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CHAPTER ONE．NATURE OF INSURANCE 1

A．Functional Definition—Contihued 1

1．Risk—Distribution 2

2．Substantial Membership 3

3．Insurer Primarily in the Business of Insur-ance 4

4．Insurer as Underwriter 5

5．Functions of an Insurer 5

B．Types of Insurance—Contihued 6

1．Life Insurance 7

a．Whole-Life Insurance 7

b．Term Life Insurance 8

c．Endowment Life Insurance 10

d．Industrial Life Insurance 11

e．Mutual Life Insurance 12

f．Group Insurance 13

i．Generally 13

ii．Types of Insurance 13

iii．Contributory U.Non-contributory 15

iv．Aduerse Selection 15

v．Agency of the Representatiue 16

B．Types of Insurance—Continued 18

vi．Consent of Members to Amend-ment or Termination 18

vii．Notice to Members 18

viii．Assignment and Change of Bene-ficiary 19

ix．Standing to Sue on the Policy 19

x．Conflict of Law 20

g．Universal Life Insurance 20

i．Generally 20

ii．Interest Rate 21

iii．Premium 21

iv．Proceeds 22

v．Loans and Withdrawals 23

h．Annuities 24

i．Tort Liability of Insurance Companies 24

2．Fire and Casualty Insurance 29

a．Fire Insurance 29

b．Casualty Insurance 30

3．Marine and Inland Marine Insurance 31

a．Marine Insurance 31

b．Inland Marine Insurance 32

i．Origin 32

ii．Personal Property Floater Poli-cies 33

（a）Definition 33

（b）Personal Property Floa-ter Policies 33

（c）Business Floater Policies 34

4．Health and Disability Insurance 35

a．Health Insurance 35

B．Types of Insurance—Continued 35

i．Generally 35

ii．Methods of Offering Health In-surance 36

（a）Service Benefit Plans 36

（b）Indemnity Insurance 37

（c）Independent or Self-In-sured Plans 38

（d）Hybrid Plans 38

iii．Limitations in Health Insurance Coverage 39

（a）Pre-existing Conditions 39

（b）Mental Health Excep-tions 40

（c）Requirement of Medical Necessity 40

iv．Construing Health Insurance Contracts 41

b．Disability Insurance 42

5．Liability Insurance 43

a．Generally 43

b．Commercial General Liability Policies 43

i．Generally 43

ii．Exclusions 44

（a）Generally 44

（b）"Work Product"Exclu-sion 44

（c）Pollution Exclusion 48

6．Title Insurance 51

a．General 51

b．Exclusions 52

B．Types of Insurance—Continued 53

c．Damages 53

d．Duty to Defend 54

e．Successors in Interest 54

C．No-Fault Compensation 55

D．Uninsured and Underinsured Motorist Coverage 62

1．Generally 62

2．Uninsured Motorist(UM)Coverage 62

3．Underinsured Motorist Coverage(UIM) 63

4．"Stacking"of Uninsured or Underin-sured Coverage 64

E．Oral Contracts 66

F．Written Binders 67

G．Premiums 68

1．Net Premium 69

2．Loading 71

H．Reserve Fund 71

I．Surplus 73

J．Surrender Value 73

K．Cancellation of an Insurance Policy 74

Chapter Two．Insurable Interest 77

A．General 77

B．Historical Development 77

C．Purposes 80

D．Distinction Between Property and Life In-surance 81

E．Insurable Interest in Relation to Property Insurance 82

1．Definition 82

2．Legal Interest v.Factual Expectancy 82

E．Insurable Interest in Relation to Property Insurance—Continueda．Origin 82

b．Early Case Law 85

i．Legal Title 87

ii．Equitable Title 88

iii．Possessory Interest 88

iv．Creditor's Interests 88

v．Future Interests in Property 89

vi．Representative's Interest 89

vii．Stockholder's Interest in Corpo-rate Property 90

viii．Liability Interest 90

c．Current Case Law 90

3．When Insurable Interest Must Exist 92

F．Insurable Interest in Relation to Life In-surance 94

1．Insurance on One's Own Life 95

2．Insurance on the Life of Another 96

a．Family Relationships 96

b．Contractual Relationship 98

3．When Insurable Interest Must Exist 99

4．Assignment of a Life Insurance Policy 100

5．Consent of the Insured 102

6．Industrial Life Insurance 102

G．Standing to Raise Defense of Insurable Interest 103

H．Counter-Defenses to the Insurable Inter-est Doctrine 104

1．Waiver and Estoppel 104

Chapter Three．Definition of Risks 106

A．Unlawful Contracts 106

A．Unlawful Contracts—Continued 106

1．Policies in Violation of Statute 106

2．Policies in Violation of Public Policy 107

3．Policies Related to Unlawful Activity 108

a．Insurance on Property Relat-ing to Unlawful Activity 108

b．Life Insurance on Individuals Involved in Unlawful Activi-ty 109

i．Death as a Result of Unlawful Activity 109

ii．Death by Execution 111

iii．Suicide 112

c．Punitive Damages 114

i．Class of Cases 114

ii．Public Policy 115

iii．Vicarious Liability 117

iv．Uninsured Motorist Coverage 118

B．Implied Exception for Intentional Conduct 119

1．Generally 119

2．Fortuitous Element 122

3．Express Exclusion for Intentional Conduct 122

4．Intentional Conduct Leading to an Unintended Result 123

5．Highly Expectable Losses 125

C．Implied Exception for Normal Wear and Tear or Inherent Defect 126

D．Implied Exception for Friendly Fire 126

E．Definition of"Accident" 128

F．All Rusk v.Specified Risk 131

G．Reasonable Expectations Rule 133

Chapter Four．Persons Insured 138

A．Definition of Insured 138

B．Identification of the Insured 139

1．"Does Insure"Clause 139

2．Endorsement 140

3．Omnibus Clause 140

4．Beneficiaries Under Life Insurance Policies 144

a．Designation of Beneficiaries 144

b．Interest of the Beneficiary 145

i．Irrevocable Beneficiary 145

ii．Revocable Beneficiary 146

c．Common Disaster Clause 147

d．Beneficiary Who Predeceases the Insured 148

e．Effect of Divorce 149

f．Creditors as Beneficiaries and Assignees 149

g．Community Property 150

h．Disqualification for Murder 151

i．Facility of Payments Clausec 152

j．Change of Beneficiary 153

k．Standing to Contest Change of Beneficiary 155

C．Assignments 156

1．Chose in Action 156

2．Entire Policy 157

a．Property Insurance 158

b．Life Insurance 159

D．Reinstatement of Lapsed Policy 163

1．Generally 163

D．Reinstatement of Lapsed Policy—Contin-ued 164

2．Incontestability Clause 164

3．Time of Reinstatement 165

E．Special Problems of Vendor/Vendee of Re-alty 165

F．Special Problems of Mortgagor/Mortgagee 168

G．Special Problems of Life Tenant/Remain-derman 171

H．Third Party Interests in Liability Insur-ance 173

I．Tort Immunity 176

Chapter Five．Procedure for Filing Claims 178

A．Generally 178

B．Notice of Loss 178

C．Proof of Loss 179

D．Timeliness for Filing Actions 182

E．Cooperation of the Insured 183

F．Appraisal 184

G．Subsequent Damage 184

H．No-Action Clauses 185

I．Direct Action Statutes 186

Chapter Six．Defenses of the Insurer 188

A．Generally 188

B．Concealment 188

C．Misrepresentations 192

1．Definition 192

2．Avoidance of the Policy 193

3．Materiality 193

4．Reliance 195

C．Misrepresentations—Continued 196

5．Obligation of Insured to Correct Rep-resentations 196

6．Interpretation of Representations 197

7．Belief or Opinion 197

8．Return of Premiums 199

9．Representations by Agents 200

10．Assignee of the Insured 200

11．Renewsl of a Policy 200

D．Warranties and Conditions 201

1．Definition 201

2．Affirmative or Promissory Warranty 203

3．Court Interpretation 203

4．Statutes Protective of Insureds 205

E．Limitations on Coverage 208

1．Types of Limitations 208

2．Comparison With Warranties and Conditions 210

3．Distinguishing Between Warran-ties/Conditions and Limitations on Coverage 211

F．Incontestability Clause 213

Insured's Duty of Cooperation 219

Chapter Seven．Waiver and Estoppel 223

Ⅰ．GENERALLY 224

Ⅱ．WAIVER 224

A．Definition 224

B．Methods of Communicating Waiver 225

1．Express Waiver 225

2．Implied Waiver 226

C．Limitations on Waiver 227

1．Public Interest 227

2．Parol Evidence Rule 228

3．Consideration 228

4．Limitation in Regard to Facts 229

5．Limitation as to Coverage 230

6．Policy Limitations on Waiver 230

Ⅲ．ESTOPPEL 231

A．Definition 231

B．Limitation as to Coverage 232

C．Parol Evidence Rule 232

D．Limitation to Facts 233

E．Common Instances of Estoppel 233

Chapter Eight．Measure of Recovery 237

A．Generally 237

1．Articles of Commerce 237

2．Unique Property 238

a．Reproduction Cost Less De-preciation 238

b．Market Value 240

i．Income Producing Property 240

ii．Non-income-producing Property 240

c．Obsolescence 241

d．Combination of Factors 242

e．Election to Replace 243

B．Coinsurance 243

C．"Other Insurance"Clauses 247

1．Generally 247

2．Conflicts Between"Other Insurance"Clauses 248

C．"Other Insurance"Clause—Continued 249

3．Rights of Contribution Among Insur-ers 249

D．Valued Policies 250

E．Appraisal Clauses 253

Chapter Nine．Insurer's Duty to Defend 257

A．Generally 257

B．Situations Affecting the Duty to Defend 257

1．Ambiguous Claims 257

2．Alternative Claims by a Third Party 258

3．Multiple Causes of Action 259

4．Untrue Statement of Facts in the Complaint 260

5．Unnecessary Allegations 261

C．Discharge of Duty to Defend by Payment of Proceeds 262

D．Remedies Available to Insured for Failure to Defend 263

E．Remedies for Breach of Duty of Care 265

F．Remedies for Untimely Withdrawal of In-surer 265

G．Methods of Self-Protection for the Insurer 266

1．Declaratory Judgment Action 266

2．Nonwaiver Agreement 266

3．Reservation of Rights Notice 268

H．Insurer's Control of the Defense 269

1．Generally 269

2．Conflicts of Interest Affecting Insur-er's Right to Control 270

I． Multiple Coverage 271

J．Duty in Regard to Appeal 272

K．Duty in Regard to Settlement 273

1．Court-Created Duty 273

L．Assignment of Claims Against Insurer 274

M．Conflict of Interest in Counsel 274

Chapter Ten．Subrogation 282

A．Definition 282

B．Rationale 284

C．Application of Subrogation to Lines of In-surance 285

1．Property Insurance 285

2．Liability Insurance 285

3．Life and Accident Insurance 285

a．Life Insurance 285

b．Accident Insurance 287

4．Medical,Surgical,and Hospitalization Insurance 287

5．Casualty Insurance 289

6．Workmen's Compensation 289

D．Remedies 290

1．Against a Third Party 290

2．Against the Insured 291

a．Prior to Payment of Proceeds 291

b．After Payment of Proceeds 291

E．Division of Fund Recovered From Third Party 293

F．Defense to Subrogation 293

1．"Volunteer"Defense 293

2．Defense of Insured 295

G．Real Party in Interest 295

1．Procedural Rule 295

2．Loan Receipts 296

H．Conventional Subrogation 297

Chapter Eleven．Bad Faith Causes of Action 299

A．Generally 299

B．Third-Party Claims 300

1．Context 300

2．Development of the Cause of Action 301

a．Early Case Law 301

b．California Origin ofthe Cause of Action 302

i．Balancing the Interests of In-sured and Insurer 302

ii．Selection of a Standard 303

iii．Criteria for Determining Bad Faith 305

c．The Negligence Standard 306

d．Strict Liability Standard 307

3．Contract v.Tort 309

4．Assignment of Cause of Action 309

5．Excess Insurer 311

6．Remedies 314

7．Insolvency of the Insured 315

8．Release 316

C．First-Party Insurance 317

1．Generally 317

2．History 317

3．Majority View 319

4．Minority View 319

5．Standard of Proof 319

6．Defenses 322

7．Statute of Limitations 322

8．Remedies 323

C．Frist-Party Insuranoe—Continued 323

a．Policy Proceeds 323

b．Emotional Distress 323

c．Economic Harm 324

d．Punitive Damages 324

e．Attorney's Fees 326

9．Subrogation 328

D．Reciprocal Causes of Action 329

1．Comparative Bad Faith 330

Chapter Twelve．Reinsurance 332

A．Generally 332

B．Insurable Interest 333

C．Statute of Frauds 334

D．Indemnity v.Liability Insurance 334

E．Defenses of the Reinsurer 335

F．Rights of the Original Insured Against the Reinsurer 337

CHAPTER THIRTEEN．Bonds 339

A．Principal/Surety Relationship 339

1．In General 339

2．Non-commercial Suretyship Distin-guished 340

3．Rights of the Obligee 340

4．Rights of the Surety 342

5．Defenses of the Surety 343

6．Co-sureties 345

B．Bonds Generally 345

1．Generally 345

2．Requirements for a Valid Bond 346

3．Categories of Bonds 347

B．Bonds Generally—Continued 348

4．Construing Bonds 348

5．Liability Under the Bond 349

6．Termination of Obligations Under the Bond 349

C．Types of Bonds 350

1．Construction-Related Bonds 350

a．Bid Bonds 350

b．Performance Bonds 352

c．Payment Bonds(Miller Act Requirements) 355

2．Fidelity Bonds 359

a．Generally 359

b．Coverage Under the Fidelity Bond 360

i．Parties Covered Under the Fidel-ity Bond 360

ii．Risks Covered Under the Fidelity Bond 361

iii．Timing of Loss 361

iv．Notice of Loss 362

c．Litigation on the Bond 363

d．Subrogation 364

e．Third Party Claims Against the Surety 364

f．Termination of the Bond 365

3．Pubic Official Bonds 365

4．License and Permit Bonds 367

Chapter Fourteen．Regulation of Insur-ance 368

Ⅰ．GENERAL 372

Ⅱ．HISTORY 372

Ⅲ．LEGISLATIVE REGULATION 372

A．Generally 372

B．Rating Legislation 372

1．Generally 372

2．Discrimination 374

C．Regulation of Unfair Competition 375

D．Current Legislation 376

1．Pro Repeal of the McCarran-Ferguson Act 377

2．Against Repeal of the McCarran-Fer-guson Act 378

E．Regulation of Unauthorized Insurers 380

Ⅳ．METHODS OF STATUTORY REGULATION 380

A．Licensing 380

B．Standard Form Requirements 381

C．Annual Statements 382

D．Bankruptcy Provisions 382

E．Penalty Statutes 382

INDEx 385