Chapter 3 – Liability Loss Exposures
"Success seems to be largely a matter of hanging on after others have let go." William Feather |
Introduction
A Standard Homeowner's Policy includes a very important protection, Personal Liability. This is known as Section II, Coverage E - Personal Liability. This section states that “if a claim is made or a suit is brought against an insured for damages because of Bodily Injury or Property Damage caused by an occurrence, the company will pay up to the stated amount in the policy". Our purpose in this chapter is to discuss the law and liability. The way the law specifically treats Homeowners Policy protection will be covered in a later chapter.
Financial resources are diminished as the result of a claim for money damages because of injury or harm to another party.
Liability Loss Exposures have the following elements:
Resources Exposed to a Liability Loss
Liability Loss Exposures put all of an individual's financial resources at risk of loss. When a court orders an individual to pay liability damages, the amount of the damages is based on the loss to the injured party. The individual's financial resources available to pay such damages are not the court's concern. As a result, all of an individual’s savings and property are exposed to loss because of the possibility that the individual might have to liquidate them to pay a large liability damages award. In addition, courts have the power to attach a portion of an individual's assets, if necessary, to pay for liability damages.
The fact that all of an individual's assets, plus his/her future income may be required to pay for liability damages makes the possibility of a liability loss a particular threatening exposure.
Possibility of a Claim for Money Damage
For Liability Loss Exposures, the peril or cause of loss is the reason of a claim for money damages. Unless a claim for money damages occurs, an individual's financial resources will not be diminished. In addition, as soon as a claim for money damages is brought, financial resourcesbegin to be diminished by the costs of investigating the claim and preparation to defend against legal action that may ensue. Therefore, the making of a claim against an individual is the action that brings about a liability loss.
As the chapter evolves, we will be discussing the law and how it pertains to Liability Loss Exposure. Keep in mind that claims for liability damages are governed by Civil Law. Civil Law deals with the rights and duties of citizens with respect to one another. The settlement of disputes between individuals and the redress of wrongs committed against individuals are within the scope of Civil Law. Several bases for claims of liability damages exist under Civil Law. Individuals are most likely to face claims arising out of Tort Liability, Contractual Liability and Statutory Liability. We will discuss these later in the chapter.
Nature of Law
Because it is the legal system that enforces obligations, an understanding of the law helps in recognizing Liability Loss Exposures. Complex legal questions require the professional expertise of an attorney. Some fundamental legal terms and concepts are essential knowledge for anyone dealing with Liability Loss Exposures or Liability Insurance.
Law exists in a civilized society to enforce certain standards of conduct. By placing limits on the freedom of some individuals, laws protect all other individuals.
While the law generally makes the world a safer and more secure place, it also imposes certain responsibilities. Where there are rights, there are also duties. Each individual must accept the constraints of the law in order to have the benefits of the law. The law accomplishes its objectives by holding people responsible for their conduct.
An important distinction exists in the American legal system between Criminal and Civil Law. While Criminal Law cases generally receive more headlines, insurance-related cases are more likely to involve Civil Law.
Criminal Law - Certain kinds of conduct so endanger the public welfare that society makes laws to prohibit them. Examples: laws prohibit murder, rape, robbery, arson, fraud, theft, and driving while intoxicated. Such offenses are crimes.
A law-abiding citizen has no reason to fear the possibility of incurring Criminal Law penalties. This chapter concentrates on Liability Loss Exposures arising from Civil Law.
Civil Law - Actions that are not necessarily crimes can still cause considerable harm to other people. Civil Law serves to settle disputes and to redress wrongs against individuals. In the absence of laws, a dispute between neighbors can turn into a never-ending feud. Civil Law procedure enables individuals to enforce the rights that have been infringed upon by others.
Example: property rights occupy an important place in American law. The old saying that a "man's home is his castle" suggests that property rights should have priority over most other objectives of the law. When someone else infringes on property rights, such as trespass, vandalism, or
theft (even thought these are also crimes), the property owner may go to court to have the property rights restored.
In the same way, the law protects personal rights. If someone inflicts bodily injury, invades the privacy of another, or harms the reputation of another person, the injured person may seek justice in court. By protecting such personal rights, the law contributes to everyone's safety.
Civil Law enforces contract rights. People are more willing to make agreements or contracts with one another when they know that those contracts are enforceable. If two parties make a contract but one party does not honor it, the other party can ask the court to compel adherence to the contract or pay damages. This possibility of seeking justice from a higher authority promotes commerce by making contracts more reliable. Not surprisingly, in ancient cities the market place and the law court were often side by side.
In a Civil Law proceeding, the aggrieved party must bring the case to court by hiring a lawyer, or by going to Small Claims Court where lawyers are not necessary.
Sources of Law
Although it is easy to see the benefits of the law, it is usually more difficult to determine exactly what the law on a particular point is. There must be some source of law that the society accepts as bonding. In the United States, there are essentially 4 sources of law: Constitutional, Statutory, Common and Administrative Law all govern American Society. They differ, however, in their origin.
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Constitutional Law - The Supreme Law of the land is the Constitution. The Constitution specifies the structure of the Federal Government and outlines the respective powers of the legislative, executive and judicial branches of the government. The Constitution provides for a federal system of government in which powers not specifically granted to the Federal Government are reserved for the individual states. The Constitution guarantees to all citizens certain fundamental rights, such as freedom of speech, religion, freedom from unreasonable searches and seizures, the right to trial by jury and the right to due process of law.
All other laws must conform to the Constitution. The courts interpret the Constitution to decide constitutional issues that may arise. If the Supreme Court decides that a particular law conflicts with the Constitution, that law becomes invalid. The Supreme Court is the highest level of law. Its decision provides the final resolution of a disputed issue and lower courts must follow the Supreme Court decision in judging future cases on the same issue. Thus Constitutional Laws consists of the Constitution itself and all of the decisions of the Supreme Court that interpret the Constitution.
Each of the separate states also has a constitution establishing the powers of the state government. Each state also has a Supreme Court to resolve legal conflicts in the state government and to hear appeals on matters of State Law. However, states must follow the Constitution of the United States, and decisions of a state Supreme Court bearing on a constitutional issue may be appealed to the Supreme Court of the United States.
Statutory Law - Legislatures at national, state and local levels enact laws or statutes to deal with perceived general problems. At the national level, Congress considers many proposed new laws each year. Any member of the Senate or the House of Representatives may introduce a bill. It may be referred to a committee for study or perhaps for hearings before it is debated on the floor of the Senate or House. If the bill receives a majority vote in both the Senate and the House and the President signs it, it becomes a law. State Legislatures and Town Councils also make new laws in similar fashion. Collectively, these formal enactments of legislative bodies are referred to as Statutory Law.
Common Law - In contrast, the Common Law has evolved in the courts by the force of custom. When a King's judges began hearing disputes in medieval England, they had little basis for their decisions except common sense and the prevailing notions of justice. Each decision became a precedent for similar cases in the future. Gradually, certain principles evolved that the King's judges applied consistently to all cases. These principles became known as Case Law or Common Law.
These common law principles guided Judges not only in England but also in the English colonies in America. Thus, the English Common Law heavily influenced the American Legal System. When neither Constitutional nor statutory law applies, judges still rely on precedents of previous cases in reaching their decisions. Legislation now exists that modifies or replaces Common Law principles, but Common Law is still important in matters of legal liability.
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Administrative Law - A final source of law is the numerous federal, state and local governmental agencies that have regulatory powers derived from Statutory Law. Examples include the National Labor Relations Board, the Federal Trade Commission, the Environmental Protection Agency, State Public Utility Commission and Local Zoning Boards. These regulatory bodies issue detailed rules and regulations covering a particular public concern or relating to a particular industry. Such rules, regulations, and decisions that implement the objectives of Statutory Law are called Administrative Law.
Other Elements of a Liability Loss
Statutory Law, Common Law, or Administrative Law could provide a basis for a finding of legal liability. However, there must be some standard in the law against which the conduct of the purportedly liable person can be measured. Thus, the law pays a critical role in liability losses.
While one party may or may not recognize its responsibility for some harm to another party, it is the legal process that enforces the liability. The legal process confirms the responsibility for the harm and determines that appropriate restitution. The factors involved in a Liability Loss include:
The remainder of this chapter considers each of these elements of Liability Loss in greater detail.
Legal Rights of Recovery
For an injured party to have a Right of Recovery from another party, some principle of law must create a link between the two parties. Often this link appears in the Law of Contracts. Any law or legal principle establishes a relationship between the two parties may support a claim, but this discussion must be confined to the most common theories of recovery. A party that initiates the suit in court trial is known as the plaintiff.
Torts
Long ago the word tort meant any kind of wrongful act. Although the word still covers a wide variety of wrongful acts, legal practice has narrowed the meaning. Torts do not include acts such as "white lies" that may be morally wrong but do not lead to legal action. Crimes, wrongs against society rather than merely against a particular individual, differ from torts because Criminal Law deals with crimes and Civil Law does not. Within the practice of Civil Law, there is a distinct body of principles. With these exceptions, almost any other wrong may be a tort. Therefore, Tort Law is that branch of Civil Law that deals with wrongs other than breaches of contract.
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A wrong usually leads to legal action only when some damage or injury results and the
issue are who must pay for these consequences. The concern of Tort Law is determining responsibility for injury. Although largely modified restated in statutes, Tort Law still rests partly on Common Law because courts determine responsibilities in such cases according to the prevailing theories of justice and the precedents of previous cases. Like other areas of Common Law, a Tort Law evolves over time as courts sought solutions to new problems that arose in a changing society. As expectations of safety and security rise and injuries become more costly, Tort Law becomes increasingly important as a means of determined responsibility for injury.
No matter how much sympathy for the victim of an injury, there must be some standard for assigning the responsibility to someone else if the victim is to be compensated. Tort Law provides essentially 3 possible standards for finding legal liability. If a tort is intentional, the liability for the consequences follows. If a tort is unintentional, negligence may be grounds for a finding of legal liability. Some activities are so inherently dangerous that absolute liability for a resulting injury may exist even though no harm is intended and no negligence is involved.
Intentional Torts - Deliberate acts that cause harm to another person, regardless of whether the harm is intended, are called intentional torts. An Example is defamation of character, which includes both libel and slander. Libel occurs when someone prints and distributes an untrue defamatory
statement about another person. Slander is a spoken defamatory untruth about another person. Liability judgment for libel tend to be greater than the amounts awarded for slander.
Negligence
While such Intentional Torts may lead to liability judgment, the greatest number of liability cases arise from negligence. Negligence occurs when one fails to exercise the appropriate degree of care. It involves acting differently than a reasonably prudent person would under similar circumstances. Tort Law enables injured parties to obtain compensation if they can demonstrate that someone else's negligence led to their injury.
Elements of Negligence - A liability judgment based on negligence depends on 4 elements. The 4 elements of negligence are:
1. a duty to act that is owed another person
2. a breach of that duty
3. the occurrence of an injury
4. an unbroken chain of events leading to that injury.
Duty to Act - the first element of Negligence is that a person must have a duty to act that constitutes an obligation to another person. A homeowner has a duty to keep icy sidewalks safe for visitors.
Breach of Duty - In order for a person to be held negligent, a breach of duty owed must occur. A breach of duty is the failure to exercise the degree of care expected of a reasonable person in that situation. When
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entertaining guests in the homes, hosts have a duty to protect them from harm. Not only must the host warn the guests of any danger, but the host must also take steps to see that guests are not harmed. Example: owing a large, aggressive dog and seeing that it is properly confined when guests arrive. Just telling the guests that the dog is vicious is not enough to meet the standard of care required. If the dog attacks a guest sitting in the living room, the host will be held responsible for the injuries.
In other situations, the same person might not be held responsible for the dog's attack. Example: if the dog attacks an intruder who breaks a window and enters the home while the owners sleep. Since reasonable people are not expected to protect intruders from harm, they have not breached their duty and are not responsible for the resulting injuries.
Injury - the third element of negligence is that definite injury or harm must actually occur to the claimant. There may be a legal duty to act and a breach of duty; but unless someone suffers injury, no recovery can be made based on negligence.
Unbroken Chain of Events - A finding of negligence also requires that the breach of duty initiate an unbroken chain of events leading to the injury. The breach of duty must be the proximate cause of the injury. Example: Jane injures a child alighting from a school bus, her careless driving is the proximate cause of the injury. When one passes a properly stopped school bus at a high rate of speed and hits a child, there is a direct casual relationship between the driver's action and the injury to the child.
Responsibility for Negligence
Individuals, business firms and other organizations may be held responsible for negligence. Generally, one expects the person whose conduct is negligent to be responsible for the consequences. This person may be called the Tortfeasor, the wrong doer, or the negligent party. In addition to the person who actually commits the act, other persons or organizations may be held responsible for the wrongdoer’s action. This responsibility is called Vicarious Liability. It is also possible for two or more parties to be jointly liable. If so, they are called Joint Tortfeasors.
Vicarious Liability - Vicarious Liability exists when one is held liable for the actions of another person. Such situations extend liability and include not only the actual wrongdoer but also a person or organization responsible for the wrongdoer. Were this not the case, business organizations could escape liability for negligence, since the person must act on behalf of a business organization for that entity to perform any act.
Vicarious Liability often arises in business situations from the relationship between employer and employee. A person at work performing work-related activities is generally acting on behalf of the employer. Therefore, the employer is vicariously liable for the actions of the employee. Parents can be held vicariously liable for the actions of their children who are engaged in an activity on behalf of their parents. If the Green's 14 year-old son cuts the grass and loses control of a power mower which injured the foot of the White's 5 year-old daughter, the Green's could be held liable for their son's actions.
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Absolute Liability - Although most liability cases arise from negligence, liability under Tort Law is not entirely limited to cases of injury caused by deliberate or negligent conduct. In certain other situations as well, Tort Law may give an injured person a Right of Recovery. In these dangerous situations, there is absolute liability for any injury regardless of the intent or the carefulness of the person held liable. The situation itself rather than the person's conduct become the standard for determining liability. A family's pet dog may be considered a dangerous animal if it has a history of attacking strangers or is a breed known to be vicious. If so, Absolute Liability exists and a person attacked by the vicious dog would not have to demonstrate negligence on the part of the dog's owner in order to claim restitution for injuries.
Absolute Liability also exists for owners of guns and other firearms. They may be under lock and key but the owner might still be held liable for any injuries they cause.
Strict Liability - A similar but slightly different concept, often applies in cases of injury involving defective products. The Strict Liability Doctrine eases the injured person's burden of proof in that he can recover from the manufacturer by showing that the harmful product was unreasonably dangerous, even if the manufacturer was not negligent. So, Strict Liability can have almost the same effect as Absolute Liability in holding someone responsible merely because of the outcome.
Contracts
Tort Law enables an injured person to receive restitution from a wrongdoer because the wrongdoer has breached a duty generally recognized in the law, such as the store's duty to maintain safe conditions for customers, or because the law generally holds a person to seek restitution because the other party has breached a duty voluntarily accepted in a contract. A contract is a legal enforceable agreement between two or more parties in which each makes some promise to the other. If one party fails to honor the promise, the other may go to court to enforce the contract. In such a case, it is the specific contract, rather than the law in general that the court interprets. Two areas involving obligations that are contractual in nature are the assumption of Liability under a Contract and Breach of Warranty.
Liability Assumed Under Contract - Parties to a contract might find it is convenient for one to assume the financial consequences of certain liabilities of the other. The party assuming the liability may be closer to the scene, exercise more control over operations, or have the ability to respond to claims more efficiently. Example of this would be an owner of a building and a contractor made a contract in which the contractor accepts responsibility for some of the action of a subcontractor. If one of these specified actions of a subcontractor injures another party then the contractor will pay the damages to the injured party. Such agreements are called hold harmless agreements.
Breach of Warranty - The Law of Contracts also governs claims arising from Breach of Warranty. Contracts for sales of goods include implied guaranties or promises by the seller. Example: the seller warrants that the
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item is fit for a particular purpose. If Jane buys the hair conditioner recommended and sold by her beautician, she relies on the implied warranty that the conditioner will be good to her hair. If the conditioner damages her hair instead, the beautician may be held liable for a breach of warranty. The buyer does not have to prove negligence on the part of the seller. The fact that the product did not work shows that the contract was not fulfilled.
Damages
For a Liability Loss to occur there must be some definite harm sustained by another person. Compensatory damages are intended to compensate the victim for harm suffered. A damage award is usually an amount of money judge equal to the victim's loss. That is the amount the party held liable will have to pay.
Occasionally, a court may award punitive damages as well because the conduct of the wrongdoer is particularly outrageous. By making the wrongdoer pay more than the amount required compensating the victim, the court makes an example of the outrageous conduct to discourage its repetition. The amount of liability loss includes, but can be greater than, the total losses sustained by the victims.
Bodily Injury
Bodily Injury is any physical injury to a person. Bodily injury losses that the liable party can expect to pay include hospital bills, physician's fees, lost income and rehabilitation expenses of the injured party. In legal terminology, payments covering such costs are called special damages.
In addition to these direct costs, the liable party may also be required to pay general damages for pain and suffering and loss of consortium. Pain and suffering damages are awarded for the physical and mental pain and suffering that a person incurs because of the bodily injury. Example: when a person is badly burned on the face and arms, for general damages compensate the injured party for the physical pain and the potential disfigurement as well as for mental suffering. Damages for Loss of Consortium compensate someone for the loss of companionship because of an injury to the spouse.
Property Damages
Property damage losses occur when a person caused direct or indirect damages (such as loss of use of property) to another person's property. Property damage awards are normally limited to the value of the damaged property, loss of income due to the damage, and additional expenses that occur because of the damage.
Other Kinds of Personal Injury
In addition to bodily injury, a person can be harmed in other ways, such as damage to one's reputation, whereas legal practices use "personal injury" as a synonym for "bodily injury", insurance contracts use a more limited definition of "personal injury" which includes libel, slander, invasion of privacy, discrimination, and malicious prosecution (improper institution of criminal proceedings against another with malice). Any of these acts may cause harm to another person for which the perpetrator may be held liable.
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Defense Costs
Defense costs include not only the fees paid to lawyers but also all other expenses associated with the defense of a liability claim. These expenses can include wages the defendant losses to attend and prepare for the trial, investigation expenses, witness fees and the cost of appeal bonds.
Liability Judgments
Whatever the legal basis of liability, the damage or injury, and the conduct or situation creating the liability, a Liability Loss becomes a definite legal obligation as a result of the legal process. At any point in the process, the parties may agree on the extent of the liability and settle the matter accordingly. If they do not agree, the injured party may seek a definitive judgment in court, which would then become the other party's legal obligation.
The Legal Process
The legal process provides a mechanism for an objective determination of liability. The process protects the rights of persons injured through the actions of others and assures them of compensation for their injury. Because the legal process can be time-consuming and expensive, many liability cases are settled out of court. Even people convinced of the merits of their case may be better off if they compromise early rather than fight a court battle through the end.
The Trial - During the trial, the plaintiff (party initiating the suit) tries to prove that the defendant's (party named in the suit) behavior toward the plaintiff caused injury.
Witnesses to the events, expert witnesses, and the plaintiff's testimony may provide evidence. The defendant has an opportunity to cross-examine each witness and to present a defense.
One of the best defenses to a negligence claim is that the defendant did not commit a negligent act, but instead acted in a reasonable manner that is commonly accepted by society.
Second common defense invokes the legal Doctrine of Contributory Negligence. This defense asserts that the negligence of the plaintiff contributed to the injury. Example: in the case of an automobile accident, the defendant may have been speeding, and the plaintiff intoxicated and thus partly to blame for the accident. The argument is that the defendant should not be held liable for the loss because a sober person in the same situation would not have been injured. The laws of many states now allow juries to apply the Doctrine of Comparative Negligence and assess damages in proportion to each party's degree of responsibility.
A third possible defense applies the doctrine of risk assumption. In this defense, the defendant argues that the plaintiff knew of the risk in advance of the injury and therefore assumes the risk. This defense might apply in a suit initiated by a hockey fan hit by a puck in the stands at a game. Team management might argue that it is common knowledge that pucks go into the stands and that the protective shield around the ice ring is a reasonable amount of protection for the fans. As long as the management of the team has taken this reasonable precaution to
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protect the fans, the fans assume the remaining risk.
Role of the Insurance Company
Under the terms of the Liability Insurance Contract, the insurance company agrees to pay the legal expenses incurred in defending a case even if the suit is without merit and also to pay judgments covered by policy. Thus the insurance company carries most of the burden of the lawsuit. The insurance company usually retains a local attorney who knows not only the law but also the way local juries and judge’s think and act. Outside attorneys who have specialized expertise in certain areas of the law, or familiarity with the insurance company's strategy and practices, may also be retained. Since it has many dollars hinging on the outcome, the insurance company often controls the entire defense process. In most Liability Insurance Policies, the insurer retains the right to decide whether to fight the claim or settle out of court. If a trial leads to a judgment against the defendant, the insurer must decide whether to appeal the case to a higher court. In professional liability cases especially, defendants are more concerned about how the outcome affects their professional reputations while the insurance company is more concerned about the litigation process.
Valuation of Liability Losses
The Valuation of Liability Losses is not nearly as exact as the Valuation of Property Losses. If the parties do not reach a settlement out of court, the amount of the defendant's liability may be decided by the judge or jury. In a bodily injury claim,
medical bills, lost income, extra expenses, loss of consortium, pain, suffering and punitive damages (where applicable) claim for damages, the jury can reject it, or accept some parts and reject others. Once the jury leaves the courtroom to consider its verdict and the amount of any award, the process is out of the hands of the lawyers and the judges until the jury returns. When the jury returns and announces its verdict and the jury's award is not in keeping with the facts presented, the respective parties may appeal the case to a higher court.
In cases where a death has occurred, the plaintiff’s attorney, through the use of an ex-pert witness, may try to calculate the economic value of the deceased person's life. This calculation includes the present value of the deceased person's earnings, fringe benefits and value of household services, the jury can accept or reject the testimony of the expert witness.
Property Damage Liability Claims can be evaluated more objectively than Bodily Injury Claims. No damages for pain and suffering, loss of services, or loss of consortium are involved. However, these can still be dispute over the fair market value of the property at the time of loss and the amount of damage that actually occurred. The value of fine arts or collectible items may be particularly difficult to judge. The facts regarding the value of the property damage are submitted to the jury for its judgment. It may accept or reject the arguments of the plaintiff's position and make the award as it sees fit. Generally, however, there are fewer disputes over Property Damage Liability Claims than Bodily Injury Claims.
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Chapter 3 - Questions
1. In a Homeowners Policy, Section II - Coverage E is known as:
A. Property Protection
B. All Risk Protection
C. Personal Liability
D. All of the above
2. If two parties do not agree on the fact or the extent of one's liability to the other, who decides?
A. the defendant
B. the injured party
C. the insurance company
D. the court
3. What law deals with wrongs other than Breaches of Contract?
A. Tort
B. Defamation
C. Contract
D. None of the above
4. Which of the following is/are elements of negligence?
A. Duty to act that is owed to another person
B. Breach of that duty
C. Occurrences of an injury
D. All of the above
5. Damages that are intended to compensate the victim for harm suffered are called:
A. Punitive damages
B. General damages
C. Compensatory Damages
D. All of the above
ANSWERS
1. C
2. D
3. A
4. D
5. C