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Insurance: The Land of Obscure Terms

What is a fast way to sow distrust? Use words the general public does not understand. How good is the insurance industry at doing this? Excellent! We might set the bar if it wasn’t for attorneys (but wait–insurance contracts are written by attorneys!).

Think about how normal people view insurance terms. “Would you like blanket coverage, Mr. Jones?” “Blanket” may have significant meaning to insurance people, but I am willing to bet 90% of the American public think blanket coverage means having a blanket big enough to cover the bed. Just saying.

Or take, “owned/nonowned auto.” To a normal person, they own a car or they do not own a car. They do not simultaneously own and “nonown” a car. What does “nonown” even mean? “If I don’t own that car over there, or even the car my buddy is letting me test drive, why do I need insurance? Are you wanting me to buy insurance for other people’s cars? Insurance is a ripoff!” Most people look at it this way, even quite a few of the people who need the coverage look at it as if the term “owned/nonowned” is completely oxymoronic.

In both cases, I see producers use the terms as if their prospects had full understanding. In reality, one reason they do this is because they don’t understand the terms adequately, so rather than learning the coverages well enough to articulate what protection each conveys, they stick to industry jargon hoping no one will ask them a question. It is the same reason many people do not use coverage checklists.

Another “wonderful” coverage is DIC. I find many insurance people have not even heard of DIC coverage. They do not know what “DIC” even stands for. It is an acronym for “differences in condition.” So how does buying a policy titled “Differences in Condition” provide insurance? I buy an auto policy for an auto. I buy workers’ compensation for workers. Differences in condition is rather ethereal.

See also: The World Is Flat; Insurance Is Round  

Insurance language is often ancient. The origins of some terms are traceable to the 1700s, sometimes to property being insured then that does not even exist in our world today, at least not outside museums. For legal purposes, that history is important because we can trace case law specific to certain words and terms back 200-plus years sometimes. We cannot afford to abandon that case law by abandoning old terms.

Simultaneously, relative to customer relations and sales, holding on to such terms is a trap. Who in America outside the industry knows intuitively that inland marine has nothing to do with water? (In fact, who outside insurance would ever even think of using the term “inland marine” to describe risks out of water?)

Much future success then depends on using common language rather than insurance language. The resistance comes from a few places. The first is that quite a few insurance people do not understand their coverages/forms, so they insist on using insurance words to hide their ignorance. Or they use insurance terms to sound smarter than they are. One facet of this industry that has not changed in the last 10, 30 or 50 years is the need to read and understand forms. I am befuddled how anyone thinks they can competently sell or underwrite without knowing the forms. If you use insurance terminology to hide not knowing, go study the forms! Take quality CE classes.

Another reason people insist on using insurance language is fear of being sued. The idea is that, by explaining a coverage using common language, a client may be unintentionally misled into thinking they have a coverage they do not possess. That fear is legitimate, but, to achieve success, one better figure out how to explain insurance in layman’s terms because, if people do not trust you, they are far less likely to buy from you.

An agent’s job is to help people understand why certain coverages are important to their well-being. An agent is THE middle man. One reason the agent is the middle man is that you are paid to be the middle man. The middle man is paid to interpret the insurance language and translate it. The situation is no different from being paid to translate Greek at the U.N. Insurance language can be just as difficult. Underwriters cannot always explain what is and is not covered once you go through the exclusions, the add backs, the exclusions to the add backs and so on, so, if they cannot explain it, why should we expect the insured to understand it?

Additionally, telling the insureds it is their responsibility to read policies that contain such terms, terms so many in the industry lack the ability to explain, is an awesome way to repel the public. I understand the purpose from an E&O perspective, but from a sales/marketing/public relations perspective, telling insureds to read their policies and call if they have questions is absolutely idiotic. It is disingenuous, too, because no one really wants insureds to call with questions. The nightmare is the retired person who actually reads a policy thoroughly and has nothing better to do than ask questions.

See also: Insurance Coverage Porn  

The opportunity truly lies in becoming knowledgeable, even an expert. Attend quality CE programs with other people who truly want to learn rather than sitting in a room of people more interested in reading a newspaper. You learn more in environments with better agents.

If you know your coverages, or not, and really need help learning to discuss coverages, let me know. We have a first class program for teaching coverages in ways that simultaneously give you the tools for asking the right questions and articulating the exposures and coverages in safe layman’s terms.

Lessons Learned From Hurricane Sandy

Hurricane Sandy is said to have been the most damaging hurricane recorded in U. S. history. There appears, however, to be some dispute as to whether Hurricane Katrina holds that dubious honor. The loss estimates and concerns are changing daily. The cost of the storm, estimated by private firms including PricewaterhouseCoopers and the PFM group, points to the fact that Hurricane Sandy destroyed or damaged more units of housing, affected more businesses and caused more customers to lose power. Here is the breakdown provided on November 26, 2012: http://www.governor.ny.gov/press/11262012-damageassessment.

  Sandy in New York ALONE Katrina & Rita in Louisiana
Housing units damaged or destroyed 305,000 214,700
Power Outages (peak) 2,190,000 800,000
Businesses Impacted 265,300 18,700
  • Number of deaths is more than 110 from Hurricane Sandy http://articles.latimes.com/2012/nov/03/nation/la-na-nn-hurricane-sandy-deaths-climb-20121103
  • The official death toll from Katrina was 1,723. http://robertlindsay.wordpress.com/2009/05/30/final-katrina-death-toll-at-4081/
  • 7.5 million power outages throughout Hurricane Sandy's two day assault on land
  • Moody's Analytics estimates the loss in the vicinity of the storm to be $50 billion, of which $30 billion will be directly from damage to property and the remaining $20 billion from economic activity, not all of which is going to come from an insurance policy.
  • 60% of the losses in economic activity, or about $12 billion, will come from the New York City metropolitan area.
  • Because of the storm's intensity and the breadth and scope of the damage, President Obama declared New York and New Jersey federal disaster zones without waiting for any damage estimates.
  • As of 12/3/2012, the Federal government has already issued $180 million in federal contracts related to Sandy.
  • The President has declared several areas as disaster areas, which means that federal funds will now be available to storm victims. (This is not limited to those without flood insurance.) This federal disaster assistance usually takes the form of low-interest loans to help home and business owners rebuild, which you can learn more about on the Disaster Loan page.

The statistics are staggering as are the losses (both covered and not covered) that are emerging from the storm. We will attempt to discuss some of the unique and troublesome issues that are arising from the storm.

Article Discussion Points:

  • Definition of “Storm” and its impact on insurance
  • Flood or NOT Flood?-that is the question (or the hope)
  • Personal Auto salvage concerns
  • The Lawyers are out to get you

Definition Of “Storm” And Its Impact On Insurance

A storm reaches tropical storm status by reaching sustained winds of 39 miles per hour. The National Hurricane Center creates annual lists of names from the database of names maintained and updated by the World Meteorological Organization. If a storm causes significant damage and /or loss of life, the name is retired from the list permanently. Thus, there will be no Katrina II or Sandy II.

1. What Does The Definition Of “Storm” Have To Do With Insurance? There May NOT Be Coverage On The DIC.
Thousands of businesses were affected by Sandy. Many times those larger clients have flood and wind coverage, but written on a large property or DIC (Difference in Conditions) policy.

In those policies there may be restrictions, sub-limits or different deductibles that apply to “Named Storms.” Those policies will define what that is, and should include flood, wind, wind gusts, storm surges, tornadoes, cyclones, hail or rain into this category once the storm has been declared by the National Weather Service to be a hurricane, typhoon, tropical cycle, tropical storm or tropical depression, thus bringing into focus the entire life cycle that a storm may go through.

We have found a number of articles written by law firms that are already taking on the issue of “named storm,” claiming that even though the National Weather Service had named the storm, it was not at hurricane strength when it reached landfall. A comprehensive definition of “named storms” would be helpful to clarify coverage. The fact that the meteorologists are discussing the attributes of this storm to be more like a winter storm rather than a tropical storm may end up on the chopping block of justice in a civil court or two and test the insurance policy coverages.

2. What Is Unique About Hurricane Sandy?

  • Sandy has defied normal storm behavior by moving east to west; it acted both like a hurricane and a cyclone simultaneously.
  • The result of this last odd wind pattern was the root cause of the flood tides and the inundation of the New York subway system.
  • The storm qualified as a hurricane at the time of landfall and its wave “destruction potential” reached a 5.8 on the National Oceanic and Atmospheric Administration's 0 to 6 scale.

3. One Storm or Two Storms:
Bad memories of the World Trade Center came immediately to mind when I read about this potential concern relating to Hurricane Sandy in the Daily Report. You might remember there was a significant concern that a second storm, following the initial impact of Sandy, was going to hit which would have further devastated the area.

Richard Mackowsky, a member of the Cozen O'Connor's global insurance group, said “new damage from a second storm could result in a separate occurrence, potentially requiring a separate set of deductibles.”

“If there is damage caused by a second storm but related to the first storm, issues arise as to whether there were one or two occurrences. A second storm could impact causation as to what is really driving the loss. If the only reason the second storm caused damage was because of damage from Sandy, the question then becomes whether that is a covered cause of loss,” Mackowsky said. “A second storm could trigger a separate limit of liability if it's a big enough situation,” he said.

But even one storm can create causation questions. Was the damage from wind or flooding? Not a simple question to answer, litigation stemming from previous storms has shown.

Excerpted from the Daily Report

Saved by the bell on this one — the second storm never hit, but the insurance pundits were armed and ready.

Flood … Not Flood? — That Is The Question

This appears, at first glance, to be Insurance 101 — most of this damage was either directly or indirectly caused by the condition of flooding. That is sure what it looked like to me and that is not a very popular observation. Why? Because most people did not have flood insurance and if they did, the flood insurance policy has limited amounts of insurance and significant restrictions such as no business income coverage.

1. Dilemma Of The Federal Flood Insurance Program — It's A Problem:
Even if it is covered on the flood insurance policy, there is real concern about the overall program. See this article from Reuters for more information.

2. Flood Or Not Flood
Whether talking about homeowner's insurance (including renters and condominium owners) or commercial property insurance, those forms most often include an exclusion for flood. So, here is where it gets a little tricky:

  1. Did the property owner sustain damage from storm surge?
  2. Was the loss due to rising flood waters?
  3. Was the loss due to too much rain that entered into the building because the wind removed the roof, blew out the windows or knocked a part of the building down?

“It is an ongoing saga,” says insurance lawyer Frank Darras, who has worked extensively on litigation scenarios following Katrina. “If you are a homeowner, you are going to argue that you have damage caused by wind and wind-driven rain. If you are the carrier, you are going to say the damage was caused by flood, tidal surge or a hurricane, which requires hurricane coverage.”

Excerpted from The Street

In a unique twist, New York has a specific website that contains a regularly updated scorecard on insurance company performance. Here's the link. For example, State Farm has had 48,109 claims; 6,363 closed with payment; 5,229 closed without payment.

3. Problems With The Flood Insurance Solution
FEMA says that less than 15% of homeowners nationally carry flood coverage. Federally backed lenders have been lax in enforcing the obligation to purchase flood insurance (that may change due to higher penalties being imposed upon the banks as of July, 2012).

The National Flood Insurance Program anticipates claims between $6 and $12 billion but has borrowing power at $2.9 billion. Reauthorization from Congress would be required, and Homeland Security is expected to request appropriation soon. Those current and new policyholders of National Flood Insurance Program coverage will be getting a scheduled rate increase that predates Sandy.

Even if the person or business purchased flood coverage, there are still problems and concerns.

  1. The limits of insurance available through the National Flood Insurance Program are small.
  2. Replacement cost coverage applies only to a dwelling and not to commercial structures.
  3. There may be wind damage to the building that the flood insurer will not pay but is covered in the homeowner's policy.
  4. The insured will get to pay two deductibles for those two separate policies.
  5. What kind of coverage is there if the first layer of property coverage is the NFIP coverage and the insured purchases excess layers of flood coverage above that policy?

    1. Will it drop down to pick up the replacement cost difference? No.
    2. Will it drop down to pick up business income, extra expense coverage? It should. Check the policy language.

4. The Future Of Flood Insurance
The future of the entire program is bleak enough. Add to that the impact of Hurricane Sandy on the future purchase of flood insurance. Homeowners in storm-damaged coastal areas who had flood insurance, and many more who did not, still now may be required to carry flood insurance and will face premium increases for flood from an estimated 20 to 25 percent per year beginning January. This is due in part to legislation enacted in July to shore up the debt ridden National Flood Insurance Program and is exacerbated by Hurricane Sandy.

“Because private insurers rarely provide flood insurance, the program has been run by the federal government, which kept rates artificially low under pressure from the real estate industry and other groups. Flood insurance in higher-risk areas typically costs $1,100 to $3,000 a year, for coverage capped at $250,000; the contents of a home could be insured up to $100,000 for an additional $500 or so a year,” said Steve Harty, president of National Flood Services, a large claims-processing company.

Excerpted from The New York Times)

Lenders, in addition, will be affected by Hurricane Sandy if they fail to enforce the requirement for their lenders to carry flood insurance. They will face even higher penalties then they have in the past.

5. Ordinance Or Law

  1. Many of those properties damaged by Hurricane Sandy had been built a number of years ago. So here are the questions:

    1. Does the Homeowner's Policy, Commercial Property Policy or Difference in Conditions include contingent ordinance or law coverage, demolition coverage and increased cost of construction coverage?
    2. What about the loss of use for the homeowner as well as the business interruption coverage?
  2. The National Flood Insurance Program policy is out as there is no coverage for the indirect loss.
  3. Many Difference in Conditions policies do not include ordinance or law automatically and many more do not include ordinance or law — increased period of restoration to cover the additional down time due to code or law enforcement.

6. Power Loss
Earlier we quoted the statistic of there being approximately 7.5 million power outages throughout Hurricane Sandy's two day assault on land. Many of these outages lasted days and weeks. There are several issues relating to insurance in terms of the power outages:

  1. Requirement Of An Off Premises Endorsement: In order for businesses to have coverage for either direct or indirect losses relating to power outage, the insurance would first have “off premises” or “utility coverage” on the policy. Typically, losses stemming from off premises situations are excluded on property insurance policies.
  2. Causation Of The Power Outage: If there was coverage on the property policies for the off premise loss, the situation that occurred off premises would have to be covered. For example, if the off premises loss were caused by a windstorm, that cause of loss is typically covered on a Commercial Property Policy or personal form. If the loss were caused by flooding, then that cause of loss is excluded and the off premises endorsement would not apply.
  3. Off Premises Deductible: Off premises coverage oftentimes has a “time” deductible or waiting period of 72 hours unless endorsed. This waiting period would have eliminated coverage for many of the properties that had their power back in three days or less.
  4. Direct vs. Indirect Loss: An Off Premises Endorsement would have to cover both direct damage and indirect to pick up a loss for Business Income.
  5. Other Perils such as Equipment Breakdown (EB): The cause of off premises loss may be due to a power surge that results from the storming. If the Equipment Breakdown policy has off premises coverage and business income coverage, then recovery can be sought under that policy.
  6. Some Off Premises Policies Have Distance Limitations: It must be ascertained if there is any distance indication on the policy to which the off premises is being attached. For example, some policies have a 500-foot distance radius which means the source of the off premises loss must be within 500 feet of the insured's premise.
  7. Spoilage: It may be that the loss the insured sustained while the power was out was spoilage, such as loss to refrigerated items and the business income that stems from that loss. This could be covered on either an Equipment Breakdown Form depending on whether there was a “breakdown” or on a Commercial Property Spoilage Form. Some Homeowners have limited coverage built in for refrigeration loss but not for the peril of flood.

7. Business Income
Now we are talking about one of the bigger claims that will result from Hurricane Sandy and much of it will not be covered. Here are some of the pressure points of this coverage:

  1. Cause of Loss — back to that one. Flood is excluded on the Commercial Property form so there will be no response for business income.
  2. The Flood insurance policy does not cover business income.
  3. If the cause of loss is determined to be “windstorm” and the insured has Business Income insurance, then the policy should respond from the causation point of view assuming they had direct damage.
  4. The insured will have to prove that their income loss is directly attributable to Hurricane Sandy.
  5. The policy has a waiting period for coverage typically 72 hours unless endorsed.
  6. The policy would have to be endorsed with Off Premise coverage for the Business Income stemming from loss of power to apply.
  7. There is no building ordinance for the business income — it would have to be endorsed.
  8. Civil Authority: Many of the businesses did not sustain direct damage but were closed by civil authority.

    1. There is limited coverage on the Business Insurance form
    2. There may be distance limitations
  9. Ingress/Egress: A bigger problem is the ingress/egress issue which basically means “because of the condition, itself, access to an area is affected or unavailable.” For example, if a road is flooded out so that there is no access to a grocery store, the grocery store will be able to demonstrate they are losing customers. However, if the store was not directly affected by the physical loss, there will be no trigger on their business income form. Civil Authority did not close down the area — it was closed due to natural events in this case.

Traditional Business Income Policies require that there be direct damage to the premises by a peril insured against for there to be any business income insurance response. However, there is talk, in the aftermath of Hurricane Sandy, of what is referred to as Non-Damage Business Interruption or Non Physical Business Interruption Insurance. It is referred to as NDBI. While articles are referring to these coverages, as if they are readily available, I believe they are truly exceptional in availability and accessibility. Sometimes these forms are part of a “supply line coverage” for very large businesses that often have an international component. There is also the TDI or CDI coverage — Trade Disruption which could come into play — however, that coverage has a very limited market. Bottom line, the average business that sustained damage as a result of Hurricane Sandy had neither one of these types of coverage. Liberty International apparently has a program.

8. Automobile Losses From Hurricane Sandy
Autos are the easiest part of this equation: whether wind, flood or a combination, all are covered under the “Other Than Collision” coverage. The salvaging of these autos is where it gets interesting. Canadian officials are now bewailing the fact that thousands of autos — some estimates are as high as 250,000 — are likely making their way to Canada. Those storm-damaged vehicle are classified in Canada as “non-repairable” and are illegal to sell. But, in the aftermath of Katrina, Canadian citizens were buying these vehicles in the thousands, and they expect the same thing to happen again. What I wonder is, who is selling those vehicles? The original owner? The salvage company the insurer uses?

The Lawyers Are Out To Get You

Errors And Omissions Litigation
Well, as if all the foregoing isn't depressing enough, we cannot end this article without a little nudge to the insurance agent and broker.

If you are relying upon “conversations” with your client along the lines of “Do you want flood insurance? No. OK, then,” you are going to be sadly mistaken that your client is not going to enjoin you in litigation over your standard of care. Your client is going to claim an increased standard of care, yes including New York residents, and that you had a duty to advise and quote coverage for them or at the very least, tell them in writing of the limitations of coverage in the policies they purchased and that they relied upon you for your expertise. Many agents simply renew, year after year, their direct bill homeowner's and small business clients without any documentation of coverage offers. Even those handling larger accounts somehow rely upon the client's memory and good will not to sue you. So, again, for the millionth time already, please, please document your file, in writing, to the insured, with a rejection signature every year or, for larger accounts, an authorization to bind affirmation from the insured.

As we were all glued to the TV, watching reporters being blown around reporting the devastation, my insurance brain immediately went to “flood exclusions.” I saw the wind ravaging the houses, the uprooted trees blocking the roads, but also saw the rising waters in the streets, along the shores, in the housing areas.

The question will come down to that simple reality — was the damage due to flooding or not? The attorneys are out in force, fighting for first page on the Google search engine so you get to them first. It reminds me of an old Gun Smoke movie — ready, aim, fire. Barrels are being loaded against the insurance companies.

There is no easy way to end this article, although I am sure all of you who reached the very end are hopeful that I will. The storm was one of the biggest ever, and the insurance story will not end soon. There is so much more we could say but best end this with a heads up to watch and see how these claims unravel; and, for those of you who did not insure any of these damaged properties, I say a toast of champagne is in order.