Filed Under:Claims, Education & Training

Splitting Hairs

Although it has been well over a decade since Bill Clinton famously stated, "It depends on what the meaning of the word 'is' is," comedians and late night talk show hosts still use the quote as a punch line. While we at FC&S do have senses of humor, we have to agree with the former president that sometimes you have to split hairs over the definitions of certain words.

One word that can make insureds and insurers alike want to pull out their hair is "occurrence." Can two events separated by time really be considered an occurrence? Is repeated exposure to a peril an occurrence?

In that same vein, an FC&S subscriber had a client who was a property manager and had a lead paint claim. A second claim was brought after the first one was paid, which was made by a different party living in a different location. Since both were lead paint claims, the insurer considered them to be one occurrence. The subscriber believed that there were two separate claims by two separate parties living in two different locations, and just because the claims dealt with the same type of loss, that did not meet the definition of "occurrence."

The insurer's view of the definition of "occurrence," was logical, considering the definition uses the phrase "continuous or repeated exposure to substantially the same general harmful conditions." However, the CGL policy's use of the phrase, "continuous or repeated exposure to the same general harmful conditions," means the same general harmful conditions at the same location happening over a period of time to the same claimants. In this case, if the claimants were all in the same family or lived in the same location and were exposed to the same harmful conditions over a period of time, then the insurer would be on stronger ground with its denial.

Likewise, rain storms that caused damage over a three-month period could not be considered one occurrence. There was enough time between the storms for them not to be considered one weather event or a giant storm.

Crime Doesn't Pay

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