Showing posts with label Exclusions. Show all posts
Showing posts with label Exclusions. Show all posts

No Coverage for Tearing Down Barn Apartment that Violated Building Code

The South Carolina Court of Appeals recently held that a general liability policy excluded coverage for the homeowners’ claim that they lost the use of property when they had to remove an apartment built on top of a barn because it violated zoning ordinances. William and Frances Walde, as Assignees of Johnson Construction Co. of Aiken, Inc. v. Assoc’n Insurance Co., (S.C. Ct. App. Op. No. 5061, Dec. 2012).

Post by Insurance Chair Pete Dworjanyn
The Waldes, (homeowners) wanted to build a barn with an upstairs apartment on their property in Aiken.  They hired Johnson Construction to obtain the necessary variances from city building ordinances.  The homeowners then contracted with Johnson to construct the barn and apartment.  Eighty percent of the work had been completed when the building inspector notified Johnson that the barn did not comply with the variance or the special exception.  The city ultimately allowed the barn to remain if the apartment was removed to lower the barn’s roof.

The homeowners filed an arbitration claim against Johnson, who tendered it to his insurer, Association Insurance Company (AIC).  AIC denied coverage.  Johnson and the homeowners settled their dispute prior to arbitration.  The settlement included an assignment to the homeowners of Johnson’s rights against AIC.  The homeowners filed suit against AIC, alleging breach of duty to defend and indemnify.  The trial court granted the homeowners’ motion for partial summary judgment, holding AIC was obligated to defend Johnson, that the policy provided coverage, and that AIC was liable for fees and costs.

Property Damage – The homeowners claimed they suffered “physical injury” to property when the barn was partially demolished.  The Court of Appeals rejected that argument holding that although “physical injury” was not defined by the policy, injury is generally considered the violation of another’s legal right. Using this definition, the court ruled that the partial tearing down of the barn’s second story did not constitute an injury because the removal was a remedial measure to fix the injury caused to the homeowners when the construction put them in violation of the City’s ordinances. However, the court also held the homeowners’ allegations raised the possibility of loss of use of tangible property that had not been physically injured, because the homeowners could not fully use the property after they were informed of the barn’s noncompliance.  The court rejected AIC’s argument that the homeowners failed to allege property damage because the physical injury to the barn resulted from faulty or defective workmanship, as faulty workmanship was only relevant to the policy’s exclusions, not the definition of property damage.

Occurrence – The court next concluded the homeowners’ allegations in the arbitration demand established the possibility of an occurrence. The demand claimed that Johnson’s advice was “wrongful”.  AIC argued the use of “wrongful” meant the claims were not based on an accident that would give rise to an occurrence. The court rejected the argument, holding the allegation that Johnson “wrongly” said its plans complied with the variance and exception could be construed as alleging Johnson was mistaken or acting without due care. The opinion noted that the court must look beyond the labels describing the acts and allegation and look to the acts themselves which formed the basis of the complaint.   

Accordingly, regardless of whether the claim was for negligence, negligent misrepresentation, or breach of fiduciary duty, the allegation of erroneous representations and provision of information was unintentional, and therefore, potential acts within the terms of the policy.

Exclusion – The court concluded, however, the “your work” exclusion applied and excluded coverage.  That exclusion excludes coverage for property damage to that particular part of any property that must be restored, repaired, or replaced because the party’s work was incorrectly performed on it.  The exception to that part of the Damage to Property exclusion provides the section does not apply to property damage included in the products-completed operation hazard.  The court agreed with AIC that the homeowners’ alleged property damage was not included in the products-completed operations hazard coverage.  Regardless of whether the contract was complete (or terminated) when the homeowners lost the use of the property, the policy deems all loss of use unaccompanied by physical injury to have occurred at the time of the occurrence. 

The homeowners claimed the loss of use of property arose out of Johnson incorrectly advising them and obtaining the necessary approval from the City.  Therefore, the loss of use was deemed to have happened at the time of those incorrect performances, and before Johnson’s work was complete.  The homeowners alleged the loss of use of the barn while they were required to tear down and build a new roof; they alleged property damage to that particular part of property that must be replaced because Johnson’s permit work was incorrectly performed.

The court rejected the homeowners’ argument that their claims were not excluded because the defective work occurred before the zoning authority rather than the construction of the barn.  The argument that their claims involved a permitting defect, not a construction defect, did not allow it to escape the damage to property exclusion.

Charleston grocery store prevails in CGL dispute

Post by Bennett Crites
A Charleston grocery store prevailed in a recent ruling involving a coverage dispute after a shooting in the store. In Pennsylvania National Mutual Casualty Insurance Company v. DOSCHER'S SUPER MARKETS, Dist. Court, D. South Carolina 2012, Anita Thorne, as Guardian ad Litem for Burton Thorne, brought suit in the Court of Common Pleas for Charleston County with respect to injuries her son sustained when he was shot by a coworker at Doscher’s Super Market.  As a result, Penn National Insurance Company, Doscher’s insurer, subsequently filed suit against Doscher’s in United States District Court regarding Penn National’s duty to defend and indemnify Doscher’s in the underlying state court action.

The facts of the underlying tort action alleged that Doscher’s employed Burton Thorne as a grocery store bagger, and that Thorne was shot by a fellow employee in the break-room during one of Thorne’s work shifts.  The underlying complaint alleges that the employer failed to take adequate steps to make the workplace safe and to protect the defendant-employee, Burton Thorne, after learning of threats by the co-worker. Thorne and others testified that he was shot because of the shooter’s jealousy over Thorne’s friendship with a fellow female employee, not because of a work-related dispute, and that the shooting coincidentally happened to take place on the premises of Doscher’s.

The CGL policy at issue excluded coverage for bodily injury to an “‘employee’ of the insured arising out of and in the course of … employment by the insured.” The only dispute here was whether Thorne’s injuries arose out of his employment.  In considering the cross motions for summary judgment, the judge noted that South Carolina courts have interpreted the term “arising out of” when used in an insurance policy exclusion, to be narrowly construed to mean “caused by.”

Viewing the evidence in the light most favorable to the insurer, Judge David Norton could not find that the alleged assault was “caused by” and “arose out of” the employment of Thorne. Rather, the evidence showed that the incident was caused by a personal dispute. Therefore, the employer’s liability exclusion does not apply, and therefore Penn National was not relieved of its duty to defend and indemnify the employer.

Only time will tell how this case will affect other CGL policies as this is a fact-specific inquiry.  To defend or not to defend in this matter? It appears we have an answer, unless the Fourth Circuit says otherwise.

Bennett Crites is a shareholder in the Collins & Lacy Charleston Office practicing in products liability, premises liability, automobile negligence, defamation, insurance bad faith and commercial trucking law. Bennett has experience in litigating cases from minor injury to wrongful death and catastrophic injury. Super Lawyers® has identified Bennett as a Rising Star®. Prior to joining Collins & Lacy, Bennett was an attorney with a law firm in Charleston, South Carolina. He also served as a judicial law clerk to the Honorable R. Markley Dennis, Jr. and has corporate experience in the financial sector. Bennett earned his law degree from the University of South Carolina School of Law and his undergraduate degree in Business Administration from the Citadel.

The "Not Covered" of Property Insurance

Here are the events usually not covered by property insurance:



-Flood

-Earthquake

-Intentional Damage By You

-Animals and Insects



Your agent can help you with the first two.



Don't do the third.



Frequent inspections for the last.

Earthquake Excluded & Other Stuff Is Too

Almost all property insurance policies exclude earthquake. Coverage is available almost everywhere in the US - either through standard or specialty insurers.



What is not commonly discussed is that the earthquake exclusion is broader than just earthquakes.



The following are excluded in the same breath:



landslide,

mudflow,

sinkhole,

mine subsidence

land shock waves before, during or after a volcanic eruption,

and any other earth movement including shifting, rising, or sinking.



These exclusions are in commercial policies and in personal insurance policies.



Class dismissed.

Bedbugs and Property Insurance

For some reason bedbugs are in the news now.  Apparently there is an epidemic of infestations.  (Perhaps there is just an epidemic of reporting of infestations - who am I to say?)



If your place is plagued by pests, how does insurance respond?



Short answer?  It doesn't.



The standard home insurance policy excludes loss caused by insects.  That means that the damage caused by insects is not covered and the cost of extermination is not covered.



The standard commercial property form includes a similar exclusion.  Damage repair?  Not covered.  Extermination? Not covered.  Loss of income because of insects?  Not covered.



I understand a few insurers are considering providing coverage to restaurants and hotels.  I have yet to see a policy, though.

Why Do Insurance Policies Include Exclusions?

Exclusions are a common bone of contention with insurance buyers. Reading some policies makes it seem like nothing is covered.



Actually, I like exclusions. They tell me what I need to worry about.



There are three reasons why something is excluded by an insurance policy:



1) The issue is insured by a separate insurance policy. Auto accidents are excluded by your home insurance policy because they are insured by your home insurance.



2) The exposure can be covered by this policy but the insurer wants to get a separate premium for the issue. Property insurance policies exclude damage by the failure of a sewer or drain. You can remove that exclusion if you are willing to pay an additional premium.



3) Exposures are not insurable due to matters of public policy, insurer reluctance, or reinsurance restrictions. Flood is excluded by most property insurance policies. Some insurers will add the coverage back for an additional premium. Most are unwilling to provide flood coverage to properties in a flood zone due to the heightened risk of loss inherent to the property. That's why most flood insurance is offered through a US government program - only the government is willing to insure an exposure of the nature of flood.



Class dismissed.

Inherent Vice

Inherent vice is an object's tendency to deteriorate.



Ray Burnham, in his most excellent, Burnham's Insurance Dictionary, uses examples of meat putrefying, iron rusting, and people aging.



Property insurance almost always excludes inherent vice, though most policy forms do not use the term.



The ISO property form excludes inherent vice with the following words:



"Rust or other corrosion, decay, deterioration,

hidden or latent defect or any

quality in property that causes it to damage

or destroy itself;"



Class dismissed.

Livery and Your Personal Auto Policy



Livery is carrying goods or people for a fee.





There are insurance coverage issues to consider when a business uses a personal vehicle owned by an employee.  Most personal auto policies exclude coverage when the vehicle is used for livery.  The purpose of the exclusion is to remove coverage for a vehicle held out to the public as being for hire - a taxi service or delivery service.





Policies usually specifically allow share-the-ride arrangements and car-pooling.





The question often comes up when a personal auto policy covers a vehicle used for pizza delivery and the like.  In many cases there has been coverage allowed as the vehicle is not for the use of the general public.





The healthcare field also presents issues when a nursing home employee is asked to transport a resident to a store or appointment.  Again, the livery exclusion may not apply (even if a fee is being paid to the employee to cover expenses) as the vehicle is not put out there for the general public.





The safest way for an insurance buyer to handle the situation is to call their agent - preferably before a claim - to find out if there is coverage should an injury occur.





An auto policy may provide coverage.  However, there may be an issue of premium and underwriting.  





Many insurance companies will shy away from the exposure of a pizza delivery vehicle or an insured who regularly trasports elderly people to doctor's appointments.  The insurer may want to charge commercial rates.





Read your policy.  Talk with your agent.  Get good advice.



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℠

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℠

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.

Exclusions

Twice in two weeks I have reviewed professional liability insurance policies with an exclusion for:

"any claim arising out of or connected with... an entity... in which any insured is a director, officer, partner or principal stockholder."

So, a consultant who volunteers as a board member for a nonprofit who at the same time acts as an advisor to the entity, is not covered.

Main Point: Read your insurance policies (or have someone else read them) focusing on the exclusions. Consider how each impacts the operation of your business.
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