WARNING

A common in the claim process is the late reporting of claims.
There are many reasons for missing a reporting deadline; however, in most cases, they will not matter. We have seen the courts stand behind the strict reporting requirements of the insurance policy. The policy is a binding contract between the two parties, and the provisions are usually very clear. We have yet to see a “sympathy clause” in an insurance policy.

Claim Reporting Requirements

An insurance policy is not tested until there is a claim made against it. Most policies are straightforward regarding the acts or events that are covered. Insurance policies also spell out the proper way to submit a claim to the insurer. Within the reporting requirements, you’ll often see time requirements, as well as a list of the information that must be included, that establish sufficient notice of claim or loss.

A common coverage objection from insurers is the late or insufficient reporting of claims. In the case of claims made and reported policies, the insured may be required to give notice of all claims, either within the policy period or a post-policy grace period of 60 to 90 days. A continuous renewal with the same insurer does not remove that reporting requirement. Every renewal is another chance to miss a claim reporting deadline.

The reporting guidelines may also require the insured to identify the act that happened, the date it happened, who might sue the insured, what parties have been injured and the magnitude of the injury. If there is a demand for damages or a lawsuit, that’s usually sufficient information to constitute a claim.

What Can Cause a Claim to be Reported Late?

• The insured did not understand that a circumstance was a reportable claim and let it go beyond the deadline.
• The notice was sent to the wrong insurer, wrong layer or wrong line of coverage.
• The claim was sent to the broker and did not make it to the insurer in time.
• A claim lands on the desk of the person at the insured’s company who is responsible for reporting claims but they are out of the office for an extended period, or the paperwork gets lost or buried.

When a claim is denied as a result of late reporting, some common complaints are:

• “Our late reporting didn’t prejudice the claim, so the insurer should pay.”
• “The first event that evolved into this claim wasn’t substantial enough to be called a claim under the policy, in our opinion.”
• “We didn’t want to report every potential claim because our premiums would go up.”
• “The broker received the claim in time, but it was late to the insurer.”
• “I’ve had my insurance with this insurer for seven consecutive years. How can they deny coverage to a loyal customer?”

The following recommendations can help reduce the possibility of late notice denials:

1. Report claims and circumstances directly to the insurer as instructed in the policy you purchased.
2. Send the direct notice of loss to the insurer and your agent, so your agent can assist.
3. Use claims hotlines included with the policy. This allows you to talk to the insurer or claims attorney before deciding to notice or not notice.
4. When in doubt, report the circumstance to the insurer. If the insurer doesn’t accept it, at least there is a record of the attempt, making it more difficult to deny the claim if it develops later.

The plaintiffs had filed eight separate lawsuits against three pharmacies and Medical Center and four of its physicians.

After the FBI raid, one of the doctors was accused of recklessly and illegally issuing hundreds of thousands of prescriptions for pain medications from the clinic; however, the doctor never faced criminal charges and now lives in the Bahamas.

Other clinic physicians involved and office manager were sentenced to six months in federal prison for their guilty pleas to conspiring to misuse a Drug Enforcement Administration registration number. The clinic now belongs to the West Virginia State Police, along with more than $340,000 in cash proceeds forfeited. According to a federal report released last year, doctors in West Virginia wrote the third-highest number of prescriptions following Alabama and Tennessee.

The apartment tower that was under construction is burnt down to ashes. Other buildings surrounding it are heavily damaged.
When the fire department is finished, who is going to pay for damages?

First, the damage to the building under construction worth at least the cost of all the materials that are now gone. These are tens of thousands of dollars that the building owner has lost, UNLESS he had Builders Risk Policy in place. Builders risk policy, which is sometimes called Course of Construction policy will pay for the cost of materials lost due to the fire.

Second, what about the neighbor buildings that are damaged too? What if there are people injured (hopefully not)? This is the liability of the apartment building owner which could be tens of thousands of dollar too, UNLESS he had Owners and Contractor’s Protective liability Policy. This is a liability policy which pays for property damage (buildings burnt, roads and street lights damaged) and bodily injury (people injured or dead) that results because of owner-builder’s liability during the construction.

Hopefully LA apartment building owner had both policies in place with adequate limits.
Also, hopefully nobody is injured.

Builder’s Risk Insurance

A Course of Construction Insurance policy, or “Builder’s Risk” policy, is designed to provide coverage for buildings while under construction. It covers the value of the property being constructed until it’s either moved into, or ready for occupancy, the Contractor’s value in materials at the job site before being installed and materials in transit intended for the job. The policy may be written to cover the whole structure for new construction or for rehab projects. It can also be used to cover a specific project such as a room addition, a kitchen remodel or a new deck.

What’s Typically Covered
A Course of Construction, (Builder’s Risk) policy is a form of Inland Marine insurance. The basic perils such as fire, wind storm, lightning, hail, theft and vandalism are common. Limited coverage may be provided for structural collapse during construction.

Standard Exclusions
Earth movement, employee theft, “mysterious disappearance,” (loss without any proof), water damage, weather damage to property in the open, war, government action, contract penalty, voluntary parting and mechanical breakdown, aircraft, watercraft or automobiles.

Liability is Not Covered
Builders’ Risk insurance does not include coverage for Bodily Injury or Property Damage of others. Ask your Broker about how your General Liability insurance could protect you during construction.

What’s Typically Not Covered
Debris removal, mold, terrorism, and damage by insects or vermin, damage resulting from faulty design, planning, workmanship and materials, plants, trees or shrubs.

All Risk
Ask your broker about an All Risk policy. All Risk policies typically don’t exclude coverage for; fire, theft, vandalism, explosion, water damage, testing, mechanical or electrical breakdown and collapse.

Time Element / “Soft Costs” Coverage
Soft Costs are those expenses for the building process that are other than materials. Including reimbursement for losses caused by a delay in completion on opening of the project. Things like; real estate taxes, interest, consulting fees, legal, accounting and advertising and/or marketing, equipment rental, overhead, insurance, refinance charges and architectural & engineering expenses.

Claims
Claims are settled on an Actual Cash Value basis for Builder’s Risk losses.

Who it Covers
The Named Insured of a Builder’s Risk policy is usually the Contractor or Developer of the property. However, it could be that the building owner or homeowner is the Named Insured, if they are responsible for insuring the property while under construction. Just as you’d expect with a Property Insurance policy, a mortgagee or lien holder may be added as an additional insured.

Always ask your Broker about what’s covered on your specific policy, as this article is intended to give you a basic overview of what a Builder’s Risk, “Course of Construction” policy is about.

Here are top 5 recommendations to homeowners to prepare for winter:

• • Do a visual inspection of your roof to look for maintenance issues or things that could make it more susceptible to hail or wind or other damage — like missing or damaged shingles or tiles on sloped roofs. Or if it’s a flat roof, look for surface bubbles in the membrane material or missing gravel.
  • Look at flashing along the roof to make sure it’s in place and in good condition. The flashing is where you transition between vertical places and the horizontal roof — things like around skylights, vents or chimneys. Anywhere where you have a change in roof elevation, you’ve got flashing there and that’s a typical source or place for water to penetrate into the roof covering.

• Take a walk around the home and look for overhanging trees and branches. Trim trees back and remove dead branches  —things that have the potential to fall when you get high winds or heavy snowfall to keep from damaging your roof.
• Check downspouts and gutters to make sure that after the leaves fall the gutters get cleaned out — anything with the potential to freeze and exacerbate the problem with ice damage. Keep the drainage of the water off the roof and not clogged in the gutters.
• Consider impact-rated roofing in parts of the country more susceptible to hail storms. If agents have customers already in the market for or considering replacing their roof, in certain areas of the country, we would suggest they at least consider it.

Want to get a quote for your Homeowners’ Insurance? Visit our website or call 877-239-0067.

Well, our answer is something most people are not going to like:

– In United States of America everyone with a slightest chance your operations/negligence/products have something to do with the accident or claim that occurred is to be found responsible.

For example,

most of us do remember that terrible shooting that happened in Denver, CO movie theatre. Only two years later parents of Colorado theater shooting victims sue ammo sellers. They filed a lawsuit on 9/16/2014 accusing four online retailers of improperly selling ammunition, tear gas, a high-capacity magazine and body armor used in the attack. The lawsuit alleges it was illegal and negligent to sell the gear to James Holmes, who is accused of killing 12 people and injuring 70 in the July 20, 2012, attack. It says the companies had no safeguards to keep dangerous people from buying their goods. Named as defendants in the case are Lucky Gunner of Knoxville, Tennessee, Bullet Proof Body Armor of Tempe, Arizona, BTP Arms of New Oxford, Pennsylvania, and the Sportsman’s Guide of South St. Paul, Minnesota. Experts say it’s going to be difficult for the lawsuit to overcoming a federal law that protects the legal manufacture and sale of weapons and ammunition.

For similar reason, any contractor working on a construction project could be found responsible for any accident that may happen at the job site, even if this contractor was not physically present at the time of the occurrence.
That’s why people who educate themselves on the subject of general liability insurance understand that buying insurance policy is not only getting some limits, but also guaranteeing a legal representation this coverage provides; certainly, the guarantee is subject to applicable policy forms and provisions and is not available in every case you may face as a proprietor. However, all business insurance policies provide insureds with defense coverage, which is the money your insurance carrier pays to hire you a lawyer to represent in a lawsuit.

For the absolute majority of the businesses insurance is something that is extremely affordable, with rates starting at 0.01% of the gross sales/receipts/commissions. And don’t think if you own a corporation or LLC or work out of your home, you are not subject to a lawsuit. See general liability insurance sample quote and request insurance quote now!

Some of the other emerging risks examined in the SONAR report includes the following:

• Cloud computing security
• Contagious emerging market crisis
• Eurozone crisis leading to deflation
• Short-termism of macro-policy measures
• Air pollution as mortality driver
• Concussion crisis in sports
• Democratisation of genetic testing
• Digital slander
• E-cigarettes
• Financial consumer protection regulation
• From closed to open business models
• Food and water safety: trade-offs with growth
• Secession risks in Europe
• “One size fits all” regulation
• Plant pathogen threatens rubber production
• Aluminium health risks
• Smart cities
• Demographic inclusion at the workplace
• Urban farming
• Action cam liability
• Epigenetics
• From 3D to 4D printing
• Missing aircrafts triggers technological change
• Collapse of oceanic ecosystems
• Enhanced humans
• Methane hydrate – an upcoming energy source?

Want to read full report? Click this link (PDF 1.54 MB): http://media.swissre.com/documents/SONAR_2014.pdf