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Catmandale
USA
67 Posts |
 Posted - 02/03/2004 : 20:43:25
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To JimF and JimL
Sorry Gents,
In my response earlier, I had referred to an old State Farm RD-3 policy rather than the ISO HO-3 policy. That SF policy did not differentiate regarding ownership of the animals.
It was my understanding also that there was no ensuing water damage, unless you count the H20 in the urine.
Egg on my face. A good example of why it is good to read the policy at hand, and in context, rather than rely on memory. Certainly draw on experience, but try to give it new eyes each time.
Dale Strain
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Jim Lakes
USA
37 Posts |
Posted - 02/04/2004 : 00:37:58
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To All,
It is late and I have driven all day. I have read all of your reponses and posts. I thank you for them.
I have discussed this with Jim Flynt, as he has stated and given him my blessing to respond in my name. We still have one "BIG" common sense approach to this problem.
With that I will let Jim F. continue with this thread.
I am on the way to the Citizens conference this week where I hope to lean more.
Thanks again to all,
Jim Lakes, RPA
Ps: Bill Cook, if you are on the "dark side" then we are all in trouble. Your comments and posts responding to my coverage questions are "ALWAYS WELCOME" and I feel you have a lot add to the education of adjusters. |
Edited by - Jim Lakes on 02/04/2004 00:45:44 |
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JimF
USA
1014 Posts |
Posted - 02/04/2004 : 09:38:35
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Jim Lakes is correct that there is one big issue within his claims scenario which no one has touched on. An issue which ultimately is perhaps the most important ingredient in resolving this claim, and all the more so if one argues that it is a covered loss.
In the interest of furthering this discussion along, let me add a couple of new factors for you to consider.
Let's assume that the damages to the carpet and subflooring from damages caused by the tenant's cat are $7,500.00 and that the HO-3 deductible in this example is $500.00.
Now here is the real surprise that Jim mentioned in his first post. In the very real world "out there", Jim's major carrier agreed to pay this claim where a tenant's cat damaged the carpet and subflooring under an HO-3 policy. That is exactly what happened.
(As a side note, both Jim Lakes and I believe this to be a non-covered loss and I'll leave open for Jim to share with all of you the carrier's coverage theories)
Yet, in the end, the recommendation that Jim and I would have made to the carrier for denial of coverage, would have had the exact same effect for the insured as this major carrier's real world decision to provide coverage and pay the claim.
My question to you is: How can that possibly be?
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Edited by - JimF on 02/04/2004 09:45:52 |
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Jportillo
USA
17 Posts |
Posted - 02/04/2004 : 10:48:23
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Crime Scene Clean-up is a business that I see many trying to get into, but they don't last after their first big clean-up job. Many do not have the stomach or training to do deal with such Drama and Psycological effects of seeing someones brains spattered all over the room. In the 5 years I have been doing this kind of work only a handful of jobs have been paid by the insurance companies. A majority of homeowners don't even know that they might have coverage for this type of accident or incident. Where would this type of information be listed in someones policy?
Well take care and GOD Bless. |
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JimF
USA
1014 Posts |
Posted - 02/04/2004 : 10:54:53
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John, it isn't so much that it is listed in the
HO-3 "All Risks" policy as it is that it is not
excluded as a cause of loss under that policy.
It would not be a covered cause of loss under the HO-1 and HO-2 policies.
By the way, could you walk us through the OSHA requirements for such a sensitive and unusual type of clean-up? |
Edited by - JimF on 02/04/2004 10:56:26 |
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CCarr
Canada
1200 Posts |
Posted - 02/04/2004 : 11:04:34
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It is a strange world in insuranceland, and that is why being an "adjuster" can be one of the best and most interesting professions in the world.
The HO3 is a contract between the owner (nonresident) of the dwelling and the carrier who issued the HO3.
Therefore, the definitions in the contract - "you", "your", have no applicability to the tenant, UNLESS the tenants are grievous relatives of the "named insured"; which would create a whole new settlement scenario.
I can't satisfy myself that this is an "accident" within the definition of "occurrence", but if it is; logical comparative thought of a feline bladder volume versus the area and extent of damage, would certainly indicate that there was more than one "accident".
With nothing else in the definitions to use or rely on for assistance, I then have to turn to "perils Insured Against".
The reported damage is restricted to Coverage A. It first "gives" in the preamble. My first stop for "taking away" is (2e2) ".... inherent vice ....". This seems to have a dictionary definition of, (inherent) "existing in something as one of its natural or permanent qualities", (vice) "evil or wickedness, an evil or bad habit, a bad fault". Well, that can be played with, but I don't think it is a 'hat hanger'.
Next is (2e8), ".... animals owned or kept by an "insured"". My third paragraph dealt with who is an "insured", and unless the tenant allowed the owner's cat to roam in the dwelling and use the carpet as its sandbox; this exclusion would not be applicable.
With nothing else in the "Perils Insured Against" to use or rely on for assistance, I then turn to "Section I - Exclusions".
First stop there is the language of the exclusionary preamble, which is much more detailed than the short, "we do not insure for loss" note in the "Perils Insured Against" preamble.
Last stop in that area is (1e) "Neglect", but it relates only to the neglect of the "insured".
To me, it is simple to say, this loss shouldn't be paid. But, based on the available limited claim information, and all there is available to grab on to in the contract - a probable weak reliance that this "occurrence" was not an "accident" - the rest seems to end up being chaf.
It would not be normal underwriting practice to write an HO3 on a tenant occupied dwelling; and this claim scenario is a good example why.
I can not see where I could exclude coverage for the reported claim, unless I had a good detailed statement from the tenant; relative to their knowledge and inactivities with regards to what the cat did.
In the absence of that, I would try hard to substantiate a reasonable number of "occurrences" and then apply the corresponding amount of deductibles. |
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Catmandale
USA
67 Posts |
Posted - 02/04/2004 : 11:33:35
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Clayton,
I suppose that you could separate the occurrences by room, although line of sight might complicate that. It's unlikely that the cats bladder could hold enough liquid to have a continous event in all rooms.
JimF, you have me stymied...when are you going to let this cat out of the bag? |
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trader
USA
236 Posts |
Posted - 02/04/2004 : 11:37:32
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| Folks you are jumping around looking for the answers.The stray cat wetting would be V &MM and the furniture would also be covered. The exclusion ,excepting, coverage for the loved/adored cats is 15. (h) as well as #8. & 9. Now I know many of you live in states that allow the HO 3 for dwellings for 1 to 4 familys, but only one is "the insured" . |
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CCarr
Canada
1200 Posts |
Posted - 02/04/2004 : 11:46:58
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Ray, in the 'tenant / cat' scenario, presented by Jim Lakes on page 3 of this thread; the damage appears to be limited to within the parameters of Coverage A.
What and where is exclusion "15h", as well as "#8&9"? |
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trader
USA
236 Posts |
Posted - 02/04/2004 : 11:56:17
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A follow up. If a member of your house left a door window /open (assume a child, but not required) and this big old stray cat came in and does his thing. Yes its an risk (unexpected-unintended-no control etc) Pay all coverage lines. How about the squirrels packing down the insulation (blown) Yes. You had no control and you were invaded. How about the vermin/rodent exclusion. Does not apply you could not control this "Occurrance". But if you property is overun with vermin/rodents you can control/have knowledge/should have
etc. Put it another way if the policy listed all the bad things that it covers in the rhelm of risk, the contract would be much longer. Its a great contract, but the buying public will not pay for coverage that some groups would like. |
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CCarr
Canada
1200 Posts |
Posted - 02/04/2004 : 11:59:19
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| Ray, relative to your previous comments, and relative to an HO3; what and where is exclusion "15h" as well as "#8&9"? |
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william s cook
53 Posts |
Posted - 02/04/2004 : 12:01:03
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Clayton
I am sure that finding sixteen spots of damage is the obvious sought for answer that would generate more deductible amounts than the damage amounts. But as you point out the devil is in the details of selectively applying policy provisons subjectively such as defining an occurrence. Some policies provide the definition of "occurrence" means an accident, including continuous OR repeated exposure to substantially the same general harmful conditions, which results during the policy period.
The insurers may elect to pay and subrogate against the responsible party which was the tenant who became an insured, but then the real insured who may becomes liable for damage to property of others (the tenant) who is no longer the insured. If a lawsuit for the liability of negligent damage to property was initiated, who would insurers be contractually bound to defend? What about a suit for voluntary payment of an excluded claim?
Just the mind wanderings of someone who should be at an educational seminar learning how to deal with such claims.
William S Cook
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trader
USA
236 Posts |
Posted - 02/04/2004 : 12:08:19
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| I have an old Allstate Delux Plus AP3 (no date) 15h is domestic animals. The biggie, 8 is increse in hazard, and 9 is intentional acts and responsibility. |
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CCarr
Canada
1200 Posts |
Posted - 02/04/2004 : 12:12:07
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Bill, I can't see how the tenant becomes an insured within the HO3 policy issued to the homeowner from the carrier - considering the scenario presented.
Further, keeping within the confines of the limited claims information we have in our supposed claim file; I couldn't even begin to reflect on negligence, it being a waste of time without adequate investigative detail.
We can not assume that the tenant watched the cat let flow over the carpet, with but a grin on the tenants face. Conversely, we can not assume that the tenant bounced the cat off the wall every time it erred in the direction and placement of its void; in an effort to train it from its then recognized poor habit. We can not assume the the tenants have no sense of smell (which is not an uncommon affliction).
Dealing with liability, I think we just go around in circles without investigation notes to reflect on. |
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CCarr
Canada
1200 Posts |
Posted - 02/04/2004 : 12:14:06
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| Ray, the property scenario we are kicking around, relative to that presented by Jim Lakes, is within the parameters of an HO3. |
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Renters abuse of a Mobile Home
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