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House Fire--A simulated claim for discussion

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House Fire--A simulated claim for discussion

Source: Forum Post Started by Racko on 9/19/2006

To kill some time in this lull period & spread some knowledge, here is the scenario (or scenarios) as you see fit to make it. I will lay out the limited info as follows, and let's see where it goes.

Heavy fire loss occurs in a single family dwelling. Cov is HO-3, no issues with eff dates. Insureds have just left home about 6:00 p.m., a couple hours before fire breaks out and is discovered. High winds fan the flames and each house on either side sustain heat/smoke damage before the fire is brought under control. Let's say both neighboring houses now have some melted vinyl siding, one sided 2 years ago and the other 12 years ago. The elderly neighbor next door initially beat on the insured's door trying to see if they were OK, and burned his hand. He then rushed home to get his wheelchair bound wife out of their house, but she spends a week in the hospital with smoke inhalation related complications.

The insureds are a young couple, both smokers, with a 6 year old son. They just moved in about 2 years ago, only work in the house since they came was replacing the kitchen flooring, and adding a center island with a new cooktop on it. These were professionally installed within the past 6 months.

You receive the claim assignment. The only loss info given is: Dwelling fire, appears to be total loss, possibly started in or near kitchen or in basement below kitchen. Neighbors have damage/injury.

When you 1st arrive at the loss, you are also "greeted" by Mr. Red Handed neighbor and his son-in-law who happens to be a well known plaintiff's attorney. You now discover that the neighbor is insured by the same carrier you are working for, but they haven't reported this loss to their agent yet because they've been waiting for you.

Now, where did you start, what is your plan of action, what do you find out, and how does this claim end? The stories will change as you will each come up with different findings in your investigation.

Old timers please hold your horses, and save critiques til later...thanx! Newbies & not-so newbies, jump in.

Note: The above is from a CADO forum that is no longer online but the 52 replies to the above post are (will be) posted below.  In some cases we do know the member ID but not the user connected to the Member ID. This discussion was also transfered to the current forum so the discussion could be continued but not all replies got transfered but some additional got posted to that discussion. Here is a link to the discussion in the current forum: 




Comment 1- First Posted on 9/20/2006 9:24:00 AM by Angus99

Great scenario!!

Briefly, a little respect empathy/sympathy to neighbor but suggest that he file a claim for property damages to his agent first. I may suggest to the neighbor to call his agent while i was at the property where there loss originated. I would call my claims manager and suggest that since i was near the property that i was able to adjust all properties at once. You need to document the damages to the adjoining properties anyway. Lastly, in regards to the neighbor, it will be presumed that the neighbors attorney will present you with a liability claim. I'll mention that later.

 Adjust claim for the insured whom reported the loss. Attempt to establish a C&O. Expect to hire a C&O expert. Document, scope, photos, estimates, etc....etc....

 Liability-(i worked for 2 carriers in over 5 years and had many subro cases in which the insured and claimant were both insured by the same happens)

 Two possibilities determined by the cause of loss. 1)If the cause of loss is determined as accidental, there is no negligence from the homeowner. Ain't paying for the damages to either adjoining properties nor for the neighbors injuries. Insured haven't breached any duties.2)that the loss was intentional-possibly it can be denied but better get the carriers attorneys prepared.

 I hope this briefly sums up my position. Great educational tool here racko!! I have handled many similar claims and they can be fun to adjust.

 Ohhhh....anybody want to give some claims(daily) to a starving Cat/Multi-Line adjuster in Virginia? Lol, this is getting bad, eating oatmeal for lunch and dinner every day and night is getting old (LOL)


Comment 2 - First Posted on 9/20/2006 10:32:00 AM by Clayton

 It is a fine scenario, a very typical type of dwelling fire loss; that is, packed full of unknowns with many stones to be turned and explored and many dusty trails to lead you in different directions during the adjustment. 

 My horses have long since gone to pasture, and this is not a critique, but, how is a "newbie" - as characterized in CADO - supposed to write about the adventures of adjusting this scenario? 

 A basic principal as you progress in any career, and claims is a good of an example as any, is that you do not accept assignments that you are not trained and experienced to handle. 

 With the scenario presented, what your Claims Manager - for the one assigned claim you have - does not want to hear, is you calling him/her to ask for the two other claims.  You have absolutely no idea, at that time in the scenario that it is suggested you go looking for more related claims; as to what the cause is, nor have you done any investigation to consider and determine negligence either by the insured or a third party. 

Comment 3 - First Posted on 9/20/2006 10:39:00 AM by 10716

 Oh great experienced adjusters...please explain in FULL DISCLOSURE, NEGLIGENCE.   Many homes today are in fact DIY projects and are done quite well.  Many products are replacing older ones which are of higher quality or standard than the original. 

Thank you.

Comment 4 - First Posted on 9/20/2006 11:08:00 AM by Angus99

What i think the original poster is requesting are ideas on how to adjust this loss. Its educational and maybe it can help someone out.  If i am reading the responses to date, correctly, why criticize?


Comment 5 - First Posted on 9/20/2006 11:15:00 AM by 10716

 Never mind [:(]....I'll go first.

 I arrive at my scheduled appointment, meeting with insureds on the site loss.  First things first, customer service- addressing insureds displacement issues.  I would also inquire about neighbors and get their contact info if available from insured.  Mr. Red Handed would be advised to contact HIS insurance company if he had any issues or concerns for HIS property and politely be dismissed from insureds scope.

 I would ask insured to walk me thru the damages, taking pics to represent actual damages AND insureds story.  Now I have their undivided attention because I have SEEN the damages.  So I get into the ale issues, get the receipts of those expenses.  Review current contact info and make sure they have my contact info.  I would then tackle the scope of damages most likely without interruption.  Once I have scoped insured, I would then get my pics of both neighbors exterior damages for dated reference and documentation.  I tell the insureds that we will have ongoing communication, encourage insureds to stay in touch, keep receipts and secure property.

  I make contact for fire dept. report while going back to office to work.  Now I will input my scope inspection into estimating software.

Comment 6 - First Posted on 9/20/2006 11:18:00 AM by TomToll


Failure to exercise the care toward others which a reasonable or prudent person would do in the circumstances, or taking action which such a reasonable person would not. Negligence is accidental as distinguished from "intentional torts" (assault or trespass, for example) or from crimes, but a crime can also constitute negligence, such as reckless driving. Negligence can result in all types of accidents causing physical and/or property damage, but can also include business errors and miscalculations, such as a sloppy land survey. In making a claim for damages based on an allegation of another's negligence, the injured party (plaintiff) must prove: a) that the party alleged to be negligent had a duty to the injured party-specifically to the one injured or to the general public, b) that the defendant's action (or failure to act) was negligent-not what a reasonably prudent person would have done, c) that the damages were caused ("proximately caused") by the negligence. An added factor in the formula for determining negligence is whether the damages were "reasonably foreseeable" at the time of the alleged carelessness.

Comment 7 - First Posted on 9/20/2006 11:32:00 AM by 10716

Thank you so much Tom, because I would be arriving to 1st meeting with that being a possible causation of peril which in my "fire claim" inexperience would want to have to been addressed.  I read here at CADO...."cause, coverage, cost".   I would want to work smarter, not harder.

Comment 8 - First Posted on 9/20/2006 11:35:00 AM by TomToll

 If my neighbor had a tree and it was rotten at the base and neither of us realized, then the tree falls on my house. There is no intentional negligence involved, no torte liability involved.

Now, I noticed the tree rot and confronted the neighbor that if it fell, it may hit my house and he disagrees. I contact an arborist and he agrees with my thoughts. I then send him a certified letter to get the tree cut down to prevent damage to my house if it fell, (leaning toward my house) and he disregards the certified letter. That is intentional neglect and becomes a legal torte. His HO carrier would then get involved to make a determination of negligence. Armed with the copy of the letter, I am sure the HO carrier would accept the liability of damages.

 Correct me if I am wrong, please.


Comment 9 - First Posted on 9/20/2006 11:43:00 AM by 10716

Thank you again Tom.  I can now picture with experienced insight just how negligence is applied or addressed in claims or interpretation of policy.  This is greatly appreciated by me because I am not presently available to "ride along" to a fire and be explained to face to face while in the passenger seat what you so graciously just provide.


Comment 10 -  First Posted on 9/20/2006 11:59:00 AM by 10716

 I need to know the cause of the fire right?

 I need to know charges if any from the fire dept. to come out to insureds right?

 I need to address the personal property right?





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Listed below are some links to other blog post and articles on other sites.

Dimechimes ClaimSmentor Adjuster Information Blog 
 Organization Chart for the Claims Handling Blame Game- A Humorous Graph -A Serious Look at Claim Bad Faith Issues
 On the page the above link takes you to you will find links to some of her other articles at the end of the above article.

Article written by John Postava
On the Ryze Claim Solutions webite

You can find additional post from John and Dimechimes in the CADO forums, they have made many post over the years contributing to the community by sharing their knowledge and experiance.

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