DougSpurlingcreated the topic: Adjuster's Life--don't do it for the money
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I have taught insurance coverage over the years and just saw an excellant example of "direct physical loss to property" this was a case of a domestic house cat trapped behind the sheetrock of a house being constucted in Winslow, AZ. The owner closed and moved in and heard "meow" over the kitchen ceiling several days ago and cut 4 holes to remove the cat, this made the poor cat to move and todays photos showed a bath room wall removed. Yep all covered under the HO-3 subject to the # 2 deductible.
Q. How many other "odd" risk of losses are in the old timers memory ?
My nephew has worked for one of the major flooring/tiling companies in Omaha for about 15 years. He had this happen to him on a bathroom remodel job in his early days. Tore out the old tub surround & flooring, prepped the walls & floor, and applied the adhesive to set while he left to go to lunch. Returned with his helper and set the remainder of the tile. The boss man received a call from the homeowner after midnight as she could hear her cat crying in the wall behind the tub. She been gone all day & night so hadn't missed it yet. Turns out the cat crawled into the cavity between the tub & wall while my nephew was gone and they tiled it in without any idea. The boss man went over to her house that same night about 1a.m. , and cut a small hole in the bedroom closet drywall behind the tub returning Felix to his freedom again. He also patched the hole, and painted the wall the next day. They had a good laugh over it, and ended up doing new carpeting, wood floors and counter tops for the same lady.
Well this cat story does not count as an "insured" peril as it was a cat behind the wall story. But to spice things up look at the 16 perils in coverage C and I do not think we will be able to remember or hypo a dozen more. One down and eleven to go. I have a hypo but will save it for Saturday. Think, think its not that easy to find all these "open policy" type claims, Is it ?
I remember a picture of a bunch of Holsteins on a front porch of an insureds house that was high ground in the fenced in acreage. The porch was damaged but was excluded loss as the animals were owned by the insured.
Anyone also see non concurrent causation ? On the HO and flood policy.
I have a little bit of a morbid one where named insured owned a rental house with all risk coverage-pretty nice place. Tenant was sitting on the toilet taking care of business and keeled over dead, falling off of the toilet and landed on the HVAC vent on the floor. Stayed there for maybe up to a week before discovery, and in the process parts of the body deteriorated and "melted" down into the duckwork. HVAC continued to run all this time spreading the severe odor of death throughout the entire risk. Was a very severe loss as you can imagine all the areas the odor penetrated throughout the property. Also a lot of hard research to determine if any of the exclusione would/could apply such as contamination, but loss was considered covered.
Had another similiar one on an auto policy involving one of those customized handicap vans-high dollar van. Named insured was parapalegic, was held up and shot in his van and the van was left in a parking lot that always had cars in it. In Okla in the summer time and after a few days a distinct odor came from it, police called and the body was discovered. Van was totalled out due to the smell not being able to be taken care of.
I have worked several dead body claims in my claims history. That odor just cannot be removed from the car. USAA spent a ton of money on one claim in an attemp to remove the odor. It was a very high end auto and they wanted it repaired. We ended up totaling the car and the salvage yard burned out the interior before compacting it.
You're absolutely right, Ray...when you narrow it down to Cov C & those 16 perils. The oddball "covered" claims are harder to find. Take the 8-year old helper when Mom's been doing laundry. Little Precious follows Mom out of the wash room with the bleach bottle and no lid on it. It's dripping/splashing out all the way across the house and up the staircase to the far bedrooms. OK, we have coverage for the damage to the attached carpeting, but that $3500 Oriential throw rug on the wood dining room floor is personal property so there's no coverage for it.
Mom then sends Little Precious (who is also a tomboy) outside to play ball. With 2 out in the bottom of the 9th, she slaps one foul and thru the picture window knocking a collection of crystal figurines to the floor where they shatter. Do you say this is covered as a "falling object", or is it no coverage for the personal property?
The 4 year old who runs through grand maws house with a glass of red kool aid would be the same as bleach, but the infant who is all dressed and has an explosion and mom puts all the garments in the laundry sink, turns on the water to make better and her phone rings and the heavy fabric falls to the drain hole and stops up the sink and floods the downstairs or both floors this is # 4. How about the 4 year old who wants to be a big boy and fills the bath tub with bubble bath and floating toys and then goes out side to play with the dog and the tub over flows when one of the toys is sucked into the overflow drain. Thats 5 and I am worn out. I need help to get 7 more .
Steve no one will be able to top this. We 6 more ,dig down folks.
The football team was drinking at the home with the parents away, and one of the stars jumped from the outside through the single pane glass on the slider(it was real clean and had been open when he got his last fill up.).** I had section II and the property claim and both were disposed of rather quickly under the premises MP. Five more to go.
** I had both Homeowner claims**
This seems to take place up North. A deer jumps through a glass window and then tries to get out of the house and does all kind of damage to the house the baby grand piano and some real nice rugs and other expensive furniture. How do you handle the UPP this is # 5
Big old house built in the 1890's with a brick fireplace/chimney running up thru the middle of the dwelling 2 stories plus attic. Hidden termite damage causes floor joists on main level to give way. More than half of the chimney comes tumbling down within the chaise & piles up in the basement on top of the firebox & mantle which also fell into the hole. The vibrations shook the walls & china cabinet, with items falling and breaking. All covered under Coverage E Additional Coverage for Collapse. Although this is not a named peril under Cov C, the language in Coverage E for Collapse only references covered property and does not confine it to the dwelling only.
This starts to stray off the topic a little, but you opened up the MP door Ray. Homeowner's heavy double-wide wooden garage door got off track, and he enlisted the help of a neighbor. While they are trying their damnednest to encourage the door back into plum, the large horizontal recoil spring snapped and a fragment of steel went into the eye of the neighbor. Handled it under med pay, no liability factor, no suit, his sight turned out OK in the end and he kept his pants hiked up whenever in the presence of his neighbors.
I am agast. Where are all the adjusters who were trained.... "if its not excluded, its covered" Did they all starve out in 2006 and 2007 or did they go to work for the water suckers and learn the real meaning of of "risk of loss" and "direct physical". seems like we had two genarations of "mold adjusters" in Kentucky, Tenn, Missouri area. Is it possible the mold police put them away.
Hey gang we are stuck on number 5 of odd ball losses that would fit under this topic for payment. Seems Texas has eliminated the "foundation claims" with the HO 3 which many carriers have gone to, but the old HOB is still around. The most popular policy in Texas is the HOA(named) with RCC on building.
Do many of you folks who have been around over 15 years remember a large class of contractors who got into storm work and were trained" It (roof) was too old to repair and I total'd it out as the they had replacement cost". I think some of these guys are running the training schools today.
Most were from Texas ,Alabama-Mississippi but in the meeting I attend their arguments were: "its like working with butterfly wings"
Frankly, I don't remember the outcome of this claim.
The insd was having a family gathering at his house and some of the nieces and nephews found a box of Rit dye powder, which they spilled on the living room furniture and hardwood floor.
In a moment of pure genius the insd used wet sponges in an attempt to clean it all up.
Speaking of pure genius, my insured tossed his cast iron patio furniture in his pool as Charley approached. He had heard that was a simple means to protect it from blowing away in the storm. It does work well with aluminum or plastic, and it even removes mildew.
Unfortunately, the iron furniture left rust marks in the plaster. By the time I got there the furniture itself was a rusty mess from the chlorine. The insured wanted new furniture and his pool re-plastered. Since this was not "sudden and accidental direct physical loss" there was no coverage.
This was great reading all these old "risk of loss" post. Well like all good adjusters, "get it right" has changed my opine on my post of 29March 2008. This was a house inside a small dairy that was surrounded by flood water and about 40 holstein cows had gone to higher ground, the front porch that was not designed or intended for cows and if it were it would hold about 15 not 40. The porch and one wall had animal damage from this event.. What is the proximate cause of loss ?. The animals not the flood.
The HO does not cover flood nor does it cover damage from the insureds animals. But the insured never expected or anticipate a flood, nor did the insured expect or anticipate his small heard try to get out of the barn and on his porch. Just because the cows were owned by him does not exclude coverage as the same damage could be done by neighbor's cows, also not anticipated or expected (2 key words in risk of loss coverage)
Number 1 post.
No. 2 post on risk of loss.
Approx. 16,000 flood claims in the Atlanta, GA area only 9% have flood coverage. This is not flood coverage but I think could be a HO-3 loss. A dwelling had about 6 feet of flood water. The water cake up slow and receded slow. The home owner finds thousands of snakes in his house when he returns.He calls a pest control company to tent the house and remove all the dead snakes, so he can began clean up from the flood. He has not have flood insurance. Is the cost of this service a direct loss under the HO-3 to effect clean up even thought clean up is not a covered peril. I say yes. The insured never expected nor anticipated an expense that was necessary for him to rebuild thier lives.
Number 3 risk of loss coverage.
A guest person or family member with an unknown undisclosed metal illness goes berserk and does extensive damage to the dwelling and its contents.
This is three that I think are covered and my last is one that I do not think is covered.