| Author |
 Topic  |
|
wfkelley
8 Posts |
 Posted - 01/15/2003 : 09:09:52
|
My last thread was generally headed downhill, so I'll try another route. For those wishing to bash attorneys, please do so, it is helpful to hear what people hate most about your profession so you can try to avoid those traits.
As I always say, 99% of the attorneys are giving the rest of us a bad name.
I am interested in a question for the adjusters who handle liability claims. It is a generally accepted principle among attorneys, that three times actual (or special) damages is a good settlement target for your personal injury cases. What do insurance companies feel is fair, or do most of them feel that indemnity only covers actualy costs and not any compensation for intangibles such as pain and suffering,etc.
By the way, I am very insurance friendly, just crossed over to the "dark side" for the thrills.
Bill Kelley, JD, MBA, CPCU, ARM |
|
|
JimF
USA
1014 Posts |
Posted - 01/15/2003 : 14:14:35
|
Bill, where do you practice in case we ever need you?
Your 'credentials' beyond your JD are impressive by the way! |
 |
|
|
Russ
USA
75 Posts |
Posted - 01/15/2003 : 16:02:48
|
Bill, You're talking to the wrong Group! We as CAT Adjusters never do liability claims. When there are no storms and we do regular business work, thats when we may see a liability claim!We have a wealth of knowledge from some of the Senior Adjusters on this site. Email one of them and see if they can help. I put my Wife through Law School for my retirement. By the way
Do you know the difference between a dead DOG in the road and a dead LAWYER in the road.Skid marks in front of the DOG!!! Ya'll have a great day!!! |
|
|
|
wfkelley
8 Posts |
Posted - 01/15/2003 : 16:52:19
|
Thanks for the advice. I practice in Georgia (Cartersville). If you ever need a good lawyer (that may be considered an oxymoron by this group), I can be contacted at bill@billkelley.com
Thanks for any help. Bill |
|
|
|
JimF
USA
1014 Posts |
Posted - 01/15/2003 : 17:30:44
|
Actually Bill, there are several adjusters on this site, cat or otherwise, who do handle liability claims, full time or in overflow situations, so we welcome you to post your questions and insights here.
While you may have to experience a little of the lawyer bashing initially, we can learn from you and hopefully, vice versa.
Like Linda, there are so many times when I am happy to work with an attorney or Public Adjuster instead of a hardheaded stubborn insured. Good lawyers (and from your credentials I can tell you are one of those Bill) just like good a Public Adjuster such as 'our own inhouse' PA Bill Cook bring a great deal of professionalism and mutual cooperation to the insurance claims settlement process.
Stay with us Bill and we welcome your posts and insights in the days ahead.
And Bill Cook, while you have been quiet of late, you know you are always welcome to share your esteemed professional thoughts as well! |
Edited by - JimF on 01/15/2003 17:31:50 |
|
|
|
Ghostbuster
476 Posts |
Posted - 01/15/2003 : 20:22:15
|
Thas right! For all of you folks that visit this clubhouse but never express your opinions, we really do want you to chime in. Please do not be afraid. You will not get dog bit or cattle prodded. There is no painful initiation or hazing here. It is true that most of us are proud members in good standing of the 'Burnt Tailfeathers Society', but that's because we let our rearends overload our mouths! If you wish, you too can join this open society. All are welcome.
|
|
|
|
Davey
USA
38 Posts |
Posted - 01/16/2003 : 06:38:07
|
Bill
In my recent limited liability experience, the actual treatments are given a higher multiplier and the rest of the "specials", a lower %.
For example, I might weight the physical therapy with a factor of 5 and the xrays and office visits 1 or 2. But it depends upon the injury, the insurance company and the part of the country you're working in. |
|
|
|
ALANJ
USA
159 Posts |
Posted - 01/16/2003 : 16:20:11
|
Mr. Kelley:
Have you jumped on the (MOLD IS GOLD) train yet? |
|
|
|
wfkelley
8 Posts |
Posted - 01/16/2003 : 19:32:57
|
I have had a couple of my clients (insurance) file mold claims, and one very large plumbing client I have (legal and insurance) has certainly had a couple of scares. The awards for mold lawsuits appear to be excessive, but not yet gold.
I am suprised that claims have been paid under first party coverage for mold, since reading most property policies lead me to believe that mold would not be covered (it is a fungus???)
From a liability standpoint, I'm sure that some claims are legitimate, but the remoteness of the negligence to the injury seems a reach to me.
The legal publications make mold out to be the next cigarette or asbestos litigation, but I hope not. Hopefully, ISO forms will make the exclusion perfectly clear, and the problem will take care of itself. I do have some cheese in my refrigerator that might be a problem though.
Bill |
|
|
|
KileAnderson
USA
875 Posts |
Posted - 01/16/2003 : 20:29:45
|
Bill,
You don't seem like a lawyer to me. At least not a very succesful one. :) |
|
|
|
ALANJ
USA
159 Posts |
Posted - 01/17/2003 : 08:09:25
|
| The first Toxic Mold Law Suit in New Orleans settled for 1.1 million. The adjuster wrote an estimate for $197.00. A water spot on the ceiling from a leaking roof. Ensueing loss,(Toxic Mold), was not addressed. CNA now Encompass settled instead of producing discovery material. |
|
|
|
wfkelley
8 Posts |
Posted - 01/18/2003 : 20:18:45
|
ALANJ: Your mold story reminds me of recent claim one of my insurance clients had. He had a roof damage claim from a storm. The adjuster determined that a coinsurance penalty was in order. For a $1985 claim, subject to a $1000 deductible, the adjuster sent the insured a check for $10.23 after the coinsurance penalty. All I could tell the adjuster is to rethink his decision, as in the eyes of a jury, that would be one expensive check. Sometimes people do the darndest things. And Kile, you are right, I'm not yet successful, but I hope to be so soon, and to retain my integrity getting there.
Bill |
|
|
|
CCarr
Canada
1200 Posts |
Posted - 01/20/2003 : 15:35:37
|
Bill, I'm from the frosty north, but I'll assume the basics are the same, i.e. special damages (actual / out of pocket loss) and general damages (pain & suffering "etc").
First, I would just like to clarify to the crowd, a comment Russ made; ".... we as cat adjusters never do liability claims." That may be so for the property only cat adjuster, however there is a growing field of liability cat adjusters. The fastest growing area of this niche is the adjusting of class action claims.
Back to your question, I have never been exposed to the "multiplier" factor to establish general damages. I note Davey's comments with interest.
The concept puzzles me when I consider a T/P with a broken arm, where specials may only amount to $500, are you suggesting generals are only worth $1500 - all other 'things' considered equal? In a tort setting, without getting into gender etc, this is worth $6000 to $7500 - given a generally uneventful 3 or 4 month recovery.
A moderate whiplash may have no plaintiff specific specials, but treatment costs of $1000 over time, surely generals are not limited to $3000. With the same qualifier as above, this is worth (and a much more difficult type of injury to hypothetically value) $7500 to $10,000 - given a generally uneventful 6 or 8 month recovery.
Getting to your roof claim 'story' and the $10.23 check. That is the kind of thing that really makes my ears turn red. Regardless if that is the whole story or not - IF the claim was properly estimated at $1985., and IF the building was underinsured, and IF a co-ins penalty was properly applied, and IF that application of the co-ins created a 'penalty' of $974.77; then what is wrong with the $1010.23 settlement that is subject to a deductible that happens to be $1000.?
What is the, ".... darndest thing" there?
If the estimate was wrong, or if the co-ins penalty should not have been applied, or if the co-ins 'penalty' assessment was too much - then sort it out and / or kick the adjuster's ass. But, if all that was done correctly, what is the "darndest thing" about a $10.23 net check? |
|
|
|
CCarr
Canada
1200 Posts |
Posted - 01/21/2003 : 06:54:09
|
I've noticed that Bill Kelley has been back to the 'forums' since my 1/20 inquiry and comment on his 'roof story', but has not responded.
I'm also quite surprised that no one else questioned or took issue with that 'story' and Bill's summation of it that, ".... sometimes people do the darndest things." I take that as a kick in our collective ass - that is anyone who calls themself or represents themself as an adjuster.
An adjuster's job - in the short version - is to determine cause, coverage, and cost; within the contract wording applicable and the insured risk.
If the proper steps are taken, if the correct determinations are made; the result is the adjustment of the loss.
Whatever the adjustment ends up being, an adjuster can not allow themselves to be intimidated by the mere scoffing of a lawyer.
What you see on this thread - in the 'exchange of stories' between two lawyers (AlanJ & wfkelley) - is a contemptuous down play of the adjuster function; with the concluding ridicule of 'you' the adjuster.
|
|
|
|
Darryl
USA
36 Posts |
Posted - 01/21/2003 : 08:59:54
|
| I have to agree with Clayton. Although the insurance policy is a contract of adhesion, it is in fact a contract. The adjustment of the loss is governed by the contract. The amount of the payment should never be the determining factor in how the claim is adjusted. In my experience as a 20+ year multi line adjuster I feel the duties of an adjuster should be to pay what is called for under the policy no matter how much or how little and the duty of an attorney is to secure the best outcome possible for his client under the legal system he is working within. These two are often at odds. Eventually there will be case law that governs the final outcome. |
|
|
|
JimF
USA
1014 Posts |
Posted - 01/21/2003 : 09:08:52
|
Clayton, with all due respects, I read the same thread and did not take away the same message. There are good adjusters as well as bad adjusters out there, just as there are good and bad lawyers.
I think the point Bill was trying to make, is that a carrier sending out a check for a Ten spot and change for roof damages totalling $1,900.00 would not play well in front of a jury. It might in Canada, but would not here in North Carolina or down in Georgia where Bill practices. Perhaps that says more about the nature of juries and those who serve on them, nevertheless they are a part of our life.
The greater question here it seems to me, is for you or Bill to set up an example for readers to show how this settlement could happen under the policy. We both know that it is only with a fairly severely underinsured risk that enough coinsurance penalty could be applied to so drastically reduce the settlement payment.
Without further knowing, I would be interested in knowing WHY this risk was so severely underinsured?
Further, for how many policy periods had this carrier indemnified this risk at the current policy level?
What role did the agent play in this underinsurance situation? Is there an E&O exposure there for this situation?
Just my thoughts. |
|
|
|
Topic |
|
|
|
Attorney - Part 2- Damage Multiples
Forum Locked
