Lesson 14 discussed he circles of coverage: (1) Coverage grants (2) exclusions (3) exceptions. If a claim does not fall within a coverage grant, there cannot be coverage. If a claim is excluded, then that coverage is removed (ambiguities and inconsistencies aside). If a claim falls within an exception, then there can be coverage only up to what was within the coverage grant. Basically, the exception makes it if the exclusion isn’t there. It cannot create its own coverage.
So, who has the burden of proof? Whoever seeks to break the status quo.
“It is the insured’s burden to establish that his claim falls within the terms of the policy.” Heniser v. Frankenmuth Mut. Ins., 449 Mich. 155, 172 (1995). Until that happens, the status quo – that the insurer owes nothing – stands.
Once coverage is established (changing the status quo), the burden shifts to the insurer to prove that an exclusion applies.
If an exclusion applies, the burden shifts back to the insured to show that an exception brings back the coverage.