If the truth be told, most people do not take the time or effort to read the
insurance policies they purchase. They depend on their agents to identify the
coverages that are required and to obtain them for their benefit.
Even among the people who do take the time to read and analyze insurance
policies, there are provisions in the commercial general liability (CGL)
insurance policy that are relatively unknown and underutilized. This series
will examine some of those provisions in an effort to give practitioners
representing both the insureds and insurers additional ammunition to represent
their client’s interest.
Declarations Provision
The first provision in this series that we will discuss will be a provision
found in the conditions section of the current CGL policy. The declarations
provision states the following.
By accepting this policy, you agree:
- The statements in the Declarations are accurate and complete;
- Those statements are based upon representations you made to us; and
- We have issued this policy in reliance upon your representations.
The declarations provision has appeared in every iteration of the Insurance
Services Office, Inc. (ISO), CGL policy form since 1973. On many occasions, a
claim will be presented to an insurer where the risks involving the claim had
nothing to do with the risks that were listed in the declarations or which the
insurer believed that it was insuring. Under the declarations provision, the
insured is making a declaration that the statements in the declarations are
accurate and complete and that the insurers are relying on them. Granted, there
are certain endorsements that can be attached to CGL policies that would limit
the exposure to the rating classification listed in the declarations. However,
most policies do not have these endorsements; most policies only have the
language found in the declarations provision that is referenced above.
Litigation Involving the Declarations Provision
One example of the use of the declarations provision is found in Gemini
Ins. Co. v. S&J Diving, Inc., 464 F. Supp. 2d 641 (S.D. Tex. 2006). In
that case, a young girl was abducted at an outdoor rock concert and motorcycle
rally called the "Texas Tea Party." Following the assault, an
investigation revealed that the kidnapper worked for Pajama Productions, Inc.,
the producer of the event. One of the principal shareholders of Pajama
Productions was Stanley Jones. Mr. Jones was also the principal shareholder in
a venture called S&J Diving, Inc. Gemini Insurance Company had issued a CGL
policy to S&J Diving. Because Mr. Jones was an executive officer of S&J
Diving as well as Pajama Productions, it was argued that coverage would be
extended to him under the S&J Diving policy.
The court declined to provide coverage in this case and held that:
In this instance, the policy declarations and exclusions, when read together,
reveal a clear intent by the parties to contract for liability insurance
coverage for activities related only to marine survey operations. It is
equally clear that the plain language of the policy characterizes S&J as
a diving company; S&J agreed that such a description of its business
operations was accurate and complete; and, Gemini relied on those
representations in setting the premiums and issuing the policy. It is
likewise reasonable to conclude that S&J's "declaration" of
its business purpose limits the available coverage to a marine
operation's typical undertakings.
Analysis
Less than 25 cases across the entire United States have focused on or
discussed the above representation provision. The majority of those cases
addressing the provision have been within the last 5 years. As a result, this
little-known and little-utilized provision is garnering greater and greater use
in the industry.
The declarations provision may impact disputes in jurisdictions that have
statutory laws that govern an insurer’s reliance on an insured’s
representations in an application. For example, many states require that the
applications be attached to the policies for an insurer to rely on a
misrepresentation. Other states require that the insured give notice within a
very short period of time if it does not intend to be bound by the policy based
on the misrepresentation in the application. The declarations provision avoids
all those statutory arguments and focuses not on the initial misrepresentation
in the application but rather on a misrepresentation in the
declarations. As a result, many insurers who were facing statutory
defenses to arguments that there was a misrepresentation in the application may
no longer have those defenses available to them.
The next article will focus on another little-known and little-utilized
provision of the CGL policy that insureds typically fail to avail themselves:
the "Supplementary
Payments" provision. Like the provision above, it is not known by most
insurance professionals and certainly not utilized for the benefit of insureds
as widely as it should.