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I think I disagree with the last post. Supplements on a residence are costly to an insurance carrier. The file has to be reworked really. This is how I try to work a water claim and 90% of regular claims are water related in some manner. The most common is water under the kitchen base cabinets. I try to use my head. The water was discoved almost as soon as it happened. The water suckers come out. When they leave no water is visable, but they want to leave the dehums and fans for 24-48 hrs for the "make sure factor". BUT the expert wants to drill into the kick plate and blow air in the drilled holes. This is over kill to run up the emergency response (whats the emergency, the water is now shut off and will not run on the floor from the hidden spot)

If walls fo not line up and one wall is thicker than another what is the reason? Adjusters need to keep the water suckers and the insureds in the ball park and not let what if,s skew the prudent repair cost. This is really the adjusters primary duty  "scope of repairs" the top 10% seem to get the scope right the first time OR leave it open for inspection, don,t guess or go along with "what if,s". Have a plan for ever "what if you come upon and they seem to decrease with time in this profession.

I think I really disagree. If I was the vice president of claims and a monster hurricane hit a coastal city and a bunch of  so called adjusters showed up to work my losses an a single adjuster program the first question I would ask would be how many of yyou have ever worked a flood loss, the next would be how many of you have ever worked a wave wash loss(tidal surge of water) and the last would be how many of you can look at the remains of a house and try to sort out the wind and flood damage. If  you said you were not qualified, it will take an engineer or an expert to sort it out.

If you made the last statement, I would tell ypu to go home I do not need people who do not have common sense. Please do not look at a loss unless you are qualified to at least write a report on what your observation were.

What I mean is when you are looking at a loss, you have to make mental notes about ever detail of the house. This is an example you get on the roof and you see an old brick chimney stick out 10 foot over the ridge. Well when you get inside, you expect to see a firepace or a wood/or gas burning stove for cooking or heating. You don,t find the other end you notice an offset or inset on one or more of the rooms. You notice a small 20 inch foor on the offset. You open it and it has brooms in it you go in the next room 180 from this door and open a 24 inch door and find a hot water tank.

Now all you can do is get in the attic and see what is holding up the brick chimney. Or, you do not see a brick chimney on the ridge, but you see a fireplace with logs or a gas heater in one room with evidence of a recent use by burning wood ash. I know it's not your job, you are the windstorm adjuster to look at the roof and ceilings etc. BS you are a so called professional and this is a fire hazard and you have a duty to your principal to report, just like you do the Pit bull on the chain in the back yard that will eat you if you come into range.

No wonder the dtaff adjusters thing we are a bunch of greedy hillbillys , when we show up in our oldest clothes and "I am JUST the wind adjuster" remarks.

 Perfection is ellusive, but if we strive for it, we can come closer to attaining it. I like this discussion very much. This is what I come here for.

Posted By Ray Hall on 08 Oct 2009 10:02 PM

I think I really disagree. If I was the vice president of claims and a monster hurricane hit a coastal city and a bunch of  so called adjusters showed up to work my losses an a single adjuster program the first question I would ask would be how many of yyou have ever worked a flood loss, the next would be how many of you have ever worked a wave wash loss(tidal surge of water) and the last would be how many of you can look at the remains of a house and try to sort out the wind and flood damage. If  you said you were not qualified, it will take an engineer or an expert to sort it out.

If you made the last statement, I would tell ypu to go home I do not need people who do not have common sense. Please do not look at a loss unless you are qualified to at least write a report on what your observation were.

What I mean is when you are looking at a loss, you have to make mental notes about ever detail of the house. This is an example you get on the roof and you see an old brick chimney stick out 10 foot over the ridge. Well when you get inside, you expect to see a firepace or a wood/or gas burning stove for cooking or heating. You don,t find the other end you notice an offset or inset on one or more of the rooms. You notice a small 20 inch foor on the offset. You open it and it has brooms in it you go in the next room 180 from this door and open a 24 inch door and find a hot water tank.

Now all you can do is get in the attic and see what is holding up the brick chimney. Or, you do not see a brick chimney on the ridge, but you see a fireplace with logs or a gas heater in one room with evidence of a recent use by burning wood ash. I know it's not your job, you are the windstorm adjuster to look at the roof and ceilings etc. BS you are a so called professional and this is a fire hazard and you have a duty to your principal to report, just like you do the Pit bull on the chain in the back yard that will eat you if you come into range.

 

No wonder the dtaff adjusters thing we are a bunch of greedy hillbillys , when we show up in our oldest clothes and "I am JUST the wind adjuster" remarks.

Key words highlighted. Ray, you have alot of experience and knowledge. However, one cannot always differentiate wind vs tidal surge (MS Gulfcoast Katrina). In this case  i firmly belive that an Engineer would be needed to keep me from ASS-U-ME ing anything. While the Adjuster should be competent and knowledgable, he/she is no Engineer in most cases. I have on many occasions used an Engineer to validate the origin of loss with wind vs flood, flood vs earth movement or settlement etc. For me to assume anything is putting my neck on the line if i am not 100% certain. Another that i just recently used an Engineer for is wall, floor cracks separation on a mobile home. NI says that wind force caused it, maybe. There was strong winds documented in this area (South LA "Ike"). I personnally believe it is just overtime wear & tear and poor maintenance, however that is only my ASS-U-Mption, but i am no Engineer.

I did not say an adjuster should be an engineer and try to be a C&O expert on "odd" losses that are inconsistant with what you have been seeing for 5 months or 50 years. This is a cop out when you are on the beach and houses were washed one mile back in the pine trees to think the wind pushed the house this far and left the slab down on the beach

If you get a bacon grease fire on a house you would expect odor and smoke and it would be detected. I have worked wave wash, before the flood insurance was around.. We always found some wind damage and tried to settle these losses out of court for the most part. I have been in the court house several times on insurance cases that I was involved in at some level. I was the first adverse witness who was called to the stand by the plaintiff, the first document on the big screen was the engineers report which was very wish-washy and the second was my report saying it was some of both, but both was larger than some(wind). The plaintiffs do not hire experts(very often) they stick our own file you know where. Thats how they win.

Now what is a blue bird, thats when the plaintiffs find the paragraphs from the "adjuster" that he .she "I,m just the wind adjuster" we need an engineer".

Posted By Ray Hall on 09 Oct 2009 10:06 AM

I did not say an adjuster should be an engineer and try to be a C&O expert on "odd" losses that are inconsistant with what you have been seeing for 5 months or 50 years. This is a cop out when you are on the beach and houses were washed one mile back in the pine trees to think the wind pushed the house this far and left the slab down on the beach

If you get a bacon grease fire on a house you would expect odor and smoke and it would be detected. I have worked wave wash, before the flood insurance was around.. We always found some wind damage and tried to settle these losses out of court for the most part. I have been in the court house several times on insurance cases that I was involved in at some level. I was the first adverse witness who was called to the stand by the plaintiff, the first document on the big screen was the engineers report which was very wish-washy and the second was my report saying it was some of both, but both was larger than some(wind). The plaintiffs do not hire experts(very often) they stick our own file you know where. Thats how they win.

Now what is a blue bird, thats when the plaintiffs find the paragraphs from the "adjuster" that he .she "I,m just the wind adjuster" we need an engineer".

 

 

 

Good point's Ray concerning the dwellings being substantially pushed from the foundation. Yes, this would be obvious. But what i mainly refer to is 65-70% total loss where the NI claims wind did the damage, but flooding or some tidal surge also occurred (both perils known to have occurred in the same event). The BIG question would be what come first? Wave or wind? How much of the % of damage is from wave, flood vs wind. I have seen wind damage where the roof was pulled off and ensuing water damage was heavy on the interior due to the opening from the top of the wall's and ceiling down. In most cases flood lines are present with flood, but then there are those where the NI gutted the interior prior to inspection removing most if not all traces of floodwater height, extent of damage etc. and then they submit poor photos that they took prior to gutting, which i can't make out much if any damage due to poor clarity it is difficult to say 100% what the peril of loss was. This is not always, but i have had these types. It is important to state that i work mostly forced place policies and in some cases will not inspect a property until many months following the loss. NI did not even know they had any coverage, and begin repairs out of pocket until discovering the lender had a policy. Most of the time the obvious is apparent. But when there are areas of gray i will call on an Engineer, and word my report accordingly: Insured stated such and such, damage APPEARED to be the result, or possibly the result. You get the point. Ray i am not at all disputing you, just sharing some of my experience.

All you have to do is try to find some wind damage as you describe. If I had a house one mile from the beach and the slab was still back at the beach, but the roof was bare deck I would assume the house was flooded inside from the roof being blow away and figure every thing that I could on the roof, attic, ceiling, walls floors and all the contents in the rooms. I would be able to come up with more than 50% of the A coverage and close to 75% of the C coverage and even some D coverage, and wish I had the flood coverage as a single adjuster to get a total loss to insurance on the HO policy at least. Only the big creator in the sky is the engineer who can put a pecentage to this loss and if you try to talk to him andf ask for help you and the policyholder is better off. The engineer does not have better eye sight or have any special tricks to get the correct percentage of wind/flood he is guessing like you, but has a seal and his opine goes further than yours, but he does not have to settle the loss. If any insurance executive in the world thinks a quick inspection by people who have never seen flood damage is the way to settle wave wash claims and call it all tidal surge, god spare us and send him to Washington.

You must know how to settle and how to estimate "wave wash losses" I leaned in 1961, 1965 and 1969 before flood insurance existed. Have we forgot what the good adjusters who trained me learned from others before them. We are supposed to be gaining knowledge not forgetting knowledge and lessons of the past.

  An Engineer does not have to settle the loss, correct. But that seal and opine of his/hers you mention makes the difference in whether payment is made or not following his/her report. I would never take a guess on something like a total loss if i was really uncertain based on what i was looking at what the exact cause of loss was. This could cost me and the carrier in the long run. I will always request another opinion if i am uncertain of something. Besides i have to have permission from the carrier to hire Engineer services. The carrier has in some cases extended the benefit of doubt to the NI and asked for me to hire an Engineer when i advised that i believe (not know for certain) that cracks and collapse issues  are the result of earth movement, settlement, zoning or faulty construction. Make no mistake about, i can differentiate the obvious flood vs wind. But when the proof of loss has been tampered with it or removed it can be very gray. Which leads me to another thing. If the proof of loss has not been saved, submitted or documented by NI, or the loss not reported in a timely manner, well then per the policy the loss can be excluded. Has the carrier ever did this, no! At least not one that i handle losses for. They will go over and beyond to bring some type of closure and eliminate the file. I have one now that i closed 11 months ago and has been recently reopened for supplemental because GC claims items not allowed for behind finished wall. However, he has not gutted the home yet he tells me, but just figures the items he claims need to be added to the estimate is there. Go figure! And carrier still has file opened for suppl. This same home at the time of my inspection revealed what appeared to be simple wear & tear, settling issues etc. I was sent to inspect as the NI requested a second opine from another adjuster. Mine and the first adjuster opinion was the same, settling appeared to be the reason for cracks and ceiling sagging with minimal wind damage to the shingles (2-3 sqs) no ensuing water damage to interior. NI cried and b**tched so the carrier asked for an Engineer to inspect. His finding: "Home was exposed to heavy wind force causing it to shift on the elevated foundation causing ceiling and roof settlement" so on and so on. Carrier paid the loss based on his finding. If i made the same statement he did in my report  and recommended payment for all you can bet your bottom dollar i would be called by the examiner saying " Revise the estimate. That is all settling and wear & tear". So yes Ray, the seal of the Engineer makes such a difference.

My point is this. A loss is a problem when it has large issues that are not covered. The adjuster should seek advice right then and state I can handle this ot I need help. Now confront the NI head on and give him you opine and try to agree on a scope. If you can not agree on a scope recommend the loss go to appraisal. Use the engineer when all else fails, as this opine will come back, because you proved up the NI case. Why not ask the NI to prove up the loss before it gets to this stage. These insureds are not stupid about how to present an insurance claim. They know how to get the original adjuster in a bad spot.

If problem property losses were worked by true nultiline adjuster property/liability adjuster with experience in both. The outcome is much better, sometime...

Example: A third party claimant falls in the Mall of America, ambulace to the ER, exam. and admitted to blunt trauma suite for neauro/ortho. the resident  refers to rasiation to take test. The adjuster is called and states he can not guarantee all cost until negligence or the liability questionhas been answered.

When you get these type losses you are at this same place. It,s ROR time, before you commit. If you hire a nexpert at this point to report on what you sispect is the cause, you are then stuck with the report and the insured will still disagree if he is inclined to disagree and you have  not settled the claim. I have had several thousand insureds ask me " how much do you think you could recommend" and then we start moving the ball down toward the goal.