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If you are the adjuster with an excess claim should you:

1) accept the adjustment of the primary claim as being accurate, since it was paid by the carrier already?

or

2) carefully review the adjustment of the primary claim, verifying its accuracy, using your NFIP "specialized knowledge".

or

3) adjust the primary claim all over again, writing your own estimate from scratch

WOW !!!!

Reading this thread sure will make the Newbies eyes get REAL WIDE OPEN. I'm gonna put this thread away and bring it back in October to show on the big screen with "Halloween" and "The Shining" .

That triple treat should scare the He11 outta them !

Mr. HuskerCat you and I travel in different circles and without going into detail it is virtually impossible for anyone to have seen one of my "files". So I am calling BS on that last statement.

Posted By Pondman on 18 Jan 2013 09:10 AM
WOW !!!!

Reading this thread sure will make the Newbies eyes get REAL WIDE OPEN. I'm gonna put this thread away and bring it back in October to show on the big screen with "Halloween" and "The Shining" .

That triple treat should scare the He11 outta them !

 

Pondman...this has just been tame exchanges amongst long-time posters (some of them a bit crabby).  If you really want to entertain or scare the jeegeebies (is there really a way to spell that word...might have to check with Larry in OKC) out of newbies, then you need to go back to the archived forums of '04-'06.  There's some dandies out there & it was non-stop.  Just ask our current moderator, Medulus.  REDRUM REDRUM

Posted By Leland on 18 Jan 2013 02:37 AM
If you are the adjuster with an excess claim should you:

1) accept the adjustment of the primary claim as being accurate, since it was paid by the carrier already?

or

2) carefully review the adjustment of the primary claim, verifying its accuracy, using your NFIP "specialized knowledge".

or

3) adjust the primary claim all over again, writing your own estimate from scratch

 

OK, you pose very good questions...and, I think they were questions.. there wasn't a "?" mark after each; so...

There are other facts of the loss that I have not disclosed, such as a separate independent inspection of the loss.  So, yes...the scope is known.  It was the specific underlying coverage that was at question.  

No longer an issue...and there's no crying allowed on this subject any longer.  But, whiners please feel free.  Let's see who's first.

 

I have to give credit where credit is due. Mr. Deaton gave the idea for the questions I posed, he brought it up first. So I now I will have to add extra credit points to his grade, I suppose.

I am not an attorney, and I don't even play one on TV.

Leland,

Combining my theological and my catadjustological (try spelling that word, O man from Worms) hats, the three questions you ask, Leland, are three in one - a veritable trinity of questions. So, should an excess carrier accept the underlying carriers adjustment of the claim or not? And the answer is often "yes", but sometimes "no". This is the mystery of adjusting. The situation Mike, the husker guy, is describing in minimal detail sounds like a "following form" excess policy. And, generally speaking, there are complications inherent in the excess carrier sending out someone to start from scratch on the claim. When this file goes to trial five years from now, I would not want to be the carrier who assessed the loss at a lower figure. That could very well be like drawing a target on one's back.

"So, Mr. Claims Examiner, if your form is excess and it "follows form", why did you decide to send out your own adjuster to write a separate estimate which - to no one's surprise - is lower than Company X's estimate....EVEN THOUGH YOUR POLICY SAYS YOU ARE FOLLOWING THEIR FORM?"

And- understand that we are in the rarefied air here where only a few adjusters dare to breathe-a decision to send out one's own adjuster on the excess policy would be the exception rather than the rule. And understand further that such a decision would be made with great trepidation and for file specific reasons.

Even if this is not a "following form" excess situation, the adjustment of the claim generally falls to the primary carrier. The excess carrier might consider sending out its own adjuster if there is coverage for something (or occasionally exclusion of something) in the excess policy that is not present in the primary policy and, therefore, the primary carrier has ignored the adjustment of that aspect of the claim. But this would be the exception rather than the rule.

And so, the bottom line is: Usually the excess carrier is in the position of accepting the work done on behalf of the primary carrier. And occasionally, in a small fraction of cases, an excess carrier will hire their own adjuster to evaluate and adjust the loss.

And, I will reiterate what Jud G said about excess versus DIC. There is no dichotomy between the two. Many DIC policies are also excess. And, by way of endorsement, I know Jud Gardner to be an exceptional adjuster because I have reviewed his work and he was the only adjuster I (and therefore the carrier for which I worked) hired to do my work in the Florida panhandle and environs when I was in charge of making such decisions at ICW.

Not to minimize anyone, but if any of you have handled a claim involving a following form that uses an NFIP policy for a base, please hold up your hand and step to the front of the line. Only fools leap in where angels fear to tread.

Oh, and please, blog your experience after you failed to write an estimate and then find that the NFIP adjuster committed actionable fraud against the United State government and you are being mentioned as an accessory.  And then try to make an E & O claim.

Didn't anyone go back and read my initial post? Read between the lines...I'm was just wanting to post a reserve to the file. There aren't intentions otherwise. And, it's more like "go with the leader" instead of "follow the leader", because we are working with a larger limit than the primary. Yeh, my field adjuster looked at the loss...the broker insisted. So, that was my only question. And it will also be the question of the 3rd layer. And this isn't a market share with a dedicated GA, so put that away.

I didn't make the initial post all that difficult; just haven't been boots on the ground NFIP, so wanted to know from those "boots". Now, the paranoia sets in, and all the mentions of lawsuits and E&O......??? Not the case at all.

I have several active files that use the NFIP policy as a deductible to a DIC policy. With them, there is no other use of the NFIP policy other than allowing them to serve as $500K deductibles. The NFIP forms are absent any common sense and have zero bearing on the provisions and limitations of the language stated within the upper layer DIC forms. The customer base I work with is aware of these emaciated provisions by the Federal Government who feigns generosity. So they pay top dollar to ensure that their precious assets are actually restored to pre-loss condition.

With my hand only halfway up Chuck (in addressing the first half of your post), I will calmly assert that one's experience with NFIP is almost irrelevant. The forms I am assigned to render the NFIP forms and my old one-day Flood Certification Card useful only for kindling. I suggested my NFIP experience to my superiors and they greeted me with a snicker as I was told to pull up a chair and listen.

In my understanding of your testy comment about fraud and E&O (as they relate to the forms you are handling), I see your point. For problem cases, this point is even a legitimate concern. However, my choice to rewrite the loss as it pertains to the language of the upper layer would not threaten the NFIP adjuster's standing with his E&O carrier.

It appears that you have assumed that the NFIP adjuster may have written up too much. I will re-emphasize that they could only be guilty (again, not my call) for writing up too little simply because the NFIP contains limited provisions. The DIC form can come in to provide the missing link for additional funds (excess) or for provisions (risk avoidance) that were limited by the NFIP or both.

As for the interests of their E&O carrier, that will be a task only for NFIP reinspectors; not mine. As I say this, I meekly confess that it is the coverage counsel we hire who venture where angels fear to tread. I can only claim that I get to watch them do the real work.

Chuck, as you may know, manuscript forms are often scripted with a single customer in mind and seldom duplicate their language from one policy to the next within a single carrier or conglomerate of carriers. Consider Steve's post above and his experience in authoring these forms. The manuscript, DIC forms that provide excess coverage and use the NFIP policy as a base deductible relate to your NFIP, Excess-only forms much like apples and oranges relate to each other. In light of this, I am neither about to concede nor suggest that Mr. Kunze's form (loss) be handled with the same degree of absolutes that you handle yours.

Additionally, I will most certainly not disqualify your suggested approach as you address your respective losses since I've not seen the forms you work with. Despite the difference in forms, there are many similarities. If there's one thing to be gained from this thread, then it would be to place heavy emphasis on becoming assumption averse. In doing so, avoid action or comment until you read the policy and confirm carrier or counsel agreement to your interpretation(s).

Steve; many thanks for your endorsement. You are too kind. I will gladly admit that in 2009, you were the first to give me that useful primer on the basic purposes of DIC forms. While in San Diego traffic, you pulled over during your work day to avoid hands-free violations, took my call, and gave me some very useful information. That primer enabled me take the first and biggest step of several in becoming prepared for the strange, but exciting claims environment I've found myself in now. Stay safe.

Posted By ChuckDeaton on 17 Jan 2013 06:54 AM
My suggestion would be that any adjuster, before handing an Excess Flood claim, especially on London paper, go through the process, get properly NFIP licensed to handle large commercial flood then actually handle flood claims, with large commercial as part of the claims mix, this process will take several years, then sort out the E&O issue, Once this steps are complete the adjuster could be qualified to throw his/her hat into the ring.

In preparing my earlier post, I overlooked this one.  The London brokers I work for don't care if you are NFIP certified.  I have ample experience writing flood losses for both domestic and overseas carriers (To the NFIP gurus reading this, NO- NFIP is not the only flood player in the U.S. of A.).  I don't need a cheesy one (1) day certification to tell someone I can read a policy especially if it their test doesn't provide a decent survey of coverage knowledge.

I got my NFIP card after one (1) year of property experience and it was not under the duress of an emergency situation.  I no longer have it since the flood claims I've handled since 2005 have all been non-NFIP, written by someone with common sense, and devoid of the hideous barrage of red tape (I guess the common sense part addresses this item too).

I thought you had to have a special certification to handle commercial or rcbap claims.

You absolutely do, brarew, when doing work for NFIP. You do not, however, when handling policies that are not part of the National Flood Insurance Program such as EZ Flood or DIC policies that cover flood. They are still not for the faint of heart. Always a good thing, in my opinion, to have the certification. I keep mine current.

I really appreciate the way Steve explains everything twice for us slow learners.

Thanx again

I really appreciate the double explanations, especially the explanations are made by adjusters who are inexperienced and know just enough to be really dangerous to themselves.

Is Robbie Robinson sick, where is he.

Yes, Chuck you said that once already. However, I am content to know that both the vendors and carriers of this niche corner of loss adjusting arena continue to hire me for my services.

I invite you to consider how your 'decades of experience' may have surfaced as the bane of your recent comments. Comments that demonstrate your understanding of this forum's topic are much more beneficial than criticizing other posters.

Are you aware that we are discussing two different excess forms? Your comments indicate that you have never heard of a DIC form.