Insurance Policy Interpretation & Coverage Analysis Flashcards

Under ISO Commercial General Liability (CGL) form, 'bodily injury' coverage applies to which of the following?

Answer: Sickness, disease, or death resulting from a covered occurrence

Under the ISO CGL form, bodily injury is defined to include sickness, disease, or death resulting from physical harm caused by a covered occurrence.

A pollution exclusion in a CGL policy that uses 'absolute' language would most likely exclude coverage for:

Answer: Carbon monoxide poisoning from a malfunctioning HVAC unit

Absolute pollution exclusions have been broadly applied by many courts to exclude coverage for carbon monoxide and other irritants that qualify as 'pollutants' under the policy definition.

The 'trigger of coverage' analysis in long-tail claims is used to determine:

Answer: Which policy year's limits apply when injury spans multiple years

Trigger of coverage analysis determines which policy period(s) are implicated when a continuous injury or disease develops over multiple years, affecting which insurer(s) must respond.

A homeowner's 'open perils' (all-risk) policy covers losses that are:

Answer: Caused by any peril not specifically excluded

An open perils or all-risk policy covers any cause of loss unless it is specifically excluded, placing the burden on the insurer to prove an exclusion applies.

Which of the following best describes the 'concurrent causation' theory that benefits policyholders?

Answer: Coverage applies when both a covered and excluded cause combine to produce the loss

The majority rule on concurrent causation favors policyholders by providing coverage when a covered peril and an excluded peril combine to cause a loss, unless an anti-concurrent causation clause applies.

A professional liability policy's 'prior acts' exclusion eliminates coverage for:

Answer: Acts or omissions that occurred before a specified retroactive date

A prior acts exclusion in a claims-made policy bars coverage for acts or omissions that occurred before the policy's retroactive date, even if the claim is made during the policy period.

When analyzing whether a liability policy's 'expected or intended' exclusion applies, the adjuster should consider:

Answer: Whether the insured expected or intended the act, not necessarily the resulting injury

The expected or intended exclusion typically applies based on whether the insured subjectively intended the act that caused harm, though some policies require intent to cause the specific resulting injury.