As always with construction projects, it is important that owners of new developments understand insurance coverage to ensure that there is adequate insurance to address any potential risks during and after the construction of the project. While most owners maintain commercial general liability policies or rely on project-specific policies, these policies may not fully protect the owner against any and all risks that they may face during and after construction. This article addresses two unique areas in which owners should take special note to ensure that they are covered for these particular risks: third party action over claims and products-completed operations coverage.

“Bodily Injury” to:

1.  An “employee” of the insured arising out of an in the course of:

1)  Employment by the insured; or

2)  Performance duties related to the conduct of the insured’s business; or

2.  The spouse, child, parent, brother or sister of that “employee” as a consequence of Paragraph (1) above.

This exclusion applies whether the insured may be liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury.

This exclusion does not apply to liability assumed by the insured under an “insured contract”.

[framed_box]About the Author
Grace A. Nguyen is a Senior Counsel at Chapman Glucksman Dean Roeb & Barger which has offices throughout California. Ms. Nguyen specializes in complex multi-party litigation, including construction and real estate claims, environmental, employment, professional liability, commercial, business and catastrophic casualty litigation. In 2016 Ms. Nguyen was selected as a Super Lawyers Southern California “Rising Star,” for her demonstration of excellence in the practice of law, which is an honor limited to less than 2.5 percent of California attorneys.

This article was originally published by AmWINS Group, Inc., a leading wholesale distributor of specialty insurance products and services. AmWINS publishes The Edge, a monthly email with informative and timely articles for P&C and benefits insurance agents and brokers. To sign up to receive The Edge or for more information about AmWINS, visit amwins.com.

Legal Disclaimer: Views expressed here do not constitute legal advice. The information contained herein is for general guidance of matter only and not for the purpose of providing legal advice. Discussion of insurance policy language is descriptive only. Every policy has different policy language. Coverage afforded under any insurance policy issued is subject to individual policy terms and conditions. Please refer to your policy for the actual language.[/framed_box]

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.

Chapter 175L was signed into law on Jan. 7, 2015, by then-Gov. Deval Patrick and became effective on April 7, 2015. The DOI stated in its bulletin 2015-02 on May 8 that the purpose of this new law is to regulate and standardize the practice of using certificates of insurance.

Chapter 175L defines a certificate of insurance as “a document or instrument, regardless of how titled or described, that is prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage.” The bulletin notes that the term shall not include a policy of insurance, insurance binder, policy endorsement or automobile insurance identification or information card. Chapter 175L explicitly regulates certificates of insurance for the first time in Massachusetts.

The new law codifies the long-time rule that insurance certificates may not modify the terms or conditions of the underlying insurance policies that they evidence. In this regard, Chapter 175L requires that all certificates of insurance must be both true and accurately reflect the policy they represent, and mandates that no one may knowingly prepare, issue or require the issuance of a certificate of insurance that contains any false or misleading information or that alters, amends or extends the coverage provided by the underlying referenced policy.

The new law applies to all certificates issued in connection with property, operations or risks located in Massachusetts, regardless of where the certificate holder, policyholder, insurer, or insurance agent is located.

The bulletin further stated that a certificate of insurance that violates the requirement of Chapter 175L will be deemed to be null and void. Under the law, the insurance commissioner is authorized to examine and investigate the activities of any person that the commissioner reasonably believes has been or currently is engaged in an act prohibited by Chapter 175L. Additionally, Chapter 175L grants the commissioner the authority to enforce the law by imposing a fine of up to $500 per violation.

Key provisions of Chapter 175L are as follows:

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• A certificate of insurance encompasses any document or instrument evidencing property or casualty insurance coverage issued by an insurer or insurance producer;
• A certificate of insurance may not “amend, extend or alter the coverage afforded by the policy it evidences;”
• A certificate cannot create any new or additional rights outside the referenced policy;
• No one may knowingly prepare, issue, request or require any false or misleading information in the certificate of insurance concerning the policy;
• No one may prepare, issue, request or require certificate of insurance that purports to affirmatively or negatively reference insurance outside the coverage provided by the underlying policy;
• A certificate of insurance may not warrant that any insurance or indemnification requirements of a contract are fulfilled by the underlying policy of insurance;
• A cancellation notice reference on the certificate of insurance does not create any right to receive notice of cancellation, non-renewal or material changes to a policy unless the terms of the policy or endorsement so provide.

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In this regard, the DOI further notes that Chapter 175L extends the jurisdictional authority of the insurance commissioner to third parties and prohibits such third parties from requesting or requiring that a certificate of insurance contain false or misleading coverage.

[blockquote]Source: The Massachusetts Division of Insurance[/blockquote]

The Affordable Care Act (ACA) was signed into law in March 2010 and installs a horde of health coverage reforms with effective dates stretched primarily over a period of four to five years. Many ACA reforms are already in effect for employers and their group health plans, but many of ACA’s key reforms will become effective in 2014.
Key ACA reforms that will affect employers in 2014 include health plan design changes, increased wellness program incentives, and a new transitional reinsurance fee. The employer “pay or play” mandate and accompanying additional reporting requirements previously scheduled for 2014 have been delayed for a 2015 implementation. In preparation for 2014 ACA reforms, employers should review upcoming requirements and ensure they have an action plan in place.

1. Confirm Grandfathered Plan Status
Applicable to: Grandfathered plans
Effective: Annual and ongoing
Description: A grandfathered plan is one that was in existence when healthcare reform was enacted on March 23, 2010. If changes are made to the plan that go beyond permitted guidelines, the plan will no longer be grandfathered.

Action Steps:
If you have a grandfathered plan:
„„Determine whether the plan will maintain its grandfathered status for the 2014 plan year (see checklist); and,
„„If you move to a non-grandfathered plan, confirm that the plan has all of the additional patient rights and benefits required by ACA including those effective prior to 2014. This includes, for example, coverage of preventive care without cost-sharing requirements.

2. No Annual Dollar Limit on Essential Health Benefits
Applicable to: All group health plans, including health reimbursement accounts (but not medical flexible spending accounts)
Effective: Plan years beginning on or after January 1, 2014
Description: Group health plans may no longer impose annual or lifetime dollar limits on essential health benefits. (Lifetime dollar limits were prohibited starting for plan years on or after September 23, 2010. Restrictions on annual limits have been allowed to be phased in over a three-year period.)

Action Steps:
Take the following steps:
„„Confirm that no annual limit will be placed on essential health benefits for the 2014 plan year and beyond
„„Consider converting existing dollar limits to visit or occurrence limits
„„Create required plan amendments

Tips:
„„Health Reimbursement Accounts may violate this requirement unless the HRA is integrated with other group health plan coverage that satisfies this rule. An employer-sponsored HRA will not be treated as integrated if it provides benefits to employees who do not enroll in the other coverage. Amounts credited to an HRA before January 1, 2014 are not subject to these rules. Employers with HRA concerns are encouraged to consult with their HRA administrator or legal counsel for additional guidance.
„„Annual limitation exclusions are specific to essential health benefits. However, as generally any medical service could be designated as either “hospitalization” or “ambulatory patient services” (two of the ten “essential health benefits”), one recommendation is that self-insured clients avoid all annual or lifetime maximum benefits, and reduce plan exposure if desired through allowed plan exclusions and visit-type limits.

3. No Pre-Existing Condition Exclusions
Applicable to: All group health plans and non-grandfathered individual health plans
Effective: Plan years beginning on or after January 1, 2014
Description: Group health plans may not impose any pre-existing conditions exclusions (PCEs) regardless of age. PCEs for enrollees under 19 already were eliminated for plan years on or after September 23, 2010.
Action Steps:
Confirm that PCEs will not be imposed on any enrollees for the 2014 plan year and beyond, and create Plan amendment if needed.

4. Applicable to: All group health plans
Effective: Plan years beginning on or after January 1, 2014
Description: Group health plans now will have to extend eligibility to all children until age 26, even if they are eligible for other employer-sponsored coverage. Previously, grandfathered plans were not required to cover adult children under age 26 if they were eligible for other employer-sponsored group health coverage.

Action Steps:
If your plan is grandfathered, confirm that it will make coverage available to adult children up to age 26, regardless of whether they are eligible for other employer-sponsored group health coverage and create plan amendment if needed.

5. Eliminate Excessive Waiting Periods
Applicable to: All group health plans
Effective: Plan years beginning on or after January 1, 2014
Description: Plans no longer will be allowed to impose waiting periods for eligibility which are longer than 90 days. An employee also must be allowed to enter the plan by the 91st day, after satisfying that eligibility requirement.

Action Steps:
If your plan has a waiting period for coverage, confirm that the waiting period is 90 days or less for the 2014 plan year and beyond, and create a plan amendment if needed.

Tips:
90 days is a strict limit. For instance, eligibility may not be determined as the first of the month following 90 days.

6. Coverage for Clinical Trial Participants
Applicable to: Non-grandfathered group health plans
Effective: Plan years beginning on or after January 1, 2014
Description: Non-grandfathered group health plans must cover certain clinical trial costs, may not limit, deny, or require additional conditions on coverage of routine patient costs for services and items furnished in connection with the trial, and may not discriminate against individuals who participate in qualified clinical trials.

Action Steps:
If applicable, remove any exclusion or limitation for required clinical trials from the plan document. Also, evaluate stop-loss for possible exclusions for required clinical trial coverage.

7.Limits on Cost-Sharing
Applicable to: Non-grandfathered health plans
Effective: Plan years beginning on or after January 1, 2014
Description: Non-grandfathered health plans are subject to limits on cost-sharing or out-of-pocket costs, currently defined as the limits applicable to coverage for HSAs. For 2014, these limits are $6,350 for individual coverage, $12,700 for family coverage, and may be applied to medical and pharmacy benefits separately. These maximum limits apply to all in-network claims and include member deductibles, coinsurance and copays. Beginning January 1, 2015, out-of-pocket expenses for medical and pharmacy benefits must apply to a combined maximum out-of-pocket limit.

Action Steps:
If you are a non-grandfathered plan:
„„Review existing plan out-of-pocket limitations and revise if not in compliance;
„„Discuss compliance requirements on prescription drugs with pharmacy benefit manager (PBM); and,
„„Create plan amendment if needed.

Tips:
Limits are indexed to inflation and increased in increments rounded to the nearest $50. As such, these may increase annually. Plan designs that are intended to remain at the highest possible limits may require annual amendments.

8. Non-Discrimination Against Healthcare Providers
Applicable to: Non-grandfathered health plans
Effective: Plan years beginning on or after January 1, 2014
Description: Plans cannot discriminate with respect to plan participation or coverage against any class of healthcare provider acting within the scope of that provider’s license or certification. Plans can still require a provider to abide by its terms and conditions and establish varying rates of reimbursement based on quality or performance matters.

Action Steps:
If needed, eliminate any discriminatory plan language and/or operational requirements of the plan as it relates to this rule.

9. Wellness Program Incentives
Applicable to: All employers
Effective: Plan years beginning on or after January 1, 2014
Description: For 2014 plan years, the maximum reward for health-contingent wellness programs increases from 20 percent to 30 percent, this amount may be increased to a maximum reward of 50 percent for wellness programs designed to prevent or reduce tobacco use.

Action Steps:
For health contingent wellness programs, confirm programs comply with current law and consider increasing 2014 rewards.

10. Other 2014 Reforms Affecting The Insured, Small Group and/or Individual Markets

Comprehensive Benefits Package
Starting in 2014, insured plans in the individual and small group market must cover each of the essential benefits categories listed under ACA. This requirement does not apply to grandfathered plans, self-funded plans or insured plans in the large group market.

Deductible Limits
For plan years beginning on or after January 1, 2014, annual limitation on plan deductibles is $2,000 single/$4,000 family. This requirement does not apply to grandfathered plans, self-funded plans, or insured plans in the large group market.

Essential Health Benefits
For plan years beginning on or after January 1, 2014, insured plans in the individual and small group market must cover, without annual or lifetime limits, each of the essential benefits categories listed under the ACA. This requirement does not apply to grandfathered plans, self-funded plans, or insured plans in the large group market.

Non-Discrimination Based on Health Status
For plan years beginning on or after January 1, 2014, non-discrimination requirements applicable to group health plans are now applicable to health insurers offering individual coverage.

Fair Health Insurance Premiums
For plan years beginning on or after January 1, 2014, insurers may only vary premium rates with respect to a plan based on coverage category, rating area, age, and tobacco use.

11. Transitional Reinsurance Fees
Applicable to: Health insurance issuers and self-funded group health plans
Effective: 2014 calendar year
Details: Health insurance issuers and self-funded group health plans must pay fees to a transitional reinsurance program for the first three years of health insurance exchange operation (2014-2016). The fees will be used to help stabilize premiums for coverage in the individual market. Fully insured plan sponsors do not have to pay the fee directly. The U.S. Department of Health and Human Services has provided an estimation of $63 per covered member for 2014.
Certain types of coverage are excluded from the reinsurance fees, including HRAs that are integrated with major medical coverage, HSAs, health FSAs and coverage that consists solely of excepted benefits under HIPAA (such as stand-alone vision and dental coverage).

2014 Requirements Now Postponed Until 2015

12. New Definition of Full-Time Employee Equivalents Related to Health Plans
Applicable to: All employers
Effective: January 1, 2015 (possibly the first plan year thereafter; unsure until further guidance is issued)
Description: In the application of shared responsibility rules and related tax-penalties, the definition of a full-time employee as it relates to healthcare coverage is defined as a person who works “on average” 30 hours per week.
Action Steps: Evaluate plan language related to full-time coverage eligibility and create plan amendment if needed.
Tip:
ACA “FTE” does not impact:

• „Overtime
• „„Work rules
• „„Other collective bargaining definitions
• „„Other benefits which are not group health plans

Reporting of Health Insurance Coverage
Applicable to: Insurers, employers that self-insure and large employers
Effective: Coverage provided on or after January 1, 2015 (but first forms will not be filed until 2016)
Details: Entities who provide “minimum essential coverage” during a calendar year must provide specific information to the IRS. In addition, large employers are required to report to the IRS and full-time employees whether they offer full-time employees and their dependents the opportunity to enroll in minimum essential coverage.

Employer “Shared Responsibility” Mandate
Applicable to: Employers with more than 50 full-time employees (see new full-time employee definition below)
Effective: January 1, 2015
Description: Beginning in 2015, employers with more than 50 full-time employees may be subject to a penalty if they do not offer affordable Minimum Essential Coverage (MEC) that provides minimum value.
The penalty is calculated as follows:

• Employers Not Offering Coverage: If an employer does not offer MEC and one or more full-time employees receive a premium credit or cost-sharing subsidy through the Exchange, the penalty is $2,000 per year per full-time worker, excluding the first 30 full-time workers.
• „„Employers Offering Coverage: If an employer offers MEC and one or more full-time employees receive a premium credit or cost-sharing subsidy through the Exchange, the penalty is $3,000 per employee (excluding the first 30 full-time employees) who receives a premium credit or cost-sharing subsidy.

An employer-sponsored plan that satisfies the ACA’s reform requirements must:

• „„Be affordable to the employee (i.e., required share of the employee’s premium for self-only coverage exceeds 9.5 percent of his or her W-2, Box 1 income); and,
• „„Provide minimum value (i.e., the plan must pay more than 60 percent of medical costs across a typical population).

Action Steps:
If you are a large employer, take the following additional steps:
„„Employers will want to consider whether they need to make changes to the cost and quality of the coverage offered to avoid penalties that will apply if that coverage is considered unaffordable or low in value;
„„Determine whether health coverage is offered to substantially all (or 95 percent of) full-time employees and dependents;
„„Assess the affordability of the health coverage under one of the IRS’ affordability safe harbors (Form W-2, rate of pay or federal poverty line);
„„Review whether the plan provides minimum value by using one of the three available methods (minimum value calculator, safe harbor checklists or actuarial certification); and
„„If you have a fiscal year plan, be on the lookout for guidance regarding when fiscal year plans must comply with the rule.

[framed_box]
This article was originally published by AmWINS Group, Inc., a leading wholesale distributor of specialty insurance products and services. AmWINS publishes The Edge, a monthly email with informative and timely articles for P&C and benefits insurance agents and brokers. To sign up to receive The Edge or for more information about AmWINS, visit amwins.com.
Legal Disclaimer: Views expressed here do not constitute legal advice. The information contained herein is for general guidance of matter only and not for the purpose of providing legal advice. Discussion of insurance policy language is descriptive only. Every policy has different policy language. Coverage afforded under any insurance policy issued is subject to individual policy terms and conditions. Please refer to your policy for the actual language.
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General liability is a must have insurance coverage for business of any size, including commercial operations performed from a residence. However, even the most comprehensive insurance policy has gaps in coverage, for example most of the claims involving the alcohol sale or serving are excluded from coverage. And that my be a threat to your business, unless you request a Liquor Liability Insurance endorsement.
California’s high court has ruled that hosts who charge admission to parties may be held legally responsible if a drunken underage guest is hurt or injures someone else.
On March 4, 2014 the state Supreme Court said in the unanimous ruling that a cover charge amounts to a sale of alcohol, and state law creates liability for those who sell alcohol to clearly intoxicated youngsters.
The case develops from a 2007 party organized by J.M. at a rental home owned by her parents. 19 years old A.E. died after being hit outside the home by a car driven by another man who had been asked to leave the gathering.
A.E.’s family sought to hold J.M. liable for his death, through her parents and their homeowners insurance.
In the end, liquor liability insurance is an inexpensive protection, that is available as part of a liability insurance or on a standalone basis. If you wish to get a quote complete this short Liquor Liability Application (MS Word 171 KB).

If you own a business and are exposed to online reviews think twice before adding disparagement clause to your ToS contract, as such can be found as violating rights of free speech.

An online retailer found an unpleasant review about customer’s experience and contacted the reviewer requesting a removal of  this review as violating a “non-disparagement clause” or pay $3,500.
The review wasn’t removed and the retailer reported a failure to pay $3,500 to credit bureaus.

Now, the customer is suing the retailer on the basis of freedom of speech rights and the trouble of credit history related denied loans and other financial problems.
While the final say is yet to be heard from the court of law, we suggest to review your ToS and liability insurance policy, in particular the coverage part on Personal and Advertising Injury. If you don’t have one, it is simple to get insurance quote and bind the coverage.

It is a common misconception that slip and fall injuries “just happen” and that there is little that can be done to prevent them. Years of experience show that proper slip, trip and fall prevention can help in reducing the number of injuries and in reducing loss costs.

Some major hazards associated with slip, trip and fall injuries include:

• Slippery surfaces
• Holes or broken surfaces
• Uneven walking surfaces
• Poorly marked and/or poorly lit walkway transitions
• Poor drainage
• Spills
• Slippery conditions due to mud, ice or water during inclement weather

Incorporating best practices and a prevention plan can help reduce the risk of a slip, trip or fall at your business or on your premises.

• Develop and implement a slip, trip and fall risk control policy.
• Conduct periodic walkthrough surveys of your premises to help ensure your property and buildings are kept in safe condition.
• Maintain your property and buildings to reduce potential slip, trip and fall hazards. All flooring surfaces should be well maintained at all times.
• Practice good housekeeping:
  • Use slip-resistant floor treatments
  • Apply floor treatments to manufacturer’s instructions
  • Use “wet floor” signs to warn of known hazards
  • Mop during times of low traffic
  • Document maintenance procedures
• Ensure materials used to prevent slips, such as mats, are well maintained.
• Conduct thorough investigations when a slip, trip or fall accident and/or injury occurs.

Watch your wallet and purse
Many people store personal information in their purses and wallets, making it easier for thieves to commit identity fraud. Help secure your identity by keeping your purse and wallet in a safe place and carrying only essentials when you go out. Leave credit cards you will not be using in a secure place at home. Unless it is absolutely necessary, avoid carrying Social Security cards, birth certificates or passports as they contain key pieces of personal information thieves could use to steal your identity.

Monitor your mail
Whether you are sending or receiving mail, take steps to help keep your mail safe from prying eyes. Never put outgoing checks, bill payments or financial information in your unlocked home mailbox. When you need to send out sensitive documents, consider using a secure postal mailbox or send them from the post office. Know when credit card statements arrive. If they are late, call the credit card company to confirm if the statement was sent. Shred old bills and unnecessary financial records containing personal information.

Keep a careful eye on your credit
According to our data, nearly half of ID fraud cases are committed using the victim’s current accounts. Review your credit report and bank statements to monitor your accounts, and take these extra precautions:

• Make a list of all your credit card and bank account information, and store the list in a secure place, such as on a password protected flash drive or in a fire-proof safe. Include account numbers, expiration dates, credit limits and phone numbers or emails of the customer service and fraud departments. If your card is missing or stolen, you will then be able to quickly notify your credit card provider to prevent fraudulent charges.
• Review your credit report and notify the credit bureaus of any mistakes. The government gives consumers the right to receive one free copy of their credit report every 12 months from each of the three main credit bureaus (Experian, Equifax and TransUnion). Order one report from a different bureau every four months to see credit activity throughout the year.

Keep your Social Security number safe
Social Security numbers are often used to open fraudulent accounts or to access financial information or assets. Do not have your Social Security number printed on your checks or allow merchants to write it on them. If a business requests your Social Security number, ask them why. If it is not a valid reason, do not provide the information they request. Also, never give confidential information to an unsolicited phone caller who claims they represent a financial institution or creditor. Instead, get the caller’s name, location, phone number and reason for the call. Call the phone number on your billing statements to verify the caller’s identification.

Get additional tips for helping protect your identity while you are online.

Consider buying identity fraud insurance, a relatively inexpensive add-on to your renters or homeowners insurance policy. This coverage typically reimburses the cost of reclaiming your identity and rebuilding your credit, such as attorney’s and notary fees and replacement of IDs. It is a low-cost investment against a high-expense crime.

The information on this site is general in nature. Any description of coverage is necessarily simplified and is not intended to provide legal, technical or other professional advice. Whether a particular loss is covered depends on the specific facts and the provisions, exclusions and limits of the actual policy. Nothing on this site alters the terms or conditions of any of our policies. You should read the policy for a complete description of coverage. Coverage options, limits, discounts and deductibles are subject to availability and to individuals meeting our underwriting criteria. Not all features available in all areas.

The holidays usually bring several things to a small business – more foot traffic, celebratory decorations and additional staff to help with boosted sales.  However, with added customers and distractions, slips and trips are never far away. So when getting into the holiday spirit, you should make safety a priority.

Training employees on safety practices key to reducing injuries

New or seasonal hires often bring greater risk when it comes to frequency of injuries. In fact, they are five-times more likely to experience an injury in their first month of employment which can be significant enough to require them to miss work, leaving you short-handed at a time when you need all hands on deck*.

Therefore, training employees in workplace safety from day one is key. Helpful tips to keep in mind when safeguarding your store include:

• Make sure new hires are familiar with their surroundings and responsibilities. While they may have a lot of industry experience, your unique facility is still unfamiliar territory.
• Train employees in proper lifting techniques and ladder safety.
• Ensure that your candles are battery operated. Decorations also go hand-in-hand with potential accidents and injuries. According to the National Fire Protection Association, the top 4 highest days of the year for candle fires happen between Christmas Day and New Year’s Eve. So in a busy retail environment, or even in the office, faux candles may be best.
• Choose your decorations wisely. Many of them are combustible, or will burn. Things like paper, decorated trees and wreaths will increase the fire load in a small business. Keep them away from heat or other ignition sources.
• Use extension cords properly, and be sure you aren’t ”daisy-chaining” them in order to extend a decoration or a theme to an area where the plug cannot reach. Aside from a potential trip and fall incident, this is also a fire hazard.
• Choose smart locations for any additional holiday displays and products. Be sure you are not covering up emergency exit signs, over-crowding aisle ways—anything that would make it difficult to get out in an emergency situation.
• Be sure decorations are secured properly and traffic can navigate easily around them, especially when it comes to big displays.
• Maintain appropriate inventory levels. Over-stocking shelves could lead to items toppling onto staff or customers.
• As a general rule, always take the time to scan your facility to make sure it’s safe for customers and employees. It should be a part of your daily process to open and/or close up shop.