Commercial General Liability & Business Owners Insurance. Commercial General Liability & Business Owners

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Commercial General

Liability

&

Business Owners

Insurance

Commercial General

Liability

&

Business Owners

Insurance

2 2 Commercial General Liability & Business Owners 1.0 COMMERCIAL GENERAL LIABILITY

1.1Common policy conditions

1.2 Commercial general liability coverage forms

Bodily injury and property damage liability Personal and advertising injury liability Medical payments Supplementary payments Who is an insured Limits of liability Conditions Definitions Exclusions

Premises and operations

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3 Commercial General Liability & Business Owners 1.3 Selected endorsements

Deductible liability insurance

Texas changes — employment-related practices exclusion Texas changes — conditions requiring notice

Texas changes —cancellation and Non-renewal 1.4 Claims-made policy forms versus occurrence forms

Texas regulations 1.5 Pollution liability

Pollution liability coverage form

Pollution liability limited coverage form

Pollution liability coverage extension endorsement

4 4 Commercial General Liability & Business Owners BUSINESS OWNERS POLICY

2.1 Characteristics and purpose

2.2 Business owners commons policy conditions form

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5 Commercial General Liability & Business Owners 2.4 Business owners liability coverage forms

Business liability Medical expenses Limits Conditions Exclusions Definitions 2.5 Selected endorsements Accounts receivable coverage

Hired auto and non-owned auto liability

Valuable papers and records electronic media and records Protective safeguards

Utility services — direct damage Utility services — time element

Texas changes — cancellation and non renewal

6 6 Commercial General Liability & Business Owners

1.1 Common policy conditions

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7 Commercial General Liability & Business Owners General liability insuranceis written to cover two major risk

exposures:

1) premises and operations; and 2) products and completed operations.

For each type of risk, coverage may be written for:

events that occur within the policy period (occurrence form); or

events for which a claim must be reported during the policy period (claims-made form).

1.2 Commercial general liability coverage forms

Bodily injury and property damage liability resulting from the premises, operations, products and completed operations. Personal and advertising injury liability, including protection for such offenses as defamation, false arrest and advertising liability.

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9 Commercial General Liability & Business Owners

Supplementary payments

Who is an insured?If the business is a sole proprietorship, the insured is the designated person and spouse, only for business acts. If the business is a partnership or a joint

venture, the partners or co-venturers and their spouses are the insureds—only for business acts.

Limits of liability include:general aggregate limit, products and completed operations aggregate limit, personal and advertising injury limit and medical expense limit.

Conditions

Bankruptcy-Bankruptcy or insolvency of the insured or of the insured's estate does not relieve the insurer of any obligation. In the event of an occurrence, a claim or a suit, the insured's duties include:

Occurrence -notifying promptly the insurer of an occurrence that may result in a claim (including how, when and where the

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11 Commercial General Liability & Business Owners Legal Action against the Insurer: The insured must comply fully with all terms of the policy before taking legal action against the insurer. A party may sue the insurer to recover damages against an insured in the form of a settlement or judgment. Such a settlement or judgment can amount to no more than the policy limits.

Representations Statements the insured makes are representations-that is, statements of fact representations-that are substantially true to the best of the insured's knowledge and belief.

Transfer of Rights of Recovery against Others to the Insurer If the insured has rights to recover from a third party all or part of any payment the insurer has made, those rights are transferred to the insurer. The insured must do nothing to impair those rights. At the insurer's request, the insured must bring suit or transfer those rights to the insurer. This transfer of rights is known as subrogation.

12 12 Commercial General Liability & Business Owners Definitions: Key definitions are:

Bodily injury –defined as the bodily injury, sickness or disease a

person sustains, including death resulting from a claim against the insured.

Covered Territory is A) the United States, Puerto Rico and

Canada. B) International waters or airspace, provided the damage or injury does not occur in the coarse of travel or transportation to or from any place not included within the U.S. Canada, and Puerto Rico.

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Impaired property means tangible property, other than the

insured's product or work, that cannot be used or is less useful because:

1) it incorporates the insured's product or work that is known or thought to be defective, deficient, inadequate or dangerous; or 2) the insured has failed to fulfill the terms of a contract or an agreement if the property can be restored to use by the repair, replacement, adjustment or removal of the insured's product or work or fulfillment of a contract or an agreement.

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15 Commercial General Liability & Business Owners Exclusions: Coverage A (Bodily Injury and Property Damage)-The policy has 14 exclusions

1) expected or intended liability 2) Contractual liability 3) Liquor liability 4) Workers’ compensation 5) Employer’s liability 6) Pollution 16 16 Commercial General Liability & Business Owners 7) Auto, aircraft or watercraft

8) Mobile equipment 9) War

10) Care, custody or control

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Coverage B (Personal and Advertising injury liability) 1) injury arising out of the willful violation of laws 2) liability assumed under a contract

3) publication of false material

4) defective products, or goods and services

5) incorrect description of price of goods, services or products 6) offense committed by an insured in the business of

advertising, publishing or telecasting.

Premises and operations

Premises: The owner or tenant of a building can be held liable if a member of the public (third party) is injured or the third party’s property is damaged as a result of a condition of, or arising out of the use of, the premises.

Operations: A firm may be held liable if a member of the public is injured or his/her property is damaged either A) on the premises where the business is conducted or B) away from the premises by an activity of the owner or an employee.

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Selected endorsements

Deductible liability insurance (CO 03 00)

Texas changes — employment-related practices exclusion (CO 26 39)

Texas changes — conditions requiring notice (CO 0103; CO 2324)

Texas changes —cancellation and Non-renewal (CO 23 55; CO 23 56)

Claims-made policy forms versus occurrence forms Occurrence Form

On an occurrence form payment is made if an insured is legally liable for injuries or damage that occurred during a policy period, even if a claim is submitted after the policy has expired.

Claims-Made Form

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1.5 Pollution liability: This section of the CGL contract provides limited liability coverage in the event of necessary pollution clean up.

Pollution liability coverage form: The only coverage is in pollution exposure covered commercial forms that fall within product/completed operations liability for emissions that are covered away from the insured’s premises and work sites, and only when resulting from use by others of the insured’s products or completed work.

Pollution liability limited coverage form: this coverage form is written only on a claims made form. It is similar to the pollution liability coverage form except clean-up costs and obligations are not covered.

Pollution liability coverage extension endorsement:This endorsement can be added by attachment to the occurrence or claims made form (on CGL). This endorsement adds liability coverage for third-party injury or damage caused by

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23 Commercial General Liability & Business Owners Almost 30 years ago, insurance agents and policyholders sought a better method to deal with the exposures of small businessowners. Personal lines policies were being offered as a package or bundle of needed coverages, but commercial

policies still were modular, needing to be built section by section. In addition, the rating system was cumbersome and time consuming. All of this required a level of sophistication and technical knowledge that was lacking among policyholders and some newer agents, who were likely to specialize in small business accounts. Originally an insurance company developed the businessowners policy (BOP), but the ISO soon came up with its own version.

Today, major insurance companies generally offer their own BOP-type policies, with names specific to those companies, but most pattern their forms after the ISO policy. The

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2.1 Characteristics and purpose

Business owners commons policy conditions form-Every BOP is a self-contained contract that includes the following parts:

¾businessowners declarations;

¾businessowners common policy conditions;

¾standard or special property coverage form;

¾businessowners liability coverage form;

¾endorsements as required.

The BOP is issued with a common policy conditions form that details the 12 conditions that apply regardless of whether coverage is purchased on a standard or a special basis. Many of these conditions are identical to those discussed in other lessons of this text. Both the property and liability sections of the policy contain additional conditions that pertain

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Common Policy Conditions:

1) Cancellation 2) Changes

3) Concealment, misrepresentation or fraud 4) Examination of insured’s books & records 5) Inspections & surveys

6) Insurance under 2 or more coverages 7) Liberization (expansion of coverage)

Common Policy Conditions:

8) Other Insurance 9) Premiums 10) Premium audit

11) Transfer of rights of recovery against others

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2.2 Business owners property coverage forms

Definitions & Coverage: BOP may be purchased with either standard or special coverage for the property, indicated on the declarations. The two forms may not be combined, so if both buildings and personal property are included, they must be insured with the same form. Most of the coverages provided in the two forms are identical. The major differences lie in the covered causes of loss. Minor differences also exist in the availability of optional coverages.

30 30 Commercial General Liability & Business Owners Coverage A-Building(s) The BOP Covers the replacement cost of the buildings at the premises described in the declarations,

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31 Commercial General Liability & Business Owners Coverage B: Business Personal Property The BOP policy covers replacement cost of the business personal property the insured owns and uses for business purposes at the premises described in the declarations and within 100 feet while in a vehicle or out in the open. Also included for coverage are: similar property the insured holds that belongs to others but does not exceed the amount for which the insured is legally liable, including the value of labor, materials and charges furnished, performed or incurred by the insured; and tenant's improvements and betterments, meaning the insured's use of or interest in

fixtures, alterations, installations or additions comprising a part of the building the insured occupies but does not own.

32 32 Commercial General Liability & Business Owners The business owners policy does not cover:

•aircraft, automobiles, motor trucks and other vehicles subject to motor vehicle registration;

•bullion, money and securities;

•contraband, or property in the course of illegal transportation or trade;

•land, water, growing crops and lawns;

•watercraft (including motors, equipment and accessories) while afloat; or

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Causes of loss:

9Fire; Lightning;

9Windstorm or hail;

9Explosion; Smoke;

9Aircraft or vehicles;

9Riot, riot attending a strike or civil commotion; 9Vandalism or malicious mischief; 9Sprinkler leakage; 9Sinkhole collapse; 9Volcanic action; 9Transportation of property 34 34 Commercial General Liability & Business Owners

Conditions The BOP contains most of the policy conditions that form a part of the property and liability coverage parts of the CPP

Limits: Vary from policy to policy-usually cost driven.

Deductibles: Minimum deductible is set by the insurer

Exclusions: Enforcement of ordinance or law; Power failure; Earth movement; Governmental action;Nuclear hazard; War and military action; and Water damage (flood and sewer backup).

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2.4 Business owners liability coverage forms include: •Business liability •Medical expenses •Limits •Conditions •Exclusions •Definitions 36 36 Commercial General Liability & Business Owners Selected endorsements may include:

Accounts receivable coverage (BP 04 03)

Hired auto and non-owned auto liability (BP 04 04) Valuable papers and records electronic media and records (BP 04 05)

Protective safeguards (BP 04 30)

Utility services — direct damage (BP 04 56) Utility services — time element (BP 04 57) Texas changes (BP 01 18)

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100 Commercial General Liability Insurance

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Section Ill-limits of Insurance

The CGL policy sets six limits of insurance:

general aggregate limit (sum of all medical damages under coverage C plus the damages under coverages A and B; excludes injury and damages included in the products and completed operations hazard); products and completed operations aggregate limit;

personal and advertising injury limit;

each occurrence limit (maximum under one limit);

fire damage limit (maximum payable for property damage to rented premises for a single fire); and

medical expense limit (maximum payable because of bodily injury to one person).

Section IV-Conditions

This section of the CGL policy deals with a number of issues, from bankruptcy to legal actions.

Bankruptcy Bankruptcy or insolvency of the insurrd or of the insured's estate does not relieve the insurer of any obligation.

Duties in the Event In the event of an occurrence, a claim or a suit, the insured's duties include:

of

Occurrence,

Claim or Suit notifying promptly the insurer of an occurrence that may result in a claim (icludiig how, when and where the occurrence took place and the names and addresses of any injured persons and witnesses); providing prompt written notice of a claim or suit;

providing immediate notice to the insurer of receipt of demands, notices, summonses or other legal papers the insured receives in connection with a claim or suit; and

cooperating and assisting in the investigation of a claim.

Except at his or her own cost, no insured voluntarily makes a payment, assumes any obligation, or incurs any expense, other than for first aid, without the insurer's consent. If the insured does so, the policy is not void, but the insurance company is not obligated to cover this particular occurrence. Furthermore, if an insured fails to notify promptly the insurer of an occurrence that may result in a claim, the insurer will probably reserve its right to refuse coverage without voiding the policy.

Legal Action against The insured must comply fully with all terms of the policy before taking legal the Insurer action against the insurer. A party may sue the insurer to recover damages

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Commercial General Liability Policy

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101

Other Insurance Generally, the CGL policy is the primarypolicy. In some situations, however, it is the excess policy. If there two policies exist, each with a provision making it primary, the method of sharing will be as follows:

If all other insurance permits contribution by equal shares, the policy will follow that approach; and if any other insurance does not permit contribution by equal shares, contribution will be by limits (pro rata to the total amount available).

Premium Audit The premium paid is an advance premium as a deposit premium only. At the end of the policy period, or during periods stated in the contract, the insurer audits the insured's basis of premium (sales, payroll, etc.) and computes the earned premium for that period.

Representations Statements the insured makes are representations-that is, statements of fact that are substantially true to the best of the insured's knowledge and belief. Separation Except with respect to the limits of insurance, the CGL policy applies sepa-

of

Insureds rately to each insured against whom a claim is made or a suit is brought. In other words, the limit of insurance is paid only once per occurrence regardless of the number of claimants or the number of persons insured. For other costs, such as defense costs, each insured is separate.

Transfer

of

Rights

of

If the insured has rights to recover from a third party all or part of any pay- Recovery against ment the insurer has made, those rights are transferred to the insurer. The Others to the Insurer insured must do nothing to impair those rights. At the insurer's request, the

insured must bring suit or transfer those rights to the insurer. This transfer of rights is known as subrogation.

Section V-Definitions

Other key definitions that arise in CGL policies are explained below. Bodily injury means bodily injury, sickness or disease a person sustains, including death resulting from any of these at any time.

Coverage territory includes:

the United States (including its territories and possessions), Puerto Rico and Canada;

international waters or airspace, provided the injury or damage does not occur in the course of travel or transportation to or from any place not included the paragraph above; or

all parts of the world if:

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1 02 Commercial General Liability Insurance

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person whose home is in the.territory described above, but who is away for a short time on the insured's business; and

- the insured's responsibility to pay is determined in a suit on the mer- its, in the territory described above, or in a settlement the insurer agrees to.

Employee includes a leased worker, but not a temporary worker,

Impaired property means tangible property, other than the insured's product or work, that cannot be used or is less useful because:

it incorporates the insured's product or work that is known or thought to be defective, deficient, inadequate or dangerous; or

the insured has failed to fulfill the terms of a contract or an agreement if the property can be restored to use by the repair, replacement, adjustment or removal of the insured's product or work or fulfillment of a contract or an agreement.

Loading or unloading means handling of property:

after it is moved from the place where it is accepted for movement into or onto an aircraft, a watercraft or an auto;

while it is in or on an aircraft, a watercraft or an auto; or

while it is being moved from a n aircraft, a watercraft or an auto to the place where it is finally delivered.

Loading or unloading does not include the movement of property by means of a mechanical device other than a hand huck that is not attached to the aircraft, watercraft or auto.

Mobile equipment includes:

bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads;

vehicles maintained for use solely on or next to premises the insured owns or rents;

vehicles that travel on crawler treads;

vehicles, whether or not self-propelled, maintained primarily to provide mobility to permanently mounted power cranes, shovels, loaders, diggers or drills or to road construction or resurfacing equipment such as graders;

other vehicles that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment such as air compressors, pumps, generators, "cherry pickers" and similar devices used to raise or lower workers; and

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Commercial General Liability Policy

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103

Certain self-propelled vehicles with permanently attached equipment are not mobile equipment, but are considered autos. This includes equipment designed primarily for snow removal, road maintenance equipment and "cherry pickers."

J

For Exampler When equipment operates as a "cherry picker" lifting workers or materials at a construction site, the CGL policy provides coverage. However, when it operates as an auto, ferrying workers or materials from one construction site to another, the CGL does not provide coverage. Instead, an auto policy applies.

Occurrence means an accident, including continuous or repeated exposure to substantially the same general harmful conditions.

Property damage means physical injury to tangible property, including all resulting loss of use of the property. All such loss is considered to occur at the time of the physical injury that caused it. Property damage also means loss of use of tangible property that is not physically injured.

Your product means:

any goods or products, other than real property, the insured sells, man- ufactures, handles, distributes or disposes of, others trading under the insured's name, or a person or an organization whose business or assets the insured has acquired; and

containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products

The term your product includes:

warranties or representations made at any time with respect to the fit- ness, quality, durability, performance or use of a product; and

the providing of or failure to provide warnings or instructions.

Your work means:

work or operations performed by the insured or on his or her behalf; and

materials, parts or equipment furnished in connection with such work or operations.

The term your work includes:

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Lesson Exam Five

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105

Lesson Exam Five

1. Which of the following is NOT an occurrence as d e f i e d in a liability policy? A. Running out of gas while driving B. Continuous discharge of chemicals that

damage a crop

C. Motor vehicle accident

D. Person who slips on a wet floor 2. Which of the following statements about

the commercial general liability policy is CORRECT?

A. It does not cover assault because it is intentional.

B. It covers assault and battery under certain conditions.

C. It does not cover assault and battery if committed by the insured.

D. It covers assault and battery only if committed by the insured's employees.

3. Legal liability is determined by A. custom and practice

B. voluntary settlement between the parties

C. applying the law to the facts of the case D. agreement between two parties in an

accident

4. Each of the following is a duty of the insured in the event of an occurrence, a claim or a suit EXCElT

A. promptly notifying the insurer of an occurrence that may result in a claim B. at his or her own expense, making any

reasonable settlement with the injured party

C. forwarding any legal papers, including suits, to the insurance company

D. cooperating with the insurer in the defense of a claim

5. Under the commercial general liability policy, if the insured receives notice of a claim or suit, he or she must no* the insurer of this action

A. within five days B. as soon as practical C. promptly

D. immediately

6. Each of the following is a covered territory under the CGL policy EXCElT

A. Canada B. Mexico C. Puerto Rico D. New Mexico

7. Under the CGL policy, mobile equipment includes which of the following?

A. Land motor vehicle designed for use on public roads

B. Vehicle designed for use principally off public roads, such as a bulldozer or forklift

C. Vehicle operated exclusively on public roads

D. Vehicle being towed by a covered vehicle

8. Which of the following is NOT a supplementary payment the CGL policy provides? A. Cost of bonds

B. Interest on judgments

C. Costs of investigation and defense D. Medical payments

9. Mobile equipment may include which of the following?

A. Equipment not subject to motor vehicle registration

B. Licensed vehicles

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Lesson Exam Six

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129

Lesson

Exam

Six

1. The duties of professionals to perform services arise out of each of the following EXCEPT

A. contractual obligations B. tort obligations

C. duty to avoid causing harm D. duty to avoid blame

2. Medical malpractice insurance policies may be issued to each of the following types of professionals EXCEPT

A. nurses B. optometrists C. veterinarians D. physical therapists

3. Errors and omissions claims may be brought against insurance agents by A. their clients

B. third parties injure their clients injure C. other agents

D. professional associations

4. The primary cause of insurance agents' errors and omissions losses is failure to

A. explain coverage limitations B. recommend needed coverage C. provide coverage

D. advise of cancelation

5. Which of the following is NOT a method used-to set the limits of liability in a professional liability policy?

6 . All of tl?e following are examples of the types of exclusions found in professional liability insurance policies EXCEFI

A. uninsurable exposures B. contractual liability C. compensatory damages

D. exposures covered under other policies 7. What is the purpose of a consent-to-settle

clause in a professional liability policy? A. To allow the insurance company to set-

tle claims regardless of the insured's desire

B. To prevent the insured from negotiating a settlement on his or her own

C. To protect the professional's reputation by allowing his or her input in the settlement process

D. To protect a claimant by making it necessary that he or she participate in all settlement negotiations

8. A corporate director or officer possesses certain fiduciary duties. Which of the following is NOT an example of one?

A. Duty of loyalty

B. Duty of reasonable care C. Duty of disclosure D. Duty of accounting

9. Which of the following is a type of suit brought by shareholders of a corporation against its officers or directors?

A. Nonderivative B. Derivative C. Nondisclosure D. Disclosure

A. Single, aggregate limit

B. Per-claim and aggregate limit C. Combined single limit

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130 Lesson Exam Six

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10. A typical directors' and officers' liability policy covers each of the following EXCEPT

A, the directors and officers for their personal liability when not reimbursed by the corporation

B. the corporation for suits brought against it by officers and directors C. the corporation for amounts it reim-

burses officers and directors in the event of a claim

D. the directors and officers for wrongful acts they may commit in the scope of their duties

11. Each of the following is a law that creates an employment practices liability exposure EXCEFT

A. the Civil Rights Act of 1964

B. the Age Discrimination Act of 1967 C. the Americans with Disabilities Act

of 1992

D. the Privacy and Nondisclosure Act of 1997

12. Which of the following policies did NOT cover employment-related practices before specific policies were designed to treat those exposures?

A. General liability

B. Workers' compensation C. Umbrella

D. Directors' and officers' liability

13. One ~f the distinguishing features of an EPLI policy compared to the professional liability policies is that it

A. is a claims-made policy B. covers wrongful acts

C. includes a coinsurance clause D. includes an aggregate limit

14. The reason to purchase an umbrella liability policy is to

A. provide higher limits of liability 8. expand coverage beyond primary

policies

C. provide coverage when primary limits are exhausted

D. do all of the above

15. The maximum limit of liability an umbrella policy contains is

A. $1 million 8. $10 million C. $100 million

D. There is no maximum.

16. Umbrella policies typically contain exclusions for each of the following situations EXCEPT

A. blanket contractual

B. bodily injury

C. incidental malpractice D. employees' liability

17. An umbrella policy provision that requires the insured to participate in a portion of a loss not covered by primary insurance is a

A. coinsurance clause

B. participation clause C. deductible

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Answers & Rationale

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133

Answers

&

Rationale

1. D. The duties of professionals arise out of tort and contractual obligations. In addition, it is the responsibility of professionals to do no harm.

2. D. Medical malpractice policies may be issued to physicians, surgeons, dentists, nurses, opticians, optometrists, chiropractors, veterinari-

ans and pharmacists.

3. A. Errors and omissions claims are brought against insurance agents by either their customers or the insurance companies with whom the agents contract.

4. C. Failure to place coverage promptly or to place requested coverage is the number one cause of E&O claims against agents by their clients.

5. C. Combined single limits are used in automobile and general liability insurance, but not professional liability.

6. C. Compensatory damages are given to claimants to offset the impact of such things as pain and suffering. Professional liability policies pay damages including both compensatory and special damages.

7. C. Although not used as often as in the past, a consent to settle clause allows a professional, particularly a physician, to review a settlement offer before it is made to a claimant. This is done to protect the medical professional's reputation.

8. D. The fiduciary duties of corporate directors and officers are the duty to exercise reasonable care, the duty of loyalty to the corporation and the stockholders, the duty to disclose material facts and ERISA duties.

9. B. Tort actions against officers and directors are based on negligence and intentional inter-

ference and result in derivative suits brought by shareholders and nonderivative suits brought by outsiders such as competitors.

10. B. A D&O policy protects corporate officers and directors. Typically, no coverage is provided for the entity itself, apart from its obligation to reimburse the officers and directors.

11. D. No such act exists

12. C. General liability, workers' compensa- tion and D&O policies all were used to provide potential coverage, or at least defense, for employment-related claims before to the emergence of separate EPLI policies. These policies now contain exclusions for these losses.

13. C. Unlike other liability policies, EPLI includes a participation or coinsurance clause to encourage the insured to control loss.

14. D. Umbrella policies provide higher limits on primary coverages, broaden the coverage the underlying policies offer and drop down to provide primary insurance in some cases.

15. D. Umbrella policies are available in a vari- ety of limits with no maximum.

16. B. Bodily injury and property damage are two of the most basic types of coverage umbrella policies provide.

17. D. A self-insured retention is used in an

umbrella policy when the umbrella does not exclude coverage, but no underlying or primary insurance exists.

18. C. When the insured does not maintain underlying limits as stated in the umbrella policy, the umbrella carrier pays as though those limits were in effect. Therefore, it does not affect the amount of coverage under the umbrella; it merely means the insured must make up the difference between what was required and what actually is provided.

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LTI Affidavit of Completion

Continuing Education Courses

Publisher & Developer of Materials

:

Lakeway Training Institute

Provider Name:

Lakeway Training Institute (Provider # 2687)

Title of CE Course:

Commercial General Liability & Business owners Policy

Number of CE hours: 4 HRs

I affirm that I have met or exceeded the actual hours of study I indicated above.

____________________________________ ______________________________

Printed Name

TDI Identification No or SS No

____________________________________________ ____________________________________

Signature Date

____________________________________________ ____________________________________

Day Time Phone

Other Phone #

This space to be completed by Notary Public:

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Printed Name

Notary Seal

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Signature Date

Lakeway Training Institute