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Posted By ChuckDeaton on 10 Nov 2012 08:14 PM 
Larry, commonsense took a hike along time ago. Flood demonstrates this.

That's true, but flood manuscript and DIC forms have a nice way of returning both dollars and common sense.  

Conversely, losses adjusted under these forms still aren't for those who believe that they've arrived by the mere receipt of a certification.

Good comments Mike and Steve. Just be on the alert for the carriers who believe that payment for these investigation-intensive (no coverage) losses sits on bottom tier of the fee schedule for coverage denials. They may have a TE clause there that allows you to investigate without worrying about a cookie-cut fee bill, but please err on the side of caution.

Posted By Jud G. on 12 Nov 2012 04:42 PM

Good comments Mike and Steve. Just be on the alert for the carriers who believe that payment for these investigation-intensive (no coverage) losses sits on bottom tier of the fee schedule for coverage denials. They may have a TE clause there that allows you to investigate without worrying about a cookie-cut fee bill, but please err on the side of caution.

I received two (2) of these losses from an unnamed carrier only because there was a time and expense clause added to the flat rate schedule. During these losses, I secured a non-waiver for both, measured the flood lines (interior and ext.), photographed the drains, commodes, basement, diagrammed, etc. so that they have an airtight defense later on. The T&E request was made, but declined, so these were the last two (2) I took. I refused a butt-load more losses that they needed help on. They've since adjusted the arrangement and had the nerve to ask me to take more.

I wanted to tell them that their inexperience and unethical approach to paying the very partners they rely on was a liability and litter the discourse with a few choice words. Fortunately, the better part of me won out this time; I simply told them that this ship had already sailed.

To respond specifically to Steve's post regarding flood versus sewer back-up, I read a manuscript form today that excludes them both. These two forms of H20 are listed as sub-captions under the excluded peril of 'Water'. It was nice seeing that they eliminated complications here. The vague, chicken/egg approach created by ambiguous, anti-concurrent causation language was clarified quite well.

 

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I am very fortunate, Jud to (as in Steve's previous words a few days back "be able to be warm & cozy") but also be an indy inside CAT commercial claims consultant/file examiner.  I'm also very fortunate to be working for a carrier that allows us to employ a plethora of expert vendors in addition to the dedicated IA firms that we have on board...and we have full reign to assign those extra helpers to assist the IA's on the not-run-of-the-mill everyday losses that they normally see.  We make exceptions to the fee schedules all of the time, for example telling them to add T&E to the fee for special requests that will not show up in the gross loss.  That's why I probably like working for the carrier that I do, and probably why I see the same field guys on a lot of my files over the past several years.  How long will this last?  Hard to tell, shucks (that's Nebraska vernacular), we're all getting to be a bunch of old fart$, but at least I'm staying warm & cozy.  God bless the rest of you!   

I was so glad to see a ranch house yesterday at the end of the day, I nearly wept. What were these builders thinking when they designed these houses on Staten Island? I worked Westchester County in 2004 and did most of it with a 12 foot ladder, even on the two story pull ups. After five years as a claims analyst working for a carrier in California I am discovering the difference between getting my "roof legs" back when I was 52 versus getting my "roof legs" back when I am 57. This assignment is not for the faint of heart.

Did I ever imagine my muscles could ache like this when I got up in the morning?

Posted By Alex_Chernov on 12 Nov 2012 09:16 PM
...which plainly says that it does not matter if there is another peril, which contributed to the damage, flood is excluded, period.

Alex, the carrier should have consulted you when they wrote the policy.

While it appears quite plain to people like us, this will change once this language is placed in front of a jury of our peers.  If the jury thinks it is confusing, then they will decide how this contract of adhesion should afford coverage.

Posted By Jud G. on 13 Nov 2012 05:36 PM

Posted By Alex_Chernov on 12 Nov 2012 09:16 PM
...which plainly says that it does not matter if there is another peril, which contributed to the damage, flood is excluded, period.

Alex, the carrier should have consulted you when they wrote the policy.

While it appears quite plain to people like us, this will change once this language is placed in front of a jury of our peers.  If the jury thinks it is confusing, then they will decide how this contract of adhesion should afford coverage.

We are agents of the carrier, and if anybody gets sued it is not going to be us but the carrier. We are reporting facts as we see them and final coverage determination is upon the insurance company. If hypothetical jury decides to afford coverage, so be it.  And, yes, language that excludes coverage for flood regardless of concurrent causation is clear and unambiguous, no matter how stupid or/and biased the jury is.  Water backup is also EXCLUDED, in case of this particular carrier and sometimes (rarely) is added by limited coverage endorsement, so good luck in court to anybody who wants to challenge that.  

I am not callous or arrogant. I just can not do anything for people that had flood  given what their policy says and intructions given by the client.  I am starting to get business interruption claims triggered by flood and off-premises power interruption. Gets interesting day by day.  Few marina claims too, docks are gone, total losses mostly.