Absolute Exclusion (Insurance) Definition
Absolute Exclusion is a clause that can be found within certain insurance policies. The clause eliminates coverage of certain events under the policy. This clause allows the insurer to deny any claim that is remotely related to the actual nature of the exclusion.
Insurance companies are legally obligated to provide forms where the absolute exclusions are clearly mentioned in plain words and simple language. If an insurance company deliberately provides obscure policy information or omits important information, or if they fail to provide clear and comprehensive forms to the policyholders, they may have face legal consequences.
A Little More on What is an Absolute Exclusion
Insurance companies price the policy premiums after assessing the risks of loss. They need to collect enough premiums to pay all policy claims and make a profit. The insurance companies need to restrict the number of claims paid. As such, they exclude some of the events from the provision of insurance coverage.
If an insurance company uses too many absolute exclusions in their policies, the customers may find it unacceptable. If the company provides coverage for an overly narrow set of risks, the customers won’t choose their policies and, as a result, they’ll lose business.
It is important for insurance companies to carefully review how much risk they can cover and at the same time they need to ensure that their policies are adequately attractive to the customers.
The absolute exclusion clause is often criticized for being obscure and ambiguous. The critics complain that it becomes impossible for the policyholder to derive whether an event is covered under that policy or not.
The legal provisions of some states make it mandatory, if a loss is a result of a combination of covered and excluded events, the insurance company has to provide coverage if the covered event was the proximate cause of the loss. However, the companies often deny coverage, if the covered event is not closely involved in the loss.
The language used for describing the events that are excluded from the coverage has evolved in the last five decades to provide clarity. In the 1970’s most of the insurance policies would read like, “Coverage does not apply to ….;” or “…to any claim for…;” or “…to any claim based upon….”
During the late ’70s and early ’80s, insurance companies modified the language and exclusions to read as follows “… based upon or arising out of….”, later it was further modified into “…based upon or arising out of or in consequence of…”
The use of language became more critical, particularly for the environment liability cases. The insurance companies were struggling to find unambiguous exclusionary language that would help them to withstand court scrutiny.
Examples of “absolute exclusion” Language
- “Directly or indirectly, based on, attributable to, arising out of, resulting from, or in any manner relating…” or
- “…based upon, arising out of, or attributable to any wrongful acts where all or any part of such acts…”
For example, homeowners’ insurance policy often excludes mold, fungus, or wet rot. That means even if the mold is caused by a plumbing defect, the insurance won’t cover the loss that is the result of the mold. It will only cover the plumbing loss.
Reference for “Absolute Exclusion”
Reason and Pollution: Correctly Construing the” Absolute” Exclusion in Context and in Accord with its Purpose and Party Expectations, Stempel, J. W. (1998). Tort & Insurance Law Journal, 1-59. This paper states that in the mid-1980s, the insurance industry mostly adopted new standard pollution exclusion language for commercial general liability (CGL) policies to respond to the flurry of environmental coverage litigation over the application of the sudden and accidental pollution exclusion.
Application of the Absolute Pollution Exclusion to Toxic Tort Claims: Will Courts Choose Policy Construction or Deconstruction?, Shelley, W. P., & Mason, R. C. (1998). Tort & Insurance Law Journal, 749-782. This article discusses the decisions that have essentially imposed an environmental restriction on the application of the Absolute Pollution Exclusion. These decisions are shown to rely on various recurrent assumptions. One of the assumptions is that the Absolute exclusion was drafted to preclude a narrow field of Superfund liability and similar environmental claims arising under pollution statutes but virtually nothing else.
Unreason in Action: A Case Study of the Wrong Approach to Construing the Liability Insurance Pollution Exclusion, Stempel, J. W. (1998. Fla. L. Rev., 50, 463. This paper explains how for many years an essential component of the scholarly commentary on insurance law has focused on the reasonable expectations doctrine enunciated by Robert Keeton in his 1970 article. It describes the doctrine’s life to date as one of the early growth followed by subsequent retreat and dilution with continuing controversy.
Carbon Dioxide: Harmless, Ubiquitous, and Certainly Not a Pollutant under a Liability Policy’s Absolute Pollution Exclusion, Donald, J. W., & Davis, C. W. (2009). Seton Hall L. Rev., 39, 107. This article explains that new litigation seeking damages for the environmental and economic impacts of global warming is targeting alleged producers of anthropogenic, atmospheric carbon dioxide. The defendants will eventually seek coverage for litigation costs and resulting judgments under their commercial general liability (CGL) policies.
Are They Lying Now or Were They Lying Then-The Insurance Industry’s Ambiguous Pollution Exclusion: Why the Insurer, and not the Innocent Insured, Should Pay for …, Timmer, A. (1994). Baylor L. Rev., 46, 355. This article explores the state and federal court cases related to global warming litigation and also discusses the theories of liability asserted by plaintiffs. It explains the historical efforts by insurance companies to avoid the coverage for environmental pollution and analyzes if this exclusion will prevent coverage for companies found liable for global warming.