251.4-2
COMMERCIAL CRIME COVERAGE ANALYSIS
(October 2006)
This analysis is based on
the Insurance Services Office (ISO) May 2006 edition. Changes from the
previous edition are in bold print.
Commercial crime coverage
can be written on either a discovery form or a loss sustained form. It may be
written as a monoline policy or as a coverage part in a commercial package
policy. The policy forms are:
- CR 00 20–Commercial Crime Coverage Form (Discovery
Form)
- CR 00 21–Commercial Crime Coverage Form (Loss
sustained Form)
- CR 00 22–Commercial Crime Policy (Discovery Form)
- CR 00 23–Commercial Crime Policy (Loss sustained
Form)
This analysis evaluates
Form CR 00 21, Commercial Crime Coverage Form (Loss sustained Form).
As with all ISO forms,
defined words are offset by quotation marks in the policy or coverage form. The
words “you” and “your” refer to the named insured listed on the declarations.
The first named insured is the entity that receives notices of premiums, cancellations
and other documents, as discussed in the common policy conditions. “We” and
“us” are the insurance company.
A. INSURING AGREEMENTS
Eight separate insuring
agreements are available in each of the commercial crime forms. If any insuring
agreement has “not covered” indicated next to it on the declarations, the
policy does not cover or provide protection for that agreement. This means that
a policy or coverage form could be issued covering only one of the eight crime
insuring agreements.
Coverage applies to losses sustained by the named insured under the
following circumstances:
- The loss must
be the result of an occurrence.
- The occurrence
must take place DURING the policy period shown on the declarations.
- The loss must
be discovered by the named insured DURING the policy period or the
extended discovery period.
All of the above are subject to:
- Condition
E.1.g Extended Period to Discover Loss;
- Condition
E.1.k Loss Sustained During Prior Insurance Issued by Us Or Any Affiliate;
- Condition
E.1.l Loss Sustained During Prior Insurance Not Issued By Us Or Any
Affiliate; and
- Definitions of
the terms “discover” and “occurrence” in Section F of the policy.
The May 2006 change eliminates the Loss Sustained Condition and moves
it into the insuring agreement. It also adds the reference to important
conditions that impact what losses are covered in addition to including the new
definition of "discover."
1. Employee Theft
This insuring agreement
applies to employee “theft” losses to “money,” “securities” and “other
property.” It covers the unlawful taking of covered insured property by
employees. Coverage applies regardless of the number of employees involved in
the loss. This is an important point, since the limit of insurance applies to
each act, not to each employee. In
this insuring agreement, theft includes forgery (May 2006 addition).
Example: A group of ten employees devises a scheme to siphon cash
from the accounts receivable of the business. The total loss is $500,000. The
policy limit of insurance for employee theft is $200,000. The insured argues
that each of the employees should be insured for $200,000 with a total possible
loss payable of $2,000,000. This argument is incorrect, because the policy
coverage pays the limit for each occurrence, not the limit for each employee.
Because the employees were all part of the same scheme, the policy limit of
$200,000 applies.
Example: In addition to the accounts receivable scheme in the
example above, another different employee is stealing merchandise by forging
documents and selling the merchandise to friends. This employee’s actions are
completely separate from the ten-person scheme and the $200,000 limit of
insurance on the policy applies separately to this claim.
2. Forgery and Alteration
This insuring agreement
applies to the actions of outsiders. Coverage does not apply to forgery or
alterations to checks done by the named insured or any employee, manager,
director, trustee or representative. Coverage applies only to checks drawn on
an insured’s accounts or the accounts of anyone while acting as an insured’s
agent. The definition of checks includes drafts, promissory notes and orders or
directions to pay “money.” It also
includes substitute checks as defined by the Check Clearing for the 21st
Century Act (May 2006 addition). A check can allegedly have been drawn,
meaning there may be some doubt whether the check was actually drawn, against:
- An insured’s account;
- Another party’s account; or
- An account that no longer exists.
Example: A crafty thief breaks into Plumber’s Palace and steals a
number of checks from the bottom of a stack he finds in the comptroller’s
office. During the next few weeks, the thief writes checks against the
insured’s account until either the theft is discovered or the cashing of
unauthorized checks is reported to the comptroller.
One of the unusual
features of this coverage is that it provides defense coverage for an insured
sued for refusing to pay on a check or an instrument the insured believes to be
forged or fraudulent. The insurance company must first give its written consent
to an insured to defend against such a suit. Afterwards, the insurer pays
reasonable legal expenses relating to defense of the suit. The defense coverage
is unlimited and is in addition to the policy limit for forgery and alteration
coverage.
3. Inside the Premises–Theft of Money and Securities
This insuring agreement
contains three basic coverages:
- It pays for theft of “money” and “securities” committed by a person actually present
inside (May 2006 change) the “premises” or a “banking
premises.” It also pays for loss due to disappearance or destruction of
“money” or “securities” from inside the premise or banking premises. No merchandise
or stock is covered in this insuring agreement. “Premises” is defined as
the interior of the building occupied by the insured and from which the
insured conducts the business. “Banking premises” is also defined and
requires the theft to occur inside the bank premises.
- It covers damage to the interior of the premises and
to the exterior of the building during an attempted or actual theft.
However, in order for coverage to apply to damage to the exterior of the
building, the named insured must either own the building or be legally
liable for damage to exterior portions of it.
Example: Burglars break down the
outside door of the building. Damage to the door is covered only if the named
insured is the owner of the building or is liable for damage to the door for
reasons of negligence or because of a requirement or obligation in a lease. If
the named insured as a tenant in the building is not liable for the damage, and
if there is no requirement or obligation in the lease agreement, there is no
coverage for the damage to the door under this coverage in the insuring
agreement.
- It covers damage incurred during an attempted or
actual theft to locked safes, vaults, cash registers, cash boxes and cash
drawers inside the premises.
4. Inside the Premises–Robbery or Safe Burglary of Other Property
Under the commercial
crime coverage form, “Other property” means property other than “money” and
“securities” having intrinsic value and not otherwise excluded.
"Intrinsic" is generally defined as: “of or relating to the essential
nature of a thing; inherent.” A chair has intrinsic value. An idea, in and of
itself, has no intrinsic value unless applied and made into something.
Under this insuring
agreement, coverage applies only to “robbery” of a “custodian” or to “safe
burglary.” The act must take place inside the premises situated inside the
building. Robbery is not theft. Robbery is a separate element of theft that
involves actual bodily harm or the threat of bodily harm, violence or
intimidation or the unlawful taking of property witnessed by another person.
“Custodian” includes the named insured, members, partners or employees but NOT
a “watchperson” or janitor. Losses from robberies during both normal business
hours and after hours not involving a "watchperson" or a janitor are
covered. A person working late and turning on the alarm before leaving is not a
“watchperson,” unless hired specifically to have custody of the property and
having no other duties. A “watchperson” is the security guard hired to watch
the premises during normal business hours.
Example: Mary is working late. She is asked to lock up before
leaving, meaning she has custody of the premises. However, she is not a
“watchperson.” She observes the contracted janitorial cleaning staff opening
desk drawers to dust inside. The next day, several people are missing valuable
tools, software and other items. She suspects the janitorial staff took the
items but since she was not threatened and did not see an obvious act of
stealing, there is no coverage under this insuring agreement.
Much like Insuring
Agreement 3–Inside the Premises–Theft of Money and Securities, damage to the
premises from an attempted or actual act of robbery or safe burglary is covered
as well as damage to the LOCKED safe or vault. If the safe or vault is open,
and is damaged during the robbery, it is not covered, but property inside the
safe or vault is covered.
5. Outside the Premises
This insuring agreement
covers “theft,” disappearance and destruction of “money” and “securities” when
outside the premises and in the custody of a messenger or an armored car
company. Coverage includes “theft,” “robbery” or, for example, the loss of a
suitcase full of cash that bounces out of the back of a pickup truck, tumbles
across a bridge, falls 120 feet into a river and is never seen again. It covers
only the “robbery” of a messenger of other property when outside the premises
and in the custody of a messenger or an armored car company. Robbery must
include at least the threat of bodily harm, violence or intimidation or the
messenger must actually observe the commission of an unlawful act. The crate of
rare vases that bounces out of the back of a pickup truck, falls to the river
below and is never seen again is not covered. If the same vehicle was
car-jacked and the robber threw the crate into the river, coverage applies.
In either of the cases
above, a messenger may be an insured or the partners and "employees"
of the insured. “Employees” do not include independent contractors, other than
an armored car company, leased employees or any agent or broker.
Example: Pink Elephant Phine Liquors arranges with Perki Personnel,
a professional employment organization (PEO) or labor contractor to supply it
with leased truck drivers to operate its fleet of trucks. When delivering a
load of liquor to a Pink Elephant warehouse, the driver is robbed at gunpoint.
There is no coverage for this claim because the leased driver was not a
“messenger” as defined in the policy. Coverage for leased employees may be added
by using form CR 25 05–Include Leased Workers as Employees.
6. Computer Fraud
In this insuring
agreement, computer fraud covers "money," "securities" and
"other property" fraudulently transferred from the insured premises
or banking premises to a location other than the insured premises or the
banking premises. It does not include transfer to a messenger. Coverage is
worldwide. As a result, fraudulent transfer of funds from the insured’s Swiss
bank account to someone in the United States is covered. In the same way, a
person breaking into the office premises and using one of the insured's
computers to transfer funds from the insured’s account to his or her Swiss bank
account is also covered. Coverage applies if someone hacks into the insured’s
computer from their home and bypasses the internal firewall in order to command
the insured computer to send money to the thief’s personal bank account.
Coverage applies to locations and premises outside the United States.
Example: Josie Proust, the top sales person for Cyberfroot
Distributors, was staying in a hotel in Beijing, where she regularly conducted
business from her room. After she left the room to meet with a local group of
lychee and pomegranate farmers, someone broke into her room, stole some of her
valuables and hacked into her laptop to transfer funds from her account. This
loss is covered under this insuring agreement.
7. Funds Transfer Fraud
This insuring agreement
provides coverage for loss of “funds” resulting directly from a “fraudulent instruction”
directing a financial institution to transfer, pay or deliver “funds” from the
insured’s “transfer account.”
8. Money Orders and Counterfeit Money (May 2006 change)
This insuring agreement
covers “counterfeit money” accepted
in good faith in exchange for purchases. It also covers money orders accepted
by the named insured in good faith but not accepted when presented by the named
insured for payment. The coverage territory is limited to the United States,
its territories and possessions and Canada. There is no coverage for fake euros
when traveling in Europe. Note: Cashier’s checks and other negotiable
instruments are NOT covered. Please refer to PF&M Section 251.6-20,
Counterfeit Cashier's Checks, for additional information about this coverage.
The May 2006 edition replaces the phrase "counterfeit paper
currency" with the defined term "counterfeit money." This is a
significant increase in coverage because the defined term includes traveler’s
checks, register checks and money orders in addition to currency, bank notes
and coins.
B. LIMIT OF INSURANCE
The limit indicated on
the declarations is the most to be paid for
all loss that results (May 2006 change) from an “occurrence.” If a loss is covered under more than one
insuring agreement, the company pays ONLY the largest limit of insurance
available, not the sum of each available limit (May 2006 change). In some
cases, this could be a significant reduction in coverage.
Example: Acme Company sustains a loss that involves both employees and
non-employees. It is found to be a single occurrence and coverage applies and
is available under Insuring Agreements 1, 3 and 7. The coverage limit under
Insuring Agreement 1 is $300,000, under Insuring Agreement 3 it is $100,000 and
under Insuring Agreement 7 it is $250,000. The total loss is $500,000. Before
this change, Acme could have recovered under each of the insuring agreements
and have been fully compensated. With this change, the maximum recovery is the
highest limit available, $300,000.
A situation like this could have claimants and claimant attorneys
searching for ways to utilize the differing definitions of occurrence within
the insuring agreements so that a single occurrence loss becomes a multiple
occurrence loss and results in freeing up all of the limits.
C. DEDUCTIBLE
Each of the eight
insuring agreements can have a different deductible. In most cases, smaller
accounts do not require deductibles for most coverages. The insurance company
does not pay any loss until the deductible amount stated on the declarations is
satisfied.
In previous editions,
the policy indicated that if different deductibles applied to the same loss,
only the highest deductible was applied. In the May 2006 edition, this
provision is removed. When the deductible provision is now read in conjunction
with the limit of insurance, it can be implied that the deductible that applies
is the one shown on the declarations and associated with the highest limit of
insurance. However, it is not stated this way. With the removal of the
deductible limitation language in the previous edition, there is no clear
direction as to which or how many deductibles apply to a given loss. Due to
this ambiguity, an insured could argue that the lowest deductible, or no
deductible, should be used since ambiguity in policy language is normally
construed in favor of the insured.
Example: Continuing
the Acme example above, Insuring Agreement 1 had a $10,000 deductible, Insuring
Agreement 3 had a $1,000 deductible and Insuring Agreement 7 had no deductible.
The insured argues that no deductible should apply but the insurance company
argues that the deductible that applies is $10,000.
D. EXCLUSIONS
1. These exclusions apply to each of the eight insuring agreements,
unless otherwise stated.
a. Acts Committed by You, Your Partners or Members
Any theft or dishonest
act of the named insured, whether committed alone or with another individual or
an employee, is excluded. The named insured cannot claim coverage for the
dishonest act of an employee if the named insured is involved in the same
misdeed. For the purposes of this exclusion, a “member” is an owner of a
Limited Liability Corporation (LLC).
b. Acts of Employees Learned of by You Prior to the Policy Period
This exclusion applies to losses committed by employees with a history
of dishonesty. If the named insured, partners, members, managers, officers,
directors or trustees hire an individual known by one or more of them to have
committed theft or engaged in dishonest acts prior to the policy period, coverage
does not apply to any loss caused by that employee.
However, coverage does apply if the member, partner, manager, officer,
director or trustee aware of the dishonest acts is in collusion with the
employee to commit the theft or dishonest act.
While this is a new exclusion, it is similar to the old Condition 1.a,
Cancellation As To Any Employee. The exclusion is added to make it clear that
even if an employee’s dishonest acts were committed before the current policy
period, any loss by that employee under the current policy is not covered. This
change is a direct result of Home Savings
Bank, SSB v Colonial American Casualty and Surety Company, 598 S.E.2d 265
(N.C.Ct. App., 2004)
Example: Trent has a troubled background so Rick, the vice president of
operations, hires Trent to help him with inventory. Rick’s plan is for Trent to
use his contacts to help them fence items stolen from the warehouse. When the
loss is discovered, the insurance company cannot not deny coverage on Trent.
This is because Rick is the only one at the company aware of his dishonest
past.
c. Acts of Employees, Managers, Directors, Trustees or Representatives
This exclusion applies to
all insuring agreements EXCEPT Insuring Agreement A.1, Employee Theft. In
addition to excluding acts committed by an insured, other dishonest acts, such
as forgery, committed by employees and outside persons working together are
also excluded.
d. Confidential Information (May 2006 addition):
This new exclusion explains that the crime policy is not designed to
cover identify theft loss issues.
Any loss caused by or resulting from any disclosure or use of
confidential information of various kinds not authorized by the insured, is not
covered. This includes, but is not limited to, patents, trade secrets,
processing methods or customer lists.
In addition, any loss caused by or resulting from any disclosure of
confidential information of others, such as financial or personal information
not authorized by the insured, is not covered.
This is considered to be a clarifying exclusion, since the policy was
never intended to cover these types of losses anyway.
Example: Marguerite works in school records. Her boyfriend, Phillip,
asks for some information about his neighbor, Paul, and uses it to steal Paul's
identity. Paul discovers the identity theft when he attempts to refinance his
home. The police track the release of information to Phillip and Marguerite,
who previously left town. Paul demands the school system compensate him for the
money lost due to Marguerite’s actions. However, the insurance company denies
coverage under the crime insuring agreements.
e. Government Action
Loss resulting from
government seizure, forfeiture or other government taking or destruction of
property is not covered.
Example: The owner of “Shot Docks” Bass Boat Rentals files a claim
for the loss of a boat. The boat was valued at $37,000 and the owner claims it
was "authoritatively" taken from her premises. The claims adjuster
questions her in greater detail about the loss and then denies the claim when
he learns that federal officers confiscated the boat under a zero tolerance
controlled substances law.
f. Indirect Loss
Indirect losses not
covered include:
- Loss of income as a result of not being able to use
“money,” “securities” or “other property.”
Examples: Coverage does not apply to
loss of interest income on “money” that could have been invested. There is also
no coverage for loss of income on stock holdings that could have appreciated
during an upturn in the market. Finally, loss of income from the profit that
could have been made if the product stolen had been sold is not covered.
Business income coverage available in commercial property forms pays for the
loss of income on property other than “money” or “securities.” Please refer to
PF&M Section 131.4-2, Time Element Coverage Forms Analysis, for more
details on these coverages.
- Legal liability claims. Coverage for property of
others is available only by endorsement. Please refer to PF&M Section
251.6-2, Clients’ Property–Form CR 04 01, for details on coverage that
applies to property of others.
- The cost of establishing the amount of a loss. The
costs and expenses involved can be substantial and can include a number of
items. Among them is the cost of financial auditors to look through books
“cooked” by an employee. Another is the cost of independent investigators
hired to ferret out all of the loss and who caused it. The last is the
cost of hiring forensic or other specialists to determine what missing
inventory was stolen and what was simply shortage. Coverage for these
costs and expenses is available by attaching Endorsement CR 25 40–Include
Expenses Incurred to Establish Amount of Covered Loss. Please refer to
PF&M Section 251.4-3, Commercial Crime Coverages Available
Endorsements and Their Uses, for more information on this additional
coverage form.
g. Legal Fees, Costs and Expenses
If the named insured
incurs costs, fees or legal expenses for any reason, including those for a
covered loss, they are not covered EXCEPT under Insuring Agreement A.2, Forgery
and Alteration.
h. Nuclear Hazard
Losses caused by or
related to nuclear energy in any manner are not covered.
i. Pollution (May 2006 addition)
There is no coverage for any loss or damage resulting from pollution.
Rather than defining pollution in the definitions section of the policy, it is
defined within the exclusion. The definition is identical to that used in ISO
property coverage forms. While there are no court cases to justify this
addition, it is added as a precaution against attempts to obtain pollution
coverage through policies that do not have the pollution exclusion.
j. War and Military Action
Losses caused by or
related to war or warlike action, including
rebellion, insurrection, revolution and government power used to defend against
such actions, are not covered (May
2006 change).
This wording is similar to wording used in other ISO property coverage
forms to be consistent.
2. These exclusions apply to Insuring Agreement A.1, Employee Theft
Coverage:
a. The Employee Cancelled Under Prior Insurance exclusion has been
rewritten, broadened and is now Exclusion 1.b, Acts of Employees Learned by You
Prior to the Policy Period (May 2006 change).
a. Inventory Shortages
There is no coverage for
shortages of "money," "securities" or "other
property" if the only proof of loss is discovery of a shortage during the
taking of inventory. This also includes profit or loss calculations, such as a
mistake on the books or in ledgers. However, if it is determined that a loss
resulted from one of the coverages included in the policy, the books, ledgers
and inventory records are used to substantiate the loss.
b. Trading
Losses resulting from
trading are excluded. Activities within the term “trading” include stock-trading
losses, commodity-trading losses and merchandise-trading losses, where one
batch of product is traded for another batch of product. Certain trading losses
to a genuine, not a fictional, account are covered by Endorsement CR 25 16–Add
Trading Coverage. Please refer to PF&M Section 251.4-3, Commercial Crime
Coverages Available Endorsements and Their Uses, for more information on this
additional coverage form.
c. Warehouse Receipts
Warehouse receipts track
and detail document storage and the transfer of products from the person
storing them to the person receiving them. The transferring party and the
recipient party are usually two separate entities. A fraudulent transfer can
occur when property is delivered to someone not authorized to receive it. A forged
instrument is frequently used by an individual who seems to have legitimate
claims to the merchandise but does not. These situations are not covered, nor
are errors in issuing, signing, cancelling or failing to cancel any warehouse
receipt. Fraudulent transfer of warehouse receipts is covered by CR 25 17–Add
Warehouse Receipts Coverage. Please refer to PF&M Section 251.4-3,
Commercial Crime Coverages Available Endorsements and Their Uses, for more
information on this additional coverage form. Warehouse Operators Legal
Liability Coverage, an inland marine coverage, can also be purchased to cover
fraudulent or other improper or negligent transfer of goods, other than by
employee theft. Please refer to PF&M Section 142.15, AAIS Warehouse Legal
Liability Coverage Form, for more information on this additional coverage form.
3. The following exclusions apply to Insuring Agreements A.3, Inside
the Premises–Theft of Money and Securities, A.4, Inside the Premises–Robbery or
Safe Burglary of Other Property and A.5, Outside the Premises:
a. Accounting or Arithmetical Errors or Omissions
Mathematical errors are
excluded. There is no standard endorsement available to "buy back"
this exclusion or purchase this coverage.
b. Exchanges or Purchases
There is no coverage for
loss in any exchange or purchase of any property. There is no standard
endorsement available to "buy back" this exclusion or purchase this
coverage.
Example: A customer pays the marked price of $2,000 for a piece of
furniture. It is later revealed that the price should have been $20,000.
Further investigation shows that the mistaken marking was an intentional fraud
and the customer information was also fraudulent. Even though this appears to
be criminal activity, coverage does not apply because this loss was the result
of a purchase.
c. Fire
Most fire losses are
covered under a standard fire insurance policy or an equivalent coverage form.
However, Insuring Agreement A.3, Inside the Premises–Theft of Money and
Securities, provides coverage for fire loss or damage (May 2006 addition) to
a safe or vault from attempted or actual theft or unlawful entry. Because of
this coverage, overlapping coverage with ISO Form CP 00 10, Building and
Personal Property Coverage Form, combined with ISO Form CP 10 30, Causes of
Loss Special Form, is possible. These property forms would cover damage to the
safe or vault from fire associated with any unauthorized entry. However, the
property policy excludes property specifically covered elsewhere and the most
either policy pays is the actual loss amount.
d. Money Operated Devices
Theft of
"money" from vending machines or other money or coin-operated devices
is not covered unless the “money” is continuously counted and recorded by the
machine itself. There is no standard endorsement available to "buy
back" this exclusion or purchase broader coverage.
e. Motor Vehicles or Equipment and Accessories
Damages to any motor
vehicle, its accessories or trailers are excluded. Coverage for theft of motor
vehicles is available under automobile comprehensive coverage, garage dealers'
coverage or garagekeepers' liability coverage in the commercial automobile
policy. It is also available for vehicle manufacturers through a commercial
property coverage form. The term “motor vehicle” is not defined in this
coverage form as it is in other ISO forms.
f. Transfer or Surrender of Property
- Loss or damage to property given to someone outside
the “premises” or “banking premises” because of unauthorized instructions
is not covered. There is no standard endorsement available to "buy
back" this exclusion or purchase this coverage. There is also no
coverage if the property was given up because of the threat of either
bodily harm or property damage. There is also no coverage if there are
various types of threats to the computer system, to harm the named
insured’s products or to release confidential information (May 2006
addition). However, since this type of activity is considered to be
extortion, coverage is available by purchasing Optional Insuring Agreement
CR 04 03–Extortion–Commercial Entities or by purchasing a Kidnap/Ransom
and Extortion Policy. Please refer to PF&M Section 251.6-4,
Extortion–Commercial Entities–Form CR 04 03, for more information on this
additional coverage form.
- The item above does not apply to Insuring Agreement
A.5, Outside the Premises, if the property is in the custody of a
messenger having no knowledge of the threat at the time the trip began, or
who knew about the threat but was the victim of an entirely different
threat. This provision covers the robbery situation where the messenger is
unexpectedly threatened with bodily harm or damage to the conveyance being
used is threatened. For example, this provision would not provide coverage
if the messenger knew of the threat and was delivering the extortion
payment and was threatened at the point where the payment was handed off.
g. Vandalism
Vandalism losses to the
building or premises, safes or cash drawers are not covered. Vandalism losses
are better covered under commercial property coverage forms. Situations may
occur where vandalism and theft are concurrent causes of loss that occur at the
same time.
Example: During a riot, vandals break a business’s showroom windows
and steal merchandise. Later, other persons climb through the debris to steal
fixtures and other building materials. Vandalism is the proximate cause of the
theft loss and the building losses should be covered by the property policy.
Theft of merchandise by the burglars who climb through the broken windows is
handled under Crime Insuring Agreement A.4, Inside the Premises–Robbery or Safe
Burglary of Other Property.
h. Voluntary Parting with Title to or Possession of Property
There is no coverage if
an insured voluntarily parts with title to or possession of any covered
property because of a trick or scheme concocted by another party. There is no
standard endorsement available to "buy back" this exclusion or
purchase this coverage.
4. The following exclusions apply to Insuring Agreement A. 6, Computer
Fraud:
a. The Exchanges or Purchases exclusion is eliminated and replaced by
the Credit Card Transactions exclusion (May 2006 change).
a. Credit Card Transactions
Coverage does not apply if the loss is the result of use of any type of
credit, debit, charge or other similar cards.
b. Funds Transfer Fraud
There is no coverage if
the loss is a result of a “fraudulent instruction,” directing a financial
institution to transfer, pay or deliver “funds” from the “transfer account” to
an unauthorized party. Coverage may be purchased using Insuring Agreement A.7,
Funds Transfer Fraud.
c. Inventory Shortages
Losses where the only
evidence of loss is an incorrect inventory count or a profit and loss statement
computation error are not covered.
d. The Voluntary Parting with Title to or Possession of Property
exclusion is eliminated. However, since credit cards are often used in such
transactions, coverage is still probably not available because of the Credit Card
Transactions exclusion (May 2006 change).
5. The following exclusion applies to Insuring Agreement A. 7, Funds
Transfer Fraud:
Loss due to using a
computer to fraudulently transfer “money,” “securities” or “other property” is
not covered. Coverage may be purchased using Insuring Agreement A.6, Computer
Fraud.
E. CONDITIONS
1. Conditions Applying to All Insuring Agreements:
a. The Cancellation as to Any Employee exclusion is eliminated from
this section and moved to Conditions that apply to Insurance Agreement A.1 only
(May 2006 change).
a. Additional Premises or Employees (May 2006 addition)
When a named insured adds employees and/or premises, coverage
automatically applies without an additional premium charge during that policy
term. The only exception is when the new premises or employees are the result
of a consolidation, merger or acquisition. Refer to the consolidation, merger
or acquisition condition below for information on the exception.
b. Concealment, Misrepresentation or Fraud
Any fraudulent act
committed by the insured voids coverage. Intentional concealment or
misrepresentation of a material fact about the property covered, the insured's
interest in the covered property or in any claim also voids coverage. Voiding
coverage includes existing claims as well as future claims.
c. Consolidation–Merger or Acquisition (May 2006 change)
The policy provides
coverage for 90 days for newly acquired entities, premises, assets or liabilities
of another entity and its employees. The coverage is automatic but the
insurance company must receive written notice of the acquisition. There is no
coverage after 90 days unless the insurance company adds it to the policy.
Additional premium may be required. The only losses covered are those that
occur AFTER the date of consolidation, merger or acquisition.
d. Cooperation (May 2006 addition)
The named insured must be cooperative and work with the insurance
company with respect to all insurance policy terms and conditions.
e. Duties in the Event of Loss
- Let the insurance company and local law enforcement
authorities know what happened as soon as possible if an unlawful act is
involved or suspected. Law enforcement authorities do not necessarily have
to be notified if the loss involves employee theft, alteration or forgery.
- Submit to an examination under oath and sign a
statement. This is required when requested by the insurance company.
- Provide
any records considered pertinent to the loss to the insurance company so
it can examine them as needed (May 2006 addition).
- Provide a detailed, sworn proof of loss within 120
days after the date of loss. This is longer than in most policies, because
of the extraordinarily long amount of time that may be needed to work
through a complicated employee theft scheme or other fraud, and where
trails of money or computer fraud are involved.
- Cooperate with the insurance company in the
investigation and claim settlement.
f. Employee Benefit Plans
Insuring Agreement A.1,
Employee Theft coverage applies to “employee benefit plans” listed on the
declarations. This is not employment practices legal liability coverage that
covers such things as forgetting to enroll an employee during the open
enrollment period. Employee benefit plans coverage is for fraudulent or
dishonest acts, such as theft of retirement funds by an employee.
- Only those plans listed on the declarations are
covered under Insuring Agreement A.1, Employee Theft. For example, this
means if the plan is called the Jones Company Retirement Plan and the plan
administrator changes, coverage still applies. However, a more complicated
name could cause a problem with a similar change in funds handling.
Example: If a covered plan is listed as
the Jones Company Retirement Plan through ABC Funding, and the insured
transfers the plan’s assets to DEF Funding, coverage does not apply to the new
plan unless the policy is amended by endorsement to recognize the change.
- If the Jones Company Retirement Plan is jointly
insured with any other insured plan, the insured is responsible for making
sure the limit of insurance is adequate to cover both plans as though each
is insured separately. This language is included because federal laws
require some employee retirement and other benefit plans carry a specific
limit of fidelity coverage. The intent of the provision is to put the
burden of responsibility for selecting that limit on the insured and not
on the insurance company.
- This coverage pays only for loss of “funds” and
“other property” of the plan and not for loss to the desks or “other
property” associated with the administration of the plan.
- If the first named insured is not the same name as
the covered employee benefit plan, any loss payment must be held by the
insured for the benefit of the plan. In other words, the insured is not
permitted to commingle loss payment or claim funds with general business
funds.
- If the policy covers two or more employee benefit
plans, losses arising out of one occurrence are shared by the funds in the
same proportion as the funds in each plan bear to the total funds of all
plans. Any payment due is made directly to the plan or plans sustaining
the loss (May 2006 addition).
Example: The loss is $100,000 and the
insurance coverage limit of insurance is $100,000. If covered plan A has
$500,000 in funds and covered plan B has $200,000 in funds, the total funds
amount is $700,000. The claim payment for plan A from the limit of insurance is
5/7 of the $100,000 and the claim payment for plan B is 2/7 of the $100,000
limit.
- No deductible apples to employee benefit plan(s)
coverage.
g. Extended Period to Discover Loss
Losses must occur prior
to the cancellation date of coverage but may be discovered:
- Within one year from the date of cancellation.
However, if another policy covering the same loss was purchased to replace
the insurance under this policy, the extended period of discovery ends
immediately.
Example: Peggy had no idea that
employees were skimming money from the cash registers. Her crime policy expired
on January 1, 2002 and she did not renew. She discovered the loss on June 10,
2002. The loss is covered if the employees began stealing the money from the
cash registers before January 1, 2002 and during the previous policy period,
January 1, 2001 through December 31, 2001.
Example: Under a previous policy, an
insured’s coverage included protection against employee theft. The new policy
also includes employee theft coverage but has a retroactive date and only
losses that occur during the policy period are covered. The extended period to
discover employee theft losses ends the moment the new policy is effective. In
this case, the insured has a gap in coverage.
- Within one year from the date of cancellation if the
coverage applies to employee benefits plan. There is no exception.
h. Joint Insured
- The first named insured acts for all other insureds,
unless excluded, deleted or not covered in some way. In that case, the
next named insured listed becomes the first named insured. The first named
insured is responsible for premium payments and receives all notices
issued by the insurance company, such as cancellation notices.
- Knowledge by one insured of anything affecting the
insurance coverage is considered to be knowledge by all insureds. This is
an important point because not all insureds in one policy may be wholly
owned by the first named insured. They may be partnerships or corporations
involving significant outside ownership.
Example: The first named insured does
not tell the other insureds the policy is cancelled. The other named insureds
have no recourse against the insurance company for lack of notification of the
cancellation.
- An “employee” of one insured is an employee of all
insureds.
Example: The first named insured lets
another named insured hire one of its employees but forgets to tell the other
named insured that the employee hired has a criminal record. Even though the
new employer does not know about the employee’s past record, because all named
insureds are considered to know what each of the others knows, any employee
theft losses involving this employee with the new employer are not covered and
were not covered before.
- The extended period to discover loss condition
applies separately to each insured.
Example: The first named insured
cancels the crime insurance for all named insureds. The first named insured
does not purchase replacement coverage and has a one-year extended period to
discover loss. The second named insured purchases coverage immediately from
another insurer. The extended period to discover loss for the second named
insured ends on the effective date of the new coverage.
- The limit of insurance applies to all insureds. A
separate limit does not apply to each insured.
Example: Insured A sustains a $100,000
covered loss and Insured B has a $100,000 covered loss from the same
occurrence. The policy limit of insurance is $100,000. The insurance company
pays $100,000 total in any one occurrence, regardless of the number of
insureds.
- When the insurance company pays the first named
insured for a loss, the claim is satisfied for all named insureds. The one
exception is employee benefit plans, which must receive a separate
settlement (May 2006 addition).
i. Legal Action Against Us
As with most policies, no
insured can pursue legal action until that insured has complied with all the
policy terms. An insured must wait up to 90 days after filing a proof of loss,
and any lawsuit must be filed within two years of the date the insured
discovered the loss, not the date the loss was filed. If a state law or local
statute requires different time periods, the policy is amended or conformed to
comply with those requirements.
j. Liberalization
If the insurance company broadens
coverage without making an additional premium charge during the policy period
or within 45 days before the start of the policy period, the broadened coverage
applies.
k. The Loss Covered Under This Insurance and Prior Insurance Issued by
Us or Any Affiliate condition is removed and replaced by wording in Section B,
Limit of Insurance (May 2006 change).
k. Loss Sustained During Prior Insurance Issued by Us or Any Affiliate
An occurrence is the
starting point of a dishonest act. The person or persons involved may perform
numerous dishonest acts over a period of years before being caught, but all
such acts are considered one occurrence. If the insured maintains continuous
coverage with the same insurer or group of insurance companies, coverage applies
back to the initial inception date of the continuous coverage. However, the
policy limits do not accumulate because of the multiple years. Instead, the
highest limit available during the total period is available to settle the
total loss over the years in which they occurred. Because of some confusion and
court cases, such as Auto Lenders Acc Ace. Corp.v Gentilini Ford, Inc., 181
N.J. 245, 854 A.2d 378 2004, the condition now has three parts and includes
three examples.
- If a loss is sustained in part during the current
insurance and in part during prior policies and there was no break in
coverage, the loss in the current policy period is settled first and the
losses in the prior periods are then settled.
- If a loss is sustained entirely during a previous
policy period, there was no break in coverage between the date of loss and
the current policy, and the current policy covers the loss, the insurance
company settles the loss under the most recent previous insurance first
and then settles the remaining amounts during previous insurance.
- Any settlement is made as follows:
- The highest single limit of insurance available
during any policy period when the loss occurred is available for the
loss.
- No settlement is paid until the deductible that
applies under the current policy is satisfied. That deductible is the
only one applied to the entire loss settlement, regardless of the number
of policy periods involved.
Note: While this condition is longer, the
intention is unchanged from previous editions.
Example: An employee has been siphoning
funds from Below Ground Enterprises for three years. The insured discovered the
loss this year and calculated the amount at $100,000. The limit of insurance on
the current policy is $100,000 but was only $25,000 three years ago. The loss
payment is $100,000.
Example: Referring to the previous
example above, the limit was reduced two years ago from $100,000 to $25,000.
The insured is still eligible for the $100,000 loss payment because the limit
of insurance at the time of the occurrence was $100,000.
Example: Alice stole $50,000 two years
ago, $20,000 last year and $30,000 this year, for a total loss from this one
occurrence of $100,000. Alice’s employer maintained a $50,000 coverage limit in
each of these three years. These limits cannot be added together even though
the dishonest acts were perpetrated during each of these years. The maximum
limit available for this one occurrence is $50,000.
l. Loss Sustained During Prior Insurance Not Issued by Us or Any
Affiliate
This condition applies only
if there was no lapse in coverage between the current coverage and the previous
coverage. Even a one-day lapse in coverage nullifies this important benefit. If
a loss sustained in a previous policy term is discovered after the end of that
policy's discovery period, coverage applies under the current policy if both
the old and new policy have the same coverage and one immediately replaces the
other. The limit of insurance available is the lesser of the two
policy limits.
Example: Number One, Inc. moved its coverage from STU Accident and
Casualty Insurance Company to the ABC Indemnity Company. They had been with STU
for five years. Number One discovered a loss that occurred during the STU
policy but after the discovery period expired. ABC Indemnity covers the loss
for either the limit of insurance under the STU policy or the limit under their
policy, whichever is less.
The coverage available
under this condition cannot be combined with the coverage available under
Condition k to increase the insurance limits. The limits under Condition k are
taken into consideration with the limits of the previous company and the lesser
is the one chosen.
The important distinction
is that if coverage stays with one company or group, the highest limit is used
to settle claims. If coverage moves between companies, the lowest limit is used
to settle claims. This creates a significant coverage gap if an insured changes
insurance companies.
m. Other Insurance
This condition is totally rewritten with the May 2006 edition but is
not really changed. It is much clearer than in the previous edition.
If other insurance is written under the
same terms and conditions as this insurance, the coverages will share any loss
proportionally. If the other insurance is not written under the same terms and
conditions, this coverage is excess. It pays only after the loss exceeds the
limit of insurance under the other policy or the deductible under this
insurance, whichever is higher. The ability of the insured to collect the other
coverage does not enter into consideration.
Example: Hershel changes insurance
carriers. Because of the terms of the cancellation and non-renewal conditions,
the two package policies overlap by two days. A holdup occurs at his business
on one of those overlapping days. Since the two crime coverages are identical,
each contributes equally. However, one of the package policies has an automatic
property extension endorsement that provides holdup coverage with a $2,500
limit. Since the property coverage is not identical to the crime coverages, it
is primary and the crime coverages are excess.
If this insurance is excess over other
coverage, this coverage only pays after the limit and deductible of the other
coverage is exhausted, whether it is collectible or not. If a deductible
applies to this coverage, the deductible amount is reduced by the amount of the
underlying coverage and the underlying deductible. This means the insured does
not have to jump the hurdle of both the deductible and the underlying limits.
Example: Continuing the example above, each
of the two crime coverages had a $2,500 deductible. Since the property
extension had a $2,500 limit, the deductible was satisfied and the crime coverages
paid the remaining loss, subject to the limit of insurance condition.
n. Ownership of Property; Interests Covered
Property covered includes
owned and leased property along with property held for others.
Note: Important
change! The exception that no coverage applies to property inside the premises
of a client is removed. In addition, the requirement that the insured be
legally liable for the property of others in order for coverage to apply is
removed (May 2006 change).
o. Records
The insured must have
records available that substantiate any loss reported.
p. Recoveries
- Recoveries made by the insurance company, minus
recovery expenses, are returned to the insured until the amount of their
loss above the deductible amount is paid. Any remaining recovery amount is
paid to the insurance company until it is completely reimbursed for the
loss settlement it made. Any additional recovery amounts available go to
the insured to reimburse their deductible. If any money remains after the
first three items are paid, the insured is paid for losses sustained not
covered by this insurance.
- Recoveries do not include reinsurance recoveries by
the insurance company or the cost of original “securities” if duplicates
have been issued.
q. Territory
The covered policy
territory consists of the United States, all its territories and possessions,
Puerto Rico and Canada. Worldwide coverage for employees temporarily outside of
the United States applies for up to 90 days under Insuring Agreements A.1,
Employee Theft, A.2, Forgery and Alteration and A.6, Computer Fraud. In order
for a loss to be covered, the named insured must sustain the loss as a direct
result of an occurrence in the coverage territory.
r. Transfer of Your Rights of Recovery Against Others to Us
The insured cannot waive
subrogation rights for any reason. In most property insurance policies, the
insured can waive rights of subrogation in writing before the loss, but this
option is not available in the crime policy.
s. Valuation–Settlement
The terms of the limit of
insurance section apply first after which the following applies:
- “Money” is valued at its face value. If the
"money" is foreign currency, it can be replaced for the face
value of that country’s currency, or the equivalent in U.S. dollars at the
exchange rate or value published in the Wall Street Journal on the
day the loss was discovered.
- “Securities” are valued at their price at the close
of business on the day the loss was discovered. Securities are either
replaced or cash is paid, at the insurance company's option. If replaced,
the insured must sign over all rights to the lost securities to the
insurance company. The insurance company then pays for the cost of a lost
securities bond, if the cost of the bond is less than the value of the security
or securities at the close of business on the date the loss was
discovered, or the limit of insurance, whichever is less.
- Replacement cost is paid for damage to the “premises”
or “other property,” subject to the limit of insurance. The damage must be
repaired or replaced promptly. If it is not, the insurance company pays
only the actual cash value of the covered property.
- Property other than “money” can be paid for either in
the currency of the country where the loss occurred or the equivalent in United
States dollars, at the exchange rate published in the Wall Street
Journal on the date the loss occurred.
- Any property the insurance company replaces or pays
for becomes the property of the insurance company.
2. Conditions Applying to Insuring Agreement A.1, Employee Theft
a. Termination as to Any Employee (moved here from Conditions Applying
to All Insuring Agreements) (May 2006 addition).
This insuring agreement can cease to apply to any employee. The time
and the manner in which it is done, depends on the circumstances.
- As soon as the
named insured, partners, members, managers, officers, directors or
trustees learn that an employee has committed a dishonest act, all
coverage for that employee ends. It does not matter if the dishonest act
happened before or after the employee joined the named insured’s business.
The only exception is if one of the named group of company representatives
was in collusion with the employee and concealed the dishonest act of the
employee in order to further his or her own dishonest plans.
- The insurance
company can terminate coverage for an employee by mailing notice to the
named insured at least 30 days before the date that cancellation takes
effect.
b. Territory
Losses caused by employees
located temporarily outside the United States, its territories and possessions
or Canada are covered for up to 90 consecutive days. This coverage does not
apply to employees permanently relocating to another country.
3. Conditions Applying to Insuring Agreement A.2, Forgery and
Alteration
a. Deductible Amount
No deductible applies to legal expenses.
b. Electronic and Mechanical Signatures
Electronic, mechanical or other similar means of duplicating signatures
are acceptable and considered the same as handwritten signatures.
However, coverage does not apply for electronic signatures that do not produce
a visible handwritten signature but that are used in electronic commerce to
verify the sender and the sender’s intent.
c. Proof of Loss
The instrument involved
with the loss, such as the check, must be attached to the proof of loss. If the
instrument cannot be provided, an affidavit describing the cause and amount of
loss must be provided in its place.
d. Territory
The territory condition does not apply to this insuring agreement since
coverage applies anywhere in the world.
4. Conditions Applying to Insuring Agreement A.4, Inside the
Premises–Robbery or Safe Burglary of Other Property and Insuring Agreement A.5,
Outside the Premises
a. Armored Motor
Vehicle Companies
If a written contract
provides for recovery from the armored vehicle company insurance, this policy
is excess insurance over the indemnity payments from that insurance.
b. Special Limit of
Insurance for Specified Property
The maximum amount
available in any one occurrence for loss of precious metals, precious or
semiprecious stones, pearls, furs or fur articles is $5,000. Fur includes
expensive minks or inexpensive rabbit. This includes articles, whether complete
or not, whose principal value is derived from the fur, precious metals or
precious stones. This limit also applies to manuscripts, drawings, or any kind
of records, the cost of reconstructing them or reproducing any information in
them.
Example: The Coat Company manufactures two nearly identical ladies’
jackets. The one trimmed with fur wholesales for $500. The one without fur trim
wholesales for $350. Since the fur trim amounts to only $150 of the value of
the $500 coat, it would not be subject to the limitation because the value of
the fur is less than half of the total value of the coat.
5. Conditions Applying to Insuring Agreement A.6, Computer Fraud
a. Special Limit of
Insurance for Specified Property
Property consisting of
manuscripts, drawings or records, including the cost of reconstruction or
reproduction is subject to a $5,000 limitation. There is no further limitation
on electronic records.
b. Territory
The policy territory is
worldwide.
F. DEFINITIONS
These definitions apply to all crime insuring agreements.
1. "Banking premises" refers to the interior of a bank or
a similar safe depository. Does it include the vestibule or entrance hall at
the bank where the ATM machine is located? At a main branch, does it extend to
the entire premises, including the securities division and the insurance
agency? Banking premises do not include a stock brokerage or other financial
institution, except a banking institution or similar safe depository. In the
current era of financial services reform, more combination financial
institutions may develop. The premises may house a bank branch in one area and
other functions, such as insurance, stocks and bonds sales and administration,
in other areas of the building. In that situation, would the entire financial
institution be classified as a bank? The policy language is not clear. The
interior of a bank may be best defined by the federal or state laws that apply
to the banking institution where the covered loss occurs.
The definition of "Client" is removed in the May 2006
edition.
2. "Counterfeit money" is a "money" imitation designed to deceive and be accepted as
real “money" (May 2006 change).
3. "Custodian" means the insured, including partners, “members”
or “employees” having custody of property INSIDE the premises. It does not mean
anyone acting as a “watchperson” or as a janitor. “Watchperson” is defined as
someone hired to watch. An employee working late and responsible for locking up
when leaving is not a “watchperson.” "Janitor" is not defined so a
person hired to perform duties such as cleaning or light maintenance would be
the common understanding of the term. A person acting as a janitor when a loss
occurs may merit serious attention and scrutiny when investigating the loss.
Example: An employee stays after work hours or comes in on Sunday
night to clean up the company conference room in advance of an important
meeting the next morning. Depending on the circumstances of a loss, the status of
that employee may affect coverage, since “janitor” is not a defined term.
4. "Discover" or "discovered" is when the named
insured has enough information so that a reasonable person would think that a
covered loss has occurred or will happen soon. There is no requirement as to
the time or place and it is not necessary to have specific details of the loss.
It also means the time when the named insured receives notice of a
claim, actual or potential, where the named insured is supposedly liable to
another party in such a manner that this insurance policy is expected to
respond.
The first paragraph is vague and is based on the "reasonable man
theory." When is there enough information to get the insurance company
involved? Since the discovery date affects coverage, this vagueness will
probably lead to legal actions and court decisions.
The second paragraph appears more precise than the first but even it is
vague because of use of the word "notice." There is no indication as
to what constitutes a "notice."
5. "Employee":
a. "Employees" ARE:
- Natural persons employed by the insured and for up to
30 days after termination of employment. This time period does not apply to any employee terminated due to
his or her dishonest acts (May 2006 addition). The person must be
compensated directly by salary, wages or commissions and the insured must
have the right to direct or control the activities of the person. The
difference between employees and independent contractors can be vague and
is somewhat fluid. Recent employment cases have scrutinized long-term
independent contracts to determine whether individuals are truly
independent or are de facto employees. Each situation is different and
requires expert legal advice to determine whether these persons should be
considered as employees or not.
Example: Kent fires employee Bob. On
Bob’s last day at work, Kent collects his keys and other items as Bob removes
his personal items. However, Bob made a duplicate key between the time he was
fired and his last day at work. He uses this key to steal merchandise from
Kent’s warehouse. Bob is an “employee” under the definition and Insuring
Agreement A.1 Employee Theft provides coverage for his actions.
- Temporary employees are “employees” if hired to meet
seasonal or short-term workloads or to substitute for permanent employees
on leave. Insurance coverage does not apply to temporary employees when
they have custody of property OUTSIDE the insured “premises.” They would
not be covered as a “messenger” or even when operating the outside cash
register during a sidewalk sale.
- Leased employees are “employees.” There must be a
written agreement between the insured and a labor-leasing firm or PEO for
the leased employee to perform duties related to the insured’s business. A
leased employee is not a temporary employee as described above.
- Trustees and officers are “employees.” Third-party
administrators or other independent contractors hired to administer
covered employee benefit plans are NOT “employees.” Directors or trustees
of covered employee benefit plans are considered employees when handling
“funds” and “other property” belonging to the plan. A pension plan
director may have administrative duties relating only to the plan but have
nothing else to do with the insured’s business. When carrying out those
administrative duties, the administrator is not an “employee.” Once the
administrator begins handling funds, he or she is an “employee” for the
purposes of this insurance.
- A former “employee,” "director,"
"partner," “member,” “manager,” representative or trustee used
as a consultant is an "employee."
- Guest students or interns pursuing studies or
performing duties are “employees,” unless they have care and custody of
the insured’s property outside the covered “premises.”
- "Employees"
of merged or consolidated entities are "employees," provided the
merger or consolidation occurred before the effective date of the current
policy (May 2006 addition).
- "Managers,"
directors or trustees are "employees" when performing duties
usual to those of an "employee" or when serving on a committee
at the request of the board of directors or board of trustees. A director
is not an "employee" when sitting in board meetings or doing
director tasks (May 2006 change). This change merely moves this from the
negative "employees are not" to the positive "employees
are, except."
b. "Employees" ARE NOT agents, brokers, factors,
commission merchants, consignees, independent contractors or other similar
parties and others not specifically
mentioned as employees (May 2006
change).
6. "Employee benefit plan" means any welfare or pension
plan subject to the Employee Retirement Income Security Act of 1974 (ERISA).
Insurable plans include defined benefit pension, target benefit, profit
sharing, 401(k), Keogh, Simplified Employee Pension (SEP) Plans, group health,
life, disability, unemployment and cafeteria (Section 125) plans and prepaid
legal services. Government plans such as Social Security are not included.
7. "Forgery" is the signing of someone else’s name with
the intent to deceive. However, “forgery” does not apply when the insured or an
employee signs something for which he or she has no signature authority.
8. "Fraudulent instruction" means any of three different
things:
·
An electronic, telegraphic, cable, teletype,
telefacsimile or telephone instruction supposedly transmitted by the insured
but actually transmitted by someone else without the insured’s knowledge;
·
A written instruction issued by the insured forged or
altered by someone without the insured’s knowledge or consent; or
·
An electronic, telegraphic, cable, teletype, fax,
telephone or written instruction initially received by the insured, supposedly
transmitted by an employee, but sent by someone else without the insured’s or
the employee’s knowledge or consent.
9. "Funds" are “money” and “securities” and are usually
associated with an “employee benefit plan.”
10. "Manager" is a person who is a director of a limited
liability company. “Manager” is not the typical “employee” with supervisory responsibilities.
That person would be considered an “employee.”
11. "Member" is an owner of a limited liability company.
A “member” may also be a “manager.”
12. "Messenger" includes the insured, the insured’s
relatives, partners, “members” or any “employee” having care and custody of the
property outside the “premises.” If the named insured is either an individual
or a partnership, a relative is considered a “messenger” when having custody of
property outside the “premises.” If the business is a corporation, it does not
have relatives. However, the president’s spouse as well as the spouse of a
rank-and-file employee could be considered a “messenger.”
13. "Money" is currency, coin or bank notes in current
use with a face value. “Money” also means traveler’s checks, register checks
and money orders held for sale. Register checks are no longer used in the
banking industry but the term remains. Cashier’s checks are NOT considered
money.
14. "Occurrence:"
This definition is significantly expanded in the May 2006 edition. The
coverage intent is the same but wording has been added to clarify the intent
due to ambiguities cited in Auto Lenders Acceptance Corporation v. Gentilini
Ford, Inc. 181 N.J. 245, 854 A 2.d 378 2004. The major change is that the
emphasis is on the individual committing the act instead of the act itself. The
defined occurrence must take place during the policy period or in the period
defined in Condition E.1.k or Condition E.1.l.
Under Insuring Agreement
A.1, Employee Theft, an act or acts committed
by an employee acting alone or with other persons is an occurrence. The act or
acts can be by an individual, the combined total of several related or
unrelated acts or a series of related or unrelated acts.
Examples: Five employees work together to skim money at different
times and by different means from their company’s accounts. This is considered
to be a single occurrence. Five employees who do not know of each other’s plans
or what they are doing skim money at different times and by different means
from their company’s accounts. This is considered to be five different
occurrences.
Under Insuring Agreement
A.2, Forgery or Alteration, forgery of
one or more instruments committed by
a person acting alone or with other persons is an occurrence. The act or acts
can be by an individual, the combined total of several related or unrelated
acts or a series of related or unrelated acts.
Under all other insuring
agreements, an act or acts committed by
a person acting alone or with other persons is an occurrence. The act or acts
can be by an individual, the combined total of several related or unrelated
acts or a series of related or unrelated acts. This also includes an act or
acts not committed by ANY person.
Example: A theft ring is never identified but evidence shows they
have been at work in the insured’s plant for five months and have stolen
hundreds of different products. This constitutes one occurrence.
15. "Other property" must have intrinsic or inherent
value, cannot be “money” or “securities” and must not be property otherwise
excluded. It does not include computer
programs, electronic data or specifically excluded property (May 2006
addition).
16. "Premises" is the interior PORTION of the building
occupied by the insured and used to conduct its business. What portion of the
building is occupied when the insured is a tenant in a mall with an interior
corridor or the insured operates with a pushcart or kiosk in the mall? What
about the storage locker located in a separate part of the mall? The lease
would be the starting point to determine the meaning of "premises" in
these situations.
17. "Robbery" is the unlawful taking of covered property
from someone having custody of it and where actual bodily harm or threat of
bodily harm is involved. It can also be an obviously unlawful act witnessed by
the person having custody of the covered property.
Example: A customer in a store is observed shoplifting at the end
of the aisle and security is called. Until and unless that customer threatens
or harms an employee, a robbery has not taken place.
Example: An employee is taking a package of product from one store
to another. When the employee is stopped at a stop sign, a pedestrian reaches
into the vehicle and steals the package. This is a robbery because the employee
witnessed it being removed.
18. "Safe burglary" must show evidence of forcible entry
into or the removal of the entire safe or vault from the premises.
19. "Securities" includes negotiable and nonnegotiable
instruments that represent “money” or property. Some "securities" may
represent commodities, such as grain or coal. “Securities” also includes
tokens, tickets, revenue and other stamps, including stamps in a postage meter.
“Securities” can also be evidence of debt related to credit or charge cards but
only if the evidence of debt is against a card not issued to the insured.
20. "Theft" is the unlawful taking of any covered
property. The theft must be to the deprivation or loss of the insured. 21. "Transfer account" is an
account maintained by the insured at a financial institution from which funds
may be transferred, paid or delivered by means of electronic, telegraphic,
cable, teletype, telephone or fax instructions. This is done through an
electronic funds transfer system or by written instructions that permit certain
types of electronic transfers to be completed.
22. "Watchperson" is a person retained specifically to
have care and custody of property INSIDE the “premises” and having no other
duties. If the insured hires a watchperson who also patrols the grounds, this
person does not meet the definitions of “watchperson” for the purposes of this
insurance.