Commercial Auto Insurance Coverage Symbols

Commercial auto policies specify the extent of coverage provided by using symbols to indicate the breadth of the protection.

The declarations page of your auto policy outlines coverage areas (liability, uninsured motorist, medical payments, etc.) with coverage symbols that apply to the type of insurance. The applicable symbols are numbers 1 through 9.

Symbol "1" is the broadest - "any auto". Symbol "9" provides coverage for non-owned vehicles only. Using symbol "7" reduces the coverage to claims from vehicles listed on the policy only. Insurers sometimes use combination of symbols - 8 and 9, for example, to provide coverage for hired and non-owned autos.

Symbol 1 in the liability section would provide coverage for any auto liability claim brought against an insured. Symbol 7 in the liability section would limit liability coverage to claims that come from a vehicle listed on the policy - significantly restricting the coverage.

Public Bid Openings

I've been working on more than my share of bid projects for schools and municipalities lately. Every time I receive bids I confirm my idea that public bid openings are not a good idea.

Inevitably there are issues that need to be addressed and alternative quotes that are needed to perform an accurate analysis. If I had provided the bid info at a public bid opening I would not be able to get the info I need in a fair manner.

Public bid openings may be good for road projects and buying pencils. Not in buying insurance though.

Scott Simmonds, CPCU, ARM, CMC
"The Guy With the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠

Credit card insurance coverage for rental cars

As usual, last time I rented a car, in Michigan, the rental car agent explained that I should purchase the exorbitantly priced property damage insurance because 1) Michigan is a fully no-fault state and 2) liability for damage to the car would include rental costs while the car was being repaired. Despite having posted on this very topic, I had no idea whether I would be fully covered by my insurance for property damage if I was in a collision.

Shortly after that I received a benefits guide from one of my credit cards and I took a close look at its rental insurance coverage. It covers vehicles rented for 31 days or less with a value of $50,000 or less. There is no coverage unless you decline the Collision/Damage waiver offered.

And, yes, it covers "reasonable loss-of-use charges imposed by the vehicle rental company for the period of time that the rental vehicle is out of service."

So next time I rent a car I'll refuse the property damage insurance with confidence--that is, if I can remember which credit card I should be using.

Save the date: Massachusetts Reinsurance Bar Association Symposium

I mentioned here the formation of the Massachusetts Reinsurance Bar Association. MReba has now scheduled its first symposium for October 1, 2009 at the Harvard Club Back Bay on Commonwealth Avenue in Boston.

Finding the Right Life Insurance Policy



TheStreet.com rates the financial strength of 900 life insurers nationwide to help consumers find sound companies to do business with. TheStreet.com Ratings has been recognized as the most conservative grader of life insurance financial strength by a leading consumer publication and was singled out as the only ratings agency that doesn’t accept payment from any of the companies it rates.

American Life Insurance Company, a unit of AIG (Stock Quote: AIG), is the largest life insurer in the U.S., with nearly twice as much premium volume as the next largest insurer, Northwestern Mutual. There are many companies in excellent financial shape that you should consider when you’re shopping for life insurance. Go to TheStreet.com to look up your specific company.

Life insurance comes in many flavors, each designed to suit a specific need. For instance, there are policies that will pay off the balance on your mortgage. There are policies that will provide your family with a specified income stream for a fixed number of years after your death. There are policies where the benefit goes up in value as you get older. And there are even policies where the benefit goes down in value as you get older.

When you boil it all down, though, there are really only two fundamental types of life insurance policies: permanent life and term life.

Permanent Life
As the name would suggest, permanent life is a lifetime insurance policy. You might also think of it as life insurance with a savings account built in. With permanent life, a portion of the premiums you pay to the insurance company go toward establishing a “cash value” which can be withdrawn if you cancel the policy or may potentially be used to pay for future premiums on the policy. And unless you exhaust your cash value, your beneficiaries are guaranteed to receive the death benefit when you pass.

So in a way, a permanent life policy is like an investment with a life insurance component. It is particularly useful for individuals who are concerned about their ability to pay premiums in later years or for those lacking the discipline to establish a separate savings plan.

Term Life
Term life, on the other hand, provides insurance coverage for only a specified period of time. The death benefit is only paid if you die during that specified term and have paid the required premiums. At the end of the term, however, the policy expires and you walk away with nothing to show. There is no cash value built up and your insurance coverage ceases to exist unless you purchase another policy.

In other words, term life insurance provides temporary coverage. If you live past the end of the term, you will have made years of premium payments but receive no money in return from the insurer. Of course, if you were to die at the beginning of the term, you would have paid very little in the way of premiums and yet the insurance company would have to pay your beneficiaries the full policy benefit.

At first blush, term life insurance may not sound as appealing as permanent life. That is, until you get to the cost. The premiums for a term life policy can be considerably less expensive than those for a permanent life policy. That’s because with term life, you’re not contributing anything extra to build up a cash value. Instead, you’re only paying for the insurance coverage plus the insurer’s administrative expenses.

When Life Insurance Becomes a Liability

People who are less wealthy suddenly need a bigger policy to protect their families. People whose policy investments have been battered face unexpected premium increases. And even those who feel adequately insured at affordable prices are worried about their insurers’ ability to meet financial commitments.

In addition to investment losses, premium increases have shocked many people. “This is a real issue for clients who own variable policies,” said Loretta Nolan, president of Loretta Nolan Associates, a certified financial planner in Old Greenwich, Conn.

These policies combine insurance protection with a tax-deferred investment account that helps to pay the premiums. During the bull market, they promised investment returns high enough to limit the size and duration of premium payments. But the marketers didn’t stress the downside: if investment performance falls short, policyholders must spend more on premiums.

And that’s what has happened. Now, policyholders must pay higher premiums, for more years, to maintain their current level of insurance. The alternative is to reduce the coverage, which sometimes leads to a surrender charge.

If you’re in this situation, do a policy stress test, advised Ms. Nolan: ask the insurer to project your future premiums, assuming the policy investments earn a modest 4 percent return. If that shows you can’t afford the premiums, you need to consider alternatives.

If your priority is keeping your insurance, Ms. Nolan suggested replacing some of your variable coverage with a less-expensive term policy. For example, if you have a $500,000 variable policy, you might buy $300,000 of term insurance and trim your variable policy to $200,000, keeping your total premiums affordable. But if you see the variable policy chiefly as an investment loss — and don’t need the insurance — you might want to exchange it for an annuity, said Glenn Daily, a fee-only insurance consultant in Manhattan. The exchange is a tax-free transaction (called a 1035 exchange) that lets you use your loss to offset taxes on future gains. If you lost $30,000 in the variable policy, for example, your first $30,000 of gain in the annuity would be tax-free.

If your net worth has taken a 30 percent hit, advisers say you probably need more insurance to protect your family, at least until your stock portfolio and your home regain value.

Determining how much you need is more an art than a science, said Richard B. Freeman of Round Table Services, a Westport, Conn., wealth management firm. Instead of relying on a software program that would probably recommend more than you would ever buy, he suggested that you think in terms of two lump sums — one to pay off your mortgage and cover your children’s college education and the other to create income for your survivors.

A nonworking spouse needs insurance, too, added Mr. Freeman: “If Mom’s home with the kids, her policy has to do more than hire a nanny and a housekeeper. It should be big enough to let Dad take a job with shorter hours closer to home, so he can have more time with the kids if he’s the surviving parent.”

The cheapest way to increase your coverage is with term insurance, often available in a group plan through your employer. But that is not necessarily the cheapest way to buy it. If you’re healthy, you might get a better deal by shopping for an individual term policy, said Mark Cortazzo, senior partner at Macro Consulting Group, a Parsippany, N.J., financial adviser, especially if you’re a woman in a state with unisex rating for group insurance.

If you’re in poor health, you might want to buy as much group insurance as possible at work. You can usually convert it to an individual policy without evidence of insurability, albeit at a price, when you leave the job, Mr. Cortazzo said.

If you have serious health problems, you should avoid the standard application process for individual coverage because your application will probably be rejected after the medical exam. With each rejection it is harder to find coverage.

Instead, you should enlist a broker who specializes in the high-risk market to present your case informally to insurers. He can make sure you formally apply only to those companies that will accept you. You may soon have more options if insurers with highly publicized financial difficulties relax their underwriting standards to maintain their sales volume, said Wil Heupel, managing principal of Accredited Investors, a Minneapolis financial planning firm.

So how do you avoid buying insurance from a company whose health is worse than your own? Advisers say that if you’re buying more than $3 million in coverage it’s prudent to diversify among several highly rated companies.

“Work with a broker who sells the policies of many carriers,” Mr. Freeman said. An agent represents only one, whose problems he may minimize.

Banks Use Life Insurance to Fund Bonuses


By ELLEN E. SCHULTZ

Banks are using a little-known tactic to help pay bonuses, deferred pay and pensions they owe executives: They're holding life-insurance policies on hundreds of thousands of their workers, with themselves as the beneficiaries.

Banks took out much of this life insurance during the mortgage bubble, when executives' pay -- and the IOUs for their deferred compensation -- surged, and banking regulators affirmed the use of life insurance as a way to finance executive pay and benefits.


Bank of America Corp. has the most life insurance on employees: $17.3 billion at the end of the first quarter, according to bank filings. Wachovia Corp. has $12 billion, J.P. Morgan Chase & Co. has $11.1 billion and Wells Fargo & Co. has $5.7 billion. (Wells Fargo acquired Wachovia at the end of last year.)

The insurance policies essentially are informal pension funds for executives: Companies deposit money into the contracts, which are like big, nondeductible IRAs, and allocate the cash among investments that grow tax-free. Over time, employers receive tax-free death benefits when employees, former employees and retirees die.

Though not improper, the practice is similar to what is known as "janitors insurance," an insurance-on-employees technique that has long been controversial. Critics say the banks' insurance contracts are a way for companies to create tax breaks for funding executive pensions. And some families have complained that employers shouldn't profit from the deaths of their loved ones.
[life-insurance policies on bank employees]

Efforts to rein in the practice largely have been unsuccessful, including the most recent rules Congress enacted in 2006. The rules limit companies to buying life insurance to just the top third of earners, who must provide consent. But the rules don't apply to life-insurance that employers bought before the August 2006 rules, which cover millions of current and former employees.

Banks are far from alone in buying such company-owned life insurance, or COLI. Thousands of companies do it, including American International Group Inc., Fannie Mae, Freddie Mac, Kimberly-Clark Corp. and Tyson Foods, Inc. But banks have been among the largest players, pumping billions more into new policies since the 2006 rules were put in place.

Last week, the Treasury proposed eliminating companies' ability to deduct interest on loans related to COLI. This would have little impact on banks, which don't borrow money to invest in life insurance. The proposal would also leave untouched the major tax breaks of the practice.

Banks had a total of $122.3 billion in life insurance on employees at the end of 2008, nearly double the $65.8 billion they held at the end of 2004, according to a Wall Street Journal analysis of bank filings. Unlike other companies, banks are required to disclose their total life-insurance holdings in regulatory filings.

In recent years, the Office of the Comptroller of the Currency affirmed that banks can buy life insurance to finance employee benefits. But filings show that executive compensation accounts for most of the benefits.

J.P. Morgan, for instance, had $10 billion in deferred-pay obligations, compared with $1 billion in retiree health obligations at the end of 2008. Offsetting these obligations was $12 billion in bank-owned life insurance, or BOLI. A spokesman for J.P. Morgan confirms the figures.

Citigroup Inc. had $919 million in unfunded retiree-health obligations, $586 million in supplemental executive pension obligations, and roughly $5 billion in deferred compensation. Offsetting these obligations: $4.2 billion in life insurance. A spokesman says Citigroup bought BOLI because it was "an attractive use of capital," and for "the tax-free nature of the death proceeds."

Bank of America doesn't disclose its deferred-compensation obligations, but filings show that at the end of 2008, its retiree health plan had an unfunded obligation of $1.3 billion, and that it owed $1.3 billion in supplemental executive pensions. The bank had a total of $17.1 billion in life insurance, which suggests a substantial deferred-compensation obligation. A BofA spokeswoman declined to comment on the deferred compensation obligation, but in an email said: "Like many companies, Bank of America uses this insurance to help defray the cost of employee benefits."

Companies don't use the policies as piggy banks to pay for compensation and benefits. Rather, they benefit from keeping the money in the contracts: Thanks to accounting rules for life insurance, gains on the investments -- from stocks, hedge funds, bonds and the like -- aren't just tax free, but are reported as income each quarter. Otherwise, companies couldn't add gains from securities as income until they sold them, and they would be taxed.

This income reduces the drag that executive IOUs have on earnings. (Banks owe interest on the deferred pay; and like any other kind of debt, the interest on executive debt lowers earnings.)

Though the investments are illiquid, the banks receive tax-free cash when employees and former employees die. Pacific State Bancorp, of Stockton, Calif., recently reported $2.6 million in income from a death benefit in 2008. The company didn't respond to requests for comment.

A subsidiary of Conseco Inc., Bankers Life & Casualty, which bought life insurance on employees in 2006, received $2.7 million that year from a death benefit, according to filings. A spokesman says the life insurance company bought the insurance "to offset the expense of deferred compensation."

Over the coming decades, banks will receive an estimated $400 billion in death benefits, consultants estimate. The death benefits sometimes are referred to in filings as "mortality dividends" or "yields." Employers track the deaths of former employees by checking Social Security Administration records.

As an incentive to get employees to consent to being covered, some companies offer them a small portion of the death benefit. But the coverage may end when they leave the company.

In December, Irma Johnson accidentally received a check for $1.6 million, from Security Life of Denver Insurance Co., payable to Amegy Bank. According to a lawsuit Mrs. Johnson filed in February in a Houston state court, in 2001 the bank told her husband, Daniel Johnson, a credit risk manager who had survived two brain surgeries, that he was eligible for supplemental life insurance of $150,000, if he signed a consent form authorizing the bank to purchase an insurance policy on his life. Four months later, the bank fired him.

Mr. Johnson died from a brain tumor at age 41 in 2008. His widow and two young children received no life-insurance benefits, which the bank had canceled when Mr. Johnson left. Mrs. Johnson says her husband was cognitively disabled when he signed the consent form.

A spokeswoman for Amegy Bank, a unit of Zions Bancorp, declined to comment on the suit, but said, "Participation in Amegy's BOLI plan was completely voluntary; employees consented to participate."

Calculation of punitive damages under 176D/93A

I reported here on a Superior Court case that I stated correctly awarded unfair settlement practices damages based on the lost interest amount. A reader pointed out that the damages that are trebled pursuant to Mass. Gen. Laws ch. 93A are actually the entire trial verdict.

He is correct. Under the current law of Mass. Gen. Laws chs. 93A and 176D, when a case goes to trial and judgment and damages are trebled pursuant to 93A, then the damages that are trebled are the verdict amount. When the underlying case settles, however, and the claimant successfully sues for treble damages under 93A, the amount that is trebled is the interest that was lost because of the delay in settlement. Single damages under 93A are always the lost interest.

Lightning Damage

Lightning is one of the most frequent causes of homeowner insurance claims.

177,000 claims in 2007
278,000 in 2004

While the number of claims went down, the average cost per claim went from $2,646 to $5,321, according to the Insurance Information Institute.

The increase in cost is attributed to an increase in sensitive electronics like flat screen TVs.  Surge protectors could make a difference.

Frankly, I never thought of a surge protector for my TVs.  I have one on my computers but not the other electronics.  I'll fix that with the next trip to the hardware store.

Scott Simmonds, CPCU, ARM, CMC
"The Guy With the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠

Collision Damage Coverage for Rental Cars

Never rent a car (Hertz, Avis, etc.) without buying the collision damage waiver.

Either buy it from the rental car company or use a credit card that includes the coverage. Call your credit card company. Most “gold” or preferred cards offer the protection.

Don't depend on your personal or commercial auto insurance. The rental agreements contractually obligate the renter to costs not covered by "normal" insurance. Issues like “loss of use” and “replacement cost” are a major source of trouble that can be avoided by purchasing the coverage from the rental car company or using the right credit card.

Short-term leasing of a commercial vehicle (Ryder Truck, etc.) presents unique exposures. Most commercial auto insurance policies provide coverage for non-owned auto liability (check with your agent). However, few provide comprehensive or collision coverage. My general advice, again, is to buy the coverage provided by the rental company. When renting trucks or vans you probably won’t be able to use the coverage offered by credit card companies.

Employee Dishonesty

It's been a while since I ranted on this...

How much coverage do you have for employee dishonesty?  

Employee theft accounts for a huge percentage of business theft losses.  Yet, business owners have a mental block about buying enough coverage.  

My readers seem to like rules.  Here goes.

Rule 1: $100,000 of coverage is a minimum for any business with employees.

Rule 2: $250,000 of coverage is a minimum if you have more that 20 employees.

Rule 3: $500,000 is a minimum if you have more than 50 employees

Rule 4: Ignore the above and tell me how much an employee (or a group of employees) is going to steal from you and I will tell you how much more coverage to buy.

Start with the above minimums and get quotes up to $1,000,000 of coverage.  Review the cost of the extra coverage compared to the value of the additional protection.  Make a value judgement: coverage vs. premium.


Scott Simmonds, CPCU, ARM, CMC
"The Guy With the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠

Court of Appeals gives good drafting tip

This is my last post on Essex Ins. Co. v. BloomSouth Flooring Corp.

In a comment near and dear to my heart as a brief-writer, the court took the insurer's counsel to task for failing to respond to an argument:

Essex, for its part, gives no good reason to affirm the [District] court's decision regarding exclusion (k). Specifically, Essex fails to offer a reasoned argument in support of the court's conclusion that the concrete floor became BloomSmith's product for purposes of the exclusion. Instead, Essex states that "The defective carpet is clearly BloomSouth's product. Just as clearly, it does not constitute real property." While we may agree with Essex on this point, BloomSouth's argument is that Suffolk's complaint may be reasonably construed as alleging that the carpet caused damage to a third party's real property-BFDS's concrete floor. Essex's statement is not responsive to that argument.

The Value I bring to My Clients

Two projects I am finishing up on prove my value to my clients.  

One got a premium reduced by 20% keeping the coverage the same.

The other got a client's premium reduced by 30% improving coverage dramatically.

Knowing how to negotiate with insurance companies and agents is part of the value I bring to my clients.

In the two cases above my total project fees are dwarfed by the reduction in my client's premiums.

For every dollar they spent with me they saved $10 in premiums.


Scott Simmonds, CPCU, ARM, CMC
"The Guy With the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠



Insurance Review - Coverage, Service, Price


Your business insurance program is determined by three components:

1) Your appetite for risk
2) The insurance marketplace
3) Your loss exposures

Those three variables determine the insurance program that protects your business.

Let's go deeper though...

--Who assesses the overall quality of your insurance plan?  

--What biases and conflicts does the quality assessment include?

--What is the program's combination of coverage, service, and price?

You can certainly have your agent evaluate your insurance program.  The results are rather predictable.

You can have a competing agent evaluate your insurance program.  Now we have set up a situation where the vested interest is in finding everything wrong!  However, I think we all know what the ultimate recommendation will be.  Somehow the reviewing agent will have all the answers.

How about an unbiased review by a professional insurance consultant?  Yep, that's me!

I'll do an amazing job and uncover every issue and problem.  I'll work through the holes in your coverage and fix the overlaps.  I'll stand next to you while we retool your insurance.

My minimum fee is $5,500.

When I'm involved in an account review my fees are small compared to the issues I usually uncover.  What is the cost of a $150,000 uninsured loss?

Some companies see my fee and gulp hard.  So, I developed my Insurance Assurance Toolbox.  For $99 you get everything you need to work through your insurance  - avoiding the bias of a new agent while pulling your agent through a comprehensive process where you have knowledge.  

My toolkit lets you know what questions to ask so you get a fair, comprehensive review of your insurance.

I even offer a money back guarantee - If this tool does not meet your expectations just send it back to me with the reasons why within 7 days. You'll get a full and immediate refund. (Insurance agents, insurance consultants, or insurers are not eligible for the refund.)

This workbook will improve your coverage and get you better value for your premium or your money back.




Scott Simmonds, CPCU, ARM, CMC
"The Guy With the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠






Court of Appeals holds that odor does not come within impaired property exclusion

Returning to Essex Ins. Co. v. BloomSouth Flooring Corp. which I have been discussing in my last several posts, the court turned next to the business risk exclusions.

The court held that the impaired property exclusion did not exclude coverage. That exclusion excludes property damage to property that has not been physically injured.

The court held that the allegation that the odor permeated the building was an allegation that the odor physically injured the property.

Pursuant to the terms of the policy the impaired property exclusion applies only to property that can be restored to use by "the repair, replacement, adjustment or removal of the insured's product or work."

The court interpreted the complaint as suggesting that the property could not be restored simply by removing, replacing, adjusting or removing BloomSouth's product or work. Rather, the complaint alleged that Suffolk attempted to remediate the odor by installing carbon air filters to the ventilation system in the building.

Why are Exclusions Excluded

A well written piece on exclusions - http://www.mynewmarkets.com/article_view.php?id=99788

Scott Simmonds, CPCU, ARM, CMC
"The Guy With the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠

Court of Appeals holds that allegation of bead-blasting is allegation of physical injury to property

I have been discussing Essex Ins. Co. v. BloomSouth Flooring Corp. in my last couple of posts.

Suffolk was the general contractor and BloomSouth was the subcontractor that installed the defective carpeting. Suffolk alleged in its lawsuit against BloomSouth that as a result of BloomSouth's installation of the defective carpet the concrete floor beneath the carpet had to be bead-blasted. The court interpreted that allegation as alleging "physical injury to property, viz, the concrete substrate."

The court held, more specifically, that the bead-blasting allegation was part of a remedial measure, not a replacement process. The decision does not explain why that distinction is important under the terms of the policy.

Ongoing Insurance Consulting Case Study

I'm frequently asked by prospective clients about the steps that my insurance review projects go through.

I've posted an ongoing case study (names changed) of a current project with a bank. I've really only just started. Check back often.

Follow my progress here.


Scott Simmonds, CPCU, ARM, CMC
"The Guy With the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠

Property Insurance - Agreed Amount

I am in the middle of about 150 different insurance bids and one thing is standing out, agreed amount.



First, agreed amount is an endorsement to property insurance that removes the coinsurance penalty. Coinsurance is a penalty. Agreed amount removes the penalty. It is a good thing for insurance buyers.



I am amazed at how many agents deliver proposals with a coinsurance penalty. There are maybe one in 1,000 accounts that should not have agreed amount - from the insureds perspective. I no longer provide bid specifications when I am getting competitive quotes for a client. I let the agent design the insurance program so I can see what kind of insurance brain an agent has.



Proposing a policy with a coinsurance penalty does not impress me. Call your agent. Ask if your property insurance has a coinsurance penalty. If the answer is yes, ask why. This single mistake is so basic as to be almost a litmus test to determine if an agent is looking out for his client.

Court of Appeals holds that permeating odor may constitute a "physical injury"

As I discussed in my last post, in Essex Ins. Co. v. BloomSouth Flooring Corp. the United States Court of Appeals for the First Circuit discussed whether an insurer must defend a construction contractor against allegations that unpleasant odors emanated from a carpet the contractor installed.

The court first held that coverage was triggered because a permeating odor may constitute a "physical injury to tangible property" within the meaning of the policy.

I have seen this issue frequently arise in the context of fumes and airborne pollutants. No published Massachusetts appellate decision has addressed the issue. The Court of Appeals relied on two Superior Court decisions to predict that the Supreme Judicial Court would hold that an odor may be a physical injury.

Flood

I just realized that it has been some time since I talked about flood insurance. There are many new readers who may have missed past rants. Here goes...

-Home insurance policies do not cover damage caused by a flood.

-Business property insurance do not cover damage caused by a flood

-The only way to find flood coverage (for most) is to get protection through the National Flood Insurance Plan.

-Even with flood insurance through the NFIP, you won't have coverage for the loss of business income that comes from being shut down due to a flood.

In short, the peril of flood is a risk management challenge for most people and most businesses.

Talk with your insurance advisor for more information.


Scott Simmonds, CPCU, ARM, CMC
"The Guy With the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠

Smart Money Article - Insurance Issues of Laid-Off Workers

A writer from Smart Money magazine called yesterday with some questions about insurance for people who have lost their jobs.

Article Here.

Scott Simmonds, CPCU, ARM, CMC
"The Guy With the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠

H1N1 Flu and Insurance

The staff at the National Underwriter just put out a paper that outlines insurance issues relative to the current concern the flu.

I am not jumping up and down about this whole thing. More than 30,000 Americans die each year from the seasonal flu. That fact is getting lost in the news reports of cases in the hundreds.

Here is the link for those who are interested.

The short answer? If someone can prove you gave them the flu you may have insurance coverage.

However, I dare say that your time is better spent looking at your building insurance limit and making sure you have enough business income coverage.

However...

Scott Simmonds, CPCU, ARM, CMC
"The Guy with the Big Insurance Brain"
Providing Unbiased Insurance Assurance℠

U.S. Court of Appeals defines "adumbrate"

My next several posts will discuss Essex Ins. Co. v. BloomSouth Flooring Corp., a decision just handed down by the United States Court of Appeals for the First Circuit.

The case addresses whether a liability insurance policy issued to a building contractor covers losses arising from an unpleasant odor emanating from a carpet the contractor installed. My next posts will deal with the substance of the decision.

For now, though, I want to applaud the Court of Appeals for providing a definition of "adumbrate." I have discussed how a court determines whether an insurer has a duty to defend("the eight corners test") here. The standard language is, "if the allegations of the complaint are 'reasonably susceptible' of an interpretation that they state or adumbrate a claim covered by the policy terms, the insurer has a duty to defend."

Although I have quoted that language numerous times in legal briefs, I have always skimmed over the word "adumbrate" without pausing to consider what exactly it means.

The Court of Appeals has now been kind enough to provide a definition in footnote 1 of the decision: "We have defined 'adumbrate' in the liability insurance context to mean 'to give a sketchy representation of; outline broadly, omitting details . . . or to suggest, indicate or disclose partially and with a purposeful avoidance of precision.'"

General Liability and Mental Anguish

General liability policies that protect most American businesses are designed to provide coverage for bodily injury and property damage to a customer or visitor.



Examples of bodily injury... A customer slips on your walkway. A product you sell causes a person to become ill. An employee causes a fire that burns down the hotel they are staying at. Faulty construction causes a collapse and ten people are killed.



The policy defines bodily injury as "bodily injury including death." Yes, bodily injury is really defined as bodily injury. In most states bodily injury does not include emotional distress or mental anguish. Some insurers have special endorsements to the policy that adds emotional distress and anguish. Some, not all. This could be a significant coverage hole in your insurance program. Talk with your insurance adviser.

Insurance Regulation

The following is a letter I wrote that has been published in the insurance publication, The Standard, May 1 edition. (Reprinted by permission.) This outlines my feelings on government regulation of all kinds - not just insurance.

To The Editor,

Your April 24th article on the UConn panel of regulators points to the fatal flaw of government regulation. Nowhere was there any mention made of the downside of regulation. The costs are high and many.

First, there is the cost to the taxpayers. Millions and millions of dollars are spent to staff and run the state departments of insurance. These are dollars that could be in taxpayer's pockets.

Next is the cost to industry. Again, huge. These are direct, in the fees charged, and indirect in the expenses of following the regulations while trying to stay in the good grace of the regulators. These costs increase the cost of insurance to the public.

There is also a cost to consumers in that regulation keeps new products and services from entering the marketplace quickly. Further, insurers cannot react promptly to changes in consumer demand for innovative extensions of current products. How much innovation have we seen lately in the most widely regulated insurance product - health insurance?

These costs are overshadowed by the cost of freedom. Capitalism and freedom are like pregnancy. You can not be a little pregnant, a little capitalistic, or a little free.

A free market allows willing buyers and willing sellers to deal together without interference - each to their own self interest. Getting and giving is based on the best value the parties can obtain. The rare dishonest or fraudulent transaction is well handled by a court system responding to facts and evidence.

The article states the arrogant regulatory premise that insurance consumers are too stupid to understand what they are buying. It follows that regulators see the industry as evil in that without regulation the Snidely Whiplashs of the insurance industry will cheat and dupe the public.

Those of us who have been in the industry for any time know the opposite is true. We are an honorable industry that serves the needs of the insurance buying public. Sure, we are out to make a profit. However, we know that profit only comes from providing value. If we don't provide value our clients will leave us in search of others who are eager to provide it.

We also know that our industry is not immune to bad apples. The initiation of force and fraud is always wrong. The courts should be used to take care of such acts. Poor performance in the marketplace is also punished by a bad reputation. In our society of freely available information and empowered consumers a stellar reputation is required for success. Those who perform well will be rewarded by the market. Bad actors will be punished.

Some will comment that the current economic maelstrom is caused by too little regulation. From what I see, regulation caused the current problems with its overly protective processes that lead to a whirlwind of unintended consequences, the cost of which are never born by or recognized by the regulators.

Our industry and our economy is not helped by regulation. Regulation is an unnecessary friction in commerce and a impingement of our freedoms.


Scott Simmonds, CPCU, ARM, CMC

Insurance Assurance℠

It's now official. Insurance Assurance℠ is in the process of being trademarked. The application is on its way to Washington.

Now, the correct spelling of the phrase is "Insurance Assurance℠."

Scott Simmonds, CPCU,ARM,CMC
"The Guy with the Big Insurance Brain"
Providing Insurance Assurance
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