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Last Post 10/16/2009 9:08 PM by  Ray Hall
Have fun with this one
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Ray Hall
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08/16/2009 6:28 PM

    We all had a lot of fun with the CP example that Steve posted last week or so. Well this is a HO-3 total loss on Bld. UPP etc. with lots of questions on duties of the carrier and adjuster. Just draw a diagram and zero in on the meat, don,t think like a person that hears the sounds of galloping hooves. Think of horses.... not zebra's. All the facts have been given to answer all the questions the carrier may have. It is you job to tell them what to do.Act like a General Asjuster.

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    Ray Hall
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    08/16/2009 8:29 PM

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    A  fire loss on a HO-3 the State is Texas and the Policy form is HO-3. The A coverage is $160.000 B $ 16,000. C *80K D. 48K Deductible is $1,000                                                                               

      The dwelling and all contents are burned out of sight. The agent sent the family of four to a motel for 2 weeks @ $168.00 per day and $40.00 per day each for meals. The investigation revealed the following. The female member (Jesabbel) is separated from Bubba Brown, the husband who does not live in the house. The divorce is not final. The community property settlement has not been made. The male living with Jezabrl, is Elton Jack who is separated from Jill Jack. Jill moved to the apaermentBubba Brown and Jill Jack rented both rented. . Both purchased a basic limit $60,000. renters policy in 2 names with a $250. Ded. We learned Bumper Jack, Elton son was living with them for a few days before the long awaited ski trip to Utah.  His bags were still packed along  a paid for RT airline ticke tin his bag.

    Elton Jack is professional musician/composer who had his studio in one bedroom of Jezebels’ house. The RC is about $30,000, but the ACV is about 50% Elton is very upset about Jezebels’ housekeeping habits and feels her sloppy manner contributed to the fire.  He has Homeowners on his vacant house. He expects some insurance company to pay him for his music instruments. He also lost  an antique VW bug housed in the attached garage, with market value $20.000.

      Bubba Brown is also very upset as his Gun safe and rifles in the same garage was totally destroyed and his property worth $10,000 should be paid by Jezebel’s insurance.  He wants his money. Jesabels Homeowners is still in both names.

      Home Supply Co. stacked new building material that was destroyed next to the garage. The material was for Elton to build a new studio on the back of the lot.He was supposed to give them a check for $2600 when it was delivered, but he was not home.

    The original adjuster had the following information that is relevant on this loss.Jesabel and Bubba saw this split coming and wanted a clear a lot of credit card debt.  They refinanced the first mortgage to pay off on the debt. Pay off  was$139,000 at time of fire.

      A short time after Bubba moved out and Elton Jack moved in Jezebel purchased a Maytag washer dryer, Oven and dishwasher from Kitchen Remodel on  rent to own contract for $117.00 a month. Three payments have been made of 24 duebefore  the fire

    Jezebel learned that Jumping Jack, Elton wife was the reason the new 56 inch wide screen TV arrived before the super bowl game. It was a present from Jumping and she wants it back or the money for it as it was a present to him, not both

    . Jezebel also learned that Bubba Brown had secured an equity loan on the house two weeks before the split for the max. Equity of 40% of the RC, which was $250 K or $100,000. She did not sign any papers and feels this is a legal problem with Bubba Brown and somedumb bank

    . We (insurance carrier) have just learned from the C & O expert found leaks from the VW fuel pump ignited when the fume got to the pilot light on the gas heater in the corner of the attached garage. The expert also learned the fuel pump on the VW was changed out by ABC classic cars 2 days before the fire and the tank was filled by Elton 7 hours before the fire was discovered.

    The C & O expert reported the gasoline leaking from a new fuel pump on the VW ignited the fire when the fume reached the pilot light in the garage. The expert also found the fuel pump was changed out two days before the fire by ABC classic Cars and the tank was filled by Elton 7 hours before the fire was reported.

    Your assignment is to sort out the community property, common law marriage statues,mortage or chattel problems. Please give us a Statement of Loss, answer to the covered questions and a direction to pay. This is after you confirm all the reports are factual.

    ***** I have cleaned this up a bit and made several claims easily to sort..

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Sorry my cut and paste is sloppy. Texas is a valued policy state on Real property for FIRE only. Texas is strong on insurable interest also, this is the main topic on this post. Just draw a diagram on primary or excess insurance , under insurance, and non compliance with RCC provisions. I have not worked out the correct SOL yet. And no I was not tripping out on LSD or any other drugs. Just had so much fun wanted to get the windstorm adjusters to reserch and stick you neck out. We will not call you a dumb SOB. I have another sorry the TV story is duplicated. Only 6 people mentioned. The 4 adults swapped partners and the two minors have seperate parents.

     

     

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    Medulus
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    08/16/2009 11:57 PM
    I hear the galloping of zebra feet. A couple of questions, Ray.

    You said the "female member is separated from Bubba Brown". Is the "female member" Jezebel?

    And when do these people appear on Jerry Springer? I want to tape the show.

    I'll need to give this one some thought for a day or two. You threw a problem or two into the mix here.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    Ray Hall
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    08/17/2009 9:18 AM
    Now Steve you know a good adjuster never takes the loss notice as the true facts, and must sort them out.
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    RJortberg
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    08/17/2009 10:34 AM

    Ray... i don't think they need an adjuster as much as a family counselor or shrink.  I'll print this off and go through it too, but I'm trying to tie up a project now in case one of these storms hits.

    Rich

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    Ray Hall
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    08/17/2009 10:42 AM

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    Sorry my cut and paste is sloppy. Texas is a valued policy state on Real property for FIRE only. Texas is strong on insurable interest also, this is the main topic on this post. Just draw a diagram on primary or excess insurance , under insurance, and non compliance with RCC provisions. I have not worked out the correct SOL yet. And no I was not tripping out on LSD or any other drugs. Just had so much fun wanted to get the windstorm adjusters to reserch and stick you neck out. We will not call you a dumb SOB. I have another sorry the TV story is duplicated. Only 6 people mentioned. The 4 adults swapped partners and the two minors have seperate parents.


     

     

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    Ray Hall
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    08/17/2009 12:31 PM

    I am sorry I had to go through my notes again after I made my diagram to get all the players correct and I just got a strange call from Bubba  and he said all the furnishings he left behind were shambles except the TV and  Bumper had borrowed his grand mothers computer with ganes and her vidio cam corder to use on the vacation trip.

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    Leland
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    08/17/2009 12:37 PM
    I have a policy based on an H03 which says "insured" means the policy holder and residents of the household who are:

    a) relatives

    b) any other person under the age of 21 who is in the care of any person named above.

    Consider the following example: You 17 year old son's best freind's dad goes off to Iraq. Mom is on drugs. The boy stays overnight at your house more and more often until he ends up being like a part of your family. You feed him and drive him to school with your son. He used your address for his driver's license. He is an " insured" by the policy definition above.

    2nd example: Man gets engaged but not yet married. Woman has her personal property in his house. She is not a resident or relative, at least according to one carrier's opinion on a DP1 policy.

    3rd example: Common law marriages. The definition of marriage is still reserved to individual states. If a man and woman live together for several years they may be considered married in many states, but not others. The adjuster needs to be aware of the law in the state he is working. The IRS also respects state law: if a taxpayer lives in a state where common law marriage is recognized, he can file as "married". If he then moves to a state where common law marriage is not recognized, he can no longer file as married. If the insured can provide evidence that they are married (such as a federal tax return) this could be the evidence the adjuster needs.

    from http://marriage.about.com/cs/common...monlaw.htm

    # Ascertain if the state/country you are living in recognizes common-law marriages. Only a few states plus the District of Columbia recognize common-law marriages.

    Currently, common-law marriages are recognized by: Alabama, Colorado, Iowa, Kansas, Montana, Rhode Island, South Carolina, Texas, Utah, and Washington, D.C.

    # Generally, there are four requirements for a valid common-law marriage. Just living together isn't enough to validate a common-law marriage.

    # Requirement One:
    You must live together.

    # Requirement Two:
    You must present yourselves to others as a married couple. Some ways of doing this are by using the same last name, referring to one another as husband or wife, and filing a joint tax return.

    # Requirement Three:
    Although the time frame is not defined, you have to be together for a significant period of time.

    # Requirement Four:
    You must intend to be married.

    # In the U.S., the agreement by every state to recognize as valid a common-law marriage that was recognized in another state has been challenged by many states creating state laws not recognizing same sex marriages valid in other locales. It is best to consult an attorney to make sure your common-law marriage is recognized in the state where you are currently residing.

    # Note:
    The Social Security Administration will only recognize your common-law marriage if the state where you reside recognizes your common-law marriage.

    To make sure that you would be eligible for survivor benefits, you need to go to a SSA office and fill out forms, provide statements from two blood relatives, and provide supporting evidence of your common-law relationship.

    # Your Federal Income Tax, Publication 17:
    "Considered married. "You are considered married for the whole year if on the last day of your tax year you and your spouse meet any one of the following tests ... 2. You are living together in a common law marriage that is recognized in the state where you now live or in the state where the common law marriage began."

    Tips:

    1. These states have restrictions and only recognize common-law marriages performed/created by a certain date:
    * Georgia, January 1, 1997

    * Idaho, January 1, 1996

    * Ohio, October 10, 1991

    * Oklahoma, November 1, 1998. Whether the Oklahoma law on this will be upheld is still unknown
    More on Oklahoma Common-Law Marriage.

    * Pennsylvania, January 1, 2005.

    2. New Hampshire only recognizes common-law marriages for probate purposes.


    Somebody please post the definitions of "resident" and insured" and "relative" from a regular HO3. If nobody else posts it I will look it up- I don't do regular HO3 policies very often.
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    Medulus
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    08/17/2009 4:22 PM

    Ok, Ray.

    I've read this two or three times and it just makes my head hurt.  I'm going to have to look at this over the course of the next couple days and do a spreadsheet on it to keep everything straight.  Meanwhile, we can hope the whole lot of them decide to try out for the Darwin awards.

    I might have to put a call in to Flynt on this one.

    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    Ray Hall
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    08/17/2009 5:46 PM

    Aw Steve just make your chart, covered, not covered, don,t know. I will help some of the newer people. The auto ain,t covered at all, need's an auto policy.These Texans are shacking up and have to git a divorce befour they can git married agin with a license.I an not sure about Elton, he kinda sounds like a yankee. Bubba sounds like East Texas. and I wood swear Jesabel sounds like New Iberia or down around Franklin, but they seem like regular folks you meet ever day in this business. Yea I miss Flynt also, you remember when he tripped me up on the cemetary vault question about 6-7 years ago. I do as I had to crawl back on CADO and make a public apology.

    Lets help each other out on this one as we sweat out Bill. Don, t forget the deductible come off the loss, and Texas does not have guaranteed Replacement Cost. so we want have to worry with that. But don,t recommend a subrogation attorney, until we rule out both carriers are not member of AF {arbitration forums}.

    I just got another call from Jesabel.  Tthis house is located way down near Smith Point in Harris County and the Fire marshall from Chambers county showed up at Jesabels work place the Do Drop In and left an invoice for $750.00 to send to her insurance company. She ask the 2nd adjuster to make a note that she just finished paying the landacape company for the new new trees and shrubs $2500. if they were covered by fire, but she found out the hard way they were not covered by the flood from Hurricane Ike. Dhe also wants to know how to get her money back for 11 months of insurance she does not need as ever thing is sestroyed by fire.

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    Leland
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    08/17/2009 7:29 PM
    " Home Supply Co. stacked new building material that was destroyed next to the garage. The material was for Elton to build a new studio on the back of the lot.He was supposed to give them a check for $2600 when it was delivered, but he was not home."

    He may not have been "owner" in the strictest sense of the word, but I think the risk of loss transferred to Elton when the materials were delivered. If Elton is an insured, the building materials can be paid under dwelling coverage. I'm guessing that the materials are always paid under the dwelling (covg A) but if they were destined to be used under a detached structure maybe they can or should be paid under that coverage. Or does the policy read "materials for repair or improvement of the DWELLING?

    My DP1 form says: "materials and supplies located on or next to the described location used to construct , alter or repair the dwelling or other structures on the Described Location...

    So on a DP1 it doesn't matter if the materials are for the dwelling or garage or shed or fence...

    What does the HO3 say?

    Also, if the dwelling limits are exhausted, the carrier might (in good faith) pay for the materials under personal property.

    Also the materials coverage makes no mention of ownership- the personal property coverage section on a DP1 says "personal property...owned or used by you" but the materials description says nothing about that.

    So, Ray, tells us the answer on that issue.

    P.S. It should be against CADO rules to put more than 16 separate hypothetical issues into one scenario.
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    Ray Hall
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    08/18/2009 4:38 AM
    No limit on the hypothetical scenarios when I made this post; but this may change as this ccould go on for weeks and we are in storm season and need answers. Elton is an idiot to build a studio on land that he does not own.The HO-3 covers(A. COVERAGE A) b.Materials and supplies located on or next to the "residence premises" used to construct, alter or repair the dwelling or other structure on the "residence premises". Now in Texas we have loose laws on co -habitation, but not on our contracts. A is A and Cis C we can,t flip flop these coverages on a whim of two persons living in sin.This is A property..Home Supply Co. is very upset as he thought Elton was ordering the material for Bubba and did not know he had moved out. He said he will sue, but certainly place a lein on the property.The limit of $160,000 will be hashed out between all parties who have an interest in the real property . *Note 3. the nlimit of liability for this coverage will not be more than 10% of the limit of liability taht applies to coverageA. Use of this coverage does not reduce the Coverage A limit of liability*
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    Leland
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    08/18/2009 8:47 AM
    Do you have a requirement in Texas to notify the DOI when fraud is suspected? (We do in California). I note several "red flags" in your scenario.

    But please post the H03 definition for who gets covered- "family members"- "residents"....?

    Also, has the fire scene been preserved and was ABC cars given an opportunity to send their expert or did Watersuckers Inc. clean up the whole place, remove all the evidence, and destroy any hope for subrogation?

    Are you going to recommend an advance payment with the possible red flags?

    You mentioned: "Jesabels Homeowners is still in both names",and that a divorce wasn't finalized. Is it possible that the insurance settlement will be subject to the divorce decree? Should the carrier wait on an order from the judge before issuing the check?
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    RandyC
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    08/18/2009 9:12 AM

    Ok, the Home Supply company needs to get that lien filed, but probably no need to hurry. There is probably a line down at the courthouse anyway. Home Supply has a contractual relationship with Elton...not Jezebell. He has no relationship with insurance company or Jezebell...until his lien is filed.  The materials for the outbuilding are covered under coverage A.

    Elton is not an insured. I'd authorize ALE for the insureds (family of Jezebell and Bubba). He can not be married by co-habitation to Jezebell because Bubba is still her husband and the state will not recognize two husbands at the same time.  Elton has to pay his own motel bill.

    We need to get them out of that motel and into a rented house in the standard of living they are accustomed to.  Then they could cook their own food as usual.  I suppose Elton could live in the house if Jez still wants him after he pointed his finger at her housekeeping for contributing to the fire.  He still smelled of gasoline as the fire burned.  Maybe the fire marshal wants to talk to him.  Maybe they want to talk to ABC classic cars as well.  SIU needs to be notified of these little details as well as the refinance to pay off debts that Bubba and Jez did together before the fire.  The extra little equity loan by Bubba is also of interest to the insurance company....and Jez, huh?

    I can't see the dec page from here so I don't know who the named insureds are. Seems like Jez is paying premiums. The check would be in the name of the named insured. It could be both. If Buba got money in his hand from equity loan, he is probably a named insured...but maybe not...the banker on that screwed up. In Texas, you can't encumber community property without consent of both parties. Jez is right. The bank has a problem with paper work. That bank will be down to the courthouse when the doors open trying to find a friendly judge. Anyway, Jez, Bubba and children are insureds. We need to know how old Bumper is. If he is < 21 he might be covered by ALE...otherwise I think not.  We need to know who the named insured is.

    Enough for now, small bite of the elephant.

    RandyC

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    RandyC
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    08/18/2009 9:35 AM
    I missed the part where the policy was in both their names. I was looking though. ;-)

    RandyC

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    RandyC
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    08/18/2009 9:44 AM
    Thanks, Leland. I was a little quick to authorize the ALE. I think we have to pay what the Agent authorized, but someone higher than me has to decide if we keep paying with the red flags waving in the wind. Could be the county and state would soon be glad to cover the living expenses. In Texas, that would not be in the manner they were accustomed.

    RandyC
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    Ray Hall
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    08/18/2009 10:13 AM

    The policy form is ISO HO-3   00 03 10 00 it is the same in Texas as the other states. The fire marshall rules this an accidental fire by gasoline ignited by the pilot light. Both names are on the house that was destroyed and also ther house of the jacks that is now vacant. Jumping Jack is 16 years old.

    stop thinking about zebra,s. Think about non compliance for RCC coverage. Think about the known encumbrances on the real and even possible chattels on the UPP. Think about the limit of insurance demand. Think about the rights of the known mortgagees rights to their security. Only one queswtion has an opine, is it correct?

    Lets use the page and paragraph when we quote policy language.

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    Leland
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    08/18/2009 10:29 AM
    By the way, Ray's scenario of a VW bug starting on fire is actually fairly common, but I think it happens while they are going down the road. For some reason they seem to have a lot of fires, maybe the fuel filter is not clamped properly to the hose and it vibrates loose.

    Adjusters need to be aware of Ford F150 fires, and other Ford products too. I had an F150 fire inside a car repair business, total loss. I'm told that the cruise control has a chip that gets more current than Texas Instruments designed it to have and then the brake fluid starts on fire and then the whole truck. A good C/O expert can make such cases very good subro. Just don't let anybody clean up the scene.There can be problems if your insured is the tenant but the building owner wants to clean up ASAP and doesn't care about the insurance companies interest. Ford must be notified, they will fly out an expert to contradict your expert. There have been Anytime you see a car as the point of origin ask the carrier about C/O. Also on older cars they may have had recent stereo install etc, also often good subro.


    Statement by Texas Instruments concerning the switch in recalled Ford vehicles
    Updated April 25, 2005

    The National Highway Traffic Safety Administration (NHTSA) recently announced that the agency is conducting an engineering analysis of the entire speed control deactivation switch system in Ford 1995–2002 model year F150 trucks and 1997–2002 Expedition/Navigator SUVs (but excluding recalled model year 2000 vehicles), based on reports of a higher rate of engine compartment fires in previously recalled the 2000 F–150s, Expeditions and Navigators, and 2001 F150 Supercrew vehicles and lower rates in similar vehicles of other model years.

    Texas Instruments supplied the switch for all of these vehicles—which is one component of the cruise control deactivation switch system. We do not believe that there is a safety defect with the switch. Ford and the NHTSA have not yet determined the root causes of the higher rate of fire incidents in the recalled vehicles. NHTSA launched the investigation to attempt to determine the root cause of the fires.

    TI has been manufacturing pressure switches for more than 25 years, and millions of these types of switches have been used reliably in a number of automotive systems. We conduct rigorous testing of our products throughout development and manufacturing. We are not aware of reports of fires in vehicles that use TI's pressure switches other than Ford vehicles.

    TI has proactively offered assistance to both Ford and NHTSA. We are confident that NHTSA's investigation will review all possible causes.


    Also re red flags, this is a tricky issue because good faith and good claims handling might mean sending an advance for 50% but if fraud is suspected you might want to wait a little bit, this is a tough call and you probably should ask the carrier for guidance.
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    Leland
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    08/18/2009 2:13 PM
    HO3 Special Form (4/91)

    "In this policy "you" and "your" refer to the "named insured" shown in the Declarations and the spouse if a resident of the same household."

    "Insured" means means you and residents of your household who are:

    a. Your relatives; or
    b. other persons under the age of 21 and in the care of any person named above.

    Covg C Personal Property

    We cover personal property owned or used by an "insured"..... At your request, we will cover personal property owned by :

    1. Others while the property is on the part of the "residence premises" occupied by an "insured";

    2. A guest or a "residence employee" while the property is in any residence occupied by an "insured".

    Our limit of liability for personal property usually located at an "insured's" residence, other than the "residence premises", is 10% of the limit of liability for Coverage C, or $1000.00 whichever is greater.


    Special Limits of Liability

    6. $2000.00 for loss by theft of firearms.


    Property not Covered. We do not cover:
    5. Property of roomers, boarders and other tenants, except property of roomers and boarders related to an "insured".

    Fire department Service Charge

    We will pay up to $500 for your liability assummed by contract or agreement for fire department charges incurred when the fire department is called to save or protect covered property from a Peril insured against. We do not cover fire department service charges if the property is located within the limits of the city, munincipality or protection district furnishing the fire department response.

    This coverage is additional insurance. No deductible applies to this coverage.

    Exclusions

    1. We do not insure for loss caused directly or indirectly by any of the following.... h. Intentional Loss,...

    Conditions

    2. Your Duties after Loss.

    f. (2) provide us with records and documents we request and permit us to make copies;

    g. Send to us....(4) Changes in title or occupancy of the property during the term of the policy;
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    Ray Hall
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    08/19/2009 7:21 PM

    While on CADO go to channels, then scope down policy forms and you can print out most of the complete policy forms you will ever need. Print them and keep them. Most ever state has most any form you want in the state insurance section. The CPCU has a handbook of insurance policies for sale for about $25.00 get free forms on ever assignment and keep them in your vehicle. You only need then  ever day you work. When you are not working read them. This is a reading job, just like the doctors and lawyers, engineers accountants and so on and so on.

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