Thieves cut through a fence to access the insured general contractor's job site’s and stole tools, a forklift, a pallet of marble tiles, and a truck loaded with precast concrete wall panels.    Notable Timestamps

[ 00:30 ] - The insured finds out that these losses are not covered under their standard CP forms.

[ 01:45 ] - The team discusses impressive thieves, the defintion of a CP policy, New Year's Resolutions, and vision boards.

[ 05:13 ] - The CP/BPP form generally applies while the property is on or within 100 feet of the premises described in the policy’s declarations. The job site is not the insured's listed place of business.

[ 07:05 ]- A Property Off Premises Coverage Extension exists, but applies only to property that is temporarily at a location the insured does not own, lease or operate.

[ 07:45 ] - Here, GC’s marble tiles and precast panels were not temporarily at the job site – they were going to be permanently installed there.

[ 08:30 ] - GC arguably “operated” the jobsite, as it had control over the site, including access etc.

[ 09:20 ] - The coverage extension also contains an exclusion for property in or on a vehicle, so that applies to eliminate coverage for the panels on the truck.

[ 09:40 ] - GC could have protected this property via Inland Marine Insurance. 

[ 10:20 ] - Originally, “marine” insurance policies were written when virtually all commercial goods were transported by boat. However, due largely to the development of railroads, marine insurance was extended to provide “warehouse to warehouse” coverage.

[ 11:04 ] - While there are a number of inland marine forms, the most common are Builders Risk, Installation Floater, Contractors Equipment, and Motor Truck Cargo Liability.

[ 12:10 ] - Builder’s risk insurance covers buildings and other structures during the course of construction, including materials and supplies that will become a permanent part of the buildings or the structures, while on the jobsite or on the way to the jobsite.

[ 14:10 ] - Under the claim scenario here, the pallet of marble tiles and precast concrete wall panels would be covered, but not the the generators, concrete saw, or forklift, since they are not materials or supplies.

[ 15:10 ] - Jeff provides a recap of the scenario and the points above.

Your PLRB Resources

Inland Marine – Prop. Q&A 187 - https://www.plrb.org/documents/inland-marine-prop-qa-187/

Form – AAIS IM 7050 09 08 – Builders Risk - https://www.plrb.org/documents/form-aais-im-7050-09-08-builders-risk/

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

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Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

For the next two weeks over the holidays, we’re going to feature some excellent podcasts from before we rebranded as “What’s the Scenario? with PLRB.” These segments were called “The Coverage Contrarian,” and they featured PLRB coverage attorneys Michele Hunter, Eric Friedmann, and Frank Gagliardi as they argued vociferously about coverage issues big and small. This week, we’ll explore the scenario of an insured repair business that repaired a valve on a large boat so poorly that the whole engine was damaged. Let’s listen in. Key Takeaways

1. The critical inquiry in a defective or faulty workmanship case is, the scope of the insured's agreed upon, contracted work.

2. Under the majority view, the damage to the engine would likely be considered damage to other property, because the insured was not hired to work on the whole engine itself.

3. Under the minority view, working on an interconnected part of an engine would be considered working on the engine as a whole.

Your PLRB Resources

PLRB on Demand (Classic Podcast Episodes) - https://www.plrb.org/education/education-resources/?general_index%5BrefinementList%5D%5Blms_type%5D%5B0%5D=Podcast&general_index%5BsortBy%5D=general_index%3Apublished_on%3Aasc

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

Subscribe to this Podcast

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Send us your Scenario!

Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

For the next two weeks over the holidays, we’re going to feature some excellent podcasts from before we rebranded as “What’s the Scenario? with PLRB.” These segments were called “The Coverage Contrarian,” and they featured PLRB coverage attorneys Michele Hunter, Eric Friedmann, and Frank Gagliardi as they argued vociferously about coverage issues big and small. This week, we’ll explore the scenario of an e-bike slamming into a tree.   Key Takeaways

1. In any coverage issue involving an E-Bike, the first step is to consider the jurisdiction you're in, and whether that particular state excludes E-Bikes from its definition of "motor vehicle."

2. If an E-Bike is not considered a "motor vehicle," there is no coverage, and no reason to consider the motor vehicle exclusion.

3. And the second EQUALLY IMPORTANT step is to see whether the particular Homeowners policy has coverage for "motorized vehicles" or "recreational motor vehicles." Because then, there may be coverage for an E-Bike accident on the insured premises or for a rented E-Bike.

Your PLRB Resources

PLRB on Demand (Classic Podcast Episodes) - https://www.plrb.org/education/education-resources/?general_index%5BrefinementList%5D%5Blms_type%5D%5B0%5D=Podcast&general_index%5BsortBy%5D=general_index%3Apublished_on%3Aasc

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

Subscribe to this Podcast

Your Podcast App - Please subscribe and rate us on your favorite podcast app

YouTube - Please like and subscribe at @plrb

LinkedIN - Please follow at “Property and Liability Resource Bureau”

Send us your Scenario!

Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

The insured's roof will need to be replaced. Upon removal of the asphalt shingles, the roofing contractor finds that the existing roof deck has gaps. Now, the contractor is requesting removal of the existing spaced sheathing and installation of new half-inch OSB.   Notable Timestamps

[ 00:30 ] - The scenario concerns the devastation that followed Hurricane Helene.

[ 01:15 ] - Mike shares a story about getting stranded up on a roof, and Rosen shares his childhood shenanigans.

[ 03:49 ] - A riddle: What kind of house is fully enclosed but it has no roof?

[ 06:00 ] - The deck holds the roof covering. In some cases it can be boards, and spaced decking or skip sheathing is where there is a "skip" between each panel.

[ 07:00 ] - Spaced sheathing is most common with coverings made from wood, e.g. cedar shake wood shingles, to provide ventilation to prevent improper curing and bending.

[ 07:14 ] - Spaced sheathing is not compatible with asphalt shingles.

[ 08:20 ] - The issues arise when cedar shake is covered with asphalt shingle, but then a storm requires removal of the shingle & shake.

[ 09:20 ] - Some contractors propose removing all the sheathing, but a three-eighth inch overlay can be installed over the spaced sheathing.

[ 11:10 ] - Without some small gap between the planks, seasonal changes would cause expansion and contraction that lead to bowing. Gaps that are too large can lead to nails not being attached to anything securing it.

[ 13:30 ] - The industry consensus seems to prefer gaps between one-eighth inch and one-quarter inch.

[ 14:25 ] - There's a misconception that planked sheathing cannot be used with asphalt shingles, but IRC R803.1 disagrees.

[ 15:40 ] - Rosen provides a recap of the scenario and the points above.

Your PLRB Resources

Recorded Webinar: Asphalt Shingle Roofs: Top 10 Code Questions - https://www.plrb.org/courses/asphalt-shingle-roofs-top-10-code-questions/

Clickable Diagram: Residential Roof Toolkit - https://www.plrb.org/building-codes/building-component/#roof_toolkit

Spaced Sheathing Does the Deck Need to be Replaced - https://www.plrb.org/documents/sheathing-spaced-sheathing-does-the-deck-need-to-be-replaced/?search=sheathing%20gap

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

Subscribe to this Podcast

Your Podcast App - Please subscribe and rate us on your favorite podcast app

YouTube - Please like and subscribe at @plrb

LinkedIN - Please follow at “Property and Liability Resource Bureau”

Send us your Scenario!

Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

The named insured's home underwent a total loss. The insured wants coverage for a place to stay while his home is being rebuilt. The insured wants to know the scope of Loss of Use coverage, and exactly how many bags of M&Ms he can snag from the minibar.    Notable Timestamps

[ 00:25 ] - The insured also lives with his girlfriend, which may come into play later.

[ 01:00 ] - Are minibars even a thing anymore?

[ 02:23 ] - ALE is triggered when the insured premises is unfit to live in, and applies to any necessary increase in living expenses incurred to maintain its normal standard of living.

[ 03:50 ] - “Expenses” could include house rental, meals, drink, tips, transportation, heating, lighting, laundry, etc., but the insured must be able to show an increase in expenses. 

[ 04:37 ] - ALE is not intended to cover a shortfall in personal property coverage.

[ 05:30 ] - ALE is analogous to Extra Expense under commercial policies, but Extra Expense can be more expansive.

[ 06:40 ] - Is alcohol a daily expense? ALE can include laundry, restaurants and tips, etc. if it can be shown the expense is more than normal.

[ 07:40 ] - The live-in girlfriend would be considered a member of his household, but ALE only applies to the insured's additional expenses.

[ 09:30 ] - In 2022, ISO added some language to allow ALE to cover expenses by residents of the household who are relatives or dependents.

[ 10:55 ] - The girlfriend may have to prove her residency.

[ 12:10 ] - ALE only applies when there is a covered cause of loss.

[ 13:10 ] - If the home is only partially fit to live in, an insured can still incur ALE. If the kitchen is uninhabitable, ALE may cover restaurants.

[ 14:30 ] - If a guest's visit was planned pre-loss, the insured's expenses for the guest may be covered.

[ 16:30 ] - Pet boarding expenses are also likely included in ALE expenses.

[ 17:35 ] - John provides a recap of the scenario and the points above.

Your PLRB Resources

PLRB, Homeowners Annot. Key HO37 - https://www.plrb.org/legacy-documents?DN=77

Adjuster Resource Sheet: ALE Claims - https://www.plrb.org/documents/adjuster-resource-sheet-ale-claims/

ALE or FRV: Insured Decides to Stay on Premises in Cottage But Loses Rent from Current Tenants - PCQ.2024.03.22.slc.a - https://www.plrb.org/documents/ale-or-frv-insured-decides-to-stay-on-premises-in-cottage-but-loses-rent-from-current-tenants-pcq-2024-03-22-slc-a/

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

Subscribe to this Podcast

Your Podcast App - Please subscribe and rate us on your favorite podcast app

YouTube - Please like and subscribe at @plrb

LinkedIN - Please follow at “Property and Liability Resource Bureau”

Send us your Scenario!

Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

The insured landlord spent considerable expense driving back and forth to the loss site in order to check on the contractors and make sure the building repairs were going smoothly. The insured submits their mileage to the adjuster for reimbursement.   Notable Timestamps

[ 00:30 ] - The team celebrates the fiftieth episode! Sort of.

[ 01:38 ] - In this scenario, the insured requests payment for driving back and forth to the loss site, which was his decision.

[ 03:34 ] - Can we find coverage here? We can try three avenues...

[ 04:11 ] - First, it's not really part of the building repair (and therefore replacement cost) unless the insured was assisting in the repair.

[ 05:25 ] - Second, it doesn't really fall under Extra Expense because he is not attempting to reduce the Period of Restoration.

[ 06:50 ] - Third, it doesn't qualify as an attempt to prevent further damages.

[ 07:40 ] - Another consequential loss scenario: The insured discovers their passport is stolen! The insured must travel to obtain a new one, and wants payment for that travel.

[ 08:40 ] - Likely, yes; it's required to replace her lost contents.

[ 09:15 ] - Can she take a helicopter? A reasonableness standard would likely apply.

[ 10:15 ] - A trophy deer head is damaged, and would like the cost of a hunting trip to replace it himself. But, sentimental value is not part of ACV.

[ 13:00 ] - A customer in Japan opened a cattle hide that had been shipped internationally, and discovered water damage. The insured who sent the hides flew to Japan to maintain the customer's good will, and wants that plane ticket reimbursed.

[ 14:30 ] - It seems to fall under Extra Expense, yet in this claim the insured's business did not shut down, so business income does not apply. The court argued that the damage to the reputation was consequential damage and not covered.

[ 16:30 ] - Tim provides a recap of the scenario and the points above.

Your PLRB Resources

PLRB, Indirect Losses Or Expenses - https://www.plrb.org/documents/indirect-losses-or-expenses/

Death – Does A.L.E. Apply to Representative and Family Members While Repairs Are Ongoing? PCQ.2020.10.08.jch.a - https://www.plrb.org/documents/death-does-a-l-e-apply-to-representative-and-family-members-while-repairs-are-ongoing-pcq-2020-10-08-jch-a/

ALE for Mileage to Visit Hospital - in Additional Living Expenses (HO37) Annotation - https://www.plrb.org/documents/additional-living-expenses-ho37/#toc47

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

Subscribe to this Podcast

Your Podcast App - Please subscribe and rate us on your favorite podcast app

YouTube - Please like and subscribe at @plrb

LinkedIN - Please follow at “Property and Liability Resource Bureau”

Send us your Scenario!

Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

Cassie and her neighbor were constantly on each other's nerves. One night, the neighbor snuck onto Cassie's property and jammed a stick into the A/C condenser fan blades out of spite, causing the mechanicals on the unit to break down.   Notable Timestamps

[ 00:29 ] - The adjuster's manager points out the exclusion for mechanical breakdown, prefaced by anti-concurrent causation language. The adjuster still feels this loss was in the nature of a vandalism loss and should be covered.

[ 01:45 ] - Trivia question! What sitting US Senator was assaulted by his neighbor while mowing his lawn?

[ 02:45 ] - Mike & Brennan get into their history of neighbor feuds and doggie disputes...

[ 04:04 ] - The "Anti-Concurrent Causation" preface deals with the multiple causation problem. The default approach is to determine which cause is dominant or proximate, but where a policy has the "Anti-Concurrent Causation" preface, that's not the approach.

[ 05:35 ] - Tim pulls the policy out of his pocket and reads that exclusions that follow the A.C.C. preface are excluded "regardless of any other cause..."

[ 07:00 ] - In four jurisdictions (AL, CA, WA, WV), the A.C.C. preface is disregarded.

[ 07:40 ] - There is an argument to be made that mechanical breakdown is in the chain of events, and therefore the exclusion applies regardless of the vandalism cause.

[ 09:11 ] - An insurance company can choose to draft their policy this way and exclude this loss.

[ 10:44 ] - Usually when you think mechanical breakdown, you think of a machine reaching the end of its life, wearing out, as opposed to sudden damage.

[ 11:23 ] - It is very rare to see the mechanical breakdown exclusion paired with the A.C.C. preface, likely due to this unintuitive situation. The A.C.C. preface is usually intended for exclusions more subject to misapplication, such as flood.

[ 12:55 ] - The way this policy is drafted, any time a machine breaks down it would eliminate coverage... even during a fire? Would a court uphold that?

[ 13:30 ] - Tim provides a recap of the scenario and the points above.

Your PLRB Resources

Mechanical Breakdown Exclusion and the Anti-concurrent Causation Preface – PCQ.2024.09.26.twh.a  - https://www.plrb.org/documents/mechanical-breakdown-exclusion-and-the-anti-concurrent-causation-preface-pcq-2024-09-26-twh-a/

PLRB, Homeowners Annot. Key – Mechanical Breakdown, Latent Defect, Inherent Vice (HO129) - https://www.plrb.org/documents/mechanical-breakdown-latent-defect-inherent-vice-ho129/

Anti-Concurrent Causation Preface (HO78) Annotation - https://www.plrb.org/documents/anti-concurrent-causation-preface-ho78/

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

Subscribe to this Podcast

Your Podcast App - Please subscribe and rate us on your favorite podcast app

YouTube - Please like and subscribe at @plrb

LinkedIN - Please follow at “Property and Liability Resource Bureau”

Send us your Scenario!

Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

At the downtown speakeasy, there’s jazz in the air and the moonshine is reasonably priced. Maybe too reasonably priced, because a few of the speakeasy’s patrons are getting belligerent. Soon half the bar is fighting, and the bouncer flips his assailant to the ground.   Notable Timestamps

[ 00:34 ] - When the bouncer flips the assailant, he is on his way to defend a waiter and trying to defend himself.

[ 01:30 ] - The crew discusses hidden speakeasies...

[ 04:00 ] - The legal backdrop is that the injured patron is arguing that the speakeasy's insurer has more money to settle the claim-- the general $1M limit, not the smaller endorsement's limit of $25K.

[ 05:00 ] - The endorsement for Assault & Battery covers damages paid out arising out of assault and battery, up to $25K.

[ 06:15 ] - The Expected or Intended Injury Exclusion does exclude injury “expected or intended from the standpoint of the insured." If you throw someone into a table, you probably expect them to be injured.

[ 07:00 ] - But, there’s an exception to the exclusion! It doesn’t apply to bodily injury “resulting from the use of reasonable force to protect persons or property."

[ 07:35 ] - The patron argues that the coexistence of these two clauses creates an ambiguity.

[ 09:30 ] - The court in Scottsdale v. Speakeasy rules that the existence of the exception to the exclusion did not preclude applicable endorsements.

[ 11:00 ] - The patron argued that the bouncer did not mean to hurt him, so it wasn't an "assault." The court ruled that the bouncer did intend to throw him, and that falls under the endorsement.

[ 12:30 ] - Brennan provides a recap of the scenario and the points above.

Your PLRB Resources

Scottsdale Ins. Co. v. Speakeasy Bar & Grill, LLC (2024) 2024 U.S. Dist. LEXIS 167125 (S.D. Ind. 9/16/24) - https://www.plrb.org/documents/scottsdale-ins-co-v-speakeasy-bar-grill-llc-2024/

Commercial General Policy Annotation Key GL71 – Expected or Intended Injury Exclusion - https://www.plrb.org/documents/gl71-expected-or-intended-injury-exclusion/

Does the “Expected or Intended” Exclusion Apply to the Employer for an Employee’s Assault? – CCQ.2023.06.28.jrm - https://www.plrb.org/documents/does-the-expected-or-intended-exclusion-apply-to-the-employer-for-an-employees-assault-ccq-2023-06-28-jrm/

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

Subscribe to this Podcast

Your Podcast App - Please subscribe and rate us on your favorite podcast app

YouTube - Please like and subscribe at @plrb

LinkedIN - Please follow at “Property and Liability Resource Bureau”

Send us your Scenario!

Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

It's not easy work standing over a hot fryer making french fry rings all day, so today's fry cook isn't in the best mood when the cashier starts complaining. After the lunch rush, the employees sneak out and step over to the neighboring gas station parking lot for a fistfight.   Notable Timestamps

[ 00:26 ] - At DonutBurgers, two employees are still on the clock and in their uniforms when they leave the premises for a fight.

[ 01:39 ] - Cold or hot? Curly or shoestring? Salt or no salt? The team discusses the best fast food fries.

[ 03:25 ] - Insurance generally covers defense against claims seeking damages for bodily injury, if caused by an occurrence.

[ 04:35 ] - The concept of an occurrence is related to fortuity, as in, insurance is generally intended to cover accidents, not purposeful actions.

[ 05:20 ] - The definition of occurrence and the Expected or Intended Injury Exclusion usually operate to preclude defense of an employee for their assaults...

[ 06:00 ] - ...but the employer is often sued for negligent hiring, negligent background investigation, negligent training, negligent supervision, etc.

[ 07:15 ] - The policy in this scenario only covered employees for acts within the scope of their employment.

[ 08:15 ] - In the case upon which this scenario was based, the court held in favor of the insurer even though negligence was alleged, because the crux of the complaint centered on intentional conduct unrelated to business operations.

[ 10:30 ] - Nevada law supports the interpretation that there is no occurrence under these facts, so the action taking place off-premises likely did not impact the result.

[ 12:22 ] - Brennan provides a recap of the scenario and the points above.

Your PLRB Resources

Safety Nat’l. Cas. Corp. v. Bender (2024) 2024 U.S. Dist. LEXIS 159524 (D. Nev. 9/4/24) - https://www.plrb.org/documents/safety-natl-cas-corp-v-bender-2024/

GL17 – Occurrence/Accident Defined - https://www.plrb.org/documents/gl17-occurrence-accident-defined/

Can There Be an “Occurrence” When the Insured’s Employee Deliberately Strikes a Customer With a Baseball Bat? 2022.01.18 - https://www.plrb.org/documents/can-there-be-an-occurrence-when-the-insureds-employee-deliberately-strikes-a-customer-with-a-baseball-bat-2022-01-18/

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

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Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

A restaurant hired a plowing service. One night, before the service plowed the lot, a grandmother exits her car, slips and falls, and breaks her hip. The woman sues, but the restaurant did not report the injured woman’s claim to their insurer for six months.   Notable Timestamps

[ 00:26 ] - By the time the insurer learned of the loss, the injured person had already obtained a judgment against the insured. 

[ 01:35 ] - How do you walk on ice?

[ 03:28 ] - A CGL's notice provision likely requires "immediate notice", "notice as soon as practicable", or "prompt notice". Courts interpret these provisions in line with a reasonableness standard.

[ 04:00 ] - Breach of this policy provision can give the insurer the right to deny coverage, so claims are often reported even prior to suit being filed.

[ 05:11 ] - In Illinois, courts examine factors including the wording of the notice provision, the sophistication of the insured, the diligence of the insured, and prejudice.

[ 07:33 ] - Some states (but not IL) require the insured to show prejudice-- in layman's terms, some impact beyond a technality.

[ 10:50 ] - Even if the insured feels that the snow plow company should be at fault, the insured must still comply with the insurance contract.

[ 12:27 ] - There's no universal bright-line rule on the amount of time: cases range from finding breach at three months, to finding no breach at two years.

[ 13:37 ] - Courts would also consider factual situations like difficulties with mail.

[ 14:10 ] - Typically in lawsuits lack of knowledge of a contract is not a defense, but in this case the sophistication of an insured is a factor.

[ 16:14 ] - Michele provides a recap of the scenario and the points above.

Your PLRB Resources

50 State Survey – Late Notice - https://www.plrb.org/documents/table-of-contents-late-notice/?search=late%20notice

Commercial General Liability Policy Annotation Key GL25, Late Notice - https://www.plrb.org/documents/gl25-notice-to-insurer/

Commercial General Liability Policy Annotation Key GL26, Notice Prompt And As Soon As Practicable - https://www.plrb.org/documents/gl26-notice-prompt-as-soon-as-practicable/

PLRB Coverage Reply, Is Prejudice Required to Deny a Claim for Late Notice? - https://www.plrb.org/documents/is-prejudice-required-to-deny-a-claim-for-late-notice-2022-09-30/

Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.

Subscribe to this Podcast

Your Podcast App - Please subscribe and rate us on your favorite podcast app

YouTube - Please like and subscribe at @plrb

LinkedIN - Please follow at “Property and Liability Resource Bureau”

Send us your Scenario!

Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].

Legal Information

The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.

Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).