Masonry Magazine May 1968 Page. 6
What? Not Covered!
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tions to another time and place. Coming from a claim background and being of a fairly conservative nature, I may tend to see more potential gaps than the next fellow, but my purpose will be served if this brief summary raises the coverage question before, rather than after, a disputed loss occurs.
Lastly, we have not gotten them all. There are undoubtedly hazards not covered by these policies beyond those enumerated, but I hope to have shed some light on the most important and most common of them.
SOME PRESUPPOSITIONS
In all of the following situations we shall make some basic assumptions which then need not be repeated:
I That the named insured is correct and complete as stated in the policy.
II That the described incident occurred within the territorial limits definition of the policy.
III That the incident occurred within the policy period.
IV That the policy has not been cancelled for some reason by either the insurance company or the insured.
V That it has not been further altered by an unspecified endorsement affecting the described incident.
VI That the insured has not jeopardized or negated coverage by failure to cooperate with his carrier as may be required by policy conditions.
QUESTIONS OF LIABILITY VERSUS COVERAGE
It is important, too, that we clear up at the onset a common source of confusion to the insured and insurer alike. Semantics make all the difference in the world here.
We have sometimes been asked to intercede in an apparent declination of coverage situation, only to find that there was no question at all about coverage being applicable the insured's legal LIABILITY was being denied. The claim adjuster may have unwittingly chosen the wrong word, or the insured may have misunderstood his company's position.
A declination of coverage requires the insured to assume his own defense, and potentially assume payment, of an uninsured claim. A declination of liability means that the carrier does not find the insured legally responsible for the injury or damage, but they will defend and, if later convinced by court decision or otherwise that payment is warranted, they will pay on behalf of the insured. The situations are totally different, of course.
You can assist your carrier in making a proper determination of legal liability by promptly supplying all necessary facts concerning a loss and cooperating fully with their investigation. Where you do not feel a loss to be your responsibility, say so, but beyond that things are best left in the hands of the carrier. Claim investigation and defense are among the matters covered by your insurance premium-let the experts determine fault, if any. They have the enormous advantage of experience and precedent to guide them through what might be to you a first-time situation.
The art of paying legitimate claims while staunchly defending others is somewhat akin to walking a tight-rope, since payments have such a marked effect upon premium costs. One practical solution is for you or your insurance representative to be kept informed of developments of consequence on claims of appreciable size.
In many cases this can be arranged as a courtesy the insured; we find it makes a big difference when you hear about a proposed settlement before it appears in black and white at renewal time. It is impractical for either you or the carrier to do this on any but major claims, of course.
THE NEW LIABILITY POLICY FORMS
Following a careful review of the revised Liability policy forms adopted by the National Bureau of Casualty Underwriters (now the Insurance Rating Board) and Mutual Insurance Rating Bureau effective October 1, 1966, we concluded that they were (1) somewhat clearer than the old versions, and (2) otherwise not much different.
That initial reaction has proven to be essentially correct; not the last word in clarity, surely, and not as complete in terms of coverage as we would have liked, but decidedly a step in the right direction.
We have undertaken this venture partially to counter adverse criticism from certain quarters and to help dispel any new concern over exclusions and limitations appearing in print for the first time in the revised format. Inevitably, insurance buyers want to know whether they have more or less coverage now, and this, in turn, has led to renewed interest in what is not insured.
Having termed the revision a clarification rather than touted it as a major improvement in coverage, we personally have not encountered opposition from buyers who have now had occasion to compare the new with the old, but a good deal has been written by others who take objection to restrictions appearing for the first time. The whole point is that they are not really new in intent at all; they merely put into black and white the carrier's original coverage commitment following a series of rather strange and far-reaching court interpretations which stretched application of coverage beyond any-
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masonry
May, 1968