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Difference in Conditions

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This presentation is being recorded for your viewing pleasure at a future date.

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The PowerPoint presentation is also available under ‘Materials’.

You will receive the course number for your state near the end of class.

Use the ‘chat’ window for questions on the content.

100% Participation in Polling Questions is required to receive credit for this class. Even if you do not intend to receive credit, please participate in the polls.


Welcome to your Insurance Community University

• All of you are currently on mute – Un-mute your own system– Telephone Option

• Select Telephone on your screen• Dial in the PIN number so that your number

becomes active– Microphone and/or Speaker Option

• You can use this option if you have a headset that you use with your computer

Audio

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Participation & Chat Window• You will receive information from the monitor via

the ‘Chat’ window. – Please locate window in the control panel

• Q & A is welcomed during the presentation and at the end of the presentation

• You will find the question box on your control panel– Write your question in that box and send it to the presenter/organizer

• The presenter will take those• questions in the order submitted

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DOI Requirements• When you see a slide with the hand up symbol, touch

the “hand” icon on your control panel– Click ONCE only

• If you do not raise your hand, the monitor will be in contact with you in the chat box

• If you are in a group, the designated proctor is responsible to make certain you are all in attendance at all times

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= Hand is down


Polling

• Throughout the class we will be conducting periodic polls

• We need 100% participation on the polls• The polls are intended to check

participation but also to create discussion topics throughout the presentation

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Forms To Complete for CE

• After class ends– Return attendance form– Proctors – return your form to email

address• Email address is in chat window or in

email sent to you today

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DOI Requirements

• We will file your hours with the DOI after the completion of this webinar and we have received the attendance form.

• You have 48 hours to return the form• You will be sent a Certificate of

Attendance/Completion by email. Please retain this for your records for five years.

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Internet Disruption

• If the presenter looses internet connection STAY ON THE LINE

• The administrators will communicate with you

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Internet Failure

• If the internet fails and all participants are kicked off line by Go To Training or other source then the seminar will be terminated

• You will receive instructions by email as to how we will proceed

• This is a precautionary notice, only

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This class is being recorded

• Available in the University• This course is approved for CE in CA Only

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DisclaimerInsurance forms and endorsements vary based on insurance

company; changes in edition dates; regulations; court decisions; and state jurisdiction. This instructional

materials provided by Insight is intended as a general guideline and any interpretations provided by the

instructor or the creator(s) of this material do not modify or revise insurance policy language. In providing these

materials, the authors assume neither liability nor responsibility to any person or business with respect to

any loss that is alleged to be caused directly or indirectly as a result of the instructional materials provided.

Copyright 2010 – 2013 All Rights Reservedwww.insurancecommunitycenter.com

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http://www.insurancecommunitycenter.com/


Your Instructor Today

Marjorie L. Segale, AFIS, CISC, RPLU, CIC, CRIS, ACSR, CISRInsurance Community Center, LLC

Director of EducationPresident: Segale Consulting

[email protected]

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mailto:[email protected]


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What This Course Will Cover

• Property policy exclusions• Earthquake, Flood, Named Storms

– Definitions– Coverage considerations– Deductibles

• PML development and concerns• Structuring coverage• Coverage review


Polling Question #1

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Purpose of a Difference in Conditions Policy• Designed to provide “all risk” coverage

subject to exclusions broader than CP Special Form

• Designed to tailor coverage for an insured’s specific needs

• May be used for international risks


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Purpose of Difference in Conditions Coverage• No standard form

– Limited market provided by carriers• Used for perils not covered elsewhere• Flood / Water Damage• Earthquake• EQ / Flood

– 80% of the losses covered by DIC insurance


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DIC Development

• Ocean Marine– DIC purchased by a merchant to fill perils

gap between the open cargo policy and any insurance required by the merchant’s sale contract

• Inland Marine– DIC purchased to provide “All Risk” as a

supplement to the Fire and “Named Perils” coverage provided.


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DIC Development

• Insurance Forms Today– Generally the admitted / standard property

form already provides “All Risk” coverage– The DIC is purchased to provide coverage

for perils excluded in the “All Risk” policy often for the catastrophe perils


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Supply And Demand In The DIC Marketplace• Limited capacity with a limited number

of markets• Little or no new capacity entering the

market• Emphasis of underlying acceptability has

moved to the BETTER risk– Better meaning better construction and

generally newer


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DIC Coverage Trends

• Coverage options are being narrowed• Policy wording is being clarified,

improved and often times more restrictive

• Deductibles are larger and more specific• Not all carriers are willing to follow

other carrier’s DIC forms (no following form)


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DIC

• The DIC will exclude any loss covered by the original property policy (referred to as an “underlying policy”)

• If coverage for the same peril exists in both policies - the other insurance clause will be invoked in both policies


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Methods To Exclude Perils On a DIC• Exclude the perils covered by the

underlying policy by including a list of traditional named perils as excluded perils in the DIC

• Exclude the perils on the underlying policy by specifically identifying the specific policy by policy number and insurer name.


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Methods To Exclude Perils On a DIC• Make a statement that all perils covered

by ISO Cause Of Loss Forms are excluded on the DIC

• Require that the insurance carry an “all risk” parallel policy whereby DIC applies only to the differences in coverage on the DIC and All Risk Policy unless otherwise excluded


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The Excluded Perils Under a DIC Policy May Include• Fire, lightning, explosion, windstorm or

hail, smoke, aircraft or vehicles, riot or civil commotion, vandalism and sprinkler leakage

• Explosion of hot water boilers or hot water heaters, mechanical breakdown and arcing– Creates a gap between DIC and Equipment

Breakdown coverages


DIC Exclusion – Fire and ECE


Polling Question #2

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Flood Exposure and Coverage Options


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National Flood Insurance Program• Why offer NFIP

– Can’t purchase coverage in standard market

– Forced Placed - Lending Documents– Capacity reasons– Carrier requirements (Excess Clause)


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National Flood Insurance Program• 100 Year Flood Zones (A and V elevation/wave

wash) • Limited coverage available on amount• Limited coverage available based on area• Limited coverage based on

comprehensiveness of “buy back”– No Business Income– No Building Ordinance

• Must purchase as first layer in order to qualify for FEMA


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National Flood Insurance Program• Provides limited coverage

– Real / Personal only– $500k - Real / $250k - Personal– Some extensions– Low Deductibles– Cheap


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Flood Endorsements

• Endorsements are available with different insurance companies modifying the property forms.– Caution: the endorsements vary as to the

comprehensiveness of coverage and deductibles applicable.

– Caution: Company endorsements do not substitute for NFIP to qualify for FEMA


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Combination NFIP and DIC

• Often the most cost effective means of securing adequate limits

• Flood coverage calls for the purchase of a maximum available limit under the NFIP and excess under a DIC– Caution: the Federal Program’s coverage

may be more restrictive then the DIC or vice versa


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Difference in Conditions

• Standard / Surplus Line Market (DIC)– May exclude Flood Hazard Zones – Large Deductibles ($ or %) w/ Minimums– Larger limits available – Can provide coverage for Business Income

and Extra Expense


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Earth Movement, Flood and Wind• The typical DIC policy first excludes the

perils • The form will specifically add back the

named perils of Earth movement, Flood and wind


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Earth Movement, Flood and Wind• Caution:

– It is essential to compare the language of the Property AND DIC exclusions with the named peril description providing the coverage

– The exclusions may be much more comprehensive then the buy backs


Property Policy ExclusionsCompared to DIC Coverage


Water Damage Exclusiong. Water (1) Flood, surface water, waves, tides, tidal waves, overflow of any body of water, or their spray, all whether driven by wind or not; (2) Mudslide or mudflow; (3) Water that backs up or overflows from a sewer, drain or sump; or (4) Water under the ground surface pressing on, or flowing or seeping through: (a) Foundations, walls, floors or paved surfaces; (b) Basements, whether paved or not; or (c) Doors, windows or other openings. But if Water, as described in g.(1) through g.(4) above, results in fire, explosion or sprinkler leakage, we will pay for the loss or damage caused by that fire, explosion or sprinkler leakage.


DIC Flood Definition• Flood means, whether natural or manmade, Flood

waters, surface water, waves, tide or tidal water, overflow or rupture of a dam, levy, dike, or other surface containment structure, storm surge, the rising, overflowing or breaking of boundaries of natural or manmade bodies of water, or the spray from any of the foregoing, all whether driven by wind or not. A tsunami shall not be considered a Flood.


Earth Movement Exclusionb. Earth Movement (1) Earthquake, including any earth sinking, rising or shifting related to such event; (2) Landslide, including any earth sinking, rising or shifting related to such event; (3) Mine subsidence, meaning subsidence of a man-made mine, whether or not mining activity has ceased; (4) Earth sinking (other than sinkhole collapse), rising or shifting including

soil conditions which cause settling, cracking or other disarrangement of

foundations or other parts of realty. Soil conditions include contraction, expansion, freezing, thawing, erosion, improperly compacted soil and the action of water under the ground surface. But if Earth Movement, as described in b.(1) through (4) above, results in fire or explosion, we will pay for the loss or damage caused by that fire or explosion. (5) Volcanic eruption, explosion or effusion…


DIC Earthquake DefinitionD. Earth Movement means any natural or manmade:1. Earthquake, including any earth sinking, rising or shifting related to such event;2. Landslide, including any earth sinking, rising or shifting related to such event;3. Mine subsidence, meaning subsidence of a man-made mine, whether or not mining activity has ceased;4. Earth sinking rising or shifting including soil conditions which cause settling, cracking or other disarrangement of foundations or other parts of realty. Soil conditions include contraction, expansion, freezing, thawing, erosion, improperly compacted soil and the action of water under the ground surface;5. Shocks, tremors, mudslide, mud flow, rock falls, volcanic eruption, sinkhole collapse, subsidence; and includes tsunami.


Wind / Hail / Named Storms

• When property is located in a mapped area that has significant exposure to wind, storm surge, etc. the property insurer will often excluded wind/hail losses.

• The DIC carrier will provide the coverage, but subject to specific underwriting, additional premium and deductibles


Wind / Hail Exclusions – CP 10 54A. The following is added to the Exclusions section and is therefore not a Covered Cause of Loss:WINDSTORM OR HAIL We will not pay for loss or damage: 1. Caused directly or indirectly by Windstorm or Hail, regardless of any other cause or event that contributes concurrently or in any sequence to the loss or damage; or 2 Caused by rain, snow, sand or dust, whether driven by wind or not, if that loss or damage would not have occurred but for the Windstorm or Hail. But if Windstorm or Hail results in a cause of loss other than rain, snow, sand or dust, and that resulting cause of loss is a Covered Cause of Loss, we will pay for the loss or damage caused by such Covered Cause of Loss. For example, if the Windstorm or Hail damages a heating system and fire results, the loss or damage attributable to the fire is covered subject to any other applicable policy provisions.


Named Storm Coverage WordingNamed Storm: for Locations wholly or partially within Special Flood Hazard Areas (SFHA), areas of 100-year flooding as defined by the Federal Emergency Management Agency (FEMA).Limit: $ 10,000,000 Regardless of the number of Coverages, Locations or Perils involved including, but not limited to, all Flood, (however caused) wind, wind gusts, storm surges, tornados, cyclones, hail, or rain, the maximum amount the Company will pay per Occurrence as respects all covered Loss or Damage arising out of a Named Storm (a storm that has been declared by the National Weather Service to be a Hurricane, Typhoon, Tropical Cyclone, Tropical Storm, or Tropical Depression). In the event covered Loss or Damage by Flood arises out of a Named Storm, the maximum amount the Company will pay per Occurrence for all such Loss or Damage by Flood shall be the Sublimits of Liability for Flood as shown in Subparagraphs E.2.a. and E.2.b. above. However, if Flood is not covered, themaximum amount the Company will pay per Occurrence for all such Loss or Damage by Named Storm shall exclude Loss or Damage by Flood.


Polling Question #2

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Probable Maximum Loss

• Insurance should be placed at limits not less than the PML– Concentration of risk– Geographic impact on loss amount– Type of loss

• EQ• Flood• Wind


Coinsurance

• There should be no coinsurance on the policy

• Often the insured is buying coverage only at the PML level and NOT at the entire value of the property

• Cross reference this to the deductible portion of the policy


Covered Property Description

• Definition should be close to the same as the Commercial Property coverage– Buildings– BPP– PPO

• Caution: For certain catastrophic perils the property definition must be broader.


Covered Property Description

• Watch for excluded or limited property such as

• Foundations, retaining walls, • Roofs over 20 years of age (often limited or with a higher

deductible)


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Examples of Excluded Property

• Land, including land on which the covered property is located, water, trees, shrubs, plants, growing crops, and animals

• Property while underground, underwater or waterborne

• Buildings or structures in the course of construction


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Excluded Property

• Dams, bridges, tunnels and pipelines• Foundations below the surface of the

ground• Property in transit


Structuring the Coverage

• Specific Limits• Blanket Limits

– Reference to SOV on file removes the blanket advantage



• Single policy– Purchase insurance equal to total loss

exposure– Small catastrophic exposure– No concentration of risk



• Loss Limit– Limit that is less than total exposure

• Occurrence loss limit– This is where an insured buys a limit that is

less than their total exposure to loss. – Purchase made on Probable Maximum Loss

(PML)– No coinsurance clause should be applied


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Occurrence Of Liability Endorsement (OLL)The premium for this policy is based upon the Statement of Values on file with the Company or attached to this policy. In the event of loss hereunder, liability of the Company shall be limited to the least of the following:

The actual adjusted amount of loss, less applicable deductible(s);The total stated value for the property involved, as shown on the latest statement of values on file with the company, less applicable deductibles;The limit of liability or amount of insurance shown on the face of this policy or endorsed onto this policy.


More Than One Company Providing Coverage

• Participation, Quota share– All insurers participating

take a proportionate share of the limits provided.

– Each participant accepts a certain percentage of the risk in return for the same share of the premium.

• Excess of Loss (Layering)– This option is where one or

more participants accept the “first dollar” of loss, and one or more participants accept losses only after the lower participants’ participation is fully exhausted.


Polling Question #3

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• Two or more policies– Layer

• Limits exceed one carrier’s capacity• Property presents frequency and/or severity

loss exposures– Participation policies

• One carrier does not have capacity to provide the excess limits

• Premium will vary depending on the limits being provided in each layer by carrier



• Layering– First layer

• Most expensive– Second layer and subsequent layers

• Placed when first layer underwriter has reached capacity

• Participation– More than one insurer on a layer


Layering Coverage

• Example:– $15,000,000 coverage requirement

• 3 carriers each share at $5,000,000 each• Each carrier shares all loss within the layer and

pays 1/3 of the loss– $15,000,000 coverage requirement

• 1 carrier has $10,000,000 and pays 2/3 of the loss

• 2nd carrier has $5,000,000 and pays 1/3 of the loss


Sample Participating Language


Critical Considerations in Layering• Coverage must match – exactly• Each carrier provides their own form

and there will be differences– Follow lead language endorsement– Not always available


Sample Followed Policy Language


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Limits Of Insurance

• Defined as the MOST the insurance company will pay in any one occurrence

• Flood and Earthquake typically have annual aggregates.– Annual aggregates apply separately to each

peril, specifically Earthquake and Flood– Annual aggregate is the most the company

will pay in any annual period– No reinstatement of aggregate


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Example Of Excess Limit Of Liability “Drop Down” ClauseIt is understood and agreed that in the event of reduction or exhaustion of the underlying aggregate limits, this policy shall apply in excess of the reduced underlying limit, or if such limit is exhausted, shall apply as underlying insurance, notwithstanding anything to the contrary in the terms and conditions of this policy.In no event, however, shall this Company be liable for more than the limits of liability specified by this endorsement.


Occurrence Language

• Key component• Earthquake, Flood and Named Storms

typically use a time reference – all loss within that time frame is deemed to be one loss

• Earthquake– 72 hours– 168 hours


Occurrence Language

• Flood / Wind– 72 hours

• For EQ, Flood, Wind– Loss or damage must be covered either

before inception (“nose” coverage) or after expiration (“tail coverage) within the occurrence definition


Polling Question #4

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“Nose” Coverage LanguageExclusion D.6. is replaced by the following: 6. We will not pay for loss or damage caused by or resulting from

any Earthquake or Volcanic Eruption that begins before the inception of this insurance.

But we will pay for loss or damage by Earthquake or Volcanic Eruption that occurs on or after the inception of this insurance, if the series of Earthquake shocks or Volcanic Eruptions began within 72 hours prior to the inception of this insurance.


“Tail” Coverage LanguageAll Earthquake shocks or Volcanic Eruptions that occur within any 168-hour period will constitute a single Earthquake or Volcanic Eruption. The expiration of this policy will not reduce the 168-hour period.


Deductibles

• Earthquake Deductible: 10% total INSURED value at the time of the loss / per unit basis: building, BPP, BI/EE

• Note that MANY DIC policies have the deductible taken against INSURABLE value

• Minimum earthquake deductible: $25,000• Flood Deductible: $50,000 per loss


Deductible Buy Down Policies

• Depending on the limits and exposure for CAT loss, i.e., EQ, Flood, wind, the deductibles on the DIC policy can be significant

• Limited number of insurance companies offer a deductible buy down


Buy Down Examples• LIMIT: The Difference between the original

deductibles being USD 250,000 per Occurrence or USD 500,000 per Occurrence in respect of locations with roofs 10 years or older and the Insured’s Retention.

• Maximum recoverable under this policy USD 450,000 per Occurrence but USD 1,800,000 in the annual aggregate

• INSURED’S RETENTION: USD 50,000 per Occurrence locations or coverages involved.


Valuation

• Replacement cost subject to SOV / OLL / Scheduled limits

• Selling price should be requested on mfg stock / inventory

• A carrier may only allow ACV on old, unreinforced property– Must put this in writing to the client


Coverage Enhancements/Endorsements• Must mimic the Commercial Property

Policy• Examples:

– Additional Debris removal• Debris removal should include covered /

uncovered property– Pollutant clean up and removal from land

or water – ask for increased limit– Spoilage


Coverage Enhancements/Endorsements

– Ordinance or Law• Coverage A included within Limit• B and C - blanket specified limit

– Increased Period of Restoration– Extended Period of Indemnity 360 days– Dependent Business Income / Extra

Expense– Civil Authority– Ingress / Egress (critical coverage point)



– Utility Services – Direct and Time Element• Water, Power, Communication• Include overhead transmission lines

– Followed policy language over primary or lead insurer

• May be included but must compare policy language



– Followed claim language• This coverage is often not granted

– Notice / Knowledge of loss limited to Executive Officer of First Named Insured

– Unintentional failure to disclose included


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Drop Down Provision / Priority of Payment Joint Loss Clause• Background

– Drop Downs• Only necessary under Primary/Excess

placements, use of inconsistent perils, sublimits or aggregates (EQ and Flood)

– Priority of Payments• Similar to a Drop Down - More widely accepted

– Joint Loss• Used to bridge a Fire, DIC or Boiler policy when

loss is a result of a combined perils


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DIC Coverage Territory

• At the locations shown in the declarations– “Per schedule on file with the company”

• Possible expansions – “All other locations” AOL– Property in due course of transit


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DIC Coverage Territory Sample Language #1We cover property wherever located within the United States, Canada, Puerto Rico, Territories, Possessions.


DIC Coverage Territory Sample Language #2This policy insures against all risks of direct physical loss or damage from any external cause except as hereafter excluded while anywhere within the 50 states of the United States of America and the District of Columbia.


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DIC Coverage Territory

• My be written for specified coverage by state.– Many DIC’s are written for California ONLY

to add earthquake coverage


Underwriting Information Required


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Underwriting Information Required• COPE

– Construction, Occupancy, Protection (private and public), Exposure

• AGES– If the buildings are older than 30 years, provide

any structural updates, including roof replacement– Many buildings may be updated to new seismic

codes for occupant safety, but have little impact on constructive total loss probability to the structure. Therefore, will not assist in reducing EQ pricing or acceptability.


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Underwriting Information Required• Statement Of Values

– Provide both the values contained in each layer and the 100% ground up values of each item exposing the layer

– Any summary information regarding split of values by age, construction, and occupancy can help place excess layers


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Underwriting CAT Loss - Information Required• Loss history, summarized by loss to each

layer under the proposed terms• Include ground up loss information as

well as losses to each proposed layer using the proposed deductibles, terms and conditions

• Catastrophe exposures by statistical or geographic zone


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Underwriting CAT Loss Considerations• Construction considerations, such as

type, age, retrofits to bring to current code, number of stories, damageability of contents

• Probable maximum loss


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Underwriting Earthquake Considerations• Location considerations such as soils,

liquefaction and landslide potential, proximity to other risks

• Coverage considerations, such as building, contents, business interruption, sprinkler leakage, coverage for building code upgrades and fire following the earthquake


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Underwriting Earthquake Considerations• Newer construction which meets

current seismic building codes• Risks of superior construction• Risks not located on or near major faults• Risks located on firm natural ground• Risks with lower liquefaction potential• Risks which accept reasonable

underlying deductibles


Polling Question #5

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Proposal from Wholesalers

• Review sub-limits• Review coverage endorsements,

limitations and enhancements• Verify that all forms on each layer are

REALLY consistent– Coverage is often placed based upon

capacity but there has been no conscious attempt to coordinate coverage terms or conditions


Terminology


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Excess of Loss Terminology

• Primary– The layer that pays the first dollar of loss after

deductible (if any)• First Excess

– In a layered structure, the first excess layer is the first layer above the primary

• Second Excess, etc.– In a layered structure, this is the next excess of loss

layer above the first excess layer, or the second layer above the primary;


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• Point of Attachment– The amount of loss that first penetrates a layer

• Point of Release– The amount of loss that completely exhausts a

layer• Mixed Participating and Excess Structure

– A layer structure where a prorata portion of the structure is shared on a proportional basis, and a portion of the structure is “internally layered” or quota shared into two or more layers.


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• Working Layer– A layer that is expected to have exposure to

frequency losses, or losses considered within the PML

• Buffer Layer– A layer that is expected to have lower frequency

than a working layer. – This layer is expected to only pay loss if some low

probability event occurs. – This layer would be involved in a Maximum

Foreseeable Loss


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• Capacity Layer– A layer that has a very low probability of

paying loss – This layer is often excess of the amount

MFL, or at least only partially exposed to an MFL event


Summary

• DIC policy placement is challenging• Critical components

– KNOWLEDGEABLE wholesaler– Review of policy language when placing

layers and/or participating insurers– Disclosure of coverage limitations to client

in writing


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