We insure a hospital that suffered a loss of a CT scan, and the replacement of the equipment took about ten months. During that period, the CT scan department was not able to generate income and suffered a suspension of its operations. The other departments of the hospital continued to operate.

The insured filed a claim for business interruption. The company argued that the coverage part in use in Puerto Rico is CP 00 30 10 90 and that the form requires a total suspension of operations in order to trigger coverage.

The 1990 form does not define suspension, and the wording on the coverage part does not read "necessary total suspension of your operations", but "necessary suspension of your operations."

We argue that since the form in use does not define suspension, a partial or slowdown of activities could satisfy the suspension of operations requirement. 

We also told the company that ISO defined suspension in the 2000 edition of the form as "the slowdown or cessation of your business activities." We feel this clarification shows what the intention was in relation to that word and what was necessary for a suspension of operations to activate coverage.

Since suspension was defined in a subsequent form, we think the company should interpret in this case that a slowdown occurred and that it triggers the requirement of necessary suspension of operations, since the loss occurred after the clarification was made. If a state uses an ISO form that later is revised to attend a matter of controversy or misunderstanding regarding a particular item of that form and a loss occurs involving that matter on a policy using the prior form because the new form is not yet approved in the state, will the clarification of the new form be used in the interpretation of the words in controversy on the previous edition of the form?

Puerto Rico Subscriber

We agree that suspension can mean a partial suspension or slowdown. That was our position even before ISO clarified the meaning of suspension. There is no rule or requirement that a clarification made later in a subsequent edition of a form must be applied to an older edition, but it does give one a stronger argument on how to interpret the meaning of an undefined term. While we cannot give legal advice, it may be that the final determination would come from a court.

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