| Author |
Message |
RUSSELL E. DOE (Rdoe)
| | Posted on Thursday, November 15, 2001 - 3:36 pm: | |
Jim, your words were still pertenant.You need to play more golf!! |
JimLakes (Jimlakes)
| | Posted on Wednesday, November 14, 2001 - 4:45 pm: | |
To All,
Even though the post I made, I still stand behind, I hate to admit that it raised the hair on my neck and I did not even take the time to look at the date of the post. Sorry about that. I will not make that mistake again.
Have a Nice Day
Jim Lakes |
Kile Anderson (Kileanderson)
| | Posted on Tuesday, November 13, 2001 - 12:10 am: | |
Never mind, I just found it, that post is almost a year old. |
Kile Anderson (Kileanderson)
| | Posted on Monday, November 12, 2001 - 11:21 pm: | |
Jim,
What are you referring to? Did I miss something? |
JimLakes (Jimlakes)
| | Posted on Monday, November 12, 2001 - 9:58 pm: | |
Ms. CPCU,
I, like many others on this site take exception to your shortsighted statement that “Cat adjusters” lack knowledge or know less about insurance policies than the average homeowner.
I do not have a CPCU, but I can adjust any claim of any kind, any type and of any size and don’t need a CPCU to do so. I have done so. This also includes being an appraiser, umpire and expert on claims exceeding $10,000,000.00 on many appraisal processes. I know many “Cat” adjusters on this site that could do the same. I also know many people who hold state licenses and certifications that couldn’t adjust a claim properly if their life depended on it. Titles don’t automatically mean that you can adjust claims, interpret policy correctly or make you an expert.
I have been related to the insurance business for over 30 years, and have dealt with many different people. I have found that MANY Cat adjusters know as much or more about policy than MANY staff people. Why? Because they deal with many or all insurance companies on a daily basis, and not just one. They must know each carrier’s policy and their coverages in order to deal with their insured’s.
We welcome your comments to this site, however we do not believe that “all” should be painted with the same brush, just as we will not paint all CPCU’s with that same brush.
Oh, by the way, I thought I heard or seen somewhere, where it was against the rule of ethics that people could not use CPCU as their name as a title or part of a business. You might want to check into that.
Respectfully Submitted
Jim Lakes RPA
National Catastrophe Director
RAC Adjustments, Inc.
866.241.6574 |
Tom Joyce (Tomj)
| | Posted on Friday, November 24, 2000 - 4:09 pm: | |
As any of you that have worked as an emergency call out adjuster you know it is best to thread lightly until circumstances and coverages are determined. At 2:am at a loss site, whether is be property, auto or truck, best to do the immediate assistance and get approvals as you move along.
I agree with TomT and others sited in his post. Issues can be discussed and batted around, but best not to be specific to an ongoing claim as it may bite you.
There was an attempt at starting a policy corner several months ago, but interest seemed to disappear.
I hope all had a happy and save holiday. |
Tom Toll (Tom)
| | Posted on Friday, November 24, 2000 - 3:32 pm: | |
I must agree with Roy Cupps and Kelley Roberson. To advise a policyholder of coverage, without knowing the loss circumstances, can release the bear trap on someones hand. How can this question possibly be answered, not knowing the circustances surrounding the loss. We are all aware of the asbestos problem and its abatement process, but if it is not a part of the loss, then the policyholder would be responsible for its removal. I agree with Roy, the acting adjuster should be contacted and concerns expressed to that adjuster from the policyholder.
Bill Cook is correct also. Let us not wade into policy interpretations and claim commentary if we do not know the circumstances surrounding the loss, ie, coverage, exclusions, loss circumstance, etc. We could cook our own tuckus by getting involved in something that does not directly involve us. |
Kelley Roberson (Kelley)
| | Posted on Thursday, November 23, 2000 - 5:52 pm: | |
It became very apparent to me while working in Detroit this summer that it does not matter so much as how we, as adjusters, interpret the policy, it comes down to how the storm manager for the insurance company interprets the policy. These people can and will override decisions. The best place to always seek interpretation of a policy is with the storm manager or the person directly over you. If you do not agree for some reason make sure to document who "made the decision". In a cat situation the manager is always right. |
Bill Cook (Billcook)
| | Posted on Thursday, November 23, 2000 - 8:42 am: | |
Hypothetical issues of coverage questions are excellent forum discussions.
Advising a friend of a real policyholder on issues that may effect decisions
regarding legal rights is risky for all the parties involved. Mr. Cupps
advices are well founded as the majority of the time outsider interference
is not always welcomed by the handling adjuster that should be fully
qualified and informed as to the full extent of the policyholder's
entitlements as they apply to his particular set of circumstances. Being
ignorant of the particular circumstances any comments based on the limited
information provided may serve to confuse the policyholder and make the
handling adjusters job more difficult. Discussions between adjusters
regarding coverage issues serve a purpose of sharing knowledge and
information and make this a worthwhile forum. Providing, sharing and
advising this same information with uninformed friends of policyholders
could create opportunities for headaches mischief and confusion at best and
potential for the insured to act in the totally wrong fashion with his
insurers or even worse.
William S Cook
Public Adjuster |
Roy Cupps (Admin)
| | Posted on Wednesday, November 22, 2000 - 9:23 pm: | |
Dear Policy Holder,
I recommend that your friend contact their Adjuster and see if he\she can be of additional assistance. Your friend should be able to explained to the adjuster the problems. The adjuster is in the best position to offer them assistance at this time. If all has been agreed to with the adjuster, he or she may be able to arrange payment of the repairs less deductible based on a signed contract. Work with the adjuster, they have the details that are needed to provide assistance and can be of more help then we can at this time. |
Tom Toll (Tom)
| | Posted on Wednesday, November 22, 2000 - 9:19 pm: | |
Ms. CPCU. Like Tom Joyce, I post my real name for everyones perusal. If you want to challenge either myself or any other cat adjuster to a policy interpretation contest, just start it and we will gladly join in. I have been a licensed adjuster for 39 years, almost 40. Have been to many, many schools, seminars, workshops, etc. I know many cat adjusters who are extremely knowledgable, but guess what, none of us, including you, know it all. That is the purpose of the CADO web site. To pass knowledge on and to ask questions if you are not sure of coverage. That, Ms. CPCU, is a form of training and learning. Yes, I have met and helped many new adjusters who think they know it all, but know very little. How do we help them? We encourage them to participate in the web site, but we certainly do not defemate their intentions, desires, and hopes. Ms. CPCU, how much did you know when you first entered this business. Please use your real name or refrain from making rude remarks about our profession. |
Linda Asberry (Linda)
| | Posted on Wednesday, November 22, 2000 - 8:03 pm: | |
I have to agree with "Not enough information". There isn't enough information to be of any valid assistance to the policy issue posed by whom I suspect is an adjuster. Ms CPCU, I regret that you feel as you do about cat adjusters. I really don't know what constitutes an "average cat adjuster". There are many of us who do pride ourselves on being knowledgeable or at the very least knowing where to find the answers. If you truly feel this way about cat adjusters, I am rather amazed that you would take the time to post on this board. Although you are more than welcome to do so.
We all want to help and will help but don't sell cat adjusters short. You are painting with a very broad brush.
If the "Policyholder" will provide all the necessary information, I am certain the answers will be forthcoming. |
Tom Joyce (Tomj)
| | Posted on Wednesday, November 22, 2000 - 2:47 pm: | |
Same old same old,
If you have something to say, use your name. The fact is cat adjusters have been a moving force in bringing new tech. to the industry. How often are adjusters on site and set up to go with no way to communicate with the company? CPCU, do you want to discuss knowledge?,many of the members thrive on policy issues as they have to deal with them in the field and with the actual adjustment of the claim. I as others welcome all your experience. But keep the bull home. By the way, what other names do you use |
Ms CPCU
| | Posted on Wednesday, November 22, 2000 - 1:37 pm: | |
Since when did knowledge (or lack of knowledge) of an insurance policy make any difference to the opinion of the average adjuster? Most cat adjusters probably know less about insurance policies than the average homeowner. |
NOTenoughinfomation
| | Posted on Wednesday, November 22, 2000 - 1:33 pm: | |
The truth of the matter is that none of us have enough information to be of assistance to the "Policyholder". Without knowing the exact policy, state of issue, and the endorsements which may be attached to this policy, we cannot provide an accurate opinion or assessment of the loss or payment issues. |
Tom Joyce (Tomj)
| | Posted on Wednesday, November 22, 2000 - 12:10 pm: | |
CPCU,
I agree with you on many levels and look fondly back on the days before the so called easy read policy. But we move along, and with endorsements to the standard HO which include bringing repairs to code, and the interpretations of the policy by the courts and insurance commissions the water has muddied on many issues. Your position on strict interpretation is, as far as I can see on target, but experience in the field is different and I along with others will attest.
Long ago I had a manager named Jim Robb. The one thing that I learned from him was his definition of his job. To make it short it came down to his definition of an adjuster, which was "I am not a contractor, I adjust,I am not a lawyer, I adjust, I am an adjuster therefor I adjust matters and take the steps to resolve the problems. I think sometimes we as adjusters loose site of this basic principal and get caught up in moving files. Our job is to assist the policyholder and the companies. We often determine a coverage issue, but be careful as recent articles have shown there are many grey areas that are very much left to the companies. |
hardknocks
| | Posted on Wednesday, November 22, 2000 - 11:11 am: | |
ASBESTOS:
If the item with asbestos needs to be removed to do the repairs or replacement of the items damaged by a covered peril, the cost of the removal is covered along with replacement of material of like kind or quality.
The company can withhold replacement cost coverage if applicable under the policy (depreciation) until the repairs have been made. They must pay the ACV or actual cash value claim less any applicable deductible up front. |
Ms CPCU
| | Posted on Wednesday, November 22, 2000 - 10:28 am: | |
Policyholder, suppose the direct loss in this instance was to items or articles which did not contain or consist of asbestos. Suppose further that due to the large amount of physical damage to property, that a local building inspector visited the loss in the permit process and determined that asbestos was present and required to be removed. If such removal was not due directly to the underlying direct physical damage, then the carrier would not owe for the asbestos removal, and that cost would be the sole responsibility of the policyholder. Otherwise, the insurance policy would rise to the level of being a maintenance contract rather than a contract of indemnity. |
Dave Dehlinger
| | Posted on Wednesday, November 22, 2000 - 7:14 am: | |
First of all, we are working under the assumption that the abatement is not excluded under the policy. If that's the case, and your friend is using the adjusters recommended company, they probably have an agreed price for the removal. Tell them to have the abatement company invoice the carrier. Or ask for an advance payment to cover the cost of abatement. There are many details of the loss that are missing that may lend to other options, but this is my two cents. |
Linda Asberry (Linda)
| | Posted on Monday, July 17, 2000 - 6:53 pm: | |
This message was sent to me from Tom Joyce:
Dug the FCS up from my daughter's computer and found that a similiar issue was addressed in a Q&A. The question dealt with a neighbors tree roots causing damage to insured foundation. Insured had a HO3, claim was denied as earth movement caused by tree roots. Note that the neighbor was put on notice regarding the problem and failed to do anything to correct the situation.
Reply was that there is no exclusion for tree root induced damage. That arguing that tree roots caused earth movement falls outside the commonly held judicial opinion. Most courts hold with the opinion of the Pennsylvania court in "Rightly v. Lebanon Mutual Ins. Co. (79 Del 319, 1993 C..C.H. 4097)" the Court finds that the earth movement exclusion applies only to sspontaneous, natural, catastrophic earth movement and not movement brought on by other causes."
FCS , in this instance the neighbors failure to correct the situation and allowing the roots to grow becomes a man made means by which the seemingly natural movement occurred. Therefore, there is coverage.
Thanks Tom for the research. |
Moderator (Jf)
| | Posted on Monday, July 17, 2000 - 10:43 am: | |
Linda, yes, I am referring to the HO 00 03 04 91.
Thanks for your wisdom. I could not, and did not say it half as well as you! |
Linda Asberry (Linda)
| | Posted on Monday, July 17, 2000 - 9:09 am: | |
I assume we are referring to the HO 00 03 04 91.
Section I.3. Excluded under Section I - Exclusions.
Under items 1. and 2. any ensuing loss to property described in Coverages A and B not excluded or excepted in this policy is covered.
Exact language.
There is absolutely no mention anywhere in this policy of tree roots. So if it is not specifically excluded then it is a covered peril.
Jim is correct that in some policies there is an exclusion for tree root damage but not in the language of the ISO policy. You can, however, in most states, purchase an endorsement for loss by tree roots.
I do not have copies of the FC&S Bulletins. However, I will attempt to research this today and will post whatever may be found.
It is truly a gray area and there may be as many interpretations as there are members of the judiciary.
If we base this under the assumption that if it is not excluded; it is included and because policies are "take it or leave it" contracts then the insured is in the favored position in most cases. The very ambiguity of the policy language normally (whatever normal is)creates this favored position.
More to come..... |
Moderator (Jf)
| | Posted on Sunday, July 16, 2000 - 11:10 pm: | |
I am going out on a limb so to speak on the tree roots coverage question.
Since we had no takers on the coverage question regarding tree root damage to the concrete slab and floor, I guess it is incumbent for me to brave my way through the policy and stick my neck out on this one.
My friend Tom Joyce says that this is a "no brainer" and the loss would be excluded under the HO-3 (04-91 Form) for because of the following language in the policy:
Section I - Perils Insured Against
2. e. (6) which contains the following language:
"We do not insure, however, for loss:
2. Caused by:
e. Any of the following:
(6) Settling, shrinking, bulging or expansion, including resultant cracking, of pavements, patios, foundations, walls, floors, roofs or ceilings;"
Now Tom Joyce may be right or is he?
Oh, if it were only that simple, or is it?
Hear me out now first, and then respond.
First of all the coverage question involves the HO-3 which insures against risk of direct damage to property (unless otherwise excluded (my language)).
Suppose for instance a water pipe laid within the concrete slab froze and ruptured during a winter ice storm due to loss of heat because of a general power outage. Suppose that when the pipe ruptured, it caused an expansion or bulging of the concrete slab which pushed the floor upwards. Would there be coverage for the resultant damage? I suggest there would be.
Suppose in another example, that the same tree was blown over by a windstorm and the uprooting damaged the slab which then caused the concrete to expand and buckle upwards. Would there be coverage? I suggest there would be.
Suppose there was an explosion which caused damage to the concrete slab. Suppose the explosion caused a shrinking or a cracking of the concrete slab with resulting floor damage. Would there be coverage? I suggest there would be.
Now, you may say well that is because these are all named perils: rupture, wind and explosion. How true, but remember this is an HO-3 which is NOT a named perils policy.
In all of the instances above, the concrete slab may have suffered shrinking or bulging or expansion or even settling. Yet, the damages would still be covered.
Now I might agree that the INTENT was to exclude tree root damage to concrete slabs and foundations, but the language of the exclusion found within the HO-3 is somewhat unclear when one looks at other scenarios where damage to concrete slabs might be covered. (Such as the examples suggested above).
I am told, although I do not recall seeing it, that the Farmer's insurance policy similar to the HO-3 has very specific language which specifically excludes damage by tree roots and tree root growth.
It just seems to me that this is a "gray area" within the policy which is subject to more than one interpretation.
Since I am on the road on assignment right now, I do not have access to the FC&S Bulletins and would be curious as to what light they might shine on this particular coverage question. If anyone has access to FC&S or has encountered this particular situation, could you please share with our readers what FC&S says or what your experiences were.
Again, I am not asserting an answer which is clear beyond doubt or debate. I am merely suggesting that there may be more than one way to look at this and more than one interpretation.
In the end, that is what makes the insurance policy the most widely sold yet least read piece of literature in America.
I invite others to share their views on this topic. |
Moderator (Jf)
| | Posted on Friday, July 14, 2000 - 5:50 pm: | |
Here is a Coverage Question which I received by email today. It is an interesting situation which an adjuster will encounter sooner or later. Please share your thoughts with all of our CADO readers.
________________________________________________
I have a loss on a single family home where a HO-3 is in place. The insured bought the home 2 years ago. There is a large tree at the East end of the property. On the West side of the home the living room tile floor has buckled. The tile is not broken but there is a noticeable rise in the surface of about 4 inches. The roots are visible above ground outside and the insured cuts his own lawn. My question, if this floor has lifted due to the tree roots is it covered. I should point out that the patio slab had cracked about a year ago and the insured did nothing about this.
________________________________________________
What do YOU think? Is there coverage? Why or why not?
(Message edited by admin on January 28, 2002) |
Lee Mushaney (Red)
| | Posted on Monday, May 08, 2000 - 8:37 pm: | |
OK Jim- here we go-----
on the Mr Diaz's watch covered under the HO-2
I do believe I know where you are going here.
President Clinton and Ms Reno both said "that
it was Mr Gonzalez fault" . We now are in a
different realm. We would be talking liability.
There is Liability coverage under the HO-2 policy. Of course Mr Diaz's expensive watch would
be covered under his own HO-3 if he has an all risk policy. But, there would be a deductible involved. Which if he has a $500 deductible, he wouldn't receive anything but under Mr Gonzales policy he would be under the liability and there wouldn't be any deductible with a $1000 limit. This would also bring the "good neighbor" provision into the mix.
I do believe that the Insurance Company would pay
it. I do wonder, however, if this might be a
s t r e t c h. |
Jim Flynt (Jim)
| | Posted on Friday, May 05, 2000 - 8:53 am: | |
"Homeowners Analysis" is THE BOOK for all of you who want to have the most current copies of the HO-1, HO-2, and HO-3 policies as well as the more important endorsements. The book also provides an in depth analysis, on a line by line basis, of these policies and their intent, definitions, and application.
"Homeowners Analysis" is available from the Rough Notes Company for $57.95 plus shipping. You can access the Rough Notes website at http://roughnotes.com/products or call them toll free at 1-800-428-4384. The product ID number for this book is # 26010.
Rough Notes also publishes similar guides for the BOP, Commercial Property. Personal Auto, Worker's Compensation, and Business Income coverages and policy. A review of these is available at their website as well.
I should have mentioned this book a long time ago for those who want to stay on top of policy and be savvy in applying it. It is the book the "Pros" use and perhaps the only one you will ever need.
This book combined with either the CPCU Guide to Policies or the Alliance Kit, makes for an adjuster ready and able to handle even the trickiest of claim situations.
I highly recommend it! |
Donald W. Mathews (Dmat)
| | Posted on Thursday, May 04, 2000 - 4:49 pm: | |
OK Jim,
Will look and see if I can find something on it from that angle. If I do, I'll be back, if not, I'll go looking for the right info before I speak on it again. |
Tom Joyce (Tomj)
| | Posted on Wednesday, May 03, 2000 - 8:17 am: | |
SIRS (Self Insured Retentions) were popular in the mid 80's as a means to reduce insurance costs. It also was a good source of business as many of the companies required that the deductible be verified and brokers found that the most reliable method was an independent adjustment company. Just a note, maybe a future source of business |
Jim Flynt (Jim)
| | Posted on Wednesday, May 03, 2000 - 5:10 am: | |
A QUESTION OF DEDUCTIBLES
We are all familiar with straight fixed amount deductibles as well as straight percentage deductibles which we are seeing more and more of lately, especially on coastal and earthquake policies.
Here are a few "NEW" deductibles which you may be seeing in the very near future.
Remember, deductibles from a risk management standpoint are "self insured retentions" or SIRS. And insurance, from the risk management viewpoint, is just one way of transferring and financing risk. These new deductibles are responses, albeit it fairly sophisticated ones, to alternative risk financing utilizing insurance.
A FRANCHISE DEDUCTIBLE is one where any loss over a stated amount or percentage of the insured value will be paid in full. If the loss falls below that stated mount or percentage, them the insured bears the loss in full. The insured thus retains all normal (or frnchise) losses but has a "cover" for losses which are catastrophic or which exceed those which are actuarily expected. Franchise deductibles are normally seen only in ocean marine cargo policies, yet you could run into the franchise deductible should you be handling a claim for a municipality which is along a coastal area or major waterway (Mississippi River for instance).
The DISAPPEARING DEDUCTIBLE is like the franchise deductible in that all losses above a certain stated amount are borne by the insurer and no deductible applies, and conversely, all losses below a stated amount are borne by the insured. In between these two points, the deductible declines until it disappears. To make the deductible disappear, the insurer pays the insured more than 100% of the amount by which the loss exceeds the deductible.
To illustrate: assume a loss conversion factor of 111% of a deductible amount of $1,000.00 thus causing the deductible to disappear at a $10,000.00 loss. The deductible disappears because the loss conversion factor is greater than 100%. The greater the loss conversion factor, the quicker the deductible disappears. If the loss is in excess of the disappearing point, the entire loss is recoverable and there is no deductible. If the loss is between the deductible amount and the disappearing point, the loss conversion factor is used. For example, if the basic deductibile is $1,000.00, and the deductible is to disappear for losses of $10,000.00 or more, the loss conversion factor is 111 percent for the portion of a loss that exceeds $1,000.00. Thus for an $8,000.00 loss, the insurer would pay 111 percent of $7,000.00 ($8,000-1,000), which is $7,770.00, leaving only $230.00 of the loss for the insured to absorb.
AGGREGATE DEDUCTIBLES provides that an insured will not have retained losses (deductibles) in excess of a stipulated amount in any given year. If an insured has a policy with a $10,000.00 straight deductible, how many times in one year can that insured afford to pay (retain) the $10,000.00 deductible for absorbing losses. Therefore, the insurer might agree that once the number of claims in one year becomes greater than 10, thus costing the insured $100,000.00 accumulated deductibles losses, that the insurer will pay 100% of the remaining losses for the year.
I thought the above deductible trend might be worth noting and post them for your awareness.
Much of the information above is taken from the latest text of "Risk Management for Public Entities" published in 1999 by the Center for the Advancement of Risk Management Education. The text is part of the RMPE 352 course which is offered in conjunction with the ARM (Associate in Risk Management) designation program.
Please feel free to email me if you have any questions or if I can clarify. |
R.D. Hood (Dave)
| | Posted on Sunday, April 30, 2000 - 10:52 am: | |
Which all serves to prove the credo of the seasoned adjuster: "READ THE POLICY" and of course be sure you have the applicable one.
Perhaps Mr. Flynt and Mr. Cook could be worthy adversaries on a HUGE commercial loss with each representing the respective parties to the loss.
Do we need a poll?, or can i make book on the outcome?
FMM, Would lay 5-2 on Flynt this week. |
Jim Flynt (Jim)
| | Posted on Friday, April 28, 2000 - 9:32 pm: | |
JP, the CP 00 30 06 95 contains policy definitions at the very end of the policy form.
Please note the following references to the 72 hour exclusion as mentioned in the answers to the commercial policy test reprinted from "Resources" magazine.
G. DEFINITIONS
3. "Period of Restoration" means the period of time that:
a. Begins;
(1) 72 hours after the time of direct physical loss or damage for Business Income coverage;
You should note also the following language which appears close to the front of the policy form:
3. ADDITIONAL COVERAGES
b. Civil Authority
(2nd Paragraph) The coverage for Business Income will begin 72 hours after the time of that action and will apply for a period of up to three consecutive weeks after coverage begins.
In the field of risk management, the deductible is often referred to as an SIR, or self insured retention, in which the insured participates in the loss along with the insurer. This is another way of saying that the insured retains a layer of financial self insurance. Since the insured does not collect for the first 3 days of business income loss after the damage event, he has that 3 day loss of income as a self insured retention, or deductible as we say on the claims side.
I hope this answers your question, but if not, please let me know. |
Jim Flynt (Jim)
| | Posted on Friday, April 28, 2000 - 8:54 pm: | |
A NEW COVERAGE QUESTION FROM A CADO READER
I received the following email today from Bill Cook, a Public Adjuster from Florida inviting a response to the coverage questions which he poses within his coverage case. I invite all of our CADO readers to respond with their thoughts on coverage in what we will call the GUS CASE.
___________________________________
Gus Case Question
Jim
I value your coverage knowledge and responses. Your opinion on this one. Insured has a 70-year-old commercial building with a replacement cost policy in effect. Building has a coal chute room in the basement (now may be considered a vaulted sidewalk due to a prescriptive easement to the city) Sidewalk is actually the concrete ceiling of insured's basement coal room and has never been city owned property. The water leaking in has caused sever rusting in the imbedded metal rebar and the metal attaching points at support walls. Area has an open expanse of 8x32. All support for ceiling slab is maintained by perimeter walls. Insured has used all type jerry rigging to support sagging ceiling in this area and it appears to be a mess that he will have to spend a large sum to shore-up, cut out, install some type of tie in to support wall to allow for a new pour of ceiling slab. The problems are exacerbated by the extensive rusting and wasting of the metal attaching points. Really hard to come to a stopping /starting place on the renovations.
Insured has had an ongoing problem with delivery vehicles using this area as a quick park pad to make delivery. Good fortune occurred and a delivery van pulled off roadway and caused tenants inside building to here a loud pop. Delivery was made and when van pulled away a large crash noise. Tenants looked out the window and saw a three-foot hole where concrete fell to basement floor. (No question a covered event for first and third party coverage) poor adjusting caused liability company to say they never parked on sidewalk and could not have caused the damage. Adjuster forgot to interview the three witnesses inside the building and took drivers word he would never commit the sin of parking on a sidewalk. Case closed by third party carrier. First party carrier was called in and they hired an engineer and he determined that the cause of the loss was rusty rebar and supports that allowed chunk to fall out when truck drove on it. (Insurers engineers report). Beside that it was just propped up with temporary jack post and wooden sticks etc. I agree that the ceiling was hanging on by a thread of rebar, but it was hanging on. The chunk fell out in the center of the slab. First party denied claim due to rust and maintenance failure. I became involved 12 months later. Big argument with insurers about the cause of loss is a covered event. They got an attorney and finally was resolved that coverage would apply and then they brought their unlicensed contractor from two hundred miles away to give an opinion as to how repairs could be made. Adjuster told him to not include or make any consideration for any worn out support items or members. This is a replacement cost policy. They said they would put a pillar under the hole area and re-pour that area for a modest sum. I disagreed arguing that it is a replacement cost policy requiring lkq. They said that the worn out supports were not going to be replaced as covered items. I contended that on a replacement cost policy they are required to put old for new where necessary to effect repairs. They said they had the option to do the repairs as insurers. I requested we go to appraisal they agreed and then said that appraisers could not consider the worn out items in the appraisal process. I argued that was a coverage issue and not for appraisers to decide. They said they would not participate if appraisers included support items. Effectively we were going to appraisal over the cost of pouring a sidewalk slab under insurer's terms of the appraisal. That would be an effort in futility as appraisers decision are usually held to be final by the courts and my best win would only be to maximize the cost of pouring a four inch slab into an insured completed form.
I said ok, we accept your option to exercise right of repair. Their contractor returned and doubled the cost he had originally offered to the insured as a settlement ($4,500 to 9,000) with city paying for sidewalk pour. They said insured would have to hire a local contractor to do the repairs that they had figured. He would also have to make arrangements to fix the support structure as well. I advised them when they agreed to take over repairs that meant they would tend to repairs in total. They disagreed that it was not their responsibility to do anything more and that they would now pay the $9,000.00 and insured could fix his building.
I filed a formal complaint to the NCDOI for thirteen different violations of statutes and rules committed by insurers, and adjusters and unlicensed contractor acting for insurers. The NCDOI has advised me to tell insured he needs to get an attorney. How can an attorney afford to get involved on a small case like this and get paid a fee worth the effort? Attorneys have no interest in small property losses and many don't have the expertise to handle.
The crux of the issue is that I am trying to get the insurers to pay a large amount of money to replace a large expanse of slab and the supporting structure on a worn and rusted out area that needed replacing prior to truck running over it. It seems unfair to call on insurers to do that but they should never have sold a replacement cost policy on an eighty-year-old building and charged the extra premium for the coverage.
North Carolina is not very consumer oriented with their insurance laws to protect the public against unfair claims settlement practices or unfair and deceptive trade practices. This insured tried to get the matters resolved for eighteen months prior to my involvement and it remains unresolved. I can accept the $9,000.00 and collect my fifty percent contingency fee but the insured cannot get the building fixed for the full amount if he did not have to pay my fee. Why should insured have to pay me a fee to collect on a covered claim mishandled by insurers? What a mess. I would like to see if your opinions regarding the structural support items fall on the side of insurers or the insured. I have requested that the chairman of the insurance committee in the NC delegation review this loss for an overview of the responses of the consumer affairs dept of the NCDOI. They seem to shy away from getting involved in a dispute regarding the activities of the department. The department has refused to address the issues in writing. A formal decision from the NCDOI is appeal-able to the Wake county superior court but I can't take a phone response to court. This is the kind of case that old salts such as you and I would enjoy hashing out over coffee on a daily basis while it was in progress. Insurers and adjusters have made many many errors of judgements and interpretation calls and bad responses. I have a dead lock bad faith response from insurers and nobody appears to have a concern or care. My question that needs answering is where did the insured go wrong in pursuit of his entitlements under the policy?
This case could be a poster boy for your insurance class that you are starting or for a coverage question on your forum.
(Message edited by admin on January 28, 2002) |
Tom Toll (Tom)
| | Posted on Friday, April 28, 2000 - 7:41 pm: | |
Congratulations Linda, well done. I love it when a lady adjuster is riding the top of the ladder. I was the first claims manager in the state of Arkansas to hire and train a female adjuster back in the 60's, much to the chagrin of the males. Fortunately she did a marvelous job. This blew the minds of the males. I am a pilot and have been since age 13 and know many lady pilots who far exceed the ability of many male pilots I know. It is wonderful that our fold now contains ladies who are mastering this once male dominated work place.
All you ladies keep up the good work. My wife is a licensed adjuster and a very good one. Perhaps CADO should include a powder puff area where the ladies can communicate exclusively and also show presence on all CADO pages. Ladies who did not want to fly, but wanted to know how to navigate and land an airplane, took a powder puff course, in the event their husbands, boyfriends, etc. had a medical emergency, rendering them unable to navigate or fly. Food for thought. |
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