Letters! Coinsurance

I get emails every week asking questions. Here is one I got Friday...

I teach commercial insurance at a University in Puerto Rico. As I've learned, the coinsurance clause cannot by applied when a total loss occurs. However, one of my students indicates a main insurer in applying the clause to total loses. A specific case is a House insured for $100,000. The Insurer evaluate the value of the house at $200,000 at the time of loss. There was a total loss. The insurer is paying only $50,000. alleging a coinsurance penalty of 50%.



My thesis is that paying the insurance amount of $100,000 the insured is already sharing a 50% of the loss, which is the coinsurance penalty.



Please clarify this issue for me and my students.



My Reply: Well, you ask a complicated question....



First, in US Homeowners insurance policies (ISO HO3 form for example) the coinsurance clause does not work as standard fire policies do. The HO coinsurance is the removal of replacement cost coverage if you are under insured.



On standard fire policies The coinsurance clause applies to every loss (unless there is an agreed amount endorsement). The mathematics usually works so there is no coinsurance penalty in a total loss - the penalty is the fact that the insured does not have enough coverage to rebuild.



Example:

$1,000,000 building (replacement cost),

80% coinsurance (should buy $800,000),

Limit purchased $600,000,

Loss Formula = $600k divided by $800k (3/4) times the loss



So, on a $100,000 loss the payment would be 3/4 of the $100k or $75,000 On a total loss of $1,000,000 the payment would be $600k policy limit.

Green Building Insurance

As more and more buildings are being built or renovated to "green" standards, insurance issues naturally come up. The industry is calling this, "green insurance."

Actual construction costs should not be an issue with replacement cost coverage. Most property insurance policies (with RC) pay the cost of replacing the property with property of comparable material, quality and for the same purpose.

You obviously must buy enough insurance - review your limits of coverage.

There may be an issue if you have plant materials as part of your roof, for example. Most policies limit coverage for trees and plants - how does that impact plants that are a part of the building?

An issue may be the cost of certification to green standards. I know that developers pay fairly substantial sums to get green certification. A major reconstruction project after a fire or windstorm would probably require recertification. That may not be considered a part of the reconstruction.

Your best approach is to get clarification from your insurance company and agent on how your policy will apply. Easy before a loss. Hard after.

McDonald's case demonstrates tension between insurers and insureds

An article on Huffingtonpost.com highlights the tension that can arise between insurers and insureds, especially in high-profile claims.

According to the original article (which begins about halfway down), a McDonald's employee was shot and seriously injured when he intervened after a male customer hit a female customer in the Arkansas restaurant. The worker's compensation carrier denied his claim on the grounds that he was not acting within the scope of his employment when he was injured. (Okay, I'm no expert on Arkansas worker's compensation law, but I just don't see how a restaurant employee breaking up a fight in the restaurant is outside the scope of employment.)

It is obvious to me from reading the article that the decision to contest the claim was made by the insurer, not by McDonalds. However, even the author of the article did not make that distinction, blaming McDonalds and accusing it of just acting ugly.

In the article update the franchise owner plays nice, stating that if the worker's compensation board agrees with the insurer, he will personally pay the medical bills. At the same time, he is no doubt telling his insurance agent to find a new worker's comp carrier.

Let's say that the insurer's denial of the claim has a sound legal basis under Arkansas law. Then the insurer has a responsibility to its stockholders to deny the claim. But in doing so, it has created a predictable swirl of horrible publicity for the restaurant, which its owner has now scrambled to undo.

And if there is no sound legal basis for denying the claim? Then the insurer is using the claim to send a message that it plays hardball and pays no claims easily, in order to discourage others from filing claims. Not only the claimant but the insured suffers--and that's why we have bad faith laws.

Work Comp Experience Modification

I got a call yesterday from a construction company in NY having trouble with their experience modification.

The experience modification can have a dramatic affect on an employer's workers' compensation premium.

Several resources...

-My work comp book covers the mod calculation extensively. See the online version.

-I have a video that reviews the ins and outs of the workers' comp modification worksheet

-I offer a service for reviewing a company's mod worksheet - telling you why you have the mod you have. Email me for info.

A primer on public adjusters

An insured who has a property damage claim--such as basement flooding--may hire a public adjuster to advocate on his or her behalf with the insurer.

As defined by Massachusetts statute public adjusters may represent an insured in connection with the assessment of damages, negotiation, settlement, appraisal or reference proceedings for property damage insurance of any sort.

Public adjusters are generally not attorneys and, like other non-attorneys, may not advise or represent clients on questions of law.

Public adjusters must be licensed by the state. The contents of a contract between a public adjuster and an insured are regulated by statute.

How To Survive Big Property Claims

Advice for large claims where you are working with your insurance company - usually property claims - fire, wind, flood...

Document every action you take and every discussion you have. Confirm all phone conversations with your agent or the adjuster by email. CC the agent on all emails to the adjuster - cc the adjuster on emails to the agent. Insist on setting time goals and next steps - always in writing.

At the start ask the adjuster the stages he sees in your claim. How does he see this moving forward. You are setting expectations.

Remember that every claim adjustment is a negotiation. Everything is on the table. Be professional at all times. Realize that every conversation is a part of the negotiation.

Insist on prompt return calls and adherence to time-frames. Be professional but a hard-ass.

All adjusters think they are overworked. (Many are.) They have a pile on their desk. Your objective is to be always on the top of the pile.

The moment your adjuster is unprofessional or adversarial, go to the supervisor. I often establish a relationship with the supervisor at the start of negotiations. "I know that I'm going to work with Bill on this. I just wanted to know who is on the team." Easier to do at the onset than when things go south.

An attorney is an important tool. However, when lawyers get involved in the minutia things slow to a crawl.

Public Adjusters also have their place. (An adjuster hired by the insured and paid a percentage of the claim.) However, most insurance companies hate PAs. Claims always seem to bog down when a PA comes on the claim. Dont hire one unless things seem to go south. (Obviously most PAs disagree with me on this.)

Have frequent conversations with your agent to let him know what is happening. He may have info that has not been passed on to you.

Have your agent explain the part of the policy that is in play. Often there is coverage for extra living expenses, extra expenses, and on business policies, loss of income. If the agent or the adjuster tells you about expenses that are not covered, ask if coverage was available and if it was offered to you. Document.

Be prepared for a tough slog. 90% of the time it all works out. Even the best of claims has problems, hassles, misunderstandings, and mistakes.

New Legislation for residential fuel oil releases

According to this Massachusetts Lawyers Weekly article, a new Massachusetts statute requires all homeowners' insurers in Massachusetts to make coverage available to pay for fuel oil cleanups. The article was written by Susan Crane, an environmental lawyer in Sudbury who represents insured homeowners. Attorney Crane is a member of 21E Homeowner Funding Work Group, the group that put together the legislation.

Congratulations to Attorney Crane, the 21E Homeowner Funding Work Group, and to the Massachusetts legislature for passing a sensible bill.

Insurance Fraud

As the economy continues to worsen, it is no surprise that some desperate people will use insurance fraud as a way out.

Seattle Man Accused of Sinking His Own Yacht

Fortunately, insurers are pretty good at discovering fraud.

Coalition Against Insurance Fraud

Investing in life insurance!

Despite the highly attractive fixed deposit rates offered till recently or the prices of gold and real estate, life insurance continues to be the preferred option for investment among Indians.

According to the annual Nielsen Life 2008 survey, life insurance has the highest penetration level, followed by bank FDs, gold and property. Clearly, the current turmoil has made it tough for equity markets to compete.

Life insurance also tops the list of future investments, with 30% respondents agreeing to consider it. “In the wake of the global financial meltdown, most investors are looking at options which help them safeguard capital. Life insurance is seen as one such avenue,” says Kalyan Karmakar, associate director, consumer research, Nielsen.

As per the survey, the key triggers for buying life insurance are family protection in case of untimely death, retirement corpus and securing a child's future. Interestingly, tax exemption as a trigger to purchase insurance has dropped significantly, compared with 2004.

Why Life Insurance?



They say life has four cycles – birth, childhood, youth and old age. This cycle has been same for ages and will remain the same, but something has changed in the past years and will keep on changing with the years to come – lifestyle.

We as a modern society have changed a lot. Technology has taken over us. Gadgets and machines make the most of our lives resulting in sedentary lifestyles. More and more working hours and less time spent in maintaining a healthy lifestyle has lead to increase in a number of critical diseases like heart attack and cancer. Families today are more insecure than they were in yesteryears. In all, life has become complicated.

We cannot avoid the stress we take on everyday basis, but certainly we can do something to ensure that we lead a secured and happy life in case of any mishappening - like taking a Life Insurance Policy.


A life Insurance Policy is one which gives you a certain amount of money (sum assured) along with some benefits, in case of any mishappening like accidents and diseases. It covers you and your family and makes them strong enough to see the bad times with a smiling face. It sees to it that you are OKAY when things around you are NOT OKAY. To see it the other way round, a life insurance policy is not just an investment, it’s an asset which you can cash when the time comes.

Life Insurance policy can be taken in four stages of life. The first one when you are still unmarried; are working and have no direct responsibilities to take care of. The second one is when you get married and have a wife to take care of. The third one, one you have one or two more added to your family. The last one is when you have earned quite a sum and now looks for retirement, say after 30 – 35 years.

Generally, life insurance plans include wealth creation plans, mortgage protection plans, education plans, retirement solutions and general health insurance plans. Choose appropriate life insurance plan as per your age, requirement and income to secure your and your family’s future. Buy a insurance plan which fits your bill, keeping in view not only the present needs but also the future needs. Get yourself insured – today…

ADVICE: Should I Buy Term or Whole Life Insurance?

Ah, the almost age old question, term versus whole life. What is the right thing to do? Forgive me for being more than just a little opinionated on this subject, but personally I think that is a right for anyone that is on the right side of an argument.

Whole life insurance, a cash value building permanent policy is one of the earliest versions of life insurance. Whole life insurance is sold as a savings plan with life insurance, a retirement plan with life insurance, a loan source with life insurance and I'm sure by some, a fountain of youth with life insurance. Whole life insurance is generally sold by life insurance agents that believe that whole life is not just the best way to buy life insurance, but the only way to buy life insurance.

What they don't tell you, primarily because it would end their career, is that whole life insurance is a horrible savings plan, a worse retirement plan, a silly place to borrow money from and unless it is in fact a fountain of youth, it is grossly overpriced. The cash value that does build in a whole policy doesn't magically appear but rather dribbles in as the leftovers from your huge premium payments after the internal and company charges. You get the honor of earning a little bit of interest on the little bit that is left. A good example is a policy my Dad had with New York Life. His parents started it in 1935. It had a $1000 death benefit. Since 1935 the premium payments paid have totaled $1387 and the cash value in the policy is now $723. Now there's some bang for your buck!

Term insurance on the other hand is essentially pure insurance. There is no cash value. No bells. No whistles. Just a guaranteed level premium for a certain period of time (the term) and a guaranteed level death benefit if you die while the policy is in force. Depending on your age you can get guaranteed terms ranging from 10 years up to 30 years.

Term insurance is a small fraction of the price of whole life insurance and really, from a practical standpoint, more appropriate. The truth is that most, and I am thinking that is 95% or more, of life insurance needs are not permanent needs. We carry life insurance because we have a spouse and children who are dependent on our income. Children, theoretically, reach a point where they are no longer dependent on us. That's a need that goes away. Term insurance! Replacing an income for our spouse is a need that should resolve itself at retirement or sooner if our assets outgrow the need for income replacement. That's a need that goes away. Term insurance.

Although I'm surprised it was never offered along with all the other magic mortgages of previous years, there are no life time mortgages, so life insurance for mortgage protection is a need that goes away. Term insurance. Business partners that carry life insurance as a buy/sell agreement aren't likely to still be business partners to age 100 or beyond. That coupled with the fact that most businesses and the associated value to a deceased partner's family change over time makes the need or at least the size of the need a temporary situation. That's a need that changes or goes away. Term insurance.

Bottom line. When there is a product that is available (term insurance) that meets 95% or more of all life insurance needs and you have people selling whole life insurance and they claim that it is the best thing for all needs, a lot of people are left wondering why. It's called compensation. An agent makes a lot more money selling whole life than term. Yes, I'm saying that whole life is a product that is primarily sold for the benefit of the agent.

Insurance, Google Style - www.GoogleSure.com


I've been reading and thinking about Jeff Jarvis's new book, What Would Google Do? A thought provoking read. It has made me look at my business quite differently.

The book and his blog do talk about insurance. However, I was not enthralled with his (and his readers) vision. Sorry Jeff. (Read the chapter here - starts a few paragraphs from the top.)

Here is my version of GoogleSure.com...

Insurance is a risk management tool. The risk of loss is assumed by an organization (the insurer) which has many units, only a small number of which will have a loss.

An insurance company insures 1,000 houses at $600 each ($600,000) knowing that only 10 will have fires that average $50,000 ($500,000).

Starting in 1688, Lloyd's of London organized risk sharing by allowing for risks to be spread amoungst many different syndicates. Each syndicate had a risk expert who would accept a share of the risk by signing a document outlining the risk - he wrote his name under the description of the risk - he was an "underwriter." (BTW, that's Lloyd's in the pic above)

Google could provide the same syndication system on a worldwide basis using its ability to organize and integrate data with those who can use the data to make decisions.

In GoogleSure.com, brokers would assimilate information on risks and the context of the insurance desired. Those risks would then be posted for the risk-taking individuals or syndicates to assume shares by bidding for the risk.

Syndicate A offers 10% of the risk at a fee (premium) of $1,000.
Syndicate B offers 15% of the risk at a fee of $1,100...

...and so on until 100% of the risk has been fully subscribed to, at a premium acceptable to the insured.

The offers of coverage and requests for indemnity would all be made public throughout the process providing a perfectly competitive environment - www.GoogleSure.com.

An eBay like rating system of claim and policyholder service would be available for any and all to see, allowing for some quantitative measure of quality. Service providers would fight as hard as eBayers do for high ratings. Buyers would seek out and pay extra for services by highly ranked providers.

Individuals could form groups of syndicates to offer similar entities similar policies - home insurance, small business insurance, etc.

In my enthusiasm for this approach I tried to grab the domain, GoogleSure.com. Already taken. Hmmm?

Impaired Property Exclusion - General Liability Insurance

You manufacture widgets. Your widgets go into another product - a blimb - made by your customer. One day your customer calls and tells you that you widgets were not up to spec and that he has had to spend $200,000 to remove the widget and fix it so his blimb worked. He wants you to pay the $200,000. You want your insurance to pay.

Sorry. Not covered.

Most general liability insurance policies exclude the above loss. They also exclude product recall expenses. Both of these are considered business risks and not insured (99% of the time).

In some cases it is possible to find insurance for impaired property and/or product recall expense. Your agent will have to do some fast talking with most underwriters to even start a conversation on the subject. However, coverage is out there - you have to ask for it.

SJC rules that drunk driving accident arose out of use of limo earlier in the evening

In Commerce Ins. Co. v. Ultimate Livery Serv., Inc., 452 Mass. 639 (2008), the Supreme Judicial Court of Massachusetts held that an insurer providing commercial automobile coverage to a limousine service must indemnify the limousine service for its negligence in allowing an intoxicated passenger to drive a car after using the insured's services.

As usual, Mike Tracy, of Rudolph Friedmann LLP, sent me the decision on the day it came down in November, 2008.

William Powers and a group of his friends hired the insured, Ultimate Livery Service, to drive them from a sports bar in South Boston to a strip club in Rhode Island and back again. Powers drank heavily throughout the evening. After the van driver left for the night, Powers drove his girlfriend's car and was involved in a collision which seriously injured passengers of another car, killing one of them.

Commerce insured Ultimate Livery under a commercial automobile policy which provided coverage for bodily injury "caused by an accident and resulting from the ownership, maintenance or use of a covered auto."

The court analyzed whether the accident "arose out of" the use of Ultimate Livery's van, stating that there is no meaningful difference between "resulting from" and "arising out of." (The meaning of the term "arising out of" has been frequently litigated, including by me.)

The court found that there was coverage. It noted that the van was used consistently with Ultimate's business objectives. It stated that it was of no consequence that Ultimate Livery did not provide any alcohol because it and its driver knew that Powers was consuming alcohol in the van and getting drunk. The court concluded, "The risk of harm is not too far removed to lack the required nexus under the broad causation standard [under the terms "arose out of" or "resulting from"] that applies. It is a reasonable incident that was contemplated in the first instance when the parties originally entered a contract for transportation service."

How to Buy Directors’ and Officers’ Insurance -- For-Profit Edition

Introduction

In my insurance consulting work, I'm often asked about directors’ and officers’ insurance, a.k.a. D&O. There is, in many ways, an air of mystery around this kind of policy. Let's get rid of that!

First, D&O insurance is protection against a breach of "duty" by the directors and officers. D&O pays for actual or alleged wrong decisions, what the policy calls "wrongful acts."

Although each insurer defines coverage in its own way, D&O insurance generally includes: "any actual or alleged act or omission, error, misstatement, misleading statement, neglect or breach of duty by an Insured Person in the discharge of his/her duties."

Some examples of claims under D&O:

Employment-related issues such as discrimination, harassment, and wrongful termination.

A stockholder issues such as mismanagement that results in loss of stock value and profits.

D&O does not pay for bodily injury or property damage. Auto insurance, workers' compensation, and general liability are purchased for such claims.


Who Should Read This


This special report is designed for anyone interested in learning how to get the right directors and offices insurance policy. I have included hints, tips and strategies that will help you find the right coverage for your company. You’ll learn the strategies you need to get the best policy at the best price.


I come at this subject from a different perspective from most insurance people you’ll run into. I don’t sell insurance. I never accept fees or commissions from insurance agents of companies. I don’t even let them buy me lunch. I have been in the insurance business since 1979 and have been involved in all aspects of the business. My whole career has been spent helping business people find the right insurance. I'm confident that this guide will help you.


Thumbnail Sketch of the Coverage


The policy is designed to address liabilities that come out of management decisions. The primary threat is from stockholders in the form of actions against your leadership caused by a loss of profits and/or value of the company. Employment practices liability coverage can also be a part of D&O; such claims as harassment, discrimination, wrongful discharge, failure to hire, and failure to promote. The cost to defend lawsuits is also included in the protection. Bodily injury, property damage, workers' compensation, employee theft, issues involving unemployment insurance and ERISA are excluded from D&O policy protection.


Coverage Considerations

As there are no standard D&O policies, each policy and proposal must be evaluated on its own merits. Every insurer uses their own policy forms, terms, and conditions. Here are some issues that should be considered:


Claims-Made Coverage

Most liability insurance policies (general liability, automobile, workers' compensation) pay for events that occur during the policy period. For example, an auto insurance policy will pay for an accident that occurs while the policy is in force.

D&O policies, however, pay for lawsuits filed during the policy period; the wrongful act could have occurred years before. Claims-made policies respond only when a suit is filed, or when a strong threat of a suit exists.

--Claims-made policy: Pays based on the date of the lawsuit.

--Occurrence policy: Pays based on the date of the accident or occurrence.


The downside of a claims-made policy comes if the policy is canceled.

Example: A D&O policy is put in force January 1, 2005, and is renewed in 2006 and 2007.
In 2008, however, the organization decides to end the coverage, as the premium has increased. Six months later, a letter from an attorney arrives announcing a lawsuit for discrimination in hiring that occurred in 2007.

No coverage. Although the policy was in force at the time of the alleged discrimination, the policy was not in force when the suit was filed. The solution to this problem is the extended reporting period found in most policies (see the next paragraph).


Extended Reporting Period/Tail Issues

Claims-made policies only provide protection for lawsuits and actions brought during the policy period. In the event that coverage is replaced or cancelled, protection may be desired for events that took place prior to expiration/cancellation but for which no claim has yet been filed. This coverage is called a "tail" or "extended reporting period" (ERP). Here are some issues to consider:

-Can you buy the ERP at your option or only when the insurance company cancels the policy?

-For what period is the ERP valid? One year? Two years?? Longer???

-What is the premium for the ERP? (The cost is usually expressed as a percentage of the current premium.)

-In what time frame must the insured decide to buy the ERP? (The usual period is 30 or 60 days.)


Policy Limit

What amount of coverage is provided by your policy? What's the total amount of protection offered for all claims during the covered time frame (also known as an "aggregate limit")? Multiple claims can, in effect, use up the limit of coverage.


Defense within Limit

Most D&O policies include the cost of defending a claim (attorneys' fees, etc.) within the policy limit of liability. That means that the amount of coverage purchased must be enough to cover the awards and the defense costs of all claims. This can be an issue when considering the amount of coverage (aggregate limit) you buy.


Failure to Provide Insurance Exclusion

This exclusion exists in about a quarter of the policies I see for nonprofit organizations. It removes coverage for suits by alleging that you did not buy the right insurance or enough insurance. If you see this exclusion in your policy, ask that it be removed.


Retroactive Date

As I’ve said, claims-made policies respond to claims brought during the policy period. Many policies include a date after which a claim must occur in order for the policy to respond—a retroactive date. When changing insurance companies, it is vital to understand the new policy retroactive date. The use of a "Tail" may be necessary if the retroactive date is not sufficiently in the past.


Employment-Related Practices Coverage

Many D&O policies include coverage for employment-related practices—wrongful discharge, harassment, discrimination, etc. Check the policy's definition of "wrongful employment act." Does it include only certain acts, such as sexual harassment? Or is the coverage broad, including workplace harassment, for example? Are discrimination suits brought by third parties covered? Remember that including employment practices claims in your organization's D&O policy could affect the limit of liability available for other claims.

See also my separate post, How to Buy Employment Practices Liability Insurance


D&O Insurance and Personal Insurance

Strictly speaking, the issue of personal insurance is beyond the scope of this article. In my presentations to boards of directors, however, I always get someone asking about using a homeowner's policy or umbrella liability policy for protection.

Personal liability insurance—either homeowner's or umbrella—covers bodily injury and property damage for which the insured—you—are liable.

Business endeavors are excluded. Volunteer activities are covered, but only for bodily injury and property damage. D&O insurance covers damage resulting from wrong decisions but not bodily injury or property damage.

Don't depend on personal liability to protect you from your actions on a board – for profit or not for profit. Also, don't depend on D&O insurance to protect you from liability for bodily injury and property damage.


Regularly Review Coverage with Your Agent

Have an annual meeting with your insurance agent to review the coverage you buy.

  • How much coverage do you have – what are the limits of liability?
  • Are defense costs included in the limit of liability?
  • Do you have coverage for employment practices?
  • Do you have coverage for prior acts?
  • What professional services are excluded?
  • What are the policy exclusions?
  • Use the coverage comparison chart at the end of this document.


Policy Exclusions

Review carefully each exclusion in your policy. Look both at the section of your policy called “exclusions,” and endorsements attached to the back of the policy.

A common exclusion in D&O in closely held companies is the removal of coverage for suits brought by family members. I have previously mentioned the failure to buy insurance exclusion. There is also an exclusion for events brought by one insured against another. Some policies exclude bankruptcy or insolvency issues.


How to Buy It If You Don’t Have It


First, consider if you need the coverage. There are two primary claim areas in D&O in for-profit companies:

Suits brought by stockholders/owners
Employment practices liability suits brought by employees

If you are a closely held or family owned company you may have little exposure to claims from stockholders or owners. In that case, you might be better off just buying employment practices liability insurance.

If you do decide to buy D&O insurance as a small, closely held company, beware of exclusions for suits brought by family members. You might buy coverage that will never step up and pay.

Now, as you are still reading…

The first step is to contact your own insurance agent. You may find that they have the expertise to provide you with the policy that you need. The specialized nature of D&O insurance means that not every retail insurance agent knows how to make this policy work for you. Gain an understanding of the agent’s experience with director’s and officer’s. How many policies have they worked with? What issues do they see in the current market? Ask for references of other D&O clients.

If, for whatever reason, you’re not comfortable obtaining D&O insurance from your current agent, find another agent. Talk with your accountant and attorney. Call an insurance consultant .

Talk with other similar businesses. Consult your trade association for names of agents.

You’ll have to complete an application before your agent can get quotes. Most insurers will have minimum premiums of at least $2,500. Your premium may be higher depending on your organization’s size, structure, and exposures. Naturally big companies pay premiums of many hundreds of thousands of dollars.

When your agent comes back with quotes, review the information carefully. Ask the agent to explain the coverage. Ask the questions from the above section. Ask for a copy of the policy and endorsements. Review alternative limits of coverage and deductibles.


Other Executive Risk Issues to Consider

Many insurers are combining D&O with other coverages to form an “Executive Risk” policy. Common elements are:

-Directors and Officers
-Employment Practices Liability Insurance
-Fiduciary Liability Coverage
-Crime Coverage
-Kidnap and Ransom Insurance
-Professional Liability Insurance

This combination of insurance may make sense. Be aware of limits of coverage and the sharing of limits between coverage sections. $1,000,000 of coverage for D&O and $1,000,000 of employment practices liability may sound good until you notice a policy aggregate limit of $1,000,000 that means you use up D&O protection when an EPLI claim is paid.


Independent Director's Liability Insurance

Several insurance companies are now selling coverage directly to independent board members to provide coverage when the corporate D&O doesn't respond due to government intervention, bankruptcy or insolvency. Hartford Financial Services Group, Inc. offers a policy called Priority Protection-IDL. Chubb Specialty Insurance calls their product Personal Director's Liability Insurance.

Here are the issues to consider:

-What are the policy limits?

-Is there a retention/deductible?

-In what circumstances will the policy pay? Must the corporate directors' and officers' policy respond first?

-Who selects the defense team - you or the insurer?

-Is coverage included for actions brought against a non-director spouse?

-Assuming the policy is a claims-made, what are the extended reporting provisions available?



Directors' and Officers' Coverage Comparison Chart

Build a chart using the following information provided by your agent or have the agent fill in the blanks.

Name of the insurance company providing quote/coverage.

Name of agent providing quote/coverage.

Insurer financial rating by AM Best Company. (Available at www.AMBest.com)

The maximum payout for the total of all claims. (Also called aggregate or total limit)

The maximum payout per claim. (Also called per claim limit)

How is wrongful act defined? (Usually found in the section of the policy titled definitions.)

What is the deductible for D&O claims?

Is coverage included for employment practices liability?

Is there a separate limit of coverage for employment practices liability insurance? (Some policies have separate limits. Others have a combined limit for D&O and employment practices.)

If the policy covers employment practices… What events are included within the definition of a wrongful employment act? (Harassment, discrimination, wrongful discharge, etc.)

If the policy covers employment practices… Do employment practices liability claims reduce the limits of coverage unavailable for other claims?

If the policy covers employment practices… What is the deductible for employment practices liability claims?

Are the costs incurred in the defense of a claim included in the limit of coverage provided or in excess of the coverage provided? (Most D&O policies will have defense as part of the limit of coverage.)

Is the policy a claims-made policy or an occurrence policy? (Most D&O policies will be claims-made.)

If claims-made, can the insured buy the extended reporting endorsement after cancellation of the policy? (Policies should offer at least 1 year of extended coverage. Three years is better.)

What is the premium for the extended reporting period endorsement?

If claims-made, how does the policy insure acts prior to the inception of the original policy?

Is there an exclusion for claims brought for failure to purchase the correct insurance? (May be a separate endorsement or within the exclusions.)

Is there an exclusion for claims involving an insured suing another insured? (May be a separate endorsement or within the exclusions.)

Is there an exclusion for professional services? (Most policies will exclude professional services. If you have an exposure as you provide medical care or financial advice, you will need to purchase separate coverage.)

Is there an exclusion for the gain of undue personal profit? (May be a separate endorsement or within the exclusions.)

Is there an exclusion for excess remuneration? (May be a separate endorsement or within the exclusions.)

Are libel and /or slander excluded? (May be a separate endorsement or within the exclusions.)

Is pollution excluded? (Most policies will exclude pollution liability.)

List other policy exclusions:

(Review both those included in the exclusion section of the base policy and separate endorsements)

How are professional services defined?

Does the policy indemnify or pay-on-behalf of the insured for a claim? (Indemnification means that you will pay the expenses and the insurer will reimburse you. In most cases, pay-on-behalf is preferable.)






































Directors’ and Officers’ Insurance Terms

ADA Americans with Disabilities Act

Adjuster/Adjustor A person who investigates and settles losses for an insurance company. May be an employee of the insurer or an employee of an independent adjusting firm.

Advertising Injury An injury rising out of an offense committed in the course of advertising activities. For example: libel, slander, defamation, violation of right of privacy, piracy, unfair competition, or infringement of copyright, title, or slogan.

Agent A legal representative of an insurance company. This person’s role in the insurance transaction is to sell and service insurance. May be an employee. See also Independent Agent, Direct Writer Captive Agent.

Agent of Record See Broker of Record

Aggregate Limit A limitation in many liability policies stipulating the maximum amount available for the total of all claims paid in a period of time. Aggregates are usually annual.

Application A form completed by the insured and/or the agent, providing information used in the underwriting and pricing process. The application becomes a part of the insurance policy for many lines of insurance.

ARM Professional designation: Associate in Risk Management. A course of study including the management of risks using techniques other than insurance.

Audit Worksheet The document prepared by the auditor that outlines the payrolls of your company. In many cases, the worksheet will show the remuneration of each employee and the classification assigned to that individual. The information on the worksheet is used to calculate the final premium.

BI Bodily Injury

Binder An oral or written statement that insurance coverage has been placed in effect. Usually issued by an insurance agent or the insurance company pending the actual policy being issued.

Bodily Injury Injury or death. Some liability policies include emotional distress in the definition.

BOR See Broker of Record.

Broker An insurance professional who represents the insured in the insurance transaction. Sometimes used incorrectly as a synonym for agent.

Broker of Record Letter A form letter used to indicate to an insurance company a policyholder's preference as to which insurance agent will have exclusive rights to the insured. Excludes all other agents/brokers from accessing the insurance company in question for that policyholder.

Business Insurance A subset of insurance that applies to the risks and hazards of business ventures, as opposed to personal insurance.

Cancellation Discontinuance of an insurance policy prior to policy expiration. May be at the request of the insured or by the insured's action (nonpayment of premium). In extreme cases, the insurance company cancels a policy for an increase in hazard. Cancellations are largely governed by state law.

Captive Agent An insurance agent who represents a single insurer or a single group of insurers. Captive agents may have to give their represented insurers first right of refusal or may be barred from accessing other insurers altogether.

Captive Insurance Company An insurance company owned by one or more non-insurance company formed to provide insurance coverage for the owners.

Carrier The insurance company.

Certificate of Insurance Proof of the existence at a moment in time of an insurance policy. Usually prepared by an insurance agent, listing the coverage included in a program of insurance. Prepared for the information of a business associate of the insured—a subcontractor would have his agent issue a certificate to the general contractor.

Certified Insurance Counselor Professional designation in property and liability insurance administered by the Society of Certified Insurance Counselors.

CGL Commercial General Liability

Chartered Property and Casualty Underwriter Professional designation administered by the American Institute for Property and Liability Underwriters. The course of study includes extensive examinations covering the breadth of property and casualty insurance issues.

CIC See Certified Insurance Counselor.

Claims Made Refers to the trigger of liability coverage. An occurrence policy responds to events that happen (occur) during the policy period. Claims-made policies respond to lawsuits filed (the making of a claim) during the policy period.

Closed Claim A claim that has been resolved. No further payments or treatments are expected.

Coinsurance A penalty clause in property insurance policies that requires a certain percentage of the property's value to be insured.

Example: A building with a replacement cost of $1,000,000 and an 80% coinsurance clause must be insured for at least $800,000 (80% of the $1,000,000 value), or a penalty is assessed at the time of a loss.

Coinsurance in health insurance means the percentage of a loss paid by the insurance company.

Liability insurance policies may have a coinsurance clause that denotes the percentage of the loss paid by the insurance company.

Commercial General Liability Policy Provides coverage for bodily injury and property damage either from operations or products.

Commercial Lines Insurance A broad category of insurance indicating insurance for businesses, professionals, and commercial establishments.

Conditions Qualifications on the terms made by an insurance company – insured must pay premiums, insured must notify insurance company of claims, etc.

Coverage The scope of protection of an insurance policy. Used as a synonym for insurance.

CPCU See Chartered Property and Casualty Underwriter.

CSR See Customer Service Representative.

Customer Service Representative An employee of an insurance agency or company that provides administrative and customer support functions.

D&O Directors' and Officers' Insurance

Dec Declarations page – see Declarations.

Declarations The part of an insurance policy that specifically describes the limits, premiums, rates, names, and other information relative to a specific insured.

Deductible The part of a claim paid for by the insured. A $5,000 deductible means that the insured pays the first $5,000 of any insured loss.

Definitions The part of an insurance policy that defines many of the words used in the policy. Most policies highlight terms that are defined or place the term in quotation marks to indicate that the word is defined in the policy.

Direct Writer An insurance company that does not work through independent insurance agents. Agents for direct writers are usually employees of the insurance company or in exclusive relationships with the insurance carrier. Liberty Mutual, State Farm, and Allstate are direct writers.

Directors' & Officers' Insurance Policy Provides coverage for allegations of third parties for mismanagement, failure to act properly, and other "wrongful acts" against directors and officers. Coverage also can be included for the bank, known as Entity Coverage

Discovery Period See Extended Reporting Period.

Dishonesty Insurance See Commercial Crime Policy.

Domestic Insurer An insurer domiciled in a state in which the insured's insurance is written.

Earned Premium The premium used in an insurance policy over the period of the policy. If a policy is two-thirds through its term, the earned premium is two-thirds of the total premium.

Employee Retirement Income Security Act U.S. federal law passed in 1974 that provides regulation over employee welfare plans – retirement funds, group insurance, pensions, etc.

Employers' Liability The second part of workers' compensation insurance policies. Provides protection from liabilities that arise out of the employment relationship but are not covered by workers' compensation. For example: the spouse of an employee who becomes ill because of chemical residues brought home on the employee's clothing.

Employment Practices Liability Insurance Liability insurance for acts of harassment, wrongful discharge, wrongful hiring, and discrimination. Also called EPLI.

Endorsement Additional policy coverage, conditions, or exclusions added to the insurance contract by the insurance company. Sometimes called a Rider.

Entity Coverage An extension of directors' and officers' insurance, providing coverage for legal actions against the insured entity.

EPLI Employment Practices Liability Insurance

ERISA See Employment Retirement Income Security Act.

ERISA Bond Provides the required protection for the assets of a retirement fund under the federal law known as ERISA

Errors and Omissions Insurance See Professional Liability Insurance.

Estimated Premium Premiums determined at the beginning of a policy period based upon estimated payrolls. The insured pays for the policy based upon the estimated premium, and then the audit determines the final premium.

Excess and Surplus Lines See Surplus Lines.

Excess Liability Policy See Umbrella Liability.

Exclusion A part of an insurance contract that removes coverage for a specific set of circumstances. Pollution is excluded from most directors’ and officers’ insurance policies.

Exclusive Agent See Captive Agent.

Exposure A vulnerability to loss.

Exposure Basis A unit of measuring exposure. In workers' compensation the exposure basis is remuneration. In the case of some rates for domestic help, the unit may be per employee.

A liability policy may use payroll, sales, or area as the basis of premium.

Extended Discovery Period See Extended Reporting Period.

Extended Reporting Period A provision included in claims-made liability insurance policies where, after the expiration or cancellation of a policy, the insured can extend the time to discover a claim that occurred prior to the end of the policy. Also called a Tail or Discovery Period.

Fiduciary A person entrusted with property or the care of an asset.

Fiduciary Coverage See Fiduciary Liability Insurance.

Fiduciary Duty The duties expected of a fiduciary.

Fiduciary Liability Insurance Protects the fiduciaries, directors, and officers of employee welfare plans (group insurance, pension plans, 401k plans) against actual or alleged wrongful acts. Covers liabilities imposed by the federal law ERISA.

First Named Insured The first person or organization listed on an insurance policy as an insured. First named insureds receive all policy notices and bills.

Foreign Insurer An insurer domiciled in a state other than the one in which the insured's insurance is written.

Form The contract of insurance that outlines terms and conditions of protection.

FRIP Fiduciary Responsibility Insurance Policy

Hammer Clause A provision in a professional liability policy or directors' and officers' insurance that limits the insurer's liability should the insured refuse to accept a settlement offer from the plaintiff.

Hard Market A description of the insurance marketplace used to indicate a period of increasing rates and constricting coverage/availability. A sellers' market. The opposite of a soft market.

Hazard A situation that presents a chance of loss or an increase in the severity of a potential loss.

Indemnification An agreement where one party agrees to provide protection for certain legal actions brought against the primary party by another.

Indemnity Contract As to liability – a provision that the insurance company reimburses an insured after settlement of a claim.

Independent Adjuster A contractor of the insurance company who manages insurance claims for the insurance company.

Independent Agent An autonomous business that sells and services insurance policies as a representative of a variety of insurance companies.

Insurance A contractual agreement where an insurance company assumes the risks outlined in an insurance policy in return for payment of a premium.

Insurance Adjuster The person who manages the claim process for the insurance company. May be an employee of the insurer or a contractor hired by the insurer.

Insurance Carrier See Insurance Company.

Insurance Commissioner The top insurance regulatory official in a state. May be called a Superintendent.

Insurance Company A commercial enterprise formed to sell and service insurance policies.

K&R Kidnapping and Ransom Insurance

Kidnap, Ransom and Extortion Policy Pays moneys demanded either for kidnapping or the threat of kidnapping. Also pays for extortion with a threat to property.

Liability A legally enforceable obligation usually due to a breach of some duty or negligence.

Liability Insurance Insurance that responds to a breach or negligence of the insured to another party.

Loss An accident or event that causes damage, injury, or illness.

Loss Adjustment Expenses Monies spent to investigate and settle losses.

Loss Control Practices and procedures used to minimize the severity of a loss. Also used to describe loss prevention activities.

Loss Prevention Practices and procedures used to keep accidents from happening. Prevents frequency of loss. Also used to describe loss control activities.

Loss Ratio Incurred losses (and loss adjustment expenses) divided by net premiums earned. Measures profitability. A measure of losses compared to premiums.

Loss Reserves Estimated amounts for future payments of medical and wage payments for a specific claim.

Loss Run A record of losses for a policy period.

Misrepresentation A false, incorrect, improper, or incomplete statement of a material fact, made in the application for an insurance policy. This constitutes as fraud in many states.

Named Insured Individual(s) and organization(s) listed on the declarations as insured.

National Association of Insurance Commissioners (NAIC) Association of state insurance regulators who administer state insurance rules and laws. NAIC promotes uniformity in regulation throughout the country.

Net Premium Premiums after all fees, charges, and credits.

Noncancelable A policy feature that provides a guarantee of continuation of insurance at the insured's option. Insurers may adjust premiums, however.

Occurrence Defined by most liability policies as "an accident, including continuous or repeated exposure to substantially the same general harmful conditions."

PD Property Damage

Personal Injury Usually a part of the commercial general liability insurance policy. This often provides coverage for libel, slander, false arrest, and defamation of character. Actual definitions of what is covered vary by policy.

Personal Injury Liability Insurance Part of the commercial general liability insurance policy that provides protection for libel, slander, defamation, or violation of right of privacy; and wrongful entry, eviction, or other invasion of right of private occupancy.

Personal Lines Insurance coverage in property and casualty insurance for families and households—personal auto coverage and homeowners’ insurance, for example.

PI Personal Injury

Policy The insurance contract. It spells out the terms, conditions, and exclusions of the insurance provided by the insurance company.

Policy Term The period of time that the insurance policy is in force.

Policyholder The person or organization that owns the insurance policy.

Pollution A cause of loss that is excluded by most property and liability insurance policies. Usually requires a special pollution liability insurance policy.

Premium The price of insurance for a specified risk for a specified period of time.

Premium Auditor Work comp – an individual who performs the audit of remuneration at the end of a policy period. May be an employee of the insurance company or a contractor hired by the insurance company.

Premium Finance Finance arrangement for the insured to make payment of the insurance premium.

Primary Insurance The insurance policy that is responsible for paying the first part of a loss. Excess policies pay after primary policies pay.

Product Liability Insurance Protection from legal actions against an insured for bodily injury and property damage caused by a product sold, manufactured, processed, or provided by the insured.

Professional Liability Insurance Insurance against negligent damage caused by a wrongful act of the insured. Usually excludes bodily injury and property damage. Also called malpractice insurance. Also called errors and omissions insurance.

Proof of Loss Presentation by the insured of documentation of the extent of a claim. Usually used in property insurance policies as a condition. Insurers must respond (pay) within a certain time to the presentation by the insured of a proof of loss.

Property Damage Physical damage to tangible property.

Property Insurance Insurance protection for loss of tangible property owned by or in the care of the insured. Includes buildings, personal property, stock, inventory, and time element insurance.

Public Adjuster A person or firm that is a representative of the insured in a claim for insurance benefits.

Reinsurance Insurance purchased by insurance companies to provide a risk transfer mechanism. Also used by self-insurers and self-insured groups.

Remuneration Payroll and other compensation paid to employees. Used to calculate premiums.

Renewal The reestablishment of an insurance policy after the expiration of a prior term of coverage.

Reservation of Rights A response to a claim whereby the insurance company defends a case without any commitment as to the coverage provided by a policy.

Reserve Amount expected to be paid on a claim that is not resolved or closed.

Residual Market See Assigned Risk Plan.

Retention Amount of a claim paid by the insured. The term is usually used in liability insurance. Similar to a deductible.

Retention Plan A loss sensitive insurance plan that adjusts the premium up or down based on losses and associated costs.

Rider See Endorsement.

Risk 1) Exposure to loss. 2) An insured. 3) A portion of an insured operation.

Risk Management The process of addressing in a systematic way the hazards and exposures of an organization. Risks can be avoided, reduced, transferred, and retained.

Insurance transfers the risk (or a part of it) to an insurance company.

Risk Retention Group Alternative risk financing tool where similar businesses band together to share risks. Usually utilizes reinsurance and individual retentions along with regimented loss control and claims management process. Meets the requirements of the Risk Retention Act of 1986.

Self-Insurance Retention of the risk, usually in a formal, calculated way. In workers' compensation, state regulations impose financial and administrative qualifications. May involve reinsurance or very large deductibles to cover catastrophic losses. Self-insurance isn't really insurance—you are retaining the risk.

Self-Insured Retention See Retention.

Short-Rate Penalty A penalty assessed when an insurance policy is cancelled by the insured in the middle of a policy period. Workers' compensation short-rate penalties are high in the early months and gradually decline through the policy period. Short-rate penalties in other property and casualty policies are usually 10% of the unearned premium.

Side A Coverage within a directors' and officers' insurance policy that pays for claims against individual directors or officers when corporate reimbursement isn't allowed.

Side B Coverage within a directors' and officers' insurance policy that pays for claims against individual directors or officers when corporate reimbursement is allowed.

Side C Coverage within a directors' and officers' insurance policy that pays for claims against the bank. Also referred to as entity coverage.

Soft Market A description of the insurance marketplace used to indicate a period of declining rates and expanding coverage/availability. A buyers' market. The opposite of a hard market.

Standard Markets Insurance companies that are not surplus lines insurers.

Standard Policy An insurance policy used by a preponderance of insurance companies to cover similar exposures and operations.

Strict Liability Liability that comes out of an exposure that is so onerous that negligence need not be proven. Some examples are blasting within a city or the keeping of wild animals.

Subrogation The procedure under which an insurance company recoups losses paid from the insurer of the negligent or responsible party. For example, a workers' compensation insurer may subrogate against the auto insurer of the driver who caused an accident in which an employee is injured.

Surplus Lines Insurance written by non-admitted insurance companies.

Tail Coverage See Extended Reporting Period.

Terrorism Risk Insurance Act Federal law outlining the taxpayer-funded reinsurance provided for certain types of terrorism losses.

Tort A civil wrong other than a breach of contract.

TRIA Terrorism Risk Insurance Act

Twisting Inaccurate or incomplete insurance policy descriptions used to entice the surrender or cancellation of an insurance policy in favor of another policy.

Umbrella Liability A form of excess insurance that provides additional limits of liability protection as well as increasing the breadth of the coverage provided.

Umbrella Liability Policy Provides extra liability coverage above the general liability, auto liability, and employers' liability coverage. Also known as excess liability.

Underlying Policies The basic liability insurance policies accessed before excess or umbrella liability policies. Usually include auto liability, general liability and employer's liability.

Underwriter 1) An insurance company. 2) The individual who performs underwriting for an insurance company.

Underwriting The process an insurance company goes through to classify, analyze, and price an insurance policy.

Unearned Premium The difference between the premium paid and the earned premium.



Some Insurers Who Provide Directors and Officers Insurance

The following list is not an endorsement of any kind. It is also not a statement of the quality of coverage provided. To access information use a search tool such a Google.com and input the name of the insurer and the phrase “directors and officers.”


Ace / Westchester
American International Group
Arch Insurance Group
Aspen Specialty Insurance Company
Axis Surplus Insurance Company
Carolina Casualty
Chubb
Crum & Forster
Evanston Insurance Company
Great American Insurance Company
Houston Casualty
Lloyd's of London
Maxum
National Casualty
One Beacon
Philadelphia Insurance
RLI Insurance Company
Scottsdale Indemnity
Shand / Evanston Insurance / Markel American
St. Paul / Travelers
Tudor Insurance Company (Western World)
United States Liability Insurance Co. / Mt. Vernon Fire


There are also a broad number of risk retention groups who offer D&O protection. Your best source for information on industry specific programs is to talk with your trade association.


Reference proceedings in fire insurance policy claims

In Massachusetts, as in many states, provisions of fire insurance policies are set by statute. The long-ago author of the legislation was one heck of a micromanager.

The fire insurance statute provides for a “reference procedure,” in which a panel of three arbitrators, or “referees,” determines the amount of loss or damage. Mass. Gen. Laws ch. 175 § 99 (Eleventh).

The reference proceeding determines only the amount of the loss sustained or the sound value of the property, unless both parties agree that the proceeding will determine other issues as well. The reference proceeding ordinarily does not affect any defenses to the claim itself.

Pursuant to the statutory scheme the insurer must, within ten days after receiving the written demand for reference from the insured, submit to the insured in writing the names and addresses of three potential referees. The insured must, within ten days, notify the insurer in writing of his or her choice of one of those people to act as referee.

The insured also submits to the insurer the names and addresses of three potential referees. The insurer must notify the insured in writing within ten days of its choice of one of those persons to act as referee.

The two referees chosen have ten days to agree upon and select a third referee. If they fail to do so, then either of them or the parties may make written application to the commissioner of insurance to appoint a third referee.

The referees must reduce their award to writing. The third referee must deliver the award to the insured and to the insurer.

If an award is rendered by the referees in favor of the insured, the insurer and the insured are each liable to the third referee for one half of his or her charges for compensation and expenses. However, the third referee’s charges are paid by the insurer, who deducts from any award the insured’s share of such charges. If the award is rendered in favor of the insurer or if no award is rendered, the insurer is liable to the third referee for his or her charges, but may deduct one half of the charges from any payment it makes to the insured.

How to Buy Employment Practices Liability Insurance

Introduction

Consider these events:

-An employee claims to have been harassed by a supervisor and threatens to sue.

-A customer service clerk who is discharged for chronic performance deficiencies claims age discrimination.

-An unsuccessful job applicant alleges racial discrimination.

-An employee claims that her supervisor ignored her reports of sexual harassment.

Any of these could cost you big dollars in defense costs and, perhaps, an award by the court. None are covered by standard commercial liability insurance. In most cases, they would be covered by an employment practices liability insurance policy (EPLI).


Who Should Read This

This special report is designed for anyone interested in learning how to get the right employment practices liability insurance policy. I have included hints, tips, and strategies that will help you find the right coverage for you. You’ll learn the strategies you need to get the best policy at the best price.

There are a thousand articles on EPLI on the Internet. I’ve read many of them. Most are focused on the policy and explaining the features. All are either from insurance companies or agents, insurance regulators or web portholes advertising a directory of insurers. They are trying to sell you a policy. In this report I focus on how to buy the right coverage for you.

I come at this subject from a different perspective from most insurance people you’ll run into. I don’t sell insurance. I never accept fees or commissions from insurance agents of companies. I don’t even let them buy me lunch. I have been in the insurance business since 1979 and have been involved in all aspects of the business. My whole career has been spent helping business people find the right insurance. I'm confident that this guide will help you.


Thumbnail Sketch of the Coverage

The policy is designed to address liabilities that come out of the employment relationship. Coverage is generally included for harassment, discrimination, wrongful discharge, failure to hire, and failure to promote. The cost to defend lawsuits is also included in the protection. Workers' compensation, employee theft, issues involving unemployment insurance and ERISA are excluded.


Coverage Considerations

As there are no standard EPLI policies, each policy and proposal must be evaluated on its own merits. Every insurer uses his or her own policy forms, terms, and conditions. Here are some issues that should be considered:


Claims-Made Coverage Trigger

Most liability insurance policies (general liability, automobile, workers' compensation) pay for events that occur during the policy period. For example, an auto insurance policy will pay for an accident that occurs while the policy is in force.

EPLI policies, however, pay for lawsuits filed during the policy period; the wrongful act could have occurred years before. Claims-made policies respond only when a suit is filed, or when a strong threat of a suit exists.

Claims-made policy: Pays based on the date of the lawsuit.

Occurrence policy: Pays based on the date of the accident or occurrence.


The downside of a claims-made policy comes if the policy is canceled. Example: An EPLI policy is put in force January 1, 2005, and is renewed in 2006 and 2007. In 2008, however, the organization decides to end the coverage, because the premium has increased. Six months later, a letter from an attorney arrives announcing a lawsuit for discrimination in hiring that occurred in 2007.

No coverage.

Although the policy was in force at the time of the alleged discrimination, the policy was not in force when the suit was filed. The solution to this problem is the extended reporting period found in most policies (see the next paragraph).


Extended Reporting Period/Tail Issues

Claims-made policies only provide protection for lawsuits and actions brought during the policy period. In the event that coverage is replaced or cancelled, protection may be desired for events that took place prior to expiration/cancellation but for which no claim has yet been filed. This coverage is called a "tail" or "extended reporting period" (ERP). Here are some issues to consider:

-Can you buy the ERP at your option or only when the insurance company cancels the policy?

-For what period is the ERP valid? One year? Two years?? Longer???

-What is the premium for the ERP? (The cost is usually expressed as a percentage of the current premium.)

-In what time frame must the insured decide to buy the ERP? (The usual period is 30 or 60 days.)


Policy Limit
What amount of coverage is provided by your policy? What's the total amount of protection offered for all claims during the covered time frame (also known as an "aggregate limit")? Multiple claims can, in effect, use up the limit of coverage.


Defense within Limit

Most EPLI policies include the cost of defending a claim (attorneys' fees, etc.) within the policy limit of liability. That means that the amount of coverage purchased must be enough to cover the awards and the defense costs of all claims. This can be an issue when considering the amount of coverage (aggregate limit) you buy.


Definition of Wrongful Employment Practice

Each EPLI policy will contain a definition of the wrongful acts that are included in the policy. Here are some acts to be considered when reviewing coverage:

• Discrimination
• Negligent Hiring
• Wrongful Discharge, Evaluation, Discipline, Promotion
• Employment-Related Personal Injury (Libel or Slander)
• Sexual Harassment
• Workplace Harassment
• Failure to Hire
• Workplace Tort – Wrongful Termination, Retention, etc.

If an act is outside the definition of wrongful act, there is no coverage.


Definition of Harassment

Some policies narrowly define this coverage as "sexual harassment." A better (broader) definition is “workplace harassment” or “harassment including sexual harassment.”


Special Insurance Company Provisions

Some employment practices liability insurance policies include special features. Usually these are measures to prevent losses. Insurers may provide access to a hotline, allowing free access to experts to discuss employment actions and situations. The purpose is to give the insured access to information and opinions on issues that could lead to a claim.

Another feature offered by some insurers is a reduction in the deductible applied to a claim if the insured called an attorney prior to the termination of an employee. Should a claim result, the deductible is reduced by half.


Retroactive Date / Prior Acts Coverage

We discussed above the idea that claims-made insurance policies respond to claims brought during the policy period. Many policies include a date after which a claim must occur in order for the policy to respond—a retroactive date. When changing insurance companies, it is vital to understand the new policy retroactive date. The use of a "Tail" may be necessary if the retroactive date is not sufficiently in the past.

When buying coverage for the first time find out how “prior-acts” will be handled. Some insurers exclude all past occurrences. Some will only exclude “pending and prior litigation.” In other words, if you knew that the incident was going to result in a lawsuit there is no coverage.


Third Party Coverage

Some insurers offer coverage that includes allegations of harassment or discrimination to non-employee, third parties. For example, a customer alleges that a clerk refused service due to her race or ethnicity.

Review the definitions of third party and the wrongful acts that are included in the extra coverage.



Employment Practices Liability Insurance Coverage Review Chart

Complete the following using the information provided by your agent or have the agent fill in the blanks.


Name of the insurance company providing quote/coverage:

Name of agent providing quote/coverage:

Insurer financial rating by AM Best Company. (Available at www.AMBest.com):

The maximum payout for the total of all claims. (Also called aggregate or total limit):

The maximum payout per claim. (Also called per claim limit):

What is the deductible for claims?

What events are included within the definition of a wrongful employment act? (Harassment, discrimination, wrongful discharge, etc.)

Are the costs incurred in the defense of a claim included in the limit of coverage provided or in excess of the coverage provided? (Most EPLI policies will have defense as part of the limit of coverage.)

Is the policy a claims-made policy or an occurrence policy? (Most EPLI policies will be claims-made.)

If claims-made, can the insured buy the extended reporting endorsement after cancellation of the policy? (Policies should offer at least 1 year of extended coverage. Three years is better.)

What is the premium for the extended reporting period endorsement?

If claims-made, how does the policy insure acts prior to the inception of the original policy?

Is there an exclusion for claims involving an insured suing another insured? (May be a separate endorsement or within the exclusions.)

Does the policy include coverage for wrongful acts against non-employees and third parties?

Does the policy indemnify or pay-on-behalf of the insured for a claim? (Indemnification means that you will pay the expenses and the insurer will reimburse you. In most cases, pay-on-behalf is preferable.)

Make a list of other policy exclusions:

(Review both those included in the exclusion section of the base policy and separate endorsements.)

Insurance Books on Line

I have added two of my books to the online world.

BankInsuranceBlook.com - All section of my bank insurance book - formated as a blog. More accurately, a blook.

WorkCompBlook.com - 200 book pages posted as a workers' compensation blook.

Useful info posted to give visitors insurance information not available anywhere else. Read, search, and comment.

National Flood Insurance Program set to expire in less than a month

The National Flood Insurance Program, or "NFIP," is a program of the Federal Emergency Management Agency ("FEMA") that issues standard flood insurance policies, mostly through private insurers.

Originally set to expire last fall, on October 1, 2008 President Bush signed legislation that extended the program until March 6, 2009. That was a compromise bill as the House and Senate were unable to agree on certain provisions. The House version included windstorm coverage, and President Bush had said he would veto the bill for that reason. The Senate version would have forgiven $17.5 billion that NFIP borrowed in recent years as a result of increased damages from hurricanes.

I called FEMA to find out whether we can expect Congress to further extend the program and, if so, with what changes. Ed Pasterick, a Senior Policy Advisor at FEMA, stated that thus far Congress is not actively considering the issue. He expects that the program as it currently stands will be again extended until the end of September, 2009. He stated that FEMA itself is not interested in including windstorm coverage in the program.

In a future post, assuming that NFIP is extended, I'll discuss how NFIP insurance differs from other types of insurance.

Shout out to the Insurance Library

Boston has a wonderful resource for anyone researching insurance issues: the Insurance Library at 156 State Street. I have occasionally used the Insurance Library for many years but recently, during a spate of intense research, I finally became a member. It was a great investment that gives me access not only to the library's excellent books, but also to its librarians, who are unfailingly helpful.

Layoffs Done Right

Interesting op-ed piece from HR Guru Roberta Chinsky Matuson on the impact of layoffs on the employer's reputation.

Roberta makes some great points. Some companies are good at managing their employment relationship. Others... Not so good.

How to read an insurance policy: the known loss doctrine, part 3

In previous posts I have discussed the known loss doctrine here and here. The insuring agreement typically defines when a loss is deemed to have been known to have occurred as the earliest of when:


--An insured reports a loss to any insurer; or


--An insured receives a written or verbal demand or claim; or

--An insured becomes aware by any other means that a loss has occurred or has begun to occur.


Those definitions are important not only for the known loss doctrine, but also because insureds are required to report losses to their insurers immediately ("as soon as practicable") and their failure to do so could result in denial of coverage for the loss. (I will discuss in a future post when an insurer can get away with denying coverage as a reult of late notice).


Insureds often fear to report claims because the mere reporting of a claim may result in their premiums going up. Although I am not an expert in this subject (and any of you who are should feel free to chime in here), my understanding is that reporting a single potential claim that never materializes into an actual claim typically does not affect premiums. On the other hand, failing to report a potential claim that does materialize could substantially affect your right to insurance coverage for that claim.


The lesson: Report to your insurer any claim as soon as you learn of it.

Certificate of Insurance Changes

The most commonly used certificate of insurance form is the ACORD 25 form. Several changes have been made this month, most of which are spelling, grammatical, or the addition of copyright notices.

The biggest change is to the disclaimer on Page 2 of the form.

The "old" language was: "The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon."

The revision is: "This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon."

The only thing I can see that's different is the removal of the phrase, "on the reverse side of this form." I'm not sure what this change does. Probably is the result of some crazy lawsuit. Such language seems to imply that the disclaimer is not a part of the certificate.

Key point 1: A certificate is not proof of insurance on any day other than the day it was issued. Coverage may have been cancelled.

Key point 2: Nothing on the certificate changes any coverage on the policy.

Key point 3: What is on the certificate does not imply a contract of any kind between the issuer and the certificate holder.

Insurance Issues For Home Based Businesses

Don’t Depend on Your Homeowner’s Insurance to Protect Your Business
Property insurance covers your stuff – desks, chairs, inventory, computers, etc. Liability coverage protects you against a lawsuit if someone is hurt either while visiting you or due to a defect in your product. In general, personal policies just don’t do the job for a business.

Many homeowner policies provide only $2,500 of business personal property coverage at your house and $250 away from your premises. Buildings not attached to your home (a separate garage) that are used in your business are also not covered by most homeowner insurance policies.

Business liability incidents are also excluded by most home policies. Personal umbrella insurance offers no business coverage either.

When I started my consulting practice, I bought a business owner’s policy to cover my home office. You may need to do the same. Talk with your insurance advisor about your options.

Auto Insurance
Many home business owners are adequately covered by a personal auto policy. If you make deliveries or use a pickup or van, you may need to buy a commercial auto policy. Talk with your insurance agent.

Renting Cars
Buy the offered coverage when renting a car from Hertz, Avis, or other short-term rental companies. Their contracts make claims a nightmare, and include obligations not normally covered by standard auto insurance. One option may be using a credit card that provides collision damage waiver coverage as a cardholder benefit. Call the toll-free number on the back of your card to check.

Workers' Compensation
Most states require workers' compensation coverage if you have any employees. You also may be able to buy work comp on yourself as a way to have some protection if you can't find health or disability insurance. Talk with your agent.

Consider Professional Liability Insurance
If you’re a consultant, architect, real estate agent, or other professional giving advice, consider coverage for claims against you for errors or omissions. Professional liability is also known as malpractice insurance. It protects you from suits alleging your advice cost your customer or client money.

Pick Your Agent Well
Find an agent you feel is interested in your business. Get recommendations from your peers and friends. Select your insurance advisor in the same way you would choose an attorney or accountant. Use one agent for all your business and personal insurance. Meet at least once a year to discuss your needs.

126 Questions to Ask Your Insurance Agent

I frequently hear from insurance buyers that they don't understand insurance. "I dont even know what questions to ask!" is a common complaint.

Here's the answer, 126 Questions to Ask Your Insurance Agent provides the questions to ask so you can assure yourself that you have the right business insurance coverage.

Download 126 Questions To Ask Your Insurance Agent

Update Your Employment Handbook


Rick Dacri is an HR consultant. He and I have known each other for some time now. In these times it is even more important to be sure your employment handbook and procedures are in place and up to date.

Here are some suggestions from Rick's recent newsletter:

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There have been a number of changes on the federal level that make immediate changes to your handbooks and policy manuals necessary. These include:

ADA: On January 1 changes to the definition of "disability" were enacted. Adopt a policy that makes it clear to employees that they should notify you in the event they require any accommodations.

FMLA: The National Defense Authorization Act amended the FMLA to include military caregiver leave and active duty leave. Amend your policies to include these. The Act also expands eligibility to "next of kin." Finally, eligibility notices, rights and responsibilities and designation notices have changed.

Retaliation Claims: There have been an increase in retaliation claims. Strengthen your policy against retaliation as part of your sexual harassment and discrimination policy. Consider adding a separate policy on retaliation.

Blogs: Make sure your policies on confidentiality and computer use covers personal blogs and what employees can and cannot say about your organization, management, employees and customers.

Employee Free Choice Act (EFCA): Though not yet law, you can expect this Act will pass this year giving unions an upper hand in organizing efforts. In anticipation of that, make sure your policies on emails and bulletin boards cover the issue of solicitation. Be sure you have a separate no-solicitation policy. Finally, consider adding a policy stating your organization's position on unions.

Amend your handbooks now and communicate the changes to your employees. If you have not reviewed your handbook in years, this may be the time for a complete rewrite. The advice above is for those who want to do it themselves. If you need outside assistance, that's where I come in.

I have written many handbooks. I can help you move through this process in a smooth and efficient way to ensure that you are both fully compliant and your handbook communicates what you want to your employees.

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You can contact Rick at 800-892-9828 or email rick@dacri.com.

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