10/31/2009 4:47 PM |
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What items would be covered on this policy (USAA HO6)? There is Contents and Loss of Use coverage listed on the loss notice. I assume this is a paint inward type policy. No roof inspection would be needed correct? Just check for water damages to the unit owners personal items? Is carpet a covered item as well?
Thanks for the help in advance!
Dave.
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BobHVeteran Member Posts:759
10/31/2009 7:16 PM |
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You gotta read the policy, and read the CC&R's* for that specific unit in that association.
We are typically responsible for "what the unit owner is responsible for"
and in some ways that answer is in the homeowner assoc. doc's (not the policy).
These type of assignments typically require that you make a copy of the relevant pages of the Assoc Doc's, even if they didn't ask you to.
In this past year I have paid for carpet in 2 unit owners (HO-6) but have never paid for a roof repair. But you may find yourself on the roof to see if an opening was created for the water to enter (if they are claiming personal property dmg)
Some of the HOA docs are crystal clear, in terms of who is responsible for what. Others can be very, very vague. I used to think we would never pay for drywall on an HO-6 but have been advised to pay it on occasion.
*covenants, conditions, and restrictions per this reference:
http://www.nolo.com/dictionary/cove...-term.html
A set of rules, commonly called "CC&Rs," that governs the use of real estate, usually enforced by a homeowners' association. For example, CC&Rs may tell you how big your house can be, how you must landscape your yard, or whether you can have pets. CC&Rs "run with the land," meaning any subsequent owner must also abide by them. Most state laws require that a copy of the CC&Rs be recorded with the county land records office and be provided to any prospective purchaser.
Bob H
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10/31/2009 10:04 PM |
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Except for states with statutes which dictate, Mr. Bob answered the question perfectly.
I do not know your background, and please do not take this as an insult, but this a very basic adjusting question and a perfect example of why one should work as a staffy for a carrier or large IA for a couple of years so you can get a good understanding of what you need to correctlly handle a claim.
Gimme a bottle of anything and a glazed donut ... to go! (DLR)
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11/01/2009 1:54 AM |
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Bob- are you back in CA now?
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BobHVeteran Member Posts:759
11/01/2009 9:48 AM |
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Yep. I was very fortunate to find work for much of this year.
Still paying off dept from some earlier lean years though...
Bob H
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MedulusModerator Veteran Member Posts:786
11/02/2009 5:57 PM |
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Just to add a bit to what Bob and Dave said above.... What is covered under a unit owners policy and by an association policy is first governed by the sate in which the condo is located. Certain states like Florida have a very clear cut delineation of who is responsible for what. In Florida, the unit owners policy is responsible for the floor, wall and ceiling coverings inward. In other states like Maryland (at least the last time I worked Maryland) it is responsible for any improvements and betterments made by the current owner. In Washington and Illinois, for example, the association policy may be primary on all building elements if the CCRs say that this is the case. If you are working for the NFIP, the Association policy is primary for the NFIP policy. So, there is no clear cut answer with the information given. First, you need to consider the condo statutes, then the CCRs and the policy. So, good luck with that. And good luck with obtaining the CCRs. Some associations are very reluctant to provide a copy to a unit owner adjuster -- or they may even charge a fee for their precious, dry-as-dust documents. And condo associations are sort of like families. Some are easy to work with and some are highly dysfunctional with everyone suing everyone else and constantly complaining about their neighbors and the association. So I wish you well with your condo unit claim, and I hope you stumbled into one of the functional associations.
Steve Ebner CPCU AIC AMIM
"With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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Ray HallSenior Member Posts:2443
11/02/2009 7:00 PM |
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Debbie with Citizens in Florida had a class on this subject about 3 years ago when she had Claims Mentor. She was with State Farm for 32 years as a catastrophe manager and an expert on condo's If any old members could post her lesson on this site. It would be appreciated by hundreds or thousands.
It was the most concise-precise post I have ever seen on a lesson.
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LelandAdvanced Member Posts:741
11/02/2009 10:10 PM |
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If the association has made a claim on its policy there will be another adjuster assigned. It is usually a good idea for you to contact that adjuster and find out what he or she is paying for as opposed to what you are paying for. Many times carriers I work for will specifically ask me to contact the other adjuster and make sure that my carrier is not paying for something the other company is also paying for. Sometimes my principal will want to cover something that the other carrier has already paid for, and perhaps shouldn't have. This also comes up with sometimes with commercial claims where one carrier has the landlord's building and the other has the tenant's BPP. It is always good claims practice for the two adjusters to speak to each other. You may find it far easier to get a copy of the CC&R's from a fellow adjuster. If you're not too proud to admit you are inexperienced, you might choose to admit your unfamiliarity with condo claims and get some advice from the other adjuster- just be careful about relying on that opinion, especially if it costs your carrier more money. And who knows, you might make a good business contact. If you are preparing a narrated daily claim report it should include the information on the other insurance coverage, including adjuster's name & claim number. Another thing to consider is if the associations loss is large enough it could trigger a special assessment against each condo owner. That assessment is usually covered by the individual owner's policy, even though it was triggered by damage that is otherwise not covered. It might show on the dec sheet as "loss assessment coverage". I would love for somebody to post on "loss assesment coverage" if they have some knowledge to share- how it works. The condo owners coverage might be called "owner's additions and alterations" which MIGHT give coverage to things that weren't actually added or altered, such as the paint already on the wall that was there when the new owner moved in. (See what Steve posted above) In commercial policies, in comparison, the tenant improvements really means "tenant improvement": if the tenant inherited it when they moved in, it is probably NOT covered, even if it is carpet, paint, etc. At least that's my experience in California.
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11/03/2009 11:44 AM |
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Thanks for the information! I have worked as an inside staff adjuster before but never had a single condo claim. I'm working hail claims in Colorado right now and I'm one of the last adjusters here. Now I'm getting all kinds of claims from re-inspects to these. I was hoping I would not have to go though so many hoops on these but wanted to get an idea of what was needed before diving in. Thanks again for the help!
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11/05/2009 12:13 PM |
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I understand that an HO-6 is a Named Peril policy. Do you know of anyway to make it a special form? I am in California. I have an Insured who hired a carpet cleaner who ended up ruining her carpets and drapes as he used too much water. The drapes soaked up the water from the carpet. The adjuster denied the claim and the "carpet cleaning company" denied the claim, as there was no coverage for "work completed" on their policy.
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claims_rayMember Posts:293
11/05/2009 2:26 PM |
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Time to seek legal council against the "carpet cleaning company".
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Tom RongstadMember Posts:76
11/05/2009 6:23 PM |
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Posted By cfisher on 05 Nov 2009 12:13 PM
I understand that an HO-6 is a Named Peril policy. Do you know of anyway to make it a special form?
HO 17 32 04 91 converts the HO 00 06 (all editions) which is a Named Peril Policy to "All Risk of Physical Damages" unless specifically excluded.
However, the Personal Property portion is still Named Peril Coverage. In this senerio, are drapes building / additions and alterations or personal property?
Looking at the liability for the cleaner - I would argue the loss did not occur after the cleaner left, but instead, it first occurred while the cleaning tasks were performed. Then it continued to "wick up" after he left. Completed Operations denial would then result in a bad faith situation.
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Tom RongstadMember Posts:76
11/05/2009 6:38 PM |
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Posted By Ray Hall on 02 Nov 2009 07:00 PM
Debbie with Citizens in Florida had a class on this subject about 3 years ago when she had Claims Mentor. She was with State Farm for 32 years as a catastrophe manager and an expert on condo's If any old members could post her lesson on this site. It would be appreciated by hundreds or thousands.
It was the most concise-precise post I have ever seen on a lesson.
Yes Debbie did a great job, but that lesson is no longer valid if the Association Insurance Policy has renewed in 2009. By 2010 all associations will abide by the revised Statutes.
Our lawmakers have been busy and the Florida Statutes have been revised as following:
This is from Chapter 718.111 Sub-paragraph (11) Insurance
(f) Every hazard insurance policy issued or renewed on or after January 1, 2009, for the purpose of protecting the condominium shall provide primary coverage for:
1. All portions of the condominium property as originally installed or replacement of like kind and quality, in accordance with the original plans and specifications.
2. All alterations or additions made to the condominium property or association property pursuant to s. 718.113(2).
3. The coverage shall exclude all personal property within the unit or limited common elements, and floor, wall, and ceiling coverings, electrical fixtures, appliances, water heaters, water filters, built-in cabinets and countertops, and window treatments, including curtains, drapes, blinds, hardware, and similar window treatment components, or
replacements of any of the foregoing.
So, another class is in order. We are putting one together right now, and are getting it certified as legal hours for CE opportunities here in the Florida Panhandle. It will address these questions: What about baseboards, interior doors, casing, crown and chair trim, commodes, pedistal sinks, showers, bath tubs. These items were the unit owners responsibility to insure, now the Association must.
Thank you lawmakers.
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Tom RongstadMember Posts:76
11/05/2009 7:00 PM |
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Posted By descher on 31 Oct 2009 04:47 PM
What items would be covered on this policy (USAA HO6)? There is Contents and Loss of Use coverage listed on the loss notice. I assume this is a paint inward type policy. No roof inspection would be needed correct? Just check for water damages to the unit owners personal items? Is carpet a covered item as well?
Thanks for the help in advance!
Dave.
To answer your question, USAA normally attaches HO 17 32 to convert to all risk coverage. If this is the case then coverage is triggered. If not, damage to the exterior by a covered cause of loss must first occur. "Leakers" will be excluded.
It appears the Declaration of Insurance is not in your possession, since you reference "loss notice". It appears USAA has engaged your services as a damage appraisal and not full adjustment. I would write the damages and submit to the examiner for adjustment.
If the Declaration has been provided and you are full adjustment, then the Statein which you are located in must first be known to answer your question. If you are in Florida, the statutes prevail. If you are in a state where statutes do not prevail. The Declaration of Condominium will need to be reviewed.
Look in the "Insurance Section", usually around chapter 10, 11 or 12. Many get confused by reading the Maintenance Section. Keep in mind, a claim is not a maintenance issue, it is a catastrophe of some level, thus the Insurance Section prevails.
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LelandAdvanced Member Posts:741
11/06/2009 8:24 PM |
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replying to Cfisher above regarding the question about carpet cleaner's liability: The simple (perhaps oversimplified) way to evaluate the cleaner's liability is to ask two questions: Did the carpet cleaners do something they shouldn't have done, that caused or contributed to a loss? and/or Did the carpet cleaners fail to do something they should have done, that caused or contributed to the loss? Don't allow your mind to be distracted by the Carpet cleaners telling you that they don't have insurance for that type of loss. Just imagine if I rammed my car into yours at 30 mph because I was texting. When you ask me to pay for it I tell you sorry, I won't pay for it because I don't have insurance. Not having insurance to cover your liability is not a defense to liability, it's just means you might have to empty your own pockets. Another question that attorneys like to ask is whether the carpet cleaner acted in a way customary for the industry they are in, and the area they work in. If all the carpet cleaners in town to sloppy work THAT could actually be a defense: "Mr. Homeowner, we did the same crummy job anyone else would have done. We aren't responsible for the damage." I don't think that defense will work because lifting drapes is a pretty basic & common thing that professional carpet cleaners do. Now if you go on the internet you can find emergency service company websites that give tips on what to do when the carpet gets soaked. Here's some tips I found: # Turn off the breaker in the damaged area before you unplug or remove any electrical devices located on the wet carpet. # Place aluminum foil under the legs of any furniture which is in contact with wet carpet. This might help prevent furniture stains on your carpet. # Lift draperies away from wet carpet. In my opinion, lifting the draperies off the carpet is common knowledge. So common in fact, it's one of the standard tips that is given to the homeowner. So I don't think the carpet cleaning company has much of a leg to stand on. They did a no-no, and they should have known better. If you review the carpet cleaners website and/or paperwork they gave the insured you might even discover that they also agree that drapes need to be lifted. It will be very hard for them to say they did nothing wrong if their own paperwork tells the homeowner they need to lift the drapes. But if they do have it on the paperwork it gives them another defense: "We warned the homeowner in writing to lift the drapes." Now the homeowner can turn around and ask why it was up to her to lift the drapes when she was told not to walk on the carpet, besides, 10 point type on page 3 is not an adequate warning, and even if it is adequate it doesn't change the fact the carpet cleaners did a no-no. Now you say the carpet cleaning company denied the claim, as there is no "work completed" on their policy. I'm not sure what you mean, but think about this: Going back to the example above when I rammed your car. How about if, when you asked me to pay, I told you I had insurance but I wasn't going to pay because my policy didn't specifically cover accidents during texting. Wouldn't make much sense, would it? What the victim needs to do is make a claim in writing, and ask the other party to notify their insurance. Then let the chips fall where they may. The victim may find out that the perpetrator has no insurance, or has insurance and doesn't want to make a claim of their own. Regardless of how the perpetrator reacts, the victim does the right thing by making a written demand. A smart way to right the demand is to think about the fact that a judge might be reading the demand letter later on, so tell a simple but complete story. Now when you say the carpet cleaning co refused to pay, did anyone speak to the owner? Sometimes managers will try to minimize problems to avoid getting in trouble but owners are willing to do the right thing. Now if this is a carpet cleaning company that the insurance company recommended or does frequent business with there may be some leverage to twist the carpet cleaner's arm to do the right thing. Has their bill been paid? It would be very simple to deduct the drapery problem from their bill. If the carpet cleaner is a sub to a general contractor then the homeowner can deduct it off the general contractor's bill (Respondeat Superior; the master is liable for the acts of the servant; same reason an insurance company can be held liable for the acts of an adjuster) And finally, if all else fails the homeowner can take the carpet cleaner to small claims court, where the judge, who is actually an attorney trying to make some extra money, will think for about 5 minutes tops, announce he will send his decision by mail, and ultimately rule for the homeowner because businesses should pay for their screw ups, simple as that. 234-9160
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LelandAdvanced Member Posts:741
11/06/2009 8:37 PM |
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I also wanted to comment on the personal property vs. Building property question. One carrier I know considers custom drapes (especially those that fit an odd size window) are building property. Drapes that are standard size ("off the rack") are personal property. They would, however, switch that thinking around of it was better for the insured.
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Tom RongstadMember Posts:76
11/09/2009 6:00 PM |
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Posted By Leland on 06 Nov 2009 08:37 PM
I also wanted to comment on the personal property vs. Building property question. One carrier I know considers custom drapes (especially those that fit an odd size window) are building property. Drapes that are standard size ("off the rack") are personal property. They would, however, switch that thinking around of it was better for the insured.
If you are talking about a condo, the drapes are Personal Property, as mandated by many by-laws. In Florida = Personal Property, never building as per Statute. But lets say they were installed by the builder and part of the original purchase when the unit was new and you are in a state other than Florida, read the Declaration of Condominium under the definition section.
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