Personal Injury Insurance Definition - Personal Injury

Personal Injury Insurance Definition

PERSONAL INJURY

This is a good time to discuss the personal injury coverage that is included in some homeowners policies, or that is an optional coverage to be added by an endorsement to others (such at the ISO HO 3 policy). As noted, while there are some variations from insurer to insurer, personal injury liability coverage extends to five basic categories of acts or conduct. These include: 

1. false arrest, detention, or imprisonment:
2. libel, slander, defamation, or product disparagement;
3. malicious prosecution (which may include abuse of process);
4. wrongful eviction, wrongful entry, or violation of right of private occupancy; and,
5. invasion of or violation of right of privacy.

None of these categories of conduct can be an accident. As a result, most homeowners liability coverages refer to the covered events as offenses, rather than attempting to subject them to the policy's occurrence/accident requirement.

There is a temporal difference between the accident-base bodily injury and property damage coverage and the offense-based personal injury coverage. Coverage applies to bodily injury and property damage that occurs during the policy period, regardless of when the occurrence that causes the bodily injury or property damage takes place.
 
In contrast, the offense-based personal injury coverage applies to that the injured commits during the policy period. As noted, the injury offenses involve intentional conduct. There are, however, limitations on the scope of coverage for these categories of intentional acts. (These are discussed in the context of exclusions that apply to the personal injury coverages.) Personal Injury Insurance Definition

Personal Injury Additional Coverages

There is a single additional coverage under the ISO personal injury endorsement - for loss assessments up to $1,000 each assessment for the insured's share of loss assessments made as the result of covered personal injury. This provision is substantially similar to the bodily injury'and property and additional damage for loss assessments. 

BODILY INJURY

Bodily injury means bodily harm, sickness, or disease, including required care, loss of services, and death that results. There really are not any hidden concepts here. Everyone can readily appreciate that if someone is hurt as the result of an accident for which you may be held liable, that person's damages include many things, such as: 

• his or her medical and hospital bills;
• past and future wage loss or earning capacity;
• costs of ongoing care; and,
• damages for his or her inability to enjoy the activities enjoyed prior to the injury.

What can be an issue is whether mental or emotional distress constitutes bodily injury in the absence of physical injury. A growing trend in the law is the view that emotional distress that is the product of noncovered conduct does not constitute bodily injury within the meaning of standard liability policy definitions of bodily injury. 

For example, emotional distress that is the product of economic loss, such as the loss in value of an investment or savings, does not constitute bodily injury under this view.

PROPERTY DAMAGE

The standard ISO HO 3 homeowners policy contains the following definition of property damage.

Property damage means physical injury to, destruction of or loss of use of tangible property.
 
The concept of physical injury to tangible property is central to an understanding of the property damage coverage of liability policies. This physical injury to tangible property requirement has the effect of excluding coverage for damages claims based on injury to nontangible property interests. Even the loss of use portion of the property damage definition is tied to tangible property. Personal Injury Insurance Definition

Tangible property means property having physical substance, apparent to the senses. Examples of intangible property are things such as easements, leasehold interests, licenses, patents, copyrights, lost profits, loss of goodwill, loss of the expected benefit of a bargain, and loss of value of an investment.
 
Diminution in value of an investment constitutes economic loss, not property damage. However, diminution in value of tangible property as the result of physical injury can be used as a measure of damages resulting from physical injury to tangible property.
 
EXAMPLE:

Let's say an adjoining landowner has an easement across your property for access to the street or highway. You build a fence across your property, including across the easement, that prevents access. The adjoining landowner sues you. His lawsuit would not constitute a covered property damage claim. Your interference with his easement is interference with intangible property rights. The physical injury element is also missing.

Another example of a noncovered economic loss claim would be a suit against you arising out of your sale to another person of a car or motorcycle that breaks down and requires expensive repairs shortly after the sale. There is no property damage here. Rather, the essence of the claim is an economic loss - loss of the buyer's expected benefit of the bargain. The buyer paid a certain amount for the car or motorcycle on the expectation that it was in good working order, when, had its true condition been known, the fair purchase price would have been much less.
 
Similar comments would apply to a suit against you by a buyer of a house for alleged nondisclosure or concealment of defects in or damage to the house, such as nonpermitted alterations or remodeling.
 
What about loss of use property damage claims? An example of a covered loss of use claim is as follows. Your residence is situated upslope from one of your neighbors. The hillside, on your property, becomes unstable, causing the local authorities to order your neighbor and his family out of their home until the hillside can be stabilized. 

Your neighbor has lost use of tangible property, his house and premises, during the period required to stabilize the hillside. He would have a loss of use property damage claim against you. Some homeowners policies' property damage definitions only extend loss of use coverage to tangible property that has been physically injured. 

Thus, assuming the same facts as the preceeding example, under a policy whose property damage definition only extends to loss of use of tangible property that has been physically injured, your neighbor's suit against you would not constitute a covered property damage lawsuit.

Insurance is always a tricky thing to understand. To learn more, you can check out Personal Injury Insurance Definition. It provides tons of useful information there!

Insurance Liability Waiver - Liability Coverages

Insurance Liability Waiver

Liability Coverages 

The overall intent of the liability coverages of homeowners policies is to insure for liability to third parties arising out of the ownership, use, and occupancy of insured premises. The liability coverages of homeowners policies are not general liability coverages. Other liability exposures generally need to be insured separately. This can include the liability arising from business pursuits or from ownership and use of automobiles, watercraft, aircraft, and other vehicles (motorcycles, all terrain vehicles, snowmobiles, etc,).
 
The physical organization of the liability coverages of homeowners policies is essentially the same as that of the property coverages. The policy's declarations will specify the liability policy limits. If the policy's definition appear at the beginning, rather than at the end of the policy, they follow the declarations and contain the definitions of terms pertinent to the liability coverages.

The liability insuring agreement (or coverage grant) generally appears in the policy as the next section following the conditions applicable to the property coverages. The liability exclusions follow next, followed in turn by the liability additional coverages. The liability conditions appear next, The basic homeowners policy concludes with the conditions that apply to both the property and the liability coverages. Endorsements that modify the property and liability coverages are attached at the end of the policy after the basic policy form ends.

INSURED CAPACITY ISSUES 
 
As with the discussion of the property portion of the policies, the liability provisions will be examined based on the ISO HO 3 policy, and who is an insured and who is not marks the first step of analysis. Generally, resident relatives are insureds, as are resident nonrelatives under the age of 21 in the care of a named insured or a resident relative of the named insured. Insurance Liability Waiver

Unlike the case with property coverages of homeowners policies, there typically are no additional insured interests with respect to the liability coverages of homeowners policies. Correctly designating the named insureds under the liability coverages of homeowners policies where property that is the subject of the policy is owned by a trust is important. 

It is becoming increasingly common for persons to create trusts for estate planning and other purposes and to transfer titles to various kinds of property, including their personal residence, to the trust. If you have done this, you need to consult with your agent in order to assure that all persons are properly designated in the policy as insureds for purposes of the liability coverages. In most cases, all the following need to be designated as named insured:

• the trust itself;
• the trustees of the trust, designated by name and described as the trustees of the trust; and,
• (assuming the same individuals are the de facto owners and occupants of the premises) these individuals in their individual capacities.

INSURED LOCATIONS
 
The concept of insured location for purposes of the liability coverages of homeowners policies begins with the same definition as applicable to the property coverages. Insured location includes the residence premises as that term is separately defined and then extends to various other locations. 

The policy then limits that rather broad scope of insured location for purposes of the liability coverages by means of an exclusion that precludes coverage for liability arising out of premises:

• owned by an insured;
• rented to an insured; or,
• rented to others by an insured that is not an insured location.

Functionally, liability coverages are less location-specific than they are activity-specific. Thus, the geographic scope of coverage is controlled more by the nature of the liability-producing conduct than where the conduct takes place. 

INSURING AGREEMENT
 
The liability coverage-insuring agreement of the homeowners policy establishes two basic duties on the insurer's part to the insured: the duty to defend and the duty to indemnify. Insurance Liability Waiver

In contrast to the property coverages of the homeowners policy, the insuring agreement coverage grant of homeowners policies is relatively simple and can be summarized as follows. The insurer will pay damages that an insured becomes legally obligated (or liable) to pay because of bodily injury or property damage caused by an occurrence. The insurer will also defend the insured in suits seeking such damages by counsel chosen and paid for by the insurer.

The bodily injury or property damage must occur during the policy period. The insurer generally has the right to settle any claims or suit against the insured at its discretion. The insurer's duty to defend terminates upon payment of the full liability policy limits.
 
Thus, the meanings of bodily injury, property damage, and occurrence are crucial to an understanding of how liability coverages work. Occurrence is the most central concept applicable to liability insurance. The definition of occurrence in the ISO HO 3 homeowners policy states:

Occurrence means an accident, including continuous or repeated exposure to substantially the same general harmful conditions, which result during the policy period in: (a) bodily injury; or, (b) property damage.

The concept of coverage for liability arising from accidents is how the fortuity element essential to insurance is incorporated into liability coverages. An accident is an unintentional, unexpected, chance occurrence or event. The occurrence is the causal event and the bodily injury or property damage is the result or consequence of the occurrence.
 
It is the liability-producing act or conduct that must be an accident, not the resulting bodily injury or property damage. Bodily injury or property damage that is unintended or unexpected by an insured is not covered if it is the product of intentional, nonaccidental conduct. Coverage turns on the insured's intent to commit the act in question, not on his or her state of mind in performing the act. 

Therefore, it does not matter whether the insured expected or intended his or her conduct to cause harm. An accident can result from a deliberate act, but only when some additional, unexpected, independent, and unforeseen event happens that causes the injury or damage in question.

It seems to much to absorb if you read it through. Do read a few times to get the meaning. If you want more details, I suggest you get Insurance Liability Waiver and download it to your iphone or ipad and read it anywhere you want!

How To Claim Insurance For Home - Duties After Loss

How To Claim Insurance For Home

This is an extensive group of conditions comprising eight sections, that further encompass thirteen subparagraphs. All of these are highly important policy provisions standard to all homeowners policies and merit your attention.

The introductory paragraph to this section states that the insurer has no duty to provide coverage for an otherwise covered loss if the insurer is prejudiced by the failure of the named insured, another insured, or a representative of an insured, to comply with the list of duties that follows.

• Give the insurer or the insurer's agent prompt notice of the loss.
• Notify the police in the event of a theft loss.
• Give the issuer of a credit card, electronic fund transfer card, or access device notice of loss or of unauthorized use of same as required by the provisions of the agreement between the issuer and the insured.
• Protect the property from further damage. If repairs to property are required, the insured must:
• make reasonable and necessary repairs to protect the property and
• keep an accurate account of repair expenses.
• Cooperate with your insurer in its investigation of the claim. This means returning phone calls, and responding to correspondence promptly. If you do not understand what a communication or an information request from your insurer means or why it is important, promptly call the claim representative or your agent and ask for an explanation so that you can provide an appropriate response. Any delay on your part that reflects mere silence in response to an insurer's request for information (in appropriate cases) can be taken as evidence of a failure to cooperate.
• Prepare an inventory of damaged personal property which shows:
• the quantity;
• the description;
• the actual cash value; and,
• the amount of loss of all items for which loss is claimed.

You must attach all bills, receipts, and related documents that justify or support the figures shown in the inventory. This can potentially be a gargantuan task in the event of a sizeable loss. Most people can recall reasonably well what items have been damaged, lost, or destroyed so that the quantity and description portions of the inventory are likely to be easier to prepare. How To Claim Insurance For Home

Areas that can be problematic here are where the insured may have extensive collections of books, or audio recordings. Other items, such as furniture that has been passed along through a family with no clear record of the value or acquisition cost, can also be problematic. The valuation issues can be even more difficult - few of us retain the receipts for everything we buy.

The requirement that the insured submit an inventory of the damaged, destroyed, or lost property is one of the reasons that it is frequently suggested that insureds videotape or photograph the interior of their homes with closets and cabinets open from time to time. This will create at least a partial visual record of their belongings and that videotape or set of photographs should be stored in a safe place, such as a safe deposit box.

Allow the insurer to examine the insured property as often as the insurer reasonably requests; provide the insurer with records and documents upon its request and permit the insurer to make copies; submit to an examination under oath, outside the presence of any other insured; and, sign a, transcript of the examination under oath. 

Examinations under oath are often, but not always, requested by insurers in cases in which the insurer perceives the insured to be uncooperative with the investigation of the claim. Examinations can also be requested when there are aspects of the claim that suggest that there may be a fraudulent aspect to the claim. Refusal to submit to an examination under oath can afford the insurer a basis for refusing to pay a claim in its entirety.

The examination is conducted before a court reporter, who takes down all the questions and answers, and transcribes them into a booklet form after the examination has concluded. The person who conducts the examination is usually a lawyer retained by the insurer. 

Under the laws of most states, the insured who is being questioned has the right to be represented by counsel at his or her own expense at the examination. The degree to which the insured's lawyer can object to questions varies from state to state.

Usually, when an insurer demands an examination under oath it also demands a lengthy list of documents for the insured to produce for inspection and copying at the examination. These document inspection requests in conjunction with examinations under oath can be duplicative of previous demands by the insurer, which is the insurer's prerogative.

Due to concerns that some insurers exercise their rights to demand an examination under oath unreasonably, some states have enacted some restrictions, For example, the California Insurance Code now provides that insurers may conduct an examination under oath only to obtain information that is relative to and reasonably necessary to process or investigate the claim. This, however, is a rather nebulous standard. How To Claim Insurance For Home

Examinations under oath may be conducted only on reasonable notice, at a reasonably convenient place, and for a reasonable period of time. The insured has the right to have counsel present, who can assert any objection to a question that would be permissible in a deposition under state or federal law. 

The insurer must provide the insured with a free copy of the transcript of the examination under oath after it is transcribed and must permit the insured to make sworn corrections to the transcript. 

Meet the proof of loss requirements that are preconditions to claim payment by the insurer. The signed and sworn proof of loss must be submitted to the insurer by the insured within sixty days of the insurer's request. It is common for the insurer and the insured to agree to extensions of the sixty-day deadline for submission of the proof of loss. 

You should confirm any such agreement in writing. The proof of loss must set forth, to the best of your knowledge and belief, the following information:

• the time and cause of loss;
• the interest of all insureds, all others on the property involved, and all liens on the property;
• any other insurance that may cover the loss;
• any changes in the title to or occupancy of the property during the term of the policy;
• specifications of damaged buildings and detailed repair estimates;
• the inventory of damaged, destroyed, or lost (in the ease of theft) personal property;
• receipts for any additional living expenses incurred and records that support the fair rental value loss if a claim is being made for same; and,
• evidence or an affidavit that supports a claim under the credit card electronic fund transfer card coverage, stating the amount and cause of loss, if such a loss is being claimed.

Hope you have a good understanding about how to claim your rights. Next post we'll talk about Loss Settlement. If you want to learn more, you can get How To Claim Insurance For Home.

House Insurance Cost Estimator - Additional Insurance Exclusions To Take Note

House Insurance Cost Estimator

ADDITIONAL EXCLUSIONS 

The next group of exclusions in the ISO HO 2 and HO 3 is essentially the flip side of several of the exceptions to certain of the personal property named perils, and/or of certain of the Additional Coverages.
 
Collapse
 
The first of these exclusions is for loss involving collapse, except as is provided in the Additional Coverages peril of collapse. As discussed, the collapse coverage is essentially a named perils coverage, which, under the ISO HO 2 and HO 3 policies, requires an actual collapse of the building or parts of the building for coverage to arise. This collapse exclusion is also modified by an ensuing loss clause that provides that coverage exists for loss ensuing from an otherwise noncovered collapse if that ensuing loss is caused by a covered peril.

Freezing

The second of these exclusions is for freezing of a plumbing, heating, air conditioning, fire sprinkler system, household appliance or for discharge, leakage, or overflow from within the system or appliance caused by freezing. There are exceptions to this exclusion. This exclusion does not apply if the insured has used reasonable care to maintain heat in the building or has shut off and drained the water from the system or appliance. House Insurance Cost Estimator

As with the personal property named peril, plumbing systems and household appliances are defined as not including sump pumps or related equipment, roof drains, gutters, downspouts or similar fixtures or equipment. This is an example of an exclusion that is essentially the flip side of one of the personal property coverage named perils. Thus, the scope of coverage for the peril of freezing is essentially the same for the dwelling and other structures as it is for personal property.
 
Freezing end Thawing 

The next exclusion precludes coverage for freezing, thawing, pressure, or weight of water or ice whether driven by wind or not to four categories of property:

• fences, pavements, patios, or swimming pools; 
• footings, foundations, bulkheads, walls, or any other structure or device that supports all or part of the building or other structure;
• retaining walls or bulkheads that do not support all or part of the building or other structures; and,
• piers, wharves, or docks. (This exclusion also has some parallels to the subsurface waters portion of the water damage exclusion.)

Theft of Construction Materials

The next exclusion in this group is for theft of construction materials and supplies from a dwelling under construction until the dwelling is finished and occupied. This exclusion is parallel to one of the exceptions to the personal property named peril of theft.

Vandalism and Malicious Mischief
 
The next exclusion is for loss caused by vandalism and malicious mischief, but only if the dwelling has been vacant for sixty or more consecutive days before the loss. This exclusion does not apply to dwellings in the course of construction. House Insurance Cost Estimator

Repeated Seepage or Leakage of Water
 
The next exclusion is for loss caused by constant or repeated seepage or leakage of water or steam over a period of weeks, months, or years from within a plumbing, heating, air conditioning, fire sprinkler system, or household appliance. This is a more specific example of the faulty, inadequate, or defective maintenance and neglect exclusions. 

As made clear by the personal property coverage named perils, coverage exists if the personal property caused by accidental discharges of water from such systems, including those caused by freezing. Further, the freezing exclusion applicable to the dwelling and other structure coverages has exceptions that will permit some coverage.
 
The point here is that it is the insured's duty to maintain his or her property and to take reasonable steps to protect it from loss. Failure to correct such leaks over a period of weeks, months, and years renders such water damage nonaccidental, nonfortuitous, and hence, not covered.

Mold, Fungus, or Wet Rot
 
The next exclusion in this group is for loss caused by mold, fungus, or wet rot. As with personal property coverage, if the mold, fungus, or wet rot damage results from an accidental discharge and is not apparent to the insured because it is hidden, coverage will exist. This exclusion therefore is parallel to and consistent with the constant or repeated water leakage exclusion, as mold, fungus, or wet rot resulting from such constant or repeated water leakage is not covered.

Exclusions Subject to an Ensuing Loss Clause 

The next group of exclusions is unified by a lengthy exception that is essentially parallel to the personal property accidental water discharge named perils, These exclusions are subject to an ensuing loss clause. These exclusions are: 

• wear and tear, marring, and deterioration, which are all exampies of expected, nonfortuitous losses;
• mechanical breakdown, latent defect, inherent vice, or any other quality in property that causes it to damage or destroy itself (parallels the faulty, inadequate, or defective materials used in construction exclusion);
• smog, rust, dry rot, or other corrosion (parallels the maintenance exclusion); 
• smoke from agricultural smudging or industrial operations (corresponds with the exception to the personal property named perils coverage for smoke); 
• discharge of pollutants, unless the release of pollutants is caused by one of the personal property coverage named perils (pollutants is specifically and quite broadly defined in the policy); 
• settling, shrinking, bulging, or expansion, including resulting cracking of bulkheads, pavements, patios, footings, foundations, walls, floors, roofs, or ceilings (this exclusion dovetails with the earth movement, subsurface water damage, freezing, and collapse exclusions); 
• birds, vermin, rodents, or insects (which include termites). These exclusions are specific examples of failure to maintain; and, 
• animals owned or kept by an insured. 

I hoped these few posts could enlighten you about the exceptions and exclusions of insurance coverages. So you have to take note when you purchase your plan, and double check with your agent to make sure they are covering the needs you want. To learn more, you can get House Insurance Cost Estimator right away!