement
to Do So.........................................................121
5-7:3.7 Public or Livery Conveyance .......................122
5-7:4 Limit of Insurance .............................................................122
5-7:4.1 Reduction for Accidents Involving
Underinsured Vehicle.....................................122
5-7:4.2 Prohibition on Duplicate Payments .............122
5-7:5 Other Insurance .................................................................122
5-7:6 Arbitration .........................................................................123
5-7:6.1 Insurance Code Section 11580.2 .................123
5-8 LOSS CONDITIONS...................................................................123
5-8:1 Appraisal for Physical Damage Loss ................................123
5-8:2 Insured’s Duties in the Event of an Accident, Claim, Suit or
Loss.....................................................................................123
5-8:3 Suit Limitation Provision....................................................124
5-8:4 Loss Payment Provisions....................................................124
5-8:5 Transfer of Rights of Recovery .........................................124
5-9 GENERAL CONDITIONS..........................................................124
5-9:1 Bankruptcy .........................................................................124
5-9:2 Concealment, Misrepresentation and Fraud ......................125
5-9:3 Other Insurance Provisions.................................................125
5-9:4 Policy Period and Coverage Territory ...............................125
5-9:5 Two or More Coverage Forms or Policies Issued by
Insurer ...............................................................................125
Chapter 6: Personal Automobile Policies...............................................127
6-1 PURPOSE OF PERSONAL AUTO POLICY............................127
6-2 TYPES OF COVERAGE INCLUDED.......................................127
6-2:1 Liability Coverage (Third Party)........................................127
6-2:1.1 Purpose of Coverage......................................127
6-2:1.2 Insuring Agreement.......................................128
6-2:1.3 Key Terms Defined........................................128
6-2:1.3a Insured .........................................128
6-2:1.3b Bodily Injury ..............................129
6-2:1.3c Property Damage..........................129
6-2:1.3d Your Covered Auto .....................129
6-2:1.3e Newly Acquired Auto...................130
6-2:1.4 Supplementary Payments...............................130
6-2:1.5 Exclusions/Limitations..................................130
6-2:1.5a An Individual Who Intentionally
Causes the “Bodily Injury” or
“Property Damage”......................130
6-2:1.5b “Property Damage” to Property
Owned or Being Transported by
That Insured.................................131
6-2:1.5c “Property Damage” to Property
Rented to, Used by or in the Case of
That Insured.................................131
6-2:1.5d “Bodily Injury” to an Employee of
That Insured During the Course of
Employment ...............................131
6-2:1.5e Public Livery or Conveyance.......131
6-2:1.5f While Employed or Otherwise
Engaged in the Business of Selling,
Repairing, Servicing, Storing or
Parking Vehicles .........................131
6-2:1.5g Maintaining or Using Any Vehicle
While That Insured Is Employed
or Otherwise Engaged in a
Business ......................................132
6-2:1.5h Using a Vehicle Without a
Reasonable Belief That the
“Insured” Is Entitled to Do So ...132
6-2:1.5i Driver Exclusion ........................132
6-2:1.5j Bodily Injury to a Family Member
of the Named Insured...................132
6-2:1.6 Limits of Liability..........................................132
6-2:1.6a No Stacking of Limits; Wrongful
Death and Consortium.................132
6-2:1.6b Offset for Loss Covered under
Medical Payments and Uninsured
Motorist Coverage........................133
6-2:1.7 Out of State Coverage....................................133
6-2:1.8 Financial Responsibility................................133
6-2:1.9 Other Insurance..............................................133
6-2:2 Medical Payments Coverage (First Party)..........................133
6-2:2.1 Purpose of Coverage......................................134
6-2:2.2 Insuring Agreement.......................................134
6-2:2.3 Key Terms Defined........................................134
6-2:2.3a Bodily injury ..............................134
6-2:2.3b Insured..........................................134
6-2:2.3c Occupying....................................134
6-2:2.4 Exclusions/Limitations..................................134
6-2:2.4a Public Livery or Conveyance .....134
6-2:2.4b Occurring During the Course
of Employment if Workers
Compensation Benefits Are Required
or Available .................................135
6-2:2.4c
1-1 TYPES OF POLICIES......................................................................1
1-1:1 Personal Lines Versus Commercial Lines Policies.................1
1-1:2 Property Versus Liability Policies...........................................2
1-1:3 Occurrence Versus Claims-Made Policies..............................3
1-1:4 Primary Versus Excess Versus Umbrella Policies...................4
1-2 DIFFERENT TYPES OF PROPERTY POLICIES........................5
1-2:1 All Risk Versus Specified Peril Policies.................................5
1-2:2 Automobile ............................................................................5
1-2:3 Homeowners ..........................................................................5
1-2:4 Commercial Property .............................................................6
1-2:5 Builder’s Risk.........................................................................6
1-3 DIFFERENT TYPES OF LIABILITY POLICIES........................6
1-3:1 Automobile ............................................................................6
1-3:2 Homeowners ..........................................................................7
1-3:3 Personal Lines Umbrella ........................................................7
1-3:4 Commercial General Liability................................................8
1-3:5 Errors and Omissions..............................................................8
1-3:6 Directors and Officers Liability..............................................8
1-3:7 Employment Practices Liability..............................................9
1-3:8 Commercial Lines Excess/Umbrella.......................................9
1-4 THE CONCEPT OF FORTUITY IN INSURANCE POLICIES..9
1-5 STANDARDIZED FORMS...........................................................10
Chapter 2: Interpretation of Insurance Policies...................................... 11
2-1 CONTRACT INTERPRETATION GENERALLY...................... 11
2-2 CONTRACT INTERPRETATION AS TO INSURANCE
POLICIES........................................................................................12
2-3 HOW TO READ A POLICY..........................................................14
2-3:1 Policy Declarations Pages.....................................................14
2-3:2 The Insuring Agreement.......................................................14
2-3:4 Exclusions.............................................................................15
2-3:5 Give Backs............................................................................15
2-3:6 Conditions.............................................................................15
2-4 EFFECT OF ENDORSEMENTS..................................................16
2-5 BURDENS OF PROOF..................................................................16
2-5:1 Insured Must Prove Loss Falls Within Insuring Agreement.16
2-5:2 Insurer Must Prove Exclusion or Limitation Removes
Coverage...............................................................................16
2-5:3 Insured Must Prove Loss Falls Within Exception to
Exclusion...............................................................................17
2-5:4 Burden of Proof Regarding Failure to Perform Conditions
Precedent...............................................................................17
Chapter 3: Commercial Property Coverage.............................................19
3-1 PURPOSE OF PROPERTY COVERAGE....................................19
3-2 VALUED POLICIES......................................................................19
3-2:1 Requirements........................................................................19
3-2:2 Agreed Value Policies Are Disfavored.................................20
3-3 KEY PROVISIONS IN PROPERTY DECLARATIONS
PAGES.............................................................................................20
3-4 THE PROPERTY INSURING AGREEMENT............................20
3-4:1 Covered Property..................................................................21
3-4:2 Covered Cause of Loss—Specified or Named Peril.............21
3-4:3 Covered Cause of Loss—All Risks......................................22
3-4:4 The Concept of Fortuity in a Property Policy.......................22
3-4:5 Indemnification Under a Property Policy.............................23
3-4:6 Direct Physical Loss.............................................................23
3-4:6.1 What Constitutes a Direct Physical Loss.........23
3-4:6.2 What Is Not a Direct Physical Loss.................24
3-4:7 Property Not Covered...........................................................25
3-5 DOES THE LOSS FALL WITHIN THE POLICY PERIOD......26
3-5:1 Discrete Loss.........................................................................26
3-5:2 Continuous and Progressive Loss.........................................27
3-5:3 Manifestation Rule................................................................27
3-5:4 Delayed Discovery Rule.......................................................27
3-6 LIMITATIONS ON COVERAGE.................................................28
3-6:1 Property That Is Missing, Where Only Evidence of Loss Is
Inventory Shortage................................................................28
3-6:2 Damage to the Interior of Any Building Caused by or
Resulting from Rain, Snow, Sleet, Ice, Sand or Dust...........28
3-7 ADDITIONAL COVERAGES......................................................29
3-7:1 Collapse.................................................................................29
3-7:2 Water Damage, Other Liquids, Powder or Molten Material
Damage.................................................................................30
3-7:3 Business Income...................................................................30
3-7:3.1 Definition of Business Income.........................31
3-7:3.2 Requirement That Operations Be Suspended..31
3-7:3.3 Suspension Caused By Covered Cause of
Loss..................................................................32
3-7:3.4 Period of Restoration.......................................32
3-7:3.5 Extended Business Income..............................32
3-7:4 Extra Expense.......................................................................32
3-7:5 Civil Authority......................................................................33
3-7:6 Forgery or Alteration.............................................................34
3-7:7 Increased Cost of Construction.............................................34
3-8 COVERAGE EXTENSIONS.........................................................35
3-8:1 Newly Acquired or Constructed Property.............................35
3-8:2 Personal Effects (and Property of Others)............................35
3-8:3 Valuable Papers and Records................................................35
3-9 EXCLUSIONS ...............................................................................35
3-9:1 Application of Exclusions.....................................................35
3-9:1.1 Loss Resulting from Single Cause or Peril......36
3-9:1.2 Efficient Proximate Cause Doctrine................37
3-9:2 Property Policy Exclusions...................................................38
3-9:2.1 Section B.1 Exclusions....................................38
3-9:2.1a Ordinance or Law...........................38
3-9:2.1b Earth Movement.............................39
3-9:2.1c Governmental Action.....................39
3-9:2.1d War and Military Action.................40
3-9:2.1e Water..............................................41
3-9:2.1e(1) Flood, Surface Water...........41
3-9:2.1e(2) Water Backing Up from
Sewer or Drain....................42
3-9:2.2 Section B.2 Exclusions....................................42
3-9:2.2a Dishonesty......................................42
3-9:2.2b False Pretense.................................42
3-9:2.2c Collapse..........................................43
3-9:2.2d Pollution.........................................43
3-9:2.2e Neglect...........................................44
3-9:2.2f Other Types of Losses....................45
3-8:2.2f(1) Wear and Tear......................45
3-9:2.2f(2) Rust, Corrosion, Fungus,
Decay, Deterioration, Hidden
or Latent Defect or Quality
in Property that Causes It to
Destroy Itself.......................45
3-9:2-2f(3) Settling, Cracking, Shrinking
or Expansion........................45
3-9:2-2f(4) Nesting or Infestations .......46
3-9:2.2g Repeated Seepage or Leakage of
Water..............................................46
3-9:2.3 Section B.3 Exclusions....................................46
3-9:2.3a Weather Conditions........................46
3-9:2.3b Acts or Decisions...........................47
3-9:2.3c Negligent Work..............................47
3-9:2.4 Ensuing Loss Provisions..................................47
3-10 LIMITS OF INSURANCE.............................................................49
3-11 DEDUCTIBLES..............................................................................49
3-12 PROPERTY LOSS CONDITIONS...............................................49
3-12:1 Appraisal...............................................................................49
3-12:2 Duties in the Event of Loss or Damage................................49
3-12:2.1 Notice of Loss ...................................................................50
3-12:2.2 Protection of Property from Further Loss........51
3-12:2.3 Production of Books, Records or Other
Evidence Supporting the Loss.........................51
3-12:2.4 Proof of Loss....................................................52
3-12:2.5 Examination Under Oath ................................52
3-12:3 Legal Action Against Us.......................................................54
3-12:4 Loss Payment........................................................................54
3-12:5 Vacancy.................................................................................55
3-12:6 Co-Insurance ........................................................................57
3-13 PROPERTY--GENERAL CONDITIONS.....................................57
3-13:1 Mortgageholders...................................................................57
3-13:2 Policy Period/Coverage Territory.........................................57
3-13:3 Concealment or Fraud...........................................................57
3:14 OPTIONAL COVERAGES...........................................................58
3-14:1 Employment Dishonesty.......................................................58
3-14:2 Inflation Guard......................................................................59
3-14:3 Replacement Cost.................................................................59
3-15 PROPERTY DEFINITIONS..........................................................60
Chapter 4: Commercial General Liability Policies..................................61
4-1 PURPOSE OF LIABILITY COVERAGE....................................61
4-2 DUTY TO DEFEND VERSUS DUTY TO INDEMNIFY..........61
4-2:1 How to Determine Duty to Defend.......................................61
4-2:1.1 An Insured’s Right to Independent Counsel....62
4-2:2 How to Determine Duty to Indemnify..................................63
4-3 HOW TO READ A LIABILITY POLICY....................................64
4-4 KEY PROVISIONS IN LIABILITY DECLARATIONS
PAGES.............................................................................................64
4-5 THE LIABILITY INSURING AGREEMENT.............................64
4-5:1 Types of Liability Insuring Agreements...............................64
4-5:1.1 Coverage A.......................................................64
4-5:1.2 Coverage B......................................................65
4-5:1.3 Combination (Business Liability Insuring
Agreement)......................................................65
4-5:2 Who Is an Insured.................................................................65
4-5:2.1 Named Insured.................................................65
4-5:2.2 Effect of Joint Venture Exclusion....................66
4-5:2.3 Additional Insureds..........................................67
4-5:2.3a Omnibus Provisions.......................67
4-5:2.3b Additional Insured Endorsements..68
4-5:3 Damages................................................................................69
4-5:3.1 What Constitutes Damages..............................69
4-5:3.2 What Does Not Constitute Damages...............69
4-5:3.3 Prohibition on Indemnification of Punitive
Damages..........................................................70
4-5:4 Bodily Injury and Property Damage Coverage.....................70
4-5:4.1 Bodily Injury...................................................70
4-5:4.1a What Constitutes “Bodily Injury”..70
4-5:4.1b What Does Not Constitute “Bodily
Injury”............................................70
4-5:4.2 Property Damage.............................................71
4-5:4.2a Tangible Property Requirement.....71
4-5:4.2b What Constitutes “Property
Damage”.........................................71
4-5:4.2c What Does Not Constitute “Property
Damage”.........................................72
4-5:4.3 Occurrence.......................................................73
4-5:4.3a Accident Requirement....................73
4-5:4.3b What Does Not Constitute an
Occurrence.....................................73
4-5:4.4 Trigger of Coverage.........................................76
4-5:5 Personal and Advertising Injury Coverage...........................76
4-5:5.1 What Is Personal and Advertising Injury.........76
4-5:5.2 Offense Based..................................................76
4-5:5.2a False Arrest, Detention or
Imprisonment.................................77
4-5:5.2b Malicious Prosecution....................77
4-5:5.2c Wrongful Eviction, Entry, or
Invasion of the Right of Private
Occupancy......................................78
4-5:5.2d Defamation or Disparagement.......79
4-5:5.2e Violation of Right of Privacy.........79
4-5:5.2f Use of Another’s Advertising Idea.80
4-5:5.2g Infringement of Copyright, Trade
Dress or Slogan..............................81
4-5:6 Suit........................................................................................81
4-5:6.1 What Constitutes a Suit...................................81
4-5:6.1a Where Term Is Undefined..............81
4-5:6.1b Where Term Is Defined..................82
4-5:6.2 What Does Not Constitute a Suit.....................82
4-6 MEDICAL EXPENSES PROVISION..........................................82
4-7 SUPPLEMENTARY PAYMENTS PROVISION.........................83
4-6:1 What Is Covered...................................................................83
4-6:2 When Is the Provision Inapplicable......................................84
4-8 EXCLUSIONS AND LIMITATIONS...........................................84
4-8:1 Application of Exclusions.....................................................84
4-8:1.1 Concurrent Cause Analysis..............................84
4-8:2 Standard Liability Policy Exclusions and Limitations..........85
4-8:2.1 Expected or Intended Acts..............................85
4-8:2.1a Insurance Code Section 533...........86
4-8:2.2 Contractual Liability........................................86
4-8:2.3 Workers’ Compensation and Similar Laws.....87
4-8:2.4 Employer’s Liability.......................................87
4-8:2.5 Pollution...........................................................88
4-8:2.5a Absolute Pollution Exclusion.........88
4-8:2.5b Sudden and Accidental...................89
4-8:2.6 Aircraft, Auto, Watercraft................................89
4-8:2.7 Damage to Property.........................................90
4-8:2.8 Damage to “Your Product” and “Your Work”.91
4-8:2.10 Damage to Impaired Property..........................92
4-8:2.11 Sistership Exclusion.........................................93
4-8:2.12 Classification Limitations................................93
4-8:2.13 Personal and Advertising Injury Exclusions....93
4-8:2.13a Exclusions Based on Insured’s
Knowledge.....................................93
4-8:2.13b Prior Publication Exclusion...........94
4-8:2.13c Breach of Contract Exclusion........94
4-8:2.13d Failure of Goods, Products, Services
to Conform.....................................95
4-8:2.13e Infringement Exclusion..................95
4-8:2.13f Employment-Related Practices......95
4-8:2.14 Medical Expenses Exclusions..........................96
4-9 LIMITS OF LIABILITY................................................................97
4-10 POLICY CONDITIONS.................................................................97
4-10:1 Bankruptcy............................................................................97
4-10:2 Duties in the Event of Occurrence, Offense, Claim or Suit..98
4-10:2.1 Ramifications of Insured’s Breach...................98
4-10:3 Suit Limitation Clause..........................................................99
4-10:4 Other Insurance Clause.......................................................100
4-10:4a Escape Clauses Disfavored............................100
4-10:5 Concealment/Fraud.............................................................100
4-10:6 Separation of Insureds Clause.............................................101
4-10:7 Transfer of Rights of Recovery Against Others..................101
4-11 OTHER ENDORSEMENTS TO LIABILITY POLICIES........102
4-12:1 Professional Services Exclusion.........................................102
4-12:2 Insured vs. Insured Exclusion.............................................102
4-12:3 Residential Construction Exclusion....................................103
4-12:4 Special Conditions Endorsement........................................103
Chapter 5: Commercial Automobile Policies.........................................105
5-1 PURPOSE OF COMMERCIAL AUTOMOBILE POLICY......105
5-2 TYPES OF COVERAGE INCLUDED.......................................105
5-2:1 Liability Coverage (Third Party)........................................105
5-2:2 Physical Damage Coverage (First Party)............................106
5-2:3 Medical Payments Coverage...............................................106
5-2:4 Uninsured Motorist Coverage.............................................106
5-3 COVERED AUTOS......................................................................106
5-3:1 Description of Covered Auto Designation Symbols...........106
5-3:2 Owned Autos Acquired After Inception of Policy..............107
5-3:3 Trailers, Mobile Equipment, and Temporary Substitute
Autos...................................................................................107
5-4 LIABILITY COVERAGE............................................................107
5-4:1 Insuring Agreement.............................................................107
5-4:1.1 Who Is an Insured..........................................107
5-4:1.1a Named Insured.............................108
5-4:1.1b Permissive Users..........................108
5-4:1.1c Anyone Liable for the Conduct of an
Insured..........................................108
5-4:1.2 Bodily Injury and Property Damage..............108
5-4:1.3 Covered Pollution Cost or Expense...............108
5-4:1.4 Accident Requirement...................................109
5-4:1.5 Resulting from Ownership, Maintenance or Use
of a Covered Auto..........................................109
5-4:2 Coverage Extensions...........................................................109
5-4:2.1 Supplementary Payments............................... 110
5-4:2.2 Out of State Coverage Extensions................. 110
5-4:3 Typical Liability Exclusions............................................... 110
5-4:3.1 Expected or Intended Injury Exclusion......... 111
5-4:3.2 Contractual Liability Exclusion..................... 111
5-4:3.3 Workers’ Compensation Exclusion................ 111
5-4:3.4 Employer’s Liability Exclusion..................... 111
5-4:3.5 Bodily Injury to a Fellow Employee
Exclusion ..................................................... 112
5-4:3.6 Care, Custody or Control Exclusion ............ 112
5-4:3.7 Handling of Property Exclusion.................... 112
5-4:3.8 Movement of Property by Mechanical Device
Exclusion ..................................................... 112
5-4:3.9 Completed Operations Exclusion ................ 112
5-4:3.10 Pollution Exclusion ...................................... 113
5-4:3.11 War Exclusion................................................ 113
5-4:3.12 Racing Exclusion .......................................... 113
5-4:4 Limit of Insurance............................................................... 113
5-4:4.1 One Accident................................................. 113
5-4:4.2 Other Coverages............................................ 114
5-5 PHYSICAL DAMAGE COVERAGE......................................... 114
5-5:1 Insuring Agreement............................................................. 114
5-5:1.1 Loss to Covered Auto ................................... 114
5-5:1.1a Comprehensive Coverage .......... 114
5-5:1.1b Specified Causes of Loss
Coverage...................................... 114
5-5:1.1c Collision Coverage ..................... 115
5-5:2 Typical Exclusions.............................................................. 115
5-5:2.1 Nuclear Hazard Exclusion ........................... 115
5-5:2.2 War or Military Action Exclusion ................. 115
5-5:2.3 Racing Exclusion ......................................... 115
5-5:2.4 Wear and Tear Exclusion ............................. 115
5-5:2.5 Exclusion for Loss to Specified Devices and
Equipment .................................................... 115
5-5:3 Limit of Insurance............................................................... 116
5-5:4 Deductible........................................................................... 116
5-6 MEDICAL PAYMENTS COVERAGE....................................... 116
5-6:1 Purpose of Coverage........................................................... 116
5-6:2 Insuring Agreement............................................................. 116
5-6:2.1 Payment for Reasonable Expenses for
Necessary Medical and Funeral Services to or
for an Insured................................................. 116
5-6:2.2 Who Is an Insured ........................................ 117
5-6:3 Typical Exclusions.............................................................. 117
5-6:3.1 Vehicle Used as Premises.............................. 117
5-6:3.2 Non-Covered Autos Owned by Named
Insured ......................................................... 117
5-6:3.3 Non-Covered Autos Owned by Family
Member.......................................................... 117
5-6:3.4 Injury to Employee ...................................... 117
5-6:3.5 Auto Business Other Than Named Insured’s
Business ........................................................ 117
5-6:3.6 War................................................................. 118
5-6:3.7 Use Without Reasonable Belief of Entitlement
to Do So ........................................................ 118
5-6:3.8 Racing .......................................................... 118
5-6:4 Limits of Insurance............................................................. 118
5-7 UNINSURED MOTORISTS COVERAGE............................... 118
5-7:1 Purpose of Coverage........................................................... 118
5-7:2 Insuring Agreement ........................................................... 119
5-7:2.1 Uninsured Motor Vehicle Requirement ........ 119
5-7:2.1a Includes Underinsured Motor
Vehicle.......................................... 119
5-7:2.1b Physical Contact Requirement for
Hit and Run.................................. 119
5-7:2.1c What Does Not Constitute an
Uninsured Motor Vehicle ...........120
5-7:2.2 Who Is an Insured .........................................120
5-7:3 Typical Exclusions..............................................................120
5-7:3.1 Punitive Damages..........................................120
5-7:3.2 Settlement Without Insurer’s Consent...........121
5-7:3.3 Workers’ Compensation or Similar Law.......121
5-7:3.4 Non-Covered Autos .....................................121
5-7:3.5 Non-Covered Leased Autos...........................121
5-7:3.6 Use Without Reasonable Belief of Entitlement
to Do So.........................................................121
5-7:3.7 Public or Livery Conveyance .......................122
5-7:4 Limit of Insurance .............................................................122
5-7:4.1 Reduction for Accidents Involving
Underinsured Vehicle.....................................122
5-7:4.2 Prohibition on Duplicate Payments .............122
5-7:5 Other Insurance .................................................................122
5-7:6 Arbitration .........................................................................123
5-7:6.1 Insurance Code Section 11580.2 .................123
5-8 LOSS CONDITIONS...................................................................123
5-8:1 Appraisal for Physical Damage Loss ................................123
5-8:2 Insured’s Duties in the Event of an Accident, Claim, Suit or
Loss.....................................................................................123
5-8:3 Suit Limitation Provision....................................................124
5-8:4 Loss Payment Provisions....................................................124
5-8:5 Transfer of Rights of Recovery .........................................124
5-9 GENERAL CONDITIONS..........................................................124
5-9:1 Bankruptcy .........................................................................124
5-9:2 Concealment, Misrepresentation and Fraud ......................125
5-9:3 Other Insurance Provisions.................................................125
5-9:4 Policy Period and Coverage Territory ...............................125
5-9:5 Two or More Coverage Forms or Policies Issued by
Insurer ...............................................................................125
Chapter 6: Personal Automobile Policies...............................................127
6-1 PURPOSE OF PERSONAL AUTO POLICY............................127
6-2 TYPES OF COVERAGE INCLUDED.......................................127
6-2:1 Liability Coverage (Third Party)........................................127
6-2:1.1 Purpose of Coverage......................................127
6-2:1.2 Insuring Agreement.......................................128
6-2:1.3 Key Terms Defined........................................128
6-2:1.3a Insured .........................................128
6-2:1.3b Bodily Injury ..............................129
6-2:1.3c Property Damage..........................129
6-2:1.3d Your Covered Auto .....................129
6-2:1.3e Newly Acquired Auto...................130
6-2:1.4 Supplementary Payments...............................130
6-2:1.5 Exclusions/Limitations..................................130
6-2:1.5a An Individual Who Intentionally
Causes the “Bodily Injury” or
“Property Damage”......................130
6-2:1.5b “Property Damage” to Property
Owned or Being Transported by
That Insured.................................131
6-2:1.5c “Property Damage” to Property
Rented to, Used by or in the Case of
That Insured.................................131
6-2:1.5d “Bodily Injury” to an Employee of
That Insured During the Course of
Employment ...............................131
6-2:1.5e Public Livery or Conveyance.......131
6-2:1.5f While Employed or Otherwise
Engaged in the Business of Selling,
Repairing, Servicing, Storing or
Parking Vehicles .........................131
6-2:1.5g Maintaining or Using Any Vehicle
While That Insured Is Employed
or Otherwise Engaged in a
Business ......................................132
6-2:1.5h Using a Vehicle Without a
Reasonable Belief That the
“Insured” Is Entitled to Do So ...132
6-2:1.5i Driver Exclusion ........................132
6-2:1.5j Bodily Injury to a Family Member
of the Named Insured...................132
6-2:1.6 Limits of Liability..........................................132
6-2:1.6a No Stacking of Limits; Wrongful
Death and Consortium.................132
6-2:1.6b Offset for Loss Covered under
Medical Payments and Uninsured
Motorist Coverage........................133
6-2:1.7 Out of State Coverage....................................133
6-2:1.8 Financial Responsibility................................133
6-2:1.9 Other Insurance..............................................133
6-2:2 Medical Payments Coverage (First Party)..........................133
6-2:2.1 Purpose of Coverage......................................134
6-2:2.2 Insuring Agreement.......................................134
6-2:2.3 Key Terms Defined........................................134
6-2:2.3a Bodily injury ..............................134
6-2:2.3b Insured..........................................134
6-2:2.3c Occupying....................................134
6-2:2.4 Exclusions/Limitations..................................134
6-2:2.4a Public Livery or Conveyance .....134
6-2:2.4b Occurring During the Course
of Employment if Workers
Compensation Benefits Are Required
or Available .................................135
6-2:2.4c
Andrew J. King
Erin M. Gallagher
Gail Ann Y. Stargardter
Rand L. Chritton
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