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Last Post 10/16/2009 9:08 PM by  Ray Hall
Have fun with this one
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RandyC
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Posts:197


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08/19/2009 8:01 PM
Besides the policy which you should read every time a coverage comes up that you haven't dealt with in a while, you have to read tons of guidance emails from your vendor. All though a cat, other adjusters will field questions and higher ups will answer and share the decisions. Guidance changes daily!

"Know before you go!" is good advice. Read before you go! is also good advice. If most of your claims are HO-3 and you've got one DP-1 you'd better read that policy before you go. Same with a BOP or any other policy. Read the cheat cheats to know what the carrier thinks...then read the policy. If there is any difference, resolve it in your head before you talk to the insured. You must think like your carrier wants you to think. Don't get twisted out of shape when one carrier does something different than another. They all follow policy. Some go beyond policy on this, others on that! You have to be well grounded in policy to make these adjustments in good faith.

Randy Cox
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Medulus
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09/01/2009 10:23 AM
I'm still hoping to get to this one, Ray. It just that this studying for a CPCU exam is getting in the way of my free time. If you can leave it up a bit longer until I can find a few free minutes to sort through this family that defines dysfunction, I (for one) would appreciate it.
Steve Ebner CPCU AIC AMIM

"With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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Ray Hall
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09/01/2009 11:47 AM

Steve this one will be around for a while, things just popped in my head when I was writing it up. I will answer the landscape question first. Yes its covered for fire and the loss is the amount paid last month.

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Ray Hall
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09/29/2009 9:10 AM

I am in trouble on this file, the Texas Department of insurance just called and wants this loss redolved in the next thirty days, seems Mrs Jack contacted them.

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jdacree
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10/10/2009 6:59 AM
Ray, the way I break this down is the total payable as the story currently stands is $164,000.00. This claim has been advised for subrogation against ABC Classic Cars. Some of the claims dollars listed above are for personal property owned by Bumper, payable after investigation. The investigation on bumper is:
A) is he under the age of 21 and in the care of Jezabeel Probable fraud
B) is he covered as an employee of the NI, if so most of his studio loss would be business equip, not covered
C) is he a guest, if so coverage would be at the request of the NI, probable fraud again

Elton has no claim against the carrier, he can not be common law due to no final divorce from Bubba.

We have a witness claiming that sloppy housekeeping by Jezabell contributed to the fire, possible negliance.

Home Supply is outside the scope of the coverage, nothing for the adjuster to contribute on this subject, the property described belonged to Bumper

As soon as Jezabell can get the unit cost on the appliciances, the claim can be suplemented. The property is hers.

The mortgage companies will be named on the settlement check.

The deductible was absorbed due to the dwelling and contents being substantially underinsured

The claim will be re-opened to allow for the inclusion of personal property not yet listed.

Ray are you sure that the adults listed above are not from Arkansas and Louisanna? If so all of the players may be related by blood, which makes them all insureds and changes the claim drasticially. I mean we still have about 40K of Coverage C not spent.
Jim Acree Stupidity is the art of not trying to learn Ignorance is the lack of opportunity to learn I am ignorant
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Ray Hall
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10/10/2009 9:36 AM

This post and his personal reply knocked my socks off. Jim has never worked his first claim yet. We will spend today scoping my house for two large trees from a windstorm damage to "lots of thangs or is it things, or componants, aw scoping the damage which is hard to see unless you think like Jim and I. All you people in EL Paso who neeeds a scoper  ready to go that knows xmate??? and will make you $$$ before sunset.

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GJAdjuster
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10/16/2009 7:48 PM

 

These are the facts as I understand them. If any of these facts change – the outcome of this adjustment will also change.
 
Named insured:            
Jezebel Brown – Living in insured premises, separated from Bubba
           
Bubba Brown – Separated from Jezebel and currently living with Jill in an apartment
 
Other Parties:              
Elton Jack - Living with Jezebel in the insured premises, separated from Jill
                                   
Jill Jack - Living w/ Bubba Brown in Apartment, separated from Elton
 
Bumper Jack - Son of Elton & Jill was staying with Jezebel and Elton in the insured premises for a few days before ski trip.
 
            Jumping Jack – Son of Elton & Jill currently living in the insured premises
 
            First Mortgage Company – Outstanding balance at time of fire $139,000
 
Some Dumb Bank – Outstanding equity balance of $100,000 secured by Bubba unbeknown to Jezebel – also valued the house at $250,000
 
Home Supply Co. – Delivered $2600 worth of building materials on behalf of Elton to insured premises
           
Kitchen Remodel – Rent to Own Washer/Dryer, Oven & Dishwasher by Jezebel $117/month for 24 months – 3 months have been paid ($351 out of $2808 owed)
 
ABC Classic Cars – Replaced fuel pump on Elton’s VW 2 days before fire.   Was determined by C & O expert to be cause of fire.
 
Settlement:
 
Coverage A: $160,000
 
The house was recently appraised at some dumb bank for $250,000 two weeks before the fire – we obtain a copy of this appraisal.
 
            RCV:                           $250,000
            Ded:                             $1,000
            Subtotal                       $249,000
 
Total Payout                             $160,000
*Note – while it is apparent this property was underinsured by 56%, if you estimate that the depreciation on the house was 25% (62,500), you still have the ACV at $187,500, well above the limits of liability. In fact, you could depreciate the house up to 36% and still = the limits of liability.
 
Check #1                                 $139,000 paid out to First Mortgage Company/Jezebel Brown/ Bubba Brown
 
Check # 2                                $21,000 This check is held until it can be determined from the legal department whether Some Dumb Bank has an insurable interest for all or part of the remaining settlement. If there is an insurable interest the check will be made out to Some Dumb Bank/Jezebel Brown/Bubba Brown.
If it has no insurable interest – then this check will be made out to Jezebel Brown/Bubba Brown. 
 
Home Supply Co.            $0 – ($2600 Claimed) - while the materials were delivered to the property for the construction of a studio on the property, it was not authorized, nor paid for by either named insured. The fact that they were not paid by Elton is a problem between Home Supply Co and Elton, not the named insureds.
 
Coverage B: $16,000
 
I do not find anywhere that any other structures where damaged.
 
Coverage C: $80,000           
 
Elton’s Music Equipment:             $0 ($30,000 claimed) - Not covered. Elton is neither a named insured nor a relative. It should be insured by Elton & Jill’s Homeowners policy on the vacant house.
 
Elton’s VW $20,000             Not covered – specifically excluded in item 4 personal property – he should consult his auto coverage
                                               
Jill Jack 56” TV            Not covered - Apparently not destroyed – just needs to be cleaned, Jill is neither a named insured or a relative, but should be insured by Elton/Jill’s HO or by Jill’s Renters Policy.
 
Jumper Computer & Video Cam - Not Covered
 
Elton’s Personal Property -            Not covered.
 
Jumping Jack’s Property            Not covered, as Jumper is not in the care of a named insured or a relative.
 
*Note: A case could be made if the named insured request it, the personal property of
guests on the insured’s premises would be covered. I can’t see Bubba going for this as he
is already going to be out a lot and he doesn’t give a rats behind about Elton or his silly
music Biz.
 
Bubba’s Gun & Safe             $10,000 - Covered – to be split between Dwelling insurance $5000 and Bubba’s renter’s insurance policy $5000 “which is usually at any Insured’s residence, other than the dwelling described in the Declarations” (apartment) Up to 10% of the $60,000 coverage is available. To be paid at ACV.
 
Kitchen Remodel Co.            $2457 claimed – Covered – Owed to Kitchen Remodel Co They have an insurable interest as this was bought by Jezebel. This is ACV.
 
Jezebel & Bubba Personal Property on the premises. This will be paid out at ACV up to
the policy limits upon presentation of itemized lists and or proof of ownership or receipts.
 
 
ALE Coverage: $48,000
 
2 Weeks of Hotel @ 168 a day is $2352. I believe this is for 1 room. If the bill
shows for more than one room, this amount will have to be adjusted accordingly. (Not
my job to police who stays in the hotel room with Jezebel, but don't owe for anywone else)
 
Since Bubba is already living somewhere else and Elton, Jumping and Bumper Jack are
not relatives nor in the care of Jezebel (they are in the care of Elton) they are not
covered.   Owed to date for food $560.
 
For a total of $2912 to date.
 
Going forward Jezebel should find a suitable place that is equivalent of the insured premises
to rent and then permanently relocate. Never the less, the limits of liability on this
coverage is $48,000. or about 16 weeks in the above scenario does not change.
 
Additional Coverage:            Debris Removal – up to $8,000.00 Available will be paid upon presentation of receipts.
                                                Trees & Shrubs  $2500.00 (up to $8000 was available)
Fire Call $500.00 of the $750.00 Invoice (Since this is Chambers County and not within a municipality it would be covered)
           
 
Also – 11 months worth of pro-rated premiums are owed back to Jezebel and Bubba Brown as this is a total loss and the policy will be cancelled upon settlement.
 
This entire claim should be turned over for subrogation to attempt to collect from ABC Classic Cars.
 
That’s it -  Man your battle stations and fire away.
 
gj

 

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Ray Hall
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10/16/2009 9:08 PM

Out standing hard work. I don,t know if I agree or not. I decided to not chirp up until I can lock my self off for 24 hours and want some others to take shots. ome may hit but many will miss, I think.

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