Frequently Asked Questions

285 frequently asked questions
What is employer stop-loss insurance for health benefits?

Employer stop-loss insurance protects self-funded health plans from catastrophic claims. If you’re considering self-funding employee health benefits instead of buying fully-insured coverage, stop-loss is essential.

How stop-loss works:

Self-funding basics: Instead of paying premiums to an insurance company, you pay employee medical claims directly. This can reduce costs but exposes you to large claims.

Specific stop-loss: Also called individual stop-loss, this kicks in when any single person’s claims exceed a specified threshold (the attachment point). If the attachment point is $100,000, the stop-loss carrier pays claims above that amount for each individual.

Aggregate stop-loss: This protects against higher-than-expected total claims across all covered employees. If total claims exceed a corridor above expected levels, aggregate stop-loss pays the excess.

Considerations for self-funding:

Cash flow: You need reserves to pay claims as they occur, before stop-loss reimbursement.

Administration: Self-funded plans require third-party administrators (TPAs) for claims processing.

Regulatory compliance: Self-funded plans are governed by ERISA and have different compliance requirements than fully-insured plans.

Self-funding with appropriate stop-loss protection can reduce health benefit costs, but it requires careful planning and adequate capitalization.

What is employers’ liability insurance and how is it different from workers’ compensation?

Employers’ liability insurance is included in your workers’ compensation policy but serves a different purpose. While workers’ comp covers employee injuries through a no-fault system, employers’ liability protects you when employees or their families sue you directly.

How they differ:

Workers’ compensation: Pays medical bills and lost wages for injured employees according to a statutory formula, regardless of fault. Employees receive benefits; they don’t sue you.

Employers’ liability: Covers lawsuits that fall outside the workers’ comp system. These typically involve claims of gross negligence, third-party actions, or situations where workers’ comp immunity doesn’t apply.

Common employers’ liability claims:

Third-party over actions: An employee is injured by a third party’s product, sues that party, and that party sues you for contribution.

Loss of consortium: A spouse sues for the loss of their injured partner’s companionship and support.

Dual capacity: You’re sued as a product manufacturer, not just as an employer.

Intentional acts: Claims that you deliberately caused unsafe conditions or ignored known hazards.

Review your employers’ liability limits. The standard $100,000/$500,000/$100,000 limits may be inadequate for serious claims.

What is employment practices liability and how does organizational change affect it?

Employment practices liability insurance (EPLI) protects against claims by employees alleging wrongful employment practices. Organizational changes often increase EPLI exposure and warrant coverage review.

What EPLI covers:

Discrimination claims: Allegations of unfair treatment based on protected characteristics.

Harassment: Sexual harassment, hostile work environment, and similar claims.

Wrongful termination: Claims that firing was illegal or violated policy.

Retaliation: Allegations of adverse action for protected activities.

Wage and hour: Some policies cover wage disputes, though coverage varies.

How organizational changes increase exposure:

Leadership transitions: New management styles may trigger complaints about changed conditions.

Restructuring: Reorganizations often involve terminations that create wrongful termination exposure.

Mergers and acquisitions: Combining workforces creates integration challenges and potential discrimination claims.

Policy changes: New policies may be implemented inconsistently, creating discrimination allegations.

Culture shifts: Changing company culture can create friction with employees comfortable with old norms.

Coverage considerations during change:

Prior acts: Ensure coverage extends to claims arising from pre-change employment decisions.

Increased limits: Major organizational changes may warrant higher EPLI limits.

Third-party coverage: Some EPLI extends to claims by non-employees like customers or vendors.

Wage and hour: If restructuring affects compensation, ensure wage and hour coverage is included.

Risk management during change:

Document decisions: Create paper trails showing legitimate business reasons for decisions.

Consistent application: Apply policies uniformly during transitions.

Legal review: Have employment counsel review significant personnel changes.

Training: Train managers on proper conduct during organizational changes.

What is employment practices liability exposure during organizational change?

Organizational changes, including mergers, acquisitions, restructuring, and leadership transitions, create heightened employment practices liability exposure. Understanding these risks helps you manage them effectively.

Why change increases EPLI exposure:

Terminations: Organizational change often involves job eliminations, creating wrongful termination exposure.

Selection decisions: Deciding who stays and who goes creates discrimination exposure if decisions appear to affect protected groups disproportionately.

Leadership changes: New managers may handle situations differently, creating inconsistency that supports discrimination claims.

Policy changes: New policies may disadvantage employees accustomed to prior arrangements.

Cultural conflicts: In mergers, combining different cultures creates friction that can become harassment claims.

High-risk organizational changes:

Reductions in force: Layoffs are prime EPLI exposure. Adverse impact analysis is essential.

Mergers and acquisitions: Workforce integration creates multiple exposure points.

Restructuring: Reassignments, demotions, and role changes generate claims.

New leadership: Management changes often correlate with increased employment claims.

Benefit changes: Reducing benefits can create claims, particularly if changes affect older workers disproportionately.

Risk management during change:

Legal review: Have employment counsel review significant personnel decisions.

Documentation: Create clear records of legitimate business reasons for decisions.

Consistency: Apply criteria uniformly to avoid appearance of discrimination.

Adverse impact analysis: Statistically analyze whether decisions disproportionately affect protected groups.

Severance agreements: Well-drafted releases can limit exposure.

Coverage considerations:

Adequate limits: Consider increasing EPLI limits during high-change periods.

Prior acts: Ensure coverage addresses claims from pre-change decisions.

Third-party coverage: If changes affect customers or vendors, third-party EPLI may be relevant.

Defense resources: Understand what resources the insurer provides for employment disputes.

What is equipment breakdown insurance?

Equipment breakdown insurance, formerly called boiler and machinery coverage, covers the cost of repairing or replacing equipment that breaks down due to mechanical or electrical failure. It fills gaps that standard property insurance leaves.

What equipment breakdown covers:

Mechanical breakdown: Failures of motors, compressors, pumps, and other mechanical equipment.

Electrical failure: Short circuits, power surges, and electrical damage to equipment.

Pressure system failures: Boilers, pressure vessels, and refrigeration systems.

Computer and electronics: Failure of servers, phone systems, and other electronic equipment.

Production equipment: Manufacturing machinery and specialized production equipment.

What it pays for:

Repair or replacement: Cost to fix or replace the failed equipment.

Business interruption: Lost income while equipment is out of service.

Spoilage: Loss of perishable goods when refrigeration fails.

Extra expense: Costs to maintain operations during repairs, like renting temporary equipment.

Expediting expenses: Overtime and rush shipping to speed repairs.

Why standard property doesn’t cover this:

Property insurance covers damage from external causes like fire, theft, and weather. Equipment breakdown covers internal failures. A motor that burns out isn’t a fire loss; it’s a mechanical failure that property policies exclude.

Who needs equipment breakdown:

Any business with critical equipment: If equipment failure would halt operations or cause significant losses, coverage makes sense.

Common examples: HVAC systems, refrigeration, manufacturing equipment, computers and servers, phone systems.

The cost is typically modest relative to the protection provided.

What is fiduciary liability insurance and when do I need it?

Fiduciary liability insurance protects individuals and organizations that manage employee benefit plans. If you offer retirement plans, health insurance, or other ERISA-governed benefits, the people who administer those plans have fiduciary duties that create personal liability.

When fiduciary coverage becomes necessary:

Retirement plans: 401(k), 403(b), pension, and profit-sharing plans all create fiduciary obligations for those who select investments, manage plan assets, or administer the plan.

Health and welfare plans: Group health insurance, dental, vision, life insurance, and similar benefits can create fiduciary exposure if you have discretion over plan administration.

ERISA requirements: Most private-sector benefit plans are governed by ERISA, which imposes strict duties on fiduciaries and allows participants to sue for breaches.

What fiduciary liability covers:

Defense costs: Legal fees to defend against claims of fiduciary breach.

Settlements and judgments: Amounts you’re obligated to pay to the plan or participants.

Regulatory actions: Defense against Department of Labor investigations.

Note that ERISA bonds (fidelity bonds) are different from fiduciary liability insurance. ERISA requires both for most plans.

What is fiduciary liability insurance and when does my business need it?

Fiduciary liability insurance protects individuals and organizations that manage employee benefit plans. If your business offers retirement plans, health insurance, or other ERISA-governed benefits, fiduciary exposure exists.

What fiduciary liability covers:

Breach of fiduciary duty: Claims that fiduciaries failed to act in participants’ best interests.

Administrative errors: Mistakes in plan administration that harm participants.

Investment selection: Claims that investment options were improperly selected or monitored.

Defense costs: Legal expenses to defend against fiduciary claims.

DOL investigations: Costs to respond to Department of Labor inquiries.

When fiduciary coverage is needed:

401(k) and retirement plans: Anyone who selects investments, manages plan assets, or has discretionary authority is a fiduciary.

Health and welfare plans: ERISA applies to most employer-sponsored health plans.

Plan administration: Decisions about eligibility, claims, and benefits create fiduciary exposure.

Committee members: Benefits committee members have personal fiduciary liability.

Who is a fiduciary:

Named fiduciaries: Persons identified in plan documents as having fiduciary responsibility.

Functional fiduciaries: Anyone who exercises discretionary authority over plan management.

Investment fiduciaries: Those who select or monitor plan investments.

Administrative fiduciaries: Those with discretion over plan administration.

Fiduciary liability vs. ERISA bonds:

ERISA bonds: Required by law, protect the plan against fiduciary theft. Minimum coverage equals 10% of plan assets.

Fiduciary liability: Voluntary coverage protecting fiduciaries against claims of breach. Different coverage purpose.

Both needed: ERISA bonds and fiduciary liability insurance serve different functions; plans typically need both.

What is garage keepers insurance and when do I need it?

Garage keepers insurance protects businesses that store, service, or park customers’ vehicles. If a customer’s vehicle is damaged, stolen, or destroyed while in your care, this coverage responds.

Who needs garage keepers:

Auto repair shops: Vehicles left for service are in your care and custody.

Body shops: Vehicles undergoing collision repair.

Parking garages and lots: Vehicles parked in your facility.

Car washes: Vehicles during the wash process.

Dealerships: Customer vehicles brought in for service.

Valet services: Vehicles in valet custody.

Towing companies: Vehicles being towed or stored in impound lots.

What garage keepers covers:

Physical damage: Damage to customer vehicles from fire, theft, vandalism, collision, and other covered perils.

Comprehensive and collision: Coverage typically includes both, though specific perils may vary.

Legal liability vs. direct: Some policies only pay when you’re legally liable for damage. Others pay regardless of fault.

Coverage limits and structure:

Per-vehicle limits: Maximum coverage for any single vehicle.

Per-location limits: Maximum coverage for all vehicles at one location.

Aggregate limits: Maximum coverage for all claims during the policy period.

Deductibles: Apply per vehicle or per occurrence.

Why general liability isn’t enough:

General liability policies exclude property in your care, custody, or control. Customer vehicles in your shop are exactly the exposure GL excludes. Garage keepers fills this specific gap.

Risk management:

Key control: Secure key storage and limited access.

Security: Surveillance, lighting, and alarm systems.

Documentation: Record vehicle condition when received.

Customer communication: Clear policies about your responsibilities and limitations.

What is inland marine insurance and when do I need it?

Inland marine insurance covers movable property and equipment that traditional property policies don’t adequately protect. Despite the name, it has nothing to do with water; the term comes from historical coverage of goods transported over land from ports.

What inland marine covers:

Equipment in transit: Property moving from place to place, which stationary property policies often exclude or limit.

Portable equipment: Tools, equipment, and property regularly taken to job sites or client locations.

Property at multiple locations: Equipment stored at various sites, not just your primary premises.

Specialized equipment: High-value items that need specific coverage terms.

Property in others’ custody: Items you own but store at third-party locations.

Common inland marine coverages:

Contractors’ equipment: Tools and equipment used by contractors at job sites.

Builders’ risk: Buildings under construction.

Installation floater: Equipment being installed at customer locations.

Computer equipment floater: Portable computers and electronics.

Signs: Business signs, whether fixed or portable.

Valuable papers: Important documents and records.

When you need inland marine:

Mobile businesses: Contractors, service technicians, and others who take equipment to work sites.

Frequent transport: Businesses that regularly move valuable property between locations.

High-value portables: Expensive equipment that travels, like medical devices, survey instruments, or production equipment.

Standard property policies have significant gaps for movable property. Inland marine fills those gaps.

What is key person insurance and when should I consider it?

Key person insurance is life and disability coverage on individuals whose death or disability would significantly harm the business. It provides funds to help the company survive the loss of critical talent.

What key person insurance covers:

Key person life insurance: Pays a death benefit to the company when a key person dies.

Key person disability: Provides funds if a key person becomes disabled and cannot work.

Policy ownership: The company owns the policy, pays premiums, and receives benefits.

When key person coverage makes sense:

Concentrated expertise: If one person holds critical knowledge, relationships, or skills that would be difficult to replace.

Revenue dependency: If significant revenue is tied to a specific person’s relationships or abilities.

Loan requirements: Lenders sometimes require key person coverage on principals.

Investor requirements: Investors may require coverage on founders or key executives.

Small businesses: Smaller companies often depend more heavily on individual contributors.

Determining coverage amounts:

Replacement costs: Recruiting, hiring, and training a replacement.

Lost revenue: Revenue that would be lost during transition.

Debt coverage: Outstanding obligations the business must meet.

Business continuation: Funds needed to keep operations running during transition.

Buyout funding: If the key person is also an owner, coverage may fund buyout obligations.

Selecting key persons:

Owners and founders: Often the most critical, especially in early-stage companies.

Top salespeople: Revenue generators whose relationships would leave with them.

Technical experts: People with specialized knowledge essential to operations.

Key managers: Leaders whose departure would destabilize operations.

Review key person coverage as your organization evolves and dependencies shift.

What is loss control and how can it lower my insurance costs?

Loss control encompasses practices that prevent losses and minimize their impact when they occur. Effective loss control reduces claims, which reduces premiums over time.

What loss control includes:

Risk identification: Finding hazards before they cause losses.

Prevention measures: Actions that prevent incidents from occurring.

Mitigation measures: Actions that reduce severity when incidents happen.

Training: Educating employees on safe practices.

Procedures: Documented processes for safe operations.

Physical safeguards: Equipment and modifications that reduce risk.

Insurance company loss control:

Inspections: Insurers may inspect your premises to identify hazards.

Recommendations: You may receive recommendations for improvements.

Resources: Many insurers provide safety materials, training, and consultation.

Compliance requirements: Some recommendations may be required for continued coverage.

Premium impact: Good loss control performance can lead to better rates.

Implementing loss control:

Management commitment: Leadership must prioritize and fund safety.

Employee involvement: Workers often have the best ideas for safety improvements.

Regular assessment: Continuously look for hazards and improvement opportunities.

Incident investigation: Learn from every incident and near-miss.

Measurement: Track leading indicators (training, inspections) and lagging indicators (incidents).

Areas to address:

Workplace safety: Prevent employee injuries through training, equipment, and procedures.

Property protection: Fire prevention, security, and maintenance.

Vehicle safety: Driver training, vehicle maintenance, and fleet policies.

Liability reduction: Product safety, contract review, and customer interaction protocols.

Cyber security: Technology controls and employee training.

Return on investment:

Premium reduction: Better experience leads to lower premiums.

Avoided losses: Prevented losses save money directly.

Productivity: Safe workplaces are often more productive.

Morale: Workers appreciate employers who prioritize safety.

Loss control is an investment that pays returns through reduced claims and lower premiums.

What is media liability insurance?

Media liability insurance protects against claims arising from content you create, publish, or distribute. As businesses increasingly produce content for websites, social media, marketing, and other channels, media exposure extends well beyond traditional media companies.

What media liability covers:

Defamation: Claims that your content damaged someone’s reputation through false statements.

Copyright infringement: Using images, text, music, or other protected content without authorization.

Invasion of privacy: Publishing private information or images without consent.

Plagiarism: Claims that your content copies someone else’s work.

Trademark infringement: Using trademarks in ways that create confusion or dilute brand value.

Who needs media liability:

Content creators: Writers, designers, videographers, and other creative professionals.

Marketing agencies: Creating content for clients exposes agencies to content liability.

Publishers: Traditional and digital publishers of any scale.

Any business with content: Your website, blog, social media, marketing materials, and advertising all create exposure.

Coverage options:

Media liability may be included in general liability policies (typically limited), available as part of professional liability, or purchased as a standalone policy for businesses with significant content operations.