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Why do you need an opinion?  Why not just read the policy and see what it says?

What is the reason that the dwelling is unlivable?

Both of these are named peril policies. The HO4 is a renter's policy, and normally wouldn't have any loss of use coverage. If the insured's apartment gets damaged, they can just stop paying rent at the damaged place and rent a different one. It's the landlord who needes coverage for loss of rental income in that scenario.

The HO6 is a condo owner's policy, also named peril.

Typically you need direct physical damage to "covered property" to trigger ALE or loss of use. So if the unit isn't damaged, or damaged enough to make it unlivable, then ALE or loss of use probably wouldn't be triggered. For example if a plumbing water leak damaged the elevators and the insured couldn't go up the stairs to get to their unit, and the elevators weren't covered property on the HO6, then you wouldn't have "direct physical damage" to covered property. The damage is to property that doesn't belong to the insured and its not what's insured on the policy. More importantly, the water leak wouldn't generally be caused by a named peril (although it could be) so that would actually be an even stronger reason to deny loss of use payment.

As always, post the policy language please.

Posted By Leland on 11 Dec 2012 06:21 PM
Both of these are named peril policies. The HO4 is a renter's policy, and normally wouldn't have any loss of use coverage. If the insured's apartment gets damaged, they can just stop paying rent at the damaged place and rent a different one. It's the landlord who needes coverage for loss of rental income in that scenario.

The HO6 is a condo owner's policy, also named peril.

Typically you need direct physical damage to "covered property" to trigger ALE or loss of use. So if the unit isn't damaged, or damaged enough to make it unlivable, then ALE or loss of use probably wouldn't be triggered. For example if a plumbing water leak damaged the elevators and the insured couldn't go up the stairs to get to their unit, and the elevators weren't covered property on the HO6, then you wouldn't have "direct physical damage" to covered property. The damage is to property that doesn't belong to the insured and its not what's insured on the policy. More importantly, the water leak wouldn't generally be caused by a named peril (although it could be) so that would actually be an even stronger reason to deny loss of use payment.

As always, post the policy language please.

"As always, post the policy language please"  may not be at the pleasure of the IA.  But you are correct Leland, because the landlord policy may actually provide coverage for "tenant relocation".  For instance, as long as there is a "covered cause of loss", and there is tentable (I'm getting a squibbly for misspelling on that word, ba humbug) "covered premises", then the insured can recover for costs to relocate said tenant and not incur "loss of income" thus off-setting loss of rents.  Works out good for both parties.....as long as the coverage as I've described exists.

Anyway, the inside examiner needs to ask those questions and know if a tenant(s) are displaced...and what the lease agreement says.

Posted By jeff on 05 Dec 2012 09:38 PM
Anyone out there getting answers on ALE payments for ho4 and 6 policies for "sandy"  I hear a lot of opinions but it seems the policy is clear that it has to be due to direct physical loss by a covered peril.  What are others hearing?

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Ah young Jeffrey,

the life and times of the public adjuster who is looking for the quickest easiest answer to that which he/she should already know.

In any case, as has been asked before, please post the specific wording of the policy in question and then apply to the damages, simple...yes?

A generic answer is the following:

ALE (Additional Living Expenses) is applicable IF: the damages to said risk are from a covered peril and are sufficient to render said risk uninhabitable until the repairs and/or replacement have been completed.

With almost a certainty, your situation will be something along the lines of: the insured has a risk that is probably uninhabitable (most likely from flood) to which your insured does NOT have flood insurance. The insured most likely has SOME wind damage to such a degree that would probably warrant a roof replacement. Is YOUR insured entitled to a new roof? Yes!! ALE? NO!!

I think I paid one ALE claim for Sandy. Boiler in an apartment building in Brooklyn caught on fire due to the flood. Minor damage in the basement, none in the insured's apartment, but mnagement at the carrier allowed a week of hotel. It was a gift.

If "young Jeffrey" is assisting an insured with an NFIP Standard Dwelling policy and the risk is determined to be post-Firm elevated cover is severely limited. Only listed items are covered below the first elevated floor.

Maybe he is not familiar with NFIP flood cover.

If "young Jeffrey" is assisting an insured with an NFIP Standard Dwelling policy and the risk is determined to be post-Firm elevated cover is severely limited. Only listed items are covered below the first elevated floor.

Maybe he is not familiar with NFIP flood cover.

Posted By ChuckDeaton on 30 Dec 2012 02:50 PM
If "young Jeffrey" is assisting an insured with an NFIP Standard Dwelling policy and the risk is determined to be post-Firm elevated cover is severely limited. Only listed items are covered below the first elevated floor.

Maybe he is not familiar with NFIP flood cover.

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Well, if this IS an NFIP policy, it's game, set, and match as there is no ALE coverage for NFIP claims.

Well of course I am sure Governor Cuomo will try to declare ALE IS now payable to NY residents (LOL) and of course FEMA was mistaken with their position on no ALE!!! I predict that Cuomo will now say that those folks who "thought" about getting a flood policy should be fully indemnified through the NFIP, regardless whether they actually purchased one.:-)

(all red text is in jest and I am NOT being serious. Just a teency weency bit O' sarcasm)

wow.

just ..... wow.