G-121500-D-(04-08)-Common-Policy-Conditions.pdf

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HEALTHCARE PROVIDERS

PROFESSIONAL LIABILITY INSURANCE

COM

MON POLICY CONDITIONS

We are the stock insurance company designated on the certificate of insurance. In consideration of the premium

charged, and in reliance upon all statements made and information furnished to us, and subject to the provisions of

this policy, we agree with you as follows:

I. TERMS AND CONDITIONS

The terms and conditions of each Coverage Part apply only to that Coverage Part and shall not apply to any

other Coverage Part. If any provision in the Common Policy Conditions is inconsistent or in conflict with the

terms and conditions of any Coverage Part, the terms and conditions of such Coverage Part shall control for

purposes of that Coverage Part.

II. DUTIES AS THE FIRST NAMED INSURED ON THE CERTIFICATE OF INSURANCE

The first named insured, on behalf of all of you, will be:

A. authorized to make changes in the terms of this policy with our consent;

B. the payee of any premiums we refund;

C. responsible for:

1. the payment of all premiums due;

2. keeping records of the information we need for premium computation, and sending us copies at such

times as we may request;

3. notifying us that the named insured wants to cancel this policy.

III. ASSISTANCE AND COOPERATION

In the event of a claim, you shall:

A. fully cooperate with us, or our designee, in the making of settlements, the conduct of suits or other

proceedings, enforcing any right of contribution or indemnity against another who may be liable to you

because of injury or damage;

B. attend hearings, deposition and trials, assist in securing and giving of evidence, and assist in obtaining the

attendance of witnesses;

C. refuse, except at your own cost to voluntarily make any payment, assume any obligation or incur any

expense without our written consent.

IV. SEPARATION OF INSUREDS

This policy applies separately to each of you against whom a claim is brought except with respect to:

A. the limits of liability; and

B. any of your duties as the first named insured on the certificate of insurance.

V. CHANGES

Notice to any person, other than our program administrator, or knowledge possessed by such person, shall not

act as a waiver or change any part of this policy. It also will not prevent us from asserting any rights under the

provisions of this policy. None of the provisions of this policy will be waived, changed or modified except by

written endorsement issued to form a part of this policy.

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At some time, we may make changes in our insurance policy forms. Where appropriate, these changes must

conform to and be filed with state insurance supervisory authorities for approval. If, during your policy period,

we make a policy change that extends or broadens your coverage, without increasing your premium, your

coverage will automatically include such extension or broadening, on the effective date the change is

approved in your state, except that this will not apply to claims that were reported to us prior to the effective

date of such revision.

VI. TRANSFER OF INTEREST

You must first obtain our written consent to transfer or assign this policy. If you die, the policy will continue for

the remaining part of the policy period; first, for the benefit of your legal representative while acting within

their duties as such, and second, for the benefit of anyone having proper temporary custody of your property

until a legal representative is appointed.

VII. CONCEALMENT, MISREPRESENTATION, FRAUD

This policy is void in any case of fraud by you relating to it. It is also void if you intentionally conceal or

misrepresent a material fact or circumstance concerning:

A. this policy;

B. any covered property or your interest in the covered property; or

C. this insurance.

VIII. AVAILABILITY OF OTHER COVERAGE

This Policy is written as specific excess insurance over the insurance policy, self-insured retention, deductible,

indemnification agreement, trust agreement, patient compensation fund or other fund or risk transfer

arrangement of any sort (“other insurance”) provided by a third party. If any “other insurance” is available to

you, such “other insurance” must pay first. It is the intent of this Policy to apply only to the amounts covered

under this Policy which exceed the available limit of any “other insurance” whether primary, contributory,

excess, contingent, or otherwise. As such, this Policy will not contribute with any such “other insurance”.

IX. INSURANCE UNDER MORE THAN ONE COVERAGE

If more than one of this policy's coverages apply to the same injury or damage, we will not pay more than the

limit of liability of the Coverage Part most applicable to the type of injury or damage sustained, or the actual

amount of the injury or damage, whichever is less.

X. TRANSFER OF RIGHTS OF RECOVERY

If any of you for whom we make payment under this policy have rights to recover amounts from another, those

rights are transferred to us to the extent of our payment. You must do everything necessary to secure our

rights and must do nothing after injury or damage to impair them.

XI. LEGAL ACTION LIMITATION

You may not bring any legal action against us concerning this policy until:

A. you have fully complied with all the provisions of this policy; and

B. the amount of your obligation to pay has been decided. Such amount can be set by judgment against

you after actual trial or by written agreement between you, the claimant and us.

Any entity, or their legal representative, is entitled to recover under this policy after they have secured a

judgment or written agreement. Recovery is limited to the extent of the insurance afforded by this policy. No

entity has any right under this policy to include us in any action against you to determine your liability, nor will

we be brought into such an action by you or your representative. If you or your estate becomes bankrupt or

insolvent, it does not change any of our obligations under this policy.

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XII. PREMIUM

All premium charges under this policy will be computed according to our rules and rating plans that apply at

the inception of the current policy period. All premiums are fixed and payable when due. They may be paid

to us or our program administrator. The first premium is due on the inception date of the policy. We compute

the premium you pay for this policy using information available prior to the effective date of the policy.

XIII. NON-RENEWAL/CANCELLATION

This policy may be non-renewed or cancelled by us in accordance with requirements specified by the named

insured’s state insurance supervisory authorities and attached by amendatory endorsement to this policy.

The named insured first named on the certificate of insurance can cancel this policy at any time. To do so,

such named insured must mail a written notice to us, telling us when the cancellation is to be effective.

XIV. RIGHT TO CLAIM INFORMATION

Upon the written request of the named insured, we will provide the named insured with the following

information relating to this and any preceding policy we have issued to the named insured during the previous

three years:

A. A list or other record of each claim, not previously reported to any other insurer, of which we were notified

in accordance with these policy Conditions. We will include the date and brief description of the claim if

that information was in the notice we received.

B. A summary by policy year, of claim status and payments made, stated separately, for each Aggregate

Limit of Liability shown on the certificate of insurance.

You must not disclose this information to any claimant or their representative without our written consent.

We compile claim information for our own business purposes and exercise reasonable care in doing so. In

providing this information to the named insured, we and our program administrator make no representations

or warranties to insureds, insurers, or others to whom this information is furnished by or on your behalf.

Cancellation or non-renewal will be effective even if we inadvertently provide inaccurate information.

XV. TERRITORY

This policy applies to claims brought against you in the United States of America, including its territories and

possessions, Puerto Rico or Canada.

XVI. HEADINGS

The descriptions in the headings and subheadings of this policy are solely for convenience, and form no part

of the terms and conditions of coverage.

XVII. DEFINITIONS

For purposes of this Policy, words in bold have the meaning set forth below. However, any bolded word

referenced in these Common Policy Conditions but defined in a Coverage Part shall, for purposes of coverage

under that Coverage Part, have the meaning set forth in that Coverage Part.

“Area of specialization” means body of knowledge or expertise attained through experience and training in

the profession specified on the certificate of insurance.

“Asbestos” means the mineral in any form whether or not the asbestos was at any time:

1. airborne as a fiber, particle or dust;

2. contained in or formed a part of a product, structure or other real or personal property;

3. carried on clothing;

4. inhaled or ingested; or

5. transmitted by any other means.

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“Auto” means a land motor vehicle, trailer or semi-trailer designed for use on public roads. Any attached

apparatus or machinery is included. Mobile equipment is not included.

“Business Premises” means the established primary practice location of the named insured business entity

and approaches immediately adjoining this location.

“Certificate of Insurance” means the page of the policy, containing specific information about the named

insured, including, but not limited to its policy period, limits of liability, premium, and policy number.

“Claim” means a demand for money or services alleging injury or damage. Claim also means the filing of a

suit or the starting of arbitration proceedings naming you and alleging injury or damage.

“Claim Expenses” means:

1. fees charged by an attorney we designate; and

2. all other fees, costs and expenses, including interest on that part of any judgment that does not

exceed the limit of your coverage, which result from the investigation, adjustment, defense and appeal

of a claim.

These expenses must be incurred by us, or by you with our prior written consent.

“Claim Expenses” does not include:

1. salary charges of our regular employees or company officials; or

2. fees and expenses of independent adjusters.

“Consulting Services” means the rendering of advice or recommendations in your area of specialization,

and the services related to the implementation of such advice or recommendations, performed by you for

others. Consulting services also includes expert witness testimony by you for others, which is directly

associated with your area of specialization.

“Damage” means:

1. physical injury to tangible property, including all resulting loss of use of that property; or

2. loss of use of tangible property that is not physically injured.

“Employee” means an individual whose work is engaged and directed by the named insured.

“Expert Witness” means one, who by reason of education or specialized experience, possesses superior

knowledge respecting a subject, to assist the trier of fact, judge, jury or counsel in the understanding of

complicated and technical subjects.

“Family member” means any person related to you by blood, marriage or adoption, whether or not living in

your residence, including wards and foster children. It also means any person not related to you who is

residing in your home.

“Hazardous Properties” means any radioactive, toxic or explosive properties.

“Hostile Fire” means one that becomes uncontrollable or breaks out from where it was intended to be.

“Injury” has the meaning set forth in each individual coverage part.

“Named Insured” means the individual healthcare provider or business entity named on the certificate of

insurance as the named insured.

“Nuclear Facility” means:

1. any nuclear reactor;

2. any equipment or device designed or used for:

a. separating the isotopes of uranium or plutonium,

b. processing or utilizing spent fuel, or

c. handling, processing or packaging waste;

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3. any equipment or device used for the processing, fabricating or alloying of special nuclear material if

at any time the total amount of such material in the named insured’s custody at the premises where

such equipment or device is located consists of or contains more than 25 grams of plutonium or

uranium 233 or any combination thereof, or more than 250 grams of uranium 235;

4. any structure, basin, excavation, premises or place prepared or used for the storage or disposal of

waste; or

5. any site on which any of the foregoing is located, all operations conducted on such site and all

premises used for such operations.

“Nuclear Material” means “byproduct material”, “source material”, and/or “special nuclear material” as

defined in the Atomic Energy Act of 1954 and any of its amendments.

“Nuclear Reactor” means any apparatus designed or used to sustain nuclear fission in a self-supporting

chain reaction or to contain a critical mass of fissionable material. With respect to damage to or destruction of

property, the word damage or destruction includes all forms of radioactive contamination of property or loss of

use.

“Personal Injury” means injury arising out of one or more of the following offenses committed in the conduct

of your professional services:

1. testimony given at or arising out of inquests;

2. malicious prosecution;

3. false arrest, detention, imprisonment, wrongful entry or eviction or other invasion of the right of private

occupancy;

4. libel, slander or other disparaging materials;

5. a violation of an individual’s or entity’s right to privacy;

6. assault, battery, mental anguish, mental shock or humiliation;

7. misappropriation of advertising ideas, trade secrets, or style of doing business; or

8. infringement of patent, copyright, trademark, trade name, trade dress, service mark, service name, logo,

title or slogan.

“Placement Services” means your responsibilities for arranging and qualifying suitable work for eligible

healthcare providers.

“Pollutants” means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot,

fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or

reclaimed. Pollutants does not mean heat, smoke or fumes from a hostile fire.

“Policy Period” means the time from 12:01 A.M. on the inception date of this Policy to the earlier of 12:01

A.M. of the expiration, termination or cancellation date of this Policy. All times are determined by the named

insured’s address as set forth in the certificate of insurance.

“Professional Services” means those services for which you are licensed, certified, accredited, trained or

qualified to perform within the scope of practice recognized by the regulatory agency responsible for

maintaining the standards of the profession(s) shown on the certificate of insurance and which you perform

as, or on behalf of, the named insured. Professional services also means your services while acting in the

profession(s) shown on the certificate of insurance as a member of a formal accreditation, standards review,

or similar professional board or committee, including the directives of such board or committee.

“Residence” means the established primary personal residence of the named insured individual healthcare

provider and approaches immediately adjoining such residence.

“Spent Fuel” means any fuel element or fuel component, solid or liquid, which has been used or exposed to

radiation in a nuclear reactor.

“Waste” means any product containing nuclear material other than the tailings produced by the extraction or

concentration of uranium or thorium from any ore processed primarily for its nuclear material content; or

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resulting from the operation by any entity of any nuclear facility included under the first two paragraphs of the

definition of nuclear facility.

“Workplace” means any location used by you to provide professional services.

“You” or “Your” has the meaning set forth in each Coverage Part.

IN WITNESS WHEREOF, we have caused this Policy to be executed by our Chairperson and Secretary, but this

Policy shall not be binding upon us unless completed by the attachment of the Certificate of Insurance and payment

of the applicable premium.

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Chairman of the Board

Secretary