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Last Post 12/26/2006 2:21 PM by  HuskerCat
Definition of insured
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nwest
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12/21/2006 11:08 PM
    I have a question regarding the definition of the insured and under that definition who all is covered.  I am doing Cov A on a large fire loss.  Another adjuster is doing Cov C.  In this scenario, the Named insured, his Mother, and his "partner", are living in the house.  I know that the mother is covered, shes family.  My question is, are the contents of the "partner" covered?  He is not a relative, or a spouse, and he is not under the age of 18 and under the primary care of the insured.  Please advise, Standard HO 3.
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    dcmarlin
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    12/22/2006 1:53 AM
    Nathan,
    Unless there is precedent in your state, based on the info provided, I do not believe that the "partner" would be considered an insured unless named on the policy.  You may also want to read the policy to see if the "partner" can be considered a guest but, If he or she receives mail at the residence, that may not fly.  The "partner" probably should have had his/her own renters policy.
    Gimme a bottle of anything and a glazed donut ... to go! (DLR)
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    Ray Hall
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    12/22/2006 1:44 PM

    I would disagree if I were the claim manager. This is a very common situation in millions of single family dwellings insured by a Homeowners. I know I have paid for hundreds simular claims in the past and have never been questioned. Of course both names would make it simple; however sometime the partners names change over the lifetime of one partner who may have purchased the house in one name only.

    I have never really been ask or questioned  on live in's of the opposite sex, or the same sex. Call the claim manager and you will get an atta boy.

     

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    dcmarlin
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    12/22/2006 3:25 PM
    Although the partner is not considered an "insured" under the policy, Ray is correct and payment can be made for the contents. In a standard ISO policy, under coverage C, the policy states; "After a loss and at your request, we will cover personal property owned by: a. Others while the property is on the part of the "residence premises" occupied by an "insured". Thus, for example, if the insured stores personal property of a friend on the residence premises, coverage may be requested by the named insured.

    Now, the partner is still not considered an insured for other purposes in the policy. There is an endorsement one can get called Other Members of Your Household Endorsement (HO 04 58) which extends insured status to the person or person named.
    Gimme a bottle of anything and a glazed donut ... to go! (DLR)
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    Ray Hall
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    12/23/2006 2:26 PM

    How many of you have thought about who paid for O.J. Simpsons defense cost in the civil suit filed by the Goldmans after he was found not guility in the murder trial. Was it his Homeowners or his Umbrella Policy or both, or neither.?

    A clue: Jim Baker of Baker Botts was the lead defense attorney !

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    nwest
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    12/23/2006 7:24 PM
    I have to agree with Ray and Dave at this point. It seems to be a fairly fine line though, or else why bother with defining the insured Although, once i presented the question to the senior claim rep, they were of the opposite opinion, and said the partners contents were not covered. Fortunately, there were only two pair of pants and two sweat shirts of the partner in the house.
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    PORTASATGUY
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    12/24/2006 2:09 AM
    The "PARTNERS" Contents ARE NOT COVERED In this Scenario!
    R. Estes
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    PORTASATGUY
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    12/24/2006 2:11 AM
    Posted By Ray Hall on 12/23/2006 2:26 PM

    How many of you have thought about who paid for O.J. Simpsons defense cost in the civil suit filed by the Goldmans after he was found not guility in the murder trial. Was it his Homeowners or his Umbrella Policy or both, or neither.?

    A clue: Jim Baker of Baker Botts was the lead defense attorney !


    THE GOLDMANS PAID FOR IT!
    R. Estes
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    Medulus
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    12/24/2006 10:17 AM

    Though the partner does not qualify as an "insured" under the policy, the standard HO3 (4/91) policy does, in fact, cover contents belonging to the partner under this clause:

    "We cover personal property owned or used by an "insured" while it is anywhere in the world. At your request, we will cover personal property owned by:

     1. Others while the property is on the part of the "residence premises" occupied by an "insured";"

    This would apply unless the partner pays rent to the insured.  In this case the exclusion for property of roomers, boarders, and tenants would apply.

    Other considerations:

    Unless the partner was just picked up off the street and brought into the household yesterday, it is not believable that he only owns two pairs of pants and two sweatshirts.  You have likely paid for several things belonging to the partner already. 

    It can be assumed in most cases that the insured would request that the partner's belongings be covered.  But, if this a potential problem, inform the insured of the policy provision above and ask him to put the rquest in writing.  Includes it in your file and, since the senior claim rep seems to think there is no coverage, quote the policy provision in your report.

     

    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    dcmarlin
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    12/24/2006 1:57 PM
    Steve,
    Good point about the roommate exclusion.  That's kind of what I was refering to in my first post about whether or not the partner received mail.  If he/she is a resident, that exclusion may apply.  If not a resident, then there probable is coverage as stated above.  This is a perfect example of an adjuster asking the right questions so proper coverage can be determined and the claim adjusted correctly.

    I'll throw something else into the mix.  What if the partner has his/her own residence and own insurance policy?  Now we have another policy that covers the same property.  Dependent on the type of property involved and limits, issues such as which is primary and apportionment may come into play.  Something else to think about.

    Dave
    Gimme a bottle of anything and a glazed donut ... to go! (DLR)
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    Medulus
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    12/24/2006 3:13 PM
    Dave,

    The exclusion does not exclude roommates. It excludes "roomers". The normal definition of a roomer would be someone who rents a room. The test would not be whether someone resides at the residence premises or whether they receive mail there. The test would be whether the partner pays rent.

    I can see no reason, assuming the partner does not pay rent, to exclude the property of the partner.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    Ray Hall
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    12/24/2006 5:14 PM
    Roy you are flat wrong on the partners property is not covered, while on the premises.  You may be wrong on the liability question. What does the Goldmans paid for it mean ?
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    dcmarlin
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    12/24/2006 5:45 PM
    Steve,
    You are right.  I believe the exclusion says roomers or boarders, not roommates, so one must meet the definition as such to apply the exclusion.  Just getting mail at the residence may be an indicator, but is not definitive.  I agree that $$$ probably have to change hands. 
    Gimme a bottle of anything and a glazed donut ... to go! (DLR)
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    dcmarlin
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    12/24/2006 6:10 PM

    Ray,

    Under Section II, Personal Liability, unless there is some exclusion that may apply, the HO carrier should have provided O.J. a defense.  It states " Provide a defense at our expense by counsel of our choice, even if the suit is groundless, false or fraudulent.  We may investigate and settle any claim or suit that we decide is appropriate." 

    Therefore, they have a duty to defend and a duty to indemnify.  There is an intended or expected act exclusion but, since he he was not found guilty in the criminal court, I do not think it should apply.

    I have no clue about the umbrella policy.  I guess it all depends on what it covers.

    Gimme a bottle of anything and a glazed donut ... to go! (DLR)
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    Ray Hall
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    12/24/2006 6:34 PM
    Yep you are correct.  Its real hard to be the carrier and have to defend these type claims but they come up sometime. The intentional act would knock this out if he was found guilty.  The umbrella is usally broader in is language than the Sec II of the Homeowners.  But it has to be read. I had a consent case of intercourse between minors that was video taped  (unknown) and shown at frat house events that comes to mind. Cost a bunch to get out.
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    Medulus
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    12/25/2006 2:55 AM
    It should be pointed out that Ray Hall is way ahead of the discussion here. He has slyly led the discussion in the direction of liability coverages. Liability and Medical coverages are the coverages under which the question of "Who is an insured?" usually comes into play. Under coverages A and B we are dealing with structures rather than insureds. The primary relevant question is "Who has an insurable interest, and is that person the named insured or mortgagee?" Under coverage C we are dealing with contents/personal property and the question of "Who is an insured?" comes into play when the contents are located away from the residence premises.  It is also important in the excluded causes of loss, such as damage caused by animals belonging to an insured or theft committed by an insured. Coverage D does not consider "who is an insured" at all. Under this coverage, it is not just any insured that is covered. It is "you", meaning the named insured and spouse.

    Under Coverage E the question of "who is an insured?" becomes very important in determining to whom a defense or indemnification is owed. Under coverage F "who is an insured?" is most important in terms of whether an insured granted permission for the injured person to be on the residence premises or whether it is an act of an insured that caused the injury.

    Consequently, in our typical work as property adjusters, who is an insured will only occasionally be an element of the claim handling. There will be important exceptions, but generally the question is asked more frequently on liability claims. It is important to note the use of the words "you" and "insured" in the definitions section of the policy and how those words are used throughout the policy. They are not synonymous. "You" is actually a more restrictive term. When the policy says "you", do not look at the definition of "insured" to determine the meaning of it. The term "insured" is used more frequently in Section II of the policy (Liability and Medical Payments coverages). The terms "you" and "your" are used with greater frequency in Section I.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    wscook
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    12/25/2006 9:49 AM
    It takes but a few moments to read the above informative threads. To draft and post a meaningful response to share knowledge and information goes unrewarded in most instances. I will take this opportunity to thank Mr. Cupps for providing this forum and to all the posters who contribute. I continue to be amazed about how much I don't know about the many intracacies of our industry .
    Once again a SINCERE THANKS to the ones that make this resource so valuable.
    William S Cook
    Public Adjuster
    William S Cook Public Adjuster/Umpire/Appraiser
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    Tom Toll
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    12/25/2006 11:23 AM
    We will be running into this scenario before long. Two females or two males marry in a state that has approved same sex marriages. They go back home and sustain a fire loss, with the owner being the named insured. The state of domicile does not approve same sex marriage. They have an extensive fire loss to contents, which most are co-owned. Do we owe for the partners contents? He receives mail at the insured's address, so, he cannot be considered a guest. There would not be coverage extended to him under normal co-habitation circumstances. Are you going to suggest the company pay claims for both parties?
    Success is not final, failure is not fatal: it is the courage to continue that counts.
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    Medulus
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    12/25/2006 7:33 PM

    Again, Tom, I don't understand why there would not be coverage extended for the partner's contents. Of course there would.  The policy certainly would cover the partner's contents located at the residence premises whether they are married or not.  The scenario you present could become a question for liability coverage or for personal property located away from the resdience premises.  It would also present some interesting problems if there had been an ensuing break up or impending divorce, especially in community property states. 

    In the scenario you present, my suspicion is that most insurance companies would decide in favor of the insured and same sex spouse.  The alternative is to allow the impending lawsuit to become a highly publicized test suit bringing heaps of unwanted publicity upon the carrier and branding them unfriendly to gay people.  Do you know any carrier who would welcome such a suit?  I don't.  The potential damages for bad faith or class action are staggering to consider.  The potential loss of business is also a consideration for the carrier.  A significant portion of their book of business is with gay people, and much of it is very good business.  How much of the book of business is with gay people is unknown because sexual preference is not one of the questions on the application.  Nor should it be.

    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    jlombardo
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    12/26/2006 8:31 AM

    Steve and Tom,

    Gay or not has nothing to do with the coverage issue under Coverages A,B, C of the standard ISO HO-3 491 policy.......Many people co-habitate and the there is a bunch of common property.....the insured pays a premium dollar for structural and contents coverage and when a loss occurrs, the property is usually covered subjected to the internal limits of liability of the policy for the specific cause of loss.........Unless the "other person is a border, the companies will pay for the contents of that party.

    Please refer to Section 1, Coverage C, Paragraph #1&2..........We cover personal property owned or used by an 'insured' while it is anywhere in the world. At your request, we will cover personal property owned by:

    1. "Others while the property is on the part of the 'residence premises' occupied by the insured"
    2. A guest or a 'resident employee,' while the property is in any residence occupied by an 'insured'

    Dave,

    In reference to apportionment , most of the time, the insured "visiting partner" would be handled as a "guest" since usually the amount of personal articles at the insured risk would be minimal when the visiting partner has their own home and coverage...but as usually, we must investigate and make the decision on how to handle the loss based on the facts presented.......From a carrier standpoint,if the personal property claim of the "visiting partner" was less than a thousand dollars we would handle under our insured's policy....if a great deal of property was claimed, then we would probably evoke the apportionment  clause in the policy and sort it out from there.

    best regards,
    Joe L

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