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The “Property Coverage: Interplay Between Policies and the Law” course is
designed to familiarize adjusters and litigators with the relationship between
the language of property coverage policies and “The Law.” For purposes of this
course, “The Law” includes laws enacted by legislative bodies and administrative
agencies, as well as case law. The course is presented by Jeffrey A. Kerensky,
J.D., Vice President of Property Legal Services, Property Loss Research Bureau,
and Kathryn Jensen, Counsel and Senior Editor, Property Loss Research Bureau.

The presenters begin by discussing the various sources of “The Law”,
including legislatures, administrative agencies, and the courts. The various
levels – federal, state, and local – of “The Law” are presented and discussed.

Next, the course discusses the relationship between the policy language
and statutes. A hypothetical claim scenario is used to illustrate the concept
that statutory language generally controls over policy language.

The
course then discusses administrative law, including regulations, rules,
bulletins, and so on. The presenters provide examples of how administrative law
may explain or expand upon existing statutes, or respond more quickly than
legislative bodies to natural disasters. Also addressed is the concept that
administrative law generally controls over policy language.

Then the
presenters discuss case law, including how to determine the relevance of a
particular case to a particular claim. Participants learn how to read and
understand a case citation, the difference between published and unpublished
opinions, and the concept of precedent – binding and persuasive.

Next, the
presenters discuss basic rules of contract interpretation as they relate to
insurance policies. Actual cases are used to illustrate how each of the rules are
applied to “ordinary” insurance claim disputes.

After thoroughly
discussing “The Law”, the presenters analyze two claim scenarios to illustrate
how policy language and “The Law” interrelate.

After completing the
course, participants will have a much stronger grasp of the relationship between
what the policy language says and what “The Law” says the policy language means.
Participants will understand that “The Law” generally controls when it conflicts
with policy language. In addition, participants will be able to explain how the
federal and state court systems are organized and the limits of authority of a
particular court. They will able to read and understand a case citation. They
will also be able to explain the differences between and relative importance of
binding precedent and persuasive precedent, and between published and unpublished
court decisions. Participants will be able to identify and explain a number of
contract-interpretation principles to apply when interpreting policy language.
Finally, participants will understand that resolving a property coverage issue
often requires reading more than just the insurance policy.

What CE Credit is available?

Note: To qualify for credit, you must submit completion (including a passed final exam if required) within five days of completing the last quiz. No partial credits will be awarded.

State:
Adjuster General
CE Hours:
Adjuster Ethics
CE Hours:
Attorney General
CLE Hours:
State's Course ID:
NH 2.0 482654
TX (classroom equivalent) 2.0 102893
NC 2.0 C96666
FL * ( Provider Number: 364169 ) 2.0 1202004
IL 2.0 528129
WY 2.0 26377
OK 2.0 1025060

* This course has been approved by the Florida Department of Financial Services for insurance continuing education credit.

Course Content

Lesson Content

A. Introduction
B. Outline
1. The Law
a. Statutes
b. Regulations
c. Case Law
2. The Policy
3. Putting It All Together: Claim Scenarios
C. Don’t Look At Just The Insurance Policy
D. The Law
1. Three branches of government
2. Three sources of law
3. Three types of law
E. Legislative Law
1. Federal statutes
2. State statutes
F. Claim Scenario
1. Homeowner’s policy’s replacement cost provision v. State’s Valued Policy statute
2. Statute generally controls when in conflict with policy language
G. Examples of statutes with relevance to insurance claims
H. Legislative Law continued
1. Local codes or ordinances
2. Hypothetical claim
I. Recap of Part 1; Preview of Part 2
J. Review
K. Quiz – Reinforcing Part 1 Materials
1. 5 Multiple-choice questions
2. 4 choices per question
3. Second quiz if score less than 80%

Lesson Content

A. Introduction
B. Administrative Law
1. Administrative agencies
a. Federal
b. State
2. Purposes of Administrative Law
a. Create New Law
b. Expand upon statutes
c. Explain existing law
d. Quickly respond to catastrophes
3. Where policy and law conflict, law generally controls
4. Recap Administrative Law
C. Judicial Law
1. Written decisions by judges
2. Identifying Relevant Case Law
a. What kind of court decided the case?
b. What level court decided the case?
c. What Is Court’s Jurisdiction?
D. Recap Part 2, Preview Part 3
E. Review
F. Quiz – Reinforcing Part 2 Materials
1. 5 Multiple-choice questions
2. 4 choices per question
3. Second quiz if score less than 80%

Lesson Content

A. Precedent
1. Binding precedent
2. Persuasive precedent
B. How to Read a Case Citation
C. Preview of Part 4
D. Review
E. Quiz – Reinforcing Part 3 Materials
1. 5 Multiple-choice questions
2. 4 choices per question
3. Second quiz if score less than 80%

Lesson Content

A. Introduction
B. Role of the Courts
C. Case discussion: Jahier v. Liberty Mutual Group, 883 N.Y.S.2d 283 (App.Div. 2d Dept. 2009)
1. Proximate cause v. anti-concurrent causation preface
2. Anti-concurrent causation preface enforced
D. Case discussion: Howell v. State Farm Fire & Cas. Co., 267 Cal.Rptr 708 (Cal.App. 1990)
1. Statute v. anti-concurrent causation preface
2. Statute controlled; preface not enforced
E. The Policy as Contract
1. The insurance policy is a contract
2. Principles of contract interpretation apply
3. Basic rules of contract interpretation
a. Four corners rule, a/k/a “parol evidence” rule
b. Plain and ordinary meaning
Case discussion: Hudson v. Tower Ins. Co. of New York, 875 N.Y.S.2d 429 (N.Y.Sup. 2008)
Case discussion: Rapp B. Properties, LLC v. RLI Insurance Co., 885 N.Y.S.2d 283 (App.Div. 1st Dept. 2009)
c. Ambiguities construed against the drafter
Case discussion: Pioneer Tower Owners Ass’n v. State Farm Fire & Cas. Co., 880 N.Y.S.2d 885 (N.Y. 2009)
Case discussion: Um v. Cumberland Ins. Group, 2008 WL 65805 (N.J. Super. App. Div. 2008)
d. Specific terms control over general provisions
Case discussion: Marsh v. American Family Mut. Ins. Co., 218 P.3d 573 (Ore.App. 2009)
e. Ejusdem generis
Case discussion: Rankin v. Generali U.S. Branch, 986 S.W.2d 237 (Tenn.App. 1998)
E. Review
F. Quiz – Reinforcing Part 4 Materials
1. 5 Multiple-choice questions
2. 4 choices per question
3. Second quiz if score less than 80%

Lesson Content

A. Review
B. Introduction
C. Claim Scenario – Water Damage to Condominium
1. Background
2. Relevant documents to consider
3. What does the Unit-Owner’s policy cover?
4. What does the Association’s policy cover?
5. Why does the Association’s policy cover unit property?
6. What, if anything, does the condominium statute require?
7. What, if anything, does the Master Deed (a/k/a Agreement, Declaration, CC&R, etc.) require?
8. “Other Insurance” provisions
9. Don’t rely on the policy alone.
D. Preview Part 6
E. Review
F. Quiz – Reinforcing Part 5 Materials
1. 5 Multiple-choice questions
2. 4 choices per question
3. Second quiz if score less than 80%

Lesson Content

A. Introduction
B. Case discussion: Volquardson v. Hartford Ins. Co.,
642 N.W.2d 599 (Neb. 2002)
1. Policy’s Intentional Loss exclusion v. Statute
2. 1943 New York Standard Fire Insurance Policy
3. Joint v. Several Obligation
4. Statute controls over policy language
C. The Law Is There To Help
D. Take Advantage of Resources
E. Three Things to Take From Course
1. The Law is your friend
2. The Law generally controls over policy language
3. Don’t look at just the policy; look at the Law too.

F. Wrap-up
G. Review
H. Quiz – Reinforcing Part 3 Materials
1. 5 Multiple-choice questions
2. 4 choices per question
3. Second quiz if score less than 80%