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MI Claims Adjuster: Casualty Insurance Basics

MI Claims Adjuster · Work through your exam, one topic at a time.

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Casualty Insurance Basics

Liability coverage structure

Casualty coverage responds to the insured's legal liability for bodily injury, property damage, and personal and advertising injury. The commercial general liability (CGL) form splits into Coverage A (bodily injury and property damage), Coverage B (personal and advertising injury), and Coverage C (medical payments - commonly $5,000 per person, paid without a fault determination). Limits are per occurrence, with a general aggregate and a separate products-completed operations aggregate; damage to premises rented to you and medical expense carry their own sublimits.

Occurrence versus claims-made

  • Occurrence: the policy in force when the injury or damage happens responds, however late the claim arrives.
  • Claims-made: the policy in force when the claim is made responds, if the act occurred after the retroactive date and was reported during the policy period or an extended reporting period.

Relationships that decide who pays

Additional insured endorsements, certificates of insurance (evidence only, not coverage), primary and noncontributory wording, and umbrella/excess layers. In Michigan comparative fault is modified: a claimant 50% or more at fault recovers nothing, and below that line damages are reduced by the claimant's percentage. Employers' liability sits beside workers' compensation to cover suits outside the exclusive remedy.

Worked example

A delivery driver injures a customer in 2022 and suit is filed in 2024. Under an occurrence CGL, the 2022 policy defends and indemnifies. Under a claims-made policy with a 2020 retroactive date and no extended reporting period, the 2024 claim is late and uncovered.

Traps

Confusing aggregate with per-occurrence limits; treating a certificate as proof of coverage; missing the expected-or-intended and contractual liability exclusions; assuming the insurer owes indemnity when it owes only a defense.