Property Basics. 2.1 Property Insurance Terminology LEARNING OBJECTIVES OVERVIEW

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1 2 Property Basics LEARNING OBJECTIVES Upon the completion of this chapter, you will be able to: 1. Define basic property insurance terms 2. Recognize the types of property losses 3. Define the scope of coverage 4. Identify types of loss valuation 5. Recognize the methods of determining appropriate property insurance limits 6. Recall the component parts of a property insurance policy 7. Differentiate between the types of insureds OVERVIEW This chapter discusses the foundation of all property insurance, whether coverage is written in Personal Lines or Commercial Lines. Property insurance is a two-party contract between the insured (first party) and the insurer (second party). Property insurance is referred to as firstparty insurance, as it covers loss to property owned by the insured for loss caused by covered perils. 2.1 Property Insurance Terminology Accident Occurrence Cancellation Pro Rata Cancellation Short Rate Cancellation Flat Cancellation Non-renewal A sudden, unforeseen, unintended, and unplanned event from which loss or damage results. An accident includes continuous or repeated exposure to the same general harmful conditions. The termination of an insurance policy before its expiration date. Once cancelled, a policy provides no coverage. A policy may be cancelled by the insured or insurer. A proportionate cancellation of insurance that refunds premium to the insured based on the precise number of days coverage was in effect. The earned premium is the premium charged and retained by the insurer for the number of days coverage was in place; the unearned premium is the premium refunded to the insured for the number of days coverage was not in place. A cancellation of insurance that incurs a financial penalty. Sometimes when the insured cancels the policy before its expiration date, a short-rate cancellation is issued. The insurer retains a portion of the unearned premium to cover costs. A cancellation of insurance that is retroactive to the effective date of the policy. No coverage is provided and the insurer must refund the policy premium paid by the insured. The termination of a policy at the expiration of its term. The policy does not renew and no coverage is provided after the expiration date. 24 A.D.Banker&Company

2 PROPERTY BASICS Proximate Cause Hostile Fire Friendly Fire Inherent Vice Binder Arbitration Right of Salvage Salvage Value Endorsement Concurrent Causation Concurrency/ Concurrent Policies Non- Concurrency/ Non- Concurrent Policies Deductible Definitions The primary cause of loss. If only one peril caused the loss, the proximate cause is the first event in the unbroken chain of events that resulted in loss. If more than two perils caused or contributed to the loss, the proximate cause is the peril having the most significant impact in generating the loss or damage. A fire that burns outside its intended boundaries, or becomes uncontrollable. Examples of a hostile fire include a wildfire or a fire that damages a home when a spark from a fire in the fireplace ignites a piece of furniture. A fire that was intentionally set and stays within its intended boundaries (e.g., a fireplace) and results in smoke damage to the inside of a fireplace. Property insurance does not cover damage from a friendly fire. A quality within property that causes it to damage or destroy itself. Examples include rust, rot and the fading of paint. Inherent vice is not covered by a property policy. A legal agreement issued by an insurance company or a producer that provides temporary proof of insurance until the insurer is able to issue an insurance policy. Binders are issued for specific time periods (maximum of 60 days) and automatically end when the policy is issued. Binders contain the name of the insurer, the amount and type of insurance, and the perils insured against. Process whereby a disputed claim is decided by a neutral third party. The disputing parties choose the impartial third party and agree in advance to accept the final decision of the arbitrator, who makes a decision after a hearing where both parties offer evidence. The right of the insurer to take possession of damaged property after paying for its loss. The salvage belongs to the insurer. The amount for which property can be sold at the end of its useful life. In property insurance, the salvage value is the scrap value of damaged property. A policy form that alters or adds to the provisions of a property and casualty insurance contract. A principle holding that when two perils simultaneously cause a loss (i.e., they are both considered the proximate cause of loss), the insurer must pay the loss even if one of the perils is excluded by the policy. The existence of two or more policies covering the same exposures, having the same policy periods, and the same coverage triggers. For example, if an auto policy and an umbrella policy are written with the same policy dates, they are considered to be concurrent. The existence of two or more policies covering the same exposures that don t have the same policy periods. Non-concurrency may create a coverage gap when underlying liability policies and an umbrella policy are non-concurrent because if an underlying liability policy exhausts its aggregate, it may violate the umbrella s underlying limits requirement. The specified amount of each loss that the insured must bear. In property insurance (and with a per claim, or per occurrence, deductible), the insurer subtracts the deductible from the amount of loss when making payment. By accepting a larger deductible, the insured s premium may be reduced. An insurer may require a larger deductible as an underwriting tool to limit small claims. Words, terms, and phrases that are clearly described and used in an insurance policy for the purpose of clarifying the intent of the insurer and to avoid coverage disputes with respect to the extent of coverage provided by the policy. Most policies contain a definitions section in the policy and emphasize policy definitions by enclosing them within quotes or highlighting them with bold text. A.D.Banker&Company 25

3 CHAPTER TWO Bailee Bailor Primary Insurance Excess Insurance Unoccupancy Vacancy Burglary Robbery Theft Mysterious Disappearance A person or any organization to which property has been entrusted, usually for repairs, servicing or storage. Because bailees are legally responsible for property in their care, property insurance policies specifically exclude coverage for property in the care of a bailee. A person or organization that entrusts property to a bailee. Any type of coverage that responds to a loss before all other coverage responds. Any form of insurance coverage that provides protection against certain perils or causes of loss ONLY after loss or damage exceeds a stated amount or the limits stated in specific policies or self-insurance. Excess insurance may be written over primary, excess, or umbrella insurance. A property that contains personal property but has no occupants. A provision in a property policy that eliminates or limits coverage for buildings that don t contain sufficient personal property to support intended occupancy or use. The taking of property from inside the premises or a locked safe or vault by a person who commits forcible entry into, or exit from, the property of another while trespassing. The taking of property from the care and custody of a person who has been caused or threatened with bodily harm. The broadest of the crime coverages, theft includes any act of stealing. The loss of property when the cause of loss is not known. This is NOT theft, burglary, or robbery. Retention Question 1 Which of the following is attached to the policy to alter or add to the policy provisions? a. Binder b. Endorsement c. Definitions d. Excess insurance Retention Question 2 A person who takes possession of another person s property in order to repair it is called? a. Assignee b. Bailor c. Subrogee d. Bailee Retention Question 3 If the insured does not agree with the insurer s decision regarding a claim, what process helps decide the outcome? a. Insurance company conference b. Arbitration c. Inspection d. Consequential hearing 26 A.D.Banker&Company

4 PROPERTY BASICS 2.2 Types of Property Losses 1. Direct Loss A loss that causes direct damage to property without an intervening cause. 2. Indirect Loss or Consequential Loss A loss that is not the direct result of a peril. Scope of Coverage There are two types of perils that may be covered by property insurance policies. 1. Named Perils This type of property coverage only provides insurance for the causes of loss, or perils, listed. If a peril is not named in the policy, no coverage applies for loss or damage caused by that peril. Typical named perils are fire and theft. Named perils may contain coverage for up to 16 named perils; coverage for additional perils may be added by endorsement. 2. Open Perils This type of property coverage provides insurance for all causes of loss that are not specifically excluded under the policy. Typical exclusions in an open perils policy are flood and earthquake. Loss Valuation A property policy pays for losses to property based on the valuation method contained in the policy or chosen by the insured in an endorsement added to the policy. 1. Replacement Value The cost to replace property with property of like kind and quality, at current pricing, without a deduction for depreciation. Many property policies providing loss valuation at replacement value require covered property to be insured to a certain percentage of its replacement value, such as 80% or 90%. 2. Actual Cash Value (ACV) The cost to repair or replace property at its replacement value, minus depreciation. 3. Agreed Value The insurance company and insured agree to a specific value of a particular property before the policy is issued. If a total loss occurs, the insurer will pay the Agreed Value. 4. Stated Value A valuation method that states the value of a particular property on the declarations page, but provides for the insurer to pay the lesser of the stated value or ACV of the property following a loss. 5. Valued Policy A policy that states the value of property as the amount shown on the Declarations page and will pay that full face value in the event of a total loss, regardless of the actual cash value. 6. Functional Replacement Value The cost to replace property with other property that performs the same function with similar efficiency, although the replacement property is not identical to the property being replaced. This valuation method is typically used with older property (such as a Victorian home) for which the replacement value exceeds the insured s ability or willingness to purchase coverage. 7. Market Value The price a willing buyer would pay for property purchased from a willing seller. Example Goods and commodities whose value fluctuates with market conditions; namely agricultural products. A.D.Banker&Company 27

5 CHAPTER TWO Classifications of Construction 1. Frame A building that has a roof, floor, and supports of combustible material, usually wood, and combustible interior walls. 2. Joisted Masonry Buildings with exterior walls of masonry or fire-resistive construction rated for not less than one hour and with combustible floors and roofs. 3. Noncombustible The buildings and its walls, floors, and structural framework are constructed of noncombustible materials. 4. Masonry Noncombustible Buildings with exterior walls of masonry (not less than 4 inches thick) or made of fire-resistive construction with a rating of not less than one hour and noncombustible floors and roofs. 5. Fire Resistive The entire building and roof are constructed of reinforced concrete and steel. Must have at least a 2-hour fire resistive rating. 6. Modified Fire Resistive The materials used in the walls, floors, and roof of a structure must have a fire resistive rating of at least 1 hour, but less than 2 hours. Retention Question 4 Each of the following is a direct loss, except: a. Loss of income b. Fire damage c. Cracked windshield d. Broken pipe water damage Retention Question 5 is the method of loss valuation that values damaged property at the cost to replace with property of like kind and quality, at current prices, and without deduction for depreciation. a. Functional replacement cost b. Actual Cash Value c. Replacement Value d. Market Value Retention Question 6 What calculation is used to determine the actual cash value (ACV) of a loss? a. Market value depreciation = ACV b. Replacement cost depreciation = ACV c. Market value original purchase price = ACV d. Replacement cost market value = A 2.3 Methods of Writing Property Insurance Limits 1. Specific Limit Insures a single item of property for a single limit of insurance. For example, a fire policy insures one dwelling for $100, Scheduled Limit Insures one or more items of property on a single policy and the amount of insurance applying to each item is shown on a schedule. For example, one farm policy insures a home for $100,000 and a barn for $200, A.D.Banker&Company

6 PROPERTY BASICS 3. Blanket Limit Insures property located at more than one location OR more than one type of property at the same location OR both. For example, the $1 million blanket limit applies to two separate buildings at two separate locations, as well as the business personal property contained in each building. Standardized Policy Structure The parts of a policy include: D I C E Declarations Insuring Agreement Conditions Exclusions In addition to the four parts of a policy, additional coverages and endorsements will be explained. Retention Question 7 Which of the following BEST describes a scheduled limit of insurance on a property policy? a. Insures multiple items of property on multiple policies b. Insures multiple items of property on a single policy c. Insures a single item of property on a single policy for a specific limit d. Insures a single item of property at a blanket limit 2.4 Policy Structure Declarations The Declarations Page describes basic information about the policy including: 1. Who Names the insurer and insured, including legal representatives in the event of the insured s death. 2. What A description of the property being insured and other parties having insurable interests, such as a mortgagee. 3. Where The location of insured property and the named insured s mailing address. 4. When The effective and expiration dates of the policy. 5. How Much The limits of liability insuring covered property and the annual premium for each type of coverage. Insuring Agreement The insuring agreement states the insurance company s promise to pay the insured. This promise is usually broad and the other sections of the policy restrict or limit the scope of coverage provided by the policy. Property insurance policies state in the insuring agreement what perils are covered. A.D.Banker&Company 29

7 CHAPTER TWO Conditions The conditions section states the obligations of the parties to the contract, as well as any other conditions of coverage. The insureds duties and obligations are spelled out in this section. 1. Policy Period Specifies that coverage only applies to losses occurring when the policy is in force. 2. Concealment or Fraud Specifies that coverage may not apply if an insured makes a material concealment, misrepresentation, or fraud in the application pertaining to the claim. 3. Liberalization Clause Specifies that if the insurer broadens coverage with no increase in premium, that broadening of coverage will apply to existing policies without the need for an endorsement. 4. Cancellation Specifies the terms under which the policy can be cancelled by the insurer and the named insured. 5. Nonrenewal Addresses the requirements of the insurer if it elects not to renew a policy. 6. Assignment Specifies that the insured may not transfer rights of ownership without the insurer s prior written consent. 7. Subrogation States the insured must transfer to the insurance company its right of recovery against any party causing a loss after it accepts payment from the insurer for a loss. Subrogation allows the insurer to recover from the party that caused a loss any amounts paid to an insured. It also: a. Prevents the insured from collecting twice for the same loss. b. Helps the insurer control expenses and premiums. c. Ultimately holds the responsible third party accountable for the loss. 8. Changes Any changes to the policy must be made in writing by the insurer. 9. Insurable Interest and Limit of Liability The insurer will not be responsible for payment of loss in an amount greater than the financial interest of an insured. 10. Restoration/Non-reduction of Limits Specifies the sum and circumstances under which an insurer charges the insured, usually a business firm, to restore a policy to its initial face value or not reduce limits of coverage after the insurer has paid a claim either to the insured business or a third party on behalf of the business. 11. Duties in the Event of Loss Specifies the obligations of the insured in the event of a loss. With respect to any loss, these obligations include: a. Giving prompt written notice to the insurer, including a complete description of how, when, and where the loss or damage occurred. b. Notifying the police if a theft occurred. c. Cooperating with the insurer in the investigation and settlement of the loss. d. Protecting property from further damage. e. Preparing an inventory of the damaged property. f. Allowing the insurer to inspect any damaged property and examine books and records. g. Submitting proof of loss to the insurer, including: 1) The time and cause of loss. 2) Any other insurance that may cover the loss. 3) Any appropriate receipts, evidence, or affidavits to support the loss. 12. Loss Settlement Specifies which loss valuation method will apply to the property insured under the policy. 30 A.D.Banker&Company

8 PROPERTY BASICS 13. Appraisal Addresses disputes about the amount of a loss. If the insurance company and insured cannot agree on the amount of a loss, either party may request an appraisal. Each party selects its own appraiser and the appraisers select an umpire. Agreement by any two parties settles the loss. Each party pays the cost of its own appraiser and shares the costs of the umpire and the appraisal. Appraisal is a dispute resolution method and is not used to determine whether the policy provides coverage for a loss. 14. Other Insurance Specifies the process to be followed when more than one policy covers the same loss. Each policy pays no more than its share of the loss. 15. Legal Action Against Us Specifies that no one may bring suit against the insurer until all terms and conditions of the policy have been complied with. 16. Loss Payment Specifies how the insurer will make payment for loss and any applicable time frames that must be honored when submitting proof of loss and other claim documents. 17. Abandonment of Property Specifies that the insurer is not obligated to accept any property abandoned by an insured. 18. Mortgage Clause Specifies how the policy protects the mortgagee s financial interest. (A mortgagee has insurable interest in real property.) Payment is made to mortgagees only up to its insurable interest in covered property and in order of precedence. The mortgagee must comply with requirements if the insured s claim is denied and the mortgagee wishes to collect under the policy: a. It must pay any premium due under the policy on demand if the insured fails to do so. b. It must notify the insurer of any change in ownership, occupancy, or substantial change in risk of which the mortgagee is aware. c. It must submit a proof of loss to the insurer if the insured fails to do so. Under cancellation requirements, the insurer must provide the mortgage holder (mortgagee) with advance written notice (typically 10 days) before cancelling or nonrenewing coverage, giving the mortgagee the opportunity to pay the premiums. 19. No Benefit to Bailee Specifies that no coverage applies if loss payment benefits a bailee. 20. Recovered Property Specifies the procedure to be followed when lost or stolen property is recovered after the insurer has made payment under the policy. Each party shall notify the other of any recovery and, under most property policies, the insured has the right of keeping the claim payment or returning the claim payment and retaining right to the property after adjustments have been made for any damage. 21. Bankruptcy Specifies that bankruptcy or insolvency of the insured does not relieve the insurer of any of its duties or obligations under the policy. 22. Death Specifies that in the event of the named insured s death, the insurer will extend coverage to the legal representative of the deceased with respect to the premises and property covered under the policy at the time of the named insured s death. 23. Loss Payable Clause Specifies how the policy protects the interests of a loss payee. A loss payee has insurable interest in personal property. Exclusions Perils that are NOT covered by the policy are listed in the exclusions section. Other perils may be excluded in provisions stated elsewhere in the policy. Common property exclusions include: 1. Ordinance or Law 2. Earth movement 3. War A.D.Banker&Company 31

9 CHAPTER TWO 4. Water Perils that are NOT covered by the policy are listed in the exclusions section. Other perils may be excluded in provisions stated elsewhere in the policy (i.e., water damage, flood, sewer backup, etc.). 5. Utility failure that originates off-premises 6. Neglect of the insured to protect covered property from further loss 7. Intentional loss 8. Nuclear hazard, war, and military action 9. Governmental action 10. Fungus, wet rot, dry rot, and bacteria (e.g., mold) Additional Coverages Additional coverages are automatically included in property policies without an additional premium. The type of additional coverages depends upon the type of policy. Additional coverages are paid in addition to those stated in the insuring agreement and include debris removal, collapse, and fire department service charges. Retention Question 8 The duties and obligations of the insured are found under what part of the insurance policy? a. Declarations b. Insuring Agreement c. Additional Coverages d. Conditions Retention Question 9 A Liberalization Clause serves which of the following purposes? a. At each annual renewal, the policy limit automatically increases in value b. The insurer has the right to recover from any party causing a loss c. The insured is given permission to bring suit against the insurer d. Broadened coverage applies automatically to all policies without a premium charge Retention Question 10 Each of the following is a typical property insurance policy exclusion, except: a. Ordinance or Law b. Flood c. Fire d. Neglect 32 A.D.Banker&Company

10 PROPERTY BASICS 2.5 Common Policy Provisions Types of Insureds 1. Named Insured The person or organization designated on the Declarations page of the policy. If property is being insured, the named insured should be the owner of the property. If vehicles are being insured, the named insured should be the party or entity to which the vehicle is titled and registered. The named insured receives the broadest coverage of all persons or organizations protected by a policy. 2. Insured A person or organization protected by an insurance contract. 3. First Named Insured The First Named Insured is the person or organization whose name appears first on the Declarations. The First Named Insured is granted rights and responsibilities by the policy that are not granted to other insureds. In commercial lines, many policies spell out those duties and responsibilities. 4. Additional Insured A person or organization not ordinarily protected by a policy but which, through the addition of an endorsement to the policy, is granted status as an insured. Under a property policy, an additional insured is often a co-owner of real property. Under a liability policy, an additional insured is often a party to an indemnification or hold harmless agreement. Coinsurance A provision contained in most policies insuring commercial property, and is used to encourage the insured to purchase and maintain insurance to value, and to establish the basis of payment in the event the insured fails to maintain a specified percentage of that value. The higher the coinsurance percentage the insured agrees to purchase, the lower the rate that the insured pays for the insurance. Coinsurance applies only in the event of a partial loss, as total losses typically are paid in accordance with the Valued Policy Law. Retention Question 11 Which of the following has the broadest coverage under the insurance policy? a. Named Insured b. Insured c. First Named Insured d. Additional Insured Retention Question 12 Which of the following is not true of coinsurance? a. It is a common policy provision b. It encourages the insured to maintain insurance to value c. It applies in the event of a total loss d. The higher the coinsurance percentage purchased, the lower the rate the insured pays A.D.Banker&Company 33

11 CHAPTER TWO Chapter Two Lightning Facts 1. An occurrence is an accident and includes continuous or repeated exposure to the same general harmful conditions If an insurer cancels an insurance policy before its expiration date, the refund is made on a pro rata basis The primary cause of a loss is referred to as the proximate cause A friendly fire stays within its intended boundaries and a hostile fire burns outside its intended boundaries An endorsement is a policy form that alters or adds to the provisions of a property and casualty insurance contract The deductible is the specified amount of each loss that the insured must bear. A larger deductible reduces the premium and the submission of small claims A direct loss causes damage without an intervening cause, and an indirect loss occurs as the consequence of a direct loss A named perils policy specifically lists the covered perils (causes of loss) and an open perils policy covers all perils except those specifically excluded The replacement value of property is the cost to replace it with property of like kind and quality, at current pricing, without a deduction for depreciation Actual cash value is the replacement value of property minus depreciation A valued policy requires the insurance company pay the total scheduled limit of insurance for a total loss A policy insuring property for a specific limit insures a single item on a single policy for a single limit of insurance A policy insuring property for a scheduled limit insures one or more items on a single policy and each item is insured at a scheduled limit of insurance A policy insuring property for a blanket limit insures multiple items of property on a single policy with one limit of insurance applying to all insured property The declarations page describes basic information about the policy; i.e., the who, what, where, when, and how much The Insuring Agreement is the insurer s promise to pay the insured The conditions section states the obligations of the insurer and the insured, as well as any other conditions of coverage The subrogation provision states the insured s obligation to transfer to the insurance company its right of recovery against any party causing a loss after it accepts payment from the insurer for a loss Perils that are NOT covered by the policy are listed in the exclusions section Additional coverages are automatically included in property policies without an additional premium and include items such as debris removal, collapse, and fire department service charges Coinsurance is a common property policy provision that requires the insured maintain a certain limit of insurance coverage in order to avoid a penalty in the event of a partial loss A.D.Banker&Company