ACORD 83 Instructions


ACORD 83 (2003/09) - Personal Umbrella Application

Personal Umbrella or Personal Excess insurance policies are personal lines insurance contracts that provide for indemnification of third parties as a result of damages and/or injuries sustained due to the insured's negligence with respect to personal acts. Coverage for negligence arising out of any professional activities and nearly all business pursuits conducted by the insured is normally excluded. It is important to note that personal umbrellas normally provide personal injury in addition to bodily injury coverage. While the latter coverage deals solely with physical injuries, the former includes "injuries" sustained as a result of libel, slander, defamation of character, false arrest and other "non-physical" perils.

Personal umbrellas typically operate in excess of or "overlay" the primary
liability coverage contained in other personal lines insurance contracts such as private passenger auto, homeowners and watercraft. Coverage limits are written on a combined single limit (CSL) basis. In some cases, Personal umbrellas may provide basic or "first dollar" coverage for certain types of negligence for which there is no primary coverage. Personal umbrellas can also overlay coverages afforded under certain commercial insurance contracts such as owners, landlords and tenants liability policies. They also provide that the insurer will pay legal defense costs on a first-dollar basis in addition to the policy limits. The majority of personal umbrellas contain a provision for a retained limit which effectively operates as a per occurrence deductible.

Although insurance coverage afforded by a personal umbrella is typically
operative "worldwide" and specific units at risk (such as automobiles) may be related to locations in varying geographical locations (rotary territories), premiums are developed on the basis of unique personal umbrella rates applicable at the insured's primary residence. No known requirement for allocating premiums back to other exposure locations exists.

The underwriting process for any personal lines policy begins with the
submission of a completed application. The generic sections of each personal lines form are explained in the Personal Lines Generic section at the beginning of the Personal Lines Section of the Forms Instruction Guide. On the ACORD website, (www.acord.org), this information appears under the title PERSONAL LINES GENERIC SECTIONS.

UMBRELLA INFORMATION

Policy Amount
Limit of liability.

Retention
The amount of liability retained by the insured. Retention is generally expressed in whole dollars but can be a percentage.

Optional Coverages to Apply
Insurance companies often provide options or special coverages. Examples:
  • Professional
  • Business
  • Major medical
  • Uninsured/underinsured motorists

Specifically note each option desired and provide all the information necessary for underwriter review and policy issuance.

In Florida, Indiana, Louisiana, and Vermont, Uninsured Motorists coverages (and Underinsured Motorist coverages in Indiana) must be offered in umbrella policies up to the liability limit of the policy when auto liability coverage is included. In Florida, auto supplement ACORD 61 FL should be used with umbrella policies. Refer to the instructions for use of this form in the State Forms section of this guide. In the other states mentioned above, no supplement is required, but the insured must initial the appropriate statement at the bottom of the back of this form, indicating selection or rejection of UM (and UIM in IN) coverage.

Premiums
Methods for calculating the policy premiums differ by company, but usually include a basic amount. Any additional autos, residences, watercraft or special options involve additional premiums based on an established schedule.

Calculations
The insurance company may require use of specific multipliers or factors which can be shown here.

PAYMENT PLAN

Indicate whether the agency or the company (direct) will bill the insured or other payee for the policy. If direct bill, also indicate who is to be billed, and the plan for payment.

PRIMARY POLICY INFORMATION

Type of Policy
The most common coverages are pre-printed on the application. Space for additional primary policies in force is provided.

Company/Policy Number
Provide the name of the insurance company and the full policy number including any alphabetical prefix and/or suffix. Be sure to list all primary policies for all insureds in the household such as children with their own auto policies.

Policy Period
Effective and expiration dates for each primary policy in force.

Limits of Liability
Limits for each policy. Some policies may offer different limits for specific hazards (fire, legal liability or waterskiing) which must be identified. Use the blank spaces to provide this information.

REAL ESTATE

Location
Address of all owned, leased, rented or occupied residences, buildings, farms and vacant land.

Description
Differentiate locations such as vacant land, apartment buildings, townhouses, single family dwellings, farms. Provide the number of acres if farm land.

Interest
Show the interest of the applicant (owner, lessor, lessee, occupier, etc.) for each described location.

Yr Built
Year the dwelling was built, use four digits (e.g., 1952).

Occupancy
Identify the occupants of the premises (self, self and tenant, tenant, three families, doctor's office). Indicate if the occupancy is seasonal.

AUTOMOBILES

Year and Make and Model
List all automobiles owned, leased or furnished for regular use.

RECREATIONAL VEHICLES

Year and Type, Make and Model
Provide the same information as for automobiles; be specific regarding the type of vehicle. Specify if it is a dirt bike, van, scooter, etc. Include size of engine in cubic centimeter displacement and/or horsepower.

WATERCRAFT

Year
Model year of the unit in YYYY format. If built at home, the year built.

Motor Type, Manufacturer and Model
Indicate type of motor (inboard, outboard, etc.), manufacturer and model.

Length
Overall length measured in feet from bow to stern.

Horsepower
Total horsepower of the watercraft.

Max Speed
Enter the maximum speed of the craft. State if measured in knots or miles per hour.

Value
Companies may require either one or both dollar amounts. Indicate in the corresponding box whether cost new or current value applies. If two amounts are required, enter the cost new first.

Waters Navigated
Body of water or geographical area navigated (e.g., Atlantic, Great Lakes, Inland Waterways, Pacific, Rivers). Specific names (Hudson River, San Francisco Bay) can also be provided.

OPERATOR INFORMATION

Name
Names of all household members and all operators of vehicles or watercraft, even if they are not members of the household. The listing should include children at home or relatives/friends who may use a vehicle or watercraft.

Sex/Mar Stat
Sex and marital status of each driver and household member.

Date of Birth
Date of birth of each driver and household resident (MM/DD/YYYY). (e.g., March 7, 1944 should be 03/07/1944.)

Drivers License #/Licensed State
Complete drivers license number and license state for each licensed operator. Copy directly from license if possible.

Social Security #
Social security number for each driver.

Vehicle, % Use
The vehicle operated by each of those named above, the percentage of use of the vehicle attributed to that operator, and annual mileage or any other information required by the insurance company.

Craft, % Use
The watercraft operated by each of those named above, the percentage of use of the craft attributed to that operator, and annual mileage or any other information required by the insurance company.

EMPLOYMENT

Occupation
Some job titles are not very specific (Manager, Analyst). Expand upon the title as necessary (e.g., Department Manager of Plastics Manufacturer).

Employer's Name and Address
Name of the employer and the address of the location where employed.

Yrs Empl
Number of years the applicant(s) has been with the employer indicated above. If less than 3 years, provide the number of years in the same or other career field or industry in the Remarks area.

PRIOR EXPERIENCE

Losses
Follow the company guidelines for required information on prior losses.

Prior Carrier and Policy Number
Provide the prior insurance company's name and the complete policy number, including prefix and suffix.

GENERAL INFORMATION

Use the Remarks section to provide additional information for any of the questions below answered with a "Yes" response.

1. Any aircraft owned, leased, chartered or furnished for regular use?
This does not include scheduled commercial airlines. If the applicant is a licensed pilot, the company may require additional information.

2. Any operators convicted for any traffic violations?
Provide the name of driver involved, the date and nature of the violation and/or conviction.

3. Any operator have physical /mental impairment?
Provide the name of the driver and the details. Determine if the operator's impairment (e.g., amputation or epilepsy) could hinder the safe operation of a vehicle. Provide a description of any special equipment installed and treatment or medication being administered.

4. Any swimming pool, spa or hot tub on premises?
Indicate if there is a swimming pool, spa or hot tub on any covered premises. If there is a swimming pool, indicate whether the pool is above/in ground and whether there is an approved fence.

5. Any real estate, vehicles, watercraft, aircraft used commercially or for business purposes?
Describe all commercial or business use.

6. Any real estate, vehicles watercraft, aircraft owned, hired, leased or regularly used, not covered by primary policies?
If yes, explain why no primary coverage exists.

7. Do you engage in farming operation?
Describe all farming operations performed by the applicant including custom farming. Include size of the farm, its acreage and annual sales.

8. Do you hold any non-compensated positions?
List any unsalaried or other philanthropic position the insured holds. Examples:

  • Corporation's board of directors
  • Master of a lodge
  • Commodore of yacht club

9. Any full-time employees?
If the applicant employs any full or part time employees, provide information on whether they work inside or outside, number of employees, duties, number of hours worked per week and total payroll (e.g., housekeeper, gardener).

10. Any non-owned property exceeding $1,000 in value in your custody?
If the applicant is responsible for the property of others, list the type of property. Examples:

  • Firearms
  • Art
  • Computers

11. Any business and/or professional activities included in primary policies?
Provide the nature of such professional or commercial activities and whether or not income is produced.

12. Any primary policy have reduced limits of liability?
Include any primary policy endorsed to limit, restrict, exclude or otherwise modify coverage provided by the basic policy form (e.g., liability may be reduced when the applicant is using watercraft for waterskiing, or for a youthful operator when operating a motor vehicle).

13. Any coverage declined, cancelled, non-renewed?
If any policy had this action taken, provide the reasons and circumstances. This question cannot be asked in Missouri.

14. Does applicant or tenants have any animals or exotic pets?
Use the remarks section to give the age, breed, or other information about livestock or pets that may be vicious or dangerous to human beings. Also give any history of biting or causing injury to others or to other animals.

15. Has insurance been transferred within agency?
Indicate if prior carrier information shown on the front of the application represents a policy being transferred within the agency. Give reason for transfer.

16. Any pending litigation, court proceedings or judgment?
If yes, describe in detail.

17. Is there a trampoline on the premises?
Indicate if there is a trampoline on any covered premises.

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