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JWG

The DP1 is an ACV policy. The VEHICLE damage to the roof would be covered. The smoke damage to the interior smoke damage to the rooms would be covered as the heating device was connected to a chimney. No coverage for the parking and vehicle fine's as this is not a named peril. Do not recall if the DP1 has a Ded. on all perils or just windstorm, hurricane and hail. So probably no Deductible. The TV antenna is excluded for windstorm and this was the proximate cause of its distruction. Santa would be a third party vendor as he charged $100.00 for the lump of coal, and none of his property is covered as he was not an "insured". What did I leave out ?

back soon.... I,m back, but I think I missed a hidden question in this post.

 

 

This would raise several questions that probably could not be answered here. Would the sleigh be considered an automobile or aircraft or falling object. The lawyer for the insured will obviously argue that the damage was caused by the sleigh and not the reindeer. Is this a condo, hence the "no parking" zone. Since the fat man and reindeer are unavailable for the foreseeable future, and unwilling to give a recored statement, (also considered by some in the neighborhood to be "mythical"), could this damage be self inflicted? And really, who has an antenna these days? Are the photos available for review? Obviously not a Texas claim, hence no mention of one of the deer being mounted and on display in the insureds home. Another question I would have is if the alleged sleigh magically flew away, how and why would it just fall off the roof?

Just a few questions, but I'm like that,

JWG

 

BTW, my wife would like to point out that most fat men in sleighs are pulled by 8 or possibly 9 tiny reindeer, depending on th weather of course,  not 12. She even has their names if needed for verification.

I mentioned the ticket placed by the police because I think that detail is relevant to determining whether the sleigh is a vehicle. Since the policy does not define "vehicle" but a law enforcement agency clearly believes it to be a vehicle, I think it would be smart for the adjuster to agree that it is in fact a vehicle. Certainly the case could be made that it is an aircraft, but as long as it can also be reasonably considered a vehicle, I think a good faith analysis of the facts requires the benefit of the doubt be given and the sleigh be considered a vehicle, which might trigger coverage for the peril of "vehicle damage". Are the reindeer, which pull the sleigh, also part of the vehicle? In other words, should damage caused by the reindeer be considered "vehicle damage"?

On a named peril policy like the DP1 there is often coverage for vehicle damage but not for damage from animals. It is rare nowdays but you can still see Clydesdales running around with beer wagons or horse pulled carriages in New York Central Park. The Amish also come to mind. If a horse, connected to a carriage, damages the dwelling, would that be covered? What if the impact is from the horse only, and the actual carriage does not hit the house?

There is, however,another issue here which I think might result in a total denial of the claim, regardless of whether the reindeer damage is determined to be "vehicle damage". I will mention this issue later, maybe someone else will post it first. A key factor in this particular issue (in my opinion) might revolve around whether Mr. Claus was bringing any unsolicited presents in addition to the lump of coal. It might also be helpful to verify if he was visiting other homes in the area, perhaps on a route, rather than making a detour to this one particular house.


On another note it is interesting that Ray Hall points out that the wind was the proximate cause of the damage to the antenna, triggering a denial for that portion of the claim. It is true that "but for" the wind, the sleigh would not have hit the antenna, but couldn't it be considered vehicle damage anyway? Or would that matter? Is antenna damage excluded no matter what the cause, or just for wind. I need to look that part up. I will post the wording. If the antenna is in fact excluded, would you cover the repairs to the shingles where the antenna ripped out of the roof, or would that also be denied?

Also this brings up the issue of wind vs. windstorm. I believe the policy covers "windstorm", not plain ordinary wind. If anyone has experience with claims on a named peril policy where wind damage wasn't covered because it wasn't a "windstorm" I would really like to hear about it.

"When out on the lawn there arose such a clatter,"

Here's your covered named-peril...  It's a civil commotion!

In the spirit of giving, everything would be covered except the TV antenna which is specifically excluded property.

DP001

“2.) Windstorm or Hail
This Peril does not include loss:…..
b) to the following when outside the building:
1)Awnings, signs or radio or television antennas or aerials, including lead-in
Wiring, masts or towers….

It appears that the antenna would not be covered under the wind peril.

However, it does appear that the antenna could be covered under the “Vehicle” peril. The vehicle peril has only two exclusions: for vehicles owned by the insured or a resident or for damage to fences and walkways. It seems to me that since the antenna was hit by a vehicle, regardless of whether the wind was a contributing factor, the antenna damage should be covered. After all, “vehicle” is a peril all by itself, whether or not wind was also involved.

I would also tend to consider the reindeer hoof damage as covered under “vehicle”, since the reindeer were connected to the sleigh which was technically a vehicle.

Ray- you posted: “The smoke damage to the interior smoke damage to the rooms would be covered as the heating device was connected to a chimney.”

“Smoke” is a peril in my DP1 but it says:

“Smoke, meaning sudden and accidental damage from smoke. This peril does not include loss caused by smoke from fireplaces or from agricultural smudging or industrial operations.”


Therefore it appears that the smoke damage can not be covered under the peril of "smoke" as it came from a fireplace.

Another peril we might consider is Vandalism & Malicious Mischief. In California, this peril is often interpreted very generously. Some strange guy landing on your roof to deliver a lump of coal would likely be covered as VM&M. Even if a visit from Santa is a beloved historical tradition, why would it not be VM&M just as if teenagers threw toilet paper all over the house? Also, in this case he was there to bring a lump of coal, which is not a very nice thing for the recipient.

If VM&M applies, then the smoke damage can be covered under the VM&M peril, even if it doesn’t get coverage under the “Smoke” peril. (The “smoke” peril excludes fireplace smoke but the VM&M peril does not exclude smoke for any reason. For example: water pipes bursting is specifically excluded. If however, the pipes burst due to a vehicle, a vandal, a riot, a burglar etc, the water damage is routinely covered. If anyone disagrees, please post)

But now I have drifted very close to the reason I think the whole claim would be denied, regardless if the damage was cause by one or more covered perils. I think the answer is under “General Exclusions”. In my opinion the entire claim could be denied under one of the “General Exclusions”.

I enjoy starting these kinds of topics because I end up learning so much myself. One subtopic here is "wind" vs. "windstorm".

Ray Hall says "Any visable wind damage has always been the criteria for windstorm as its too hard to disprove if you can see damage from wind on the building."

I suppose thats always true for most storms but I can think of 3 claims here in California where it wasn't so clear cut. One of mine was a tree that had some rot and fell over in the wind. There was a very localized "windstorm" that never hit the news. I documented it by getting a printout from some weather website, and the fact that other items were also blown over by the same strong wind.

Another claim I heard about was from an agent I've known many years. His insured had the wind blow in his front picture window but again, it was a very localized wind gust. The claim was denied for not being a "windstorm". The insured went to small claims.

Here's a defintion from an insurance company that sounds surprisingly similar to the defintion of "flood":

"Note that the wind must reach sufficient velocity to have caused direct damage at more than one location to establish a "windstorm" loss. However, leakage through an aging roof during heavy rain is not a basis for a windstorm claim. The windstorm peril does not cover loss to the following property when located outside of the insured building: awnings, signs, radio or television antennas or aerials including wiring, masts or towers; canoes and rowboats; lawns, plants, shrubs or trees. Back to More Information "

Here's an interesting Wyoming case where it apprears the appeals court ruled against the insurance company for denying a wind claim for not being strong enough to be a "windstorm".

http://wyomcases.courts.state.wy.us...iteID=1629

cited by the court:

In the case of a policy against damage by tornado, hurricane, or windstorm, the words 'tornado' and 'hurricane' are synonymous and mean a violent storm distinguished by the vehemence of the wind and its sudden changes. The word 'windstorm' partially takes its meaning from 'tornado' and 'hurricane,' and indicates wind of unusual violence. A 'windstorm' need not have either the cyclonic or the whirling features which usually accompany tornadoes or cyclones, but it must assume the aspect of a storm, that is, an outburst of tumultuous force."

noted but disregarded by the court:

"an ordinary gust of wind, no matter how prolonged, is not a windstorm."

The courts conclusion re windstorm:

We think the correct standard and applicable to the instant situation is stated in Gerhard v. Travelers Fire Ins. Co., 246 Wis. 625, 18 N.W.2d 336, as follows:

"In the absence of definition or limitation in the policy, we think that a windstorm must be taken to be a wind of sufficient violence to be capable of damaging the insured property either by its own unaided action or by projecting some object against it. This is especially true where, as here, the more violent forms of windstorm are specifically named as something different from a mere windstorm. Any other view would work an imposition upon the insured. If defendant wishes to adopt some scale which establishes the velocity of wind necessary for a windstorm, or if it desires to limit its liability beyond the point that we have indicated, it should incorporate its proposed standard in the policy by clear terms and such ambiguities as are left in this policy should be resolved against it."

¶7 Considering the purpose of the coverage and the field of the risk, it would seem that any wind that is of such extraordinary force and violence as to thereby injuriously disturb the ordinary condition of the things insured is tumultuous in character, and is to be deemed a windstorm within the purview of the policy, in absence of a provision therein to the contrary.

¶8 An example of judging the quality of the wind by its effect is to be found in Atlas Assur. Co., Ltd., v. Lies, 70 Ga. App. 162, 27 S.E.2d 791, where the court approved an instruction of the trial court wherein it is declared "if you find that the wind blew hard enough to blow a tree down, then that would be the same as a windstorm, if the wind was that hard." We do not hold that the blowing down of the plum tree above referred to establishes the fact of a windstorm as a matter of law, but we do hold that fact to be competent evidence touching the force and violence of the wind and that same together with other matters herein recited were sufficient to sustain the finding of the jury that a windstorm was the proximate cause of the falling of the roof.

------

So it really isn't that clear cut that wind always equals windstorm but this Wyoming court seemed to think so.

Anybody else have experience on this topic, "wind" vs. "windstorm"??

Dennis Mclure appears to have a problem with Public Adjusters. The way I look at it, if you have a problem with cracked floor tiles claims, then have the company exclude them or limit them. However, until then, pay the claim and quit your japping!

There would be no need for Public Adjusters if Independant Adjusters, COmpany Adjusters, and Examiners would all do thier jobs correctly. I have been doing clean-up duty for many cat-adjusters since Hurricane Wilma hit in Florida Especially from Texas Adjusters.

Besides, the business is big enough for all of us. We all have to work together so...in the elegant and subtle words of Rodney King, "Can't we all just get along?"

Can't answer the question. I have yet to handle a DP1 claim and until I do, don't care to look at the policy.


MERRY CHRISTMAS to all!!!

I think Mr Santos missed the entire point of Dennis' remark about the cracked tile flooring (a topic of discussion either here or on Claimspages).  If it's the one I'm thinking about, it had to do with cracked & missing tiles in a rental under a DP.  There was no consistency in the areas of cracking, and the landlord wanted to attribute it to vandalism when it was obviously hard use or neglect on the part of the tenant(s) over a period of months/years. Mr Santos' suggests that the insured in question was cheated, without even knowing what the facts of the loss are or what the policy language is.  

DP's are the most basic of any HO coverage, and if you haven't seen or heard of them prior to handling any claims...one wonders.  This whole thread was, I believe, intended as a fun little exercise by Leland...but once again a PA has taken undue offense and  then also showed why some statements are made toward the PA field.  Please don't tell us how bad someone did their job, and then admit that you've never even seen a particular coverage form, nor care to see it.     

Merry Xmas to all, and to all a good night!      

 

Let’s get this forum back on track.

Sure my scenario was a bit light-hearted but it’s not that different from a daily claim any of us could be assigned.

Just to make clear I didn’t write up the post with a pre-conceived answer already thought out. I’m thinking this one through myself, and learning as I go.

I think these are the relevant issues:

Causation & Coverage

As this is a named peril policy, we need to determine if the loss is covered under one or more of the named perils including: (partial list)

1) Fire or lightning
2) Windstorm or Hail
3) Aircraft
4) Vehicles
5) Smoke
6) Vandalism or Malicious Mischief

Just reviewing this list I realize I made an error in not considering the possibility of “aircraft” as a peril.

We have established that the sleigh can be considered a vehicle, but it could also be considered an aircraft. Certainly there do exist a very few amphibious cars which are both vehicles and boats. Santa’s sleigh could be considered both an “aircraft” and a “vehicle”, at least under this fact scenario. It might not make much difference in this particular case but damage to fences is not covered under the “vehicle” peril but would be under the “aircraft” peril.

Another peril I failed to consider is “fire or lightning”. The dwelling suffered smoke damage but there was an actual fire in the fire place. Obviously the “smoke” peril covers smoke damage even when there is no flame but could smoke damage also be covered under the “fire” peril? If so it would avoid the “smoke” exclusion “this peril does not include loss caused by smoke form fireplaces…”

The “vandalism or malicious mischief” peril definitely is a possibility for coverage.

The issue I was thinking might trigger a denial for the whole claim is this:

General Exclusions

Intentional Loss, meaning any loss arising out of any act committed:

a) by or at the direction of you or any person or organization named as an additional insured; and
b) with the intent to cause a loss.

I realize now I didn’t read that real carefully- I missed the “AND” between “a” and “b”. Clause “a” is true but “b” is not, so this exclusion does not apply.

As I said I’m thinking this one through as I go.

So here’s my tentative conclusions:

The roof damage falls under the peril of “vehicle” and/or “aircraft”. I am considering the reindeer to be part of the “aircraft” or “vehicle”.

I would probably submit the damage to the antenna as a question to the company- can this be paid under “windstorm” or not?


The smoke damage might be covered under “Fire” or VM&M, but not under the peril of “smoke” due to the fireplace exclusion. I am going to think about three questions: 1) Does the peril of “fire” also cover smoke damage in this hypothetical? 2) Does Santa Claus, entering the chimney as an “invitee”/hired vendor constitute VM&M? 3) Can all of the damages (antenna, smoke, roof) be paid under VM&M?

I would love to see responses from adjusters that have had similar issues such as these on previous claims.

Another mistake on my part I just noticed- if the sleigh is an "aircraft" it doesn't matter if there was a "windstorm"- the antenna damage is covered. Also I forgot that antennas are excluded anyway under "windstorm", so the "windstorm question is moot.

Another question relating very closely to which peril(s) applies- would you apply more than one deductible to this claim??

Xmas is now over, so there are no gifts for the insured any longer.  The only coverage that exists is for "vehicle" damage to the antenna, if we disregard the possibility of wind as the proximate cause.  And, this is assuming that the antenna was struck by the sleigh, and not the reindeer.

Smoke from a fireplace is specifically excluded, and the intervening cause of Santa's rotundness plugging the chimney doesn't matter because it does not fit any named peril.  The scenario doesn't state "fire" damage, just smoke from the friendly fire after the intervening event.

Shingle damage from reindeer hooves...no coverage, again not a named peril.  They are not a vehicle in and/of themselves.  Think of them as having been there without a sleigh.

The intentional act exclusion has no bearing.  The only intent was for Santa to arrive, not to cause damage.  The exclusion is pointed at "intended loss". 

The DP1 edit 01/88 I'm looking at doesn't even mention the word deductible, so you have to look at accompanying forms to reach a conclusion on whether concurrent events require separate deductibles.

V&MM is an additional coverage on this same edition only by endorsement and payment of additional payment as shown on the declarations.  But with Santa being a "jolly ol' soul", V&MM can also be ruled out.  His status as an invitee would only come into play had he fallen down and broken his crown (oops, wrong fairy tale) and filed a liability claim against the insured.  But, alas, the DP1 does not offer any liabilty or med pay coverage in its singular form.

Next year, leave a key under the mat for Santa.

Mike Kunze has made some good points and raised some additional issues.

I’m not sure, however, about this line:

“The only coverage that exists is for "vehicle" damage to the antenna, if we disregard the possibility of wind as the proximate cause”

Two points: First, I don’t think we have to “disregard the possibility of wind as the proximate cause” to allow coverage for vehicle damage.
The policy wording is: “….We insure for direct physical loss to the property caused by:…Vehicles…”

In my opinion the direct damage caused by the vehicle should be covered regardless of what caused the vehicle to impact the antenna. In other words: if Santa drove his Sleigh into the antenna on purpose or if somebody dropped the sleigh from a construction crane it wouldn’t make any difference.

(from a lawyer website):
Principles of Insurance : Proximate Cause
The efficient cause which brings about a loss with no other intervening cause which breaks the chain of events.
Example:
Firemen remove undamaged stock from a burning building to avoid its involvement in the fire. It is stacked in the open yard and subsequently damaged by rain. Was the proximate cause of the damage the fire or the rain ?
If the rain damage occurred before the Insured had an opportunity to protect it then the proximate cause of the damage would be the fire and fire is covered under a fire policy. However, if the stock was left unprotected for an unreasonably long period, the rain would be a new and independent cause of damage and damage caused by rain may not be covered under a policy.

My comment on the article above-. Identifying fire as the proximate cause is only important in the example above when 1) rain is not also a covered peril AND 2) there is a delay which can be considered “an intervening cause which breaks the chain of events”. If rain is a covered peril all by itself then it wouldn’t matter whether fire was the proximate cause or not.

So in our Santa example it doesn’t matter whether wind is the proximate cause or even if wind is a covered peril because “vehicle” is also a covered peril.

My second issue is that “aircraft” is also a named peril.

Anyway, thanks for mentioning “proximate cause” because I had to look it up and think about it, which is why I posted this scenario in the first place, as a learning exercise.


I think I have to agree with the next comment, the smoke is not covered:

Smoke from a fireplace is specifically excluded, and the intervening cause of Santa's rotundness plugging the chimney doesn't matter because it does not fit any named peril. The scenario doesn't state "fire" damage, just smoke from the friendly fire after the intervening event.

I also appreciate the use of the term “intervening cause” which was also part of the “proximate cause” definition. Certainly this is an example where “Fire” is not the proximate cause, because of the “intervening cause” which, as Mr. Kunze says, is not a named peril.

I’m not so sure about excluding the reindeer damage by deciding it’s not from the “vehicle” or the “aircraft” peril. The reindeer are attached to the sleigh and it doesn’t fly without them. I would be careful denying this straight out. I would want to ask the company if they wanted to allow coverage or not. That way I’m not sticking my neck out. Also I mentioned it was only a few shingles which migh affect the carrier’s decision on how strictly they should interpret the policy. I’d let them make the call.

"The intentional act exclusion has no bearing. The only intent was for Santa to arrive, not to cause damage. The exclusion is pointed at "intended loss".
V&MM is an additional coverage on this same edition only by endorsement and payment of additional payment as shown on the declarations. But with Santa being a "jolly ol' soul", V&MM can also be ruled out. His status as an invitee would only come into play had he fallen down and broken his crown (oops, wrong fairy tale) and filed a liability claim against the insured. But, alas, the DP1 does not offer any liabilty or med pay coverage in its singular form."

I agree with Mr. Kunze’s analysis about intentional acts. The reason I used the word invitee is I was thinking about “invitees” such as delivery people who are coming onto the insured’s property at the insured’s request. I can’t imagine a carrier denying a claim when the UPS delivery person accidentally breaks some dwellin property because the UPS person was there at the “ insured’s direction”, but the policy wording could be misunderstood. Mr. Kunze put a much better explanation on it.

I also appreciate Mr. Kunze’s point about liability and med pay. I never adjust those kinds of claims but it’s good to be aware of another area of coverage that is covered by the HO policy but not covered by the DP.

As far as VM&M goes, I still think it might be applicable. I’ve seen it paid on all kinds of claims, and it doesn’t always seem to require malicious intent although maybe it’s being interpreted incorrectly.

I’m going to read up on VM&M and post what I learn.

"Next year, leave a key under the mat for Santa."
What, and forget the milk and cookies?

Wow... just "wow".