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Last Post 08/17/2012 3:10 PM by  Medulus
You receive a commercial claim assignment
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HuskerCat
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08/07/2012 11:06 PM

    This question is posed to you by an independent inside claims consultant. 

    I've been in your shoes as a field adjuster, both staff and independent. You are an IA, and a new assignment comes in via Xact from your IA firm.  You know who the carrier is and may have worked previously for them, but it has been directly assigned to your IA firm by the carrier's call center before all coverage information is confirmed or is provided by the carrier's inside examiner.

    This is a commercial loss due to wind & hail, and perhaps flooding, and maybe multiple locations.

    Now, then, for instance let's say it's a country club/golf course(s).

    What are your first 5 steps in handling this/these losses?

      

     

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    ChuckDeaton
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    08/08/2012 9:56 AM
    First things first, check coverage.

    Most commercial cover, whether underwritten in the admitted or non-admitted markets, does not cover flood. However, self insureds frequently have flood cover included in a manuscript with excess cover. The excess may be following cover or not.

    The example suggests "country club/golf course", frequently the cover on this class of risk includes landscaping, i.e. trees, bushes and the small buildings and accoutrements located out on a golf course.

    Additionally, time element can be covered.
    "Prattling on and on about being an ass with experience doesn't make someone experienced. It just makes you an ass." Rod Buvens, Pilot grunt
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    HuskerCat
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    08/09/2012 12:04 AM

    Fine observations, CD.... but no answers.  We have new info now.

    It's a day later (maybe 12 hours after the loss was reported), and I've reviewed the coverages available, and contacted the insured.  This isn't your little local country club, it's an old well established club with geographical if not national prominence. 

    What I have now learned is......... there are a multitude of trees down on the course from the high winds and torrential rains and hail, the power was out for 5 days, and there is damage also to the club house, other outbuildings, greens, bunkers, cart paths, fencing, and a bridge to an island hole.  There was a tournament scheduled for this same date of loss, along with a wedding reception for the daughter of the largest benefactor of the club.

    I've entered a note into Xact, now knowing who you are that was assigned to the loss.   That note has been forwarded to you via email not only via Xact notes, but also your direct email, and a message left on the phone number of record.

    OK, you have not had to handle a loss of this type before (or if you have), there is no need to push the panic button.... if you do what? Again, what are the 1st 5 steps?

    Keep this in mind.  Your file reviewers are not your enemy; rather, they can be your best friend if you let them.
      

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    ChuckDeaton
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    08/09/2012 9:11 AM
    Company file examiners, especially experienced long term employees of carriers who specialize in tailored cover for country clubs with exclusive memberships, club houses, restaurants, swimming pools and golf courses can be the field adjusters friend. On the other hand very few file reviewers working for vendors handle specialized catastrophe losses of this type and can be the road straight into legal proceedings.
    "Prattling on and on about being an ass with experience doesn't make someone experienced. It just makes you an ass." Rod Buvens, Pilot grunt
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    AcceleratedAdjuster
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    08/09/2012 12:44 PM
    Worst case, if you have no coverage info (this happens to my firm regularly on emergency commercial losses), follow the first 5 steps:

    1. Contact the insured right away (just a simple phone call saying something to the effect of "we know you are out there and are working to assist you will save you from a great number of problems that can arise if the insured feels ignored). Do not get into the fact that you have no idea what is covered, just ask about the damages and let them know you are working on it.

    2. Schedule the inspection for as quickly as you can get it done. Again, remember that while to you, it may just be another claim with insufficient information regarding coverage, to them it is an emergency.

    3. Call and email the people with the information you need.

    4. Even if you do not have the coverage info, go and scope the loss ASAP. This may add hours of additional work that is not necessary if coverage is not in place, but do keep in mind that any insured will wish to show you all of the damages to everything anyway, regardless of coverage. At the bare minimum, you can get a good scope and reassure the insured that they are being taken seriously, which honestly is every bit as important as generating an accurate report. Further, one generally spends more time in reports justifying lack of coverage on any specific item than one does recommending payment for a covered item, so scoping areas that are not covered is not a waste of time.

    5. If you still do not have coverage info, file a first report with a brief overview of the damages, a note that indicates that you will file a full estimate upon receipt of the coverage info, and a detailed photo report. This will not only cover your rear if the claim gets ugly, but it will also save you a considerable amount of work on the back end, as the photo report and damage summary will have already been submitted. You can at that point diary the file, pending receipt of the coverage info (and likely invoices from contractors), and file the full estimate upon receipt of all relevant documents.

    www.acceleratedadjusting.com www.acceleratedadjustingisrael.com
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    HuskerCat
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    08/09/2012 8:26 PM
    Posted By ChuckDeaton on 09 Aug 2012 09:11 AM
    Company file examiners, especially experienced long term employees of carriers who specialize in tailored cover for country clubs with exclusive memberships, club houses, restaurants, swimming pools and golf courses can be the field adjusters friend. On the other hand very few file reviewers working for vendors handle specialized catastrophe losses of this type and can be the road straight into legal proceedings.

    I'm not sure what you are implicating with that last statement other than paranoia...because in this scenario, I am the company file examiner although not "staff".

    In any event, it has now been the course of 2 days since the assignment was placed to the IA firm.  A review of Xactanalysis shows that the individual IA assigned by the IA firm has not even downloaded the assignment.  Nor has the insured been contacted by said IA (they called me and confirmed that, since I had requested they do so if no contact had been initiated).  Nor have I had any response from the IA to my emails and voice message.

    This is a large loss by all accounts given me by the insured.  Specialized coverages such as this can be handled with relative ease by an IA with exposure to commercial losses, although the broadened coverages would surprise many.  That is the very reason for reaching out to the IA, in order that nothing be overlooked in scoping & documenting the loss.  At this point, it appears we may need to reassign the loss to another IA who is working a similar loss and was willing to ask for and accept direction.  It's all about one common goal. 

     

     


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    Leland
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    08/09/2012 11:19 PM
    For a high profile, large dollar commercial loss, it is very important for the adjuster to know what the coverages are before visiting the loss location. For example: what if the coverage mentions "Building #3 - golf cart wash station". When the adjuster arrives at the golf course he sees a metal shed but nothing that looks like a "golf cart wash station". But because he has the policy, he can ask the employees which building is the "golf cart wash station". One of the older employees explains that the metal shed was used for washing golf carts 12 years ago but now it is used for storing merchandise for the gift shop.

    Imagine if the adjuster learns that the "Building # 3 golf cart wash station" is the smallest insured building with a $20,000 limit but $50,000 of estimated damages.

    Only by having the policy info BEFORE inspecting would the adjuster know what questions to ask - the opportunity to ask random employees which building is which might be gone once the adjuster leaves. Trying to get the info over the phone could be much harder. And the underwriting file might be lost or not have any details or photos to help.

    So it is very important to have the policy before inspecting. The policy can be used as a guide to what questions to ask.

    regarding the Xact net:

    Not every adjuster uses Xact net every day. So it is possible the adjuster didn't realize he had an assignment. But there's no excuse for not answering the emails or phone calls.

    The claim should be reassigned ASAP to another IA who can call and go the same day.

    I think what Chuck is referring to is the trouble an unexperienced VENDOR file examiner can cause on a specialized claim that needs a COMPANY file reviewer.

    I will give a simple example: large loss file reviewers are often conscious of the money burning up for loss of business income. They might be very aware, for example, that the BI loss is about $1000 per day and decisions need to be made quickly to save the carrier money.

    Residential file examiners, however, might not even think about the fact that taking 30 days longer to settle a $500 problem could result in an extra $3000 ALE payment. The residential file examiner is often not expected to think that way and doesn't have enough authority to decide things quickly.

    Now think about a complex business loss with many different coverages, coinsurance, etc etc.

    A COMPANY file reviwer might immediately think to ask the adjuster "did the wedding party have cancellation insurance?" because they have seen that scenario before.

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    ChuckDeaton
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    08/10/2012 7:51 AM

    All of Leland's comments are pertinent. Success in handling large commercial claims require a high level of care and competence

    Where large complicated losses with detailed involved cover are concerned, it is my opinion that a healthy dose of "paranoia" on the part of the independent field adjuster is warranted. My mother raised me to look before I leap. As far as I am concerned several factors will be weighed before I make the decision to accept a claim such as this. It would not be uncommon for the transmittal of the loss and acceptance of the claim decision making process, in the aftermath of a catastrophe, to require 24 hours. Commonly, lines of communication are down, lodging is problematic and travel is required.

    As a comparison, lets consider Hurricane Gustav and Hurricane Ike. When Gustav struck South Louisiana something on the order of 800,000 people evacuated, the line of vehicles filled I-55 from Houma to Memphis. Cell communications and email were non-existent. All forms of communication were out for several days as families filtered back into the area West of New Orleans.

     

    "Prattling on and on about being an ass with experience doesn't make someone experienced. It just makes you an ass." Rod Buvens, Pilot grunt
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    okclarryd
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    08/10/2012 8:47 AM
    Nice discussion but the original question still hasn't been answered.

    1. Contact the insured and discuss the loss(damages)
    2. Make no commitment as to coverages other than what is known to exist..
    3. Contact supervisor and discuss damages and coverages. Order the dec sheet and policy, if necesssary.
    4. Contact insured and make appointment to inspect and discuss claim activity to date.
    5. Make all pertenant diary entries to document claim activity.

    That should start the process nicely

    Happy Trails
    Larry D Hardin
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    Leland
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    08/10/2012 10:25 AM
    I would say its not a question of "if neccesary". The adjuster will ALWAYS want to get a copy of the policy and dec sheet for a loss like this, BEFORE going to see it.

    Let me explain a bit more about what I posted before. I handled a total loss residential fire in Malibu one time, where the policy covered a "barn", a "garage" and a "storage shed", besides the dwelling and unscheduled structures. There were a bunch of buildings that were burned and it wasn't clear which was which. The insurance company might not have any notes or diagrams or photos in the underwriting file to describe the different buildings, in situations like this. The best time to straighten it out is on the first visit. The adjuster can ask the insured "Which one is the barn?" and get a straight answer. Consider a scenario where there's a metal building with $100,000 of damage, and the "barn" has a scheduled limit of $120,000 but the "storage shed" only has $50,000.00. Depending on which building the metal structure is on the policy, the insured is going to be paid either $50,000 or $100,000. So this is just one reason why an adjuster shouldn't go inspecting a large commercial loss without a copy of the policy.

    I'll give another example. I had a commercial warehouse where the criminals used blow torches to cut into the metal doors and avoided triggering the alarm. The policy had a clause about the insured maintaining a centrally monitored alarm system, for coverage to be valid. They also had coverage for "business personal property" AND "business personal property of others". So right away, after reading the policy, I know what questions to ask on my first visit. I asked them who their alarm company was, and I asked for a copy of the alarm printout and recent invoice. I also evaluated the total value of their merchandise and the total value of customer's merchandise (for co-insurance calculations). If I didn't have the policy it might not have occurred to me to ask about the proof they had a working alarm that the policy required, and I might have failed to realize that the thousands of boxes in their warehouse were covered under two different lines of coverage.

    I once had a fire were a tenant started the fire while smoking crack. (A common problem in LA). The roommate suffered from some smoke inhalation and was complaining about having to go to the hospital. There were some questions about whether the building had proper smoke alarms, activated quickly enough. It was easy to see that the roommate's complaint could become a liability claim against the insured. The roomamte could have sued for big money, claiming the smoke alarm situation contributed to his smoke inhalation, and therefore make the building owner liable.

    I called the carrier and notified them of the potential liability claim and asked them if they had liability coverage on the building. They did, and we took extra steps to document the issues. This particular carrier had a habit of not sending me the liablity pages of the policy. I asked them to start sending me the whole policy and they started doing that for all of their adjusters.

    Let's go back to the golf course claim. What if the policy includes coverage for vehicles used to maintain the grounds. Ordinarily, the property adjuster doesn't look at the vehicles. But if the adjuster has a copy of the policy with $100,000 of vehicle coverage, the adjuster would be alerted to ask questions and investigate that portion of the loss.

    There's just so many different issues come up when the adjuster looks at the policy. To go on a large, complicated commercial loss without looking at the policy first is asking for headaches.

    Imagine if you went to the golf course and saw all the destruction with the pro shop destroyed by wind. You don't have the policy, because the carrier doesn't like to send it to you and you don't want to be to pushy to ask for it. The carrier doesn't want you to have the policy because they had bad experiences in the past with stupid adjusters making innaccurate statements about coverage. When you get to the golf course you see brand new golf clubs, golf clothing, etc. strewn everywhere. So, like a good adjuster, you interview the pro shop manager and collect all the business records. Because you are a smart adjuster and you know about coinsurance you make sure to calculate the total value off ALL the merchandise prior to the loss, not just what was damaged.

    When you are back in your office a few days later you get a call from the owner of the pro shop. He wants to know why you are adjusting his claim, when he has a different carrier. That's when you realize that the pro shop is a tenant of your insured, the golf course. The main information you needed to get from the pro shop was how much rent they pay your insured, and a copy of the rent agreement. So all the info you gathered was unneccesary, and what you really needed you failed to obtain.

    These kinds of problems are greatly reduced by having a copy of the policy in hand before visiting the loss. In my opinion, it is always neccessary, at least for big commercial losses.
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    Leland
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    08/10/2012 12:43 PM
    To answer the original question, "what would you do?"

    * get a copy of the policy. look through it.
    * look at the loss notice and talk to the file examiner to learn a basic idea of what the loss is
    * find out if the file examiner has some specific requests, like wanting a recorded interview
    * run directions to the loss, which also tells me how long my drive time is
    * for a high profile loss with a large dollar amount, I might google the business, google the owner, look at the buildings on google earth
    * call the insured for an appointment. Let the insured know what documentation I am going to need (financials, etc.)
    * send an email or call the file examiner to let him/her know I have made an appointment (remember, this is a high profile/high dollar loss)
    * go see the loss the same day I get the appointment because it is a high profile/high dollar loss
    * fax/email/ or call with reserves while I am at the loss or the same evening

    On a big daily claim loss the insured and the agent are worried about some large amounts of money and expect some service. By going the same day it calms everybody down and shows the insured his interests are important. This will avoid problems with the agent calling the carrier or the insured jumping to hire a PA.

    So that's my answer what I would do.
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    Medulus
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    08/10/2012 1:52 PM
    Just a couple observations for now because I have pressing work and not enough time right now to read and digest the situation and responses so far. I want to enter this fray as soon as I am able.

    First, the IA firm should have downloaded and assigned the claim immediately. It came in through a claim hotline and it sounds like there is more than a little urgency to the claim with a tournament set to start on the date of loss. I recently had a situation where our emergency hotline responder contacted me a week after it was reported and asked if I wanted them to handle the loss or whether we had already assigned it. As it happened the broker had contacted us directly after five days of hearing nothing and we had set the claim up and assigned it to another IA firm. My response to the emergency responder IA firm was not kind. I pulled it from them immediately with a wee bit of a lecture about the meaning of an "emergency after hours hotline".

    So, just off the top of my head I would say:

    1. Download and assign the claim.
    2. Contact the Carrier and tell them we received the claim. Request coverage information and verification of the assignment to your firm to proceed with handling. If you get the examiner in person, discuss the claim handling strategy. If not, make sure you leave a message and/or email. Keep calling until you speak to a person with authority.
    3. Contact the insured and tell them you have received the claim. Inform them that you do not yet have coverage information so you can make no admissions of coverage, but will be glad to make an appointment to see the loss because you want to document the loss and allow them to proceed with clean up and remediation without making any commitments.
    4. Prepare a non-waiver documenting potential coverage issues.
    5. Proceed to handle the claim until you are told not to do so, but only under a non-waiver. (note that in some states a non-waiver is of limited value, but there must be some documentation that you are proceeding in the best interests of the insured even though you have not verified that it is a covered loss.)
    5a. Remember that most lawsuits originate out of how competent the initial handling is. I have handled many files in litigation, but only two of the claims I handled from day one have ever had suit filed on them in 22 years (crossing my fingers and knocking on wood).

    This is my answer, and I am a file examiner on staff who oversees all property claims for my company.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    Leland
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    08/10/2012 2:34 PM
    Steve makes a good point about the non-waiver but that's not a decision that the field adjuster makes.

    In my opinion it is up to the file examiner to decide if there is a coverage question that needs a non-waiver or reservation of rights.

    It is true that the field adjuster should be aware of coverage questions, and should notify the file examiner of issues that could result in denial (Example: Policy excludes vandalism damage when the property is vacant more than 30 days. On inspection, the adjuster learns from neighbors that the dwelling has been vacant 6 months. The adjuster should immediately notify the file examiner so the file examiner can decide to do a reservation of rights letter)

    But the question posted here was about what the field adjuster would do, not what the file examiner would do.

    As a field adjuster I would never presume it was OK for me to decide on my own to inspect under a non-waiver unless I knew ahead of time that the carrier wanted and expected me to make that kind of decision.
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    Medulus
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    08/10/2012 3:23 PM
    I got your phone message, Leland. I will note that the instructions to IA firms working for the company I am on staff with (which instructions I wrote) specifically instruct IAs to prepare a non-waiver and handle the claim under a non-waiver if any questions of coverage exist. So anyone working for my company would have that authority in the written instructions. Each carrier should have similar instructions filed with each IA firm they use. There should be some guidance in the written instructions. It is my firm belief borne out by experience that failure to handle a claim promptly will result in far more lawsuits than a non-waiver, properly explained, will. The non-waiver does not have to be as specific as a Reservation of Rights letter, which IA firms do not have the authority to write on our behalf. I would certainly not make up possible exclusions, but simply state in the non-waiver that coverage has not yet been verified. Most states do not have the problems related to non-waivers that California does. In every case, however, the adjuster should do all he or she can to determine potential coverage problems before the inspection (without delaying the inspection) so that the non-waiver is not used unless absolutely neccessary.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    Leland
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    08/10/2012 3:59 PM
    Steve, thanks for the response.

    What's important here is the field adjuster has to do what they're told, and if it's not clear, ask.

    I never do non-waivers unless I am told, except for one carrier that tells me to do it on all water losses.

    If an adjuster works for you, he needs to follow your rules, and do the non-waivers.

    It's good that you have spelled out your expectations in writing, so the adjuster has a way of knowing what you want. This may be because of your CAT background.

    In my experience, CAT claim management is more likely to have procedures written out than daily claims management.

    When we have a California wildfire with thousands of damaged homes, the claims may get handled by daily claims adjusters and each claim will be done differently. In general, you won't see a bulletin saying "We do/don't pay for spoiled food in the refrigerator". Unfortunately, it gets handled differently by each adjuster. So kudos to you for standardizing your companies procedures. I know you have them all written out, which is rare.

    Which leads me to another point we can add to the things a field adjuster needs to do:

    * learn the companies/file examiners standard procedures before working the claim. Ask if you don't know.
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    Leland
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    08/10/2012 4:15 PM
    I wanted to also mention something about the golf course business income claim.

    Let's say the hail caused the cancellation of a tournament or wedding and that resulted in a loss of income for the insured.

    But that might not be covered. If the hail is just falling on the lawn and driving everybody away, that might not be enough to trigger coverage.

    It might be neccesary (under the policy) to determine if the hail damaged the insured lighting system so the wedding was cancelled becasue there was no light.

    If the hail damaged the big white tent provided by the caterer and that in turn caused the wedding to cancel, that might not be covered because the loss of income wasn't triggered by damage to the insured's property.

    Also if the wedding party fails to pay the bill because of the hail, but there is a contract saying they have to pay regardless of the weather, then that loss of income might(?) be denied.

    This issue is very similar to ALE on a residence. When a home is uninhabiable due to flood damage doesn't mean you can pay ALE on the wind claim.

    If the golf course loses money because of hail storm doesn't mean you can pay BI loss if the loss of income isn't due to actual physical damage to insured property.

    So can I add another thing that the field adjuster must do?

    * understand the policy and coverage issues, preferably before inspecting but at least before opening mouth. If you don't know, ask.
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    AcceleratedAdjuster
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    08/10/2012 4:58 PM
    Posted By Leland on 10 Aug 2012 10:25 AM
    I would say its not a question of "if neccesary". The adjuster will ALWAYS want to get a copy of the policy and dec sheet for a loss like this, BEFORE going to see it.

    Wanting and working with what you have are two entirely different scenarios. Would you really delay an inspection (possibly for days) because an emergency claim was assigned and the inside staff did not efficiently provide you with the info you needed? While I do understand that walking in with knowledge of coverage is a desirable situation, but sometimes it simply does not work out that way. In those situations, I would think it best to get the most detailed scope one can, while making the insured aware that you are making no coverage determination (which is normally reserved for the inside adjuster anyway), and simply working as the eyes and ears of the carrier.

    I have, in the past, delayed files based on insufficient information, and I have to tell you that it was an enlightening experience.  The insured simply wishes to feel like they are being taken care of, and delaying a file causes the insured to feel that you consider their claim unimportant (which can lead to all manner of outcomes, none of them pleasant). It is much better, I think, to go ahead and inspect, and explain to the insured that you are working with them to present their claim to the carrier in the most comprehensive and efficient manner, deflecting questions about coverage and deferring those answers to the staff adjuster. The insured still feels taken care of, and you just bought the staffers the time they require to get the information into your hands. Win/win, and the only negative is that you may end up spending a couple of extra hours scoping areas that you had no business scoping. That couple of extra hours is minuscule to you (especially if the file is T&E, which it generally is on large commercial losses), and your prompt attention to the concerns of the insured may well be the factor that (a) helps the carrier keep the client who pays hefty premiums on several locations; and (b) prevents the claim from getting nasty, be it the involvement of a PA or litigation measures.

    www.acceleratedadjusting.com www.acceleratedadjustingisrael.com
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    CatAdjusterX
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    08/10/2012 9:53 PM
    Posted By Leland on 10 Aug 2012 04:15 PM
    I wanted to also mention something about the golf course business income claim.

    Let's say the hail caused the cancellation of a tournament or wedding and that resulted in a loss of income for the insured.

    But that might not be covered. If the hail is just falling on the lawn and driving everybody away, that might not be enough to trigger coverage.

    It might be neccesary (under the policy) to determine if the hail damaged the insured lighting system so the wedding was cancelled becasue there was no light.

    If the hail damaged the big white tent provided by the caterer and that in turn caused the wedding to cancel, that might not be covered because the loss of income wasn't triggered by damage to the insured's property.

    Also if the wedding party fails to pay the bill because of the hail, but there is a contract saying they have to pay regardless of the weather, then that loss of income might(?) be denied.

    This issue is very similar to ALE on a residence. When a home is uninhabiable due to flood damage doesn't mean you can pay ALE on the wind claim.

    If the golf course loses money because of hail storm doesn't mean you can pay BI loss if the loss of income isn't due to actual physical damage to insured property.

    So can I add another thing that the field adjuster must do?

    * understand the policy and coverage issues, preferably before inspecting but at least before opening mouth. If you don't know, ask.

    ....................................................................

    Leland/Steve/Chuck/Larry and to all commercial experienced hands responding to this thread, it's very inspiring to see the amount of views and responses to this thread. It's discussions such as these that capture the true spirit of the benefits of claims industry social media websites such as CADO and ClaimSmentor. Their are untold numbers of newly licensed individuals reading every word of this and other topics here on CADO.

    In any case, my query is directed to Leland but anyone could answer. I have never handled such a large commercial claim such as the aforementioned Country Club and golf course and am curious as to two specific instances:

    1) Leland, you spoke of hail damage to golf courses. Along those lines, golf ball (no pun intended) sized hail stones would be absolutely devastating to putting greens of country club/PGA/Nike tour rated courses. So let's think of the country club in Augusta Georgia (Where one of the PGA Majors, the Masters)is played every year. There are 28 putting greens(to include practice greens) just obliterated from the hail. What complicates this question (hence the reason I am asking) is in the course of daily play and especially during high profile events, these same greens sustain impact damage from hundreds of players golf balls. The only apparent difference between a golf ball and a golf ball sized hail stone is impact damage is spread out over a day of play whereas golf ball sized hail stone happen over the course of a few minutes. Do putting greens hold an insurable value?

    2) As with Augusta, there are literally thousands of trees strewn about the course. Let's say as a result of Hurricane X, 500 of them are down in such a way that they impede play until they are removed. I know there are limits to tree removal and the like with typical HO series of policies, commercial policies, I don't know. Would these courses have an additional endorsement to cover the removal of all 500. Either way,would BI be triggered from this?

    Thank guys for a great thread!!

    "A good leader leads..... ..... but a great leader is followed !!" CatAdjusterX@gmail.com
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    HuskerCat
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    08/10/2012 9:57 PM
    Posted By OkcLarryD on 10 Aug 2012 08:47 AM
    Nice discussion but the original question still hasn't been answered.

    1. Contact the insured and discuss the loss(damages)
    2. Make no commitment as to coverages other than what is known to exist..
    3. Contact supervisor and discuss damages and coverages. Order the dec sheet and policy, if necesssary.
    4. Contact insured and make appointment to inspect and discuss claim activity to date.
    5. Make all pertenant diary entries to document claim activity.

    That should start the process nicely

    Happy Trails

    Typical Larry.......short and to the point. In fact, point on! Although you might substitute #3 for #1, now knowing that I've already spoken to the insured. 

    Knowing what I know now about the loss, you will look like a pretty smart fellow and have the full confidence of the insured when you visit the site and have dedicated a better part of the day to them.  Afterall, this is a 200 acre complex with coverage for trees and other portions of the golf course surface due to broadened perils beyond the normal commercial policy. 

    This thread wasn't intended to test anyone's coverage knowledge, because as Chuck & Leland said, there can be a myriad of coverages available on this type of loss.  The purpose of this was "what would you do?".  

    It seems the senior members have all the right responses, and the newer generation hasn't "chimed in"... to paraphrase you know who.

    Tune in later to see what happened after the loss was reassigned.

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    Leland
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    08/11/2012 3:36 AM
    To answer Robby's question, I have never handled a golf course claim and I was working under the assumption that the grounds (grass) wouldn't be covered. But Mr. Kunze gives us a clue that the policy DOES cover the "surfaces" and he mentions "broadened perils". So maybe the lawn damage caused by hail IS covered, and would also trigger business income loss coverage.

    So I would be interested to see how the "surfaces" are covered. Are the sand traps covered? If wind blows the sand away, is that covered? If hail hits the lawn, is the damage from hail covered? Is the removal of the hail covered, perhaps if it is necessary to restart play faster than waiting for it to melt? And trees are always an issue. Most policies will pay for trees that are damaged by the peril of fire, but not when damaged by wind. Is there some special tree coverage on this golf course policy?

    My assumption was wrong, but it just proves my point- the adjuster must read through the policy before inspecting the loss in order to know what to look for.

    I did some internet searching and found that there are lots of golf course polices that include coverage for the grounds. Here's a list of some coverages from one carrier:

    Property

    Lawns Coverage – for greens, tees and cut fairways: $50,000
    Golf Course Property – includes foot bridges, retaining walls, fences, underground sprinklers, hole or tee markers, benches, water coolers, ball washers, pins and hole cups, exterior light poles, paved walks and patios: $50,000
    Golf Carts and Grounds Maintenance Equipment – $5,000
    Perishable Stock – such as refrigerated food service stock: $5,000
    Hole-In-One Coverage – when award procedures are established: 50% of prize, up to $1,000

    General Liability

    Pollution Liability – limited coverage for operations usual to a golf course
    Vehicle Damage – covers damage to vehicles caused by golf course patrons' golf balls up to $250 per vehicle
    Professional Liability for Golf Instructors – covers bodily injury or property damage caused by the rendering or failure to render professional services as a golf instructor
    Additional Insured – covers your golf pro, golf cart users, club members and volunteers
    Extended Medical Payments – coverage is extended to club members and athletic participants


    If I was told to inspect a loss and was also told I couldn't have a copy of the policy, and after I looked at the loss I found out I should have also examined the lawn for damage, I would politely expect the carrier to pay me for driving out a second time. (Unless I was already an experienced golf course claim expert, or I had thought to check the internet and already knew that grounds could be covered)

    Here's a good question based on Mr. Kunze's scenario:

    What do you say to an insured when a loss has been reassigned to you and the first adjuster already contacted the insured? What do you say when the first adjuster already spent 3 hours scoping the loss and meeting the insured?
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    ChuckDeaton
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    08/11/2012 8:28 AM
    Certainly the answer to what can be covered is an unqualified YES. Any element of any business can be provided cover in a brokered manuscript policy. There are brokers who specialize in this area, Arthur J. Gallagher comes to mind. Trees are frequently provided coverage and, at least in some instances, individual trees are provided coverage. Hail damage cover for landscape features such as greens, shrubbery, trees and lawns can also be provided in brokered manuscript policies written by the non-admitted market. My expectation is that the manuscript and schedule detailing cover for Augusta National is several inches thick and entails literally hundreds of pages. Note that my initial suggestion was to secure a copy of the coverage before making any decision to accept the loss. If the assignment springs from a source that cannot immediately supply a complete copy of the policy it is very likely that your efforts will go unrewarded.
    "Prattling on and on about being an ass with experience doesn't make someone experienced. It just makes you an ass." Rod Buvens, Pilot grunt
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    sbeau4014
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    08/12/2012 12:02 PM
    Just a note on this thread in that I would guess most larger more established golf courses and country clubs would carry the "Greens, Tees and Fairways" endorsement that some of the larger carriers may specialize in. I know that St Paul Ins (Travelers) started writing this type of coverage around 1988 and when Hugo hit in 89 every golf course/country club we insured in SC had it. It was a great endorsement for the insureds and they could get cover from $50k up to $250k, and wind/hail damage to the trees was covered (an intregal part of the fairways). In a hurricane situation like that the destruction to the trees, greems and fairways will almost always mean a policy limit for those endorsements.
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    ChuckDeaton
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    08/12/2012 1:29 PM
    http://www.ksre.ksu.edu/library/hort2/mf632.pdf

    A publication I used for years to assist in writing estimates involving damage to trees and shrubs.
    "Prattling on and on about being an ass with experience doesn't make someone experienced. It just makes you an ass." Rod Buvens, Pilot grunt
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    HuskerCat
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    08/14/2012 9:48 PM

    Initial settlement has been made on this claim now, after the loss was re-assigned.

    IA #2 responded immediately to me the evening of reassignment.  I had left him my personal cell # & we discussed the coverages available.  If there were any questions, he would call me back.  #2 met with the insured the following day.  It was a 2 hr drive, with a subsequent time spent of 6 hours with the clubhouse manager/controller, head greens keeper, and local tree service contractor.  There were no real coverage questions, except for damage to some pothole bunkers and a wooden bridge that led to an island hole.

    Rather than provide 398 pages of policy forms/endorsements to the IA, we spent 15 minutes on the phone initially and another 10 during his inspection.  The coverage is Blanket Real & Personal Property in the amount of $28.5M which includes the clubhouse, banquet facility, 12 unit lodging, tennis/pool & fitness facility, maintenance buildings, halfway house (9th hole concessions), restrooms, etc.;  additional coverages are added for "debris removal of covered property" in the amount of $250K.  There are more than 24 endorsements added to the form, of which the most applicable is the "tee to green".  This endorsement not only defines "covered property", but also amends the specified perils for damage to trees, shrubs, etc., to include the perils of wind or hail.  There is also an endorsement adding limited flood coverage to this particular insured, but it did not come into play.  Had it come into play, there was also another endorsement that re-defined "flood", meaning it included surface water as a covered cause of loss.  However, another endorsement re-defines the exclusions and explains that bunkers & fairways are not covered for flood or surface water....unless endorsement XYZ is added, and then the loss is covered up to the amount shown on the declarations of endorsement XYZ.

    It can go on & on, as these are all tailored to fit the insured.  And these only address the property coverages, not their liability, work comp, auto, etc.

    I'll move on to a new window now.

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    HuskerCat
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    08/14/2012 9:52 PM
    First, to answer some questions, and respond to some prior posts...I'll go in reverse order, starting with Chuck's offering of a source.
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