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  1. Sewer back up through toilet | Ask PIA

    I have an insured whose toilet backed up during flooding conditions in our area. There was no surface water, just the water backing up through the toilet. The insurer has denied the claim based upon the sewer backup exclusion. Shouldn’t this be covered?

    It is likely that not even sewer backup coverage will cover this loss because of the cause you stated. A flood policy will be required to cover this loss. Despite the sewer backup exclusion, many insurers have covered an overflow (as opposed to backup) from toilets as long as...

  2. Resident relative—common-law husband and wife | Ask PIA

    I am in New Jersey and we have a carrier that is denying coverage on the grounds that the injured party is a resident relative of the insured. The carrier is claiming that because the injured party was the live-in girlfriend of the insured for 10 years, they are common-law...

    No. New Jersey Statute Section 37:1-10 explicitly states that no relationship shall be deemed to be a marriage unless a valid marriage license has been issued and the marriage was duly solemnized. The statute further states that any relationship purporting to be a marriage in the absence of these steps...

  3. Debris removal | Ask PIA

    When figuring the replacement cost amount on a Homeowners Policy, some companies are including cost for debris removal. The debris removal is an additional coverage provided in the homeowners contract. Can the companies charge for this by including the amount in the dwelling replacement cost?

    There is nothing in New York State laws or regulations that spell out what a carrier can and can't use in determining the replacement cost on a dwelling. Therefore, the carrier could include the cost of debris removal.

  4. Rebates—charitable contributions | Ask PIA

    We were thinking of telling prospective clients that we would donate a portion of our commissions to charity, as an incentive for them to give us their business. Would this be legal?

    No. The Department of Financial Services answered a similar question from an agent who wanted to advertise in programs for charitable dinners for nonprofit groups. The agent planned to say, “For every new policy written, we will make a donation to the [synagogue, church or charity].” For example, the ad...

  5. Branch offices in various states | Ask PIA

    If I must give up my New York and New Jersey resident licenses, how can I have branch or home offices in the three [Florida] states?

    According to licensing bureaus in New York and New Jersey: New Jersey: A producer cannot change their license to a nonresident license until they are licensed in Florida. The New Jersey Department of Banking and Insurance issues a nonresident license based upon holding a resident license in a home state....

  6. Reservation of rights | Ask PIA

    Please give some insight as to how to respond to and protect our insureds when a carrier sends a reservation of rights letter on a claim.

    Information about reservation of rights letters and nonwaiver agreements can be found in QuickSource document No. QS90438, titled Reservation of rights letters and nonwaiver agreements. Included in this resource kit are some tips on producer involvement.

  7. Travel buddies | Ask PIA

    A customer of ours (they have a personal auto policy) asked the following question: We are renting a van to travel to Florida and are going with another couple. They will be listed on the rental contract as drivers, but the rental contract will be in our names. If there...

    The Rental Vehicle Coverage Endorsement—New York (PP 03 46) provides coverage for the insured’s obligations in the event of actual damage to, or loss of, any rental vehicle. Since you signed the rental agreement and the other party had your permission to operate the rental vehicle, your policy would respond...

  8. School bus passenger | Ask PIA

    If a child is injured on a school bus, what policy pays their medical expenses? It is my understanding that the school bus is not required to maintain personal injury protection coverage. I have been told that the injured child would present a PIP claim against their parent’s personal automobile policy; however,...

    The New Jersey Automobile Reparations Reform Act (also known as the no-fault law) provides a generous package of PIP benefits to persons injured in an accident involving an “automobile,” which is defined in the law to exclude a school bus. Consequently, there are no PIP benefits to pay for...

  9. Credit scoring | Ask PIA

    What is the Connecticut Insurance Department’s stance on credit scoring?

    Effective July 1,2011, as a result of Public Act 10-7, insurers are required to provide a written disclosure of consumer protections regarding an insurer’s use of credit information as determined by the insurance commissioner. For details, see CID Bulletin PC-69.

  10. Referrals, where a nonlicensee initiates the conversation | Ask PIA

    Is a nonlicensee permitted to initiate contact with a prospective insured to determine their interest in being referred to a licensee?

    Yes, a nonlicensee can initiate such a conversation, provided there is no discussion of specific insurance policy terms and conditions and the nonlicensee’s compensation is not based on the purchase of insurance. PIANY has received a significant number of questions about setting up referral programs recently. To help members, PIANY...

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