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Tom and Sandy have an HO - 3 policy covering their home. The policy has Section II Coverage E Personal Liability with a limit of
Tom and Sandy have an HO policy covering their home. The policy has Section II Coverage E Personal Liability with a limit of $ for each occurrence and Coverage F Medical Payments to Others with a limit of $ for each person. Both Tom and Sandy are listed as named insureds on the policy and the policy has been in effect for six months. Their fiveyearold son, Johnny, and Sandys mother, Margaret, reside with them.
Recently, Margarets friend, Cathy, came over to the residence for a card game. Cathy tripped over one of Johnnys toys and hit her head on a counter top when she fell. She suffered cuts and bruises to her head. She was immediately taken to a hospital and treated for her injuries. She incurred $ in hospital expenses. Due to her injuries, she was unable to work for four weeks. She incurred $ in lost wages. She also had recurring headaches since the accident, which her doctor prescribed medication for. Her doctor has warned her that her headaches may continue indefinitely. The pain medication costs $ per year.
Cathy wants to be paid for her medical expenses, lost wages, and pain and suffering. Toma and Sandy promptly reported the accident to their insurer and are cooperating in the insurers investigation. The insurer has requested Cathy submit to a physical exam by an insurerselected doctor to determine if her recurring headaches are related to the accident. Cathy has refused to be examined by the insurers doctor, claiming her own doctor records should be enough.
Given the facts presented in the case, will the HO liability claim be covered?
If so what amount will the insurer pay for the claim?
When determining whether coverage applies to the losses, apply the four steps of the DICE method, explaining what portion of the policy you considered in each step as well as what you determined.
a DICE Analysis Step : Declarations
b DICE Analysis Step : Insuring Agreement
c DICE Analysis Step : Conditions
d DICE Analysis Step : Exclusions
For full credit, be sure to identify any or all coverages that are or could be applicable.
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