Property and Casualty Coverage and Claims
This domain tests coverage triggers and claim mechanics in property and casualty lines, including Idaho claim-handling standards.
Property coverage
- Homeowners and dwelling forms cover named perils such as fire, lightning, wind, and hail; flood, earth movement, and ordinary maintenance are excluded. Ordinance-or-law, debris removal, and mold coverage are limited or endorsement-driven.
- Commercial property adds building, business personal property, business income/extra expense, and spoilage. Reporting forms and coinsurance change the limit calculation.
- Valuation: replacement cost, ACV, and functional replacement; depreciation, betterment, and salvage affect the net payment.
Liability and casualty
- CGL uses an occurrence trigger: bodily injury or property damage during the policy period. Additional insured endorsements, contractual liability, auto, and Idaho workers' compensation interact.
- The duty to defend is broader than the duty to indemnify; a reservation of rights preserves coverage defenses.
Claims and Idaho standards
- Idaho's unfair claim settlement practices law (Idaho Code § 41-1329) prohibits misrepresenting policy provisions, unreasonable delay, and failing to conduct a reasonable investigation. Idaho Code § 41-1839 can shift attorney fees when an insurer denies a claim without reasonable cause.
Worked example
A burst pipe closes a restaurant for three weeks. The insurer pays building damage but denies business income because the books are disorganized. The adjuster should reconstruct revenue, payroll, and period of restoration. A blanket denial without analysis conflicts with the duty to investigate and gives the insured a basis to challenge the denial and seek fees under § 41-1839.
Traps
- Calling flood damage a wind claim; the peril that caused the loss controls.
- Missing sublimits for ordinance-or-law, debris removal, and business income.
- Assuming the duty to defend ends when the insurer reserves rights.