July 2009
|Introduction
The mandatory special provisions discussed herein apply to the 2000 forms, unless otherwise noted. The edition dates of the forms discussed in this article are correct as of this writing (February, 2009); please be aware, though, that legislative changes or new legal interpretations resulting in new edition dates can occur at any time.
Some of the changes in the special provisions reflect various state laws regarding coverage, such as the valued property laws; others, again in accordance with state laws, amend the cancellation or nonrenewal provisions. For example, the unamended policy calls for an underwriting period for new business of 60 days. This is the length of time an insurer has to make a final decision as to the acceptability of the risk. During the 60 days, the insurer may cancel for any reason, giving a 10 day notice. But in some states, notice of cancellation requires only five days if certain conditions exist.
After the 60-day period is over, the unamended policy limits the reasons for cancellation to nonpayment of premium, material misrepresentation on the part of the insured, or substantial change in the risk. The insurer is required to give a 30 day notice, if canceling for any reason besides nonpayment of premium. However, the various states may amend the reasons or the time required in the mandatory special provisions. The allowable reasons for cancellation are indicated as numbers in this discussion. In general, proof of mailing is sufficient proof of notice; exceptions are noted.
Please be sure to note the edition date prior to making any coverage determinations based on a special provisions form. The states are described alphabetically, with the current special provisions form number and edition indicated.
Cancellation reasons are:
1. Nonpayment of premium.
2. Material misrepresentation or fraud. (In applying for the policy, in presenting a claim, or both.)
3. Increase in hazard.
4. Substantial change in risk.
5. Conviction of certain crimes, which increase a hazard.
6. Acts (or omissions) by the insured which increase any hazard.
7. Failure by the insured to reduce conditions which have contributed to a loss or may do so in the future.
8. Violation of any local fire, health, or safety code that increases the hazard.
9. Material violation of a policy provision.
10. Vacancy and/or unoccupancy of longer than 60 consecutive days.
11. Failure to begin repairs within 30 days after payment for a previous loss.
12. The building has: an outstanding order to vacate; an outstanding order to be demolished; or been declared unsafe by a governmental authority.
13. Fixed and salvageable items are being removed—but not being replaced—from the home.
14. Failure by the insured to supply the necessary utility service to the home for 30 consecutive days; and failure to pay property taxes.
15. Transfer of the property to another person.
16. Failure to comply with underwriting requirements, as established during the underwriting period.
17. All insureds in the state with this type of policy are being cancelled.
18. A determination by the insurance commissioner that continuation of the policy would be a violation of the law.
19. Breach of contractual duties, conditions, or warranties.
20. Financial impairment of the insurer.
21. Loss of, or inability to obtain, reinsurance on the risk.
22. Evidence of arson.
23. Any reason approved by the insurance commissioner.
24. Physical changes that make the property “uninsurable.”
25. Material changes in the property, its use, or the insured's interest in the property that now make the property uninsurable.
26. Physical changes in the property which are not corrected within a reasonable time after they occur and which result in the property becoming uninsurable.
27. Completion of repairs has not occurred within 60 days of loss payment.
28. The building is in danger of collapse.
29. Property taxes have been delinquent for two or more years.
30. The insurer stops writing homeowners business in the state or ceases operations in the state altogether.
31. Failure of the insured to pay membership dues required by the insurer as a condition of issuance and maintenance of the policy.
32. Claims frequency.
Alabama
Alabama 's special provisions endorsement (HO 01 01 05 08) contains a definition of actual cash value that applies wherever the term is used throughout the policy. The Section I exclusion for intentional loss is deleted and replaced so that if the named insured commits an act with the intent to cause a loss related to and in furtherance of domestic abuse, an innocent insured victim of such abuse may be afforded coverage.
The suit against us condition is amended; there must be full compliance with all the terms of the policy, and the suit must be brought within the time limitations prescribed under Alabama law.
The subrogation condition is amended. An insured may waive all rights of recovery in writing before a loss, unless that insured is an innocent victim of domestic abuse. In that case, the insurer is entitled to subrogate against the perpetrator to recover for any amounts paid for property damage.
Alabama does not amend the ISO homeowners cancellation provisions, so a policy may be cancelled for reasons 1, 2, 4, or 23.
Alaska
This special provisions endorsement (HO 01 54 09 01) contains an efficient proximate cause provision: if a loss is caused by a series of causes, and a peril insured against is the dominant cause of the loss, then the insurer cannot deny coverage even if a secondary cause is not a peril insured against. This provision supersedes all provisions to the contrary in the body of the policy. Forms HO 00 03 10 00 and HO 00 05 10 00 exclusions are not changed, but are given different numbers.
Amended property provisions are: 1) in the appraisal process each party has 10, rather than 20, days to choose an appraiser and notify the other party of that choice upon receiving a written demand for an appraisal; 2) losses are payable within 30 (rather than 60) days following settlement agreement; and 3) the time for a suit against the insurer is extended to three years.
There is an additional section II exclusion of coverage for bodily injury arising out of failure to supervise, or the negligent supervision of, a person that results in: a) corporal punishment, sexual, or mental abuse, b) transmission of a disease, or c) controlled substance abuse.
The section II additional coverages include the portion of the attorney's fees awarded as costs in accordance with Alaska statute. The concealment or fraud condition is amended to state that the insurer will not provide coverage if misrepresentations were fraudulent, material, or if the insurer would not have issued the policy as requested had the true facts been known.
Reasons for cancellation are: 1 (20 days notice required), 2 (10 days), 5 (10 days), 6 (30 days), and 24 (30 days). Alaska does not limit the underwriting period. If the named insured is 70 or older, another person may be designated to receive notice as well as the named insured.
Arizona
Arizona, in form HO 01 02 05 06, adds a definition of the term actual cash value: “the amount it would currently cost to repair or replace covered property with new material of like kind and quality, less allowance for physical deterioration and depreciation, including obsolescence.” The additional coverage for fire department service charge is deleted. The section I exclusion for intentional loss is amended so that it does not apply to an innocent insured's claim for an otherwise covered property loss caused by an act of domestic violence. If payment is made to an insured who is a victim of domestic violence for a loss caused by an act of domestic violence, the insurer has the right to recover damages from the perpetrator of the violence.
The section I conditions are amended. The appraisal condition specifies that the umpire should be “competent and impartial.” Losses must be paid within 30 days of reaching agreement. The concealment or fraud condition of both sections I and II is amended to include false statements that would have precluded policy issuance.
Following the 60 day underwriting period, a policy may be cancelled only for reasons 1 (10 days), 2, 4, and 7. The latter three require 30 days notice. Nonrenewal (giving 30 days notice) may be based on the condition of the premises. The insured is given 30 days to remedy the situation, in which case coverage will be renewed. But if the conditions are not remedied to the insurer's satisfaction, and the insured pays the premium, then the insured has an additional 30 days to rectify the problem.
The 2006 edition of the special provisions clarifies that cancellation can be based only on reasons specified in Ariz. Rev. Stat. Ann. §20-1652; other changes are editorial in nature.
Arkansas
The special provisions endorsement HO 01 03 02 07 amends the appraisal condition so that both insurer and insured must voluntarily agree to the appraisal. The suit against us provision is amended—a suit may be brought within five years, rather than one year. The subrogation condition states that the insurer is entitled to recovery only after an insured has been fully compensated for a covered loss. The mortgagee provision is amended. The mortgagee is given 10 days notice of cancellation for nonpayment of premium or if cancellation is within the 60 day underwriting period; 20 days in all other cases.
Reasons for midterm cancellation are 1, 2, 3, 8, 9, and 31. Twenty days notice is required except for 10 days for non-payment of premium.
California
California's special provisions form HO 01 04 09 06 gives notice that throughout the policy, the term “spouse” includes an individual registered under California law as the named insured's domestic partner. The section I intentional loss exclusion is amended so that it does not apply to an innocent insured's claim if arson is the cause of loss.
The section I conditions are amended. Now, if loss or damage relates to a state of emergency under California law (the 2007 wildfires, for example), the insured has 24 months after the insurer's actual cash value payment to notify the insurer of the intent to repair or replace the damaged property (applies to forms HO 00 02, HO 00 03, and HO 00 05). In all other cases, the insured has 12 months. In form HO 00 08, if the insured repairs or replaces the loss to restore the property for the same occupancy and use at the same site within 24 months because of a state of emergency, or 12 months in all other cases, the insurer pays the lesser of the limit of liability, or the necessary amount actually spent to repair or replace using common or functionally equivalent materials.
The appraisal clause is amended; the two appraisers are to select a competent and impartial umpire. An insured has one year from the date of loss to bring suit against the insurer. The loss settlement provision states that a loss is payable within 30 days after settlement is reached, rather than 60.
In event of loss by fire, the concealment or fraud condition applies only to the insured that has intentionally concealed or misrepresented facts. But if loss is caused by another peril, the concealment or fraud condition precludes coverage for all insureds if one has intentionally concealed or misrepresented facts.
A policy cannot be cancelled during the 60 day underwriting period or nonrenewed solely because the insured accepts the insurer's offer of earthquake coverage, or because corrosive soil conditions exist on the residence premises, or because the insured cancelled or did not renew an earthquake policy issued by the California Earthquake Association. But if the named insured accepted a new or renewal earthquake policy, and did not pay the premium, the insurer may cancel. The “corrosive soil” provision applies only to special form homeowners (ISO forms HO 00 03 or HO 00 05) or to condominium policies with open perils coverage on real or personal property, which exclude loss caused by corrosive soil conditions. Twenty days notice is required during the underwriting period. Midterm cancellation (30 days notice) reasons are 1 (10 days required), 2, 5, 6, and 24 (other than corrosive soil conditions). When the insurer cancels the policy, the return premium must be refunded within 25 days after the cancellation date.
Nonrenewal requires at least a 45 days notice. If the insured accepts an offer of earthquake coverage, the insurer may nonrenew if the insurer's ability to pay claims is jeopardized because of the earthquake exposure, or the nonrenewal is based on sound underwriting principles as filed with the Department of Insurance, or the insurer has lost reinsurance or seen a substantial increase in reinsurance premium.
An insurer may not nonrenew solely because: 1) an offer of earthquake coverage was accepted; 2) the insured cancelled or did not renew an earthquake policy through the California Earthquake Authority; 3) of corrosive soil conditions on the insured premises; 4) on the grounds that a claim is pending under the policy; or 4) on the basis of an insured's age.
Colorado
The special provisions endorsement (HO 01 05 05 02) states that the insurer's total liability for all damages arising out of any one occurrence will not be greater than the limit of liability shown in the declarations. Further, the insurer's total liability for any rehabilitation services for a child or minor for which an insured is legally liable because of vicarious liability is $10,000. The provision does not apply with respect to damages arising out of fungi, wet or dry rot, or bacteria if endorsements HO 04 26, HO 04 27, or HO 04 28 are attached.
The cancellation and nonrenewal provisions are amended. During the underwriting period, the insurer may cancel for any reason. A 30 day notice is required.
Midterm cancellation reasons are 1 (10 days notice), 2, and 4. The cancellation notice must state the reason for the cancellation. Thirty days notice is required.
A nonrenewal notice (30 days required) must state the reason for the nonrenewal.
Connecticut
“You” and “your” now refer to the named insured, spouse, or a party who has entered into a legally-recognized civil union with the named insured, if resident of the same household, in the changes made in form HO 01 06 03 06.
In section I property coverages the following changes are made: (1) water or steam are deleted as property not covered; (2) the additional coverage for collapse is amended. The additional coverage does not increase the applicable limit of liability, nor does it reduce or eliminate coverage with respect to a loss caused by a coverage C named peril. Collapse caused by use of defective materials or methods in construction, remodeling, or renovation need not occur during the course of the remodeling, renovation, or construction.
The exclusion for intentional loss is modified to state that the insurer does not provide coverage for the insured who commits an act with the intention of causing a loss.
The section I conditions are modified. The appraisal provision is modified so that each party is to choose a competent and disinterested appraiser. If the insurer pays a claim to the mortgagee, the insurer can cancel with ten days written notice to the mortgagee. If the mortgagee provides proof of loss, the appraisal, suit against us, and time of payment provisions become the province of the mortgagee. The concealment or fraud condition is deleted.
The section II exclusion for motor vehicle liability is modified so that the exclusion does not apply to a motor vehicle used to service an insured's residence (the unendorsed policy states “vehicle used solely to service an insured's residence”). Exclusion E.1. expected or intended injury is modified to eliminate coverage only for the insured who intended or expected the injury or property damage. Exclusion F.6. is deleted in all forms and in endorsement HO 24 73 10 00. Therefore, the exclusion for bodily injury to the named insured or an insured (as defined) is eliminated, thus leaving the possibility for intrafamily suits.
The sections I and II condition pertaining to death of the named insured is amended to reflect the partner in a civil union. A condition precluding coverage for the insured who, whether before or after a loss, intentionally concealed or misrepresented any material fact or circumstance, engaged in fraud, or made material false statements relating to the insurance.
Cancellation during the 60 day underwriting period requires a 30 day notice. Midterm cancellation is permitted for reasons 1 (10 days notice), 2, or 4; 30 days notice is required. Excess premium (if not tendered) is refunded on demand.
Notice of nonrenewal must be sent at least 60 days prior and must include the reason for the nonrenewal.
Delaware
Delaware 's special provisions form is HO 01 07 01 09. The suit against us condition is amended so that the action must be brought within two years after the date of loss. Any action brought as the result of the denial of a claim must be started within two years after the date of loss, or one year after the date of denial, whichever is later.
Cancellation may be delivered, or mailed to the named insured at the last known address. After the 60 day underwriting period, cancellation reasons are 1 (10 days), 2, or 4. A 30 day notice is required. However, if any of the following conditions are present at an insured premises, cancellation can be sent with only a 5 day notice: 10, 11, 12, 13, 14, or 29 (owing for more than one year, instead of two). Cancellation notice may be delivered or mailed to the insured's last known address.
A nonrenewal requires at least a 30 day notice delivered or mailed to the insured's last known address.
District of Columbia
The District of Columbia uses form HO 01 08 05 02. The section II conditions are amended—the phrase “This limit is the same regardless of the number of 'insureds', claims made or persons injured” is deleted from A. but added under the special limit of liability. The special limit of liability of $10,000 is for damages for which an insured is legally liable because of vicarious liability, unless the vicarious liability is otherwise excluded. However, this condition does not apply when the home-based business endorsement HO 07 01 10 00 is attached. The condition does not apply with respect to damages arising out of fungi, wet or dry rot, or bacteria when HO 04 26, HO 04 27, or HO 04 28 are attached.
The underwriting period is thirty days with a 30 day notice required. A midterm cancellation may be for reasons 1 (10 days), 2, 15, or 25. A 30 day notice is required.
Florida
Because of the hurricane damage inflicted in Florida in recent years, the special provisions (HO 01 09 12 07) have been substantially amended to reflect this. Three definitions are added: fungi (any type or form of fungus, including mold or mildew, and any mycotoxins, spores, scents, or by-products produced or released by the fungi); and hurricane occurrence (which begins at the time a watch or warning is issued for any part of Florida by the National Weather Service, continues for the time hurricane conditions exist for any part of Florida, and ends 72 hours following the termination of the last watch or warning issued for any part of Florida). Catastrophic ground cover collapse means “geological activity that results in all of the following: (1) the abrupt collapse of the ground cover; (2) a depression in the ground cover clearly visible to the naked eye; (3) structural damage, other than settling or cracking, of a building or structure insured under this policy, including the foundation; and (4) the building or structure being condemned and ordered to be vacated by the governmental agency authorized by law to issue such an order for that building or structure.”
Coverage for $10,000 for fungi, wet or dry rot caused by a peril insured against that occurs during the policy period is an additional coverage. Loss caused by repeated seepage or leakage or the presence or condensation of humidity moisture or vapor over a period of weeks, months or years is excluded unless unknown to all insureds and hidden within the walls, floors, or ceilings of a structure. The exclusion for fungi, wet or dry rot does not apply to fungi, wet or dry rot resulting from fire or lightning, or to the extent coverage is provided by the additional coverage.
Damage to covered property from sinkhole collapse was included on the prior special provisions forms. It was then removed and endorsement HO 23 94 was used to provide coverage, since Florida law mandated that coverage be available to all.
The current special provisions form, however, includes the coverage, but is now called “catastrophic ground cover collapse.” The special provisions form adds catastrophic ground cover collapse as peril .17 of the coverage C named perils of the HO 00 03, and peril .17 for forms HO 00 02, HO 00 04, and HO 00 06. The earth movement exclusion now specifically states that it does not apply to loss by theft or by catastrophic ground cover collapse.
The appraisal provision is modified by adding a mediation provision. If agreement on the amount of a loss is not reached, either party may demand mediation. The loss amount must be $500 or more prior to the application of the deductible, or there must be a difference of $500 or more between the amount of loss settlement offered by the insurer and the amount requested by the insured. The results of the mediation are binding only if both parties agree in writing. The insured has 3 business days in which to rescind the settlement. If the insurer demanded the mediation and either party rejects the results, the insured is not required to submit to or participate in an appraisal as a precondition to action against the insurer.
The suit against us condition is modified to allow the insured up to 5 years to bring suit against the insurer.
The loss settlement provisions applicable to the insurer's option are amended. If the policy is not on a mobile home, loss settlement is paid according to the loss settlement provisions 2.a. and 2.b. whether or not actual repair or replacement is complete. If the policy is on a mobile home, no more than actual cash value is paid until actual repair or replacement is complete. In Form HO 00 06, the terms “repaired” or “replaced” do not include increased costs incurred to comply with enforcement of any ordinance or law.
Losses are payable within 20 days after settlement is reached, or 60 days after there is an entry of final judgment or appraisal or mediation settlement.
The section II exclusion for controlled substances is modified to “a Controlled Substance as defined under federal law,” rather than giving the cite reference to the law as in the unmodified form. A sublimit of $10,000 applies to statutorily imposed vicarious parental liability not otherwise excluded. This condition does not apply with respect to damages arising out of fungi, wet or dry rot, or bacteria when endorsement HO 03 34 is attached.
The underwriting period is 90 days. During that time, cancellation may be effective immediately for material misrepresentation or for failure to comply with underwriting requirements. Nonpayment within the first 90 days requires a 10 day notice. For any other cancellation within the underwriting period, 20 days notice must be given. However, the insurer cannot cancel for property claims resulting from acts of God, unless the insured fails to take steps to prevent further such losses. Likewise, a single claim for water damage, or on the basis of filing claims for partial sinkhole loss regardless of whether the claim was made under this policy, unless the total of such claims exceeds the current policy limits, or the insured has failed to repair the damage in accordance with engineering recommendations, cannot be used as reasons for cancellation. After the policy has been in effect for 90 days, it may be cancelled for reasons 1 (10 days notice), 2, 4, 16, 17, or for claims that are “acts of God,” but the insured has failed to act to prevent a recurrence, or a single claim for water damage, if the insured has failed to act to prevent a recurrence, or for failure to repair sinkhole damage, or if the total of sinkhole-related claims exceed the policy limits. If the date of cancellation becomes effective on or after December 1 and before June 1, 100 days notice is given. If the date of cancellation falls on or after June 1 and before December 1, 100 days notice is given, or before June 1, whichever is earlier.
Special cancellation provisions apply in event of a state of emergency declared by the Governor and an emergency order filed by the Commissioner of Insurance. If the insured residence premises has been damaged by hurricane or wind loss that is the subject of the declared emergency, the insurer can decide to cancel beginning from the date the state of emergency is declared to the expiration of 90 days following repairs to the dwelling or other structure only for nonpayment of premium (ten days), material misrepresentation of fraud related to the claim, if the insured has unreasonably caused a delay in repair of the dwelling or other structure, or if the insurer has paid the applicable limits. In this event, 45 days notice is required. If the date of cancellation becomes effective during a hurricane occurrence (as defined), the cancellation will not become effective until the end of the hurricane occurrence, and the insurer is entitled to collect additional premium for the additional coverage, unless the insured has obtained other coverage.
Nonrenewal requires the same notice as in the cancellation provisions. If the date of nonrenewal becomes effective on or after December 1 and before June 1, 100 days notice is given. If on or after June 1 and before December 1, 100 days prior to renewal date or June 1, whichever is earlier, will be the number of days notice. An offer of renewal must be given in writing and accompanied by the amount of renewal premium at least 45 days prior to renewal date. Although nonrenewal cannot be solely for “acts of God,” the insurer may demonstrate through claims frequency that the insured has failed to take reasonable action as requested by the insurer to prevent further damage. Likewise, a single claim for water damage cannot be used as a reason, unless the insured failed to act to prevent a recurrence. Filing sinkhole claims cannot be used unless the total of such claims exceeds the current policy limits, or the insured has failed to repair the structure in accordance with engineering recommendations. If the nonrenewal date occurs during a hurricane occurrence (as defined), the expiration date will not be effective until the end of the occurrence. The insurer has the right to collect additional premium, unless replacement coverage has been obtained.
If a state of emergency has been declared and the residence premises has been damaged, nonrenewal may be based only on nonpayment of premium, material misrepresentation or fraud with regard to the claim, an unreasonable delay in repair caused by the insured, or the applicable limits have been paid. The insurer has ninety days from the period beginning from the date of the declared state of emergency to decide to nonrenew. In this instance, 45 days notice is required.
The subrogation provision is amended so that the insurer waives any right of recovery against a corporation or association of property owners where an insured condominium is located.
Georgia
Georgia 's special provisions endorsement HO 01 10 10 01 amends the ISO homeowners 2000 definition of collapse. It adds the statement that “if any part of the interior dwelling building separates from another part of the interior of the dwelling building with the result that any part of the interior dwelling building cannot be occupied for its intended purpose, it would be considered to be in a state of collapse.”
The section I intentional loss exclusion is modified so that innocent insureds may recover for damage if the damage arises out of family violence and is caused by an intentional act of an insured against whom a family violence complaint is filed for the act.
The mortgage clause is amended. The mortgagee must be notified at least 30 days prior to a cancellation or nonrenewal, unless within the 60 day underwriting period or for nonpayment of premium. In that case the mortgagee receives 10 days notice.
The exclusion for bodily injury or property damage arising out of the use, etc., of any controlled substance is modified to provide coverage if the involvement with the controlled substance is without the knowledge of any insured.
The cancellation provision is amended. If the insured requests cancellation, then the effective date will be the later of the requested date or the date the insurer receives the request. If the policy cannot be cancelled—even at the insured's request—without first notifying a third party (such as a governmental agency or mortgagee), the insurer will send a notice showing the effective date as either 10 days from the date of mailing or the date the insured specified, whichever is later.
Within the 60 day underwriting period, cancellation may be for any reason. Ten days notice is required. Reasons for midterm cancellation are 1 (10 days), 2, 4, or violation of any material terms or conditions of the policy. A 30 day notice is required in these instances.
Nonrenewal requires a 30 day notice. A receipt or evidence of mailing as prescribed or accepted by the U.S. Postal Service constitutes proof of notice.
The insurer has the right to recompute premium if information is received which affects the premium charged.
Guam
Guam special provisions form HO 01 51 04 02 deletes the exclusion for neglect in all forms. A condition called the “valuation clause” is added to all forms. This clause is a valued policy clause; if a peril insured against causes total loss to real property, then the amount of insurance is taken to be the true amount of loss. If the policy insures personal property, and a peril insured against causes total loss to the property, then the following applies: if the amount of loss (as established by appraisal or by agreement between insured and insurer) is less than the amount of insurance, the insurer is to refund any unearned premium for the amount of insurance exceeding the amount of the loss.
The suit against us condition is modified so that suit may be brought to recover on a final judgment or settlement against an insured signed by the insurer. The insurer is not responsible for damages that are not payable or are in excess of the limit of liability.
Cancellation for nonpayment is 10 days. The underwriting period is 60 days; cancellation during that period may be for any reason. After that, cancellation is for reasons 1, 2, or 4; 30 days notice is required. An affidavit setting forth the facts of the mailing is evidence of notice. The insurer can cancel for any reason at the policy's anniversary by giving at least 30 days notice. Nonrenewal requires 30 days before expiration date; an affidavit setting forth the facts of the mailing is evidence of notice.
Hawaii
This form HO 01 52 07 05 is promulgated by the Hawaii Insurance Bureau, Inc., 2005, and includes copyrighted material of ISO Properties Inc.
A definition of “domestic abuse” is added: physical harm, bodily injury, assault or the infliction of fear of imminent physical harm, bodily injury or assault between family members, sexual assault of one family or household member by another, stalking of one family or household member by another family or household member, or intentionally, knowingly or recklessly causing damage to property so as to intimidate or attempt to control the behavior of another family or household member.
The intentional loss exclusion is modified similarly to that of Georgia to protect the rights of an innocent insured. If the insurer pays an innocent insured because of an act of domestic abuse, the insurer may recover from the perpetrator. The insured must file a police report and cooperate with any law enforcement investigation relating to the act of domestic abuse that caused the loss. Any payment is then limited to the innocent insured's interest.
Loss settlement provisions 2.d. of forms HO 00 02 10 00, HO 00 03 10 00, and HO 00 05 10 00 are modified; no more than the actual cash value of the damage will be paid unless (rather than until) the actual repair or replacement is complete; or the cost to repair or replace is both less than 5 percent of the amount of insurance on the building and less than $2500. The insurer has 30 days from the time settlement is reached to pay a claim.
Under section II liability coverages, the phrase “Damages include prejudgment interest awarded against the 'insured'” is deleted. There is a limit of $10,000 for statutorily imposed vicarious parental liability not otherwise excluded. The amended limit of liability provision does not apply to losses covered under the home business endorsement HO 07 01 10 00 or with respect to damages arising out of fungi, wet or dry rot, or bacteria when HO 04 26, HO 04 27, or HO 04 28 are attached.
The sections I and II concealment and fraud provisions are amended. If, whether before or after a loss, there is misrepresentation or concealment made with actual intent to deceive, or that materially affects the insurer's acceptance of the risk, coverage is precluded.
There is a 60 day underwriting period. Notice of cancellation during that time requires 10 days notice. Midterm cancellation normally requires a 30 day notice (except for nonpayment of premium); cancellation may be for reasons 2 or 4. If the insurer cancels, return premium is pro rata; if the insured cancels, then short rate cancellation is used.
Idaho
Cancellation for nonpayment of premium (10 days notice, which begins to run 5 days following the date of postmark, if the U.S. mail is utilized) or for any reason within the 60 day underwriting requires a 30 day notice. This is the only change form HO 01 11 12 07 makes.
Illinois
Form HO 01 12 01 03 modifies the intentional loss exclusion, similarly to many other states, so that the rights of an innocent victim of “a pattern of criminal domestic violence” are protected in event of a loss to covered property. The loss must arise out of the pattern, and the perpetrator of the loss must be criminally prosecuted for the act causing the loss. The insurer's payment is limited to the innocent insured's insurable interest.
The appraisal provision is amended. If the insured requested the appraisal, and the amount is agreed to by the insurer's appraiser or by the umpire, then the insurer bears the cost of the appraisal. The time limit of two years for bringing a suit against the insurer is extended by the “number of days between the date proof of loss is submitted and the date the claim is denied in whole or in part.” Loss payment is required within 30 days of reaching an agreement, a final judgment, or the filing of an appraisal award.
The concealment or fraud provision is amended (in both sections I and II) to state that this condition does not apply once the policy has been in effect for one year, or one policy period, whichever is less. However, the insurer may still cancel in accordance with the cancellation provisions.
Section II modifications include: prejudgment interest is not included in the damages payable under section II; the exclusion for communicable disease is modified so that only loss resulting from sexually transmitted disease is excluded. The exclusion for bodily injury arising out of sexual molestation, corporal punishment or physical or mental abuse is modified so that coverage E and F do not apply “to an 'insured' who inflicts, or directs another person to inflict, upon any person, sexual molestation, corporal punishment or physical or mental abuse which results in 'bodily injury' or 'property damage'.”
Following a loss, the insured's duty is to secure and give evidence (C.4.d.) rather than to “obtain the attendance of witnesses.”
The underwriting period is 60 days. After that, a policy may be cancelled for these reasons: 1 (10 days notice), 2, or 6. The latter reasons require 30 days notice. The insurer must also send notice to the agent. Once a policy has been in force for five years or more, it can only be nonrenewed for misrepresentation or fraud, measurable increase in risk, or if 60 days notice is given. In the case of either a cancellation or a nonrenewal, the insurer must obtain a certificate of mailing.
Indiana
Indiana 's special provisions endorsement HO 01 13 12 02 modifies the ordinance or law coverage to state that the cost to comply with any ordinance regarding pollutants applies whether or not the “irritant or contaminant has any function with respect to your property or 'business'.”
A midterm cancellation for the following reasons requires 20 days notice: 2 or 4. Ten days notice is required for nonpayment of premium.
Condition H. adds that the insured's notice to the insurer's agent of a loss is deemed to be notice to the insurer.
Iowa
The special provisions endorsement is HO 01 14 06 08. The insurer has 30 days from the receipt of the proof of loss and an agreement is reached, a final judgment is entered, or a filing of an appraisal is made to pay a claim.
Section II condition suit against us is amended to give a judgment creditor a right of action against the insurer in event that an execution on a judgment is returned unsatisfied.
During the 60 day underwriting period, cancellation for any reason requires a 30 day notice. Iowa adds a cancellation paragraph stating that if the policy insures a dangerous wild animal as defined by Iowa law, the named insured must notify the Iowa Department of Agriculture and Land Stewardship if the policy is cancelled, or if the minimal amount of liability insurance, as required by the state, is no longer maintained.
Kansas
The special provisions endorsement HO 01 15 11 04 adds a definition of actual cash value: “the amount which it would cost to repair or replace covered property with material of like kind and quality, less allowance for physical deterioration and depreciation, including obsolescence.” The appraisal condition is amended so that both insured and insurer must agree voluntarily to have the loss appraised.
A suit against the insurer must be brought within 5 years after the date of loss. Losses are payable within 30 days after reaching settlement agreement with the insured.
The section II liability coverage for “damages” has been changed; the coverage for prejudgment interest is moved to the section II additional coverages claims expense as provision A.5.
Cancellation during the 60 day underwriting period requires a 30 day notice. If the insurer cancels, any return premium will be sent with the notice. If the insured cancels, any return premium will be sent within a reasonable time.
Kentucky
Form HO 01 16 01 01 amends the additional coverage for fire department service charge to state that the charges are not covered if the insured does not have a contract or agreement with the responding department.
The section I exclusion for intentional loss is amended so that payment will not be denied to the innocent coinsured victim of a pattern of criminal domestic abuse, if the loss arises out of the criminal domestic violence and the perpetrator is criminally prosecuted for the act causing the loss. The insurer may then subrogate against the perpetrator.
The loss settlement provision is changed; losses are payable 30 days after settlement is reached.
The section II exclusion F.6. for bodily injury to an insured as defined in 5.a. or 5.b. of the 2000 homeowners forms is deleted.
A cancellation during the 60 day underwriting period requires a 14 day notice. A midterm cancellation for nonpayment also requires a 14 day notice. Other midterm cancellation reasons are: 2, 6, 4, 8, or 21. A 75 day notice is required. Notice of nonrenewal must be sent at least 75 days prior to renewal date.
If a renewal notice is sent and the renewal premium is not received by the due date, the policy terminates without further notice; however, within 15 days of the due date notice will be sent stating the policy was not renewed and was terminated.
Louisiana
Special provisions form HO 01 17 03 08 amends the section I property coverages. A motor vehicle not required to be registered and used to service an insured's residence is now covered (the unamended form states the vehicle must be used solely to service an insured's residence). The additional coverage for reasonable repairs is amended; the provision states that the insurer will pay the reasonable cost incurred by the named insured for necessary repairs (rather than measures taken to protect covered property) made solely to protect covered property from further damage if a peril insured against has caused the loss. The additional coverage for credit card, etc. has been amended but only with regard to a slight change in punctuation.
Section I property exclusion A.8. is modified into loss caused by fire (by or at the direction of the insured), and loss caused by a peril other than fire (with respect to all insureds). The distinction is reflected in the section I concealment or fraud condition. No coverage with respect to a fire loss is provided to the insured who intentionally concealed or misrepresented any material fact; with respect to any other loss no coverage is provided to any insured if one or more insureds intentionally concealed or misrepresented any material fact. However, if any intentional concealment or material misrepresentation was in relation to procurement of the policy, and if known to the insurer would have resulted in nonissuance of the policy, coverage is denied only if the conduct was committed with intent to deceive. If the insurer pays an insured for a fire loss intentionally caused by another insured, the insurer has the right to recover from that insured.
The duties following a loss condition has been modified. If the loss results from a catastrophic event for which a state of disaster or emergency was declared, then the insured has 180 days following the insurer's request for the proof of loss. However, the 180 day period does not commence until the state of disaster or emergency has ended and the insured has access to his or her property. In all other cases, the insured has 60 days following the insurer's request.
Losses must be paid within 30 days after settlement is reached. The mortgagee cancellation clause is changed so that cancellation for nonpayment requires 10 days notice; other cancellations require 30 days notice. A nonrenewal requires 30 days notice to the mortgagee.
The Louisiana form does not specify that, under section II liability, damages include prejudgment interest. The section II exclusion for use of a motor vehicle is amended—the vehicle does not need to be used solely to service an insured's residence. Exclusion E.1. expected or intended injury is broken into two separate provisions, one applying with respect to loss caused by fire which is expected or intended by the insured; the other with respect to loss caused by a peril other than fire and which is expected or intended by one or more insureds. The exclusion of coverage for bodily injury to an insured is deleted in its entirety.
The suit against us condition is deleted. The section II concealment or fraud condition will not preclude coverage unless there was a deliberate attempt to deceive on the part of an insured. If the insurer pays one insured for a fire loss intentionally caused by another insured, the insurer has the right to subrogate against that insured.
If the insured's premium payment check or other negotiable instrument is returned because it is uncollectible, the policy may be cancelled from the date the premium was due. Ten days notice must be given. But if the insured sends a cashier's check or money order within ten days of the date the cancellation notice was mailed, the policy is reinstated with no lapse.
During the 60 day underwriting period, a 30 day notice of cancellation is required. Midterm cancellation reasons are 2 or 4 before the policy has been in effect for three years. Cancellation at anniversary date can be for any reason if the policy has not been in effect for three years. After that, cancellation reasons are 2, 4, 20, or 32. However, cancellation is not allowed solely for “acts of God,” defined as incidents “due directly to natural causes and exclusively without human intervention.”
After a policy has been in effect for more than three years, the insurer cannot nonrenew except for reasons: 1, 2, 4, 20, or 32. A nonrenewal cannot be based solely upon a loss caused by an act of God.
Maine
The first modification in form HO 01 18 04 08 is to the effective time: “to the extent the coverage under this policy replaces coverage in other policies terminating noon standard time on the inception date of this policy, coverage under this policy will not become effective until such other coverage has terminated.”
Two definitions are added. The first is for actual cash value: “the replacement cost of covered property at the time of loss, less the value of physical depreciation as to the damaged property.” The second is for physical depreciation, which is defined as “a value as determined according to standard business practices.”
Coverage D is amended so that an insured may elect either additional living expense or fair rental value, unless the residence premises is not the insured's principal place of residence. In that case, only additional living expense is available. The additional coverage for a fire department service charge is modified. The exclusion for payment of the charge if the property is located within city limits is deleted. The additional coverage for ordinance or law is deleted.
The exclusion of coverage for any loss committed by or at the direction of an insured with the intent to cause a loss is modified so that coverage is excluded for the insured who committed the act or directed that it be committed.
Losses are payable 30 days following settlement. In event of a covered loss, if the insured fails to provide proof of loss the mortgagee may do so. If a loss is made payable to a designated mortgagee, its interest in the policy may be cancelled by giving 10 days notice. If the insurer cancels the policy, the mortgagee will be given the same number of days notice as the cancellation or nonrenewal provisions of the policy require.
The concealment or fraud condition is deleted in both sections I and II; however, it is in the conditions applicable to both sections I and II. The insurer will not provide coverage for the insured who has intentionally concealed or misrepresented any material fact or circumstance, engaged in fraud, or made false statements relating to the insurance.
The section II exclusion for expected or intended injury is amended. Excluded is “bodily injury or property damage which is intended or reasonably (italics added) expected by an insured.” The exclusion for bodily injury to an insured is limited to “you or to any son or daughter of yours, if a resident of your household.” In the section II additional coverages, the provision for the inclusion of prejudgment interest is added as a claims expense.
The underwriting period is 90 days, except for a seasonal or secondary residence “expected to be continuously unoccupied for 3 or more months in an annual period,” in which case the underwriting period is 120 days. Cancellation during the underwriting period for nonpayment of premium requires 10 days notice; all other reasons require 20 days notice.
Midterm cancellation may be for these reasons: 1 (10 days required), 2, 5, 6, or 25. Maine also allows cancellation for the following: insured property is vacant and there is no custodial care; a trampoline or unfenced or improperly fenced swimming pool remaining on the property for 30 days or more after the insurer has notified of the intent to cancel if not removed or, in the case of the pool, properly fenced; a loss caused by a dog bite and the dog remains after notice of intent to cancel; or the insured's failure to comply with reasonable loss control recommendations within 90 days after receipt of intent to cancel. Twenty days notice is required.
The insurer must provide 30 days notice of nonrenewal. The notice must include the reason for nonrenewal. A postal service certificate of mailing is proof of notice for both cancellation and nonrenewal.
The Maine form includes provisions exempting the insurer, its agents, employees, or service contractors from liability resulting from furnishing or failing to furnish inspection services, unless there is negligence on the part of the insurer's agent, employees, or service contractor. There are certain other circumstances when the exemption does not apply; consult the endorsement.
Maryland
The Maryland special provisions form HO 01 19 01 09 amends the coverage D provision for civil authority prohibiting use of the insured premises. The maximum that will be paid is $3,000. If the loss involves fair rental value, then no more than two weeks is covered.
The form replaces the appraisal condition. Each party may choose a competent, rather than a competent and impartial, appraiser. The other insurance condition deletes the service agreement wording and refers only to other insurance. In form HO 00 06, the other insurance condition states that a loss will be prorated between the insurers if there is other insurance, unless the other insurance is in the name of a corporation or association of property owners. In that event, the HO 00 06 is excess over the amount recoverable.
The time period in which suit may be brought is changed from one to three years after the date of loss.
Section II liability exclusion 9. is added, which eliminates coverage for bodily injury or property damage arising out of written or oral statements material to the sale of any property made by an insured or a representative of an insured.
Cancellation at any time for nonpayment of premium requires 10 days notice. Within the 45 day underwriting period, a 15 day notice is required. The insurer may cancel for any reason. After that, a midterm cancellation requires 45 days (except for nonpayment), and may be for reasons 2 or 4. A nonrenewal requires 45 days notice.
Massachusetts
Form HO 01 20 09 01 contains a definition of vermin: “animals that tend to access, or enter into or under, structures for foraging or shelter, and, as a result, cause loss. Such animals include, but are not limited to, armadillos, bats, beavers, coyotes, lizards, opossums, porcupines, raccoons, skunks, snails, snakes, slugs, or squirrels.”
The insured's duties after a covered loss are amended. These are the section I conditions 4., 6., 7., and 8. The insured is required to protect the property from further damage, and make reasonable and necessary repairs. Some or all of these expenses may be reimbursed. Additionally, the loss settlement provisions are modified. In order to receive replacement cost coverage the insured is required to repair or replace the damaged building on the residence premises “or some other location within the Commonwealth of Massachusetts within a reasonable time but not more than two years from the date of loss.” (This provision is not applicable to the HO 00 04 10 00 or HO 00 06 10 00.)
The appraisal provision is amended—the insurer, upon written request from the insured, refers the matter to a three member board of referees. The suit against us provision is modified. The insured may bring suit within two years after the loss date; however, if for some reason a court prevents the start or continuance, but later allows the action to continue, it must resume within one year. If a request for appraisal is brought within two years of the date of loss, the insured has 90 days following the board's decision to bring suit.
The insurer has the option, if written notice is sent to the insured within 15 days after the proof of loss is received, to repair or replace the damaged property with like property.
Losses are payable within 30 days after the proof of loss is received. If the insurer does not pay the claim within the allotted time, the insured is to receive interest at the rate of 1 percent over prime for so long as the claim remains unpaid. Sales taxes are considered a part of any loss under the policy.
If the policy is cancelled, the mortgagee must be given 20 days notice; if the policy is nonrenewed, then the mortgagee must be given 10 days notice.
The Massachusetts provisions add two conditions: (1) City or Town Liens: The insurer must notify the local building inspector or board of health at least 10 days prior to making a payment of over $1,000 for a building or structure, or if damage makes the building a health or safety hazard. If there is a pending or official lien on the property, payment may be delayed until the matter is settled. (2) Vacancy: If the insured building has three or fewer units and is intended for residential purposes, the insurer is not liable for loss from fire or lightning while the building is vacant. The vacancy must extend beyond a period of 60 consecutive days. For all other residential buildings, the vacancy must extend beyond a period of 30 consecutive days.
The section II condition 4.a. requiring the insured to help the insurer reach a settlement is deleted. The duty of an injured person (or someone acting for the person) is changed from “authorize us to obtain copies of medical records” to “executive authorization to allow us….”
Cancellation for nonpayment of premium requires 10 days notice. During the 60 day underwriting period, cancellation for any reason other than nonpayment requires a five day notice. A midterm cancellation requires a 5 day notice, and may be for reasons 1 (10 days required), 2, 5, 6, 18, or 24. A U.S. Postal Service certificate of mailing is proof of notice. Nonrenewal requires a 45 day notice.
The special provisions endorsement also modifies the pair and set clause of the HO 04 61, if it is attached to the policy.
Michigan
The first of the modifications form HO 01 21 08 05 makes is that the coverage under the policy does not become effective until other coverage has terminated, if the termination is noon standard time on the inception date.
The section I exclusion for intentional loss does not apply to an innocent insured with respect to loss to covered property caused by fire, but only to the extent of that insured's insurable interest. Likewise, the concealment or fraud condition does not apply to an insured who was innocent with respect to loss caused by fire, although it applies with respect to other losses. The insurer has the right to subrogate against the insured who caused the loss by fire.
The appraisal condition is amended to state that each party must choose “a competent and independent appraiser.” A suit against the insurer may be brought within two years after the date of loss. The time for beginning an action is tolled (that is, suspended) from the time the insured notifies the insurer of a loss until the insurer formally denies liability.
Loss payment is required within 30 days following settlement agreement. If the insured property is in a municipality applying the provisions of Public Act 217, a part of the payment will be withheld and paid either to the municipality, a licensed contractor repairing the loss, or to the insured and the mortgagee. This provision applies only if the loss was caused by fire, explosion, windstorm or hail, vandalism or malicious mischief, or riot or civil commotion. This same provision is in the amended mortgagee condition.
The concealment or fraud condition is amended so that with respect to loss caused by fire, the insured who intentionally concealed or misrepresented material facts or engaged in fraud is not covered; however, other insureds are covered. There is no coverage for any insured for a loss caused by another peril if an insured engaged in fraudulent conduct or made material misrepresentations.
The section II liability coverage for damages because of bodily injury or property damage is amended; prejudgment interest is deleted as a part of damages and added as an additional coverage under claims expense, A.5.
The exclusion of coverage for bodily injury and property damage arising out of a controlled substance is amended so that it does not apply to an insured who has no knowledge of the involvement with the substance.
The section II loss conditions are amended. Someone acting “on behalf of” the insured may perform the loss duties. Under damage to property of others, the insured cannot be held to submitting a statement of loss within 60 days, if it is not reasonably possible to do so.
The other insurance provision of coverage E, personal liability, states that the insurance is excess over other valid and collectible insurance for watercraft and vehicles covered by the homeowners policy.
Cancellation during the 55 day underwriting period requires a 30 day notice except for nonpayment. When the policy has been in effect for 55 days, cancellation is based on reasons 1 (ten days notice), 2, or 4 with a 30 day notice. The form adds the provision that the minimum earned premium for the expired time will be the pro-rated premium or $25, whichever is greater. Notice of nonrenewal must be sent at least 30 days prior.
Minnesota
Minnesota form HO 01 22 06 08 adds a deductible provision to the effect that in event of a total loss to a building covered under section I, no deductible will be applied to the building loss. This does not preclude application of a deductible to other property covered under section I, such as personal property. Under “property not covered” a vehicle used to service the insured's residence is covered only while being operated on the residence premises. Under the additional coverage for ordinance or law, the statement is added that the coverage provided under the additional coverage does not reduce any similar coverage provided elsewhere in the policy. The section I insuring agreement states the insurer insures for all loss caused by fire or any damage caused by lightning.
Section I exclusions are amended. The ordinance or law exclusion states that exclusion A.1.a. does not apply to all forms other than HO 00 08 with respect to the damaged portion of a building in event of a partial loss, or for all forms with respect to the entire building in event of a constructive total loss. The intentional loss exclusion does not apply to an insured who does not commit, conspire to commit, or direct another to commit any act resulting in a loss by fire. The subrogation condition is amended so that the insurer may subrogate against the insured who committed the act resulting in a fire loss. Likewise, the concealment or fraud condition is amended so that loss by fire is not covered for the insured who concealed or misrepresented material facts or circumstances; loss caused by all other perils is not covered if any insured has committed fraud or material misrepresentation.
The section I condition dealing with an insured's duties after loss has been changed to require the insured to provide records and documents “reasonably related to the loss” or certified copies thereof. Before submitting to an examination under oath, the insured must be informed of his or her right to counsel and that the insured's answers may be used against him or her in future proceedings, either civil or criminal. After agreement is reached, loss payment must be made within 5 working days. The insurer may deny the insured's claim but may still honor the valid claim of a mortgagee or contract for deed vendor. The insurer promises to notify the mortgagee of changes to the policy resulting in a substantial reduction of coverage.
In event of loss caused by fire, the insurer will not provide coverage for the insured who either before or after the loss concealed or misrepresented any material fact or circumstance relating to the insurance. In event of loss caused by a peril other than fire, no insured will be covered if any insured concealed or misrepresented any material fact or circumstance relating to the insurance.
A valuation clause has been added as condition S. In the event of a total loss, the amount of coverage A is agreed to represent the value of the dwelling, and no deductible applies to the loss to that building.
Payment of prejudgment interest has been removed from section II liability coverages and moved into section II, additional coverages, as a part of claims expense. Damages include loss caused by an intoxicated person to whom an insured furnished or permitted the consumption of alcohol leading to the intoxication. This is in compliance with Minnesota Statutes 340A.90.
The exclusion for motor vehicle liability provides coverage only for a vehicle used to service an insured's residence and only while being operated on the residence premises.
The medical payments to others exclusion for those eligible to receive workers compensation benefits includes residence employees paid $1,000 or more in any three-month period during the current calendar year or during the preceding calendar year. The insured is required by law (Minn. Statute 176.181, Subd.2) to purchase a standard workers compensation policy.
The bankruptcy of an insured condition is amended to state that bankruptcy, insolvency or dissolution of an insured will not relieve the insurer of its duties.
A cancellation during the 60 day underwriting period requires a 20 day notice. A midterm cancellation may be for reasons 1 (20 days notice), 2, 6, and 26; a 30 day notice is required. Notice of nonrenewal requires a 60 day notice.
Minnesota adds the provision that the insurer has no right of subrogation against any insured or against anyone else that has a policy with the same company, covering the same loss, provided the loss was not intentionally caused by such insureds.
If farmers personal liability HO 24 73 10 00 is attached the insurer has the right to examine and audit the insured's records with regard to that coverage.
Mississippi
The special provisions endorsement HO 01 23 12 06 amends the suit against us condition. The insured has three years after the date of loss to file suit. The form changes the mortgage clause to require that a 30 day notice of cancellation be given to any mortgagee. If the declarations show a loss payee for certain listed personal property, the definition of “insured” is amended to include the loss payee with respect to that property. The loss payee will be notified of cancellation or nonrenewal; 10 days for nonpayment and 30 days in all other cases.
The 30 day notice of nonrenewal remains unchanged. During the 60 day underwriting period, a 30 day notice is required. Midterm cancellation reasons are 1 (10 days required), 2, or 4.
Missouri
Missouri special provisions endorsement HO 01 24 01 05 amends additional coverage for ordinance or law; pollutant losses are excluded even if the irritant or contaminant has a function with respect to the insured's property or business. This same wording precluding coverage is carried into the pollution exclusion (except for pollutants resulting from a coverage C named peril) and the section I ordinance or law exclusion.
The section I exclusion for intentional loss does not apply to an innocent insured victim of domestic violence, if the insured files a police report, and completes a sworn affidavit indicating the cause of loss and pledging to cooperate in any criminal prosecution of the person committing the act that caused the loss. Payment to an innocent coinsured may be limited to that insured's ownership interest. The rights of that insured to recover against the perpetrator are transferred to the insurer to the extent of the payment.
The appraisal condition allows an appraisal if either party disagrees on the amount of the loss or the actual cash value. Suit against the insurer may be brought within 10 years after the date of loss. Condition H. our option adds wording for loss by fire only. If the insured suffers a partial loss from fire, the insurer has the option of paying the actual cost of the damage or repairing the damage. The result must be that the damaged property “is returned to the same condition it was prior to the fire.”
Prejudgment interest is deleted from inclusion in section II damages, but is added as a claims expense in the additional coverages. Exclusions 9. and 10. are added to the section II exclusions. There is no coverage for negligent supervision or failure to supervise a person where an act results in communicable disease, sexual abuse, or controlled substance (exclusions 6., 7., and 8.) Exclusion 10. states that there is no coverage for bodily injury or property damage arising out of any written or oral statement made by an insured or others on his behalf which is material to any financial transaction.
During the 60 day underwriting period, notice of cancellation requires 30 days (except for nonpayment, which requires 10 days). Midterm cancellation reasons are 1 (10 days required), 2, and 4.
Montana
Montana 's special provisions endorsement HO 01 25 10 05 amends the loss payment condition, and adds two conditions to the section I conditions. The loss payment condition states that loss is payable within 30 days after the proof of loss is received. If the insurer requests additional information, payment or denial must be made within 60 days unless the insurer notifies the insured, or a claimant, or unless fraud is suspected and this is reported to the commissioner. The first additional condition applies to scheduled property. In event of total loss or total damage, the loss is computed on the stated valuation with no deductions or offsets except for the deductible, if any. This clause does not affect the insurer's right to repair or replace the property. The second condition applies to real property. In event of a total loss to covered property, the amount of insurance will be considered the amount of loss and the measure of damages.
During the underwriting period, notice of cancellation for any reason except nonpayment of premium (20 days required) requires a 45 day notice. After that, a midterm cancellation (45 day notice required) may be for reasons 1 (20 days), 2, 4, 18, 19, 20, or 23. Nonrenewal requires 45 days. Notification of nonrenewal to the insured's insurance producer via electronic transfer meets the requirements of a mailed or delivered copy.
Conditions H. and I are added to the sections I and II conditions. Condition H. states that the provisions of the policy conform to Montana statute, and that these provisions control over those of any other state in which the insured resides on or after the policy's effective date. All provisions are amended to conform to Montana statute. Condition I states that if the insurer proposes to renew at less favorable terms or with a higher rate then a notice with the new terms or rate must be sent at least 45 days prior to the expiration date of the policy.
Nebraska
Special provisions form HO 01 26 05 06 states that any provision using the term “actual cash value” has the following added: “In our determination of the actual cash value of Covered Property at the time of loss, an adjustment will be made for factors such as depreciation, deterioration and/or obsolescence.”
The special provisions endorsement amends the section I intentional loss exclusion. The exclusion does not apply to deny coverage to an innocent insured if the damage arises out of abuse of the innocent insured by another insured. This exception applies only to the peril of fire, and only to the extent of the innocent insured's legal interest in the property. “Abuse” means intentionally causing damage to property to intimidate or control the behavior of another, including a minor child. If the insurer pays an innocent coinsured, then the rights of the coinsured to recover are transferred to the insurer.
The appraisal condition requires that both insured and insurer agree in writing to the appraisal and to be bound by the results. The Nebraska form adds a valuation clause that spells out how the insurer will settle certain losses, in accordance with Nebraska 's valued policy law. In the event that the home is a total loss from fire, tornado, windstorm, lightning, or explosion, the policy limit is to be paid to the insured.
Nebraska adds an exclusion of liability coverage for an insured who inflicts, or directs another person to inflict, corporal punishment or sexual abuse. Sexual abuse includes physical or mental harassment or assault of a sexual nature.
The section I and II conditions are modified so that the policy is voided if the named insured or someone on the named insured's behalf made a material misrepresentation with intent to deceive, and the insurer relied on it to the insurer's injury. A breach of warranty or condition voids the policy if the breach exists at the time of a loss and contributes to the loss. Because of this, the concealment or fraud conditions in both sections I and II are deleted.
During the 60 day underwriting period, the insurer may cancel for any reason, giving 60 days notice, except for nonpayment of premium, which requires 10 days.
Midterm reasons for cancellation are 1 (10 days notice required), 2, 4, 9, 18, and 21. A 60 day notice is required. Notice of nonrenewal requires a 60 day notice. Both cancellation and nonrenewal notices require the reason for the action to be shown.
Nevada
Nevada form HO 01 27 05 02 adds a sublimit of liability of $10,000 for statutorily imposed vicarious parental liability not otherwise excluded. This sublimit is within the coverage E limit of liability. However, this amendment to the limit of liability does not apply to any loss covered under the home business endorsement HO 07 01 10 00, or with respect to damages arising out of fungi when endorsements HO 04 26, HO 04 27, or HO 04 28 limited coverage for fungi are attached.
The cancellation provisions are amended. After the 60 day underwriting period, midterm cancellation reasons are 1 (10 days notice required), 2, and 4; however, the substantial change in the risk must “warrant a substantial difference in the premium charged.” A 30 day notice is required.
New Hampshire
New Hampshire special provisions HO 01 28 05 08 declares that “you” and “your” refer to the named insured and spouse, or a party who has entered into a civil union with the named insured as recognized under New Hampshire law, if resident of the same household.
The $2,500 special limit for theft of silver is deleted.
An intentional loss will not be covered, unless the loss involves fire. In that case, an insured who did not commit or conspire to commit an act resulting in fire will be covered, but only to the extent of the insured's legal interest.
The endorsement adds a valuation clause as section I condition S: total destruction of an insured building by fire or lightning results in the insured amount being paid, provided there was no criminal fault. In the event of a partial loss, the insured will be entitled to actual loss sustained, but no more than the policy amount. Buildings insured under a blanket form are not subject to this valuation clause.
Section II liability coverage is amended. Prejudgment interest is removed as a part of the amount of damages payable, and added as an additional coverage under claims expense (5.). The section II exclusion (6.) of bodily injury to any insured is deleted, thus allowing coverage for intrafamily lawsuits. The deletion also deletes the exclusion of coverage for any claim brought against an insured to share in or repay damages with another person obligated to pay damages because of bodily injury to an insured.
The condition for concealment or fraud is deleted from sections I and II, and added into the conditions applying to both sections. It has been modified so that coverage for the insured is precluded, rather than for one or more insureds who intentionally conceal or misrepresent a material fact.
The underwriting period is 90 days. During that time, 10 days notice of cancellation is required. After that, 10 days notice is required for nonpayment of premium. Other midterm cancellation reasons are 2, 5, 6 (the acts must be “grossly negligent”), or 24. A 45 day notice is required. Notice of nonrenewal requires a 45 day notice.
The death condition is amended to provide coverage for the civil union partner.
Following a covered loss, any undisputed incidental costs incurred by the insured that are directly related to the loss are payable by the insurer within 15 days after receipt of proof of loss.
New Jersey
Special provisions form HO 01 29 08 07 declares that in the policy, “you” and “your” refer to the named insured, and spouse, or a party who has entered into a civil union with the named insured as recognized under New Jersey law, if resident of the same household.
The form modifies the section I exclusion for intentional loss: coverage is precluded for all insureds, but there is coverage for a coinsured who did not cooperate in or contribute to the creation of the loss provided the loss arose out of domestic violence. Payment for such loss is limited to the innocent insured's insurable interest.
The section I loss payment condition is amended; loss is payable within 10 working days after reaching agreement with the insured, there is entry of a final judgment, or there is a filing of an appraisal award.
The policy states that the insurer will pay up to its limit of liability for damages for which an insured is legally liable; prejudgment interest as a part of this is deleted. Prejudgment interest is added as a claims expense.
The exclusion for expected or intended injury is modified to state that it applies with respect to all insureds, regardless of the severability of insurance clause. The exclusion for bodily injury or property damage arising out of a controlled substance is modified, so that the insured who has no knowledge of the involvement with a controlled substance is covered. The maximum amount of coverage for damages because of vicarious liability is $10,000. Notice of cancellation or nonrenewal to the mortgagee requires 30 days. The New Jersey underwriting period is 60 days. During that time, if the insurer cancels for nonpayment of premium or for “the existence of a moral hazard” (as defined in the New Jersey code), a 10 day notice is required; all other reasons during the underwriting period require a 30 day notice. After the underwriting period, cancellation reasons are 1 (10 day notice required), 2, 3, 8 (including any federal or state law), 9, 16, 19, 20, and 21.
Additional reasons include: the existence of a moral hazard as defined by New Jersey code (10 days notice), lack of cooperation by the insured on loss control matters materially affecting the nature of the insured risk, material increase in exposure arising out of changes in statutory or case law subsequent to the issuance of the policy, any other reason in accordance with underwriting guidelines, agency termination, or any other reason in accordance with underwriting guidelines for cancellation. A 30 day notice is required.
Notice of nonrenewal requires a 30 day notice. Nonrenewal must be by certified mail, or first class mail if the insurer has obtained a date stamped proof of mailing showing the named insured and address. Any cancellation reason may also be used as a reason for nonrenewal. However, under New Jersey law, any reason cannot be “arbitrary, capricious, or unfairly discriminatory” or without prior notice. The insurer must maintain the underwriting reasons or guidelines used to cancel or nonrenew and must furnish them to the insured on request. This provision does not apply to a policy in force less than 60 days.
If the insurer pays an insured victim of domestic violence for a loss caused by domestic violence, the insured has a right to recover from the perpetrator.
The special provisions adds that the policy provides at least the equivalent, or greater coverage, that that mandated by New Jersey law. The death condition is amended to include a spouse or party who has entered into a civil union with the named insured as recognized by New Jersey law.
New Mexico
New Mexico form HO 01 30 08 01 modifies the intentional loss exclusion. If the named insured commits an act with the intent to cause a loss, the innocent insured victim of domestic abuse (as defined by New Mexico law) is protected if the damage is “proximately related to and in furtherance of domestic abuse.” In this case, the insurer is subrogated to the rights of the innocent coinsured to recover for any losses paid for property damage.
Loss settlement provisions are modified. Under forms HO 00 02, HO 00 03, and HO 00 05, losses to buildings under coverage B that are not used as residences are subject to the usual replacement or actual cash value (if the 80 percent insurance to value provision is not met) settlement. However, buildings insured under coverage A dwelling or coverage B other structures used as a residence are settled at not more than the limit of liability, the replacement cost of the damaged building, or the necessary amount actually spent. There is no reference to the 80 percent insurance to value provision.
If the cost to repair the damage is both more than 5 percent of the amount of insurance and more than $2,500, then no more than actual cash value is paid until the actual repair or replacement is complete. However, if the actual cash value is insufficient to begin repair, the necessary amount will be advanced by the insurer, provided the insured forwards evidence of an agreement with the party repairing or replacing the damage. The loss provisions governing loss under the HO 00 06 are similarly worded. If property is rebuilt at a new premises, replacement is limited to the cost that would have been incurred at the residence premises.
In event of a catastrophe declared by the superintendent of insurance and covered by the policy, a claim is payable within 90 days of the declaration of the catastrophe provided the insured reported the claim prior to the declaration of the catastrophe. If the claim is reported after the declaration, then the insurer has 90 days following the report of the loss. In both instances, the insurer may extend that time if fraud is suspected and further investigation is necessary.
New Mexico amends the cancellation provisions so that within the 60 day underwriting period any cancellation requires only a 10 day notice, provided that the cancellation itself falls within the 60 day period. A midterm cancellation for reasons 2 or 4 requires 30 days; a cancellation for nonpayment requires 10 days notice.
New York
New York special provisions form HO 01 31 10 02 increases the additional coverage for credit card loss to $1,000. The section I perils are amended. For forms HO 00 02, HO 00 04 and HO 00 08, there is no vandalism coverage if the dwelling has been vacant for more than 30 consecutive days before the loss. For form HO 00 06, there is no vandalism coverage if the building containing the unit has been vacant for more than 30 consecutive days before the loss. For form HO 00 02, the “accidental discharge” peril will not apply if the dwelling has been vacant for more than 30 consecutive days; similarly, for form HO 00 06 if the building has been vacant more than 30 consecutive days. In all the forms, where the ISO 2000 program broadened coverage for certain named perils to 60 days, New York has retained a 30 day limitation. All references to an exception for coverage for mold, fungus or wet rot that is covered if hidden and caused by covered accidental discharge or overflow have been removed in all forms. The definition of “pollutant” is taken out of the open perils coverage for pollution loss resulting from a coverage C named peril.
The section I exclusion of coverage for an intentional loss is modified to preclude coverage for “an 'insured' who commits or directs an act with the intent to cause a loss.”
The section I concealment or fraud condition is deleted; it is added in the conditions applicable to both section I property and section II liability. A condition is added that upon request the insurer will furnish the insured (or a representative) with a written estimate of damages to real property if the insurer has had one prepared.
Defense coverage of section II liability is amended to delete the statement that the insurer's duty to settle or defend ends when the amount paid for damages equals the limit of liability. The insurer must therefore continue to provide a defense after limits are tendered.
Exclusion E.1. is modified—coverage is excluded for bodily injury or property damage expected or intended by an “insured”; the exception for reasonable force to protect persons or property is deleted.
The section II liability conditions are amended. Notice of a claim may be given to the insurer by the insured, someone acting for the insured, or by any claimant. Notice may be given to the insurer or the insurer's agent so long as the agent is in the state of New York . Under coverage F medical payments, an injured person may give notice to the insurer or to the insurer's agent; again, the agent must be in New York .
The section I and II concealment or fraud condition precludes coverage for the insured who has intentionally concealed or misrepresented any material fact, or engaged in fraud relating to the insurance.
A 15 day notice is required for cancellation because of nonpayment of premium. There is a 60 day underwriting period. During that time, cancellation may be for any reason; a 30 day notice is required. A midterm cancellation (30 days notice required) may be for reasons 1 (15 day notice required), 2, 5, 6, 18, or 24. A 30 day notice is required. In New York , if the insurer has the right to cancel, the insurer may elect instead to amend the limits of liability or reduce coverage not otherwise required by law. Notice of this action requires 20 days. The insurer may cancel, giving a 20 day notice, if the insured property is subject to the Anti-Arson Application in accordance with New York Insurance Department Regulation 96, and the insured fails to return the completed, signed and affirmed application.
A nonrenewal notice or notice of amendment of policy limits or coverage must be in accordance with the laws of the state of New York , and requires a 45 day notice.
Finally, if the farmers personal liability endorsement HO 24 73 is attached, the exclusion for liability arising out of business pursuits is amended as above. The exclusion for pollution is modified to cover pollution that is “sudden and accidental.”
North Carolina
The North Carolina form HO 32 32 03 08 is promulgated by the North Carolina Rate Bureau, and includes ISO material.
The definition for “business” is amended to state that “business” includes any full or part-time activity of any kind engaged in for economic gain, including the use of any part of any premises for such purposes. A definition of “fungi” is added; it means “any type or form of fungus, including mold or mildew or any mycotoxins, spores, scents or byproducts produced or released by fungi.” (This does not include, under section II, any fungi that are intended for consumption, such as mushrooms.)
Two of the special limits of liability are modified. Theft of firearms and related equipment is limited to 10 percent of coverage C or a maximum of $10,000. Theft of silver-, gold-, or pewterware is limited to 25 percent of the coverage C limit or $10,000. Under property not covered, the word solely is removed from c.(2)(a) so that the insurer will cover motor vehicles used to service an insured's residence.
The additional coverage for debris removal is amended; the insurer will pay no more than $500 for debris removal of a fallen tree that damages a covered structure or blocks a drive or ramp for the handicapped. In form HO 00 06, debris removal for fallen trees applies only to trees the insured solely owns, or a neighbor's trees, that damage a covered structure. In form HO 00 08, the additional coverage for debris removal applies to the insured's trees felled by windstorm (no coverage for trees felled by the weight of ice, snow, or sleet).
The additional coverage for landlord's furnishings is amended: under accidental discharge, paragraph 2.(d) which eliminates coverage for mold, fungus, or wet rot unless hidden is replaced to exclude coverage if damage is caused by constant or repeated seepage or leakage over weeks, months, or years. However, an additional coverage of up to $5,000 for loss to property covered under coverages A, B, or C caused by “fungi” as defined that results from an insured peril is included.
For forms HO 00 03 and HO 00 05, an exclusion for “constant or repeated discharge, seepage or leakage” which applies to both dwelling and contents is added. The section I exclusion of intentional loss has been reworded to eliminate coverage only for the insured who committed or conspired to commit an act with the intent to cause a loss. An exclusion for fungi, wet or dry rot, or bacteria is added except with regard to the coverage provided under the additional coverages.
The duties after loss condition has been amended. If a state of disaster is declared within the state, and the covered property is within the designated area, then the 60 day period for returning a proof of loss does not commence until the expiration of the proclamation, including all renewals of that proclamation, or 45 days, whichever is later.
Loss settlement provision C.2.a. of the HO 00 02, HO 00 03, and HO 00 05 is modified, so that the insured can be reimbursed the amount actually spent to repair or replace the damaged building on the residence premises or some other premises within the state of North Carolina. Losses are payable within 60 days after the amount of the loss is finally determined.
The appraisal provision is modified to state that an appraisal is not to be used to interpret any policy provision or determine coverage. Suit can be brought against the insurer within three years after the date of loss.
The section II exclusion for coverage for a motor vehicle unless used solely to service an insured's residence is changed to “used to service an 'insured's' residence. The section II exclusion of liability for bodily injury or property damage expected by one or more insureds is modified. Excluded is injury or property damage intended by or “which may reasonably be expected to result from the intentional acts or omissions or criminal acts or omissions of one or more 'insured' persons.” The exclusion applies: (1) whether or not the perpetrator lacks the mental capacity to govern their own conduct; (2) whether or not the results are different from what was intended; or (3) whether or not the injury or damage is sustained to a different person or entity than intended. The exclusion applies regardless of whether or not one or more insured persons was actually charged with or convicted of a crime.
The section II exclusion for bodily injury or property damage arising out of or in connection with a business does not apply to an insured minor (as defined) engaged in a part-time, self-employed business. There is no coverage for any bodily injury or property damage arising out of any exposure to fungi, wet or dry rot, or bacteria.
The cancellation and nonrenewal provisions are those of the homeowners forms; they are not amended.
The final amended condition declares that the policy is issued in accordance with the laws of North Carolina, and covers property principally located in North Carolina .
North Dakota
Form HO 01 33 08 03 modifies the section I exclusion for intentional loss. An innocent coinsured will be given coverage if a loss arises out of domestic violence and the perpetrator is criminally prosecuted for the act causing the loss. The insurer has the right to subrogate against the perpetrator.
In North Dakota , suit against the insurer may be brought within three years of a loss. A valuation clause is added to the section I conditions. In the event of a covered total loss to real property, the amount of insurance on the property is taken to be both the value of the property and amount of the loss, except in two circumstances. The first of these is loss to a covered other structure, which is settled on a replacement cost or actual cash value basis, depending on the policy. The second is if the loss occurs within 90 days after: (1) the policy's issuance; or (2) the limit of liability applying to the real property is increased by more than 25 percent at the insured's request. In that event, the insurer will pay no more than the least of the cost to repair or replace, the actual cash value, or the limit of liability.
In section II liability, prejudgment interest is deleted as a part of damages payable, and added to the additional coverages as a claims expense.
The underwriting period is 60 days. During that time, the insurer may cancel for any reason, giving 10 days notice. A midterm cancellation may be for reasons 1 (10 days notice), 2, 4, 5, 8, or 18. Except as noted, 30 days notice must be given. North Dakota adds additional reasons for cancellation that require only a 5 day notice. These are: at least 65 percent of rental units in a building are unoccupied; the insured or the passage of time has indicated that repairs will not be made following a loss; permanent repairs have not begun within 60 days following a fire loss; the building is in danger of collapse; 13; reasonable knowledge the property is endangered and unprotected from possible arson with intent to defraud the insurer; characteristics of ownership, occupancy, or maintenance that violate law or public policy; or failure to correct dangerous conditions or maintain the building in accordance with applicable law, or failure to furnish heat, water, sewer service or public lighting for 30 consecutive days or more.
Nonrenewal requires a 45 day notice.
Ohio
Ohio 's special provisions HO 01 34 03 01 adds exclusion 9. to the section II liability exclusions. There is no coverage for bodily injury or property damage arising out of the actions of a vicious or dangerous dog, as defined by Ohio Code, and the failure of the insured to keep the dog restrained.
The underwriting period is 60 days. During that time, cancellation may be for any reason; 30 days notice is required (10 days for nonpayment of premium). After the underwriting period, the policy may be cancelled by giving 10 days notice for reasons 1, 2, or 22, and by giving 30 days notice for reason 4.
Oklahoma
The special provisions endorsement HO 01 35 03 01 amends the loss settlement provisions. In all forms except the HO 00 04 and HO 00 06, roof surfacing is added as an item covered at actual cash value.
The appraisal provision is modified—only the party demanding the appraisal is bound by the results. Covered losses are payable with 60 days after agreement is reached, or within 30 days if there is an entry of final judgment.
Following receipt of proof of loss, the insurer must submit a written rejection or offer of settlement within 45 days.
The cancellation provisions are not modified.
Oklahoma Notice HO 03 45 states that any person who knowingly and with intent to injure or defraud an insurer is guilty of a felony.
Oregon
Oregon special provisions form HO 01 36 01 08 changes the definition of “you” and “your” to include the spouse, or a party who has entered into a domestic partnership, as recognized by Oregon law, with the named insured, if resident of the same household. This party is also recognized in condition G. death. The form amends the special limits of liability for personal property. The $2,500 for property on the residence premises for property primarily used in business does not apply to property used in a home day care business. The limit of $500 for property primarily used in a business and away from the premises does not apply to property used in a home day care business or to electronic apparatus as described. In fact, loss to all property primarily used with a home day care business is excluded, except when Oregon Home Day Care Coverage Endorsement HO 05 97 is attached.
The loss settlement provisions are modified. The insured has 90 days following the insurer's request to furnish a proof of loss. If the insured does not do so, the mortgagee may furnish this. The appraisal provision is modified to state that both parties must agree to the process, and must agree to be bound by the results. The mortgage clause is amended to comply with Oregon law. The concealment or fraud clause is deleted from the section I (and section II) conditions, and is added to the conditions applying to both sections I and II (discussed later).
Prejudgment interest is deleted from damages payable in the section II liability coverage. But, unlike other state provisions where this coverage is added as an additional coverage under claims expense, there is no further mention in the Oregon endorsement. Presumably, therefore, the amount is not payable.
Oregon retains the section I and II conditions clause that voids the entire policy if before or after a loss the insured has willfully concealed or misrepresented a material fact or circumstance regarding the insurance. However, any statements arising from an error in the application cannot be used to defend denial of a claim unless the statements are in a written application attached to the policy when issued. Further, the insurer must demonstrate the representations are material and that the insurer relied on them.
There is a 60 day underwriting period. During that time, the insurer may cancel for any reason except for the sole reason that a home day care business is operated on the premises. Thirty days notice is required. A midterm cancellation may be for reasons 1 (10 days notice), 2, or 4; a 30 day notice is required. Again, however, cancellation cannot be solely for the reason a home day care business is being operated on the premises. Nonrenewal notice must be sent 30 days prior to the renewal date; operation of a home day care business cannot be the sole reason for the nonrenewal.
Pennsylvania
Pennsylvania previously contained any amended provisions or conditions in the policy forms themselves. Now, there is state special provisions endorsement HO 01 37 06 07. This form adds a definition of actual cash value: “Actual cash value is calculated as the amount it would cost to repair or replace covered property, at the time of loss or damage, with material of like kind and quality, subject to a deduction for deterioration, depreciation and obsolescence. Actual cash value applies to valuation of covered property regardless of whether that property has sustained partial or total loss or damage. The actual cash value of the los or damaged property may be significantly less than its replacement cost.”
The intentional loss exclusion is modified so that there is coverage for an innocent insured, if the loss arises out of abuse to that insured by another insured.
The homeowners forms contain the following changes. The additional coverage for debris removal includes coverage for removal of felled trees, provided the trees are felled by a covered peril and damage a covered structure or windstorm, hail, or weight of ice, snow or sleet damages a covered structure and the Pennsylvania governor declares the area in which the residence premises is located a disaster area because of the weather conditions.
The loss settlement provisions are modified. The insurer has the option of repairing or replacing the damaged property with like property provided the insured receives written notice within 15 working days.
Prejudgment interest is deleted as a part of damages payable in section II liability, and added as an additional coverage for claims expense. Funeral expenses are not included as a part of medical payments to others.
The underwriting period is 60 days. Cancellation during that time, which may be for any reason, requires a 30 day notice. A midterm cancellation reason may: 1, 2, 3, 4, 6, or 23. A 30 day notice is required. A nonrenewal may only be for one of the mid-term cancellation reasons.
Puerto Rico
Form HO 01 58 05 02 deletes the additional coverage for fire department service charge. The appraisal condition is deleted.
Section II liability coverage adds that a sublimit of $10,000 applies to any statutorily imposed vicarious liability.
Any valid reason may be used to cancel a policy during the 60 day underwriting period. Ten days notice must be given. A midterm cancellation may be for reasons 1 (10 days notice), 2, 4, 6 (but the acts must be willful and negligent), and 20. A 30 day notice is required. A 30 day notice is also required for nonrenewal.
Puerto Rico also requires endorsement HO 03 44 05 04, mandatory premium and coverage conditions endorsement. The endorsement describes different premium payment arrangements and their possible effects on cancellation.
Rhode Island
Rhode Island special provisions form HO 01 38 02 05 changes the section I conditions mortgagee clause to state that any claim payable under coverages A or B equal to or in excess of $3,500 will be paid to insured and mortgagee as interests appear. If the claim equals less than $3,500, the claim will be paid to the insured unless no liability exists as to the mortgagor.
No suit can be brought for recovery of any claim for direct loss or damage by fire or lightning unless the provisions have been complied with, and the action is begun within two years after the date of loss. Presumably, therefore, a suit for any other loss can be brought at any time. Losses are payable within 30 days after the insurer reaches agreement with the insured. Condition S. is added—there is no coverage for loss caused by fire or lightning while an insured building is vacant beyond a period of 30 consecutive days, whether or not the building is intended for occupancy. However, the 30 days must be subsequent to the issuance of an order by the local building inspector in accordance with Rhode Island law.
In the section II liability coverages, prejudgment interest is removed from the damages for which the insured is legally liable. Prejudgment interest is additional coverage A.5.a. and A.5.b. The insurer is liable for prejudgment interest on: (1) the entire judgment if the insurer rejects a written settlement offer by the plaintiff that is equal to or less than the applicable limit of liability; or (2) that part of the judgment the insurer pays.
There is an additional section II condition. The insurer is directly liable for the damages to the injured party to which the insurance applies. In event of that party's death, the insurer is obligated to the party entitled to sue as a result of the injured party's death.
During the 60 day underwriting period, cancellation may take place for any reason, provided 30 days notice is given. Nonpayment of premium requires 10 days notice. A midterm cancellation requiring 30 days notice may be for reasons 2, 4, 10, 11 (except that the insured has 60 days to begin repairs following payment), 12, 13, or 14. Nonrenewal requires 30 days notice. The subrogation clause is modified. If a loss is successfully subrogated, the insurer must first reimburse the insured the deductible portion less the prorated share of any subrogation expenses, and then may retain the recovered amount.
South Carolina
Two of the section I conditions are modified by special provisions form HO 01 39 07 05. A suit against the insurer may be brought within three years after the date of loss. A valuation clause is added to the section I conditions: the limit of liability as stated in coverage A (except for forms HO 00 04 and HO 00 06) is considered to be the value of the dwelling with regard to the perils of fire and lightning.
Except for nonpayment of premium, which requires a 10 day notice, any cancellation is subject to a 30 day notice. Reasons are 1, 2, 4, 19, and 21. The underwriting period is 90 days. Notice of nonrenewal requires a 30 day notice. Both cancellation and nonrenewal notices must contain the precise reason for the cancellation or nonrenewal.
South Dakota
South Dakota form HO 01 40 05 01 amends the section I conditions. The appraisal provision provides that both parties must agree to the appraisal procedure, although the outcome is not binding on either party. A suit against the insurer may be brought within six years after the loss.
South Dakota adds a valuation clause. The amount of insurance on the insured real property is considered to be the true value of the property if the property is wholly destroyed by fire, tornado, or lightning. This provision does not apply to a fire loss: (1) which occurs less than 90 days after the policy was initially issued; or (2) the limit of liability was increased at the insured's request by 25 percent or more. However, if the increase was in accordance with an inflation adjustment the provision will apply. The provision will apply as well if the insured is upgrading coverage to replacement cost basis, provided that the insurer agrees in writing that the policy will be written on a valued basis. The valued basis does not apply to covered other structures unless a value is specifically stated in the declarations, or in various endorsements insuring other structures. (See the special provisions endorsement for a comprehensive list.) If there is other insurance on the property, then the insurer pays on a pro rata basis.
The cancellation provisions allow 20 days for notice if the premium is not paid. A 20 day notice is also required during the 60 day underwriting period. A midterm cancellation may be for reasons 1 (20 days notice), 2, 3, 4, 6, 8, or 9; a 30 day notice is required. Written notice of nonrenewal must go to the agent as well as the insured.
Tennessee
Tennessee's special provisions endorsement HO 01 41 12 01 contains only one added condition, and that is that the rights and obligations as outlined in the mortgage clause apply to any party who is not an insured but who has an insurable interest in the residence premises.
Texas
There are two added definitions in form HO 01 42 06 04. First, a definition of “fungi”—”any type or form of fungus, including mold or mildew, and any mycotoxins, spores, scents or by-products produced or released by fungi.” Second, there is a definition of “business day”—”a day other than a Saturday, Sunday or holiday recognized by the state of Texas .”
Throughout the property coverages at any time the exclusion for hidden mold, fungus, or wet rot (see, for example, A.2.c.(5) in the 2000 edition HO 00 03) appears, it is replaced with an exclusion for constant or repeated seepage or leakage of water, including condensation, humidity, moisture, or vapor. In all forms except the HO 00 08, ordinance or law coverage applies to repair, replacement or demolition to property located in an areas eligible for coverage and as required by the Texas Windstorm Insurance Association following a windstorm disaster.
The section I exclusion for intentional loss is modified to provide coverage for an innocent coinsured provided the coinsured has filed a police report and cooperated with law enforcement investigation and prosecution relating to any other insured causing the loss. An exclusion for “fungi” is added; an exception provides coverage if it results from accidental discharge covered by the policy. A hidden loss of this type must be reported within 30 days of its being detected.
The property conditions are modified substantially. First, in event of a total loss by fire, the insurance policy is held to be a liquidated demand for the full amount of the policy, except for personal property. Following a loss, the insured has 91 days after the insurer's request to send the proof of loss. If replacement cost coverage is being claimed, the proof must include the replacement cost of the dwelling. A set of duties for the insurer following a loss is listed. The insurer has 15 days to acknowledge receipt of the claim, begin any investigation, or request any additional information. Then the insurer has 15 “business days” to notify the insured whether the claim will be paid, denied, or still more information is needed. If the insurer suspects arson, there is an additional 15 days. The claim must either be approved or denied within 45 days after requesting more time.
The loss settlement provisions are modified. A loss to jewelry is settled at replacement cost at the time of loss. Loss to a jewelry pair or set is settled at replacement cost at the time of loss.
The insured has two years and one day after a cause of action accrues to bring suit. The insurer has 5 “business days” to pay an agreed-upon claim. But if a declared catastrophe or major natural disaster occurs, claim handling deadlines are extended an additional 15 days.
The mortgagee clause is revised. If the mortgagee cancels the policy because of a foreclosure, the mortgagee must credit any unearned premium against any deficiency owed by the borrower; any return premium not so credited must be returned to the borrower.
Because of Texas ' residential community property law, the policy continues to protect the interest of each spouse, unless excluded by endorsement, until the policy expires or is cancelled.
Section II exclusions 1., 6., and 7. are modified. In 1., the language precluding coverage even if the bodily injury or property damage is of a different kind or sustained by another person (paragraphs 1.a. and b.) are removed. The exclusion for communicable disease applies only to transmission by sexual contact. In exclusion 7., “abuse” is defined as “an act which is committed with the intent to cause harm.”
The underwriting period is 60 days, and cancellation may be for reasons 1 (10 days), 2 (30 days; 10 days for claim fraud), 3 (10 days), 18 (10 days), for an unacceptable required inspection report completed by an authorized inspection and within the allotted time frame (30 days). Following 60 days, the policy may be cancelled for reasons 1, 2, 6, or 18; 10 days notice is required.
Nonrenewal cannot be based on claims resulting from natural causes, or because the insured is an elected official. If the insured has filed three or more claims in any three year period that do not result from natural causes, the insurer can nonrenew the policy. However, following a second claim in a period of less than three years, the insurer must notify the insured that the policy might not be renewed if a third claim is filed; if the insurer fails to do this, then the insurer must renew the policy. Thirty days notice is required.
Utah
The form (HO 01 43 02 09) amends the section I conditions, duties after loss. The insured may give prompt notice to the insurer or to his or her agent; one way of doing this is by mailing the notice through prepaid first class mail. The proof of loss may also be mailed (prepaid) via first class United States mail. Failure to submit proof of loss within 60 days following the loss will not invalidate the claim, if the insured demonstrates it was not reasonably possible to do so, and that the proof was submitted as soon as reasonably possible. Similar wording appears in the section II conditions—duties after loss.
The insured has up to three years following the date of loss to bring suit. A loss is payable within 30 days after agreement is reached.
The concealment or fraud condition is amended: the provision eliminates coverage if an insured has concealed or misrepresented any fact upon which the insurer has relied, or concealed or misrepresented any fact and that fact contributes to a loss.
Section II watercraft liability is not covered if arising out of any watercraft owned by an insured for which security is required under the Utah Financial Responsibility Motorboat Owners and Operators Act.
The section II exclusion for bodily injury or property damage arising out of a controlled substance is amended to delete the reference to the Federal Food and Drug Law at 21 U.S.C.A. Sections 811 and 812.
The condition “duties after occurrence” is amended similarly to the duties after loss in the property conditions.
Cancellation for any reason during the 60 day underwriting period requires a 10 day notice. A midterm cancellation, with a 30 day notice required, may be for reasons 1 (10 days required), 2, 4, or 19. A nonrenewal requires a 30 day notice.
Vermont
Vermont special provisions form HO 01 44 03 06 amends the lead-in to the definitions. “You” and “your” now refer to the named insured, spouse, or a party who has entered into a civil union under Vermont law with the named insured, if a resident of the same household. The definitions of aircraft liability, hovercraft liability, motor vehicle liability, and watercraft liability are amended. “Failure to supervise” is an excluded cause of loss only with respect to motor vehicle liability. The definition of “occurrence” is deleted entirely, so the definition in a common desktop dictionary would apply.
The exclusion for loss caused by freezing (peril 14. in form HO 00 02; exclusion A.2.c.(1) in form HO 00 03; A.2.a in the HO 00 05) is modified to apply “only while the dwelling is vacant, unoccupied or being constructed” unless reasonable care has been used to maintain heat or shut off the water, providing there is no automatic fire protective device. The named peril of freezing in forms HO 00 04 and HO 00 06 (and coverage C in form HO 00 03) is also modified to provide coverage only if the insured has used reasonable care to maintain heat or shut off water (unless there is a sprinkler system) while the dwelling is unoccupied.
The section I exclusion of coverage for intentional loss is modified to exclude coverage only for an insured who commits or directs an act with the intent to cause a loss. Other insureds not committing or intending to commit a loss are covered.
Four section I conditions are modified. First, the suit against us provision notes that the insured's right to bring suit is not conditioned upon compliance with the appraisal provisions. Second, losses are payable within 10 working days after agreement is reached. Third, in event of cancellation the insurer must notify the mortgagee: 15 days for nonpayment of premium or substantial increase in hazard (except after 60 days approval from the insurance commissioner must be obtained for the substantial increase in hazard); or 45 days for fraud or material misrepresentation regarding presentation of a claim. A nonrenewal requires 45 days notice to the mortgagee. Fourth, the concealment or fraud clause is deleted from section I.
The section II exclusion for bodily injury or property damage which is expected or intended is amended to exclude coverage even if the resulting bodily injury or property damage “is of a different kind, quality or degree than a reasonable person would have expected or intended.” The exclusion for sexual molestation, physical or mental abuse is amended. The exclusion applies to sexual molestation of any person, or to corporal punishment or physical or mental abuse inflicted upon an insured by an insured.
The section II conditions are modified. The concealment or fraud clause is deleted. If a suit against the insured is continued by the insurer after a judgment is rendered against the insured, no limitation of liability is valid unless the insured agrees to the continuation. The insured's payment of any judgment for any of the insurer's liability does not bar the insured from suit against the insurer.
The section I and II concealment or fraud condition is amended so that there is no coverage for the insured who has intentionally concealed or misrepresented any material facts or circumstances relating to the insurance. The death condition is modified to include a party, if resident of the named insured's household, who has entered into a civil union under Vermont law with the person named in the declarations.
During the 60 day underwriting period, the insurer may cancel for any reason, giving a 45 day notice. However, nonpayment or a substantial increase in hazard requires only a 15 day notice. After 60 days, the policy may be cancelled at any time for nonpayment of premium or substantial increase in hazard, provided that, in the case of the increase in hazard, the insurer has secured approval from the commissioner of insurance. A 15 day notice is required. For reason 2, a 45 day notice is required. A notice of nonrenewal requires a 45 day notice.
If the insurer elects to renew the policy, 45 days prior to renewal the intent to renew with the renewal premium must be sent to the insured. If this condition is not met, the insured is granted renewal coverage at the premium in effect on the expiration date. This continues for 45 days after the insurer confirms renewal coverage and premium, unless the insured accepts the renewal policy, in which case this provision does not apply.
Virginia
The special provisions endorsement HO 01 45 04 99 modifies the 1991 edition of the homeowners forms. Coverage C personal property is amended. The personal property coverage for a residence employee has been expanded to include while the property is in any residence occupied by an insured, or is in the control of the employee and he or she is “engaged in the service of an insured.”
The special limits of liability of coverage C have been changed as follows: in item 1. medals are deleted; in item 2. personal records are deleted; in item 5. the limit for loss by theft of jewelry is increased to $1,500; in items 7., 8., 9., and 11. the sublimits for theft of silverware, on business property (both on and off-premises), and on electronic apparatus not in a motor vehicle are deleted. The property not covered section in the Virginia form amends the sections on motor vehicles, aircraft, property of roomers, and business property. The Virginia form does not exclude devices for the transmitting, etc. of pictures (only sound). The only exception to aircraft is model (rather than model or hobby) aircraft. Property of roomers is expanded to include as not covered the property of residence employees (this property is covered under coverage C). The form excludes the following classes of business property: in storage or held as a sample or for delivery; pertaining to a business that is conducted on the residence premises; and all such property away from the residence premises.
Coverage D, loss of use, is amended to show that no deductible applies.
Debris removal is modified. There is no mention of volcanic ash. Debris removal of fallen trees that damage covered property is included in the limit applying to the covered property, with an additional 5 percent available. The additional coverage of collapse is deleted entirely; however, the peril of collapse is added as a covered cause of loss for personal property in forms HO 00 03, HO 00 04, and HO 00 06. The exclusion of collapse as a peril does not apply to coverages A and B on the HO 00 03.
In forms HO 00 02, HO 00 03, HO 00 04, and HO 00 06 the exclusion of theft from that part of the residence premises the insured rents to others is replaced with a lengthier limitation. Where the ISO policy excludes theft from “that part of a residence premises rented by an insured to other than an 'insured',” the Virginia form is much more specific. The limitation applies while “the portion of the residence premises customarily occupied exclusively by an 'insured' is rented to others.”
Theft caused by a “tenant, members of the tenant's household, or the tenant's employees” is not covered. Theft of any of the following items is not covered: money, bank notes, bullion, gold, goldware, gold-plated ware, silver, silverware, silver-plated ware, pewterware, platinum, and coins; securities, accounts, deeds, evidences of debt, letters of credit, notes other than bank notes, manuscripts, passports, tickets, and stamps; and jewelry, watches, furs, precious and semi-precious stones.
In forms HO 00 02, HO 00 03, and HO 00 04 the limitation of coverage for the peril of windstorm and hail to watercraft, etc. does not apply to rowboats and canoes that are on the residence premises. Form HO 00 06 deletes the exclusion for vandalism coverage if the unit has been vacant.
The exclusion of coverage for an intentionally caused loss is modified to exclude coverage for the particular insured who commits or directs the act. The exclusions for weather conditions, acts or decisions, or faulty or inadequate construction or maintenance are added to the HO 00 02, HO 00 04, and HO 00 06.
The section I condition that requires an insured to submit to an examination under oath while not in the presence of another insured is not in the Virginia form. A modification of the loss settlement provisions allows the insured to make an initial claim for an actual cash value settlement, and within six months of the later of the last date the insured received an ACV payment, or the date of entry of a court order declaring the insured's right to replacement cost, make a claim for replacement cost. The appraisal condition stipulates that if the demand for an appraisal is made by the insurer, then the insurer must bear the cost of the insured's appraiser as well as that of the insurer. The insurer retains the right to deny the claim. An insured may bring suit against an insurer within two years after a loss. Losses must be settled within 30 days of reaching an agreement. A mortgagee must receive a 30 day notice of nonrenewal. Payment of a loss does not reduce the amount of insurance.
In section II liability, prejudgment interest is deleted as a part of the damages for which an insured may be legally liable. It is not added as a claims expense. The section II exception to the exclusion of motor vehicles (f.(2) and (4)c.) is changed so that it applies to nonowned golf carts or snowmobiles or to any such vehicles that the insured owns, if they are on an insured location. Liability arising out of a motor vehicle in dead storage is covered; the wording “not subject to motor vehicle registration” is removed.
The exception to the watercraft exclusion of nonowned watercraft powered by inboard or inboard-outdrive motors of 50 horsepower or less is changed so that both owned and nonowned watercraft meeting the motor specification are covered.
Added as covered section II claim expenses are premiums on bonds to release attachments and the cost of bail bonds an insured incurs because of an automobile accident. The $50 per day loss of earnings includes loss of “vacation time or other benefit loss.”
The additional coverage of damage to property of others is amended to specifically remove snowmobiles, golf carts, and other motorized land conveyances not subject to motor vehicle registration and designed for off-road use from the motor vehicle exclusion.
The Virginia form changes two section II conditions. The suit against us provision states that if a plaintiff has secured a judgment against the insured, that plaintiff is entitled to recovery under the policy. The other insurance provision calls for the policy to contribute on a pro-rata basis with other valid and collectible insurance. However, the policy is still excess over other policies covering motor vehicles and watercraft.
Virginia also changes some of the conditions that apply to sections I and II. The liberalization clause calls for any broadened coverage to apply immediately, regardless of when that change takes place during the policy period.
During the 90 day underwriting period, the policy may be cancelled for any reason. A midterm cancellation is allowed only for the following reasons: 1 (10 day notice), 2, 5, 6, and 24. A 30 day notice is required. If the policy is endorsed with any of the following, the notice must be 15 days for nonpayment and 45 days for other reasons: HO 23 42, HO 24 43, HO 24 71, and HO 23 39. Likewise, nonrenewal requires a 45 day notice if one of those forms applies. The insurer is required to send notice of cancellation or nonrenewal by registered or certified mail, and obtain a written receipt from the U. S. Postal Service.
Virgin Islands
The special provisions form for the Virgin Islands is HO 01 50 03 08. The form amends the appraisal provision. Both parties must agree to the appraisal process. Loss is payable 30 days after receipt of the proof of loss and the insurer reaches an agreement with the insured, there is an entry of a final judgment, or there is a filing of an appraisal award.
The concealment or fraud condition in both sections I and II allows the insurer to void the policy if, whether before or after a loss, an insured has intentionally concealed or misrepresented any material fact or circumstance; engaged in fraudulent conduct; or made false statements regarding the insurance. The provision does not apply to any misrepresentation or warranty in negotiation of the policy unless made with intent to deceive.
The underwriting period is 60 days. Cancellation reasons are 1, 2, (15 days notice) or 4 (30 days notice). Cancellation at anniversary can be for any reason. Nonrenewal requires 30 days notice. Cancellation or nonrenewal notices will also be sent to any mortgagee or other person shown on the policy to have an interest. If the insurer cancels, a refund will be made on a pro rata basis. If the first named insured cancels, a refund may be less than pro rata (sometimes referred to as a short rate cancellation).
Washington
The State of Washington , through the Washington Surveying and Rating Bureau, promulgates its own forms. The current homeowners edition date is May, 2008. The forms incorporate ISO 2000 homeowners material, but are modified. There is no special provisions form; all modifications are contained within the homeowners forms themselves.
West Virginia
West Virginia special provisions HO 01 47 04 06 modifies the loss settlement condition to reflect the West Virginia valued policy law, in that a total loss to real property situated in West Virginia is settled at policy limits. In event of a partial loss to real property, payment will be the total amount of the partial loss, but not to exceed the limit of liability applying to the real property. The loss payment condition is amended by removing all reference to a time limit for settlement. However, condition H. is added to the sections I and II conditions calling for payment by the insurer within 15 working days of reaching an agreement. All losses are adjusted with the named insured, unless some other person is named in the policy or is legally entitled to receive payment. The appraisal condition calls for a written demand of either party for an appraisal.
During the 60 day underwriting period, the insurer may cancel for any reason; a 10 day notice is required. Ten days notice is required for nonpayment of premium. The following is added to the cancellation conditions: the insurer may cancel with a 30 day notice for the following reasons: 2, 4, 5, 6, 8, 18, 19, 29, and 30. A nonrenewal notice must contain the reason for nonrenewal. After the policy has been in force for four years, the insurer may nonrenew only for these reasons which would also allow cancellation: 2, 3, 4, 5, 6, 8, 18, 19, 29, and 30. The other permissible reasons for nonrenewal are any other “valid underwriting reasons which involve a substantial increase in the risk,” or payment of two or more claims within a period of 36 months, one of which occurred after July 1, 2005.
West Virginia has an alternative nonrenewal provision HO 02 24 02 06 that can be used if the insurer is nonrenewing its book of business in the state. Nonrenewals are not to exceed one percent per year of the number of policies in force in a given county at the end of the previous calendar year. Thirty days notice is required.
Wisconsin
Wisconsin form HO 01 48 04 01 amends the definition of a motor vehicle. A motor vehicle means “a self-propelled land or amphibious vehicle, whether or not it is operated on rails, skis, sleds, tracks, or treads; or any trailer or semitrailer which is being carried on towed by or hitched for towing by [such a vehicle].”
The exclusion of intentional loss is slightly reworded to preclude coverage for an insured who commits or directs the act causing the loss. The ordinance or law exclusion does not apply to a total and constructive loss.
Three of the section I conditions are changed. First, the insured is required to give notice of loss as soon as reasonably possible to the insurer or to the agent. Losses are payable within 30 days of reaching agreement. The concealment or fraud condition states that the insurer must rely on the misrepresented fact and such misrepresentation must be either “material or made with intent to deceive,” or the misrepresentation must contribute to the loss.
The section II concealment or fraud condition is amended similarly to the section I condition. The suit against us condition does not apply in Wisconsin .
During the 60 day underwriting period the insurer may cancel for any reason upon giving a 10 day notice. The midterm cancellation condition is amended by limiting cancellation to the following: 1 (10 days required), 2, 4, and 19. Thirty days notice is required. Nonrenewal requires a 60 day notice.
Subrogation allows the insurer to collect from the negligent party only after the insured is fully compensated.
Three conditions are added. The first states that knowledge by an agent of any act that “breaches a condition of this policy” will be considered as knowledge to the insurer if the action is known by the agent at the time of application or issuance, or becomes known thereafter. However, such knowledge will not “defeat a recovery.” The second added condition makes it clear that any provision of the policy in conflict with Wisconsin law is changed to conform with that law. The third condition states that failure to comply with a policy condition before a loss and “no breach of a promissory warranty” affects the insurer's obligations, unless that failure or breach increases the risk at the time of the loss or contributes to the loss.
Wyoming
Wyoming form HO 01 49 01 06 changes additional coverage 6., credit cards. In Wyoming the insurer's duty to defend does not end with the tender of policy limits prior to judgment or settlement.
The suit against us provision is modified; action must be brought within four years after discovery of the loss. Claims must either be paid or rejected within 45 days of “receipt of the claim and supporting bills.”
The cancellation and nonrenewal provisions are amended. The insurer can cancel for any reason during the 60 day underwriting period, giving 10 days notice. After the 60 day underwriting period, cancellation reasons are: 1 (10 days notice), 2, and 19 (45 days notice). Nonrenewal requires a 45 day notice.
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