Elements of Policy Analysis
A: This tactic could result in awarding punitive damages against the insurer.
Q: What is acting in bad faith?
(See page 3-3 of the textbook)
Q: What is the declaration page?
The declarations page provides details of who is insured, how much insurance was purchased and for what lines of coverage (for example, building, contents, additional living expense), the policy period, a description of the insured property, lists of endorsements or riders that apply, loss payees, and other identifying information specific to the risk. (See page 3-9 of the textbook).
A: Against the offeror.
Q: What is contra proferentem?
It applies when one party, like an insurance company, creates the terms of a contract, giving them an advantage. (See page 3-11 of the textbook).
A: This level of law governs statutory conditions, general conditions, regulations, and some auto insurance coverage.
Q: What are provincial (and territorial laws)?
(See page 3-14 of the textbook).
A: Previously, if one cause of a loss wasn't covered while another was, courts excluded the entire loss.
Q: What is concurrent causation?
Courts now often allow coverage for the part caused by the covered event, unless the policy clearly states otherwise. If it's unclear which cause led to the damages, the full loss may be covered. (See page 3-7 of the textbook).
A: These are specific, and in addition to the statutory conditions.
Q: What are policy conditions?
Example: warranties. If the insured breaches a warranty, the insurer has grounds to void the policy from the date of the breach. (See page 3-10 of the textbook).
A: These are the articles of the Code of Quebec that describe the rules governing how to interpret contracts.
Q: What are Civil Code Articles 1425–1432, 1436, and 1437?
(See page 3-13 of the textbook).
A: This type of liability policy covers events that happen during the policy period, regardless of when claim is made
Q: What is an occurrence-based liability policy?
The majority of liability policies are occurrence-based. The date that the accident took place is the date to be qualified under the policy term. (See page 3-18 of the textbook).
A: This is the first step in mapping out an investigation plan.
Q: What is a review of the entire policy against the FNOL?
(See page 3-4 of the textbook).
A: In a residential broad-form policy (all risks of direct physical loss or damage), these are used to determine coverage.
Q: What are exclusions?
Exclusions may also include exceptions that return coverage on a limited basis. (See page 3-10 of the textbook).
A: This principle helps protect policyholders from unfair or unclear wording in insurance contracts.
Q: What is coverage provisions construed broadly?
The law of precedent has established that coverage provisions must be construed broadly in the insured’s favour. (See page 3-11 of the textbook).
A: Under these liability policies, it is not the accident date but rather the date the third party makes a claim against the insured that defines coverage.
Q: What are a "claims-made" basis?
(See page 3-19 of the textbook).
A: These are the three (3) questions to ask when determining insurable interest.
Q: What are:
1.What property was damaged by an insured peril?
2.Is the property the subject matter of the insurance?
3.What is the insured’s relationship to the property in law?
(See page 3-5 of the textbook).
A: These types of damages are not recoverable under the insurance policy.
Q: What are punitive damage?
Only the actual damages suffered by the third party are recoverable. (See page 3-9 of the textbook).
These four (4) rules are used to interpret insurance contracts in the common law provinces and territories.
A: What are:
A: This type of framework helps adjusters thoroughly analyze coverage by reviewing all relevant issues.
Q: What is a structured framework?
Having a detailed list of items to analyze will assist an adjuster in making sure he or she reviews all relevant issues regarding coverage. (See page 3-14 of the textbook).
Describe proximate cause and name the landmark case that further defined it.
Proximate cause is an uninterrupted unfolding of events, without the intervention of another main cause from the initial act to the conclusion. The case is Scott v. Shepherd (1773).
(See page 3-5 of the textbook).
Name the three (3) standardized wording forms generally used in residential personal lines policies.
A: What are:
(1) named perils, (2) broad form, which provides all-risks coverage for building and named-perils coverage for contents, or (3) comprehensive form, with all-risks coverage for building and contents. (See page 3-9 of the textbook).
A: This legal precedent has established that exclusions in insurance policies are to be interpreted narrowly and generally against the insurer.
Q: What is the principle of Exclusion Clauses Construed Narrowly?
This approach helps protect policyholders from overly broad or unclear exclusions that might unfairly deny coverage. (See page 3-12 of the textbook).
A: This may affect coverage provided under a policy, by specifying minimum coverage requirements for certain kinds of policies.
Q: What is legislation?
Provincial and territorial laws govern statutory conditions, general conditions, regulations, and some auto insurance coverage. Even if these rules aren't included in the policy, the insured is still entitled to the protections provided by the law. (See page 3-14 of the textbook).