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Last Post 01/05/2008 6:12 PM by  HuskerCat
Christmas time claims handling
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Author Messages
Ray Hall
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Posts:2443


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12/29/2007 2:21 PM

Leland the house I inspected had a DP 1. It also had an cast iron oil fired heating stove connected to the brick chimney with a horizontal metal stove pipe; therefore I argue the smoke damage is covered as the vented smoke is traveling in the intended confine escaped.

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Leland
Advanced Member
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12/29/2007 2:41 PM
Here's what my DP1 (o1/05) says:

"PERILS INSURED AGAINST... 7) Smoke, meaning sudden and accidental damage from smoke. This peril does not include loss caused by smoke from fireplaces...."

Ray-

1) Was it smoke?
2) Was it sudden and accidental?
3) Was it FROM the fireplace?

If the smoke came out FROM the vent pipe FROM the furnace that happened to be connceted to the chimeny that is connected to the fireplace, then the smoke is not FROM THE FIREPLACE. It is FROM THE VENT PIPE or FROM THE FURNACE.

(I don't mean to SHOUT, I can't make the italics work)

So I would agree with you, the smoke in your example should be covered.

Where I see a big problem is if you had a basement furnace catch on fire, sending smoke up the vent and then out through the fireplace into the living room.

You could say the smoke was FROM THE FURNACE and you could also say the SMOKE WAS FROM THE FIREPLACE.

Would a claim like that be covered or denied?



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RandyC
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01/01/2008 1:53 PM
If you use the dictionary definition of "from" you might determine the origin or starting point of the fire was "from" the furnace....then through the fireplace. If the fire was totaly contained, intentional and within the intended area of its useful purpose it would be friendly fire. However once the fire "suddenly" left it's intended place to an unintended place it would be hostile. Then smoke leaving a hostile fire should be covered. If it traveled through the fireplace, I 'd opine that it was covered.

I think this "from fireplace" language intends to exclude slow escaping smoke from a lazy fire of poor combustion and weak draft. That damage would occur slowly over a period of time and properly be a maintenance issue. If the fire grows out of control and the flames lap out of the firebox charring the wood mantel which might allow "hostile' smoke to damage covered property, I'd try to get that covered on the basis of it being hostile. One could say the charring wood mantel is part of the fireplace, but I think it would be outside of the intended fire area and covered the same as when a furnace catches fire where it is not supposed to catch fire.

As usual the adjuster recommends, the carrier decides, the homeowner negotiates, the insurance commish pressures, and a hierarchy of courts review the whole process.
Of all those levels of authority....my opinion is subject to adjustment.

Randy Cox

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Ray Hall
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01/01/2008 6:17 PM

Very well thought out response to friendly & hostile fire.

In Texas which has always had a lot of open gas heaters, that is the type that is connect to the shut off valve coming out of the wall or floor without any type chimney, this was the standard 163 line policy (NY163 line) exclusion.  SPECIFIC COVERAGE CONDITIONS

Conditions Applicable only to Smoke:loss by smoke shall be limited to loss caused by a sudden, unusual and faulty operation of any heating, disposal or cooking unit, only when such unit is connected to a chimney by a smoke pipe, and while in or on the premises described herein, excluding, however, smoke from fireplaces or industral apparatus.

Bath rooms use to have a small heater in the wall..( no smoke pipe) .that would smoke up a whole whole house with low pressure on a very cold day.

*** I will scan the old Texas Standard 163 line Fire and Lightning Policy which is three pages. If you read ever line on ever page you will never have a problem reading any fire insurance form...... ever..Homeowners, BOP, CP etc. Please send me a email and I will attached and send back.

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HuskerCat
Veteran Member
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Posts:762


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01/01/2008 8:57 PM

Just 3 pages, Ray?  Can't find that anymore, can you?...try 15 to 50 plus endorsements.  Irregardless, my mentors always preached "RTFP".  How many of you have heard that before?      

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sbeau4014
Founding Member
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01/02/2008 4:44 PM
As in " Read The Friggin policy" or something similiar to that
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Ray Hall
Senior Member
Senior Member
Posts:2443


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01/02/2008 5:49 PM

Yep I think thats what I have drummed into my head also. Well I guess my offer had no value is I did not charge for the policy; therefore; I will charge $5.00 for it and all who request a copy can put $5.00 in the Salvation Pot the next time they pass a bell ringer.

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HuskerCat
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01/02/2008 8:15 PM

Sounds like the same school!!

Ray, can you really scan that old 3 page policy?  Last I checked, stone tablets don't feed thru a scanner all that well.  Justifies the extra 5 bucks, I suppose, for wear & tear.

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Wesley
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Posts:1


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01/03/2008 3:58 PM

In addition to the previous comments there is definately subrogation potential in this claim due to the fact that there was a paid contract between the insured and Mr Clause I would be sure to send all known information about the contractor (Mr Clause) so that the insurance company can persue legal actions against the contractor to rcoup moneys owed.

Wes

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Ray Hall
Senior Member
Senior Member
Posts:2443


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01/04/2008 3:04 PM

The subrogation was not covered by the first adjuster, but when the 2nd adjuster inspected for the cause and origin he noticed a contract on white paper with red and green ink and ask the insured if he could read it. When reading the HOLD HARMLESS & INDEMNITY AGREEMENT the adjuster read about some risk of damage to property or person in the method of delivery in foul weather conditions signed by Mr. Insured and Mr. Clause on Thanksgiven day. The adjuster suggested subrogation not be pursued as the insurer would have to defend Mr. Clause under the HH&IA any only the lawyers would come out on top.

It seems the inside adjuster not up to speed on  HH&IA and sent it to outside council for an opinion, which confirmed what the second adjuster had recommended and the opine cost $2,000. The claims manager was upset and chewed the inside adjuster out who was PO'd at the 2nd adjuster and cut the firm off from further assignments.  This resulted in the IA chasing off the old 2nd adjuster who was let go at christmas time and no storms to go on on a very slow time for old IA who spend idle hours on the internet. Happy new year all and going to be good for me , don,t fret.

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RandyC
Member
Member
Posts:197


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01/05/2008 11:02 AM
Okay, the holidays are over, time to get serious! The world changed forever on 9-11. Did anyone check this guys identification? Did he have a green card? Eye witness descriptions say he was a big man. Was that really all man under that large red suit or something more sinister? Was it really a little round belly that shook like a bowl full of jelly...or something more plasitic. Did he file a proper flight plan. If not, how did he get in under the radar; what kind of technology are we dealing with here? Without disclosing classified information, can anyone tell me the difference between waterboarding and snowboarding?

Happy New Year to all, especially those guys in the red suits that will be unemployed until next year and other individuals known to hop from roof to roof in the course of their employment.

RandyC
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Ray Hall
Senior Member
Senior Member
Posts:2443


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01/05/2008 3:49 PM

When some of the large metro cities have some roof claims this spring I think Homeland Security should be required to keep track of all the adjuster reports of bullet holes and slugs found during the roof inspection to determine if the crack down on the border security is working effectivly.

The vendors should also require the adjuster to do a complete investigation for subrogation purposes. Fines will be imposed on both for non compliance. Each vendor must have a certified mold police chief to report the non compliance violations . The bullet hole certification can only be offered by the Texas or other states reputable license schools who can meet the filing dateline of January 31, 2008 by sending a notorized letter of application to National Zhar of three day wonder schools in Costa Rica. This certification will be required to work any roof claims between February 1, 2008 and November 30, 2008; however, it will expire on January 1, 2010 and require recertification.

This certification will assure you of work this spring as many of the old crusty adjusters, who think "certifications" from the three day wonder schools are worthless will be sitting at home while you are out working.

*** Side note the fees for the certification should be very competive and I advise you to shop around for the correct credentials and be wary of mail order or online presentations as you will be acting as a quasia federal agent.

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HuskerCat
Veteran Member
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Posts:762


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01/05/2008 6:12 PM

Great idea, Ray!  Pretty soon, you can run a banner promoting all of the services you have suggested and/or offered.  Maybe it could be called "Hallmark", or something similar.  Select members of CADO could buy stock in your company, and sit back reaping in the cashflow that comes from the 3-day wonders.  I will offer my services to help tutor from my barcalounger, and also help issue the certificates to those that pay the class fees.  We will build a list of those that paid, and put them on permanent standby status.  As additional ideas come up, they can enroll in those classes too.  To avoid discrimation, new students would also be accepted for a modest late enrollment fee and completion/payment of prior sessions offered.   It may be necessary, though, to rename the the mold police certification to mold enforcement regulator to avoid any legal problems such as impersonating an officer. 

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