In an insurance policy, every word matters.
Apr 13, 2022
מאת: גנית מיכאלי מנהלת תחום עסקים מורכבים
פוליסת ביטוח היא חוזה משפטי שבו כל מילה חשובה". ניסוח מסוים ואפילו מילה בודדת יכולים לשנות מקצה לקצה את היקף הכיסוי ואף את קיומו או העדרו יום פקודה.
דברים אלה נאמרים ביתר שאת לגבי ביטוח עבודות קבלניות, שכן לא כל סוכנויות הבי טוח בישראל מכירות את ענף הבנייה על בוריו. כפועל יוצא מזה רבות מהן מתקשות להבין את משקלן של מילים בודדות בפוליסה הקבלנית.
על מנת לזהות את ה"מורכבויות" הללו ואת המקומות שבהם מילה קטנה משנה את המהות, חשוב להיות בקיאים הן בפוליסות שמשווקות בשוק והן באופיו של ענף הבנייה. כלומר, לדעת איך נראה אתר בנייה, אילו כוחות פועלים בו ומה מערכות היחסים המקצועיות-מסחריות ביניהם, מי השחקנים הראשיים והמשניים, באלו כלים נעשה שימוש, מהם הסיכונים לרכוש ולגוף, מהם מדרגי האחריות בהגשת תביעה וכדומה.
סוכנות הביטוח איציק סימון אשר צברה וותק של למעלה מ-30 שנה בעריכת ביטוחי בנייה, גאה להיות סוכנות ביטוח עם קסדה ובוץ בנעליים". בזכות ההבנה בענף הבנייה והעובדה שזכינו לקחת חלק בביטוחי אלפי פרויקטים לאורך השנים, אנחנו יודעים לזהות מבעוד מועד נקודות בעייתיות בפוליסה ולספק להן מענה. בין אם בשלבים הראשונים של החתימה ובין אם לאחר מכן כשמתעוררת מחלוקת מול חברת הביטוח. להלן הסבר ודוגמאות.
By: Ganit Michaeli, Manager of Complex Business
An insurance policy is a legal contract in which "every word counts ." Certain wording and even a single word can drastically change the scope of coverage and even its existence or absence on a whim.
These things are said even more strongly regarding contractor insurance , as not all insurance agencies in Israel are familiar with the construction industry. As a result, many of them have difficulty understanding the significance of individual words in a contractor policy.
In order to identify these "complexities" and the places where a small word changes the essence, it is important to be familiar with both the policies that are marketed and the nature of the construction industry . That is, to know what a construction site looks like, what forces are at work there and what the professional-commercial relationships are between them, who the main and secondary players are, what tools are used, what the risks to property and person are, what the levels of liability are when filing a claim, and so on.
The Itzick Simon Insurance Agency, which has accumulated over 30 years of experience in handling construction insurance, is proud to be " an insurance agency with a helmet and mud in its shoes ." Thanks to our understanding of the construction industry and the fact that we have been privileged to take part in the insurance of thousands of projects over the years, we know how to identify problematic points in the policy in advance and provide a solution to them. Whether in the initial stages of signing or later when a dispute arises with the insurance company. Below is an explanation and examples.
Expected? Unexpected? Predictable?
Every insurance policy, including contractors' insurance or any other insurance related to the construction industry (such as professional liability, product liability, etc.), consists of three levels - definitions, an operative clause (what activates the policy), and exclusions.
If we focus for a moment on the operative section, then even though the title of contractor work insurance is "all-risks policy," an analysis of the policies shows that this is not necessarily the case.
A notable example is the fact that the real trigger in most policies is “ accidental, sudden and unexpected damage .” An insurance agency that deeply understands the nature of risks on construction sites must ensure that this definition is as clear as possible to both the insured and the insurance company.
In many cases, it is difficult to decide what does or does not fall under the heading of "accidental, sudden and unexpected damage." Take, for example, winter damage caused to a site as a result of an especially strong storm, heavy rain, heavy hail, etc. Ostensibly, the insurance company can claim that the damage was "expected" because winter is an integral part of the seasonal cycle, but in practice, it is clear that sometimes storms of unusual intensity or consecutive rainy days with unusually heavy rainfall occur.
כל פוליסת ביטוח, לרבות ביטוח קבלנים או כל ביטוח אחר הנוגע לענף הבנייה (כמו אחריות מקצועית, חבות מוצר וכו'), מורכבת משלושה מישורים – הגדרות, סעיף אופרטיבי (מה מפעיל את הפוליסה) וחריגים.
אם נתמקד רגע בסעיף האופרטיבי, אזי למרות שהכותרת של ביטוח עבודות קבלניות היא "פוליסת כל הסיכונים", ניתוח של הפוליסות מעלה שאין זה בהכרח המצב.
דוגמה בולטת היא העובדה שהטריגר האמיתי ברוב הפוליסות הוא נזק תאונתי, פתאומי ובלתי צפוי. סוכנות ביטוח שמבינה לעומק את המהות של הסיכונים באתרי בנייה חייבת לוודא שההגדרה הזו ברורה ככל שניתן גם למבוטח וגם לחברת הביטוח.
במקרים רבים קשה להחליט מה נכנס או לא נכנס תחת הכותרת "נזק תאונתי, פתאומי ובלתי צפוי". קחו למשל נזקי חורף שנגרמים לאתר כתוצאה מסופה חזקה במיוחד, גשמים עזים, ברד כבד וכדומה. לכאורה, חברת הביטוח יכולה לטעון שהנזקים היו "צפויים" משום שהחורף הוא חלק בלתי נפרד ממחזור העונות ובפועל, ברור שלעתים מתרחשות סערות חריגות בעוצמתן או ימי גשם רצופים עם ממטרים כבדים בכמויות חריגות.
At our insurance agency, we are careful to distinguish between mild and severe and usually make sure to define the trigger as " unforeseen in advance ." Here is one word ("in advance") that may change the coverage picture beyond recognition. When it appears in the policy, the insurance company will have a hard time rejecting the claim in unusual storms for which there were no specific warnings from the meteorological service.
The dispute between "expected" and "unexpected" does not only concern climate damage. Another example is a "sudden and unexpected" breakthrough of groundwater during drilling on the site. An event that could create a dispute between the ability to predict the existence of groundwater as part of the preliminary survey and the risks that the insurance company took (or did not take) upon itself when preparing the policy.
There are situations where even an addition that is less than a word can dramatically change the chances of insurance coverage. For example, there are contractor policies that condition insurance coverage on the condition that all contractors employed on a project be registered with the Registrar of Contractors. Since experience shows that not all contractors on a construction site are indeed registered contractors, it is worth softening the requirement and adapting it to reality.
At our insurance agency, for example, we usually formulate the condition as follows – " The main contractor and/or additional contractors will have appropriate registration ." The addition of "and/or" allows you to benefit from coverage even if only the main contractor has appropriate registration and not every subcontractor who comes through the project gates.
Unforeseen
The COVID-19 period has posed many challenges for those working in the construction industry and, as a result, for the insurance companies that insure them. A situation has arisen in which a few words in contractor work policies have created ambiguity regarding coverage for direct and indirect damages resulting from the pandemic.
For example, we have seen many delivery delays resulting from circumstances related to Corona, such as hermetic closures, shortages of Palestinian labor, shortages of foreign labor, "traffic jams" at ports in terms of construction inputs, and more.
Many policyholders have found themselves at odds with insurance companies, among other things, over a coverage clause in "denial of access." That is, an extension to the policy (which not everyone buys) that states that the insured is entitled to compensation for consequential damages due to denial of access to the site.
Since the policies do not specify what "denial of access" is, the question arose as to whether the Corona restrictions are included (the answer is of course: no, because the definition of coverage in the contractor's policy is: physical damage ).
A recent example from the Corona era
Another situation that brings to light the meaning of the words in the insurance policy is when the document contains clauses that appear to contradict each other.
For example, a contractor's work insurance policy requires insureds to ensure that every crane entering the construction site also has a third-party policy with required minimum liability limits, say 1-2 million shekels, and also has a valid employers' liability policy.
This is a requirement that is on its face unreasonable, as the contractor's policy is supposed to contain - without specific stipulations - coverage for bodily injury to an employee or any third party as a result of the use of cranes on the site.
If the insured does not pay attention to the issue and an insurance event occurs related to the crane, the insurance company may claim that the crane policy was defined as primary and prior to coverage in the contractor's work policy issued for the project. In other words, claim that the coverage, if any, will only be above the coverage provided in the crane policy. After all, you have a kind of deductible "through the back door."
Without going into the nitty-gritty of the issue on a legal level, it is clear that if the contractor/developer/insured had taken care to address the crane clause in advance, he would have avoided a situation in which there is a dispute regarding the existence/absence of coverage as a result of crane activity on the site.
Note that this is not just a question of coverage – yes or no. Even if the insured is completely right, the very conduct of the legal process can cause financial damages, emotional distress, delays, reputational damage, and the like.
Conflicting clauses, what prevails over what?
Another common example of the weight of words in contractors' policies relates to coverage for defense expenses in criminal proceedings. Contractors may find themselves facing criminal charges following construction site incidents such as a fatal or serious accident.
In this regard, it is important to know that not every criminal lawyer specializes in representing such cases, and the few who do charge accordingly. In other words, insurance coverage for defense expenses in criminal proceedings is critical and significant.
Although almost all policies provide coverage for these expenses, most of them contain a caveat stating that the coverage is only for the main contractor or the main insured . That is, it does not apply to other parties who may be investigated and even stand trial with considerable probability, including the work orderer / policyholder / main insured / main contractor.
At our insurance agency, which understands the implications of criminal liability on a construction site, we do not take the defense expenses section lightly. We will usually make sure that the insurance coverage does indeed include coverage for defense expenses in criminal proceedings, even for additional parties against whom the insured has signed.
Criminal lawyer only for the contractor or for other parties?
In conclusion
An insurance policy is a legal contract, and a construction insurance policy is an even more complex legal contract. Every word in the policy can change the coverage and affect the insured's right to rely on the insurance company.
Since these are huge sums that frequently climb to hundreds of thousands of shekels and even millions of shekels, the issue should not be taken lightly. Quite the opposite. One must be careful to the last detail, so to speak.
פוליסת ביטוח היא חוזה משפטי ופוליסת ביטוח בענף הבנייה היא חוזה משפטי מורכב עוד יותר. כל מילה בפוליסה יכולה לשנות את הכיסוי ולהשפיע על זכותו של המבוטח להישען על חברת הביטוח.
היות שמדובר בסכומי עתק המטפסים תדיר לכדי מאות אלפי שקלים ואף מיליוני שקלים, אין להקל ראש בנושא. נהפוך הוא. יש להקפיד על קוצו של יוד, תרתי משמע.
מסמכים
