|  | | Author | Messages | |
Steve Ebner
Moderator
Lake Ariel, PA
Posts:320
 | | 12/24/2006 3:13 PM |
| Dave,
The exclusion does not exclude roommates. It excludes "roomers". The normal definition of a roomer would be someone who rents a room. The test would not be whether someone resides at the residence premises or whether they receive mail there. The test would be whether the partner pays rent.
I can see no reason, assuming the partner does not pay rent, to exclude the property of the partner. | |
Steve Ebner
"With great power comes great responsibility." (Stanley Lieber, Amazing Fantasy # 15 August 1962) | |
| Ray Hall
Adjuster
Houston, TX
Posts:808
| | 12/24/2006 5:14 PM |
| | Roy you are flat wrong on the partners property is not covered, while on the premises. You may be wrong on the liability question. What does the Goldmans paid for it mean ? | | | |
| Dave Marlin
CO
Posts:49
| | 12/24/2006 5:45 PM |
| Steve,
You are right. I believe the exclusion says roomers or boarders, not roommates, so one must meet the definition as such to apply the exclusion. Just getting mail at the residence may be an indicator, but is not definitive. I agree that $$$ probably have to change hands. | | | |
| Dave Marlin
CO
Posts:49
| | 12/24/2006 6:10 PM |
| Ray, Under Section II, Personal Liability, unless there is some exclusion that may apply, the HO carrier should have provided O.J. a defense. It states " Provide a defense at our expense by counsel of our choice, even if the suit is groundless, false or fraudulent. We may investigate and settle any claim or suit that we decide is appropriate." Therefore, they have a duty to defend and a duty to indemnify. There is an intended or expected act exclusion but, since he he was not found guilty in the criminal court, I do not think it should apply. I have no clue about the umbrella policy. I guess it all depends on what it covers. | | | |
| Ray Hall
Adjuster
Houston, TX
Posts:808
| | 12/24/2006 6:34 PM |
| | Yep you are correct. Its real hard to be the carrier and have to defend these type claims but they come up sometime. The intentional act would knock this out if he was found guilty. The umbrella is usally broader in is language than the Sec II of the Homeowners. But it has to be read. I had a consent case of intercourse between minors that was video taped (unknown) and shown at frat house events that comes to mind. Cost a bunch to get out. | | | |
| Steve Ebner
Moderator
Lake Ariel, PA
Posts:320
| | 12/25/2006 2:55 AM |
| It should be pointed out that Ray Hall is way ahead of the discussion here. He has slyly led the discussion in the direction of liability coverages. Liability and Medical coverages are the coverages under which the question of "Who is an insured?" usually comes into play. Under coverages A and B we are dealing with structures rather than insureds. The primary relevant question is "Who has an insurable interest, and is that person the named insured or mortgagee?" Under coverage C we are dealing with contents/personal property and the question of "Who is an insured?" comes into play when the contents are located away from the residence premises. It is also important in the excluded causes of loss, such as damage caused by animals belonging to an insured or theft committed by an insured. Coverage D does not consider "who is an insured" at all. Under this coverage, it is not just any insured that is covered. It is "you", meaning the named insured and spouse.
Under Coverage E the question of "who is an insured?" becomes very important in determining to whom a defense or indemnification is owed. Under coverage F "who is an insured?" is most important in terms of whether an insured granted permission for the injured person to be on the residence premises or whether it is an act of an insured that caused the injury.
Consequently, in our typical work as property adjusters, who is an insured will only occasionally be an element of the claim handling. There will be important exceptions, but generally the question is asked more frequently on liability claims. It is important to note the use of the words "you" and "insured" in the definitions section of the policy and how those words are used throughout the policy. They are not synonymous. "You" is actually a more restrictive term. When the policy says "you", do not look at the definition of "insured" to determine the meaning of it. The term "insured" is used more frequently in Section II of the policy (Liability and Medical Payments coverages). The terms "you" and "your" are used with greater frequency in Section I. | |
Steve Ebner
"With great power comes great responsibility." (Stanley Lieber, Amazing Fantasy # 15 August 1962) | |
| william cook
Posts:19
| | 12/25/2006 9:49 AM |
| It takes but a few moments to read the above informative threads. To draft and post a meaningful response to share knowledge and information goes unrewarded in most instances. I will take this opportunity to thank Mr. Cupps for providing this forum and to all the posters who contribute. I continue to be amazed about how much I don't know about the many intracacies of our industry .
Once again a SINCERE THANKS to the ones that make this resource so valuable.
William S Cook
Public Adjuster | | | |
| Tom Toll
Life Member
Moderator
Posts:916
| | 12/25/2006 11:23 AM |
| | We will be running into this scenario before long. Two females or two males marry in a state that has approved same sex marriages. They go back home and sustain a fire loss, with the owner being the named insured. The state of domicile does not approve same sex marriage. They have an extensive fire loss to contents, which most are co-owned. Do we owe for the partners contents? He receives mail at the insured's address, so, he cannot be considered a guest. There would not be coverage extended to him under normal co-habitation circumstances. Are you going to suggest the company pay claims for both parties? | |
Success is not final, failure is not fatal: it is the courage to continue that counts. | |
| Steve Ebner
Moderator
Lake Ariel, PA
Posts:320
| | 12/25/2006 7:33 PM |
| Again, Tom, I don't understand why there would not be coverage extended for the partner's contents. Of course there would. The policy certainly would cover the partner's contents located at the residence premises whether they are married or not. The scenario you present could become a question for liability coverage or for personal property located away from the resdience premises. It would also present some interesting problems if there had been an ensuing break up or impending divorce, especially in community property states. In the scenario you present, my suspicion is that most insurance companies would decide in favor of the insured and same sex spouse. The alternative is to allow the impending lawsuit to become a highly publicized test suit bringing heaps of unwanted publicity upon the carrier and branding them unfriendly to gay people. Do you know any carrier who would welcome such a suit? I don't. The potential damages for bad faith or class action are staggering to consider. The potential loss of business is also a consideration for the carrier. A significant portion of their book of business is with gay people, and much of it is very good business. How much of the book of business is with gay people is unknown because sexual preference is not one of the questions on the application. Nor should it be. | |
Steve Ebner
"With great power comes great responsibility." (Stanley Lieber, Amazing Fantasy # 15 August 1962) | |
| joseph lombardo jr.
Adjuster
Clearwater, Florida
Posts:112
| | 12/26/2006 8:31 AM |
| Steve and Tom,
Gay or not has nothing to do with the coverage issue under Coverages A,B, C of the standard ISO HO-3 491 policy.......Many people co-habitate and the there is a bunch of common property.....the insured pays a premium dollar for structural and contents coverage and when a loss occurrs, the property is usually covered subjected to the internal limits of liability of the policy for the specific cause of loss.........Unless the "other person is a border, the companies will pay for the contents of that party.
Please refer to Section 1, Coverage C, Paragraph #1&2..........We cover personal property owned or used by an 'insured' while it is anywhere in the world. At your request, we will cover personal property owned by:
1. "Others while the property is on the part of the 'residence premises' occupied by the insured"
2. A guest or a 'resident employee,' while the property is in any residence occupied by an 'insured' Dave, In reference to apportionment , most of the time, the insured "visiting partner" would be handled as a "guest" since usually the amount of personal articles at the insured risk would be minimal when the visiting partner has their own home and coverage...but as usually, we must investigate and make the decision on how to handle the loss based on the facts presented.......From a carrier standpoint,if the personal property claim of the "visiting partner" was less than a thousand dollars we would handle under our insured's policy....if a great deal of property was claimed, then we would probably evoke the apportionment clause in the policy and sort it out from there.
best regards,
Joe L | | | |
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