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Jim Flynt
Posted on Friday, December 24, 1999 - 6:23 pm:   

Merry Christmas to all and May there be Peace on Earth, and let it begin with me.

To each and all of the readers, writers, and sponsors, as well as Roy Cupps, without whom none of us would have a place to air our differences and learn, May the New Year 2000 be one of Great Joy, Happiness, Health and Prosperity.

Have a Safe and Happy Holiday All!
Posted on Friday, December 24, 1999 - 5:23 pm:   

Daddy said"There is book sense and a thing called common sense.These two things own their own lead up to being somewhat dumb about life itself.When you have both its called "Horse Sense". People, please wake up!
Posted on Friday, December 24, 1999 - 3:17 pm:   

Glenn, R.D. and Steve,
I agree with what you all have said. Jim I am sorry for letting this go on so long. I guess things like this are why diffrent carriers handle the same loss diffrently. Sometimes I get so involved with showing how much I think I know and at some point I quit listening.

MERRY Christmas
Glen Garoutte
Posted on Friday, December 24, 1999 - 2:13 pm:   

To each that have given their advice on the subject I commend to the highest. One question I ask to you Jim and c.d.b. is why do you have to get into a verbal B.S. battle when it does no one any justice. These kind of spats are exactly what turns me off at times. If you kids need to have spats then battle through each others e-mail. Merry Christmas
R.D. Hood
Posted on Friday, December 24, 1999 - 1:32 pm:   



Lets table this for a bit, shall we?
Steve Ebner
Posted on Friday, December 24, 1999 - 12:45 pm:   

I'm finding your responses troubling, c.d.b. I only wish I had Jim Flynt's experience. As Dave Hood has already stated, decisions to pay for losses excluded or seemingly excluded by the policy are the provence of the carrier and the decision to pay such a loss is usually made far above the level of a line adjuster. We as catadjusters are in a position where we are telling other people (the carriers and ultimately the insureds who pay their premiums) how to spend their money and how much of their money to spend. I never feel it is my place to pay this money in ways the carrier does not intend.
Intentionally damaging one's property in order to collect from an insurance company, although difficult to prove, can lead to a felony conviction. At least one of the insureds I dealt with while working as part of an Auto Theft Unit during most of 1994-1995 would agree with this if we were to go to prison and interview him (based on our tip, the police caught him putting his car back together with the very parts that had been stripped from it). Intentional acts may be covered by a carrier for reasons other than that the policy allows it, but usually for reasons that include avoidance of litigation. As far as I'm concerned, the carrier should be presented with all the facts available and allowed to make the final decision. That may mean we make less from a file we deny that we might from the same file if it were a paid and closed claim, but so be it. We have to be honest above all. It is indeed an ethical issue and an issue of integrity. And the carriers and vendors have to be able to trust our findings concerning the cause of loss and whether the policy provides coverage.
Posted on Friday, December 24, 1999 - 11:42 am:   

It is more than clear that you are a text book adjuster. This would show inexperiance in claims handling. I am sure that you area a great CAT adjuster and would perform fine when all the losses are the same cause of loss. I would suggest to you that in the every day buisness it is a different world. The policy is not BLACK AND WHITE it is very grey. You may start reading the policy more than just finding a part and copying it to your post. The policy givith and the policy taketh away. I suggest you visit the real world stud fry!!!!!!!!!!!!!!!!! If you are going to give advise please please give correct advise.............................
merry x-mas to all
Jim Flynt
Posted on Friday, December 24, 1999 - 10:58 am:   

For any reader of reason and reasonable prudence, I commend to you the following language excerpt directly from the HO-3 Policy form (other policies follow the same or similar language):


1. We do not insure for loss caused directly or indirectly by any of the following. Such loss is EXCLUDED (emphasis mine) REGARDLESS of ANY OTHER CAUSE OR EVENT contributing concurrently or in any sequence to the loss:

"h." INTENTIONAL LOSS (emphasis theirs), meaning any loss arising out of any act committed:

(1) By or at the direction of an "insured"; and

(2) With the intent to cause a loss."

The policy speaks for itself as does a review of the general statutes and case law from around the United States.

I will let the volumes previously written by more learned scholars in insurance speak in support of the position that I have outlined as they do.

I invite the gentleman to read further and study the errors contained within his post so as not to continue to espouse his ignorance for all the world to see.
R.D. Hood
Posted on Friday, December 24, 1999 - 10:56 am:   


Fellow adjusters,

The differences of opinion are to be sorted out by the Carrier. We can only make recommendations. Every policy and examiner and "higher-up" will make the final call.
IMHO, a claim resuting in a loss in which arson is the suspected "cause of loss", is a covered peril. However, to prove this action, is the MOST difficult for the carrier. Thats why we always call in the C&O people and get their opinions before making a recomendation to the carrier.
My thoughts run to a difference , in hearing what is said , or intended to be said, on this board.

As in adjusting all claims, sans ALL OF THE INFORMATION, we cannot pose an exact and truthful opinion. Perhaps we should pose a senario, like is done at the PLRB annuals, and present a claim, with all of the known facts, and then let the participants examine the issues and make their respective recommendations.

Lets think about it after the Holidays, EH?

In the interium, relax, enjoy and keep the peace on earth, we are here only too short a time.
Posted on Friday, December 24, 1999 - 10:16 am:   

Jim Flynt,
I Think maybee you should do a little more research or even call P.L.R.B. Arson is indeed covered no matter who caused the loss. Morals have nothing to do with it. Are you trying to tell me that because insurance fraud is involved now we have no coverage. Then I will tell you to go back to all the classes you took and brush up.
Jim Flynt AIC, CIC, AAI, AIS
Posted on Friday, December 24, 1999 - 7:42 am:   

The following excerpt from the CPCU 2 ("Personal Insurance: Property and Liability Guide") is posted in response to the post by c.d.b regarding "intentional acts of an Insured:"

"The homeowners policies EXCLUDE COVERAGE for loss arising out of an act committed by or at the direction of ANY INSURED (emphasis mine) with the intention of causing loss. This attempts to elimnate coverage for any insured - meaning the named insured AND HIS OR HER SPOUSE, resident relative, and resident dependent under the age of 21 - EVEN IF NOT INVOLVED in committing the act out of which the loss arises. For example, if a husband burns down a covered dwelling, the wife, even if not involved in the husband's act of arson, may not receive payment for the loss from the insurer. Jurisdictions vary on the enforcement
of this provision against an innocent party. Some jurisdictions do allow recovery by the innocent party. Often recovery is LIMITED to the inncoent party's PROPORTION OF INSURABLE INTEREST in the property."

Mortgage holders and lenders are in a different insurable interest position, and their insurable interest is generally not compromised by the intentional acts of an Insured.

I absolutely and totally disagree with the statement made by c.d.b., and believe it to be in grave error. The language of insurance policies, the very nature of the insurance concept of insuring accidental losses, and the moral requistes of a civilized society are in juxtaposition to such statements and beliefs. Intentional acts of Insureds to cause damage and collect insurance benefits are also known by another name: INSURANCE FRAUD, which as we all know is considered a criminal felony, whether committed by an Insured, an adjuster, or any other party causing intentional acts to profit unlawfully from an insurance company.

In my humble but enlightened opinion, intentional acts of an Insured are ALWAYS EXCLUDED.
Posted on Thursday, December 23, 1999 - 9:36 pm:   

Steve Ebner,
I appreciate the words you selected in your statement, BUT is it not true that intentional acts our indeed covered under most policies. Lets say that my wife and I have a home and for some reason I decide without my wifes knowledge set the house on fire. Or if I wanted to prove a point to my adjuster that no-claimed my roof, and I got up on my roof and destroyed the roof by foot traffic. All these acts are covered by a homeowners policy. The insurance company has the right to subrogate or even press charges against me, but the fact remains they still have to pay the claim. In alot of cases there are multiple interest in homes, such as Mortgage companies, spouse or even co-borrowers. I guess what I am trying to say is simply INTENTIONAL ACTS OUR COVERED..................!!!!!!!!!!!!!!!!!

Steve Ebner
Posted on Thursday, December 23, 1999 - 7:34 pm:   

Snow and Ice Update:

Eight inches of snow has fallen here in Erie, PA in the last two and a half hours and no let up is in sight. That doesn't mean much by itself. We get this amount of snow often. If a freeze event occurs after two feet or so it becomes a completely different matter, however.
Steve Ebner
Posted on Thursday, December 23, 1999 - 1:50 pm:   

OK, Jim, I'll take up your challenge (though I would do better to shut up and listen and learn in this company). "Acts of God" as an insurance term is not really terribly inclusive in theological terms. Theologians and regular people are just as likely to view miracles, healing from a disease, the birth of a child, or even the sprouting of a blade of grass as an act of God. As catadjusters we are usually dealing with "Acts of God" as our cause of loss. In fact, "Acts of God" really only comes into play in most insurance policies in the liability section of the policy. If the insured's healthy tree falls on the neighbor's roof, it is an "Act of God" and therefore no liability is imputed to the insured so the neighbor and his/her carrier are responsible for the tree removal and resultant damage.

Whether or not a cause of loss is an "Act of God" rarely is a consideration. Whether it is an "Act by People(rejecting the use of the generic man for women might be just as responsible)" is more of a concern. Most of the roof damage I saw last year in Detroit was a result of careless snow removal companies who charge $500 to $800 a pop to remove ice from the roof and in the process tear up a number of edge shingles. Technically this is a separate liability claim, but some carriers chose (the carrier I worked most for on that storm chose this proceedure) to pay a minimum roof repair charge for such damage and attempt subrogation against the snow removal company. There was almost no damage to the roofs done by insureds who removed the snow and ice themselves. Only the "professionals" seemed to be unable to remove ice without tearing up shingles.
A second concern surrounding "Acts by People" is whether or not the act was intentional. Anyone who has seen "ballpeen hail" or roof shingles torn off "to determine if it is wet underneath" will understand why intentional acts are not covered. Of course, there are exceptions. A riot or theft is an intentional act, but usually not intentional on the part of the insured.
Geez, Dave. Your question was so short and the answer is so long. I'm not even done yet. Just finished for now. That will teach you to toss me the ball, Jim.
Jim Flynt
Posted on Thursday, December 23, 1999 - 12:42 pm:   

To clarify for those who may be confused: there is coverage for damages under an HO-3 and a DP-3 policy for "ice dam" damages for Coverage A and Coverage B items WITHOUT AN OPENING to the outside.

Coverage C (contents) which is "named perils" coverage, does not cover damages to "contents" from "ice dams" unless there is an endorsement which extends "all risks" coverage to Coverage C.

Endorsements are used by insurance companies to expand or restrict policy coverage and to increase or reduce policy premiums for values at risk.

Coverage for additional perils can be added by endorsement to a "named perils" policy or likewise, perils insured against can be "lasered" out by endorsement, to reduce the policy premium and coverage.
Jim Flynt
Posted on Thursday, December 23, 1999 - 12:12 pm:   

QUESTION: If there is no coverage for "contents" (Coverage C) for "ice dams" under "named perils" coverage for Coverage C, why would there be any coverage for Coverage A damages under an HO-6, where the perils coverage for Coverage A is the same as coverage under an HO-2 (Broad Form - which is "named perils")?

Think about it.
Jim Flynt
Posted on Thursday, December 23, 1999 - 11:14 am:   

International Order Of Honororius Omnious

PS to Steve Ebner: If you answer the question "properly," perhaps I can convince RUSS LOTT to honor you by bestowing membership in his international insurance fraternity, the IOOHO (International Order of Honororius Omnious) (it rhymes with his home state of Iowa) (I never did do well in Latin in school, so don't ask me what it means). He inducted Roy Cupps as a member while in Greenville during Hurricane Floyd (Roy had to promise Russ a page for the Insurance 'HO's on the CADO Member's Page) and I am sure he inducted Dave Hood last winter in Montreal as well as Marty Paradis, Carlton Steubing, Bob Curren, John Ronk, Pardeep Sidhu, and Curtis Overby; all of whom are also well known as Insurance 'HO's.

Russ has been an Insurance 'HO for a long time and I was inducted not long after meeting him myself. I take pride in calling myself an Insurance 'HO as well, as I am sure you will too!
R.D. Hood
Posted on Thursday, December 23, 1999 - 11:10 am:   

I sure do wish y'all a very Merry Christmas, and if you want to keep the folks at home happy,
Jim Flynt
Posted on Thursday, December 23, 1999 - 10:42 am:   

Professor Ebner, Adjuster Extraordinaire, where are you?

Dave, I am beginning to think that you and Russ Lott have developed a "conspiracy" to ask me questions in order to prevent me from contributing my small part to the Gross National Product by completing my Christmas shopping.

Knowing you as well as Russ, I know that both of you generally ask questions where you already know the answer, and this time you are asking a rhetorical question for the enlightenment of our Newbees.

Therefore, I am going to ask that Steve Ebner respond to your question, for two reasons:

Steve is a most knowledgeable and well spoken adjuster who has my highest respect.

And secondly, as a former "man of the cloth" he has better "connections" than Russ and I with our Creator to address issues involving "Acts of God."

Steve, PLEASE help me on this one or there are going to be a few members of my family and a girlfriend who are never going to forgive my gift giving oversight. Steve, this is my GIFT to you.
Posted on Thursday, December 23, 1999 - 10:27 am:   

R.D. Hood,
I know you asked Jim this question, But I would like two put my two cents in.
The opening has to be a storm opening and there has to be actual damage.
Is it a grey area YES it is.
You refered to melted ice seeping up thru the shingles. That would be called Ice Damming. In most situations on an HO-6 the unit will have another unit on top of it. If not The grey area is there. As you well know we can make it look how we want. But the fact remains you have to have an opening to gain covrage. The Ice damming does not give you the coverage. Another thing people make a mistake on is HO-3 wind driven rain. On wind driven rain you have no contents coverage unless you have a storm opening. It is a similar situation. GOOD Luck
R.D. Hood
Posted on Thursday, December 23, 1999 - 10:15 am:   

Question for you. On an HO-6 , with an Ice dam claim,the coverage is in force and effect, with no obvious opening created,(unless the Ice and snow are removed to properly investigate the issue), and with the requirement of an "opening" as you stated, is there not an opening that is created when the melted ice, (water) is forced up and under the shingles and felt (if present) and enters the structure? Or, is it the accepted opinion that the opening must be made by man? If not, nature created the opening and it is therefore an "Act of God? I often have to ask myself, who writes some of this stuff, where the BIG words giveth and the small words taketh away?
Common sense sometimes gets buried by the verbage and local inturpertation, IMHO.
Posted on Thursday, December 23, 1999 - 9:54 am:   

I would loke to comment on when to and when not to get on a roof. From the experiance I have with both Independent Adjusting firms and Insurance companies.
Fellas I dont know one I.A. or insurance company that would ever want to put you in danger. You can contact any roofing manurfacturer and they will provide you with a guide to measure the roof from the ground. Athough I dont condone measuring a roof from the ground, in some situations you have no choice. If you ever have a question of saftey dont climb. As long as you dont make a bad habbit out of not climbing the roof it wont be a problem. There is a big diffrence between saftey and being lazy.
One more suggestion would be contact a local roofing company to assist you. I like Jim's answer with the rope and harnes which is the correct way to tackle the sittuation. Unfortantley we dont all have access to a rope in harness team.
I have seen alot of adjuster's climb roofs to prove a point. One of the biggest things you see is adjuster's rushing on there losses to get to the next loss. We all know that quanity is how we make our money unless we are on per-diem. All I can say is hump it. but be carefull. The faster you go the less you think.
Jim Flynt
Posted on Thursday, December 23, 1999 - 8:02 am:   

c.d.b. is correct that coverage under the HO-6 is for the same perils as the HO-2 (Broad) form policy so there is no coverage for ice dams or interior damages from rain (or wind) without an "opening." I agree with the "concept" of using the inside air/outside air adage as a "rule of thumb," but there is no escaping the need for examining the Condo Association By-Laws which, in the abscence of state law to the contrary, will generally dictate responsibility for each carrier's (Condo Master Policy or Homeowners Policy) apportioned coverage for items such as paint, "coverings", drywall, appliances, and fixtures.

I did not address the issue of "ice dam" coverage under the HO-6 as there are numerous damage events which could occur during a winter storm which would of course be covered. Ice dams damage would be excluded without an opening.
Posted on Thursday, December 23, 1999 - 12:52 am:   

Just remember on a HO-6 you have to have a storm opening for wind or rain. If you do not have the opening there is no coverage afforded. Jim sometimes the rule of thumb on condos is if the inside air touches it, it is the condo owner. If the outside air touches it it is the associations.
Russ Lott
Posted on Wednesday, December 22, 1999 - 7:42 pm:   

David, my question to Jim was rather simplistic but the discussion from the "Pros" is one to well heed. White ice and snow are the perils you can see, black ice will break your neck. When you least expect to get hurt you will. Dave Hood hit the nail on the head , use common sense. Every body will sit around the motel rooms and "Gosh he was a good adjuster". You are an island on any storm. You have your tools and your wits use them both. Good luck. I have survived as Mr. Hood so well spoke by not taking chances. No single fee bill is worth a lifetime of injury and hurt. If it does not feel good don't do it. As the old addage goes , "Work smarter not harder".
Posted on Wednesday, December 22, 1999 - 4:15 pm:   

This is an excellent place for coverage questions to be posted and opinions given. My hat is off to the participants.
Don Elkinton
Posted on Wednesday, December 22, 1999 - 11:43 am:   

Good stuff fellas. I concur with all that has been stated concerning roof safety and Ice Dams 101. One step further concerning HO 6 (condos). During my most recent adventure along the beaches of the Carolinas, once again I discovered somthing new.. Even though the Master Deed (Condo doc's) required the Unit Owner to make repairs to wallcoverings and floor coverings. Many of the the HOA carriers (primary) provided coverage for these items. So, once again I have been enlighted to pursue "all avenues" before filing my claim. To the Condo Guru (Sanford Plumlee), I'm finally starting to get it!! You know if you try hard enough you'll learn something every storm. In my case, I don't have to put forth much effort before I learn.

Appreciate this discussion. Let's have many more!!!
R.D. Hood
Posted on Wednesday, December 22, 1999 - 10:03 am:   

The prior posts, related to the "Winter Ice Storms" cannot be more on the bullseye, so to speak. In 1996, the North East was affected by a severe storm, and many of us were here to work these files. I personally had 550 in my area, and climbed ONE (1) ROOF THAT WAS SUSPECT, to have had damages, and only on a clear dry day.

Tom,Steve,Jim, Russ and I are still here because we use common sense and DO NOT CLIMB a roof that we are not 100% certain that we are safe. We all tie off the ladder at the top and sometimes the base, and use a rope and harness when necessary.
The "ice dam claims" are great to work, and the incident of having to climb a roof is minimal, unless of course, the Insured or someone has taken the option of removing the ice with a fire ax, pick ax, hammer, ice scraper, etc. as was the case in Canada. These roofs had to be inspected, and I only did two (2) there, but I will venture a guess that several thousand were replaced , in the spring, due to the damages inflicted by the removal. (reinspections by others)

On occasion, this removal is necessary and recommended, especially when the weight of the ice can possibly lead to the collapse of the structure and the incurrance of additional damages. The insured has an obligation to "mitigate the damages" in a resonable manner. This would be the reason for the ice removal. (Some 12 inches of ice on a roof, especially a flat one, can weight several hundred pounds per square foot.

Measuring the deflection of the deck from the interior, using a string line and line level, on a flat roof will give you an idea of the amount of weight that is on the roof. You may need an engineer to determine this. Again an adjuster call to have the ice removed, (and possibly the carrier will cover this action).

As proviously stated, you must know the policy, consult with the carriers examiner, as to coverage, and above all, DO NOT CLIMB ANY ROOF THAT ANY REASONABLE PERSON WOULD DEEEM DANGEROUS.
Steve Ebner
Posted on Wednesday, December 22, 1999 - 1:54 am:   

As usual our resident Socrates, Plato, and Aristotle (Mr. Flynt, Mr. Hood, and Mr. Lott) have pretty thoroughly covered the subject. I wish I could think of something wise enough to add to this discussion except to say Amen to Mr. Weems and urge us all to "Always, always, respect the roof." I gave the same advice to an insured or two in Detroit last winter as they contemplated climbing up and shoveling off their roof. Apparently the Emergency rooms in the Detroit area were filled at the beginning of last year with people who decided to shovel off the roof.
Jim Flynt
Posted on Tuesday, December 21, 1999 - 11:25 pm:   

Obviously in the previous post, when I suggested that the adjuster look at the cause of loss, what I was suggesting is to make sure that the cause of loss and any resulting damges (including loss of rents and/or ALE) were from a peril insured against. I wanted to post this to clarify that an adjuster should always make sure damages are from a covered peril.


If you ever have a question where you do not know the answer for coverage, make a phone call and ask the insurance carrier examiner. That is what they are there for.
Jim Flynt
Posted on Tuesday, December 21, 1999 - 11:15 pm:   

OK, Russ before I try to answer your question, I must point out that it is a tricky one in certain respects. You have not pointed out specifically which policy form you are inquiring about, and knowing you personally as well as I do, I rather suspect that the reason behind your question was to assist Newbees in thinking through such treacherous policy issues. Further, I also know that you could have answered this question as well as I.

As you know, a rental property (or tenant occupied as you worded it) may be covered under numerous policy forms.

The first step an adjuster should take, is to do as Dave Hood has suggested and READ THE POLICY. In adjusting any type of loss, THE POLICY IS ALWAYS THE "BIBLE" in determining coverage.

Secondly, the adjuster should determine the cause of loss. The situation you described might not be covered if the ceiling damage occured as a result of ice dams, while it might be if the damges were caused by a ruptured pipe on the floor level above.

Similarly, there might also be coverage for smoke, fire, or power outage events, as well as actions prohibiting entry to the risk (Civil Authority) under a certain policy, while damage from ice dams might be excluded.

I think that Dave is also right in suggesting that the loss of a "particular" room such as a bathroom or kitchen could give rise to loss of rents and/or loss of use; again, depending on the policy form. The loss of such "critical rooms" necessary to the habitation of a risk location would make it impossible for safe, sanitary, and healthful occupation by anyone.

Dave is also correct in stating that an adjuster must look at differences in policy language from state to state, carrier to carrier, (and remembering Montreal all TOO WELL Dave) from country to country.

I hope that this "answers" your question Russ, but without looking at the particular circumstances of the claim, cause of loss, policy form, nature of the Insured, and any other factors having a bearing on policy, it would be impossible and unfair to give you a generalized and specific black and white answer which would apply in all circumstances.
R.D. Hood
Posted on Tuesday, December 21, 1999 - 9:48 pm:   

Of course you have to read the particular policy carefully, as Jim stated, every State and Carrier has variations. But in the case of a kitchen, or a bathroom, where the occupant cannot have use of particular facilities they may have a valid claim, even though it is only one (1) room.
And also some policies that afford all risk, may be an aggregate policy in which the coverage amount applies to each of the coverages, so unlike an HO-3 which is named peril for contents, an aggregate coverage policy will afford coverage.
The only way to be sure is to review each policy, and then ask what the Carriers wants to do, because they change their minds very often, depending on the area, storm and conditions, remember Canada? Jim. Every day, Nes't Pas?
Russ Lott
Posted on Tuesday, December 21, 1999 - 8:59 pm:   

Jim, a question for you, if I am assigned a tenant occupied structure, and the Insured is asking for loss of rents because the tenants have had to move out because the ceiling has come down in the kitchen, do I owe this loss of rents? Only one room is affected and the insured has a public adjuster calling me every other day.
Jim Flynt
Posted on Tuesday, December 21, 1999 - 11:46 am:   


In my prior post, I neglected to mention the special requirements for handling a condo (HO-6) or renter's policy (HO-4).

Under the HO-4 Renter's Policy, just remember that there is no "contents" coverage for "ice dams" damage because contents coverage is named perils coverage.

Under the HO-6 Condo Policy, the important thing to remember is that the insurance carrier is going to require that you provide a copy of the Condominium Association By-Laws with your claims report which will specify who is responsible for damages in the event of a catastrophe event. Generally, the Condo Association "Master Policy" will respond to exterior (gutters, fascia, soffits) and to structural damages while the HO-6 will pay for repairs to "coverings." The issue which cause the most difficulty is generally who replaces drywall and floor coverings. Coverings are usually defined in the Condo By-Laws and will inform the reader which carrier (Condo association or homeowners) will respond to particular damages. In some states, coverages for condo coverings and apportionment will also be covered under that state's Condominium laws.

I hope this additional information helps as well and please feel free to email me if any of you have further questions.
Jim Flynt
Posted on Tuesday, December 21, 1999 - 9:34 am:   


David, having worked ice storms almost each year, here is what my experience tells me you should expect.

First of all, ice damage in homes and properties is generally a result of "ice dams" which occur when sleet, snow or ice precipitates onto roof tops. After the deposit of precipitation, there is generally a freeze-thaw cycle wherein the melted ice flows to the gutters and then freezes. After a short while, the gutters fill up and over and then freeze, and when the next cycle starts, the melted ice water starts to backflow UP the roof having no other place to go. When this happens, the water goes UNDER the shingles and UNDER the felt paper, and then enters the attics and ceilings causing interior damages.

Generally speaking, there is never any "damage" to the roof from these storms, unless the precipitation is such that from "weight of ice", the roof or a portion thereof collapes. This happened in Buffalo, NY last winter due to the unusual amount of snow which fell.

Because there is no roof "damage", the adjuster does not have to inspect the roof. Most adjusters working ice storms don't even bring a ladder. I always do, only because I don't know what storm I may have to go to next before coming home again.

When the melted ice water enters into the home or commercial properties, the water may find its way onto the top of the ceiling sheetrock where it has no way to further gravitate to lower elevations. When this happens, in time the water will soften the drywall board and it may and probably will collapse into a room area. If not, it will generally "bow" the ceiling drywall. MAny times, the best thing to do for this (and the Insured may already have by the time you arrive) is to punch a few nail holes in the ceiling drywall to allow the water to escape.

Water is always going to find it's way downhill, and in doing such, it causes "staining" of the walls, ceilings, carpets, floors and contents.

Remember, even under the HO-3 Policy which is "all risks" coverage for Coverage A & B, that Coverage C is Named Perils coverage, and as such there is no coverage for "contents" due to damage from "ice dams."

The other damages which an adjuster may see is where there is a pipe rupture due to freezing which can cause the escape of a lot of water in a very short time period, thus causing extensive damages to a home or commercial property.

Ice storms generally may cause local power outages, so you may also see claims for freezer food loss and other loss as a result of power outage. Remember that general power outages are not covered for damage unless the power loss is caused by damage to a power line between the street and the residence.

You may also see damages from small (and sometimes even large)fires due to defective heaters, misuse of candles, and "accidental fires." You may also see "smoke damage" from candles and heater "puff backs."

Finally, expect to see some fallen gutters, which will often peel away the fascia and soffits from the risk as well, due to the extra weight of frozen water within the gutters.

All in all, the majority of claims which an adjuster is going to see are going to be the "cosmetic" damges within a few rooms, with most repairs consisting of drywall repair and replacement, painting of walls and ceilings, and the cleaning or replacement of carpets and floor coverings. You may also need to replace insulation in attics or walls at times due to heavy water penetration, although the replacement should not be allowed without a physical inspection of the damaged insulation.

What I love about ice storms, is despite the cold weather in these damage locales, you generally are going to be outside only between your vehicle and the front door of the risk, and if done properly, a scope of damages can be performed relatively quickly, and the file closed quickly as well when the adjuster understands the issues involved in ice damages and the reason for cause of "ice dams."

Due to the nature of damages, your inspections are going to require appointments with the Insureds, so that they may be present to allow entry and for you to explain causation. If the adjuster does not understand the cause of ice dams, THEN he is going to ultimately have to deal with roof inspections and explaining later why there was no roof damage. This can be avoided by having a full understanding of the ice dam cause and being able to explain that to the Insured. A "handout" with a visible diagram I find to be very helpful for the Insured's understanding.

For those adjusters who may handle a commercial claim, remember that there are some significant differences in policy language and coverage than those coverages under homeowner policies. Many of the items which may be covered under a homeowners policy are not covered under the commercial forms.

David, I hope this helps answer your question, and further if you will type in the words "ICE DAMS" on one of the internet search engines, you will find some excellent information as well as diagrams which outline the causes. These also make excellent "handouts" to give to your Insureds who suffer damages during these ice events.

Good Luck, buy some warm clothes, bundle up, and I'll see you there in January.
Tom Weems
Posted on Tuesday, December 21, 1999 - 9:17 am:   

Real simple, if the roof has ice and snow on it, stay off. If you think you are taking a chance climbing a particular roof, you are. If you have the slightest thought that a roof is dangerous, don't climb it. I have never seen a roof worth getting hurt over.....
David Pierce
Posted on Monday, December 20, 1999 - 11:37 pm:   

Can anyone share information about winter ice storms and the adjusting side of these storms. In light of the adjuster who fell off the roof recently it seems quite a bit more dangerous in a winter setting. Any information or experiences would be greatly appreciated by myself and all the other new adjusters in this business.
Thanks again and Merry Christmas, Also remember why we celebrate this day and thank Jesus he is giving all of us many blessings.

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