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Author Message
Jim Flynt (Jimflynt)
Posted on Thursday, November 08, 2001 - 8:00 pm:   

(Here is an edited version of Tom Joyce's Coverage Question, which he requests CADO readers to review and then comment on for coverage).

Got a challenge for you all!

I know it's going to come back and kick me, but a friend in need...
I'm 99% sure I'm correct, but your learned advice would be welcome.

It is the time of year when bucks (deer variety) get moving around.
Employees of a landscaping company see a deer and follow, and then give chase. The deer dives into a home, spreads blood on furniture, walls, and personal contents.

Glass from windows and contents is scattered in carpets with associated damage to walls and other building items; then tears up a bathroom where the police herded him. (4 point and about 130 lbs according to animal control)

Insured has an HOB (Texas) All Risk policy, about the same as an HO-3, and with a 101 endorsement.
(For CADO readers not familiar with the Texas HOB feel free to address this coverage question using the ISO HO-3 policy as the basis for your answer)

The claim is reported within a few hours, insured requested advice on how to proceed. Adjuster sets an Appointment for five days later!!!!!!
The adjuster refers him to a preferred contactor and advises him to remove the contents as necessary for cleaning and list other items damaged. Also approves ALE as necessary with a limit.

Keep in mind, there is a 16 month old and 5 year old child living at this house.
Policyholder has limited ALE expenses to the point of trying to paint walls and ceilings and secure a room for the children.
The insured requests an advance on extra expense ASAP. Company tells him that it might be a week to get a check, then, (now think), tells him that the contents are not covered.

There are several issues involved here:

First is delay in issuing an advance check once approved.

Second is authorization and commitment on removal and repairs to Personal Property, even though this is a named peril section, then denying coverage.

Third are there estoppels involved? Once the door is opened?

Fourth, I see why there is a reason for Public Adjusters.

Fifth, I could go on but I think the learned responses will cover the other points.

This is a real situation, so be serious please.
And the answer will surprise some, but not all.

Thank you all for your time.
Tom Joyce

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