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CHAPTER ONE．NATURE OF INSURANCE1

A．Functional Definition—Contihued1

1．Risk—Distribution2

2．Substantial Membership3

3．Insurer Primarily in the Business of Insur-ance4

4．Insurer as Underwriter5

5．Functions of an Insurer5

B．Types of Insurance—Contihued6

1．Life Insurance7

a．Whole-Life Insurance7

b．Term Life Insurance8

c．Endowment Life Insurance10

d．Industrial Life Insurance11

e．Mutual Life Insurance12

f．Group Insurance13

i．Generally13

ii．Types of Insurance13

iii．Contributory U.Non-contributory15

iv．Aduerse Selection15

v．Agency of the Representatiue16

B．Types of Insurance—Continued18

vi．Consent of Members to Amend-ment or Termination18

vii．Notice to Members18

viii．Assignment and Change of Bene-ficiary19

ix．Standing to Sue on the Policy19

x．Conflict of Law20

g．Universal Life Insurance20

i．Generally20

ii．Interest Rate21

iii．Premium21

iv．Proceeds22

v．Loans and Withdrawals23

h．Annuities24

i．Tort Liability of Insurance Companies24

2．Fire and Casualty Insurance29

a．Fire Insurance29

b．Casualty Insurance30

3．Marine and Inland Marine Insurance31

a．Marine Insurance31

b．Inland Marine Insurance32

i．Origin32

ii．Personal Property Floater Poli-cies33

（a）Definition33

（b）Personal Property Floa-ter Policies33

（c）Business Floater Policies34

4．Health and Disability Insurance35

a．Health Insurance35

B．Types of Insurance—Continued35

i．Generally35

ii．Methods of Offering Health In-surance36

（a）Service Benefit Plans36

（b）Indemnity Insurance37

（c）Independent or Self-In-sured Plans38

（d）Hybrid Plans38

iii．Limitations in Health Insurance Coverage39

（a）Pre-existing Conditions39

（b）Mental Health Excep-tions40

（c）Requirement of Medical Necessity40

iv．Construing Health Insurance Contracts41

b．Disability Insurance42

5．Liability Insurance43

a．Generally43

b．Commercial General Liability Policies43

i．Generally43

ii．Exclusions44

（a）Generally44

（b）"Work Product"Exclu-sion44

（c）Pollution Exclusion48

6．Title Insurance51

a．General51

b．Exclusions52

B．Types of Insurance—Continued53

c．Damages53

d．Duty to Defend54

e．Successors in Interest54

C．No-Fault Compensation55

D．Uninsured and Underinsured Motorist Coverage62

1．Generally62

2．Uninsured Motorist(UM)Coverage62

3．Underinsured Motorist Coverage(UIM)63

4．"Stacking"of Uninsured or Underin-sured Coverage64

E．Oral Contracts66

F．Written Binders67

G．Premiums68

1．Net Premium69

2．Loading71

H．Reserve Fund71

I．Surplus73

J．Surrender Value73

K．Cancellation of an Insurance Policy74

Chapter Two．Insurable Interest77

A．General77

B．Historical Development77

C．Purposes80

D．Distinction Between Property and Life In-surance81

E．Insurable Interest in Relation to Property Insurance82

1．Definition82

2．Legal Interest v.Factual Expectancy82

E．Insurable Interest in Relation to Property Insurance—Continueda．Origin82

b．Early Case Law85

i．Legal Title87

ii．Equitable Title88

iii．Possessory Interest88

iv．Creditor's Interests88

v．Future Interests in Property89

vi．Representative's Interest89

vii．Stockholder's Interest in Corpo-rate Property90

viii．Liability Interest90

c．Current Case Law90

3．When Insurable Interest Must Exist92

F．Insurable Interest in Relation to Life In-surance94

1．Insurance on One's Own Life95

2．Insurance on the Life of Another96

a．Family Relationships96

b．Contractual Relationship98

3．When Insurable Interest Must Exist99

4．Assignment of a Life Insurance Policy100

5．Consent of the Insured102

6．Industrial Life Insurance102

G．Standing to Raise Defense of Insurable Interest103

H．Counter-Defenses to the Insurable Inter-est Doctrine104

1．Waiver and Estoppel104

Chapter Three．Definition of Risks106

A．Unlawful Contracts106

A．Unlawful Contracts—Continued106

1．Policies in Violation of Statute106

2．Policies in Violation of Public Policy107

3．Policies Related to Unlawful Activity108

a．Insurance on Property Relat-ing to Unlawful Activity108

b．Life Insurance on Individuals Involved in Unlawful Activi-ty109

i．Death as a Result of Unlawful Activity109

ii．Death by Execution111

iii．Suicide112

c．Punitive Damages114

i．Class of Cases114

ii．Public Policy115

iii．Vicarious Liability117

iv．Uninsured Motorist Coverage118

B．Implied Exception for Intentional Conduct119

1．Generally119

2．Fortuitous Element122

3．Express Exclusion for Intentional Conduct122

4．Intentional Conduct Leading to an Unintended Result123

5．Highly Expectable Losses125

C．Implied Exception for Normal Wear and Tear or Inherent Defect126

D．Implied Exception for Friendly Fire126

E．Definition of"Accident"128

F．All Rusk v.Specified Risk131

G．Reasonable Expectations Rule133

Chapter Four．Persons Insured138

A．Definition of Insured138

B．Identification of the Insured139

1．"Does Insure"Clause139

2．Endorsement140

3．Omnibus Clause140

4．Beneficiaries Under Life Insurance Policies144

a．Designation of Beneficiaries144

b．Interest of the Beneficiary145

i．Irrevocable Beneficiary145

ii．Revocable Beneficiary146

c．Common Disaster Clause147

d．Beneficiary Who Predeceases the Insured148

e．Effect of Divorce149

f．Creditors as Beneficiaries and Assignees149

g．Community Property150

h．Disqualification for Murder151

i．Facility of Payments Clausec152

j．Change of Beneficiary153

k．Standing to Contest Change of Beneficiary155

C．Assignments156

1．Chose in Action156

2．Entire Policy157

a．Property Insurance158

b．Life Insurance159

D．Reinstatement of Lapsed Policy163

1．Generally163

D．Reinstatement of Lapsed Policy—Contin-ued164

2．Incontestability Clause164

3．Time of Reinstatement165

E．Special Problems of Vendor/Vendee of Re-alty165

F．Special Problems of Mortgagor/Mortgagee168

G．Special Problems of Life Tenant/Remain-derman171

H．Third Party Interests in Liability Insur-ance173

I．Tort Immunity176

Chapter Five．Procedure for Filing Claims178

A．Generally178

B．Notice of Loss178

C．Proof of Loss179

D．Timeliness for Filing Actions182

E．Cooperation of the Insured183

F．Appraisal184

G．Subsequent Damage184

H．No-Action Clauses185

I．Direct Action Statutes186

Chapter Six．Defenses of the Insurer188

A．Generally188

B．Concealment188

C．Misrepresentations192

1．Definition192

2．Avoidance of the Policy193

3．Materiality193

4．Reliance195

C．Misrepresentations—Continued196

5．Obligation of Insured to Correct Rep-resentations196

6．Interpretation of Representations197

7．Belief or Opinion197

8．Return of Premiums199

9．Representations by Agents200

10．Assignee of the Insured200

11．Renewsl of a Policy200

D．Warranties and Conditions201

1．Definition201

2．Affirmative or Promissory Warranty203

3．Court Interpretation203

4．Statutes Protective of Insureds205

E．Limitations on Coverage208

1．Types of Limitations208

2．Comparison With Warranties and Conditions210

3．Distinguishing Between Warran-ties/Conditions and Limitations on Coverage211

F．Incontestability Clause213

Insured's Duty of Cooperation219

Chapter Seven．Waiver and Estoppel223

Ⅰ．GENERALLY224

Ⅱ．WAIVER224

A．Definition224

B．Methods of Communicating Waiver225

1．Express Waiver225

2．Implied Waiver226

C．Limitations on Waiver227

1．Public Interest227

2．Parol Evidence Rule228

3．Consideration228

4．Limitation in Regard to Facts229

5．Limitation as to Coverage230

6．Policy Limitations on Waiver230

Ⅲ．ESTOPPEL231

A．Definition231

B．Limitation as to Coverage232

C．Parol Evidence Rule232

D．Limitation to Facts233

E．Common Instances of Estoppel233

Chapter Eight．Measure of Recovery237

A．Generally237

1．Articles of Commerce237

2．Unique Property238

a．Reproduction Cost Less De-preciation238

b．Market Value240

i．Income Producing Property240

ii．Non-income-producing Property240

c．Obsolescence241

d．Combination of Factors242

e．Election to Replace243

B．Coinsurance243

C．"Other Insurance"Clauses247

1．Generally247

2．Conflicts Between"Other Insurance"Clauses248

C．"Other Insurance"Clause—Continued249

3．Rights of Contribution Among Insur-ers249

D．Valued Policies250

E．Appraisal Clauses253

Chapter Nine．Insurer's Duty to Defend257

A．Generally257

B．Situations Affecting the Duty to Defend257

1．Ambiguous Claims257

2．Alternative Claims by a Third Party258

3．Multiple Causes of Action259

4．Untrue Statement of Facts in the Complaint260

5．Unnecessary Allegations261

C．Discharge of Duty to Defend by Payment of Proceeds262

D．Remedies Available to Insured for Failure to Defend263

E．Remedies for Breach of Duty of Care265

F．Remedies for Untimely Withdrawal of In-surer265

G．Methods of Self-Protection for the Insurer266

1．Declaratory Judgment Action266

2．Nonwaiver Agreement266

3．Reservation of Rights Notice268

H．Insurer's Control of the Defense269

1．Generally269

2．Conflicts of Interest Affecting Insur-er's Right to Control270

I． Multiple Coverage271

J．Duty in Regard to Appeal272

K．Duty in Regard to Settlement273

1．Court-Created Duty273

L．Assignment of Claims Against Insurer274

M．Conflict of Interest in Counsel274

Chapter Ten．Subrogation282

A．Definition282

B．Rationale284

C．Application of Subrogation to Lines of In-surance285

1．Property Insurance285

2．Liability Insurance285

3．Life and Accident Insurance285

a．Life Insurance285

b．Accident Insurance287

4．Medical,Surgical,and Hospitalization Insurance287

5．Casualty Insurance289

6．Workmen's Compensation289

D．Remedies290

1．Against a Third Party290

2．Against the Insured291

a．Prior to Payment of Proceeds291

b．After Payment of Proceeds291

E．Division of Fund Recovered From Third Party293

F．Defense to Subrogation293

1．"Volunteer"Defense293

2．Defense of Insured295

G．Real Party in Interest295

1．Procedural Rule295

2．Loan Receipts296

H．Conventional Subrogation297

Chapter Eleven．Bad Faith Causes of Action299

A．Generally299

B．Third-Party Claims300

1．Context300

2．Development of the Cause of Action301

a．Early Case Law301

b．California Origin ofthe Cause of Action302

i．Balancing the Interests of In-sured and Insurer302

ii．Selection of a Standard303

iii．Criteria for Determining Bad Faith305

c．The Negligence Standard306

d．Strict Liability Standard307

3．Contract v.Tort309

4．Assignment of Cause of Action309

5．Excess Insurer311

6．Remedies314

7．Insolvency of the Insured315

8．Release316

C．First-Party Insurance317

1．Generally317

2．History317

3．Majority View319

4．Minority View319

5．Standard of Proof319

6．Defenses322

7．Statute of Limitations322

8．Remedies323

C．Frist-Party Insuranoe—Continued323

a．Policy Proceeds323

b．Emotional Distress323

c．Economic Harm324

d．Punitive Damages324

e．Attorney's Fees326

9．Subrogation328

D．Reciprocal Causes of Action329

1．Comparative Bad Faith330

Chapter Twelve．Reinsurance332

A．Generally332

B．Insurable Interest333

C．Statute of Frauds334

D．Indemnity v.Liability Insurance334

E．Defenses of the Reinsurer335

F．Rights of the Original Insured Against the Reinsurer337

CHAPTER THIRTEEN．Bonds339

A．Principal/Surety Relationship339

1．In General339

2．Non-commercial Suretyship Distin-guished340

3．Rights of the Obligee340

4．Rights of the Surety342

5．Defenses of the Surety343

6．Co-sureties345

B．Bonds Generally345

1．Generally345

2．Requirements for a Valid Bond346

3．Categories of Bonds347

B．Bonds Generally—Continued348

4．Construing Bonds348

5．Liability Under the Bond349

6．Termination of Obligations Under the Bond349

C．Types of Bonds350

1．Construction-Related Bonds350

a．Bid Bonds350

b．Performance Bonds352

c．Payment Bonds(Miller Act Requirements)355

2．Fidelity Bonds359

a．Generally359

b．Coverage Under the Fidelity Bond360

i．Parties Covered Under the Fidel-ity Bond360

ii．Risks Covered Under the Fidelity Bond361

iii．Timing of Loss361

iv．Notice of Loss362

c．Litigation on the Bond363

d．Subrogation364

e．Third Party Claims Against the Surety364

f．Termination of the Bond365

3．Pubic Official Bonds365

4．License and Permit Bonds367

Chapter Fourteen．Regulation of Insur-ance368

Ⅰ．GENERAL372

Ⅱ．HISTORY372

Ⅲ．LEGISLATIVE REGULATION372

A．Generally372

B．Rating Legislation372

1．Generally372

2．Discrimination374

C．Regulation of Unfair Competition375

D．Current Legislation376

1．Pro Repeal of the McCarran-Ferguson Act377

2．Against Repeal of the McCarran-Fer-guson Act378

E．Regulation of Unauthorized Insurers380

Ⅳ．METHODS OF STATUTORY REGULATION380

A．Licensing380

B．Standard Form Requirements381

C．Annual Statements382

D．Bankruptcy Provisions382

E．Penalty Statutes382

INDEx385