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trader
USA
236 Posts |
 Posted - 12/22/2003 : 11:02:10
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"All risk contracts". A short lesson for the many adjusters that ask this question on a daily basis. The following is the answer to some of a paraphrased list of sample questions I have ask COVERAGE ATTORNEYS and Vice Presidents of claims over the years. Was it sudden and accidental? If's it's not unforseen, it's probably not covered; (find out). If it's inevitable, it's not a risk. It may be fortuitous, but it can't be expected. Sounds like a design flaw. Was it an accident or an occurrence?. Look under the general exclusions, or look under the specific exclusions. Not unless its named in the coverage extensions. Was it in this policy peroid? Why was it reported late? It can't be neglect or maintainace problems. Sounds like vermin to me. Sounds like settlement from any cause.
Hope some may benefit. My christmas present to the group. |
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CCarr
Canada
1200 Posts |
Posted - 12/22/2003 : 12:27:02
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| Ray, whatever your "short lesson" was; it went over my head. |
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trader
USA
236 Posts |
Posted - 12/22/2003 : 13:04:26
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| I ask a question. The experts answered with a question or a statement that required an answer. Every time you have an all risk problem arise, go to the above and you may find the answer your self. |
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C Bond
32 Posts |
Posted - 12/22/2003 : 13:41:23
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| The actual cause of the interior water damage was due to incorrect application of the comp roof. The leak was a direct result of continuous butt seam directly below a downspout location on the roof surface. Exclusions That Apply To Property Coverages 2. b. Errors,Omission, and Defects. However the interior damage would still be considered as an insuing loss which is covered. Thanks Clayton for leading me down the "yellow brick policy road". Olderthandirt,As the roof did sustain wind damage and was payed for, these points of MINOR interior damage have become purely academic. I payed a min. interior paint and closed the file. Eventhough this was a minor item I appriciate the debate. Next time it may be a more serious. |
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TomS
USA
32 Posts |
Posted - 12/22/2003 : 20:59:24
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CBond,
May I offer a quick insight to your review of policy and claims, # 1, and only, Look for every way in the policy and beyond to pay the claim, and guess what, when you can't find it, you will have your answer, it is not covered. Once you have looked to pay it, all the coverages, and exclusions will be reivewed. Our job is not to look for denials, it is to look for coverages based on the situation and then "if" covered recommend, if not recommend denail. looking to deny each and every claim will mount to quite a few returns and redo's.
Good luck and happy holidays.
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C Bond
32 Posts |
Posted - 12/22/2003 : 22:59:26
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| Point well taken Tom. I am merely reviewing those coverage questions that struck me during the last storm. You know, all those what ifs......... |
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JimF
USA
1014 Posts |
Posted - 12/23/2003 : 07:19:22
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| Just out of curiousity CBond, was the last storm your first storm? |
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CCarr
Canada
1200 Posts |
Posted - 12/23/2003 : 10:38:58
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Chuck, these comments relate solely to your 12/22 @ 13.41 post.
I sincerely hope that with your willingness to bring your questions to the forefront of the assembled group, that as a result, you don't feel like the current 'throw around toy' of the week.
Reading your background that you provided in another thread, I think you are well suited in many ways to meet and enjoy the challenges that you will encounter from the "people" aspects of the business and that of the construction / technical part of it; regardless of the length of your current storm experience that has no relevance to this thread.
You made the following quote in your noted post, "Exclusions That Apply to Property Coverages 2. b. Errors, Omission, and Defects"; after you mentioned a cause of a loss.
Assuming that that discussion was still relevant to an HO3, I can not find that "quote" in my infamous HO3 wording; which leads me to the point and tip I want to offer in a constructive manner. If you are quoting from some other wording, that is relevant to that post; then my comments are generic to 'handling' issues.
Whenever you refer to policy wording - verbally or in writing - whether it be just a term or a paragraph or two, use the exact policy language that you are referring to. This will apply with equal importance, regardless if you are communicating with your vendor, the carrier or the insured.
I have two old briefcases that I used when I travelled. One, full of any policy wordings that I had or would need, and the other full of maps (from pre GPS / Delorme days).
I learned the hard way, to discontinue the practice of paraphrasing coverage wordings, especially to insureds. In fact, I got into the consistent practice of whenever I had to refer to a wording with an insured, to pull it out and read from the wording and show them where it was in their policy; both for coverage they didn't realize they had and for areas where I couldn't recommend indemnity. This accomplished at least two things, first, the insured got the exact 'chapter and verse' relative to the issue at hand; and later could not say that I had said otherwise. And, from a perception point of view, the insureds realized I was not just making it up or giving them my personal interruptation of their wording.
As your career in claims progresses, referring to the exact policy language relevant to the issue you are dealing with (be it a positive or negative issue), will be a value added benefit as you work your files. |
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C Bond
32 Posts |
Posted - 12/23/2003 : 13:09:00
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JimF
In Oct 02 I began riding along with a seasoned adjuster. He started me out on simple hail cliams and then exposed me to more complicated fire and theft that were received from local customers. My first cat was tornado in central Missouri. (May 03) This was followed by working the Pennsylvania area after Isabel. The Eastern PA Isabel damage was nothing compared to midwest tornados. Finally the most recent wind event, also in PA. (Nov 03). Total claims for the year, about 400. Not much, but me feet feel wet.
CCarr,
I learned a long time ago to present yourself as something you are not benefits no one, especially self. Based on what I had read prior to posting, I would have been a fool to try and debate issues with the ladies and gentlemen of this site. But I do have questions. As far as a "throw around toy of the week", I've eaten humble pie before. Its kinda like eating your spinich when you were a kid, it tastes like hell but it's good for ya. We're all professionals here, personal attacks should be out of the question.
Thanks for the tips on quoting policy language, I have followed these methods when writing letters to both sides of the claim. I do carry varies policies with me during inspections but have not used them to read to the insured. Mostly due to unfamiliarity. I've got the basics but the fine details are still coming. I always check with a more experienced adjuster if I have a question. I can see the advantages of doing this when required. My shorting of the policy language was just to keep the post short. Incidently, the policy I quoted was a Form-3 Ed 2.0 Special Form. The quote came from pg 15, sec 2b "Errors, Omissions, and Defects." I refered to this policy as a HO-3. Once again I would have to bow to experience if the reference to the HO-3 was incorrect.
Thanks for the advise |
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MRichardson1952
USA
24 Posts |
Posted - 12/23/2003 : 15:08:40
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CBond,
You're doing great, keep it up. Some people here haven't worked 400 claims in the past two years, so don't worry about wet feet, sounds like you're getting a well rounded wealth of experience. |
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C Bond
32 Posts |
Posted - 12/23/2003 : 20:25:50
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Mark,
Thanks for the encouraging words. Looking forward to another great year.
Merry Christmas to all and God Bless.
Chuck |
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C Bond
32 Posts |
Posted - 01/07/2004 : 23:01:05
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I asked this question in another thread but wanted to present it in this thread as it more approriately belongs under this subject.
What are the specific characteristics that define a loss as an ensuing loss? Websters defines "ensuing" as, "to take place afterward or as a result." What are the time factors and the nature of the relationship (direct or indirect) that apply to the use of this term as it applies to insurance coverage? |
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trader
USA
236 Posts |
Posted - 01/08/2004 : 10:58:19
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| An old person climbing out of a window into a rescue boat, who slipped and lost thier eye glasses. Sustained a property damage loss from the lost glasses in the muddy waters. But not a direct loss to property from flood. Always go back to DIRECT cause. The DIRECT cause must be an insured peril. In the first example of popped nails, the nail heads popped by the actions of workmen would never be ask if the coverage was named peril only. If impact or weight caused the "pop" its an seperate occurance. Hope this helps. |
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C Bond
32 Posts |
Posted - 01/08/2004 : 12:14:43
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The words "direct cause" and "Seperate Occurance" provide the clarification I was looking for.
Thanks Trader.
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trader
USA
236 Posts |
Posted - 01/10/2004 : 11:19:44
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| Cold day topic. Name all the examples of "bad things" an individual adjuster's Errors & Ommissions & General Liability policies will AFFORD PROTECTION AND INDEMNITY for. Who can collect? The answers will startle you. |
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