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Last Post 01/10/2013 11:50 PM by  Torrential
Sandy Discussion
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chadecoen
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11/11/2012 12:05 AM
Hi guys,
I got deployed by one of the bigger IA firms to do office duty for a carrier. Getting lots of calls with steep/tall roofs. Not gonna be pretty when snows start. Not a lot of volume and I expect them to start letting people go as soon as next week (just my opinion) but then again they brought on another 80 (inside) folks yesterday. Most of the field guys left the building to go to work yesterday. Call volume has already dropped by half in the week I have been here. But a few friends of mine are calling asking if I want to go out cause the smaller firms they are working for actually have claims so I can't get a good feel for how quickly this is going to fall off. But that's not why I was posting.

Someone on the first page brought up a great point about carrying a gun on assignment. I am in a north eastern state right now and I almost left the deep south with my pistol sitting under my arm rest in my truck where it has been for years. Most southern states recognize my states carry permit and it isn't a big deal. The state I am staying in has no carry permits for non law enforcement related people. CHECK YOUR STATE LAWS before driving across country with an illegal firearm in the car. They don't give a doo doo what state you are from and whether or not you have a permit in said state. It will flat ruin your trip, promise. Be safe everyone. And, as an old Army Ranger friend of mine keeps telling me about carrying a weapon, "don't bring anything on to the battle field you don't want stuffed up your hind side. Cause someone you run in to is likely to value their life more than yours and take it from you." This could get really ugly for wind guys when the cold weather comes in. Geesh, I feel like I am on the set of Game of Thrones......WINTER IS COMING!


Chad
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Alex_Chernov
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11/11/2012 5:15 PM
Ok. Now that a week has passed, situation in NYC is more or less clear. Minor wind damages, especially more so in the open coastal areas and spotty flooding on low areas close to the water. Not many have flood insurance in these areas. I inspected a claim a couple of days ago where insured was claiming the water came from the sewer backup. He had exterior water line of 3 feet and completely gutted the basement. However, he could not explain how SEAWEEDS! got to his basement and were seen on the walls. Areas, like Breezy Point are more like a war zone, police, military in there and total mayhem. It's a good opportunity to do some flood work.

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Jud G.
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11/11/2012 5:18 PM
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.

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HuskerCat
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11/11/2012 7:46 PM
Claims made are claims to be worked, whether coverage is available or not. More than plenty to go around...and the commercial BI claims require inspection to determine if there may be coverage for it.
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Medulus
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11/11/2012 10:56 PM
Bravo, Huskerman.

And when it comes to sewer backup versus flood, the adjuster needs to check with his or her supervisor and/or the carrier before reccommending denial unless he or she wants to be the one in court or on the evening news explaining how sewer backup water and flood water can be separated out. Handle this stuff the way the carrier wants it handled. People tend to see the devastation (and it is there - I've seen plenty of it already) and seek to get our help to indemnify them. Within what the policy allows, we need to be part of the solution, not part of the problem.
Steve Ebner CPCU AIC AMIM

"With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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Jud G.
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11/12/2012 4:42 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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Alex_Chernov
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11/12/2012 9:16 PM
Most of the policies I handle have a concurrent causation language, which plainly says that it does not matter if there is another peril, which contributed to the damage, flood is excluded, period. Most of BI claims, unless they are really simple ones, go directly to accountants. All denials are handled, in my firm, on T&E basis. But, usually, insured has a shingle or two torn off, so I can get them a couple of dollars for the wind and close the file.
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Alex_Chernov
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11/12/2012 9:16 PM
Most of the policies I handle have a concurrent causation language, which plainly says that it does not matter if there is another peril, which contributed to the damage, flood is excluded, period. Most of BI claims, unless they are really simple ones, go directly to accountants. All denials are handled, in my firm, on T&E basis. But, usually, insured has a shingle or two torn off, so I can get them a couple of dollars for the wind and close the file.
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HuskerCat
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11/13/2012 1:31 AM
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.

 

**

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!   



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Medulus
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11/13/2012 6:31 AM

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?

Steve Ebner CPCU AIC AMIM

"With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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Jud G.
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11/13/2012 5:36 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.

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Alex_Chernov
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11/13/2012 11:43 PM
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.  

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Medulus
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11/14/2012 7:22 AM
As Charles Dickens wrote (I believe it was Mr. Bumble who uttered the words, but have no time to look it up), "The Law is a Ass (sic)". The courts will do what they will do, and it may have nothing to do with what the policy says, or for that matter what the law says. That is my take away from spending a good portion of my time over the last five years handling Hurricane Wilma litigation files. Many decisions will be made by the carriers five years from now that cannot be foreseen today. Make sure you read the policy, read the endorsements, and follow the carrier instructions. And...document that it is the carrier who is asking that the claim be handled in that manner. CYA and you will be fine. Do what you can to help the insured within the confines of what the policy and the carrier instructions allow.

And - another take away from the last five years - the most difficult files tomorrow will be those in which the initial interaction between the adjuster and the insured goes poorly. More lawsuits arise out of arrogance on the part of the adjuster than on any claim denial. Trust me 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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okclarryd
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11/14/2012 8:34 AM
Gettin' old ain't for Sissies......................

Happy Trails
Larry D Hardin
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Alex_Chernov
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11/14/2012 2:35 PM

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. 

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Medulus
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11/14/2012 7:16 PM
The arrogant comment was not directed at you, Alex. You actually seem to be dedicated and knowledgable. It was a comment to the catadjusting community at large, as sort of reminder that hubris is not warranted in situations like this. I was actually thinking about two files I received when I started with my (now) past employer. My boss told me, "This file is your number one priority, and this other one is your second highest priority." They had both gone severely south. What they had in common is that the initial independent adjuster on each file had treated the insured poorly on first meeting. Each adjuster had virtually accused the insured of fraud and treated the insured accordingly. The first took two years of finessing the high powered and hard nosed attorney to reach an amicable settlement. The second went through the court system where we lost every decision we should have easily won.
Steve Ebner CPCU AIC AMIM

"With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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HuskerCat
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11/16/2012 12:35 AM
There is currently a banner ad from Cimmaron Claims looking for help on the Stanton Island losses.  Where is Stanton Island?  I've googled it, and nothing comes up.  I think I know what they meant...but, who's minding the house? 
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olderthendirt
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11/16/2012 8:16 AM
If the vendor can not spell, then it is a grate place fore all the adjustirs whoo caint spel.
Life is like a sewer, what you get out of it depends on what you put in it
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ChuckDeaton
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11/19/2012 10:03 PM
Know before you go!!!!!!!!!!!!!!!!!!! Know before you go!!!!!!!!!!!!!!!!!!!!!!!!!!
"Prattling on and on about being an ass with experience doesn't make someone experienced. It just makes you an ass." Rod Buvens, Pilot grunt
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olderthendirt
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11/19/2012 10:43 PM
Chuck, I am so happy to be sitting (ie already working) this one out. Maybe in the spring if they need clean up.
Life is like a sewer, what you get out of it depends on what you put in it
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