By BreAnn Stephenson
Welcome to our “Is It Covered?” series. For a fuller introduction of the series, read HERE. We hope these quick reads will help you increase your understanding of your insurance coverage, clear up confusion and avoid preventable losses!
So, what’s the confusion?
Many people think that their insurance policy only details what they are covered for in the event of a loss. While it does include the types of losses your insurance carrier will reimburse and what types of losses are excluded, insurance is a contract between two parties (you and the insurance company). That means that while your insurer has responsibilities to you because of the premium you pay, you also have responsibilities to protect the property they are covering from unnecessary losses and to cooperate with them during the claims process. Failing to do either one of those can negate coverage that may have otherwise been available.
What happens if I don’t fulfill my responsibilities as laid out in the insurance policy?
Failing to cooperate with your insurer during the claims process, protect the property they insure from unnecessary losses or fail to implement Protective Safeguards, can result in your claim being denied when you might have otherwise been covered. Not cooperating with your insurance company at any other time during your business relationship may result in rate increases, non-renewal or even cancellation of your coverage.
What is a Protective Safeguard?
Protective safeguards are conditions at your property that must be met for coverage to be available in the event of a loss. Without them, you may not be covered for any damage associated with their absence. Two common examples are:
- to have working smoke detectors in each unit, or
- to have vacant properties boarded and secured.
What does the “Duties in the Event of a Loss or Damage” section include?
This section in your insurance policy lists what is expected of you if you have a loss at your property and during the claims process.
Is there a time limit to submit a claim?
Yes, most insurance policies require you to report a loss within a timely manner, generally within 60 days. Damage may not always result in a claim or you may not know all the details about a loss right away, especially if someone is injured, but you should report any damage at your property to your insurer immediately. Timely reporting of a loss can lessen the risk of additional damage at the property and helps the claims process go more smoothly for all parties. Small details that can become crucial to the fair settlement of a loss can be easily lost if too much time goes by before they are reported.
What does the lawyer-y-speak version of these requirements look like in my policy?
Sample policy language may look similar to this:
“As a condition of this insurance, you are required to maintain the protective devices or services listed in the Schedule above:
“P-9”: Operable smoke detectors in each unit.”
Duties in the Event of a Loss or Damage
“You must see that the following are done in the event of loss or damage to Covered Property:
- Notify the police if a law may have been broken.
- Give us prompt notice of the loss or damage. Include a description of the property involved.
- As soon as possible, give us a description of how, when and where the loss or damage occurred.
- Take all reasonable steps to protect the Covered Property from further damage, and keep a record of your expenses necessary to protect the Covered Property, for consideration in the settlement of the claim. This will not increase the Limit of Insurance. However, we will not pay for any subsequent loss or damage resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasible, set the damaged property aside and in the best possible order for examination.
- At our request, give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed.
- As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records. Also, permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records.
- Send us a signed, sworn proof of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms.
- Cooperate with us in the investigation or settlement of the claim.
We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including an insured’s books and records. In the event of an examination, an insured’s answers must be signed.”
Timely Reporting of Losses
“Discovery: It is understood and agreed by the Insured that, in the event of any occurrence which may result in loss, damage, injury, expense or claim for which the Insurer may become liable under this policy, notice shall be immediately given to said Insurer. Furthermore, the Insurer is not liable, under any circumstances for any loss, damage, injury, expense or claim of whatever nature, which is insured by this policy; unless any and every notice of claim, pleading and paper of any kind relating to such occurrence shall be given to the Insurer within 60 days of the date of loss or when the condition becomes known to the Insured.”
*As insurance policies may vary, please check your own policy for language specific to your covered property.
Do I really need to read my entire policy?
You should read and understand the complete insurance contract so you don’t miss details that could impact your coverage. In addition to the “Protective Safeguards” and “Duties in the Event of a Loss or Damage” sections, the policy may also detail precautions you must take for coverage to be available within the definition or description of that coverage. A perfect example of this is water damage caused by a burst pipe. Many policies will specify that for coverage to be available for this type of loss, you must either maintain heat in the building or alternately, shut off the water and drain the water supply.
What can I do to maintain coverage availability at all times?
Know what is in your policy: Read the sections of your insurance policy that address protective safeguards and your duties in the event of a loss. It is important to know what your insurance company expects of you so that you do not jeopardize your coverage. If you don’t understand your coverage or have questions, don’t hesitate to ask your agent who should be happy to help you!
Check out articles like “How to Maximize Your Insurance Benefits” which further details Your Duties in the Event of a Loss or “Timely Inspections Can Keep You from Losing Insurance Coverage.”