An insurer is liable for a loss of which a peril insured against was the proximate cause, although a peril not contemplated by the contract may have been a remote cause of the loss; but he is not liable for a loss of which the peril insured against was only a remote cause.
LossCauses of Loss
Section § 530
This law explains that an insurance company must cover a loss if the main cause of that loss is a risk covered by the insurance policy. Even if another, unexpected cause played a minor role, the main insured risk was responsible. However, the insurer is not responsible if the insured risk was only a minor, indirect cause of the loss.
insurer liability proximate cause remote cause
Section § 530.5
If your insurance policy covers a certain type of event (peril) and something like a landslide or mudslide happens along with that event, your insurance should cover the loss or damage, as long as the covered event is the main cause of the damage. The terms for this coverage will be the same as your insurance policy's terms for the covered event.
If a loss or damage results from a combination of perils, one of which is a landslide, mudslide, mudflow, or debris flow, coverage shall be provided if an insured peril is the efficient proximate cause of the loss or damage and coverage would otherwise be provided for the insured peril. Coverage shall be provided under the same terms and conditions as would be provided for the insured peril.
efficient proximate cause landslide mudslide
Section § 531
This law states that insurance companies are responsible for paying for losses if an insured item is saved from a covered danger but then gets lost, in whole or in part, due to a different, uncovered danger while trying to rescue it. Also, if any loss occurs because someone tries to rescue the insured item from a covered danger, the insurer must cover those losses.
An insurer is liable:
(a)CA Insurance Code § 531(a) Where the thing insured is rescued from a peril insured against, and which would otherwise have caused a loss, if, in the course of such rescue, the thing is exposed to a peril not insured against, and which permanently deprives the insured of its possession, in whole or in part.
(b)CA Insurance Code § 531(b) If a loss is caused by efforts to rescue the thing insured from a peril insured against.
insurer liability insured items rescue operations
Section § 532
This law says that if an insurance policy specifically excludes certain risks or events (called perils) and a loss happens that wouldn't have occurred without one of these excluded perils, then the loss is not covered by the insurance. This applies even if the direct cause of the loss wasn't one of the excluded perils.
If a peril is specially excepted in a contract of insurance and there is a loss which would not have occurred but for such peril, such loss is thereby excepted even though the immediate cause of the loss was a peril which was not excepted.
insurance exclusions perils insurance claims
Section § 533
This law says that if someone intentionally causes a loss, their insurance company doesn't have to cover it. However, if the loss was due to a mistake or carelessness, the insurance company can still be responsible.
An insurer is not liable for a loss caused by the wilful act of the insured; but he is not exonerated by the negligence of the insured, or of the insured’s agents or others.
insurer liability wilful act intentional loss
Section § 533.5
This law makes it clear that insurance policies cannot cover fines, penalties, or restitution in criminal cases or certain legal actions related to business practices brought by government authorities. It also prohibits these policies from providing a defense in such cases, even if the policy does not explicitly say so. Essentially, insurance can't help you pay or defend against these specific legal consequences. If an insurance policy tries to provide such coverage or defense, it's considered invalid and against public policy.
(a)CA Insurance Code § 533.5(a) No policy of insurance shall provide, or be construed to provide, any coverage or indemnity for the payment of any fine, penalty, or restitution in any criminal action or proceeding or in any action or proceeding brought pursuant to Chapter 5 (commencing with Section 17200) of Part 2 of, or Chapter 1 (commencing with Section 17500) of Part 3 of, Division 7 of the Business and Professions Code by the Attorney General, any district attorney, any city prosecutor, or any county counsel, notwithstanding whether the exclusion or exception regarding this type of coverage or indemnity is expressly stated in the policy.
(b)CA Insurance Code § 533.5(b) No policy of insurance shall provide, or be construed to provide, any duty to defend, as defined in subdivision (c), any claim in any criminal action or proceeding or in any action or proceeding brought pursuant to Chapter 5 (commencing with Section 17200) of Part 2 of, or Chapter 1 (commencing with Section 17500) of Part 3 of, Division 7 of the Business and Professions Code in which the recovery of a fine, penalty, or restitution is sought by the Attorney General, any district attorney, any city prosecutor, or any county counsel, notwithstanding whether the exclusion or exception regarding the duty to defend this type of claim is expressly stated in the policy.
(c)CA Insurance Code § 533.5(c) For the purpose of this section, “duty to defend” means the insurer’s right or obligation to investigate, contest, defend, control the defense of, compromise, settle, negotiate the compromise or settlement of, or indemnify for the cost of any aspect of defending any claim in any criminal action or proceeding or in any action or proceeding brought pursuant to Chapter 5 (commencing with Section 17200) of Part 2 of, or Chapter 1 (commencing with Section 17500) of Part 3 of, Division 7 of the Business and Professions Code in which the insured expects or contends that (1) the insurer is liable or is potentially liable to make any payment on behalf of the insured or (2) the insurer will provide a defense for a claim even though the insurer is precluded by law from indemnifying that claim.
(d)CA Insurance Code § 533.5(d) Any provision in a policy of insurance which is in violation of subdivision (a) or (b) is contrary to public policy and void.
insurance coverage restrictions criminal action fines penalties coverage
Section § 533.7
This law allows insurance companies to defend licensed doctors, specifically physicians or surgeons, in lawsuits related to actions performed as part of their professional duties.
Notwithstanding any other law, an insurer may defend a duly licensed physician or surgeon against any cause of action involving the performance of any act for which a physician’s and surgeon’s certificate is required.
insurance defense licensed physician surgeon
