AAIS Homeowners Program
January 30, 2017
Summary: The American Association of Insurance Services (AAIS) homeowners program includes forms that provide coverage for the owner-occupant of one to four family dwellings used for private residential purposes. There are forms for the tenant homeowner and for cooperative apartment or condominium owners. There are seven coverage forms in all, each providing both property and liability coverages. Following is a brief overview of the program followed by a comparison of the most commonly used homeowners form.
Topics covered: Introduction Eligibility Rating information Overview of forms Comparison of form 3 Ed. 2.0 to HO 0003 01 06 Definitions Coverage A – residence Coverage B – related private structures Coverage C – personal property Incidental property coverages Perils insured against – coverages A, B, C, and D Exclusions that apply to property coverages Principal liability coverages Incidental liability coverages Exclusions that apply to liability coverages What must be done in case of loss or occurrence How much we pay for loss or occurrence Policy conditions
Introduction
The American Association of Insurance Services (AAIS) has filed a revised homeowners program with an effective date of September 2008. The prior forms were revised in 2006. The prior revision was in 1988. The current forms are distinguished from the earlier forms in that they are numbered HO 0001 01 06, HO 0002 01 06, etc.; the earlier equivalent forms were referred to as Form 1, Edition 2.0, Form 2, Edition 2.0. AAIS notes that homeowners form HO 0008 01 06 has an extremely limited use, so many of the coverage options previously available for use with the form have been withdrawn. Basic form HO 0001, however, is still available with the full range of coverage options.
Unlike the earlier forms, the new forms do not contain any provisions that apply to mobile homes. For example, form 3, under loss settlement terms, states “The Replacement Cost Terms apply only to buildings covered under Coverages A and B that have a permanent foundation and roof. They do not apply to… mobile homes whether or not on a permanent foundation.” Now, the applicable provision states the replacement cost terms apply only to buildings with a permanent foundation and roof, but make no reference to the coverage not applying to mobile homes. This is because the mobile homes will be addressed by means of a mandatory endorsement filed only in the mobile homeowners program.
Endorsements, discussed elsewhere (see Common Endorsements—AAIS Program) have undergone the same numbering system as the homeowners forms. For example, the scheduled personal property coverage endorsement is HO 3061 01 06 as opposed to ML-61 1.0.
For the remainder of this discussion, for simplicity's sake, we will refer to the forms and endorsements simply as HO 0002 or HO 3061, without the edition date.
The AAIS forms HO 0001, HO 0002, HO 0003, HO 0005, and HO 0008 may be used to cover a one- to four-family dwelling that is owner-occupied. Each family unit may house no more than two roomers or boarders, or two families. Homeowners forms may be used to insure co-owners of a two- to four-family dwelling, provided that the policy is issued in the name of only one owner. Each owner must occupy a separate apartment within the building. The other owner's interest may be protected through use of endorsement HO 6041, additional insured. (This endorsement provides coverage as the co-owner's interest may appear with regard to the described premises. Liability and medical payments coverage is limited to loss arising out of the described premises; for this reason, a co-owner must carry his or her own tenant homeowners insurance.)
A homeowners policy may also be issued to the occupant of a dwelling who is purchasing the dwelling under a long-term contract (rules do not allow for the seller acting as mortgagee), the occupant of a dwelling under a life estate arrangement, or the owner and intended occupant of a dwelling under construction. A homeowners policy may also be issued to the owner of a seasonal dwelling that meets all eligibility requirements.
Form HO 0004 can be used to insure a tenant of a dwelling or apartment, or the owner-occupant of a dwelling, condo, co-op, or building containing an apartment that is not eligible for usual homeowners coverage, such as an apartment located over a retail establishment or in, for example, a building containing a hundred apartments. Even so, the apartment must be used for residential purposes, and be occupied by no more than one family with two boarders or roomers, or two families with no boarders or roomers.
Form HO 0006 is used to insure the owner-occupant of a condominium or cooperative that is used for residential purposes, occupied by no more than one family with no more than two boarders or roomers, or two families with no boarders or roomers.
Certain incidental business activities of the insured are permitted on the residence premises, subject to insurer guidelines. For the insured with a home-based business, AAIS has developed a home-based business coverage option, which may be attached to an AAIS homeowners, farmowners, or mobile homeowners policy. For a brief discussion of this form, see Common Endorsements—AAIS Program or, for a more complete discussion, go to The AAIS Home-Based Business Coverage Form—Property and The AAIS Home-Based Business Coverage Form—Liability.
Rating Information
The AAIS manual contains program information, submission and rating instructions, loss costs, and explanations of available coverage options. Generally, the rating approach is similar to ISO homeowners rating. There are some differences to note, however. The ISO manual may be used countrywide, with state exception pages included for a particular state. AAIS provides a separate manual for each state.
The AAIS program uses a simplified fire protection classification. Instead of the usual ten classes, AAIS uses three. These are “protected,” “partially protected,” and “unprotected.” “Protected” buildings are those located within five miles of a responding fire department, and within 1,000 feet of a fire hydrant. Alternatively, the building may be within 1,000 feet of a year-round water source (in other words, a pond subject to freezing will not qualify) of at least 3,500 gallons, and the responding fire department must have pumper truck capabilities; or, the responding fire department must have a pumper/tanker truck capable of carrying at least 3,500 gallons. “Partially protected” buildings are those located within five road miles of a responding fire department; however, the water source requirements are not met. “Unprotected” buildings are those not meeting any of the above requirements (similar to class 10 in the usual classification system). Of course, this classification system does not mean that dwellings located in any of these areas are automatically eligible for coverage; the underwriting guidelines of each company should be consulted.
The rating procedures are different for ISO and AAIS. Neither program, though, furnishes rates. Both programs include loss costs, which then must be multiplied by the individual company's multiplier to obtain a final rate. The ISO rating procedure consists of finding a key premium based on territory; multiplying this by a form factor; multiplying the result by the protection-construction factor; and, finally, multiplying this figure by the key factor. (The company multiplier is then applied.) In the AAIS procedure, the pertinent base amount for the applicable territory is multiplied by the applicable policy form relativity and rounded to the nearest whole dollar. This amount is then multiplied by the applicable protection/construction relativity and rounded to the nearest whole dollar. This amount is then multiplied by the applicable amount of insurance relativity and rounded to the nearest whole dollar. In both rating procedures any additional premium for optional coverages must be added separately.
The AAIS homeowners program includes seven forms, as opposed to ISO's six (ISO has withdrawn the HO 00 01 in most jurisdictions). Forms HO 0001, HO 0002, HO 0003, HO 0005, and HO 0008 provide property coverages consisting of coverage for the residence, related personal property, and additional living costs or loss of rent. Form HO 0004, the tenant homeowners form, covers personal property, additional living costs, or loss of rent. Form HO 0006, the unit-owners form, covers personal property, additional living costs or loss of rent, as well as fixtures, additions and alterations, and structures owned by the insured. Coverage D, additional living costs, is now 30 percent of the coverage A amount for one or two family dwellings, and 20 percent of the coverage A amount for three or four family dwellings. This applies to forms HO 0001, HO 0002, HO 0003, and HO 0005.
The term “described location” means “the one-to four-family house, the townhouse, or the row house where 'you' reside and which is shown on the 'declarations' as the 'described location'. It includes related private structures and grounds at that location.” As noted earlier, reference to a mobile home has been deleted (previously, “residence” included “a one- or two-family mobile home used mainly for family residential purposes”). The ISO form defines “residence premises” as the “one family dwelling where you reside, the two, three or four family dwelling where you reside in at least one of the family units….” In both programs, a mobile home can be insured through endorsement. Forms HO 0001 and HO 0008 are intended for situations where the insured either does not desire, or does not qualify for, the broad or special form coverages. Form HO 0005, the special building and contents form, provides open perils coverage for building and personal property.
Forms HO 0001, HO 0002, HO 0004, HO 0006, and HO 0008 cover loss caused by fire or lightning, windstorm or hail, explosion, riot or civil commotion, aircraft, vandalism, vehicles, sudden and accidental smoke damage, sinkhole collapse, volcanic eruption and theft. In a broadening of coverage, vandalism is now included in HO 0008, rather than an optional coverage as in the earlier edition. Theft coverage in HO 0008 is new in this form; however, it is limited to $1,000, and applies only to theft that occurs from on the described premises. Forms HO 0002, HO 0004, and HO 0006 cover loss caused by the previous perils, as well as falling objects, weight of ice, snow, or sleet, sudden and accidental tearing apart, cracking, burning or bulging, accidental discharge or overflow of liquids or steam, freezing, and sudden and accidental damage from artificially generated electrical currents. Form HO 0003 provides “open perils” coverage for the dwelling; the perils enumerated above apply to personal property. Form HO 0005, the special building and contents form, provides “open perils” coverage for the dwelling and personal property. For a more complete discussion of the coverages and the pertinent exclusions, see Property Coverages—AAIS Homeowners.
There are fifteen incidental coverages (called additional coverages in the ISO forms); however, not all forms contain all the coverages. All of the forms include coverage for association deductible (new with this filing); credit card, forgery, and counterfeit money; debris removal; loss to covered property removed from the insured premises to prevent damage from a peril insured against; fire department service charge; credit card, forgery, and counterfeit money; trees, plants, shrubs, or lawns; glass breakage; reasonable repairs; refrigerated food spoilage; and loss assessment. In the prior edition, the coverage for reasonable repairs was found in the loss conditions. Now, the coverage is found in the incidental coverages, and corresponds to the loss condition requiring the insured to take reasonable measures to protect the property at the time of loss. Forms HO 0002, HO 0003, HO 0004, HO 0005, and HO 0006 cover collapse, grave markers, increased cost—ordinance or law, and liquid fuel remediation. Form HO 0004 includes coverage for tenants improvements, but not coverage for property in rental units, a new coverage found in HO 0001, HO 0002, HO 0003, and HO 0005. Form HO 0005 adds lock and garage door transmitter coverage. As a comparison, the ISO additional coverages are: debris removal; reasonable repairs, trees, shrubs and other plants; fire department service charge; property removed; credit card, fund transfer card, forgery and counterfeit money; loss assessment; collapse; glass or safety glazing material; landlord's furnishings; and ordinance or law. As with the AAIS program, not all the ISO homeowners forms contain all the additional coverages. For a discussion, see ISO Homeowners Section I.
The AAIS forms provide liability coverage up to the limit of insurance for the amount that an insured may become legally obligated to pay as a result of bodily injury or property damage caused by a covered occurrence. Medical payments to others coverage pays necessary medical expenses for injury to a person on the insured's premises with the insured's permission, or for injury to a person away from the insured's premises if the bodily injury arises from a condition on the insured premises or from an activity of the insured. Medical payments coverage also applies to an injury caused by a domestic employee of the insured while performing his or her duties, or to an injury sustained by a domestic employee that arises from performance of those duties.
There are eight incidental liability coverages. These are: damage to property of others; contracts and agreements; claims and defense cost; first aid expense; motorized vehicles; watercraft; business; and loss assessment. The ISO form contains four additional section II coverages: claim expenses, first aid expenses, damage to property of others, and loss assessment. Coverage for certain contracts and agreements, motorized vehicles (such as those used to service the insured premises), watercraft (those under a certain length and horsepower), and business (such as the rental of an insured location on an occasional basis) is included in the main body of section II. For a more complete discussion, see Liability Coverages—AAIS Homeowners.
Comparison of AAIS HO 0003 09 08 to ISO HO 00 03 05 11
This policy was designed with the intent to keep pace with the ever changing insurance industry. Water, mold, collapse, “kiddie cars,” and other issues that have developed and changed over time are addressed. The policy begins with the definitions section, and then proceeds through the property coverages, liability coverages, and other provisions. Throughout this discussion revisions with the 09 08 form will be addressed. Language that remains the same will not be discussed so that the changes may be highlighted.
3. “Actual cash value” means the cost to repair or replace property using materials of like kind and quality, to the extent practical, less a deduction for depreciation, however caused.
4. Under the Liability Coverages provided by this policy, “aircraft” means an apparatus or a device designed or used for flight, but this does not include:
a. a model aircraft that is not designed or used to carry people or cargo;
b. a “hovercraft”; or
c. a model hovercraft that is not designed or used to carry people or cargo.
8. “Described location” means the one- to four-family house, the townhouse, or the row house where “you” reside and which is shown on the “declarations” as the
“described location”. It includes related private structures and grounds at that location.
However, if the “described location” is a townhouse or a row house, it includes only related private structures and grounds at that location that are used or occupied solely by “your” household for residential purposes.
10. “Employee” means a person employed by an “insured”, or a person leased to an “insured” under a contract or an agreement with a labor leasing firm, to perform duties other than those performed by a “domestic employee”.
11. “Fungi” means any kind or form of fungus, including but not limited to mildew and mold, and any chemical, matter, or compound produced or released by a fungus, including but not limited to toxins, spores, fragments, and metabolites such as microbial volatile organic compounds.
12. Under the Liability Coverages provided by this policy, “hovercraft” means a self-propelled motorized ground effect machine or air cushion vehicle designed or used to travel over land or water. This includes, but is not limited to, a flarecraft.
However, “hovercraft” does not include:
a. a model hovercraft that is not designed or used to carry people or cargo;
b. an “aircraft”;
c. a model aircraft that is not designed or used to carry people or cargo;
d. a “motorized vehicle”;
e. a “watercraft”; or
f. a model watercraft that is not designed or used to carry people or cargo.
16. “Motorized vehicle” means:
a. a self-propelled land or amphibious vehicle, regardless of method of surface contact, but this does not include a:
1) “hovercraft”;
2) model hovercraft that is not designed or used to carry people or cargo;
3) “watercraft”; or
4) model watercraft that is not designed or used to carry people or cargo; or
b. a trailer or semi trailer that:
1) is attached to or being carried on or towed by; or
2) becomes detached while being carried on or towed by; a vehicle described in a. above.
21. “Vermin” means an animal of a type that is prone to enter or burrow into or under a structure to seek food or shelter, including but not limited to:
a. armadillos;
b. bats;
c. opossums;
d. porcupines;
e. raccoons;
f. skunks; and
g. snakes.
22. Under the Liability Coverages provided by this policy, “watercraft” means an apparatus or a device primarily designed to be propelled on or in water by engine, motor, or wind, but this does not include:
a. a model watercraft that is not designed or used to carry people or cargo;
b. a “hovercraft”;
c. a model hovercraft that is not designed or used to carry people or cargo;
d. a “motorized vehicle”;
e. an “aircraft”; or
f. a model aircraft that is not designed or used to carry people or cargo.
Analysis
These definitions were all new to the AAIS HO 0003 policy and had not been in the prior policy. These terms were added to clarify meaning within the policy. A clear definition of actual cash value is necessary for the handling of claims. Of note is the inclusion of depreciation in the definition. For example, a ten year old roof is damaged and the cost to repair the damage is $5000. The expected life span of the roof is twenty years; since the roof is half way through its expected life span, depreciation of fifty percent is deducted from the settlement leaving a settlement of $2500.
Aircraft were not previously defined in the policy, and the new definition specifically indicates that aircraft are designed for flight and that hovercraft are not aircraft. A distinction is made between aircraft designed to carry passengers or cargo from model aircraft; model aircraft are not included in the definition of aircraft. When the policy lists exclusions for aircraft, as model aircraft are not included in the definition of aircraft, they are an exception to those exclusions. Drones are not addressed as the policy predates the current drone popularity.
Described location has been broken out of the definition of insured premises to stand on its own. It replaces the term residence in the old form and further specifies that if the home is a townhouse or row house, that the only related private structures and grounds that are covered by the policy are those used only by the named insured's household for residential purposes. This is to avoid providing coverage for community property such as a clubhouse or exercise room within the common property of all residents.
Employee was another new term in this edition of the policy. It is set aside separately from domestic employee, and describes someone employed by an insured that does not fit the definition of domestic employee.
The term fungi has been added to the policy as well and describes any form of fungus and includes mold, mildew, and compounds that may be released by a fungus. Of note is this inclusion of spores, toxins, and compounds that may be released from fungi in the definition itself.
Hovercraft are defined here in order to differentiate them from aircraft. While aircraft are defined as being used for flight, hovercraft are defined as being ground effect machines or air cushion vehicles designed to travel over land or water. Hovercraft do not travel high above the ground; the average lift off the ground ranges from six inches to one hundred and eight inches depending on the size of the vehicle. Similar to the aircraft definition, it is specified that watercraft and aircraft are not considered hovercraft, nor are model hovercraft that are not designed or used to carry people or cargo.
The language for motorized vehicle was expanded and the separate definition for motor vehicle was removed. Also removed is the wording for motorized vehicle that includes a vehicle designed for use on public roads. The definition of motorized vehicle now specifically excludes hovercraft, model hovercraft, watercraft and model watercraft.
Vermin are now defined in the policy; they are described as animals that enter or burrow in or under a dwelling to seek food or shelter and include armadillos, bats, raccoons, skunks, and snakes. This area often gets confusing; are insects vermin or animals? What exactly is an animal? Snakes are included in the list of examples and they are reptiles; what differentiates a reptile from an insect from an animal? A return to basic biology reminds us that in the natural world living creatures are differentiated by Kingdom, Phylum, Class, Order, Family, Genus, and Species. There are five different Kingdoms; Animals, Plants, Fungi, Protist (includes algae and protazoa), and Moneran (bacteria). Armed with this information, insects and reptiles are indeed part of the animal family. The question now becomes whether or not the animals have a tendency to enter structures for shelter or to seek food.
Watercraft are described as vehicles designed to be propelled on or in the water but does not include hovercraft, aircraft, or motorized vehicles. The policy has taken care to specifically describe these other vehicles in their own definitions.
The terms motor vehicle and recreational motor vehicle were removed from the policy. The essence of these definitions was incorporated into the definition of motorized vehicle, so these terms are no longer needed.
13. “Insured” means:
a. “you”;
b. “your” relatives if residents of “your” household;
c. “your” relatives under the age of 25 years who:
1) are financially dependent upon “you”;
2) are students enrolled in school full time, as defined by the school; and
3) were residents of “your” household just before moving out to attend school;
d. persons, other than “your” relatives, under the age of 21 years who:
1) reside in “your” household; and
2) are in “your” care or 'in the care of” your” resident relatives;
e. persons, other than “your” relatives, under the age of 21 years who:
1) are in “your” care or in the care of “your” resident relatives;
2) are students enrolled in school full time, as defined by the school; and
3) were residents of “your” household just before moving out to attend school; or
f. solely with respect to the Liability Coverages provided by this policy:
1) persons in the course of acting as “your” real estate manager for the “described location”, but only with respect to acts falling within the scope of such duties;
2) persons while engaged in the employ of an “insured” as defined in a., b., c., d., or e. above, but only with respect to a “motorized vehicle” to which this insurance applies;
3) persons using a “motorized vehicle” to which this insurance applies on an “insured premises” with “your” consent, but only with respect to such use;
4) persons or organizations accountable by law for “watercraft” or animals:
a) owned by an “insured” as defined in a., b., c., d., or e. above; and
b) to which this insurance applies; but only with respect to such “watercraft” or animals. However, this does not include persons or organizations using or having charge or control of such “watercraft” or animals in the course of “business” or without the owner's consent; or
5) persons or organizations accountable by law for a motorized golf cart:
a) owned by an “insured” as defined in a., b., c., d., or e. above; and
b) to which this insurance applies; but only with respect to such golf cart. However, this does not include persons or organizations using or having charge or control of such golf cart without the owner's consent. The phrase an “insured”, wherever it appears in this policy, means one or more “insureds”.
14. “Insured premises” means:
a. the “described location”;
b. that part of any other premises used by “you” as a residence and shown on the “declarations” as an “insured premises”;
c. that part of any other premises used by “you” as a residence and that is acquired by “you” during the policy period for such use;
d. premises used by “you” in connection with a premises described in a., b., or c. above;
e. cemetery lots and burial vaults of an “insured”;
f. that part of a premises not owned by an “insured” and that is temporarily used by an “insured” as a residence;
g. that part of a premises occasionally rented to an “insured” for other than “business” purposes; and
h. vacant land owned by or rented to an “insured”. This includes land where a one- to four-family house, a townhouse, or a row house is being built for use as an “insured's” residence. This does not include farm land.
15. “Limit” means amount of insurance.
18. “Pollutant” means:
a. any solid, liquid, gaseous, thermal, or radioactive irritant or contaminant, including acids, alkalis, chemicals, fumes, smoke, soot, vapor, and waste. Waste includes materials to be disposed of as well as recycled, reclaimed, or reconditioned; and
b. electrical, magnetic, or electromagnetic particles or fields, whether visible or invisible, and sound.
Analysis
The definitions of insured, insured premises, limit, and pollutant have all been revised. Insured has been revised to include relatives under the age of twenty five who are financially dependent on the named insured or are in school full time, and full time as defined by the school. The student must have been a resident of the named insured's household immediately before moving out to attend school. The language specific to persons under age twenty one who are not relatives has some minor language modifications but coverage remains the same.
Coverage for persons acting as the named insured's real estate manager for the described location are covered only for acts that fall within the scope of their duties; the same applies to persons in the employment of the insured, or those accountable for animals or watercraft owned by the insured. Liability coverage is available to these other persons only to the extent that they are acting on behalf of or at the direction of the named insured. The prior policy was not so specific.
A new section has been added to this coverage and that is for persons or organizations accountable by law for a motorized golf cart owned by a named insured and to which the policy applies. People who have taken the golf cart without the named insured's consent are not covered.
The definition of insured premises, in the clause describing land on which a dwelling is being built for the named insured is specific as to the type of residence – a one- to four- family house, a townhouse, or a row house. The prior policy only mentioned land where a residence is being built, with no limitation on the type of residence.
Limit has been revised slightly and now reads “amount of insurance” instead of “amount of coverage that applies”.
A pollutant now includes electromagnetic particles or fields.
a. “We” cover the residence on the “described location”. This includes additions attached to the residence and built-in components and fixtures, as well as building materials and supplies located on or adjacent to the “described location” for use in the construction, alteration, or repair of the residence or related private structures on the “described location”.
b. “We” do not cover:
1) land, including the land on which covered property is located, except as provided under the Incidental Property Coverage for Liquid Fuel Remediation;
2) underground water or surface water;
3) trees, plants, shrubs, or lawns, except as provided under the Incidental Property Coverage for Debris Removal and the Incidental Property Coverage for Trees, Plants, Shrubs, Or Lawns; or
4) grave markers or mausoleums, except as provided under the Incidental Property Coverage for Grave Markers.
c. The “limit” that applies to Coverage A is the most “we” pay per occurrence for all property covered under Coverage A.
Analysis
Included in the property covered under coverage A is building supplies used for the repair, alteration or construction of the residence or the related private structures (emphasis added.) the reference to related private structures is new language to the policy.
In the “We” do not cover portion of the policy it is pointed out that for land and grave markers or mausoleums, there is coverage provided separately under the incidental property coverage. It is also specified in this section of the policy that the limit that applies to coverage A is the most that is paid for all property under coverage A.
Coverage B – Related Private Structures
a. “We” cover related private structures on the “described location” that are not attached to the residence covered under Coverage A. Structures that are connected to the residence covered under Coverage A by only a fence, a utility line, or a similar connection are not considered attached.
b. “We” also cover fences, driveways, sidewalks, and other permanently installed outdoor fixtures.
c. “We” do not cover:
1) land, including the land on which covered property is located, except as provided under the Incidental Property Coverage for Liquid Fuel Remediation;
2) underground water or surface water;
3) trees, plants, shrubs, or lawns, except as provided under the Incidental Property Coverage for Debris Removal and the Incidental Property Coverage for Trees, Plants, Shrubs, Or Lawns;
4) grave markers or mausoleums, except as provided under the Incidental Property Coverage for Grave Markers; or
5) any structure:
a) rented or held for rental to any person who is not a tenant of the residence covered under Coverage A, other than a structure used solely for private garage purposes;
b) used, in whole or in part, for the direction or operation of a “business”; or
c) used, in whole or in part, for the storage of “business” property. However, this exclusion does not apply to a structure used by an “insured” or a tenant of the residence covered under Coverage A to store “business” property that:
(1) is a private passenger auto, a pickup truck, a van, or a “motorized vehicle” designed for grounds maintenance activities such as lawn mowing or snow plowing; or
(2) is owned solely by such “insured” or tenant and is not a “motorized vehicle”; and does not consist of or contain gaseous or liquid fuel, other than fuel contained in a permanently installed fuel tank of a vehicle, craft, or grounds maintenance machine or in a portable container that is designed to hold fuel and has a capacity of no more than five U.S. gallons.
d. The “limit” that applies to Coverage B is the most “we” pay per occurrence for all property covered under Coverage B.
Analysis
All references to building materials and supplies for use in the alteration, construction or repair of a related private structure have been removed. This coverage is now part of the coverage A limit, thus giving the named insured more coverage for these items. The same wording found in coverage A for land and grave markers being covered under incidental property coverage is also found here, as is the language stating that the limit that applies to coverage B is the most that applies per occurrence for all property covered under B.
The wording discussing structures used for business, rented by a non-tenant, or for the storage of business property has been expanded and reworded. New to this section is that the exclusion does not apply to a structure used by an insured or tenant to store business property if that property is an auto, truck, van, or vehicle meant for grounds maintenance such as mowing. Also excepted from the exclusion is property owned by an insured or tenant that is not a motorized vehicle and does not contain gaseous or liquid fuel unless it is in a permanently installed fuel tank, or a portable container with less than five gallons. Therefore, if the insured has an auto used in his floral delivery business in the garage and the garage burns down, the structure is covered. However, if the garage contains business property such as flowers, vases, floral tape, etc. and the garage burns down, there is no coverage for the garage as it was housing business property at the time of loss.
Coverage C – Personal Property
a. “We” cover personal property owned or used by an “insured”. At “your” option:
1) personal property owned by a guest or “domestic employee” is covered while it is in that part of any residential premises occupied by an “insured”; and
2) personal property owned by a person other than a guest or “domestic employee” is covered while it is in that part of the “described location” occupied by an “insured”.
b. Limitation On Property At Residential Premises Other Than The Described Location — Coverage for personal property usually on residential premises of an “insured” other than the “described location” is limited to 10% of the Coverage C “limit” or $1,000, whichever is greater. However, this limitation does not apply to personal property:
1) that is removed from the “described location” because the “described location” is undergoing alteration, reconstruction, or repair and is unfit for use as a residence or a place in which to store property; or
2) in “your” newly acquired principal place of residence for 30 days from the date that “you” first move property there.
c. Limitations On Certain Property –
The special “limits” shown below do not increase the Coverage C “limit”. The “limit” for each class is the total “limit” per occurrence for all items in that class.
1) $250 on money; bank notes; bullion; gold other than goldware and goldplated ware; silver other than silverware and silver-plated ware; platinum other than platinumware and platinum-plated ware; coins; medals; scrip; smart cards; and cards or other devices on which a cash value is stored electronically.
2) $1,500 on securities, stamps, letters of credit, notes other than bank notes, personal records, tickets, accounts, deeds, evidence of debt, passports, and manuscripts. This special “limit” applies regardless of the medium on which these items exist, and includes the cost of research or other expenses necessary to reproduce, replace, or restore the item.
3) $1,500 on electronic devices and accessories while in or on a “motorized vehicle” or watercraft, if the device can be operated from the electrical system of the “motorized vehicle” or watercraft and by another source of power. Accessories include antennas, films, tapes, wires, discs, records, or other media that can be used with such devices.
4) $1,500 on electronic devices and accessories used primarily for “business” purposes while away from the “described location” and not in or on a “motorized vehicle” or watercraft, if the device can be operated from the electrical system of a “motorized vehicle” or watercraft and by another source of power. Accessories include antennas, films, tapes, wires, discs, records, or other media that can be used with such devices.
5) $1,500 on watercraft, including their furnishings, equipment, engines, motors, trailers, and semitrailers.
However, this does not apply to:
a) model watercraft that is not designed or used to carry people or cargo; or
b) hovercraft.
6) $1,500 on trailers and semitrailers, other than trailers and semitrailers designed for or used with watercraft.
7) For loss by theft:
a) $2,500 on jewelry, watches, precious and semiprecious stones, gems, and furs;
b) $2,500 on silverware, goldware, platinumware, pewterware, and items plated with gold, silver, or platinum; and
c) $2,500 on guns and items related to guns.
8) For loss to personal property used primarily for “business” purposes, other than property rented or held for rental to others:
a) $2,500 on property while on the “described location”; and
b) $500 on property while away from the “described location”. However, this special “limit” does not apply to electronic devices and accessories described in 3) and 4) above. These special “limits” include the cost of research or other expenses necessary to reproduce, replace, or restore “business” data.
Analysis
The policy provides coverage for personal property of an individual other than a guest or domestic employee of the residence while the property is in the part of the residence occupied by the insured. For example, the insured borrows a neighbor's laptop to work on a project. The laptop is at the insured's residence, but the neighbor is not a guest; the neighbor is not present when the insured's kitchen catches fire and the laptop is burned. Since the property is owned by a person other than a guest or domestic employee, the laptop is covered for damages covered by the policy.
The limitation on property at residential premises other than the described location has been changed to pay a maximum of 10% of coverage C or $1,000 whichever is greater. The prior policy did not have the $1,000 limit. Also new to this limitation is the exception that property removed from the residence due to alteration, reconstruction, or repair of the residence because the residence is unfit to use, the limitation on personal property does not apply. For example, the insured is having the home substantially remodeled and cannot stay in the house during the renovations. The insured moves most of the furniture and property into her sister's mansion; if this property suffers a loss, payment is not restricted to the limit of the maximum 10% of coverage C or $1,000, whichever is greater.
There are various revisions to the limitations on certain property. In the special limit for money, bank notes, bullion, etc. platinum other than platinumware is now included, as are coins, medals, scrip, smart cards, and other devices on which a cash value can be stored electronically. This reflects society's growing use of ATM, debit, and credit cards.
The special limits for electronic devices have been reworded, and make special provisions for devices used for business. A separate limit of $1,500 is available for devices used for business purposes while away from the insured location and not in a motorized vehicle or watercraft. Accessories are included as they were previously.
The special limit of $1,500 on watercraft now excludes model watercraft not designed or used to carry people or cargo or hovercraft. This exclusion was not in the prior policy.
Platinumware is now included in the $2,500 limit for loss by theft of silverware, goldware, etc. Also, items related to guns are now included in the gun special limit of loss applicable to theft. In the prior policy only guns were covered, not items related to guns. Therefore bullets, earphones, cases, are now covered as well.
The limit for loss to personal property used in business and while away from the described location has been increased from $250 to $500. This limit does not apply to the electronic devices discussed in the limits to electronics sections discussed previously.
d. Personal Property Not Covered -
“We” do not cover:
1) property separately described and specifically insured by this or any other policy, regardless of the “limit” that applies to such property under such insurance;
2) animals, birds, fish, or insects;
3) “motorized vehicles”.
a) This includes:
(1) their parts, equipment, and accessories, other than property described in c.3) above; and
(2) electronic devices and accessories that can be operated only from the electrical system of a “motorized vehicle”, including antennas, films, tapes, wires, discs, records, or other media that can be used with such devices; while in or on a “motorized vehicle”.
b) However, this does not include a “motorized vehicle”:
(1) that is designed to assist the handicapped; or
(2) that is:
(a) owned by an “insured”;
(b) designed only for use off of public roads; and
(c) used only to service an “insured premises” or a premises of another;
if such “motorized vehicle” is not required by law or governmental regulation to be registered for use on public roads or property and is not used for “business” purposes;
4) aircraft, meaning apparatus or devices designed or used for flight. This includes parts or equipment of aircraft, whether or not attached. However, this does not include model aircraft that are not designed or used to carry people or cargo;
5) hovercraft, meaning self-propelled motorized ground effect machines or air cushion vehicles, including but not limited to flarecraft, designed or used to travel over land or water. This includes parts or equipment of hovercraft, whether or not attached. However, this does not include model hovercraft that are not designed or used to carry people or cargo;
6) property of roomers, boarders, or other tenants, but this does not include property of roomers or boarders who are related to an “insured”;
7) property rented or held for rental to others by an “insured”, but this does not include property in:
a) that part of the “described location” normally occupied solely by “your” household while rented to others on an occasional basis for residential purposes;
b) the portion of that part of the “described location” normally occupied by “your” household that is rented or held for rental to no more than two roomers or boarders for use as a residence; or
c) an apartment on the “described location” regularly rented or held for rental to others by an “insured”, but only to the extent that coverage for such property is provided under the Incidental Property Coverage for Property In Rental Units;
8) loss that results from credit cards, electronic fund transfer cards, or electronic access devices that make possible the deposit, withdrawal, or transfer of funds, except as provided under the Incidental Property Coverage for Credit Card; Electronic Fund Transfer Card Or Access Device; Forgery; And Counterfeit Money;
9) grave markers or mausoleums, except as provided under the Incidental Property Coverage for Grave Markers;
10) land, including the land on which covered property is located, except as provided under the Incidental Property Coverage for Liquid Fuel Remediation;
11) underground water or surface water; or
12) trees, plants, shrubs, or lawns, except as provided under the Incidental Property Coverage for Debris Removal or the Incidental Property Coverage for Trees, Plants, Shrubs, Or Lawns.
e. Subject to the limitations described in b. and c. above, the “limit” that applies to Coverage C is the most “we” pay per occurrence for all property covered under Coverage C.
Analysis
The personal property not covered section was clarified in the 2008 edition. An exception was added to the exclusion of motor vehicles so that vehicles not required to be registered on public roads, or used for business, or are designed to assist the handicapped or are owned by the insured, designed for use off public roads and used to service the insured's or another premises are covered. For example wheelchairs, motorized scooters, and lawn mowers used to service the premises are covered. Of note is that not only are vehicles used to service the premises covered, but vehicles used to service the premises of another are also covered. Therefore, if the insured has a riding mower that he generally uses on the infirmed neighbor's lawn, there is coverage for that mower.
The exclusion for aircraft has been reworded but the nature of the exclusion has not changed.
New to this section is an exclusion for hovercraft including parts or equipment. Not excluded are model hovercraft that are not designed to carry people or cargo.
The exclusion for loss resulting from credit or debit cards was expanded to include electronic fund transfer cards or access devices that allow the deposit, withdrawal or transfer of funds except as provided under the incidental property coverage for credit card. The new wording clarifies exactly what kind of electronic devices cards are excluded from this section.
Grave markers or mausoleums are excluded except as provided for under the incidental property coverage for grave markers and land is excluded except for coverage provided under the incidental property coverage for liquid fuel remediation. These exclusions identify that while these items are excluded here there is coverage under the incidental property coverage section.
Underground water or surface water is excluded, as are trees, plants shrubs or lawns. Trees, plants shrubs or lawns are covered under the incidental property coverage for debris removal or the incidental coverage for trees, shrubs, etc.
Language stating that the limits that apply to coverage C are the most that apply per occurrence for all property covered under C is added to this section.
Coverage D has been reworded for clarification and there are no coverage changes; therefore this section will not be discussed.
This policy provides the following Incidental Property Coverages. They are subject to all of the “terms” of the applicable Coverage A, Coverage B, or Coverage C. These coverages provide additional insurance unless otherwise stated.
1. Association Deductible
a. “We” pay for “your” share of a deductible applicable to the insurance held by a homeowners, condominium, or similar residential association. Coverage applies only when the deductible:
1) is charged against “you”, during the policy period, as owner or tenant of the “described location”; and
2) results from direct loss to property that:
a) would be eligible for coverage by this policy if it were owned by “you”;
b) is covered under the insurance held by “your” association; and
c) is caused by a Peril Insured Against described under Coverage A in this policy, but this does not include:
(1) earthquake; or
(2) land shock waves or tremors before, during, or after a volcanic eruption.
b. The most “we” pay is $1,500 per occurrence unless a higher “limit” for Association Deductible is shown on the “declarations”. The “limit” that applies is the most “we” pay for any one loss, regardless of the number of deductibles charged against “you”.
c. The Policy Period condition under Conditions Applicable to Property Coverages Only does not apply to this Incidental Property Coverage.
2. Collapse
a. “We” pay for direct physical loss to covered property involving the collapse of a building or a part of a building if the collapse was caused only by one or more of the following:
1) a Peril Insured Against described under Coverage C;
2) insect, rodent, or “vermin” damage, but only if no “insured” knew of or could reasonably be expected to suspect the presence of such damage prior to the collapse;
3) decay, but only if no “insured” knew of or could reasonably be expected to suspect the presence of such decay prior to the collapse;
4) weight of animals, equipment, people, or personal property;
5) weight of rain that collects on a roof; or
6) the use of defective materials or methods in construction or repair if the collapse occurs during the course of construction or repair.
However, “we” do not pay for loss to awnings, bulkheads, cesspools, decks, docks, drains, fences, flues, foundations, patios, paved areas, piers, retaining walls, septic tanks, swimming pools, underground pipes, or wharves caused by a peril described in 2) through 6) above unless the loss is the direct result of the collapse of a building or a part of a building. With respect to loss caused by a peril described in 2) through 6) above, unless the loss is the direct result of the collapse of a building or a part of a building. With respect to loss caused by a peril described in 2) through 6) above,awnings, bulkheads, cesspools, decks, docks, drains, fences, flues, foundations, patios, paved areas, piers, retaining walls, septic tanks, swimming pools, underground pipes, and wharves are not considered to be buildings or parts of buildings, whether or not such property is attached to or connected to one or more buildings.
b. In this Incidental Property Coverage:
1) collapse of a building or a part of a building means an abrupt caving in, falling in, falling down, or giving way of the building or the part of the building that prevents the building or the part of the building from being occupied for the purpose for which it was intended just before caving in, falling in, falling down, or giving way; and
2) the following are not considered to be in a state of collapse:
a) a building or a part of a building that has not caved in, fallen in, fallen down, or given way even if it displays evidence of bending, bowing, bulging, cracking, expansion, inadequate load bearing capacity, leaning, sagging, settling, or shrinkage;
b) a building or a part of a building in danger of caving in, falling in, falling down, or giving way; or
c) a part of a building that has not caved in, fallen in, fallen down, or given way even if it has separated from another part of the building.
However, the “terms” stated in 1) and 2) above do not limit coverage for direct loss to covered property caused by a Peril Insured Against described under Coverage C.
c. With respect to this Incidental Property Coverage, the peril of Weight Of Ice, Snow, Or Sleet means the weight of ice, snow, or sleet that causes damage to a building.
d. This coverage does not increase the “limits” that apply to the property covered.
e. The Bacteria, Fungi, Wet Rot, Or Dry Rot and Errors, Omissions, And Defects exclusions under Exclusions That Apply To Property Coverages do not apply to this Incidental Property Coverage.
3. Credit Card; Electronic Fund Transfer Card Or Access Device; Forgery; And Counterfeit Money
a. “We” pay for loss if an “insured”:
1) by law must pay for the theft or unauthorized use of credit cards issued or registered in the name of an “insured”;
2) has a loss resulting from the theft or unauthorized use of:
a) an electronic fund transfer card; or
b) an electronic access device that makes possible the deposit, withdrawal, or transfer of funds;
issued or registered in the name of an “insured”;
3) has a loss when checks, drafts, or negotiable instruments are forged or altered; or
4) accepts in good faith counterfeit United States or Canadian paper money.
The most “we” pay is $1,500 per occurrence unless a higher “limit” for Credit Card; Electronic Fund Transfer Card Or Access Device; Forgery; And Counterfeit Money is shown on the “declarations”. All loss resulting from a series of acts committed by any one person or in which any one person is involved or implicated is considered one occurrence.
b. “We” will defend a suit seeking damages against an “insured” if the suit results from the theft or unauthorized use of:
1) a credit card;
2) an electronic fund transfer card; or
3) an electronic access device that makes possible the deposit, withdrawal, or transfer of funds;
issued or registered in an “insured's” name.
Subject to the limitation set forth in d. below, “we” will pay for the expense of such defense. Defense will be provided by counsel that “we” choose.
c. At “our” option, “we” may defend an “insured” or an “insured's” bank against a suit for the enforcement of payment when checks, drafts, or negotiable instruments are forged or altered. If “we” choose to provide such defense, “we” will pay for the expense. Defense will be provided by counsel that “we” choose.
d. “We” may make investigations and settle all claims or suits under this coverage that “we” decide are appropriate. “We” do not have to provide a defense after “we” have paid an amount equal to the “limit” that applies to Credit Card; Electronic Fund Transfer Card Or Access Device; Forgery; And Counterfeit Money as a result of a judgment or a written settlement agreed to by “us”.
e. “We” do not pay for loss:
1) that results from the use of a credit card, an electronic fund transfer card, or an electronic access device that makes possible the deposit, withdrawal, or transfer of funds:
a) if an “insured” has not complied with all rules under which the credit card, fund transfer card, or access device was issued or granted;
b) by a resident of “your” household; or
c) by a person who has the credit card, fund transfer card, or access device with the consent of an “insured”;
2) caused by the dishonesty of an “insured”; or
3) that results from the “business” of an “insured”;
nor do “we” provide a defense for suits resulting from such loss.
Analysis
The association deductible provides coverage for a deductible of a condominium, homeowners or other residential association that is assessed to the insured during the policy period. The loss must be a direct loss to property that would be covered under coverage A in this policy if the property were owned by the insured. The most that is paid is $1,500 per occurrence unless a higher limit is stated in the declarations. For example, the community clubhouse sustains a large fire. The association policy will pay the damages, but the association deductible is $20,000. There are twenty homes in the community so each homeowner is assessed $1,000 for their share of the association deductible. This policy would pay the association deductible for the insured.
The collapse coverage specifies that the policy pays for loss when collapse was caused only (emphasis added) by one or more of the listed perils in the policy. This is to clearly indicate that other causes of collapse are not covered. Rodents have been included in the insect or vermin damage peril, and it is specified that this is covered only if no insured knew about or could be expected to suspect the presence of such damage prior to the collapse. Therefore, as long as the insured has seen no sign of any rodents, vermin or insects and there is no damage to visible areas, there is coverage for collapse. However, if there is obvious termite damage to posts and the insured simply didn't get around to taking care of the problem, there is no coverage for collapse. Decay is treated the same way; if the insured did not know about nor could reasonably be expected to suspect such decay existed prior to collapse there is coverage.
Weight of contents or people has been revised to include animals and equipment, and contents is replaced with personal property. Damage to awnings, bulkheads, etc. is covered by perils 2) through 6) when the loss is the direct result of collapse of a building or part of a building. The language regarding part of a building was new to the policy in 2008; also newly included in the items listed were decks. The policy now specifies that regarding perils 2) through 6), awnings, bulkheads, cesspools, decks, docks, drains, fences, flues, foundations, patios, paved areas, piers, retaining walls, septic tanks, swimming pools, underground pipe or wharves are not considered to be buildings or parts of buildings. Therefore, if the deck collapses due to insect damage to the deck only, there is no coverage; the deck is not part of the building, even though it may be attached. If the kitchen wall is damaged due to insects and collapses which results in loss to the deck, then the deck would be covered since part of a building collapsed.
The policy goes on to define collapse and what is not collapse. In order for a loss to be considered collapse, there must be an abrupt caving, falling in or down, or giving way of the building or part of the building that prevents the building or part of the building from being occupied for its intended use. Note that the building or building part must be unusable, and there must be an absolute collapse. The threat of collapse, or leaning, sagging, bending, bowing of a building or part of a building, or even the separating from other parts of the building do not constitute a collapse. If the sunroom separates from the rest of the house that is not considered a collapse.
The bacteria exclusions do not apply to this incidental coverage, this coverage does not increase the property limits, and the weight of ice and snow means the weight of ice or snow that causes damage to a building. Coverage for direct loss to covered property by a peril insured against in coverage C is not limited by the terms stated in 1) and 2).
The credit card coverage includes electronic fund transfer cards or access devices. Theft is now included as a cause of loss for credit cards, electronic fund transfer cards, and access devices that allow deposits/withdrawals/transfers of funds.
A series of acts committed by or involving one person are considered to be one occurrence. The policy now also provides for defense of a suit seeking damages against an insured if the suit is a result of the theft or unauthorized use of an insured's credit or electronic fund access card. The defense will be provided by counsel the carrier selects. The carrier can, at its option, defend an insured or insured's bank when checks have been altered, and the carrier may investigate and settle any claims under this coverage that it decides is appropriate. These are standard defense provisions.
In the section of this coverage defining what is not insured, it is now specifically stated that a defense is not provided for suits resulting from such losses.
4. Debris Removal
a. “We” pay for the reasonable cost to remove the debris of covered property after a loss. The loss must be caused by a Peril Insured Against that applies to the damaged property. “We” also pay for the reasonable cost to remove volcanic ash, dust, or particulate matter that causes direct physical loss to a covered building or covered property contained in a building.
“We” will not pay more for direct physical loss to property and debris removal combined than the “limit” that applies to the damaged property. However, if the covered loss plus the cost of debris removal is more than the applicable “limit”, “we” will pay up to an extra 5% of the applicable “limit” to cover the cost of debris removal.
This coverage does not include any cost or expense to test for, monitor, clean up, remove, contain, treat, detoxify, neutralize, or in any way respond to or assess the effects of “pollutants”.
b. Subject to the limitations set forth in c. below, “we” also pay for the reasonable cost to remove from the “described location”:
1) “your” fallen tree or trees if the falling of the tree or trees is caused by the peril of:
a) Windstorm Or Hail; or
b) Weight Of Ice, Snow, Or Sleet;
or
2) a neighbor's fallen tree or trees if the falling of the tree or trees is caused by any of the Perils Insured Against described under Coverage C in this policy.
Regardless of the number of fallen trees, the most “we” pay is $1,000 per occurrence.
However, “we” pay no more than $500 of this “limit” to remove any one tree.
With respect to this Incidental Property Coverage, the peril of Weight Of Ice, Snow, Or Sleet means the weight of ice, snow, or sleet that causes a tree to fall.
c. The coverage described in b. above applies only to a fallen tree that:
1) causes damage to a covered structure;
2) prevents a “motorized vehicle” that is registered for use on public roads or property from using a driveway on the “described location”; or
3) obstructs a ramp or other fixture designed to make the residence on the “described location” accessible to a handicapped person.
5. Emergency Removal — “We” pay for direct physical loss to covered property that is moved from a premises to prevent a loss from a Peril Insured Against. The property is covered for up to 30 days; however this coverage does not extend past the date on which this policy expires.
This coverage does not increase the “limits” that apply to the property being removed.
The Exclusions That Apply To Coverage A And Coverage B and the Exclusions That Apply To Property Coverages do not apply to such property while removed.
However, “we” do not pay any “insured” for loss that results from any act committed by or at the direction of an “insured” with the intent to cause a loss. This applies even with respect to an “insured” who was not involved in the commission or direction of the act that caused the loss.
6. Fire Department Service Charge — “We” pay for charges assumed by “you” under a contract or an agreement when a fire department is called to save or protect covered property from a Peril Insured Against.
However, “we” do not pay for such charges when the property is located within the limits of the city, municipality, or protection district that provides the fire department response.
The most “we” pay is $500 per occurrence unless a higher “limit” for Fire Department Service Charge is shown on the “declarations”.
7. Glass Or Safety Glazing Material
a. “We” pay for:
1) the breakage of glass or safety glazing material that is part of a covered building or storm door or window; and
2) direct physical loss to covered property caused only by broken pieces of glass or safety glazing material that, before breaking, was part of a building or storm door or window.
b. The Earth Movement exclusion under Exclusions That Apply To Property Coverages does not apply with respect to the coverage described in a. above.
c. Under this Incidental Property Coverage, “we” do not pay for loss:
1) to covered property that occurs because of the breakage of glass or safety glazing material, except as provided in a.2) above; or
2) on the “described location” if the residence covered under Coverage A was vacant for more than 60 days in a row just before the loss.
However, this does not apply to loss caused by breakage of glass or safety glazing material that is the direct result of earth movement. A residence being built is not vacant.
d. This coverage does not increase the “limits” that apply to the property covered.
8. Grave Markers — “We” pay up to $2,500 for direct physical loss to grave markers and mausoleums on or away from the “described location” caused by a Peril Insured Against described under Coverage C. With respect to this Incidental Property Coverage, the peril of Weight Of Ice, Snow, Or Sleet includes the weight of ice, snow, or sleet that causes damage to a mausoleum.
9. Increased Cost — Ordinance Or Law
a. When loss to the residence covered under Coverage A or a related private structure covered under Coverage B is caused by a Peril Insured Against and “you” elect to repair or replace the damage, “you” may apply up to 10% of the Coverage A “limit” to cover the increased cost that “you” incur due to the enforcement of a code, ordinance, or law that regulates the construction, repair, replacement, or demolition of the damaged residence or structure.
b. “You” may use all or part of this Increased Cost — Ordinance Or Law coverage to cover the increased cost “you” incur to remove debris resulting from the construction, repair, replacement, or demolition of the residence covered under Coverage A or a related private structure covered under Coverage B when:
1) loss to the residence or structure is caused by a Peril Insured Against; and
2) a code, ordinance, or law regulates its construction, repair, replacement, or demolition.
This does not increase the “limit” that applies to this Incidental Property Coverage.
c. However, “we” do not pay for:
1) any loss in value of property that results from the enforcement of a code, ordinance, or law; or
2) any loss, cost, or expense that results from the enforcement of a code, ordinance, or law requiring that an “insured” or others test for, monitor, clean up, remove, contain, treat, detoxify, neutralize, or in any way respond to or assess the effects of “pollutants”.
Analysis
Debris removal specifies that the reasonable cost to remove debris is covered, not just any cost. The cost of removal must be reasonable. The loss must be due to a peril insured against, and the removal of volcanic ash or dust is covered when it causes loss to a covered building or covered property within a building. No more than the limit that applies to property will be paid for debris removal; this is different than the prior policy which allowed up to 25% of the limit of the property to be used for debris removal.
Trees are covered for debris removal only for the perils of windstorm or hail, weight of ice, snow, sleet, or a neighbor's tree if the falling is caused by any of the coverage C perils. The prior policy did not contain this restriction. The maximum limit per occurrence has been increased from $500 to $1000 and no more than $500 is available for the removal of any one tree.
Trees are removed when they fall and damage a covered structure, block access to public roads from the driveway on the premises or block the access ramp provided to a handicapped person. A tree that falls in the yard and does not block access to roads or damage a covered structure is not covered.
The emergency removal coverage now states that the exclusions that apply to coverage A and B do not apply to property while it is removed from the premises; the prior policy excepted exclusions that apply to property coverages in general. The coverage for $250 towing charge for a mobile home that is in danger from a peril insured against is no longer provided; that language has been removed from this policy.
The fire department service charge has been changed to specify that charges are not paid when the property is located within the limits of a city, municipal or protection district that provides the fire department response.
The glass or safety glazing coverage language has been clarified and expanded. The policy now specifies that coverage is provided for material that is part of a covered building, storm door or window instead of just a structure. The earth movement exclusion that applies to property coverages does not apply to this coverage. The vacancy condition has been expanded from thirty days to sixty days.
Coverage for grave markers has been increased to $2,500 from $1,500 and covers markers and mausoleums on or away from the described location. The weight of ice, snow and sleet includes the weight of ice, snow or sleet that damages a mausoleum with respect to this coverage.
The increase percentage for ordinance or law coverage has been reduced from 25% to 10% of the Coverage A limit to cover increased costs due to code, ordinance or law enforcement. When loss is caused by a peril insured against and a code, ordinance or law regulates its construction, repair etc. all or part of the increased cost – ordinance or law coverage may be used. There is no extra ten percent above the limit that can be applied in event of a loss involving ordinance or law concerns.
a. “We” pay for loss to:
1) property covered under Coverage A, Coverage B, or Coverage C;
2) land:
a) within the “described location”;
b) owned by an “insured”; and
c) on which the residence covered under Coverage A or a structure covered under Coverage B is located; but this does not include farm land; or
3) property covered under the Incidental Property Coverage for Trees, Plants, Shrubs, Or Lawns;
Asssssssssssssssssssssssssssssssssssssssssssssssss09caused directly or indirectly by the discharge, dispersal, emission, escape, leaching, leakage, migration, release, seepage, or spillage of liquid fuel from the fuel system of a heating or air conditioning system, water heater, or domestic appliance located on the “described location”.
b. When there is discharge, dispersal, emission, escape, leaching, leakage, migration, release, seepage, or spillage of liquid fuel from a fuel system described in a. above, “we” also pay for:
1) cost or expense “you” incur to take temporary measures to stop any further discharge, dispersal, emission, escape, leaching, leakage, migration, release, seepage, or spillage of such fuel from such system;
2) cost or expense “you” incur to prevent or hinder the spread of the discharged, dispersed, emitted, escaped, leached, leaked, migrated, released, seeped, or spilled fuel over a larger area;
3) cost or expense “you” incur to clean up or treat such fuel on or remove such fuel from:
a) property covered under Coverage A, Coverage B, or Coverage C;
b) land:
(1) within the “described location”;
(2) owned by an “insured”; and
(3) on which the residence covered under Coverage A or a structure covered under Coverage B is located;
but this does not include farm land; or
c) property covered under the Incidental Property Coverage for Trees, Plants, Shrubs, Or Lawns.
This includes cost or expense to remove the debris of such property or land;
4) cost or expense “you” incur to remove and replace those parts of covered property necessary to gain access to the system from which such fuel discharged, dispersed, emitted, escaped, leached, leaked, migrated, released, seeped, or spilled;
5) the necessary and reasonable increase in living costs “you” incur to maintain the normal standard of living of “your” household if that part of the “described location” occupied by “your” household is made unfit for use as a residence; and
6) cost or expense “you” incur to assess, monitor, or test the effects of discharged, dispersed, emitted, escaped, leached, leaked, migrated, released, seeped, or spilled liquid fuel.
However, “we” will pay for such cost or expense only if the assessment, monitoring, or testing:
a) is necessitated by a statutory or regulatory requirement or is in response to a request, demand, or order by a governmental body or authority or court of law; and
b) arises out of loss for which payment is made under a., b.1), b.2), or b.3) above.
c. The Policy Period condition under Conditions Applicable to Property Coverages Only does not apply to this Incidental Property Coverage.
d. Under Exclusions That Apply To Coverage A And Coverage B, the exclusion for loss caused by the discharge, dispersal, disposal, emission, escape, leaching, leakage, migration, release, seepage, or spillage of “pollutants” does not apply to the coverage provided under this Incidental Property Coverage for the discharge, dispersal, emission, escape, leaching, leakage, migration, release, seepage, or spillage of liquid fuel.
e. “We” do not pay for:
1) loss, cost, or expense involving underground water or surface water;
2) loss, cost, or expense involving trees, plants, shrubs, or lawns grown for “business”;
3) loss, cost, or expense due to the cancellation of a lease or an agreement;
4) the replacement of discharged, dispersed, emitted, escaped, leached, leaked, migrated, released, seeped, or spilled fuel;
5) any loss in the market value of property or land, whether or not damaged by discharged, dispersed, emitted, escaped, leached, leaked, migrated, released, seeped, or spilled fuel;
6) any damages resulting from:
a) a loss of; or
b) a reduction in value of;
an agreement to sell property or land; or
7) any cost or expense to repair, replace, remove, or demolish any part of the fuel system from which the fuel discharged, dispersed, emitted, escaped, leached, leaked, migrated, released, seeped, or spilled, except as provided under b. above.
f. The “terms” and “limits” applicable to:
1) Coverage D — Additional Living Costs And Loss Of Rent; and
2) the Incidental Property Coverage for Debris Removal;
do not apply to any loss, cost, or expense arising out of the discharge, dispersal, emission, escape, leaching, leakage, migration, release, seepage, or spillage of fuel from a fuel system described in a. above.
g. The most “we” pay for this Incidental Property Coverage for Liquid Fuel Remediation is $10,000 unless a higher “limit” for Liquid Fuel Remediation is shown on the “declarations”. The “limit” for this Incidental Property Coverage for Liquid Fuel Remediation:
1) is the most “we” pay for the total of:
a) all discharges, dispersals, emissions, escapes, leachings, leakages, migrations, releases, seepages, or spillages of liquid fuel that an “insured” first discovers or is made aware of during the policy period; and
b) all coverages described in a. and b. above; and
2) applies regardless of the number of:
a) claims made;
b) discharges, dispersals, emissions, escapes, leachings, leakages, migrations, releases, seepages, or spillages of liquid fuel that an “insured” first discovers or is made aware of during the policy period; or
c) locations insured under this policy.
With respect to loss to property covered under the Incidental Property Coverage for Trees, Plants, Shrubs, Or Lawns, the most “we” pay is an amount equal to 5% of the Coverage A “limit”, but not more than $500 for any lawn or any one tree, plant, or shrub. This does not increase the “limit” that applies to this Incidental Property Coverage for Liquid Fuel Remediation. With respect to coverage for the necessary and reasonable increase in living costs incurred to maintain the normal standard of living of “your” household, “we” pay only for the period of time reasonably required to make the “described location” fit for use or, if “your” household is permanently relocated, only for the period of time reasonably required for relocation. This period of time is not limited by the policy period. This does not increase the “limit” that applies to this Incidental Property Coverage for Liquid Fuel Remediation.
Analysis
This entire section on liquid fuel remediation was new in 2008. The covered property is property under coverage A, B, or C, including land within the described location, owned by the insured and on which the residence is located. Also included is property covered under incidental trees, plants, and shrubs coverage. Not included is farm land. The property land is covered for loss caused directly or indirectly from the discharge, spillage, leakage, etc. of liquid fuel from the fuel system of a heating or air conditioning system, water heater or domestic appliance located on the premises. Note that the fuel must come from an appliance or system for the household; if the truck delivering heating fuel springs a leak in the driveway and oil seeps into the ground, there is no coverage. When the fuel release is from a covered system, the policy also covers the cost to the named insured for expenses taken to temporarily stop further discharge, to prevent spread of the discharge over a larger area, and the cost to clean up or treat fuel on, or remove fuel from the covered property. Also included is the cost to remove the debris of such property or land, expenses to remove and replace parts of covered property in order to gain access to the system causing the loss, and increased costs of living if the part of the house occupied by the named insured is made uninhabitable by the loss.
The costs incurred to assess, monitor or test the effects of the fuel are covered only if such testing is required by regulation or is in response to a request/order of a governmental agency. The exclusion for loss caused by the discharge, disposal, escape etc. of pollutants does not apply to this incidental property coverage. Also not applicable to this coverage is the policy period condition under conditions applicable to property coverages only.
Not covered by this section is loss, cost, or expense involving underground or surface water, trees, shrubs, plants grown for business, due to the cancellation of a lease or agreement, replacement of escaped fuel, loss to market value of any land, damages resulting from loss of or reduction in value of an agreement to sell property or land, and any cost to repair the fuel system that is not covered above. The escape or spill of liquid fuel is covered for the covered property only; if fuel leaches into the groundwater or other underground water that is not covered. The costs to prevent the spread of the spill or leak are covered to encourage the insured to mitigate the loss as soon as possible.
The terms and limits of the policy that apply to additional living costs and loss of rent and incidental property coverage for debris removal do not apply to losses of property listed in a., property covered under A, B, or C and land excluding farm land.
Unless a larger amount is specified in the declarations, the limit for fuel remediation is $10,000. This is the maximum paid for all discharges, dispersals, etc. during a policy period and for all coverages described in a and b above. The limit applies regardless of the number of claims made or discharges during the policy period. Therefore, if during the policy period an insured experiences three separate discharges from the heating system of the house and the value of all three losses is $25,000 the most that will be paid is $10,000 during the policy period.
Property covered under the incidental coverage for trees, plants, shrubs, and lawns is limited to a maximum of five percent of the coverage A limit, and not more than $500 for any lawn, any one tree, plant or shrub. This does not increase the limit applicable to the incidental liquid fuel remediation coverage.
The coverage for increased living costs incurred pays for the reasonable period of time to make the household fit for use or the amount of reasonable time to permanently relocate the household.
11. Loss Assessment
a. “We” pay for “your” share of an assessment levied by a homeowners, condominium, or similar residential association. Coverage applies only when the assessment:
1) is levied during the policy period;
2) results from direct loss to property that is:
a) owned collectively by all association members;
b) of the type that would be eligible for coverage by this policy if it were owned by “you”; and
c) caused by a Peril Insured Against described under Coverage A in this policy, but this does not include:
(1) earthquake; or
(2) land shock waves or tremors before, during, or after a volcanic eruption; and
3) is levied against “you” as owner or tenant of the “described location”.
b. However, “we” do not pay for an assessment that:
1) results from a deductible in the insurance held by the association; or
2) is levied against “you” or the association by any governmental body or authority.
c. The most “we” pay is $1,500 per occurrence unless a higher “limit” for Loss Assessment is shown on the “declarations”. The “limit” that applies is the most “we” pay for any one loss, regardless of the number of assessments.
d. The Policy Period condition under Conditions Applicable to Property Coverages Only does not apply to this Incidental Property Coverage.
12. Property In Rental Units — “We” pay for direct physical loss to “your” appliances, carpeting, and other household furnishings in an apartment on the “described location” regularly rented or held for rental to others by an “insured” when the loss is caused by a Peril Insured Against described under Coverage C, other than the peril of Theft.
The most “we” pay for loss to such property in each apartment rented or held for rental to others is $2,500 per occurrence. The “limit” applies regardless of the quantity of appliances, carpeting, or other household furnishings damaged.
This coverage does not increase the “limits” that apply to the property covered.
13. Reasonable Repairs
a. “We” pay for the reasonable costs incurred by “you” for necessary measures performed solely to protect covered property from further damage by a Peril Insured Against if a Peril Insured Against has already caused a loss.
b. If the measures described in a. above involve repair to other damaged property, “we” pay only if the property that is repaired is covered by this policy and only if the damage that necessitates the repair is caused by a Peril Insured Against.
This coverage does not:
1) increase the “limit” that applies to the property covered; or
2) relieve “you” of the duties described in 1.b., Protecting Property, under What Must Be Done In Case Of Loss Or Occurrence.
14. Refrigerated Property — “We” pay for direct loss to covered property stored in a freezer or refrigerated unit on the “described location” caused by:
a. complete or partial disruption of electrical power due to conditions beyond an “insured's” control, if such disruption is caused by damage to the generating or transmission equipment; or
b. mechanical breakdown of the freezer or refrigerated unit.
Coverage applies only if the freezer or refrigerated unit had been maintained in proper working order prior to the loss.
The most “we” pay is $500 per occurrence unless a higher “limit” for Refrigerated Property is shown on the “declarations”.
The Power Failure and Bacteria, Fungi, Wet Rot, Or Dry Rot exclusions under Exclusions That Apply To Property Coverages do not apply to this Incidental Property Coverage.
15. Trees, Plants, Shrubs, Or Lawns — “We” pay for direct physical loss to trees, plants, shrubs, or lawns on the “described location” caused by:
a. Fire Or Lightning, Explosion, Riot Or Civil Commotion, Aircraft;
b. Vehicles if not owned or operated by an occupant of the “described location”; or
c. Vandalism Or Malicious Mischief or Theft.
“You” may apply up to 5% of the Coverage A “limit” to cover trees, plants, shrubs, or lawns. “We” do not pay more than $500 for each tree, plant, or shrub. This includes the cost to remove the debris of the covered item.
“We” do not cover trees, plants, shrubs, or lawns grown for “business”.
Analysis
The loss assessment coverage has some modifications; the reference to a mobile homeowners association has been removed as has the reference to volcanic effusion or explosion; only earthquake, or landshock waves before, during or after a volcanic eruption are indicated as excluded. New to the exclusions is that part of an association deductible; that is handled by separate coverage discussed earlier. This coverage has the option of increased limit per occurrence; the limit is still $1500 but the insured now has the option of indicating a larger amount on the declarations.
The property in rental units and reasonable repairs sections were new to the policy in 2008. Appliances, carpeting, and other furnishings that are in an apartment regularly rented are covered to a maximum of $2,500 each occurrence. The reasonable repairs section provides coverage to protect property from further damage once a peril insured against has caused a loss. If other property is involved in this repair, it is covered only if the property is covered by the policy and damaged by a peril insured against.
Refrigerated property has been broadened to include refrigerated property, not just food. The coverage has been clarified to indicate that a complete or partial disruption of power is covered as long as it is beyond an insured's control. The prior policy stated the power disruption and mechanical breakdown reference to wear and tear under exclusions that apply to property coverage do not apply to this coverage. This policy states that the power failure and bacteria, fungi, wet or dry rot exclusions do not apply. Removed from that language is the language stating that mechanical breakdown under wear and tear does not apply.
The coverage for trees, plants, shrubs or lawns has been modified. Malicious mischief is also covered now along with vandalism or theft. The ability to use up to ten percent of the coverage C limit to cover trees, plants or shrubs has been reduced to five percent of coverage C.
Perils Insured Against – Coverages A, B, C, and D
1. Coverage A — Residence And Coverage B — Related Private Structures — “We” insure property covered under Coverage A or Coverage B for risks of direct physical loss, unless the loss is excluded under the Exclusions That Apply To Coverage A And Coverage B.
a. Exclusions That Apply To Coverage A And Coverage B
1) “We” do not pay for loss excluded under the Exclusions That Apply To Property Coverages.
2) Freezing, Discharge, Leakage, Or Overflow — Subject to the exceptions stated in a) and b) below, “we” do not pay for loss caused by freezing of, or the resulting discharge, leakage, or overflow from, a plumbing, heating, air-conditioning, or automatic fire protective sprinkling system, water heater, or domestic appliance.
a) When the building is protected by an automatic fire protective sprinkling system, this exclusion does not apply if “you” have taken reasonable care to:
(1) maintain heat in the building; and
(2) continue the water supply.
b) When the building is not protected by an automatic fire protective sprinkling system, this exclusion does not apply if “you” have taken reasonable care to:
(1) maintain heat in the building; or
(2) shut off the water supply and completely empty water from all systems, heaters, and appliances.
With respect to this exclusion and the exceptions stated in a) and b) above, plumbing systems and domestic appliances do not include sumps, sump pumps, or related equipment; any other type of system designed to remove subsurface water which is drained from the foundation area; or roof drains, gutters, downspouts, or like equipment.
3) Freezing, Thawing, Pressure, Or Weight Of Ice Or Water — “We” do not pay for loss caused by freezing, thawing, pressure, or weight of ice or water, whether driven by wind or not, to:
a) fences, patios, paved areas, or swimming pools;
b) bulkheads, footings, foundations, walls, or any other structures or features that support all or part of a building or other structure;
c) bulkheads or retaining walls that do not support all or part of a building or other structure; or
d) docks, piers, or wharves.
4) Theft — “We” do not pay for loss caused by theft in or to a residence being built, or theft of materials or supplies for use in construction of the residence, until the residence is occupied for its intended use.
5) Vandalism Or Malicious Mischief — “We” do not pay for loss:
a) caused by vandalism or malicious mischief; or
b) that ensues from a wrongful act committed intentionally in the course of vandalism or malicious mischief;
if the residence covered under Coverage A was vacant for more than 60 days in a row just before the loss. A residence being built is not vacant.
6) Water, Humidity, Moisture, Or Vapor — “We” do not pay for loss caused by:
a) continuous or repeated discharge, seepage, or leakage of water; or
b) the presence or condensation of humidity, moisture, or vapor;
over a period of weeks, months, or years, unless no “insured” knew of or could reasonably be expected to suspect such discharge, seepage, or leakage of water or the presence or condensation of humidity, moisture, or vapor.
Under Exclusions That Apply To Property Coverages, 1)b) and 3) of the Water Damage exclusion that apply to surface water and water below the surface of the ground do not apply with respect to loss caused by continuous or repeated discharge, seepage, or leakage of water from a plumbing, heating, air-conditioning, or automatic fire protective
sprinkling system, water heater, or domestic appliance on the “described location” if no “insured” knew of or could reasonably be expected to suspect such discharge, seepage, or leakage of water.
Plumbing systems and domestic appliances do not include sumps, sump pumps, or related equipment; any other type of system designed to remove subsurface water which is drained from the foundation area; or roof drains, gutters, downspouts, or like equipment.
7) Collapse Or Impairment — “We” do not pay for loss involving:
a) collapse; or
b) impairment of structural integrity, including but not limited to sagging, bowing, bending, leaning, or inadequacy of load bearing capacity;
except as provided under the Incidental Property Coverage for Collapse.
8) Settling, Cracking, Shrinking, Bulging, Or Expanding — “We” do not pay for loss caused by the settling, cracking, shrinking, bulging, or expanding of:
a) bulkheads;
b) ceilings;
c) floors;
d) footings;
e) foundations;
f) patios;
g) paved areas;
h) roofs; or
i) walls.
9) Birds, Vermin, Rodents, Insects, Or Animals — “We” do not pay for loss caused by:
a) birds;
b) “vermin”;
c) rodents;
d) insects; or
e) any animal owned or kept by an “insured”;
except as provided under the Incidental Property Coverages.
10) Smoke — “We” do not pay for loss caused by smoke from agricultural smudging or industrial operations.
11) Pollutants — “We” do not pay for loss caused by the discharge, dispersal, disposal, emission, escape, leaching, leakage, migration, release, seepage, or spillage of “pollutants”, unless the discharge, dispersal, disposal, emission, escape, leaching, leakage, migration, release, seepage, or spillage is caused by a Peril Insured Against described under Coverage C.
12) Wear And Tear — “We” do not pay for loss caused by:
a) wear and tear, marring, or deterioration;
b) mechanical breakdown, latent defect, inherent vice, or any quality, fault, or weakness in property that causes it to damage or destroy itself;
c) rust or other corrosion or smog; or
d) pressure from or the presence of roots of trees, plants, shrubs, or other vegetation.
b. Exceptions To Exclusions That Apply To Coverage A And Coverage B
1) “We” pay for an ensuing loss that results from a.2) through a.12) above, unless the ensuing loss itself is excluded.
2) Unless the loss is otherwise excluded by this policy, “we” pay for loss to property covered under Coverage A or Coverage B that results from water or steam that, due to a cause or event excluded under a.8) through a.12) above, accidentally discharges or overflows from:
a) a storm drain, or a water, steam, or sewer pipe, away from the “described location”; or
b) a plumbing, heating, air conditioning, or automatic fire protective sprinkling system, water heater, or domestic appliance on the “described location”. This includes the reasonable cost of removing and replacing those parts of a building or other structure on the “described location” needed to repair the system, heater, or appliance. However, “we” will pay the cost of removing and replacing part of a structure that is not a building only if the water or steam causes direct physical loss to a building on the “described location”.
“We” do not pay for loss to the system, heater, or appliance from which the water or steam escaped.
In this exception, plumbing systems and domestic appliances do not include sumps, sump pumps, or related equipment; any other type of system designed to remove subsurface which is drained from the foundation area; or roof drains, gutters, downspouts, or like equipment.
Under Exclusions That Apply To Property Coverages, 1)b) and 3) of the Water exclusion that apply to surface water and water below the surface of the ground do not apply with respect to loss by water covered under this exception.
Analysis
There are changes throughout the perils insured against. Under exclusions that apply to coverage A and coverage B, the first exclusion picks up the exclusions that apply to property coverages; therefore the exclusions listed later in the policy are also specifically excluded for coverages A and B. In the freezing, discharge, leakage or overflow peril, the vacancy and unoccupancy provisions have been removed. In their place are requirements for when the building is protected by an automatic fire protection sprinkling system. When the property is protected by a sprinkler system the exclusion does not apply if heat has been maintained in the building and the water supply has been continued. If there is no sprinkler system, the exclusion does not apply if the heat has been maintained in the building or the water supply has been shut off and the water drained from all systems. These provisions are similar to the vacancy requirements, but are based now on the presence of a sprinkler system. Therefore, if the property with a sprinkler system has been left vacant for six months and the pipes freeze and burst, as long as the heat and water supply have been maintained, there is coverage. The policy now specifies that plumbing systems and appliances do not include roof drains, gutters, downspouts, or like equipment or sumps or related equipment.
The exclusion for freezing, thawing, pressure or weight of ice or water specifically includes walls or any other structures or features that support all or part of a building or other structure and bulkheads or retaining walls that do not support all or part of building or other structure. The prior policy simply excluded retaining walls, bulkheads and foundations. This clarifies the exclusion and specifically indicates what is not excluded.
The exclusion for vandalism now includes malicious mischief, and loss caused by an intentional action in the course or vandalism or malicious mischief. While vandalism and malicious mischief are similar, they are not identical. Merriam Webster Online defines vandalism as willful or malicious destruction or defacement of public or private property. Malicious is arising from malice, which is a desire to cause pain, injury or distress of another. Malicious mischief is an action to cause damage with intended malice, whereas vandalism is willful but not necessarily malicious. The vacancy restriction has been expanded from thirty days to sixty days.
The seepage or leakage exclusion has been modified and replaced with an exclusion for water, humidity, moisture or vapor. Repeated or continuous seepage or leakage from plumbing, heating, air-conditioning systems etc. remains the same. New is the exclusion of the presence or condensation of humidity, moisture, or vapor. The policy specifically states that loss over a period of weeks, months, or years is excluded unless no named insured knew or could reasonably be expected to suspect that there was a problem. The language regarding exceptions to this exclusion has been moved into a separate section under exceptions to exclusions that apply to coverage A and coverage B. Parts one and three (loss caused by freezing, thawing, pressure, weight) of the Water Damage exclusion do not apply with respect to loss by water covered under this exception. Therefore, if because of freezing and thawing the pipes leak, loss which the insured could not reasonably suspect existed will be covered.
The collapse exclusion has been expanded to include impairment of structural integrity which includes but is not limited to sagging, bowing, bending, leaning or inadequacy of load bearing except as provided under the incidental collapse coverage. This clarifies the meaning of collapse.
The settling, cracking, shrinking exclusion has been revised; references to mobile homes, buildings, or other outdoor structures have been removed, and bulkheads, ceilings, floors, footings, foundations, roofs or walls are specifically identified. Therefore only the items mentioned are what is excluded.
The pollution exclusion is expanded to include the disposal, emission, escape, leaching, leakage, or spillage of pollutants.
The exclusion for wear and tear that had been in the section of exclusions that apply to property damage has been moved to this section, exclusions that apply to coverages A and B. New to this exclusion is any quality, fault or weakness in property that causes it to damage or destroy itself, and the pressure from the presence of roots of trees, plants, shrubs or other vegetation is also excluded. This provides a reduction in coverage by excluding more causes of loss.
The policy contains a new section of exceptions to the above exclusions that apply to coverages A and B. The exception covers losses resulting from the listed excluded perils unless that resultant loss is specifically excluded as well. The listed perils are in a.2) through 12), and begin with freezing, discharge, leakage or overflow. For example, rodents chew into the house and chew the wiring. The damage to the siding and wiring is not covered. However, if a fire results from the damaged wiring, as fire is a covered loss, that fire would be covered even though it was caused by an excluded peril, a rodent.
Another exception is that loss resulting from water or steam due to an excluded cause of birds, vermin, smoke, pollutants, or wear and tear is covered if water accidentally discharges or overflows from a storm drain, water, steam, or sewer pipe away from the described location. Water or steam is also covered if it discharges or overflows from a plumbing, heating, air-conditioning, sprinkler system, water heater or domestic appliance on the described location. Included in this coverage is the reasonable cost of removing and replacing those parts of a building or structure in order to repair the system, heater or appliance. The cost to repair to the system from which the water escaped is not covered, only the cost to get to the system. Therefore, if water escapes from a pipe due to wear and tear and floods the basement, the damage to the basement would be covered as would the cost to gain access to the worn out pipe. The cost to repair the pipe itself is not covered. Plumbing systems and domestic appliances do not include roof drains, gutters, downspouts, or like equipment or sumps, sump pumps, or related equipment.
2. Coverage C — Personal Property — “We” insure against direct physical loss to property covered under Coverage C caused by the following perils, unless the loss is excluded under the Exclusions That Apply To Property Coverages:
a. Fire Or Lightning
b. Windstorm Or Hail
However, “we” do not pay for loss:
1) to property inside a building caused by dust, rain, sand, sleet, or snow, all whether driven by wind or not, that enters through an opening in the building not made by the direct force of wind or hail; or
2) to watercraft or their furnishings, equipment, engines, motors, trailers, or semitrailers unless inside a fully enclosed building.
c. Explosion
d. Riot Or Civil Commotion
e. Aircraft — This includes self-propelled missiles and spacecraft.
f. Vehicles
g. Sudden And Accidental Damage From Smoke — This includes sudden and accidental damage from fumes, smoke, soot, or vapors that emit or back up from a boiler, furnace, or related equipment.
However, “we” do not pay for loss caused by smoke from agricultural smudging or industrial operations.
h. Volcanic Eruption
However, this does not include loss caused by earthquake, land shock waves, or tremors.
i. Vandalism Or Malicious Mischief
j. Theft — This includes attempted theft and loss of property from a known place when it is likely that theft occurred.
However, “we” do not pay for loss:
1) caused by theft by an “insured”;
2) caused by theft in or to a residence being built, or theft of materials or supplies for use in construction of the residence, until the residence is occupied for its intended use;
3) of a precious or semiprecious stone from its setting;
4) that results from the theft of:
a) a credit card;
b) an electronic fund transfer card;
or
c) an electronic access device that makes possible the deposit, withdrawal, or transfer of funds;
except as provided under the Incidental Property Coverage for Credit Card; Electronic Fund Transfer Card Or Access Device; Forgery; And Counterfeit Money;
5) caused by theft from a part of the “described location” rented by an “insured” to a person other than another “insured”; or
6) caused by theft that occurs away from the “described location” of:
a) trailers or semitrailers;
b) campers or camper bodies;
c) watercraft or their furnishings, equipment, engines, or motors;
or
d) property while on the part of residential premises that an “insured” owns, rents, or occupies, except for the time while an “insured” temporarily resides there. “We” do cover the property of an “insured” who is a student while it is in the living quarters occupied by the student at school if the student has been at such living quarters at any time during the 60 days just before the loss.
k. Falling Objects
However, “we” do not pay for loss to:
1) property inside a building, unless the falling object has first damaged an outside wall or the roof of the building by impact; or
2) the object that falls.
l. Weight Of Ice, Snow, Or Sleet that causes damage to property inside a building.
m. Sudden And Accidental Tearing Apart, Cracking, Burning, Or Bulging of a steam or hot water heating system, an air-conditioning or automatic fire protective sprinkling system, or a water heater.
However, “we” do not pay for loss caused by or resulting from freezing, except as provided under the peril of Freezing.
n. Accidental Discharge Or Overflow Of Water Or Steam from a plumbing, heating, air-conditioning, or automatic fire protective sprinkling system, water heater, or domestic appliance.
However, “we” do not pay for loss:
1) caused by continuous or repeated discharge, seepage, or leakage of water, or the presence or condensation of humidity, moisture, or vapor, over a period of weeks, months, or years, unless no “insured” could reasonably be expected to suspect such discharge, seepage, or leakage of water or the presence or condensation of humidity, moisture, or vapor;
2) caused by or resulting from freezing, except as provided under the peril of Freezing;
3) on the “described location” caused by accidental discharge or overflow that comes from off the “described location”; or
4) to the system or appliance from which the water or steam escaped.
In this peril, plumbing systems and domestic appliances do not sumps, sump pumps, or related equipment; any other type of system designed to remove subsurface water which is drained from the foundation area; or roof drains, gutters, downspouts, or like equipment.
Under Exclusions That Apply To Property Coverages, 1)b) and 3) of the Water exclusion that apply to surface water and water below the surface of the ground do not apply with respect to loss by water covered under this peril.
Freezing — This means freezing of a plumbing, heating, air-conditioning, or automatic fire protective sprinkling system, water heater, or domestic appliance, subject to the requirements stated in 1) and 2) below. In this peril, plumbing systems and domestic appliances do not include roof drains, gutters, downspouts, or like equipment or sumps, sump pumps, or related equipment.
1) When the building is protected by an automatic fire protective sprinkling system, coverage for loss caused by the peril of Freezing applies only if “you” have taken reasonable care to:
a) maintain heat in the building; and
b) continue the water supply.
2) When the building is not protected by an automatic fire protective sprinkling system, coverage for loss caused by the peril of Freezing applies only if “you” have taken reasonable care to:
a) maintain heat in the building; or
b) shut off the water supply and completely empty water from all systems and appliances.
p. Sudden And Accidental Damage From Artificially Generated Electrical Currents
However, “we” do not pay for loss to tubes, transistors, electronic components, or circuitry that are a part of any type of an electronic apparatus, including but not limited to appliances, fixtures, computers, and home entertainment units.
q. Sinkhole Collapse — This means the sudden settlement or collapse of earth supporting covered property. The earth settlement or collapse must result from subterranean voids created by the action of water on a limestone or similar rock formation. However, “we” do not cover the cost of filling sinkholes.
Analysis
In the peril for windstorm or hail, water has been removed from the exclusion as a cause of loss to property inside a building caused by dust, rain, sleet or snow, wind driven or not, that enters through an opening in a building not created by the effect of wind or hail. Therefore, water that enters the building as a result of a windstorm or hailstorm is covered.
The exception to the exclusion for watercraft of canoes and rowboats while on the insured premises has been removed. The coverage still exists for these items, but the exception to the exclusion has been removed to avoid confusion.
Aircraft now includes self-propelled missiles and spacecraft as part of the peril. If a piece of a satellite falls and damages the house, there is coverage.
The smoke and accidental damage from smoke peril has added a description of covered events such as damage from fumes, smoke, soot, or vapors that emit or backup from a boiler, furnace or related equipment. This allows coverage for the occasional puff back when homeowners first turn on the heating system in the winter.
Removed from the volcanic eruption perils is the definition of what volcanic action is, and the inclusion of an exclusion for loss caused by earthquake, shock waves or tremors.
Malicious mischief has been added to the vandalism peril.
The theft peril has some minor rewording, the inclusion of electronic access devices with debit and credit cards, for example. The significant change is that in order for property of a student to be covered for property away at school, the student must have occupied such living quarters during the sixty days just before the loss.
The sudden and accidental tearing apart, cracking, burning or bulging peril now includes steam or hot water heating systems. The exclusion for loss caused by freezing except for what is covered under the peril of freezing is reworded to include loss resulting from freezing.
Changes to the accidental discharge or overflow of water or steam peril include the specification of water to the continuous or repeated leakage or seepage exclusion, as well as discharge, and the presence of condensation or humidity, moisture or vapor over weeks, months, or years unless an insured could not reasonably be expected to suspect such a situation. Plumbing systems excluded from this peril include roof drains, gutters, downspouts or like equipment.
The freezing peril for personal property has the same modifications as the exception to the exclusion for the freezing peril for coverages A and B. The vacancy provisions have been removed and have been replaced with provisions regarding maintenance of heat and water in a building when there is an automatic fire protective sprinkling system.
Sudden and accidental damage from artificially generated electrical currents has been clarified by making specific reference to computers, fixtures, appliances and home entertainment units.
Exclusions That Apply to Property Coverages
1. “We” do not pay for loss or damage caused directly or indirectly by one or more of the following excluded causes or events. Such loss or damage is excluded regardless of other causes or events that contribute to or aggravate the loss, whether such causes or events act to produce the loss before, at the same time as, or after the excluded causes or events. These exclusions apply whether or not an extensive area suffers damage from or is affected by the excluded cause or event.
a. Ordinance Or Law – “We” do not pay for:
1) any loss or increased cost that results from the enforcement of a code, ordinance, or law that regulates the construction, repair, or demolition of property or the removal of its debris, except as provided under the Incidental Property Coverage for Increased Cost — Ordinance Or Law;
2) any loss in value of property that results from the enforcement of a code, ordinance, or law; or
3) any loss, cost, or expense that results from the enforcement of a code, ordinance, or law requiring that an “insured” or others test for, monitor, clean up, remove, contain, treat, detoxify, neutralize, or in any way respond to or assess the effects of “pollutants”. This exclusion applies whether or not there has been physical damage to covered property.
b. Civil Authority – “We” do not pay for loss caused by the confiscation, destruction, or seizure of property covered under Coverage A, Coverage B, or Coverage C by order of civil authority. “We” do pay for loss caused by acts ordered by a civil authority at the time of a fire to prevent its spread, but only if loss caused by the fire would be covered by this policy.
c. Nuclear Hazard
1) “We” do not pay for loss caused by nuclear reaction, radiation, or radioactive contamination:
a) whether controlled or uncontrolled; or
b) however caused; or any consequence of such reaction, radiation, or contamination.
2) Loss caused by nuclear reaction, radiation, or radioactive contamination is not considered loss caused by:
a) fire;
b) explosion; or
c) smoke;
even if this policy provides coverage for loss caused by one or more of these perils.
3) Direct loss by fire resulting from nuclear reaction, radiation, or radioactive contamination is covered.
d. War And Military Action – “We” do not pay for loss caused by:
1) war, including undeclared or civil war;
2) warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign, or other authority using military personnel or other agents; or
3) insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. With respect to any action that comes within the “terms” of this exclusion and involves nuclear reaction, radiation, or radioactive contamination, this War And Military Action exclusion supersedes the Nuclear Hazard exclusion. Discharge of a nuclear weapon is deemed a warlike action even if it is accidental.
e. Neglect – “We” do not pay for loss caused by the neglect of an “insured” to use all reasonable means to save and preserve covered property at and after the time of a loss.
f. Earth Movement – “We” do not pay for loss caused by earth movement whether the earth movement results from or is caused by human or animal forces or an act of nature.
Earth movement means:
1) earthquake;
2) land shock waves or tremors before, during, or after a volcanic eruption;
3) landslide, mudflow, mudslide;
4) subsidence, erosion; or
5) any other earth movement, including but not limited to earth sinking, rising, shifting, expanding, or contracting. However, this does not include Sinkhole Collapse as described under the Perils Insured Against that apply to Coverage C.
“We” do pay for direct loss to covered property caused by fire or explosion resulting from earth movement.
This exclusion does not apply to loss caused by theft that is otherwise covered by this policy.
g. Water Damage – “We” do not pay for loss caused by water damage whether the water damage results from or is caused by human or animal forces or an act of nature.
Water damage means:
1) flood, surface water, waves, tidal water, overflow of a body of water, or spray from any of these, all whether driven by wind or not;
2) water or matter present in water that backs up through sewers or drains or that overflows or is discharged from:
a) a sump, sump pump, or related equipment; or
b) any other type of system designed to remove subsurface water which is drained from the foundation area; or
3) water or matter present in water below the surface of the ground. This includes water or matter present in water that exerts pressure on, or seeps or leaks through or into, a building, sidewalk, driveway, foundation, swimming pool, or other structure. “We” do pay for direct loss to covered property caused by fire or explosion resulting from water damage. This exclusion does not apply to loss caused by theft that is otherwise covered by this policy.
h. Power Failure – “We” do not pay for loss caused by the failure of power or other utility service, whether or not it is caused by a Peril Insured Against, if the cause of the failure is not on the “described location”.
“We” do pay for direct loss that is otherwise covered by this policy that occurs on the “described location” as a result of the failure of power or other utility service.
i. Intentional Acts – “We” do not pay any “insured” for loss that results from any act committed:
1) by an “insured”, alone or in collusion with another; or
2) at the direction of an “insured”; with the intent to cause a loss. This exclusion applies even with respect to an “insured” who was not involved in the commission or direction of the act that caused the loss.
j. Bacteria, Fungi, Wet Rot, Or Dry Rot – “We” do not pay for loss, cost, or expense caused by, consisting of, or relating to the existence of or any activity of bacteria, “fungi”, wet rot, or dry rot that is not the direct result of a Peril Insured Against. “We” do pay for direct loss to covered property caused by a Peril Insured Against resulting from bacteria, “fungi”, wet rot, or dry rot.
2. “We” do not pay for loss or damage to property covered under Coverage A or Coverage B that is caused by or results from one or more of the following excluded causes or events. However, “we” do pay for an ensuing loss to property covered under Coverage A or Coverage B that is otherwise covered by this policy.
a. Weather Conditions – “We” do not pay for loss caused by weather conditions that initiate, set in motion, or in any way contribute to a cause or event excluded under the preceding Exclusions That Apply To Property Coverages (Numbers 1.a. through 1.j).
b. Errors, Omissions, And Defects –
“We” do not pay for loss caused by one or more of the following:
1) an act or decision of any person, group, organization, or governmental body or authority, or the failure of any person, group, organization, or governmental body or authority to act or decide; or
2) a defect, a weakness, the inadequacy, a fault, or unsoundness in the:
a) development, planning, siting, surveying, zoning;
b) construction, compaction, design, grading, remodeling, renovation, repair, specification, workmanship;
c) materials used in construction, remodeling, renovation, or repair; or
d) maintenance; of any property, whether in whole or in part, and whether on or away from the “described location”, except as provided under the Incidental Property Coverage for Collapse.
Analysis
Many of the exclusions that apply to property coverages have minor wording changes. Ordinance or law now excludes loss from the enforcement of a code or law that regulates the construction, repair or demolition of property, and no longer includes codes or laws that regulate the use of property. The civil authority exclusion has been clarified and indicates that loss caused by the confiscation, destruction, or seizure of property covered under coverage A, B, or C by order of civil authority is excluded. The prior policy did not specify the cause of loss; just that loss resulting from the action of civil authority was excluded.
The nuclear hazard and war and military action exclusions have minor wording changes but the nature of the exclusion is not changed. The war exclusion specifies that it supersedes the nuclear hazard exclusion regarding reaction, radiation, or radioactive contamination.
Animal forces are now included in the earth movement exclusion. Also, the coverage for breakage of glass that is part of a covered structure resulting from earth movement has been removed from this section. That coverage is now provided in the incidental glass coverage so an exception to the exclusion is no longer needed here.
Water damage has also been revised to exclude damage caused by human or animal forces, as well as acts of nature. Not only is water below the surface of the ground excluded, but matter in water below the surface of the ground is excluded. If the loss is caused by theft, then this exclusion does not apply as long as the cause is otherwise covered by this policy. When thieves break into the house and puncture the indoor hot tub and leave the water running, that loss is covered.
Power disruption has been renamed power failure, and loss from the failure of power is not covered. This is significant, because there is quite a difference between a disruption and a failure. Merriam Webster Online defines disruption as to interrupt the normal course; failure is defined as an abrupt cessation of normal functioning. In a disruption the flow of power is interrupted briefly but then restored. When power fails, it is stopped, and not just interrupted. There is no more power flowing through the system. The policy now excludes power failure, therefore allowing coverage when power is merely disrupted.
The intentional acts exclusion has been broadened to include insureds who were not involved in the commission or direction of the act that caused the loss.
A new exclusion in this policy is the exclusion for Bacteria, Fungi, Wet Rot or Dry Rot. This excludes coverage caused by, consisting of or relating to the existence of any activity of fungi, bacteria, wet or dry rot that is not the direct result of a peril insured against. If mold develops in a basement because of high humidity levels, there is no coverage since the growth of the mold is not the result of an insured peril.
Item 2 and its exclusions, weather conditions and errors, omissions, and defects have been reworded although the restriction of coverage has not been modified.
1. Coverage L – Personal Liability – “We” pay, up to the “limit” that applies, all sums for which an “insured” is legally liable because of “bodily injury” or “property damage” caused by an occurrence” to which this coverage applies.
“We” will defend a suit seeking damages if the suit resulted from “bodily injury” or “property damage” caused by an “occurrence” to which this coverage applies. Such defense will be provided at “our” expense by counsel that “we” choose.
“We” may make investigations and settle claims or suits that “we” decide are appropriate. “We” do not have to settle or provide a defense after “we” have paid an amount equal to the “limit” that applies as a result of a judgment or written settlement.
2. Coverage M — Medical Payments To Others — “We” pay the necessary medical expenses if they are incurred or medically determined within three years from the date of an accident causing “bodily injury” covered by this policy. Medical expenses means the reasonable charges for medical, surgical, X-ray, dental, ambulance, hospital, professional nursing, and funeral services; prosthetic devices; hearing aids; prescription drugs; and eyeglasses, including contact lenses.
This coverage does not apply to “you” or to any person who is a regular resident of “your” household, other than a “domestic employee”. With respect to others, this coverage applies only to:
a. a person on an “insured premises” with the permission of an “insured”; or
b. a person away from an “insured premises” if the “bodily injury”:
1) arises out of a condition on an “insured premises” or the access ways immediately adjoining an “insured premises”;
2) is caused by an activity of an “insured”;
3) is caused by a “domestic employee” in the course of his or her employment by an “insured”; or
4) is caused by an animal owned by or in the care of an “insured”.
any property.
Analysis
The principal liability coverages have had some wording revisions; under personal liability it is specified that sums for which an insured is legally liable are covered instead of just sums for which the insured is liable.
Medical payments liability has been reworded for clarification, and now specifies that the coverage does not apply to the named insured or any member of the named insured's household other than a domestic employee. Coverage applies to conditions on an insured premise or on access ways immediately joining the insured premises; the coverage for access ways is new to this policy.
Incidental Liability Coverages
1. Business
a. “We” pay for “bodily injury” or “property damage” that arises out of:
1) the rental or holding for rental of an “insured premises”:
a) on an occasional basis for use only as a residence;
b) in part for use only as a residence (No family unit may include more than two roomers or boarders.); or
c) in part for use as a school, studio, office, or private garage; or
2) the “business” activities of an “insured” under the age of 21 years, but only if such “insured” is involved in a part-time or occasional, self-employed “business” that does not employ others and the “bodily injury” or “property damage” arises out of activities related to that “business”.
b. This Incidental Liability Coverage for Business is subject to all of the:
1) Exclusions That Apply To Coverage L And Coverage M, other than exclusion g.;
2) Additional Exclusions That Apply Only To Coverage L; and
3) Additional Exclusions That Apply Only To Coverage M.
2. Claims And Defense Cost — “We” pay for:
a. the costs incurred by “us” and the costs taxed to an “insured” in a suit “we” defend;
b. the premiums on required bonds in a suit “we” defend, but only for bond amounts up to the “limit” that applies. “We” are not required to apply for or furnish bonds;
c. the necessary costs incurred by an “insured” at “our” request for assisting “us” in the investigation or defense of a claim or suit. This includes up to $250 per day, per “insured”, for the actual loss of earnings, but not loss of other income, for time spent away from work at “our” request;
d. the interest on the entire judgment that accrues after the entry of the judgment, but ending when “we” tender, pay, or deposit in court that part of the judgment that does not exceed the “limit” that applies; and
e. prejudgment interest awarded against an “insured” on that part of the judgment “we” pay. If “we” offer to pay the “limit” that applies, “we” will not pay any prejudgment interest based on that period of time after the offer.
3. Contracts
a. “We” pay for “bodily injury” or “property damage”:
1) for which an “insured” is liable under a written contract that directly relates to the ownership, maintenance, or use of an “insured premises”; or
2) for which “you” are liable under a written contract, made before the loss, in which “you” have assumed the liability of others. The loss causing the “bodily injury” or “property damage” must have occurred during the policy period.
b. This Incidental Liability Coverage for Contracts is subject to all of the:
1) Exclusions That Apply To Coverage L And Coverage M;
2) Additional Exclusions That Apply Only To Coverage L, other than exclusion c.; and
3) Additional Exclusions That Apply Only To Coverage M.
4. Damage To Property Of Others –
Regardless of an “insured's” legal liability, “we” pay, at replacement cost, for “property damage” to property of others caused by an “insured”. The “limit” that applies to this coverage is $1,000 per “occurrence”. The exclusions that apply to Coverage L and Coverage M do not apply to this coverage. However, “we” do not pay for “property damage”:
a. covered under the Property Coverages section of this policy. However, “we” will pay for “property damage” in excess of the amount recoverable under the Property Coverages, to the extent that such “property damage” is covered under the “terms” of this Incidental Liability Coverage;
b. to property owned by an “insured”, or owned by, rented to, or leased to another resident of “your” household or a tenant of an “insured”;
c. caused intentionally by an “insured” who has attained the age of 13 years;
d. arising out of an act or omission in any way related to a:
1) “business” undertaken by an “insured”; or
2) premises owned, rented, or controlled by an “insured”, other than an “insured premises”; or
e. arising out of the ownership, operation, maintenance, use, occupancy, loaning, entrusting, supervision, leasing, loading, or unloading of “aircraft”, “hovercraft”, “motorized vehicles”, or “watercraft”.
However, this exclusion does not apply to “property damage” arising out of a “motorized vehicle”:
1) that is not owned by an “insured” and is designed:
a) for recreational use off of public roads; or
b) to assist the handicapped; or
2) that is not owned by an “insured” and is used only to service:
a) an “insured premises”; or
b) a premises of another, not in the course of “business”; if, at the time of the “occurrence”, such “motorized vehicle” is not required by law or governmental regulation to be registered for use on public roads or property.
Analysis
The first four incidental liability coverages contain some rewording and new language, as well and the reordering of the coverages. Business coverage is discussed first, and it is now specified that injury or damage that arises out of rental of an insured premises is covered when the premises is rented on an occasional basis as a residence. The prior policy did not specify a time frame. New to the business coverage is coverage for the activities of an insured under the age of twenty one years as long as it is part-time or occasional, there are no employees and the injury or damage arises out of activities related to the business. If the daughter has a snow shoveling business and in the course of shoveling the driveway scrapes the side of the car with the shovel, there is coverage for the loss.
New language exists that specifies that this incidental coverage is subject to the exclusions that apply to coverages L and M except for exclusion g. which pertains to business activities and additional exclusions that apply solely to coverage L and only to coverage M.
Claim and defense costs coverage has removed the language providing coverage for bail bonds and has increased the loss of earnings paid from $50 to $250 per day. Another new feature is that the interest on the entire judgment, not just prejudgment interest is paid. This is the interest on the entire judgment that accrues after the entry of the judgment and ends when the carrier pays that part of the judgment that does not exceed the applicable limit.
The language for contracts has been slightly revised, but new to this coverage is the clause that this coverage is subject to the exclusions that apply to coverages L and M, additional exclusions that apply solely to coverage L other than exclusion c. which pertains to liability from the operation of motorized vehicles and watercraft, and additional exclusions that apply only to coverage M.
Damage to property of others now specifies that the carrier pays at replacement cost and the limit per occurrence has been raised from $500 to $1000. An exception to the exclusion for property damage to property covered under the property sections of this policy exists. The carrier will pay for damage in excess of the limit under property coverages when such property damage is covered under the terms of this incidental liability coverage. The exclusion for aircraft, motorized vehicles and watercraft now includes hovercraft, and the act of leasing aircraft, hovercraft, watercraft, etc. Vehicles to assist the handicapped are a new exception to the exclusion for property damage as a result of the use of motorized vehicles.
5. First Aid Expense — “We” pay the expenses incurred by an “insured” for first aid to persons, other than “insureds”, for “bodily injury” covered by this policy.
6. Loss Assessment
a. “We” pay for “your” share of an assessment levied by a homeowners, condominium, or similar residential association if the assessment is levied as a result of:
1) “bodily injury” or “property damage” to which Coverage L and Coverage M apply; or
2) damages or legal fees the association legally must pay for the acts of a director, officer, or trustee that result from the exercise of his or her duties solely on behalf of the association. This applies only to the acts of a director, officer, or trustee who is elected by the members of the association and who serves without receiving a fee, salary, or other compensation, other than reimbursement of expenses incurred.
b. However, “we” do not pay for assessments levied against “you” or a homeowners, condominium, or similar residential association by any governmental body or authority.
c. Coverage applies only when the assessment is levied during the policy period and is levied against “you” as owner or tenant of the “described location”.
d. The most “we” pay is $1,500 per occurrence. Regardless of the number of assessments, this “limit” is the most “we” pay for loss arising out of:
1) any one accident, including repeated exposures to similar conditions; or
2) an act of a director or trustee. An act involving more than one director or trustee is considered a single act.
e. The Policy Period condition under Conditions Applicable To Liability Coverages Only does not apply to this Incidental Liability Coverage.
7. Motorized Vehicles
a. Subject to the limitations set forth in b. and c. below, “we” pay for “bodily injury” or “property damage” that arises out of a “motorized vehicle” that:
1) is in dead storage on an “insured premises”;
2) is used only to service:
a) an “insured premises”, but only if the “occurrence” takes place on an “insured premises” as defined in 14.a., 14.b., 14.c., 14.f., 14.g., or 14.h. under Definitions; or
b) an “insured premises” or a premises of another, but only if such “motorized vehicle” is designed only for use off of public roads;
3) is designed to assist the handicapped;
4) is designed for recreational use off of public roads and is:
a) not owned by an “insured”; or
b) owned by an “insured”, but only if the “occurrence” takes place on an “insured premises” as defined in 14.a., 14.b., 14.c., 14.f., 14.g., or 14.h. under Definitions;
5) is operated only from electrical current supplied by a battery and is:
a) not built or modified after manufacture to exceed a speed of 15 miles per hour on level ground; and
b) not a motorized bicycle, moped, or golf cart; or
6) is a motorized golf cart that:
a) is owned by an “insured”;
b) is designed to carry no more than four persons;
c) is not built or modified after manufacture to exceed a speed of 25 miles per hour on level ground; and
d) at the time of the “occurrence”, is within the legal boundaries of:
(1) a golfing establishment and is:
(a) parked or stored there; or
(b) being used by an “insured” to:
(i) play the game of golf or for other recreational or leisure activity allowed by the establishment;
(ii) travel to or from an area where “motorized vehicles” or golf carts are parked or stored; or
(iii) cross public roads at designated points to access other parts of the golfing establishment; or
(2) a private residential community, including its public roads upon which a motorized golf cart can legally travel:
(a) that is subject to the authority of an association of property owners; and
(b) in which an “insured premises” is located.
b. The coverage described in a. above applies only to a “motorized vehicle” that, at the time of the “occurrence”, is not:
1) registered for use on public roads or property;
2) required by law or governmental regulation to be registered for use at the location of the “occurrence”;
3) being used in, or in the practice or the preparation for, a prearranged or organized racing, speed, pulling or pushing, demolition, or stunt activity or contest;
4) being rented to others;
5) being used to carry people or cargo for a fee; or
6) being used for any “business” purpose, except a motorized golf cart while on a golfing
establishment.
c. This Incidental Liability Coverage for Motorized Vehicles is subject to all of the:
1) Exclusions That Apply To Coverage L And Coverage M, other than:
a) exclusions c. and e.; and
b) solely with respect to the use of a motorized golf cart while on a golfing establishment, exclusion g.;
2) Additional Exclusions That Apply Only To Coverage L; and
3) Additional Exclusions That Apply Only To Coverage M.
8. Watercraft
a. Subject to the limitations set forth in b. and c. below, “we” pay for “bodily injury” or “property damage” that arises out of a “watercraft” that:
1) is in storage;
2) is a sailing vessel, with or without auxiliary power, that is:
a) less than 26 feet in overall length; or
b) 26 feet or more in overall length and not owned by or rented to an “insured”; or
3) is not a sailing vessel and is powered by:
a) an inboard or inboard-outdrive engine or motor, including an engine or motor that powers a water jet pump, of:
(1) 50 horsepower or less if not owned by an “insured”; or
(2) more than 50 horsepower if not owned by or rented to an “insured”; or
b) one or more outboard engines or motors with:
(1) 25 total horsepower or less;
(2) more than 25 horsepower if the outboard engine or motor is not owned by an “insured”;
(3) more than 25 horsepower if the outboard engine or motor is owned by an “insured” who acquired it during the policy period; or
(4) more than 25 horsepower if the outboard engine or motor is owned by an “insured” who acquired it before the policy period, but only if:
(a) it is listed on the “declarations” as insured for personal liability; or
(b) a written request for liability coverage is received by “us” within 45 days after it is acquired. In this Incidental Liability Coverage for Watercraft, horsepower means the maximum power rating assigned to the engine or motor by the manufacturer.
b. The coverage described in a. above applies only to a “watercraft” that, at the time of the “occurrence”, is not being:
1) rented to others;
2) used to carry people or cargo for a fee;
3) used for any “business” purpose; or
4) used in, or in the practice or the preparation for, a prearranged or organized racing, speed, pulling or pushing, demolition, or stunt activity or contest.
However, this does not apply to a sailing vessel or to a “watercraft” being used in a predicted log contest or cruise.
c. This Incidental Liability Coverage for Watercraft is subject to all of the:
1) Exclusions That Apply To Coverage L And Coverage M, other than exclusions c. and e.;
2) Additional Exclusions That Apply Only To Coverage L; and
3) Additional Exclusions That Apply Only To Coverage M.
Analysis
Motorized vehicles now indicates that vehicles kept in dead storage on premises are covered if they are the cause of injury or property damage. Vehicles that are used to service the premises are covered as well, as long as the premises fit certain policy definitions of insured premises. Vehicles to assist the handicapped are now specifically mentioned as covered. In order to receive coverage, the vehicle must be run from electrical current supplied by a battery, and the vehicle is not modified to exceed fifteen mph and it is not a motorized bicycle, moped, or golf cart. This restriction ensures that the correct property is covered. Kiddie cars are also covered under motorized vehicles.
Golf carts that are covered must be designed to carry no more than four people and cannot be built or modified to exceed twenty-five miles an hours on level ground. The coverage for carts used on golfing establishments is discussed in detail; coverage applies when carts are being used by an insured to play golf or participate in other leisure activities, travel to where the carts are stored, or cross public roads at specifically designated areas. The use of golf carts in residential communities is also defined. New language specifies that not covered under motorized vehicles are vehicles registered for use on public property or roads, required by law to be registered for use at the location, being used in, or in practice or preparation for a race, demolition or stunt contest, being rented to others, used to carry people or cargo for a fee, or any business purposes except for a golf cart on golfing establishments. The homeowners policy is not intended to provide liability coverage for motorized vehicles as they are not part of the normal home exposure.
New language specifies that this coverage is subject to the exclusions that apply to coverages L and M, other than exclusions c. and e. which pertain to motorized vehicles and exclusion g. as it pertains to use of a golf cart on a golfing establishment. Additional exclusions that apply solely to coverage L and additional exclusions that apply only to coverage M are applicable to this coverage.
Under the watercraft coverage, sailing vessels more than twenty six feet in overall length that are not owned by or rented to an insured are covered; this is a change from the prior policy, where such boats that were owned by or rented to an insured were covered. Also new to this coverage is the specification that coverage only applies to watercraft that are not rented to others, used to carry people/cargo for a fee, used for business or racing/stunt contests. This exclusion does not apply to vessels being used in predicted log contests on cruises. The concern is contests for speed, stunts, or other hazardous activity. This section also contains the clause that this coverage is subject to the exclusions that apply to coverages L and M, other than exclusions c. and e. which pertain to motorized vehicles. Additional exclusions that apply solely to coverage L and additional exclusions that apply only to coverage M are applicable to this coverage.
Exclusions That Apply to Liability Coverages
1. Exclusions That Apply To Coverage L And Coverage M — Coverage L and Coverage M do not apply to:
a. “bodily injury” or “property damage” caused directly or indirectly by:
1) war, including undeclared or civil war;
2) warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign, or other authority using military personnel or other agents; or
3) insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. Discharge of a nuclear weapon is deemed a warlike action even if it is accidental.
b. “bodily injury” or “property damage” arising out of:
1) the ownership or leasing of “aircraft” or “hovercraft” by an “insured”;
2) the operation, maintenance, use, occupancy, loading, or unloading of “aircraft” or “hovercraft” by any person;
3) the entrustment or loaning of “aircraft” or “hovercraft” by an “insured” to any person; or
4) an “insured's” negligent supervision of or failure to supervise any person with respect to “aircraft” or “hovercraft”.
However, this exclusion does not apply to “bodily injury” to a “domestic employee” arising out of and in the course of his or her employment by an “insured”.
c. “bodily injury” or “property damage” arising out of:
1) the ownership or leasing of a “motorized vehicle” or “watercraft” by an “insured”;
2) the operation, maintenance, use, occupancy, loading, or unloading of a “motorized vehicle” or “watercraft” by any person;
3) the entrustment or loaning of a “motorized vehicle” or “watercraft” by an “insured” to any person; or
4) an “insured's” negligent supervision of or failure to supervise any person with respect to a “motorized vehicle” or “watercraft”.
However, this exclusion does not apply to “bodily injury” to a “domestic employee” arising out of and in the course of his or her employment by an “insured” or if coverage is provided under the Incidental Liability Coverage for Motorized Vehicles or the Incidental Liability Coverage for Watercraft.
d. “bodily injury” or “property damage” for which an “insured” is vicariously liable if the “bodily injury” or “property damage” arises out of the actions of a child or minor with respect to:
1) “aircraft”; or
2) “hovercraft”.
This applies whether or not such liability is imposed by law.
e. “bodily injury” or “property damage” for which an “insured” is vicariously liable if the “bodily injury” or “property damage” arises out of the actions of a child or minor with respect to a:
1) “motorized vehicle”; or
2) “watercraft”.
This applies whether or not such liability is imposed by law.
However, this exclusion does not apply to the extent that coverage for the “motorized vehicle” or “watercraft” is provided under the Incidental Liability Coverage for Motorized Vehicles or the Incidental Liability Coverage for Watercraft.
f. “bodily injury” or “property damage” arising out of the rendering of or the failing to render a professional service.
g. “bodily injury” or “property damage” arising out of or in any way related to a “business” conducted from an “insured premises” or undertaken by an “insured”, regardless of location,
whether or not the “business” is owned or operated by an “insured” or employs an “insured”.
This includes but is not limited to “bodily injury” or “property damage” arising out of an act or a failure to act, regardless of its circumstance, involving a service or duty owed, promised, provided, or implied to be provided because of the nature of the “business”.
However, this exclusion does not apply to the extent that coverage is provided:
1) for the use of a motorized golf cart while on a golfing establishment under the Incidental Liability Coverage for Motorized Vehicles; or
2) under the Incidental Liability Coverage for Business.
h. “bodily injury” or “property damage” that arises out of premises that are:
1) owned by an “insured”;
2) rented to an “insured”; or
3) rented to others by an “insured”; and that are not “insured premises”.
However, this exclusion does not apply to “bodily injury” to a “domestic employee” arising out of and in the course of his or her employment by an “insured”.
i. “bodily injury” or “property damage” that is:
1) expected by, directed by, or intended by an “insured”;
2) the result of a criminal act of an “insured”; or
3) the result of an intentional and malicious act by or at the direction of an “insured”.
This exclusion applies even if the “bodily injury” or “property damage”:
1) that occurs is different than what was expected, directed, or intended; or
2) is suffered by persons, entities, or property not expected, directed, or intended.
However, this exclusion does not apply to “bodily injury” or “property damage” that arises out of the use of reasonable force by an “insured” to protect people or property.
j. “bodily injury” or “property damage” that arises out of the transmission of a communicable disease by an “insured”.
k. “bodily injury” or “property damage” that arises out of sexual molestation.
l. “bodily injury” or “property damage” that arises out of physical or mental abuse.
m. “bodily injury” or “property damage” that arises out of corporal punishment.
n. “bodily injury” or “property damage” that arises out of the use, sale, manufacture, delivery, transfer, or possession by any person of a Controlled Substance as defined by the Federal Food and Drug Law at 21 U.S.C.A. Sections 811 and 812, including any amendments.
Controlled Substances include but are not limited to cocaine, LSD, marijuana, and all narcotic or hallucinogenic drugs. However, this exclusion does not apply to the legitimate use of prescription drugs by a person following the orders of a licensed physician.
Analysis
The introductory language to the exclusions has been removed. Warlike action now includes action in hindering or defending against an actual or expected attack by any authority using military personnel, or action taken by governmental authority to hinder or defend against insurrection, rebellion, revolution or usurped power. This language change broadens the exclusion so that other actions, such as potential terrorist actions, are also excluded.
The exclusion concerning injury or damage as a result of aircraft or hovercraft has been reworded, and the exception to the exclusion for model aircraft has been removed. The exclusion regarding motorized vehicles and watercraft has been revised as well, with no changes to the nature of the exclusion.
Vicarious liability for bodily injury or property damage as a result of actions of a child or minor with respect to aircraft, hovercraft, motorized vehicles or watercraft is excluded, regardless of whether this liability is applied by law. These are new exclusions to the policy. For example, if an insured allows a neighbor's child to use the hovercraft and the child's use of the vehicle results in damage to the neighbor's fence, the insured is vicariously liable for the damage by having allowed the child to use the vehicle. The exclusion for vicarious liability for motorized vehicles or watercraft does not apply with regards to the incidental liability coverage for motorized vehicles or watercraft.
The exclusion for injury or damage as a result of business activities has been redefined, and specifies that regardless of location or whether or not the business is owned or operated by the insured, or employs an insured; coverage is excluded for injury or damage. Also excluded are injuries/damages from an act or failure to act, regardless of circumstance if a service is involved or there is a duty owed, promised, or implied due to the nature of the business. The prior policy simply stated that business of an insured, except as provided under incidental business coverage, was excluded and listed rendering or failure to render a professional service separately. Exceptions to this exclusion include the use of a motorized golf cart while on a golfing establishment under the incidental motorized vehicle coverage and incidental coverage for businesses.
The exclusion regarding premised owned, rented to an insured or others has been reworded but coverage has not changed.
The intentional acts exclusion has been reworded with no change in coverage.
New exclusions exist for bodily injury or property damage as a result of the transmission of a communicable disease, that arises from sexual molestation, physical or mental abuse, or corporal punishment. If a teacher spanks a student in school, there is no coverage. Likewise, if an insured contracts legionnaire's disease and gives it to coworkers, there is no coverage.
Also excluded are injuries or damages that arise from the use, sale, manufacture, delivery, transfer or possession of controlled substances as defined by the Federal Food and Drug Law. This includes but is not limited to marijuana, LSD, cocaine, and all narcotic and hallucinogenic drugs, unless legitimately used upon the orders and prescription of a licensed physician. Therefore, if an insured is under the influence of drugs and injures someone, there is no coverage. Likewise if the insured is dealing drugs there is no coverage for damages or injuries that may occur during the sales transaction.
2. Additional Exclusions That Apply Only To Coverage L — Coverage L does not apply to:
a. “bodily injury” to an “insured” as defined in 13.a., 13.b., 13.c., 13.d., or 13.e. under Definitions.
b. any claim made or suit brought against an “insured” seeking:
1) reimbursement of; or
2) contribution toward; damages for which another person may be liable because of “bodily injury” to an “insured”.
c. liability under a contract or an agreement entered into by an “insured”, except as provided under the Incidental Liability Coverage for Contracts.
d. “property damage” to property owned by an “insured”.
e. cost or expense for measures performed on property owned by an “insured” to prevent:
1) injury to a person; or
2) damage to property of others; on or away from an “insured premises”, whether such cost or expense is incurred by an “insured” or others.
f. “property damage” to property that is rented to, occupied by, used by, or in the care of an “insured”.
However, this exclusion does not apply to “property damage” to such property caused by fire, smoke, or explosion.
g. sickness, disease, or death of a “domestic employee” unless a written notice is received by “us” within 36 months after the end of the policy period in which the injury occurred.
h. “bodily injury” to a person, including a “domestic employee”, if:
1) an “insured” has a workers' compensation policy covering the injury; or
2) benefits are payable or are required to be provided by an “insured” under a workers' compensation, nonoccupational disability, occupational disease, or like law.
i. liability for any assessment levied by a homeowners, condominium, or similar residential association, except as provided under the Incidental Liability Coverage for Loss Assessment.
j. “bodily injury” or “property damage” for which an “insured” under this policy is also an insured under a nuclear energy liability policy or would be an insured under a nuclear energy liability policy but for the exhaustion of its “limits”. (A nuclear energy liability policy is a policy issued by Mutual Atomic Energy Liability Underwriters, Nuclear Energy Liability Insurance Association, or Nuclear Insurance Association of Canada or
their successors.)
3. Additional Exclusions That Apply Only To Coverage M — Coverage M does not apply to “bodily injury”:
a. to an “insured” or any other person, other than a “domestic employee”, who regularly resides on any part of the “insured premises”.
b. to a person, including a “domestic employee”, if a workers' compensation policy covers the injury or if benefits are provided or required to be provided under a workers' compensation, nonoccupational disability, occupational disease, or like law.
c. to a “domestic employee” if the “bodily injury”:
1) occurs away from an “insured premises”; and
2) does not arise out of or in the course of his or her employment by an “insured”.
d. from any:
1) nuclear reaction;
2) nuclear radiation; or
3) radioactive contamination; whether controlled or uncontrolled or however caused; or
4) any consequence of 1), 2), or 3) above.
Analysis
Exclusions that apply only to coverage L and only to coverage M have some changes. Exclusions that apply to coverage L now excludes claims or suits against an insured for reimbursement or contribution towards payment for damages that another person may be liable for because of bodily injury to an insured. Also excluded are the costs or expenses for actions taken on the property owned by an insured to prevent injury to a person, damage to property or others on or away from the insured premises whether the cost is incurred by the insured or others. This would include basic maintenance of the property; the policy intent is to cover accidental losses, not maintenance issues. The cost to the insured to have the dead limbs that overhang the neighbor's house trimmed is not covered nor is the cost to repair the broken railing on the stairs; these are maintenance items.
New to exclusions under coverage L only is the exclusion pertaining to bodily injury or property damage when the insured is also insured under a nuclear energy liability policy. This exclusion had previously been under the exclusions for both coverage L and M, but now it appears only under coverage L.
Exclusions that apply only to coverage M have been revised. The exclusion for a person on the insured premises for business conducted by the insured has been removed from the policy. Injury to a domestic employee is not covered if the injury occurs away from an insured premises and does not arise out of the course of employment. Also excluded is injury from nuclear reaction, radiation, or radioactive contamination whether controlled or uncontrolled, however caused, and any consequence of such nuclear incident.
What Must Be Done in Case of Loss or Occurrence
1. Property Coverages
The following duties apply when there is loss to covered property. These duties must be performed by “you”, “your” representative, an “insured” seeking coverage, or the representative of an “insured” seeking coverage.
“We” are not obligated to provide the coverages described in this policy if these duties are not performed.
a. Notice – Prompt notice must be given to “us” or “our” agent. “We” may request written notice.
Notice must be given to the police when the loss involves theft. Notice must be given to the credit card, electronic fund transfer card, or electronic access device company when the loss involves a credit card, an electronic fund transfer card, or an electronic access device.
b. Protecting Property — All reasonable measures must be taken to protect covered property at and after a covered loss to avoid further loss. If the property must be repaired, “you” must:
1) make reasonable and necessary repairs to protect the property; and
2) keep an accurate record of the costs of such repairs.
c. Cooperation — All “insureds” seeking coverage, and the representative or representatives of all “insureds” seeking coverage, must cooperate with “us” in the investigation of a claim.
d. Inventory Of Damaged Personal Property — “We” must be given an inventory of personal property involved in a loss that shows, in detail, the:
1) quantity;
2) description;
3) “actual cash value”; and
4) amount of loss.
Copies of all bills, receipts, and related documents that confirm the figures stated in the inventory must be attached.
e. Showing Damaged Property – As often as “we” reasonably request, “we” must be:
1) shown the damaged property; and
2) allowed to take samples of damaged property for inspection, testing, and analysis.
f. Records And Documents — As often as “we” reasonably request, “we” must be:
1) given requested records and documents, including but not limited to tax returns and bank records of all canceled checks that relate to the value, loss, and costs; and
2) permitted to make copies of such records and documents.
g. Examination Under Oath — As often as “we” reasonably request, all “insureds” must:
1) submit to examination under oath in matters that relate to the loss or claim; and
2) sign such statement made under oath. If more than one person is examined, “we” have the right to examine and receive statements separately from each person and not in the presence of other “insureds”.
h. Proof Of Loss — “We” must be given a signed, sworn proof of loss, within 60 days after “our” request, that:
1) states, to the best of “your” knowledge and belief, the:
a) time and cause of the loss; and
b) interests of all “insureds” and the interests of all others, including all mortgages and liens, in the property involved in the loss;
2) identifies:
a) other policies that may cover the loss; and
b) any changes in title or use of the property during the policy period; and
3) provides:
a) available plans and specifications of damaged buildings;
b) detailed estimates for repair;
c) the inventory of damaged personal property described in d. above;
d) receipts for additional living costs incurred and records that prove the fair rental value; and
e) evidence or affidavit supporting a claim under the Incidental Property Coverage for Credit Card; Electronic Fund Transfer Card Or Access Device; Forgery; And Counterfeit Money and stating the amount and cause of loss.
i. Assistance With Enforcing Right Of Recovery — At “our” request, “we” must be given assistance with enforcing any right of recovery that an “insured” may have against a party causing the loss.
2. Liability Coverages
The following duties apply when there has been an “occurrence”. These duties must be
performed by “you” or another “insured”. “You” must assist “us” by seeing that they
are performed. “We” are not obligated to provide the coverages described in this policy if these
duties are not performed.
a. Notice – Written notice must be given to “us” or “our” agent as soon as is practical. The notice must state:
1) “your” name and the policy number;
2) reasonably available information regarding the time, location, and other details of the “occurrence”; and
3) the names and addresses of all known potential claimants and witnesses.
b. Volunteer Payments — Any:
1) payments made;
2) rewards paid or offered; or
3) obligations or other costs assumed; by an “insured” will be at the “insured's” own cost.
However, this does not apply to costs that are covered under the Incidental Liability Coverage for First Aid Expense.
c. Cooperation — The “insured” must cooperate with “us” in the investigation, defense, or settlement of a claim or suit.
d. Notices, Demands, And Legal Papers — The “insured” must promptly give “us” copies of all notices, demands, and legal papers that relate to the “occurrence”.
e. Assistance With Claims And Suits —
At “our” request, the “insured” must help “us”:
1) to settle a claim;
2) to enforce the right of recovery or indemnification against all parties who may be liable to an “insured”;
3) to conduct suits. This includes being at trials and hearings;
4) in the securing of and giving of evidence; and
5) in obtaining the attendance of all witnesses.
f. Other Duties — Damage To Property Of Others — “We” must be given a sworn statement of loss within 60 days after the loss. The damaged property must be shown to “us” if it is within an “insured's” control.
Analysis
The conditions included in what must be done in case of loss or occurrence contains some revisions and removal of some language. The loss is now specified as a loss to covered property, and not just a loss. Electronic fund transfer cards and access devices are specifically included in the requirement to notify credit card companies in event of a loss to credit cards. There are minor language changes that do not modify the requirements of the condition. Volunteer payments are now listed under liability coverage conditions, and the statement that this does not apply to costs allowed by the policy has been rephrased to indicate that this does not apply to incidental liability coverage for first aid expense. The standard requirements for documentation, notice, cooperation exist.
How Much We Pay for Loss or Occurrence
1. Property Coverages
a. Our Limit – “We” pay the lesser of:
1) the “limit” that applies; or
2) the amount determined under the applicable Loss Settlement Terms; regardless of the number of “insureds” with an interest in the property. However, no “insured” will be paid an amount that exceeds his or her interest in the property at the time of loss.
b. Deductible
1) This applies to all Principal Property Coverages and all Incidental Property Coverages except:
a) Credit Card; Electronic Fund Transfer Card Or Access Device; Forgery; And Counterfeit Money;
b) Fire Department Service Charge; and
c) Refrigerated Property.
It applies to all Perils Insured Against unless otherwise stated.
2) Subject to the “limits” that apply, “we” pay that part of the loss over the deductible. The deductible applies:
a) per occurrence and, with respect to the Incidental Property Coverages for
Association Deductible and Loss Assessment, regardless of the number of deductibles
charged or assessments levied; and
b) separately at each covered location. Only one deductible applies at each location.
c. Loss To A Pair Or Set — If there is a loss to an item that is part of a pair or set, “we” pay only to replace or repair the item, or “we” pay the difference in the “actual cash value” of the pair or set just before the loss and the “actual cash value” just after the loss.
d. Loss to Parts — If there is a loss to a part of an item that consists of several parts when it is complete, “we” pay only for the value of the lost or damaged part or the cost to repair or replace it.
e. Loss Settlement Terms — Subject to the “terms” shown above, “we” settle losses according to the Replacement Cost Terms. If the Replacement Cost Terms do not apply, “we” settle losses according to the Actual Cash Value Terms. In the Replacement Cost Terms and the Actual Cash Value Terms, replacement cost and cost to repair or replace do not include any increased cost that results from the enforcement of a code, ordinance, or law, except to the extent that coverage for such increased cost is provided under the Incidental Property Coverage for Increased Cost — Ordinance or Law.
1) Replacement Cost Terms
a) The Replacement Cost Terms apply only to buildings covered under Coverage A or Coverage B that have a permanent foundation and roof. However, Replacement Cost Terms do not apply to:
(1) window air-conditioners;
(2) awnings and canopies;
(3) appliances;
(4) carpets; and
(5) antennas;
whether or not attached to a building.
b) If the “limit” that applies to the damaged building at the time of loss is less than 80% of its full replacement cost just before the loss, the larger of the following amounts is used in applying the “terms” under Our Limit:
(1) the “actual cash value” of the damaged part of the building just before the loss; or
(2) that part of the cost to repair or replace the damaged part, after application of any deductible, which the “limit” on the damaged building bears to 80% of its full replacement cost just before the loss.
c) If the “limit” that applies to the damaged building at the time of loss is at least 80% of its full replacement cost just before the loss, the smaller of the following amounts is used in applying the “terms” under Our Limit:
(1) the amount actually and necessarily spent to repair or replace the damaged building; or
(2) the cost to repair or replace the damage:
(a) using materials of like kind and quality; and
(b) for like use.
However, when a damaged building is rebuilt at another location, such cost is limited to the cost that would have been incurred if the building had been repaired or replaced at the location where the damage occurred.
d) In determining the replacement cost, do not include the cost of:
(1) excavations; brick, stone, or concrete foundations; piers; footings; or other structures or features that support all or part of the building that are:
(a) below the undersurface of the lowest basement floor; or
(b) below the surface of the ground inside the foundation walls, if there is no basement; or
(2) underground flues, pipes, wiring, or drains.
e) When the cost to repair or replace exceeds the lesser of $2,500 or 5% of the “limit” that applies to the damaged building, “we” will pay no more than the “actual cash value” of the loss until repair or replacement is completed. Once repair or replacement is completed, “we” will settle the loss as described in b) and c) above.
f) At “your” option, “you” may make a claim under the Actual Cash Value Terms instead of these Replacement Cost Terms. “You” may later make a claim for any additional amount payable under these Replacement Cost Terms, but only if “you” have informed “us”, within 180 days after the date of loss that “you” plan to do so.
2) Actual Cash Value Terms
a) The Actual Cash Value Terms apply to all property not subject to the Replacement Cost Terms.
b) The smaller of the following amounts is used in applying the “terms” under Our Limit:
(1) the cost to repair or replace the lost or damaged part of the property with materials of like kind and quality, to the extent practical; or
(2) the “actual cash value” of the lost or damaged part of the property just before the loss.
2. Coverage L — Personal Liability – The “limit” shown on the “declarations” for Coverage L is the most “we” pay for loss for each “occurrence”. This applies regardless of the number of:
a. persons insured under this policy;
b. parties who sustain injury or damage;
c. claims made or suits brought; or
d. policy periods involved.
All “bodily injury” and “property damage” arising out of any one accident or out of repeated exposures to similar conditions will be considered one “occurrence”.
3. Coverage M — Medical Payments To Others — The “limit” shown on the “declarations” per person for Coverage M is the most “we” pay for all medical expenses payable for “bodily injury” to one person as the result of one accident. When a “limit” is shown on the “declarations” per accident for Coverage M, that “limit” is the most “we” pay for any one accident.
The payment of a claim under Coverage M does not mean an admission of liability on “our” part or on the part of any “insured”.
4. Severability — The Liability Coverages provided by this policy apply separately to each “insured”, but this does not increase the “limit” that applies for any one “occurrence”.
5. Insurance Under More Than One Coverage — If more than one coverage of this policy applies to a loss, “we” pay no more than the actual loss.
6. Insurance Under More Than One Policy
a. Property Coverages
1) If there is other insurance that applies to a loss, cost, or expense, other than insurance in the name of an association or a corporation of property owners, “we” pay “our” share of the loss, cost, or expense. “Our” share is that part of the loss, cost, or expense that the “limit” of this policy bears to the total amount of insurance that applies to the loss, cost, or expense. However, this does not apply to loss, cost, or expense that is also covered by:
a) a home warranty, a service or maintenance plan or agreement, or any other warranty, plan, or agreement that provides for the repair or replacement of property, even if such warranty, plan, or agreement has the characteristics or qualities of insurance; or
b) a government fund.
2) When a loss, cost, or expense is also covered by insurance in the name of an association or a corporation of property owners, this insurance is excess over the “limit” that applies under such other insurance.
However, this excess provision does not apply with respect to the coverage provided under the Incidental Property Coverage for Association Deductible.
b. Coverage L — Personal Liability –
This insurance is excess over other valid and collectible insurance that applies to the loss or claim, other than insurance written specifically to provide coverage in excess of the “limits” that apply in this policy. If the other insurance is also excess, “we” pay only “our” share of the loss.
“We” pay only that part of the loss that the applicable “limit” under this policy bears to the total amount of insurance covering the loss.
7. Warranties And Service Or Maintenance Plans Or Agreements — If loss, cost, or
expense covered by this policy is also covered by a home warranty, a service or maintenance plan or agreement, or any other warranty, plan, or agreement that provides for the repair or replacement of property, this insurance is excess over any amount payable by such warranty, plan, or agreement. This applies even if such warranty, plan, or agreement has the characteristics or qualities of insurance.
8. Government Funds — If loss, cost, or expense covered by this policy is also covered by a government fund, “we” pay “our” share of the loss, cost, or expense. “Our” share is that part of the loss, cost, or expense that the “limit” of this policy bears to the total amount payable for the loss, cost, or expense to the extent permitted by law.
Analysis
The reference to the deductible and other limitations that may apply under Our Limit has been removed. The policy now pays the lesser of the limit that applies or the amount determined under the settlement terms; the value of the insured's interest in the item is no longer used as value for payment. There are now fewer exceptions to the incidental property coverages to which the deductible does not apply. The deductible now applies to emergency removal, grave markers, and loss assessment.
New language under loss settlement terms specifies that in the replacement cost terms and actual cash value terms, the cost to repair or replace does not include enforcement of a code, ordinance, or law other than what is provided in the Incidental Ordinance or Law coverage.
Replacement cost terms have removed the exclusion for window coverings that was in the prior policy. Therefore, drapes and curtains are now covered at replacement cost.
In the discussion of the payment of replacement cost at the lesser of the cost to repair or replace the damage or the amount actually spent to repair/replace the damage, the policy includes new language. This language specifies that under the cost to repair or replace the damage, like kind and quality materials are used and for like use. The policy also states that if the building is rebuilt at another location, the cost is limited to the amount it would have cost to rebuild the building at the original location. This is to avoid paying more for something different than what the insured had; if a residence with three bedrooms and one bath burns down, the insured cannot rebuild a home at another location with two bedrooms and three master baths including Jacuzzis and saunas. The point is to replace what was lost.
The policy clarifies what is not included in the replacement cost value; not only excavations, brick, stone or concrete foundations, piers, and other supports below the surface of the ground or below the basement, but also footings and other structures or features that support all or part of the building.
In the actual cash value terms, the language specific to mobile homes has been removed.
Coverage L contains new language that states that the limit on the declarations is the most paid per occurrence regardless of policy periods involved, and that all injury or damage arising out of one accident or repeated exposures to similar conditions is considered one occurrence. For example, repeated exposure to similar conditions occurs over three policy periods, and a loss is filed. The most that will be paid is the limit shown on the declarations, even though three policy periods are involved. The limits for each policy are not added to each other for an increased limit available to the claimant.
A new section on severability appears and states that liability applies separately for each insured, but the limit is not increased for any one occurrence. For example, while babysitting for the neighbor's the insured's twin daughters get distracted and a child falls down the stairs. The injuries to the child equal $160,000 in medical bills, and the policy limit is $100,000. While the coverage can be applied separately for each twin, the limits are not doubled. The total amount available for the claim is $100,000 and not $200,000.
The language stating that this policy is excess over loss covered by insurance in the name of a corporation or property owners or an association has been revised for clarification. New language in this section states that the sharing of loss does not apply to loss that is also covered by a home warranty or service agreement, or any other warranty, plan or agreement that provides for the repair of such property even if the warranty or agreement has characteristics of insurance. The same applies to government funds. What this language is really saying is that certain agreements, while they may look like insurance and would seem to invoke to provisions for sharing a loss, they are not insurance and do not invoke such provisions.
Another new section is that of warranties and service or maintenance plans or agreements and a separate section on government funds. This explicitly states that this policy is excess over any warranties, maintenance plans etc. even if they have the characteristics of insurance. When government funds exist that also cover the property covered in a loss, this policy will pay a proportional amount based on the limit of this policy in relation to the total amount of the loss.
CONDITIONS APPLICABLE TO ALL COVERAGES
1. Assignment — This policy may not be assigned without “our” written consent.
2. Cancellation And Nonrenewal — “You” may cancel this policy by returning the policy
to “us” or by giving “us” written notice and stating at what future date coverage is to
stop. “We” may cancel or not renew this policy by written notice to “you” at the address shown
on the “declarations”. Proof of delivery or mailing is sufficient proof of notice. During the first 59 days this policy is in effect, “we” may cancel for any reason. “We” will give “you” notice at least ten days before cancellation is effective. When this policy has been in effect 60 days
or more, or if it is a renewal of a policy issued by “us”, “we” may cancel or not renew only at the anniversary date unless:
a. the premium has not been paid when due;
b. the policy was obtained through fraud, material misrepresentation, or omission of fact, which, if known by “us”, would have caused “us” not to issue the policy; or
c. there has been a material change or increase in hazard of the risk.
If “we” cancel this policy for nonpayment of premium, “we” will give “you” notice at least
ten days before cancellation is effective. If “we” cancel this policy for any other reason
when it has been in effect for 60 days or more, “we” will give “you” notice at least 30
days before cancellation is effective. If “we” do not renew this policy, “we” will
give “you” notice at least 30 days before nonrenewal is effective. “Your” return premium, if any, will be calculated on a pro rata basis and will be refunded at the time of cancellation or as soon as practical. Payment or tender of the unearned premium is not a condition of
cancellation.
3. Change, Modification, Or Waiver Of Policy Terms
a. A waiver or change of the “terms” of this policy must be issued by “us” in writing
to be valid.
b. If “we” adopt a revision that broadens coverage under this edition of “our” policy without an additional premium, the broadened coverage will apply to “your” policy as of the date “we” adopt the revision in the state in which the “described location” is located. This applies only to revisions adopted within 60 days prior to or during the policy period shown on the “declarations”.
However, this does not apply to revisions adopted as part of an overall program revision that both broadens and restricts coverage, whether “we” bring about the program revision by introducing:
1) a subsequent edition of “our” policy; or
2) an endorsement that amends “our” policy.
c. “Our” request for an appraisal or examination under oath does not waive policy “terms”.
4. Conformity With Statute — “Terms” in conflict with the laws of the state in which the “described location” is located are changed to conform to such laws.
5. Death — The “terms” in a. and b. below apply if any person named as the insured on
the “declarations” or that person's spouse, if a resident of the same household, dies.
a. “We” provide coverage for the legal representative of the deceased person:
1) but only with respect to the deceased person's premises and property covered by this policy at
the time of death; and
2) only to the extent that coverage is provided by this policy.
b. “Insured” includes:
1) an “insured” who is a member of the deceased person's household at the time of the deceased person's death, but only while a resident of the “described location”; and
2) persons having proper, temporary custody of the deceased person's covered property, but only with respect to such property and only until such time as a legal representative is appointed and qualified.
6. Inspections — “We” have the right, but are not obligated, to inspect “your” property and
operations. This inspection may be made by “us” or may be made on “our” behalf. An inspection or its resulting advice or report does not warrant that “your” property or operations are safe, healthful, or in compliance with laws, rules, or regulations. Inspections or reports are for “our” benefit only.
7. Misrepresentation, Concealment, Or Fraud — “We” do not provide coverage for any “insured” if, before or after a loss:
a. an “insured” has willfully concealed or misrepresented a material fact or circumstance that relates to this insurance or the subject thereof; or
b. there has been fraudulent conduct or false swearing by an “insured” with regard to a matter that relates to this insurance or the subject thereof. This applies even with respect to an
“insured” who was not involved in the concealment, misrepresentation, fraudulent
conduct, or false swearing.
8. Subrogation — If “we” pay for a loss, “we” may require that the “insured” assign to “us”
the right of recovery up to the amount “we” pay. “We” are not liable for a loss if, after the
loss, an “insured” impairs “our” right to recover against others. An “insured” may waive his or her right to recover, in writing and before a loss occurs, without affecting coverage.
In the event that “we” require such an assignment, the “insured” must:
a. sign and give to “us” all related documents; and
b. cooperate with “us”.
Subrogation does not apply to Coverage M — Medical Payments To Others or to the
Incidental Liability Coverage for Damage To Property Of Others.
CONDITIONS APPLICABLE TO PROPERTY COVERAGES ONLY
1. Abandonment of Property — An “insured” may not abandon property to “us” unless “we” agree.
2. Appraisal — If “you” and “we” do not agree as to the value or amount of loss, either may
demand an appraisal of such loss. In this event, “you” and “we” will each select a competent and impartial appraiser within 20 days after receiving a written request from the other. The two appraisers will select a competent and impartial umpire. If they do not agree on an umpire within 15 days, “you” or “we” may ask a judge of a court of record of the state where the “described
location” is located to make the selection. A written agreement of the two appraisers will set the amount of loss. If the appraisers fail to agree, they will submit their differences to the umpire. The written agreement of any two of these three will set the amount of the loss. “You” will pay the expense of “your” appraiser and “we” will pay the expense of “our” appraiser. “You” and “we” will share equally the expense of the umpire and the other expenses of the appraisal. Under no circumstance will an appraisal be used to interpret policy “terms”, determine causation, or determine whether or not a loss is covered under this policy.
3. Loss Payable Clause — With respect to those items of personal property for which a loss payee is shown on the “declarations”, the definition of “insured” is extended to include that loss payee, but only with respect to those items of personal property. If “we” cancel or do not renew this policy, “we” will so notify, in writing, any loss payees shown on the “declarations”.
4. Mortgage Clause
a. If a mortgagee is named on the “declarations”, a loss payable under Coverage A or Coverage B will be paid to the mortgagee and “you”, as interests appear. If more than one mortgagee is named, the order of payment will be the same as the order of precedence of the mortgages. The word mortgagee includes trustee.
b. If “we” deny “your” claim, that denial does not apply to a valid claim of the mortgagee if the mortgagee has:
1) notified “us” of change in ownership, occupancy, or substantial change in risk of which the mortgagee became aware;
2) paid the premium due under this policy on demand if “you” neglected to pay the premium; and
3) submitted a signed, sworn statement of loss within 60 days after receiving notice from “us” if “you” failed to do so.
All “terms” of this policy apply to the mortgagee unless changed by this clause.
c. If “we” cancel or do not renew this policy, “we” will notify any mortgagees named on the “declarations” at least ten days before the date cancellation or nonrenewal takes effect.
d. If “we” pay the mortgagee for a loss and deny payment to “you”, “we” are subrogated, up to the amount “we” paid for the loss, to all the rights of the mortgagee granted under the mortgage on the property. Subrogation will not impair the right of the mortgagee to recover the full amount of the mortgagee's claim. At “our” option, “we” may pay to the mortgagee the whole principal on the mortgage plus the accrued interest. In this event, “we” will receive a full assignment and transfer of the mortgage and all securities held as collateral to the mortgage debt.
5. No Benefit To Bailee — Coverage under this policy will not directly or indirectly
benefit those who are paid to assume custody of covered property.
6. Policy Period — This policy covers only losses that occur during the policy period.
7. Recoveries — This applies if “we” pay for a loss and lost or damaged property is recovered or payment is made by those responsible for the loss. “You” must inform “us” or “we” must inform “you” if either recovers property or receives payment. Proper costs incurred by either party are paid first. At “your” option, “you” may keep the recovered property. If “you” keep the
recovered property, the amount of the claim paid, or a lesser amount to which “we”
agree, must be returned to “us”. If the claim paid is less than the agreed loss due to a deductible or other limiting “terms”, the recovery is prorated between “you” and “us” based on the interest of each in the loss.
8. Suit Against Us — No suit may be brought against “us” unless all of the “terms” that
apply to the Property Coverages have been complied with and the suit is brought within
two years after the loss. If a law of the state where the “described location” is located makes this time period invalid, the suit must be brought within the time period allowed by the law.
9. Volcanic Eruption — All volcanic eruption that occurs within a 72-hour period constitutes a single occurrence.
CONDITIONS APPLICABLE TO LIABILITY COVERAGES ONLY
1. Bankruptcy Of An Insured — Bankruptcy or insolvency of an “insured” does not relieve
“us” of “our” obligations under this policy.
2. Duties Of An Injured Person – Medical Payments To Others Coverage — In case
of a loss, the injured person or someone acting on behalf of that person must:
a. give “us” written proof of claim (under oath if “we” request) as soon as practical; and
b. authorize “us” to get copies of medical records.
The injured person must submit to medical exams by doctors chosen by “us” when and
as often as “we” may reasonably require.
3. Policy Period — This policy covers only “bodily injury” and “property damage” that
occur during the policy period.
4. Suit Against Us — No suit may be brought against “us” unless all of the “terms” that
apply to the Liability Coverages have been complied with and the amount of the
“insured's” liability has been fixed by:
a. a final judgment against the “insured” as a result of a trial; or
b. a written agreement of the “insured”, the claimant, and “us”.
No person has a right under this policy to join “us” or impede “us” in actions that are brought to fix the liability of an “insured”.
Analysis
In the conditions applicable to all coverages, the clause stating that bankruptcy of an insured does not affect the carrier's obligation to pay has been removed from this section, and added to the conditions applicable to liability coverages only.
The cancellation and nonrenewal section of conditions has had minor modifications; the policy now states that during the first fifty nine days of the policy the carrier can cancel the policy for any reason; the prior policy stated that during the first sixty days the carrier could cancel for any reason. Another modification to the cancellation section is that the policy now specifies that return premiums on cancelled policies will be calculated on a pro rata basis.
New language appears in the conditions that apply to changes to policy terms. The current policy states that the date broadening language is added to the policy is the effective date of that revision when the revision occurs sixty days before or during the policy period. The new language makes an exception for revisions that are adopted as part of an overall program revision that broadens and restricts coverage; the date the revision is adopted does not automatically become the effective date of the revision. For example a new edition of the policy is adopted on March fifteenth; since it is a new edition of the policy, the effective date of that new policy can be May first.
An entirely new section in conditions is the section concerning death of the insured; the condition specifies what coverage is provided to the representative of the estate when an insured or resident spouse dies during the policy period. In this section of the policy insured includes individuals having proper and temporary custody of the deceased's property until a legal representative of the estate is appointed.
Minor verbiage changes have occurred in the misrepresentations section but the coverage itself has not changed. The subrogation section also has some language changes, and includes a new section as well. If the carrier requires the insured to assign recovery rights, the insured is now required to sign and give the carrier all related documents and cooperate with the carrier.
The appraisal conditions when the carrier and insured do not agree on the value of the loss have been changed; when appraisers are selected they are required to select a competent and impartial umpire within fifteen days; the prior policy had no time specification. If the two appraisers agree in writing the amount of the loss is considered set. If the appraisers do not agree, then the amounts are submitted to the umpire; the written agreement of any two of the three sets the amount of the loss. This change gives the appraisers the opportunity to come to an agreement before involving the umpire.
The condition now states that an appraisal is not used to interpret policy terms, causation, or coverage. The appraisal determines the value of the loss only, not coverage issues.
The mortgage, secured party, and lender's loss payable clause has been changed and now only includes mortagees; references to secured parties and lender's are removed. The sections involving payment to mortgagee, secured parties and lenders are removed as well.
The sections on recoveries and suits which had been in the general conditions sections are now in the property conditions section only.
The volcanic eruption condition has been shortened; while previously all action that occurs within 168 hours was considered one occurrence, now all action that occurs within 72 hours is one occurrence.
Certain conditions have been moved to a new section, conditions applicable to liability coverage only. The nature of the conditions has not changed, but they are now designated as applying to liability coverages only. These conditions are bankruptcy of an insured, duty of an injured person, policy period, and suit against us.

