Chapter 3 - The Insurance Contract and The Personal Auto Policy


 

 


"We know what happens to people who stay in the middle of the road, they get run over."


 

Introduction

 

Through the study of the Personal Auto Policy it is important to review the basics of contract provisions and specif­ically general provisions in the Personal Auto Policy.  Automobile Insurance cannot prevent automobile acci­dents from occurring but it can sure help take the "sting" out of potential finan­cial loss.  As we review the Automobile Policy, various covera­ges are designed to protect individu­als from catastrophic accidents.  Coverages that protect an insured's investment in a vehicle, to pay medi­cal expenses due to injury and cov­erage for potential legal liability are all offered to the insured through the Personal Auto Policy.  Keep in mind that such coverages are combined in a single policy, which, in reality, is a contract between the insured and the insurance company.  Let's take a closer look at contracts and their use in pro­viding protection through the Personal Auto Policy.

 

Contracts

 

Insurance transactions differ from pur­chases of goods.  A car buyer, for ex­ample, can ex­amine and even test drive a car before buying it.  While war­ran­ties and promises of reliable ser­vice may influence the decision to buy, the primary consideration is the car itself.  Insur­ance, on the other hand, is not som­ething a person can try before buying.  It exists only in the future.  The essence of

 

insurance is prom­ise.  The evidence of the insurance company's promise is the Insurance Policy.  The policy de­fines in detail the rights and duties of each party to the transaction.  An Insurance Policy is a contract between the insurer and the insured.

 

A contract is a set of promises ex­changed by two parties and enforce­able in a court of law.  Even though some­one purchasing insurance re­ceives only a promise, that promise has value be­cause it is a legal obli­gation the insur­ance company cannot escape. Valid insurance contracts must meet the same requirements as contracts in general.  However, in­surance contracts have special char­acteristics that influence the applica­tion and interpretation.

 

Elements of A Contract

 

A court will enforce only those ag­ree­ments that are valid contracts.  The validity of a contract depends on certain essential elements.  An agree­ment must involve mutual assent, competent par­ties, a legal purpose and some consid­eration to be a valid contract.  If a court cannot find all of these elements, it simply will not enforce the agree­ment.

 

Mutual Assent - One essential element of a contract is that both parties agree to its terms.  One party must make an offer and the other party must accept it in its exact terms.  The process begins when someone completes an applica­tion, an offer to buy insurance.  The details on the application describe the expo­sures to be insured and indicate the terms the applicant will accept.

 

In a perfect world, an underwriter ac­cepts the application and agrees to provide the coverage requested.  At this point, an agreement exists and a con­tract has been formed.

 

In some cases, the underwriter might not be willing to meet all the re­quests of the appli­cant.  The under­writer could request a higher de­ductible.  When the underwriter's alterna­tives are communi­cated to the applicant, these alternative terms constitute a counteroffer.  To be enforceable, the agreement cannot be the result of duress, coercion, fraud or a mis­take.  If any of these can be proved, a court might declare the con­tract to be void!

 

Competent Party - For the contract to be enforceable, both parties must be legally competent.  Each party must have the ability to understand the agree­ment and the power to make the agree­ment.  Individuals are generally consid­ered to be competent and able to enter into legally enforceable con­tracts, un­less they are:

 

  • minors (persons not yet of legal age)
  • insane or otherwise mentally in­com­petent
  • under the influence of drugs or alcohol

 

Even minors may be considered com­pe­tent to purchase Auto Insurance when Auto Insurance qualifies as a necessity.  State laws vary.

 

Legal Purpose  - A contract is enforce­able only if its purpose is within the law.

 

Consideration - Simply is the thing of value given by each party to a contract.  Example:  when an auto is pur­chased, the buyer gives money (con­sideration) to the seller who, in turn, provides the car (which is also con­sider­ation).  In insurance contracts two types of con­siderations are in­volved.

 

  • the insured's consideration is the payment of a premium

 

  • the insurer's consideration is its promise  

      to fulfill the obligations sp­eci­fied in the  

contract, conditioned on the occurrence of          insureds’ losses.

 

In order to form a legally enforceable contract, an offer must be accepted; the parties must have genuine assent, the parties must be com­petent, the contract must be for a legal purpose and the contract must involve consid­eration.  If any of these elements are missing, the contract might be voided by one of the parties and thus would have no effect.

 

An Insurance Policy is a written docu­ment that contains words ex­pressing the agreements of the par­ties to the Insur­ance Contract.  The wording of the Insurance Policy also reflects certain fundamental charac­teristics of insur­ance.

 

 

 

 

 

 

Special Characteristics of Insurance Con­tracts

 

Insurance contracts have special charac­teris­tics that affect their en­forcement.  In settling disputed cas­es, courts recog­nize that insurance is:

 

  • a conditional contract
  • a contract involving the exchange of unequal amounts
  • a contract of utmost good faith
  • a contract of adhesion
  • a contract of indemnity

 

Conditional Contract - An Insurance Policy is a conditional contract because the insurer has to perform only under conditions.  Wh­eth­er the insurer pays a claim de­pends on whether an insured loss occurs.  An insured loss may never occur but that does not mean the insur­ance has been worthless.  In buying an Insur­ance Policy, the in­sured acquires a valuable promise, the promise of the insurer to make payments "if needed".  The prom­ise is present, even if the insurer's performance is not needed.

 

Contracts Involving the Exchange of Un­equal Amounts - Because they are condi­tional, Insur­ance Contracts involve an ex­change of un­equal amounts.  This often times is referred to as aleatory.

 

The premium paid by the insured for a partic­ular policy does not equal the amounts paid by the insurer to, or on behalf of, the insured.  It is the addi­tional factor that the insurer's obli­gation may be much greater (but only if cer­tain events occur) that makes the trans­action a fair price.  Example:  ­an insurance company charges a $500 premium to Provide Property Coverage ("Collision" Coverage or "Phys­ical Damage" Cover­age) on a car worth $10,000.

 

  • If the car is not damaged while the policy is in force, the insurance compa­ny pays nothing.

 

  • If the car is partially damaged, the

      insurance pays the cost of re­pairs, after   

subtracting a deductible (unless the repairs cost more than what the car is worth).

 

  • If the car is a total loss, the insurance company pays $10,000 (less any de­ductible) to the insured.

 

If by chance the insurer's obli­ga­tions in a "fender bender" come to exactly $500, un­equal amounts are involved in all three cases.  However, it does not follow that insurance buyers; with no losses or with only very minor losses, do not get their money's worth or that the insured who has a major accident profits from the insurance.  The premium reflects the value of the insur­er's promise.  Many insureds have no losses, while some are very large.

 

The premium reflects the amounts the insurer expects to have to pay, on the whole, to honor its agreements with all insureds with similar policies.

 

Contracts of Utmost Good Faith - Because insurance involves an intan­gi­ble promise, it requires complete hones­ty and disclosure of all relevant facts be­tween the parties.  This is the reason insurance contracts are considered con­tracts of utmost good faith.  The in­sured has a right to rely on the insur­ance company to fulfill its promise, even if the insur­ance com­pany is obli­gated to do not­hing until some years in the future (claims may involve long delays, es­pecially when Liability Expo­sures are involved). Likewise, the insurer has a right to expect that the insured deal be in good faith.  An insur­ance buyer who intentionally misrepre­se­nts certain facts or intentionally con­ceals certain infor­mation does not deal in good faith.  Similarly, as an insured who makes a promise or warranty as part of the Insurance Contract. An insurance company may be released from a contract on the grounds of Con­cealment, Misrepresen­tation or Breach of Warranty.

 

Concealment - is the failure to disclose infor­mation that could have been given. Courts have held that the insurer must prove two things in order to establish that Concealment has occurred.  First, it must estab­lish that the concealment occurred intentionally, which is often difficult to prove. Usually, the insurer must show that the insured knew the infor­mation should have been given and then withheld it. Second, the insurer must also es­tablish that the information withheld was a material fact.  A mate­rial fact is any informa­tion that would have affect­ed the insurer's underwriting decision.

 

Example:  for an Auto Insurance applicant, material facts may include who drives the autos, the ages and driving records of the drivers, where the autos are garaged and how the autos are used. Insurance companies care-ful­ly design applications for Insur­ance Poli­cies to include ques­tions re­garding all factors material to the un­derwriting process. By asking a question on a specific subject, the applicant must respond.  In this way, the appli­cant has less chance to conceal any perti­nent in­formation.

 

Misrepresentation - A misrepresenta­tion is a false statement of a material fact.  Unlike concealment, the insurer does not have to prove that the Misrep­resentation is intentional.  Example:  assume an Auto Insurance appli­cant has had two speeding tick­ets during the fifteen- (15) months prior to the applica­tion for insurance.  When asked if any driving viola­tions have occurred within the past two years (a question found on all auto application forms), either of the fol­lowing is considered a Misrepresenta­tion:

 

  • "I remember having one speeding ticket about two years ago."

 

  • "I have never been cited for a mov­ing vio­lation only a few parking tickets.

 

In the first answer, the information provided is incorrect.  In the second instance, information is withheld. Be­cause the application form poses the direct question, anything other than a full and honest response is a mis­repre­senta­tion, whether intentional or not.  As in the case of concealment, a misrepresentation of a material fact allows the insurer to cancel the poli­cy and return the premium because of the violation of utmost good faith.

 

Breach of Warranty - A warranty is a state­ment that someone holds to be true.

 

 

 

 

Contracts of Adhesion - The wording in Insurance Contracts are drafted by the Insur­ance Company and reprinted forms are used for many different insureds.  Since the insur­ance determines the exact word­ing of the policy, the insured has little choice but to "take it or leave it".  That is, the insured must adhere to the contract drafted by the insur­er.  The fact that contracts are Con­tracts of Adhe­sion significantly influ­ences their enforce­ment.  Usually, when questions arise as to the lan­guage of the policy, the courts will rule in the favor of the insured since the wording was presented in ambig­uous terms by the insurer.

 

Contracts of Indemnity - Most Property and Liability Insurance Policies Are Contracts of Indemnity.  With a Contract of Indemnity, the amount paid by the insurer depends on the amount lost by the insured.

 

  • Property Insurance generally pays the     

      amou­nt of money necessary to repair      

      covered property that has been damaged            

      or to replace it with similar property.

 

  • Liability Insurance generally pays to       

      a third party claimant, on behalf of the   

insured, any amounts the insured  becomes legally obligated to pay as damages due to a Covered Liability Claim, and also to pay legal costs asso­ciated with the claim.

 

A Contract of Indemnity does not neces­sarily pay the full amount needed to restore an insured that has suf­fered a covered claim.  The point is that the amount the insurer pays is directly related to the amount of the in­sured's loss.  Most policies con­tain a policy limit, which specifies the maximum amount the insurer will pay for a single claim.  Many policies also contain limitations and other provisions that may reduce the amount of recov­ery.

 

According to the Principle of Indem­ni­ty, the insured is not supposed to profit from the insured loss.  That is, the insured should not be financially better off after the loss than before.  Insurance Contracts usually include certain provi­sions that reinforce the principle of indemnity. Example: policies may be worded to prevent an insured from collecting under two different Insurance Policies for the same claim.  Insurance Policies also may provide that the in­sured trans­fers rights of recovery against oth­ers if the insurance com­pany pays the loss.  In each of these cases, the insured could otherwise collect more than the loss.  Another factor enforc­ing the Principle of Indemnity is that generally a person cannot buy insur­ance unless that person is in a posi­tion to suffer a financial loss.  In other words, one must have an insur­able interest.  Exam­ple:  one can­not buy life insurance on the life of a stran­ger, hoping to gain if the stranger dies. Property Insurance Contracts cover losses only to the extent of the insured's insur­able interest in the property.  This re­striction prevents an insured from collecting more from the insur­ance than the amount of the loss.  In­sur­able interest is not a problem in Liability Insurance because a Liability Claim against an insured automatically proves that the insured could suffer a Liability Loss.

 

 

 

 

 

 

Insurance Contracts

 

Before specifically introducing the Personal Auto Policy and how it is organized, we will take a look at the general provisions of the insurance contract.

 

General Provisions of Insurance Contract   - Because they must provide for con­tin­gencies of all sorts, Insurance Contracts must be drafted carefully.  The parties must agree about how to handle many situations that could arise even if they are not likely in a particular case.  While Insurance Contracts can be com­plex documents, a little knowledge helps in under­standing the contract.  Certain mat­ters must be addressed in every Insurance Policy in order to de­fine the coverage pro­vided.  These are critical elements in the content of any Insurance Policy.  The location within the policy, however, depends on its structure.  Thus, some famil­iarity with both the content and the structure of Insurance Policies in general helps one to analyze the terms of a particular policy more readily.

 

Content of Insurance Policies

 

An Insurance Policy specifically defines the

coverage it provides.  Since no Insurance Policy covers every single contin­gency, the policy must describe its limitations, restric­tions and exclu­sions as clearly as possible.  Example:  most Insurance Policies do not cover losses due to acts of war or nuclear contamination.  If the insurer does not intend to cover such losses, the policy must clearly state those exclusions.

 

Thus, the policy aims to specify the agree­ments between the parties to the contract.  In consideration of the premi­um, the insurer promises to make pay­ment according to the terms of the contract and conditions on the occur­rence of an insured loss.  Any Insurance Policy must contain certain information to make agree­ments clear. The best way to deter­mine the coverage provided by a particular policy is to examine its provisions in regard to each of these items.

 

Name of Insurance Company and Insured  - An Insurance Policy must identify the parties to the ag­ree­ment.  The name of the insurer and the name(s) of the insured(s) are usually shown in the first sheet of paper that forms a part of the policy.  This sheet may be called a declara­tion's page or simply declarations.  Some policies call it the information page.  The name of the insurance company is preprinted on the form, while computer enters the name of the insured.

 

Policy Period - Insurance Policies usual­ly provide coverage for a speci­fied period of time.  This time period must be stated.  The beginning ("in­ception") date of the policy appears in the policy declarations.  The expi­ration date may also appear there, or the policy term may be clarified else­where in the print­ed documents.  In case either the insur­er or the in­sured wants to cancel the policy before the end of the specified policy period, Insurance Policies need a section usually labeled "termi­nation" or "can­cellation" that addresses this possi­bility.

 

Consideration - The Insurance Policy must describe the "consideration" in­volved.  The insured's consideration is the payment of premium, and the insur­er's consideration is its promise to make payments of an insured loss oc­curs.

 

The policy declaration page normally shows the premium amount.  Else­where, the Insur­ance Policy may contain a number of specified state­ments re­garding when the premium shou­ld be paid, to whom it should be paid and what happens if it is not paid when due.

 

Definitions - Standard practice is to interpret Insurance Policies and other contracts by giving words their ordi­nary meaning or dictio­nary defini­tions, un­less the contract specifi­cally defines those words.  Since Insurance Policies often contain technical terms or words that are used in a very specific way, many policies contain a separate section labeled "definitions".  Sometimes defi­nitions appear at the beginning of a policy and some­times near the end.  Sometimes one or more terms are defined where they appear in the policy.  Insurance Policies may distinguish defined terms by placing quotation marks around defined words every time they appear in the policy or by printing the terms in bold­face type.

 

Insuring Agreement(s) and Exclu­sions - An Insurance Policy contains specific statements regarding the nature of the insurer's promises.  Example:  it states what Loss Exposures the insurer has agreed to cover, and what expo­sures the insurer does not intend to cover.

 

These statements may be called in­suring Agreements and Exclusions. An Insur­ing Agreement is the state­ment in which the insurer agrees to provide coverage. The in­surer's promise is then limited by Exclusions, which eliminate some of the things that would otherwise be covered by the broad insuring agree­ment.  Insurance Policies contain Exclu­sions for several reasons:

 

  • to avoid covering "uninsurable" losses,    

some things cannot reason­ably be insured by insurance.

 

  • to avoid insuring losses that could be      

      prevented.  Some things are within the   

con­trol of the insured, i.e., many policies exclude coverage for damage intentionally caused by the insured.

 

  • to eliminate providing duplicate coverage.           Some things are best covered by one type of insurance and are ex­cluded by other types of policies.

 

  • to eliminate coverage that most insureds

      do not need.

 

  • to eliminate coverage for expo­sures that requires some special han­dling by the insurer.

 

  • to keep premiums reasonable.

 

Limits and Valuation Provisions - An insur­ance policy must specify exactly how to deter­mine the amounts the in­surer must pay if a loss does occur.  Insurance Policies usually state a maxi­mum amount, or policy limit, which is the most an insurer will pay for a given loss.

 

Duties of Insurer and Insured - Both insurer and insured must fulfill cer­tain duties for the insurance to func­tion as intended.  Example:  the insurer cannot pay claims unless it is informed when a loss occurs.  There­fore, Insurance Policies delineate the insured's duty to report claims promptly.  Often policies also pre­scribe other things the insured should do after the loss to pro­tect the insurer's rights.

 

Dispute Resolution - Last in the ques­tion of what to do if there is a dis­agree­ment between the insurer and the in­sured.  Disagreements can take two forms:

 

  • first, the parties may agree that there is coverage but disagree about the amount the insurer is obligated to pay.

 

  • second, there can be a disagree­ment as to whether the policy pro­vides cover­age at       all for a given type of claim.

 

Property Insurance Policies generally contain an appraisal provision that clarifies how the first type of dispute should be resolved.  Normally, both insurer and insured appoint an ap­prais­er and the two appraisers ap­point an umpire.  When any two of the three parties reach an agreement, the claim is settled.

 

Some Liability Policies prescribe a simi­lar approach to both coverage and amount dis­putes with an arbitra­tion provision.  Either party may demand arbitration, each party ap­points an arbi­trator and both arbi­trators select a third arbitrator.  A decision of two of the arbitrators is binding.

 

Both appraisal and arbitration repre­sent ways of resolving disputes with­out going to court.  However, a law­suit is always available as a final option.  Insurance Policies contain a suit provi­sion, often titled "Legal Action Against Us", which states that a legal action may not be brought against the insur­ance company, un­less all other terms of the policy have been complied with.  A lawsuit is intended to serve only as a last resort.

 

Personal Auto Policy and Its Organi­za­tional Format

 

Before we enter into the specific details of the Personal Automobile Policy, we will discuss the provisions and format of the policy.  Since the Personal Auto Policy is a bundle of protec­tion, we will first deal with the property as­pects of this cover­age, then deal with the liability provi­sions in a general na­ture.  We will conclude the chapter with a look at the policy format.

 

Property Insurance Characteristics

 

Property Insurance is any type of insur­ance that indemnifies an insured party who suffers a Financial Loss because property has been damaged or de­stroyed.  Pertaining to the Auto Policy, this section is known as the "Auto Phys­ical Damage" part of the policy.

 

In the Auto Physical Damage section, three degrees of coverage may be avail­able:

 

  • All Risks
  • All Risks excluding Collision
  • specified causes of loss (with or without Collision)

 

Like other property, cars and trucks is sub­ject to fire, theft, vandalism and other perils.  However, the most serious peril threatening autos is collision.  Insurance against collision also costs much more than insurance against all other periods combined.  Therefore, colli­sion coverage may be either includ­ed or ex­cluded with either "All Risks" or "Named-Perils-Coverage".  The specific causes of loss in a typical Auto Insurance Policy include:

 

1.   fire, lightning, or explosion

2.   theft

3.   windstorm, hail, or earthquake

4.   flood

5.   mischief or vandalism

6.   the sinking, burning, collision or derailment of any conveyance trans­port­ing the coverage.

 

One of the most significant perils, miss­ing from this list, is the peril of glass breakage.  Insureds who desire cover­age against glass breakage should pur­chase the "All-risk" Cover­age.

 

Liability Insurance Characteristics - Because of differences in the nature of the exposures, Liability Insurance differs from Property Insurance in many ways.  As mentioned be­fore, Property Insur­ance claims usually in­volve two parties: the insurer and the insured (the insured is also the claimant).  Liability Insur­ance claims involve three parties, the insurer, the insured and a "third party".  The "third party" who brings a legal complaint against the insured is the claimant.

 

Liability Insurance may be enforced by an insured, against whom a claim has been made, provided the claim is within the scope of the policy.  In­surable inter­est is not an issue in Liability Insurance although disputes can still arise over the questions of who is insured.  Property Insurance Policies cover claims when covered property, at a covered location, is damaged by covered perils, during the policy period, resulting in cov­ered consequences. Most of the wording in Property Insurance Policies, therefore, concentrates on clari­fying precisely which property, per­ils and consequenc­es the insurance intends to address. In contrast, Liability Insurance covers claims against an insured arising out of the insured's legal liability for a cov­ered activity or situa­tion involv­ing covered expenses or damages, provided the event that "triggers" coverage oc­curs during a covered time period. Most liabil­ity insuring agreements make essentially the same broad pro­mise: to pay damages (usually for Bodily Injury or Property Damage) for which an in­sured becomes legally responsible and to which the cover­age applies.  The in­surer also prom­ises to pay related defense costs.

 

Auto Insurance provides an example of Spec­ific Liability Insurance.  The insur­ing agree­ment of an Auto Insurance Policy states that it applies to claims because of auto accidents.  Exclusions narrow the scope of cov­erage and fur­ther clarify the inten­tion of the insurer.  Example:  a typical exclusion elimi­nates coverage for accidents intentional­ly caused by the insured.  This Specific Liability Coverage applies only to certain sou­rces of loss, such as auto accidents.  Even so, it is necessary for policy pro­visions to narrow the broad cov­erage of the insuring agreement to avoid cover­ing:

 

  • insurable losses (such as claims against    

      the driver of a stolen car)

 

  • losses that could be prevented (such as   

      intentionally Caused Proper­ty Dam­age)

 

  • losses that could only be insured at much higher premiums (such as Liability Coverage for business use of truck in a           

      Personal Auto Policy).

 

Overview of the Personal Auto Policy - The Personal Auto Policy (PAP) was first intro­duced in several states by the Insurance Ser­vices Office in 1977.  The PAP is designed to be easy to read and understand. Highly techni­cal terms have been eliminated and simple defi­nitions and short sentences are used through­out the policy.  The result is that the insured should be able to un­derstand the basic provi­sions of this important contract with­out too much difficulty.

 

Eligible Vehicles - The PAP is designed to insure only certain types of motor vehicles.  The vehicle must be owned, or leased for a minimum of six months, by an indi­vid­ual or by a husband and wife residing in the same house.  An eligi­ble vehicle is a four-wheel vehicle. Thus, a private passenger automobile, station wagon, or jeep owned by the insured is eligible for coverage.  A pick-up or van also can be insured if the vehicle has a gross weight of less than 10,000 pounds and is not used to deliver or trans­port goods or danger­ous materials.  However, coverage is provided if such use of a pick-up or van is (1) inciden­tal to the insured's business of installing, main­taining or prepar­ing furnishings or equip­ment, or (2) for farming or ranch­ing.

 

A private passenger automobile owned by two or more resident relatives (such as father and son) or by two or more non-related individuals re­siding together can also be insured under the PAP by adding a Miscella­neous Type Vehicle Endorsement (PP 02 23) to the policy.  Finally, the PAP can be used to insure motorcycles, golf carts, snowmobiles and similar vehicles by adding the appropriate endorsement (discussed in a later chapter).

 

Summary of Coverages

 

The PAP consists of a declaration page, an agreement and definitions page and six sepa­rate parts.  The six parts are:

 

  • Part A - Liability Coverage
  • Part B - Medical Payments Cover­age
  • Part C - Uninsured Motorists Cov­erage
  • Part D- Coverage for damage to your  auto
  • Part E - Duties after an accident or loss
  • Part F - General Provisions

 

Part A - provides Liability Coverage to pro­tect an insured against a suit or claim arising out of the negli­gent opera­tion of an automo­bile.

 

Part B - provides Medical Expenses Coverage that pays Reasonable-and-Nec­essary Medical Expenses incurred by an insured because of bodily injury caused by an automobile acci­dent.

 

Part C - provides protection if an in­sured is injured by an uninsured motor­ist, a hit-and-run driver, or a driver whose insurer is insolvent.

 

Part D - provides Physical Damage Insurance on a covered auto.

 

Part E - outlines the duties imposed on an insured after an accident or loss.

 

Part F - contains certain general provi­sions such as cancellation and termina­tion of the policy.

 

There are other optional coverages which can be added to the policy, such as Towing and Labor Costs Cov­erage.  We will discuss these optional coverag­es in a later chapter.

 

Declarations

 

The declarations page provides infor­ma­tion about the insured, a descrip­tion of the insured automobile(s), a schedule of coverages and other important details.  The following infor­mation is usually provided:

 

Name Insured - The declaration page states the named insured and the named insurer's mailing address.  The named insured can be a single indi­vidual, hus­band and wife or other parties.

 

Policy Period - The period of protec­tion starts at 12:01 a.m. Standard Time on the date the policy becomes effective and ends at 12:01 a.m. Stan­dard Time on the date the policy expires.  The period of protection is usually six months or one year.

 

Description of Insured Automobiles - The declaration page describes the automobiles or trailers that are in­sured.  This description includes the age of the automobiles, model and body type, trade name, vehicle iden­tifica­tion num­ber, annual mileage, use of the automo­bile, date of purchase, and other infor­mation.  Two or more automobiles may be described on the declaration page. A multiple-car discount is generally available if all vehi­cles are insured in the same company.

 

Premium Amount - The premium for each  coverage and the total premium amount are shown.

 

Limits of Liability - Liability limits for Bodily Injury and Property Damage is shown.  The amount of insurance can be shown as a single limit per accident or as separate limits that apply to Bodily Injury and Property Damage.

 

Schedule of Coverages - The various coverages and the amount of insur­ance for each coverage is shown.  Part A indicates the Limits of Liability and premi­ums for Liability Insurance.  Part B indicates the amount of Medi­cal Pay­ments Coverage for each per­son.  Part C shows the amount of Uninsured Motor­ists Coverage, and Part D indicates whether there is coverage for damage of the insured's auto.  If Physical Damage Coverage applies, the deductible amounts for Collision Loss and Other-Than-Collision Loss are indicated.

 

Lien Holder - The vehicle may be fi­nanced through a bank, savings and loan association, credit union, or other financial institution which holds a lien on the vehicle until the loan is paid off.  In such a case, the name of the lien holder is usually stated on the declara­tion page.

 

Garage Location - Unless otherwise stated, the described automobile is assumed to be principally garaged at the mailing address stated on the declara­tion page.

 

Rating Information - The rating class in which the vehicle is placed and any applicable credits and discounts are shown.  Premiums can be reduced by a multiple-car discount, driver training, good student discount, bum­per discount, accident prevention course, passive restraint discount, anti-theft device discount and other discounts and cred­its.

 

Cancellation by Another Insurer - If the insured has been previously cance­led by another insurer, this information may also be shown on the declaration page.

 

Applicable Endorsements - The decla­rations page also indicates any en­dorse­ments that are attached to the policy, for example: a high-risk teen­age driver may be excluded from coverage under his or her parent's policy by a Driver Exclusion Endorse­ment.

 

Signatures - The signatures of autho­rized legal representatives of the insurer are shown at the bottom of the declara­tions page.

 

Agreements and Definitions

 

The first page of the Personal Auto Policy contains the insuring agree­ment and defini­tions of several terms used throughout the policy.

 

Agreements - The policy begins with a brief general agreement that serves as an introduc­tion to the policy and states that the insurer's obligations under the policy are dependent upon the payment of premiums by the insured.

 

Definitions - A series of important defi­nitions apply to the entire con­tract. The definitions are written in simple, easily understood lan­guage.  The fol­lowing words are phrases that are de­fined in this section:

 

  • You and your.  The words "you" and  “your" refer to the named in­sured shown     on the declaration page and also to the spouse of the named insured if he or she is a resident of the same household.

 

  • We, us and our.  The words "we", "us" and "our" refer to the insur­ance company that is providing the insurance under the contract.

 

  • Private Passenger Auto. This defini­tion clarifies that, for purposes of the policy, a Private Passenger Auto that is leased is deemed to be an owned auto­mobile if it is leased under a written agreement for a continuous period of at least six months.  Thus, a private pas­senger sedan that is rented under a six-month leasing agreement would be considered an 'owned' automobile un­der the PAP.

 

  • Bodily injury is defined as bodily harm, sickness, or disease, including death that results.

 

  • Business includes a trade, a profession or an occupation.

 

  • Family Member is a person who is related    to the named insured or spouse by blood, marriage, or adoption and resides in the named insured's household.

 

  • Occupying is defined as in, upon, getting in, on, out, or off a motor vehicle. This definition has relevance for Part B - Medi­cal Payments Coverage and Part C - Uninsured Motorist Coverage.

 

  • Property Damage is physical injury to or destruc­tion of tangible property.  It also includes loss of use of tangible prop­erty that is not physically injured.

 

  • Trailer is defined as a vehicle designed to be pulled by a private passenger auto, pickup or van. A trailer is a farm wagon or farm implement while towed by such a vehi­cle.

 

  • Your Covered Auto.  An extremely important definition that applies to the ve­hicles covered under the PAP.  The four classes considered to be covered ve­hicles are:

 

  • any vehicle shown in the declarations
  • a newly acquired vehi­cle
  • a trailer owned by the insured
  • a temporary substitute auto or trail­er.

 

A covered auto is any vehicle listed in the declarations. As noted, cov­ered vehicles include a private pas­senger automobile, sta­tion wagon, jeep, pickup truck or van owned by the named in­sured.  A private pas­senger automobile leased for at least six months is also considered a cov­ered auto.

 

A newly acquired vehicle is also con­sid­ered to be a covered auto.  Cover­age is automatically provided from the date the insured becomes the owner. There­fore, if the insured purchases a new car, the car is auto­matically covered when the insured drives it away from the car dealer's lot.  However, the coverage continues only if the insured asks

 

the insurer to insure the vehicle within 30 days after it is acquired.  An additional premium must be paid for the newly acquired vehicle.  If the newly ac­quired vehicle is a pickup or van, the Automat­ic Coverage Provision applies only if no other Insurance Policy provides cover­age for that vehicle.

 

If the new vehicle the insured ac­quires replaces one shown in the declarations, it auto­matically has the same coverage as the vehicle it re­placed.  However, the insurer must be notified within 30 days if the insured wishes to add or continue Physical Damage Insurance (Part D - Coverage for Damage to Your Auto) on the replacement vehicle.  Example:  as­sume that the insured Has Collision Insur­ance on a 1987 car that is traded in for a 1994 car. The insured has 30 days to notify the insurance company to continue the Colli­sion Insurance of the new car. If the in­sured forgets to noti­fy the com­pany and six weeks later is involved in an accident, the Physical Damage Loss to the new car is not cov­ered.

 

If the newly acquired vehicle is an additional vehicle, it has the broadest coverage provided for any vehicle listed in the declarations.  One with Collision Coverage and the other with­out, an addition vehicle purchased by the insured would be insured for a Collision Loss.

 

A temporary substitute vehicle is also covered under the PAP. A temporary substitute vehi­cle is a Non-Owned Auto or Trailer that the insured is using because of the breakdown, repair, servicing, loss or destruction of a cov­ered vehi­cle. However, temporary substitu­tion vehicles are not within the definition of covered auto as that definition applies to Part D.  Coverage for damage to your auto with respect to Physical Damage Coverage, tempo­rary substitute vehicles are considered non-owned vehicles and will be discussed in a later chapter.

 

 

 

Chapter 3 - Review Questions

 

 

1.   The essence of an Insurance Policy is:

A.     monetary gain

B.     monetary loss

C.     a promise

D.     all of the above

 

2.   In order for a contract to be valid and enforceable, it must have 

A.     mutual assent

B.     consideration

C.     legal purpose

D.     all of the above

 

3.   A contract involving an exchange of unequal amounts is known as:

A.     adhesion

B.     aleatory

C.     indemnity

D.     none of the above

 

4.   The names of the insurance company and the insured are usually found in:

A.     declaration page

B.     table of contents

C.     definition page

D.     all of the above

 

5.   The property section of the PAP is commonly known as:

A.     Liability Coverage

B.     Endorsement Section

C.     Medical Payments

D.     Auto Physical Damage

 

 

ANSWERS

 

1.  C

2.  D

3.  B

4.  A

5.  D