Lesson 4 - CGL Other Provisionsmagma.magma.scic.com/Elearning/1IC/2013/1IC_Lesson_4.pdfLesson 4 Topic A CGL Supplementary Payments p2 (1IC) 7 Types of Supplementary Payments . Learning

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Lesson 4 - CGL Other Provisions

Lesson 4 CGL Other Provisions Intro p1 (1IC)

This lesson on the CGL Policy provides an overview of additional provisions that apply to the Policy. The provisions are important because they:

• give additional coverage, • or they restrict coverage, • or they set forth the rules governing the insured and the insurer.

You will find similar provisions in most liability policies regardless of what type of liability coverage is involved.


Lesson 4: Topics of Discussion

Our discussion of these provisions are centered around the following three topics:

1. Supplementary Payments-Coverages A and B 2. Limits of Insurance 3. Conditions


Lesson 4

After completing this lesson, you will be able to:

1. Give examples of Supplementary Payments included in the CGL Coverage Form. 2. Identify the different limits of insurance of the CGL Coverage Form. 3. Determine the amount of limits available under a CGL Coverage Form for specific loss examples. 4. Briefly describe the provisions found in the CGL Coverage Form Conditions studied in this

course.

Forms Used In This Lesson: None

Commercial Casualty I – CGL & AI Course Print 11.22.2013

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Lesson 4 Topic A - Supplementary Payments

Lesson 4 Topic A CGL Supplementary Payments p1 (1IC)

Learning Objective: Give examples of Supplementary Payments included in the CGL Coverage Form.

Refer to the bottom of page 8 of the CGL Coverage Form.

The CGL Coverage Form includes coverage for Supplementary Payments in addition to coverage for damages assessed in a claim. Supplementary payments are related to the insurance company's expenses for handling claims and for defending suits as well as some expenses that may be incurred by the insured. The Policy provides this coverage as additional limits of insurance that is over and above the limits shown on the Declaration Page and outlined Topic B-Limits of Insurance.

SUPPLEMENTARY PAYMENTS – COVERAGES A AND B 1. We will pay, with respect to any claim we investigate or settle, or any "suit" against an insured we

defend: a. All expenses we incur. b. Up to $250 for cost of bail bonds required because of accidents or traffic law violations arising out of

the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds.

c. The cost of bonds to release attachments, but only for bond amounts within the applicable limit of insurance. We do not have to furnish these bonds.

d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $250 a day because of time off from work.

e. All court costs taxed against the insured in the "suit". However, these payments do not include attorneys' fees or attorneys' expenses taxed against the insured.

f. Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer.

g. All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of the judgment that is within the applicable limit of insurance.

These payments will not reduce the limits of insurance. 2. If we defend an insured against a "suit" and an indemnitee of the insured is also named as a party to the

"suit", we will defend that indemnitee if all of the following conditions are met: a. The "suit" against the indemnitee seeks damages for which the insured has assumed the liability of

the indemnitee in a contract or agreement that is an "insured contract"; b. This insurance applies to such liability assumed by the insured; c. The obligation to defend, or the cost of the defense of, that indemnitee, has also been assumed by

the insured in the same "insured contract"; d. The allegations in the "suit" and the information we know about the "occurrence" are such that no

conflict appears to exist between the interests of the insured and the interests of the indemnitee;


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e. The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit" and agree that we can assign the same counsel to defend the insured and the indemnitee; and

f. The indemnitee: (1) Agrees in writing to: (a) Cooperate with us in the investigation, settlement or defense of the "suit"; (b) Immediately send us copies of any demands, notices, summonses or legal papers received in

connection with the "suit"; (c) Notify any other insurer whose coverage is available to the indemnitee; and (d) Cooperate with us with respect to coordinating other applicable insurance available to the

indemnitee; and (2) Provides us with written authorization to: (a) Obtain records and other information related to the "suit"; and (b) Conduct and control the defense of the indemnitee in such "suit".

So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 2.b.(2) of Section I – Coverage A – Bodily Injury And Property Damage Liability, such payments will not be deemed to be damages for "bodily injury" and "property damage" and will not reduce the limits of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litigation expenses as Supplementary Payments ends when we have used up the applicable limit of insurance in the payment of judgments or settlements or the conditions set forth above, or the terms of the agreement described in Paragraph f. above, are no longer met.

Lesson 4 Topic A CGL Supplementary Payments p2 (1IC)

7 Types of Supplementary Payments

Learning Objective: Give examples of Supplementary Payments included in the CGL Coverage Form.

Refer to the bottom of page 8 of the CGL Coverage Form.

1. All expenses the insurance company incurs, such as investigation costs, legal costs, and court costs.

2. The costs of bail bonds up to $250 if the bonds are required because of accidents or traffic law violations arising out of the use of covered vehicles.

3. The cost of bonds to release any attachments placed against the insured.

4. All reasonable expenses that the insured incurs at the insurance company's request when they assist in the investigation or defense. There is a sublimit of $250 per day for actual loss of earnings (including salary, commissions, and fees) if the insured misses work.

5. All court costs assessed against the insured because of a covered loss. This does not include


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attorneys' fees or attorneys' expenses taxed against the insured.

6. Any prejudgment interest the court awards against the insured because of a judgment the insurer pays. Prejudgment interest is the interest (usually set by the court) that the injured party is allowed to collect from the day of the loss until the day of the judgment.

7. Any post-judgment interest the court awards is interest that accrues from the date of the judgment until the date the judgment is paid.


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Lesson 4 Topic B - Limits of Insurance

Lesson 4 Topic B CGL Limits p1 (1IC)

All policies set a maximum limit on the amount the insurer will pay in the event of a loss. The CGL Policy is unique in that it sets forth several different limits depending on the type of loss. The Limits of Insurance shown in the CGL Declarations and the rules described in this section set the maximum amount of money payable, regardless of the number of insureds, claims, suits, or people making claims or suits.

Six Limits of Insurance Found in the CGL Policy

1. Each Occurrence Limit 2. Damage to Premises Rented to You Limit 3. Medical Expense Limit 4. Personal and Advertising Injury Limit 5. General Aggregate Limit 6. Products/Completed Operations Aggregate Limit

SECTION III – LIMITS OF INSURANCE 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay

regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage"

included in the "products-completed operations hazard"; and c. Damages under Coverage B. 3. The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for

damages because of "bodily injury" and "property damage" included in the "products-completed operations hazard".

4. Subject to Paragraph 2. above, the Personal And Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization.

5. Subject to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of:

a. Damages under Coverage A; and b. Medical expenses under Coverage C

because of all "bodily injury" and "property damage" arising out of any one "occurrence".


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6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner.

7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person.

The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance.


Limits continued

Learning Objective: Identify the different Limits of Insurance of the CGL Coverage Form.

Aggregate Limit vs. Occurrence Limit

The word aggregate means the total sum that will be paid during a policy period.

The occurrence limit is the most that will be paid for all "bodily injury", "property damage", and medical payments arising from one "occurrence". It makes no difference how many people or organizations suffer a loss under the occurrence.

Each limit is indicated on the Declarations of the CGL Policy. The picture to the right is that of the CGL Declarations.

In order to understand how these limits are applied in the Policy, let's take a closer look at each one. Click on the red arrows on the right to get a brief description of each limit.

Refer to the slide to view a sample Policy Declarations.


Limits continued



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Each Occurrence Limit This is the most that will be paid for all "bodily injury", "property damage", and medical payments arising from ONE "occurrence". The limit applies regardless of the number of individuals or organizations who suffered a loss due to that "occurrence".


Limits continued


Damage to Premises Rented to You: This limit is the most that will be paid under Coverage A for all "property damage" to a premises rented to or temporarily occupied by a named insured if covered by the CGL Policy. There are two instances where this limit is applicable.

1. If it is "property damage" to premises, including the contents of such premises, rented to the named insured for a period of 7 or fewer consecutive days.

2. Except for the Expected or Intended and Contractual Liability Exclusions, for "property damage" by


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fire to premises while rented to the named insured or temporarily occupied by the named insured with permission of the owner.

Medical Expense Limit:

This limit is the most that will be paid per person under Coverage C Medical Payments for all covered medical expenses resulting from "bodily injury" to that person.


Limits continued


How is a Sublimit Applied?

Each of the limits, Damages to Premises Rented by You and Medical Payments, is considered a sublimit of the Each Occurrence Limit. The sum of payments made to all persons under, Medical Expenses, for example, for a particular loss would be subtracted from the Each Occurrence Limit available for that loss. Example: A customer is injured when she slips and falls on the business premises. She is paid $5,000 for incurred medical expenses. A lawsuit is filed and an award of $500,000 is granted. How much of the award will be paid by the CGL Policy?

General Aggregate Limit $1,000,000 Personal & Advertising Injury Limit $500,000 Damage to Premises Rented to You $100,000 Completed Products Aggregate Limit $1,000,000 Each Occurrence Limit $500,000 Medical Expense Limit (Per Person) $5,000

Answer: The Each Occurrence Limit has already been reduced by $5,000 for the medical expenses paid. This leaves for this occurrence, a balance of $495,000 that the CGL Policy will pay towards this award.



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Limits continued


General Aggregate

A General Aggregate Limit is shown in the Declarations. Think of it as a bucket of dollars to pay for losses. All losses during a policy period (other than Products-Completed Operations losses) are paid from this bucket. Losses paid for an "occurrence" or to a person or organization are subtracted from the General Aggregate. Once the money runs out, there are no more dollars to pay for any other losses during that policy period. One large loss could deplete the total coverage available for any policy period.

The General Aggregate Limit is the most that will be paid for all of the following during a policy period:

• Coverage A-Bodily Injury and Property Damage Liability (Other than Products-Completed Operations claims)

• Coverage B-Personal Injury and Advertising Liability • Coverage C-Medical Payments • Damage to Premises Rented to You


Limits continued



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Personal and Advertising Injury

This limit is the most that will be paid for all damages to any one person or organization arising from one or more "personal and advertising injury" offenses. Dollars paid for covered losses of this type are subtracted from the General Aggregate Limit.

Note: This is not subject to the occurrence limit. It is a direct sublimit to the General Aggregate, and does not apply per offense but rather, as stated, per person or organization.


Limits continued


Products-Completed Operations Aggregate Limit

This limit is the most that will be paid during a policy period for all "bodily injury" and "property damage"


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arising from the "products/completed operations hazard".

These types of claims are also subject to the Each Occurrence Limit. Claims paid for each of these types of occurrences are subtracted from the Products/Completed Operations Aggregate Limit.

Please complete the knowledge check found on Lesson 4 Topic B CGL Limits p9 (1IC).



Learning Objective: Determine the amount of limits available under a CGL Coverage Form for specific loss examples.

How are Limits Applied?

Imagine at policy inception the Occurrence, General Aggregate, and Product/Completed Operations Aggregate buckets are full of water representing their limits. As the claims are paid, the applicable bucket of water is reduced.

Each Occurrence Limit: The occurrence limit is the most that will be paid for all “bodily injury”, “property damage” and medical payments arising from one occurrence.

General Aggregate Limit: The maximum amount of money/damages that will be paid for all covered losses sustained during a specified policy period.

Products/Completed Operations Aggregate: The most that will be paid during the policy period for Products/Completed Operations claims.



Claims are paid on the Policy until the (Occurrence, Aggregate, or Product/Completed Operations Aggregate) bucket is empty — in which case the bucket is exhausted and nothing is left.

The Each Occurrence Limit is only reduced or exhausted for all claims resulting from that particular occurrence.


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Please refer to Lesson 4 Topic B CGL Limits p12 (1IC) to complete the Knowledge Check at this time.


Learning Objective: Determine the amount of limits available under a CGL Policy for specific loss examples.

Example 1

In this exercise, we determine how three separate "occurrences" or offenses impact the limits available under a CGL Policy. First, let's assemble the facts for the exercise.

Limits of Insurance

Imagine a CGL Policy with the following limits:

• Damage to Premises Rented to You Limit: $100,000 (Any One Premises) • Medical Expense Limit : $5,000 (Any One Person) • Personal & Advertising Injury Limit: $500,000 (Any One Person or Organization) • General Aggregate Limit: $1,000,000 • Products/Completed Operations Aggregate Limit: $1,000,000

3 Claims (each a separate occurrence or offence) – Three separate occurrences or offenses result in the following claims during the policy year:

• $125,000 “Property Damage” arising from the operation of mobile equipment • $500,000 “Bodily Injury” arising from a premises slip and fall • $400,000 “Personal and Advertising Injury arising from wrongful entry

None of these claims arise out of the products-completed operations hazard, so all three are subject to the General Aggregate Limit.



Example 1: Claim 1 - $125,000


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“Property Damage” arising from the operation of mobile equipment.

• General Aggregate Limit: $1,000,000 • Each Occurrence Limit: $500,000

Since the $125,000 claim amount does not exceed the $500,000 occurrence limit, the entire amount is paid.

What is the effect of Claim 1 on the Each Occurrence Limit for any additional claims resulting from this “occurrence”?

What is the effect of Claim 1 on the General Aggregate Limit?


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“Bodily Injury arising from a premises slip and fall.

• General Aggregate Limit (after Claim 1): $875,000 • Each Occurrence Limit $500,000

Recall that this claim is a separate “occurrence”.

Since the $500,00 claim amount does not exceed the $500,000 occurrence limit, the entire amount is paid.

What is the Effect of Claim 2 on the Each Occurrence Limit?



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Personal Injury arising from wrongful entry.

• General Aggregate Limit (after Claim 1 and Claim 2): $375,000 • Personal and Advertising Injury Limit: $500,000

Even though the Personal and Advertising Injury Limit is $500,000 per person or organization, there is not enough money left in the General Aggregate to pay all of this claim. The CGL Policy will pay $375,000 of this $400,000 claim.



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What effect does Claim 3 have on the Products/Completed Operations Aggregate Limit since the General Aggregate Limit has been exhausted?

No effect. Remember: none of these claims involve the Products/Completed Operations hazard.



Summary of Example 1

None of these claims arise out of the "products completed operations hazard", so all will be paid under the General Aggregate Limit.

Claim Type Claim Amount

Amount Paid

Remaining General Aggregate Limit

1 “Property Damage” arising from the operation of mobile equipment $125,000 $125,000 $875,000

2 “Bodily Injury” arising from a premises slip and fall $500,000 $500,000 $375,000

3 Personal Injury arising from wrongful entry $400,000 $375,000 $0


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Example 2

In our second exercise, we will include a loss that involves the Products/Completed Operations Aggregate Limit. First let’s assemble the facts for the exercise.

Imagine a CGL Policy with the following limits:

• Each Occurrence Limit: $500,000 • Damages to Premises Rented to You Limit: $100,000 (Any One Premises) • Medical Expenses Limit: $5,000 (Any One Person) • Personal & Advertising Injury Limit: $500,000 (Any One Person or Organization) • General Aggregate Limit: $1,000,000 • Products/Completed Operations Aggregate Limit: $1,000,000

3 Claims – Three separate “occurrence” result in the following claims during the policy year:

• Claim 1: $110,000 Covered Property Damage to Rented Premises • Claim 2: $10,000 Medical Expenses for One Injured Person • Claim 3: $780,000 Bodily Injury Arising from a Defective Product




Damage to Premises Rented to You

• General Aggregate Limit: $1,000,000 • Each Occurrence Limit: $500,000 • Limit for Damage to Premises Rented to You: $100,000

What is the effect of Claim 1 on the Damage to Premises Rented to You Limit?


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What is the effect of Claim 1 on the Each Occurrence Limit?



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Medical Expenses for One Injured Person

• General Aggregate Limit (After Claim 1): $900,000 • Each Occurrence Limit: $500,000 • Medical Expense Limit for One person: $5,000

The CGL Policy will pay the $5,000 from the Medical Expense Limit for the injured person for a claim made under Coverage C Medical Payments.

What is the effect of Example 2 Claim 2 on the Each Occurrence Limit for any additional claims resulting from this same “occurrence”?

What is the effect of Example 2 Claim 2 on the General Aggregate Limit?


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“Bodily Injury” arising from a defective product

• General Aggregate Limit (after Claim 1 and Claim 2): $895,000 • Each Occurrence Limit: $500,00 • Products/Completed Operations Aggregate Limit: $1,000,000

What is effect of Example 2 Claim 3 on the Each Occurrence Limit?


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What is the Effect of Example 2 Claim 3 on the General Aggregate limit?


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Lesson 4 Topic C – Conditions

Lesson 4 Topic C CGL Conditions p1 (1IC)

Learning Objective: Briefly describe the provisions found in the CGL Coverage Form Conditions studied in this course.

Refer to pp. 10 through 16 of the CGL Coverage Form.

Like any other insurance policy, the CGL Coverage Form contains a number of policy conditions that govern the responsibilities of the insured and the insurance company. Although we will not examine all the conditions found in the CGL Coverage Form, we will study some of the more important provisions. They include:

• Duties in the Event of Occurrence, Offense, Claim or Suit • Other Insurance • Premium Audit • Separation of Insureds • Transfer of Rights of Recovery Against Others to Us

SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Bankruptcy

Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part.

2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which

may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable.

You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses or legal papers received in

connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization

which may be liable to the insured because of injury or damage to which this insurance may also apply.

d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent.


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3. Legal Action Against Us No person or organization has a right under this Coverage Part:

a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with.

A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative.

4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows:

a. Primary Insurance This insurance is primary except when Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in Paragraph c. below.

b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (i) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for

"your work"; (ii) That is Fire insurance for premises rented to you or temporarily occupied by you with

permission of the owner; (iii) That is insurance purchased by you to cover your liability as a tenant for "property damage"

to premises rented to you or temporarily occupied by you with permission of the owner; or (iv) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent

not subject to Exclusion g. of Section I – Coverage A – Bodily Injury And Property Damage Liability.

(b) Any other primary insurance available to you covering liability for damages arising out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured.

(2) When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers.

(3) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of:

(a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and

(b) The total of all deductible and self-insured amounts under all that other insurance. (4) We will share the remaining loss, if any, with any other insurance that is not described in this

Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part.

c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first.


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If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers.

5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of

each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured.

c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request.

6. Representations By accepting this policy, you agree:

a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. 7. Separation Of Insureds

Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies:

a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us

If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them.

9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice.


Duties In The Event Of An Occurrence, Offense, Claim Or Suit



Notification The first duty is that of notification. The named insured must see to it that the insurer is notified as soon as is practical of an "occurrence" or an offense which may result in a claim.


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A lack of timeliness can have an adverse effect on the insurer's ability to investigate and settle a claim. If the named insured fails to provide notice on a timely basis and the insurer can show that the named insured's lack of action prejudiced their settling of the claim, coverage may be denied.


Duties In The Event Of An Occurrence, Offense, Claim Or Suit continued



Cooperation Another duty is cooperation. All insureds must cooperate with the insurer in the investigation, settlement of a claim, or in the defense of any "suit" brought under the Policy.

Assist the Insurance Company Another important duty is to assist in the enforcement of any rights against any person or organization that may be liable to the insured because of injury or damage to which this insurance may also apply. This provision and the subrogation provision grant the insurer the right to seek recovery from other responsible parties.


Other Insurance



This condition states that if other valid and collectible insurance is available to the insured the insurance coverage is primary, except in specified circumstances when it is excess. The CGL Policy is excess over:

• Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work".


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• Fire Insurance for premises rented to the named insured or temporarily occupied by the named insured with permission of the owner.

• Insurance purchased to cover the named insured's liability as a tenant for "property damage" to premises rented to the named insured or temporarily occupied by the name insured with permission of the owner.

• If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent the CGL Policy covers the loss.

• Any other primary insurance available for premises or operations or products and completed operations, for which the named insured has been added as an additional insured to another policy.

This condition also outlines the methods of sharing when there is other primary insurance applicable.


Premium Audit



In general, CGL Policies are written on an auditable basis: estimated payroll, gross sales, etc. The Premium Audit condition states:

1. The insurer will base premiums on the company's rules and rates.

2. The Policy premium is a deposit premium only. The company will audit the name insured's books to determine the true exposure for the audit period and then make a premium adjustment.

3. The first named insured must keep records and provide them to the insurer upon request.

4. The first named insured is responsible to pay any audit premiums due and will be the payee for any return premium.


Separation Of Insureds & Transfer Of Rights


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Separation Of Insureds There are many persons and/or entities considered to be insureds under the CGL Coverage Form. This provision deals with how the Policy will handle insureds except under the Limits of Insurance. Insurance under the CGL Coverage Form applies to each covered person or entity as though each had its own separate policy. If one insured brings a covered claim against another insured under the same Policy, the Policy will respond. However, the Limits of Insurance do not increase!

Transfer Of Rights Of Recovery Against Others To Us (Subrogation) This provision is commonly referred to as the subrogation provision. Once an insurer has paid for a loss, they are entitled to recover the money from any other party or entity that might have caused the loss. The insured must do nothing after loss to impair these rights. There is an endorsement that is used for the other insured to waive its right to recovery.


Subrogation


Basically, subrogation means the insurance company's right to recover all or parts of any amounts paid from the party that caused an injury or damage. A contract may require an organization to waive the insurance company’s right to subrogate against the other party to the contract. In fact, many contracts include a mutual waiver of subrogation. Example: Smith Contracting, Inc. has entered into a contract with Jones, Inc. for a building project. The sample


http://onlinedev.scic.com/dev/NewLinx/RunThruCluster.php

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contract language is available to the right.

Sample Language SECTION 4.12.5 SUBROGATION Smith Contracting, Inc. and Jones Inc. shall obtain waiver of subrogation from its insurers in favor of the other, and subsidiary and affiliated companies, under all policies of insurance, including (without limitation those referred to above maintained by or for the benefit of this project. Each party waives its rights to recovery against the other subrogations.


Transfer Of Rights Of Recovery Against Us (CG 24 04)


To satisfy Smith’s contractual obligation to obtain a waiver of subrogation, the endorsement Waiver of Transfer of Rights of Recovery Against Others to Us (CG 24 04) must be added to Smith’s CGL Policy. Under this endorsement, the insurance company is verifying in writing what is otherwise implied, that it waives its right to subrogate against Jones, Inc. for either:

• injury or damage arising out of Smith’s ongoing operations or • Smith’s work done under a contract with Jones and included in the products-completed

operations hazard.

Unfortunately, while this endorsement is suitable for a contractor, it is not suitable for other types of risks. This is the only standard waiver of subrogation endorsement that has been developed by ISO.

Refer to the slide online to view a copy of the endorsement.

This concludes our study of the CGL Coverage Form. After completing the next self-quiz, you will be ready to begin your study of Additional Insureds.

Please refer to the end of Lesson 4 Topic C to complete Self Quiz 8 at this time.


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Lesson 4 Review Page (1IC)

Lesson 4: Learning Objectives Review

We suggest reviewing the Learning Objectives for this lesson to prepare for the final exam.

1. Give examples of Supplementary Payments included in the CGL Coverage Form. 2. Identify the different limits of insurance of the CGL Coverage Form. 3. Determine the amount of limits available under a CGL Coverage Form for specific loss examples. 4. Briefly describe the provisions found in the CGL Coverage Form Conditions studied in this course.


Documents

Lesson 4 - CGL Other Provisionsmagma.magma.scic.com/Elearning/1IC/2013/1IC_Lesson_4.pdfLesson 4 Topic A CGL Supplementary Payments p2 (1IC) 7 Types of Supplementary Payments . Learning