C111 Advanced Loss Adjusting

Updated April 2012

11.    1.       Occurrence- An accident (element of suddenness) and/or continuous or repeated exposure to the same general conditions.

1. 2.       Qualities affect coverage of an occurrence
   a.       Suddenness – definite as to time and place; one of the elements (accident) of an occurrence.
   b.      Intent – insurance does not apply to losses expected or intended regardless of what the amount of damage is.
   c.       Foresee ability – As long as the result was unintended (accidental), it is still insurable, even if the result is foreseeable.
   d.      Chance – An occurrence must be fortuitous to be insurable. If an insured has been warned about a process or activity, and continues that practice with a resulting occurrence, the resulting damage did not occur by chance (not fortuitous) and is not insurable.
   e.      Criminality – Any criminal act falls under the intentional act exclusion.
   3.       How does Vicarious Liability (“The responsibility of the superior for the acts of the subordinate”) for employers apply to sexual abuse claims? – Current Policies exclude sexual misconduct of any kind (abuse or molestation) and also extends to defence obligations.
   4.       How does coverage under the CGL policy apply to damage resulting from defective products or faulty workmanship? – It is limited to damage resulting from a defective product or faulty workmanship and does not extend to the faulty workmanship or product itself. i.e. the damages caused by a poorly built wall that collapses (injuries or property damage to neighbours property/persons) would be covered but the damage to the wall itself would not be covered. Coverage is not intended for the insured’s work that does not meet adequate standards....just the damage to others that results from the poor work.
   5.       Remember – Duty to defend and indemnify are not necessarily mutually inclusive.
   6.       2 basic policy trigger approaches used in CGL & other liability policies? – Claims made & Occurence.
   7.       “Claims made”  - Triggers when a claim is made against the insured during the policy period. The date of the incident does NOT have to fall within the policy term. “Occurrence” – Coverage is triggered when the occurrence takes place and must occur within the policy term.  
   8.       Retroactive Date – a cut off date for an incident to qualify for coverage under a “Claims made” policy.
   9.       Extended reporting period – an endorsement that extends the time which an claim may be reported after the policy “expires” – this allows for an extended period of time that an occurance can be discovered.

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