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Posted By Residential & Commercial Adjuster on 05 Sep 2012 07:46 PM
If I have agreed to pay for the ceramic tile stairs that extended up the hallway and into a room, do I pay for the hallway and room since the ceramic tile is continuous and a discontinue product?

 

Not many of us IA's put IA behind our names. Also most IA's have claim managers and the like to answer query's such as your's.

 If you have agreed to pay for anything, one can assume you are either a staff adjuster or an IA with some draft authority. In either case you would NOT need to come to an open forum in which to seek an answer that most adjusters would consider basic knowledge. Further, what does the policy state? What kind of policy are we dealing with?

Are you a PA, if so why not state as much?

Hello CatdjusterX,

Thanks for your response; and I apologize for my claim scenario question. As some of us might have those same questions such as how do we pay all four sides of the roof if only two sides (50% damages on each side) of the roof is damaged and not the whole thing (Trust me I want the percent on all four sides) but I cannot find that in the Dwelling, Home, Commercial policy, Insurance Code or will this be considered under Ordanance/Law in the Policy under the International Residential Code (IRC) (Section AJ501.3 Extensive Alterations - "which most city municipalities don't adopt that section in their city ordnance") or would this be consider as Like Kind and Quality or Principle of Indemnity?

You’re correct, your Claims Examiner or Quality Control is the person to speak with but as we know the carriers objective are to minimize the payout to prevent or avoid Insurance Adverse Selection.

So let’s rephrase the scenario question:

If I am the Insured or Public Adjuster (PA) and my Staff/Independent Adjuster (IA) agreed to paid for the ceramic tile stairs and it extended up the hallway into a room, is the Staff/IA obligated to pay for the hallway and room since the ceramic tile is continuous and a discontinue product or will the Staff/IA consider this a contiguous at the breaking point at the riser of the step?

And let’s say that we have a HO-2 (Name peril) or HO-3 (All-Risk or Open Peril)

Thanks for your input,

 

Hello CatAdjuster X,

Thanks for your response; and I apologize for my claim scenario question. As some of us might have those same questions such as “Do we pay for the whole roof if only two sides (50% damages on each side) of the roof are damaged” (Trust me, I want the percent on the whole roof). I cannot find the replacement cost in the Dwelling (D-2 or D-3), Home (H0-2, H0-3), or Commercial policy or Insurance Code or will this be considered under Ordinance/Law (10% of Coverage A) under the International Residential Code (Section AJ501.3 Extensive Alterations) or would this be consider as “Like Kind and Quality” or “Principle of Indemnity” ?

So let’s rephrase the claim scenario question:

If I am the Insured or Public Adjuster (PA) and my Staff/Independent Adjuster (IA) agreed to paid for the ceramic tile stairs, and it extended up the hallway into a room, is the Staff/IA/CE/QC obligated or in good faith to pay for the hallway and room since the ceramic tile is continuous and a discontinue product or will the Staff/IA/CE/QC consider this a contiguous at the breaking point at the riser of the step or would this be consider as “Like Kind and Quality” or “Principle of Indemnity”?

And let’s say that we have a HO-3 (All-Risk or Open Peril) and was covered under a peril.

Oh, yes you are correct, your Claims Examiner (CE) or Quality Control (QC) is the person to speak with but as we know the carriers objective are to minimize the payout to prevent or avoid Insurance Adverse Selection.

What's your input if the CE & QC said that its your call on the stairs since you commited to paying for the tile stairs and you might be liable to pay for that out of your next claim? What is the right thing to do?

Hello CatAdjuster X,

Thanks for your response; and I apologize for my claim scenario question.  As some of us might have those same questions such as “Do we pay for the whole roof if only two sides (50% damages on each side) of the roof are damaged” (Trust me, I want the percent on the whole roof).  I cannot find the replacement cost in the Dwelling (D-2 or D-3), Home (H0-2, H0-3), or Commercial policy or Insurance Code or will this be considered under Ordinance/Law (10% of Coverage A) under the International Residential Code (Section AJ501.3 Extensive Alterations) or would this be consider as “Like Kind and Quality” or “Principle of Indemnity” ?

So let’s rephrase the claim scenario question:

If I am the Insured or Public Adjuster (PA) and my Staff/Independent Adjuster (IA) agreed to paid for the ceramic tile stairs, and it extended up the hallway into a room, is the Staff/IA/CE/QC obligated or in good faith to pay for the hallway and room since the ceramic tile is continuous and a discontinue product or will the Staff/IA/CE/QC consider this a contiguous at the breaking point at the riser of the step or would this be consider as “Like Kind and Quality” or “Principle of Indemnity”?

And let’s say that we have a HO-3 (All-Risk or Open Peril) and was covered under a peril.

Oh, yes you are correct, your Claims Examiner (CE) or Quality Control (QC) is the person to speak with but as we know the carriers objective are to minimize the payout to prevent or avoid Insurance Adverse Selection.

What's your input if the CE & QC said that its your call on the stairs since you commited to paying for the tile stairs and you might be liable to pay for that out of your next claim? What is the right thing to do?

Posted By Residential & Commercial Adjuster on 10 Sep 2012 11:55 PM
Hello CatAdjuster X,

Thanks for your response; and I apologize for my claim scenario question. As some of us might have those same questions such as “Do we pay for the whole roof if only two sides (50% damages on each side) of the roof are damaged” (Trust me, I want the percent on the whole roof). I cannot find the replacement cost in the Dwelling (D-2 or D-3), Home (H0-2, H0-3), or Commercial policy or Insurance Code or will this be considered under Ordinance/Law (10% of Coverage A) under the International Residential Code (Section AJ501.3 Extensive Alterations) or would this be consider as “Like Kind and Quality” or “Principle of Indemnity” ?

So let’s rephrase the claim scenario question:

If I am the Insured or Public Adjuster (PA) and my Staff/Independent Adjuster (IA) agreed to paid for the ceramic tile stairs, and it extended up the hallway into a room, is the Staff/IA/CE/QC obligated or in good faith to pay for the hallway and room since the ceramic tile is continuous and a discontinue product or will the Staff/IA/CE/QC consider this a contiguous at the breaking point at the riser of the step or would this be consider as “Like Kind and Quality” or “Principle of Indemnity”?

And let’s say that we have a HO-3 (All-Risk or Open Peril) and was covered under a peril.

Oh, yes you are correct, your Claims Examiner (CE) or Quality Control (QC) is the person to speak with but as we know the carriers objective are to minimize the payout to prevent or avoid Insurance Adverse Selection.

What's your input if the CE & QC said that its your call on the stairs since you commited to paying for the tile stairs and you might be liable to pay for that out of your next claim? What is the right thing to do?
..........................................................................................

Hello Eric,

thank you, you have given additional information necessary for a response.

Based upon your words below:

Oh, yes you are correct, your Claims Examiner (CE) or Quality Control (QC) is the person to speak with but as we know the carriers objective are to minimize the payout to prevent or avoid Insurance Adverse Selection. 

So Eric, the above verbage tells me everything I need to know about which side of the fence you are on. As stated earlier if you were a PA or attorney/restoration or whatever, just state as much from the onset.

Since you wanna conceal the truth, figure out your own claims friend.   

I guess I need a sasprilla or somethin'.

Why would a PA ask a bunch of adjusters about floor coverings on stairs? "avoid Insurance Adverse Selection"??

I think I'll just go down to the parlor and relax........................

Happy Trails

So, Larry...was there any hell damage at the parlor back in the end of May?  Understand you're their "dedicated juster"!

Most adjusters know that they should recommend payment to match all the tile in contiguous rooms, they just don't really know why. It isn't in the policy. It is in the state regulations or insurance code and/or case law. I posted examples from different states in an earlier thread, it can be found here on CADO. But that rule only applies to RCV policies, including RCV policies that get settled at ACV. That rule does not apply to ACV policies, and in fact in many cases the carrier has the contractual right to pay only for the damaged area on an ACV policy.

Is it an ACV policy or RCV?

And on a personal note, Mr. Ramirez is welcome here, in my opinion, as long as he adds to the discussion. Disparaging IAs with blanket statements does not add to the discussion. There are many PA's who we could complain about but I know one or two that I might call for an opinion once in a while. It's not your title that counts, it's how you behave.

Yeah, we got some hail damage to the skylights and to the mirrors on the ceilings. Man, that adjuster sure took his time looking everything over and measuring and photographing and all that adjuster stuff.. We had a full staff the day he showed up. Hmmmmmm

I agree, Leland, that all are welcome until they overstay the aforementioned welcome. And, I suppose a PA can't just call a supervisor and chat about tile on the stairs. But, from some of his statements, I think that the profit motive has raised its ugly head and is the motive for this discussion.

Happy Trails

Eric,

If teh IA has agreed to pay for the tile on the staircase and is continuous onto the landing and other rooms with no matural breaks then yes he should allow for the continuos flooring. if there are natural breaks, thresholds that break up the floor then NO the insured is not entitled to the flooring in those aras even if they are of the same kind.

Posted By Leland on 14 Sep 2012 08:08 AM
Most adjusters know that they should recommend payment to match all the tile in contiguous rooms, they just don't really know why. It isn't in the policy. It is in the state regulations or insurance code and/or case law. I posted examples from different states in an earlier thread, it can be found here on CADO. But that rule only applies to RCV policies, including RCV policies that get settled at ACV. That rule does not apply to ACV policies, and in fact in many cases the carrier has the contractual right to pay only for the damaged area on an ACV policy.

Is it an ACV policy or RCV?

And on a personal note, Mr. Ramirez is welcome here, in my opinion, as long as he adds to the discussion. Disparaging IAs with blanket statements does not add to the discussion. There are many PA's who we could complain about but I know one or two that I might call for an opinion once in a while. It's not your title that counts, it's how you behave.

................................

Leland, I agree with your sentiments. I would never say, your a PA go somewhere else. I am a proponent for both sides of the fence. As I stated above, if the guy is a PA then say as much. When the guy is deceiving those from which he seeks clarity from, it's not much of a stretch to think the guy is gonna deceive the carrier and most assuredly has deceived the insured into believing that said individual is an expert. Of course even experts have questions, but they don't often come to a social media site and ask a question that most adjusters learn coming out of training.

An educated IA/SA/PA would know to look at the policy and then the respective state's DOI for the answer 

Or, if all else fails, there's always the Wigi board in the closet.

Happy Trails

Just a minor point but the term "adverse selection" doesn't usually have much to do with residential property claim adjusting. I know this only because I learned the term when I studied for my life insurance license years ago. I have always looked pretentious or even stupid when I have used terms incorrectly, especially if I was trying to impress strangers with knowledge I didn't have. And I hope I can prevent others from making the same mistake.

Adverse selection is when you are an insurance agent and your company rolls out a new life insurance policy that doesn't require a medical test for a deadly disease that is common in your community. Most other insurance companies test for the disease and charge a much higher premium. So you get the idea to visit the local medical clinic that tries to treat that disease and you sign up as many patients as you can. Even the doctor recommends you to patients. You discover there is a newsletter for sufferers of the disease and you advertise in it. A year or two later the carrier notices that your insureds seem to die much more frequently than the average customer, and the carrier is paying out a lot more money than they ever expected.

That's adverse selection.

Other examples of "adverse selection" are: dental insurance and the guaranteed issue life policies for those 55-80 that you see on the infomercials.  In these cases, they are adverse selection by invitation.

Dental insurance is expensive for the limited benefits you get...because the actuaries know that those that sign up are either good dental health and will only use the 2x yearly cleanings/exams (cost = about 3 mo premiums).  The others have poor dental health, but aren't aware of the limited benefits and waiting periods involved.  And those same folks usually terminate their employment or coverage before utilizing it at all.

The Life policies are advertised as costing only about 35 cents per day ("per unit of coverage"), but until you read your policy...a unit might be $500 and a max $2500 policy for a 60 yr old, may be a $1000 policy for the 75 yr old and benefits are limited to a scale of 25-50% of face value during the first 1-2 years. I'm sure it's disclosed in that small print at the bottom of your TV screen as required by law, but have you ever tried to read it before it flashes away?

 

 

 

Posted By Mike Kunze on 23 Sep 2012 12:03 AM

Other examples of "adverse selection" are: dental insurance and the guaranteed issue life policies for those 55-80 that you see on the infomercials.  In these cases, they are adverse selection by invitation.

Dental insurance is expensive for the limited benefits you get...because the actuaries know that those that sign up are either good dental health and will only use the 2x yearly cleanings/exams (cost = about 3 mo premiums).  The others have poor dental health, but aren't aware of the limited benefits and waiting periods involved.  And those same folks usually terminate their employment or coverage before utilizing it at all.

The Life policies are advertised as costing only about 35 cents per day ("per unit of coverage"), but until you read your policy...a unit might be $500 and a max $2500 policy for a 60 yr old, may be a $1000 policy for the 75 yr old and benefits are limited to a scale of 25-50% of face value during the first 1-2 years. I'm sure it's disclosed in that small print at the bottom of your TV screen as required by law, but have you ever tried to read it before it flashes away?

 .....................

Thank god for TIVO!!!!!!!!!! It is easy to see why attorneys advertisers and the like despise TIVO for that very reason, enough time to read the small print

 

 

I am new to this board and just had to laugh reading this thread. I am having flashbacks to my staff adjuster days and conversations with public adjusters about ceramic tile.

Posted By dpadjuster on 18 Jan 2013 08:26 PM

I am new to this board and just had to laugh reading this thread. I am having flashbacks to my staff adjuster days and conversations with public adjusters about ceramic tile.

 

That is amazing...you are new to this board, and your first post wasn't "how can I get started as a Cat Adjuster?"  

Husker, leave the cynicism to the truly old f*rts. In reality the posts about I r an adjuster with 3 days training and ready to make 50K a month appear to be way down. If Cat Adjusting (as we knew it) survives maybe there is some hope that we are attracting people who can read.

Thank God it wasn't stairs with "porcelian tile" ...... WHO KNOWS what would have happened then. ACV and RCV are thrown out the window, and then and only then will the sasparilla make things A. OK.