Volume 1, Issue 13 Subscribe Reply to Editor Full Articles DMA Home
Developments in Property


Coverage – Ambiguity – Primary and Excess Policies
by Ray Coates of Low, Ball and Lynch

Northrop Grumman Corporation v.
Factory Mutual Insurance Company
United States Court of Appeals, Ninth Circuit (August 14, 2008)

In this Ninth Circuit Court of Appeals decision, the issue of ambiguity was considered with reference to a term used in both a primary and excess policy. The policies defined the term differently, and the issue was whether this created an ambiguity.

Northrop Grumman Corporation, and its Mississippi subsidiary, Northrop Grumman Ship Systems, were insured by Factory Mutual Insurance Company. Northrop obtained a primary policy from Factory Mutual, providing comprehensive property insurance. The policy included coverage for all risks, including earthquake, flood, boiler and machinery. An excess policy was obtained from Factory Mutual and included all risks, including boiler and machinery, but excluding earthquake and flood. The primary policy defined flood as including wind-driven water. The excess policy definition of flood did not include within its definition wind-driven water.

Northrop’s Mississippi subsidiary suffered severe damage in Hurricane Katrina. Factory Mutual paid Northrop $15 million under the primary policy, but informed Northrop that the remainder of the $1.257 billion claim would be evaluated under the excess policy as two separate losses, that caused by wind, which was covered, and that caused by flood, which was excluded.

Northrop sued Factory Mutual to obtain coverage under the excess policy. The District Court granted Northrop’s motion for partial summary judgment. It concluded that the flood exclusion was ambiguous because it did not plainly and clearly refer to hurricanes or damage caused by wind. Judgment was entered in favor of Northrop. Factory Mutual appealed.

The Court of Appeal reversed, applying California law. The Court stated the flood exclusion in the excess policy encompassed the water damage to Northrop’s shipyards. The definition of flood, based on lay and legal dictionaries, was an overflowing or inundation of water over usually dry land. The shipyards were covered in ten feet of water and therefore experienced a flood within the meaning of the excess policy. Northrop argued that since wind-driven water was included in the primary policy’s definition of flood, but did not appear in the excess policy’s definition of flood, this created an ambiguity. It argued, therefore, that wind-driven flood was covered.

The Court disagreed. It stated the primary and excess policies should not be construed as one document. The Court stated different definitions in the primary and excess policies of flood did not create ambiguity. Further, the absence of the phrase “whether driven by wind or not” in the flood exclusion in the excess policy did not show an intent on Factory Mutual’s part to expand coverage to include wind-driven flood. The Court stated the absence of that language did not render the otherwise clear language of the flood exclusion ambiguous. The Court stated this was merely indicative of a lack of specificity on Factory Mutual’s part rather than an omission evidencing an intent to narrow the exclusion. The Court further rejected the argument that since the language “whether driven by wind or not” was industry standard, this created an ambiguity. The policies were different and provided different types of coverage.

The Court found the flood exclusion unambiguously barred coverage for water damage under the excess policy. The District Court’s summary judgment was reversed and the matter remanded for further proceedings.

COMMENT

This case can be used by insurers to argue that just because an excess policy defines terms differently than a primary policy issued by the same insurer, this does not create an ambiguity.

SOURCE: (c) 2008 Low, Ball & Lynch

From the Industry


Poll: Californians Overwhelmingly Recognize
Personal Responsibility To Update Insurance
By Insurance Information Network of California

Californians overwhelmingly consider it their responsibility to prevent underinsurance, with homeowners in areas struck by catastrophic wildfire most strongly recognizing that they must keep their homes adequately insured, according to a new statewide poll.

Sixty-one percent of those surveyed in the poll commissioned by the Insurance Information Network of California said that homeowners have the primary responsibility to keep their insurance policies current. Of the 800 people interviewed, 73 percent of San Bernardino County and 68 percent of San Diego County respondents – people located in areas devastated by recent wildfires – call insurance updates a personal responsibility.

California courts this year reaffirmed that homeowners have the primary responsibility to make sure their home insurance is up-to-date. In the case, Everett v. State Farm, the state Appellate Court ruled that, “It is up to the insured to determine whether he or she has sufficient coverage for his or her needs.”

In the IINC poll, likely voters were asked, “Which of the following (do) you believe has the responsibility to make sure that your homeowners insurance policy is kept current?” Of the 800 likely voters surveyed, 61 percent called it their own responsibility; 17 percent said it was the responsibility of their insurance agent; 12 percent, their insurance company; 5 percent, all of the above and 6 percent either did not know or did not answer.

The new poll was conducted for IINC by Public Opinion Strategies September 21st – 24th with a margin of error of 3.46 percent.

“Only the homeowner will know if they have done substantial renovation work that requires an increase in insurance limits,” said IINC Executive Director Candysse Miller. “Year after year, our independent surveys have confirmed that Californians understand that.”

Past surveys by IINC revealed that while as many as two-thirds of those surveyed said that homeowners have the primary responsibility to keep their insurance policies current, only about one-third had actually had read their homeowners policy in the past year.

“Financial preparedness is a key and sometimes overlooked part of disaster readiness,” Miller said. “It may sound like a chore, but understanding your insurance coverage is a critical step in protecting your home and assets.”

IINC offers a number of free Web-based tools to help consumers track and evaluate their insurance and finances, including software to create a home inventory, track financial goals and create a wallet-sized insurance information card. For more information, visit the IINC Web site at www.iinc.org.

IINC is a non-profit, non-lobbying association dedicated to helping the public understand insurance and manage risk.

SOURCE: (c) 2008 www.iinc.org

Property Claims Chronicles


RELIEF IS ONLY A PHONE CALL AWAY
by DMA Property Supervisor

Hello. For many years I adjusted property claims and now I am a Supervisor handling property adjusters at the Los Angeles office of DMA Claims Services. The element that sets DMA apart is SERVICE. It is an attitude that started with the founder of the company, David Morse, and is drilled into every new adjuster upon arrival, no matter how experienced.

Here is an example of what I mean by service:

Our insured sustained damage to the tiles on his roof in a winter storm. But this was not just any house, it was a beautiful custom-built home overlooking the Pacific Ocean. And the roof tiles were not just any tiles, they were customized, glazed ceramic tiles from Japan. The damage was slight. Immature cones from two large fir trees each weighing two to three pounds had fallen 30 feet onto the roof and broken 10 or 15 tiles. There was minor interior water damage.

The problem arose in the cost of repairing the roof. Because these were custom tiles, they could not be matched and the whole section of the roof would have to be replaced to get a consistent look. The estimate for this was over $43,000.

My adjuster had a background as a roofer and disputed the estimate but was not getting anywhere. That is where experience pays off. He made some calls and found the company that had supplied the tiles used in the original construction, and determined they still had about 100 of these tiles in storage. These of course were a perfect match. He then had the supplier give written instructions on the replacement of single isolated tiles rather than whole sections at a time. The insured’s contractor was totally handled and did the job for less than $2,000.

All this was handled quickly and despite the savings to the carrier of $41,000, the end product of the repair was superior to what had been originally planned and estimated, due to the use of original tiles.

What accounts for this unusual combination of three happy entities (insured, carrier, and contractor)?

Service. Good, fast service, a bit beyond what is ordinary in the profession.

It is this kind of service that can produce a combination of elements even more rare – insureds happy, claims fair and not inflated, and the surface of your desk shining through.

Give us a call at any of our offices for more information or to give us an assignment.

Yours truly,
A DMA Claims Supervisor


DMA Claims Services
2705 Media Center Drive, Los Angeles, CA 90065
(800) 649-7602 Fax (323) 275-2150
If you'd like to unsubscribe from this newsletter, go here:
http://www.dmaclaims.com.com/askoff.shtm
l