| Author |
Message |
Harold J. Geoffrey (Stormadjuster)
| | Posted on Wednesday, May 17, 2000 - 11:55 am: | |
I neglected to mention the 80% insured to value requirement in my previous post. This of course will also have to be satisfied. Sorry. |
Harold J. Geoffrey (Stormadjuster)
| | Posted on Wednesday, May 17, 2000 - 10:51 am: | |
Tom, if the backup occurred due to a general condition of flooding within 72 hours it’s a flood loss subject to an additional $250.00 deductible. Since the obstruction occurred off the insured premises it is not covered. I believe there is sufficient case law to support my position on the HO-3 denial. |
Tom Joyce (Tomj)
| | Posted on Wednesday, May 17, 2000 - 9:45 am: | |
Trust Me General Contracting is repaving the street, and due to the fact it is in the south and the water and waste lines are about 2 feet underground, crushes the main line. This line was installed before EPA regulations and also serves as a storm drainage line. Unfortunalty your insured is at the end of the line right before the waste treatment plant. Insured is out of town and a major rainstorm hits resulting in backup of water from the damaged lines. Your investigation reveals that the damage to the line was due to the contractors heavy equipment. Insured has a HO3 and a policy with NFIP. Is there any coverage? |
Harold J. Geoffrey (Stormadjuster)
| | Posted on Wednesday, May 17, 2000 - 9:20 am: | |
Jim, I will stick to my original answer yes it would be covered. I would not consider this sewage back up since the source of the water is the washing machine. I would consider this accidental discharge or overflow of water from a plumbing system. |
Jim Flynt (Jim)
| | Posted on Wednesday, May 17, 2000 - 7:12 am: | |
Harold, lets just say the snake clogged the line and died within the drain line less than 6 feet from the washing machine discharge outlet. |
Harold J. Geoffrey (Stormadjuster)
| | Posted on Wednesday, May 17, 2000 - 7:00 am: | |
Jim I would say it depends on where the obstruction was located at the time of backup. I would also say it would depend on whether the damage was caused by water or sewage. But based on your description of the loss. I would say that if the obstruction was on the insured premises I believe there is coverage. If beyond the insured premises I would say no. |
Jim Flynt (Jim)
| | Posted on Tuesday, May 16, 2000 - 11:45 pm: | |
Snake Coverage Question # 2
To "piggyback" on the earlier coverage question which was asked by Steve Florig, here is another one.
Fred and Wilma have an HO-3 Policy, 04/91 Form.
Somehow a snake has found its way into Fred and Wilma's washing machine drain line, where it dies after clogging up the line. Wilma throws a large load of clothes into her washer and then heads off to work at Bedrock Adjusting. As you might guess, the water backs up, overflows, and thus ruins the hardwood floors on the first level of her palatial residence. The damage is substantial. Policy limits are $250,000, Deductible is $250 and Damages are $7,500.
What does the Insurance company, Dark Age Mutual, owe to Fred and Wilma?
Is this loss covered? Why or why not? |
steve florig (Stormpro)
| | Posted on Tuesday, May 16, 2000 - 7:04 pm: | |
Yes Jim you are correct sir!
This was the exact same verbage that I was given by my claims manager at the time reference to this loss.
We paid the claim because it was not the "intent" of the policyholder to damage his home.
If "stupid" acts were an exclusion in the policy our friends in daily claims may have to come over to cat adjusting to make a living. |
Jim Flynt (Jim)
| | Posted on Tuesday, May 16, 2000 - 4:36 pm: | |
Goodness Snakes Alive, today I got an email from an adjuster asking if I had snakes in my head with the answer I gave to the "snake coverage question" from Steve Florig.
The answer is of course not, and let me try and explain in a little more detail why not.
This adjuster continued to believe that the loss was excluded because the act of the insured was "intentional" and thus it is excluded by policy.
But the truth is, sometimes we all need to take a closer look at the policy for a second and more precise reading than perhaps our memory may serve.
Using the Ho-3, 04/91 Form for example, the Policy has a section entitled: "Section 1 - EXCLUSIONS"
Here is what this policy then says:
" 1. We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss.,,,,,,,,
h. Intentional Loss, 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."
Therefore, both sentences are REQUIRED for there to be an exclusion for Intentional Acts, and when we include the verbiage from the second sentence, we do not now have an Insured in my opinion who INTENDED to damage his home. His intent was to damage or kill the snakes, and he just got carried away in his fearful yet passionate ardor while failing to realize until later his poor judgment and his terribly awful marksmanship.
As I said in my earlier response, ignorant and stupid acts of Insureds are not excluded from policy coverage. |
Jim Flynt (Jim)
| | Posted on Saturday, May 13, 2000 - 4:28 pm: | |
Good question Steve.
Here's is my shot at it, so to speak.
I suggest that the loss IS COVERED under an HO-3 policy and here's why. Yes, the Insured shot at the snakes intentionally, but he intended to shoot the snakes and did not (I presume) intend to damage his residence, by shooting holes in his fascia, gutters, and ceilings. He was in a state of panic from seeing the snakes and was not necessarily thinking of damaging anything, other than the snakes. Besides, he overestimated his marksmanship skills and was just a plain bad shot.
Snakes are not the cause of loss here, as Steve talks about.
The damage to the risk is from gunfire, which is not excluded. Suppose for example, that the Insured and his family are out to dinner, and a group of teenagers drive by and shoot his front windows out. The damage is covered.
While the actions of "Our Hero," Mr. Insured, might rise in our minds and the minds of most to the level of great stupidity and ignorance, ignorant acts of an insured are not excluded under the policy either.
Suupose for instance, that the Insured decided to try and commit suicide instead of shooting at snakes. Suppose also, that in the process of blowing his head off, he also splattered the walls, ceilings, and carpet with blood and gore, while leaving holes in drywall and trim, and damaging fixtures. The resulting damage would be covered under an HO-3 (but NOT to Coverage C, contents items). Although he intended the act, he did not, it would be presumed, intend the other collateral damages to the walls, ceilings, paint, carpet, fixtures, etc.
The gist of this claim, I feel, would center on the concept that the Insured intended the act, but did not intend the consequences. Not much different than an Insured setting a brush fire, and then having his garage burn down when the fire gets out of control.
Damages would be covered under an HO-3 as I see it. |
Steven W. Ebner (Medulus)
| | Posted on Saturday, May 13, 2000 - 9:38 am: | |
My thinking is this. First of all, the presence of snakes is not a covered loss. Even should they cause damage, there is an exclusion for damage caused by animals, vermin, etc. Secondly, the firing of a gun inside the house by the insured is an intentional act that even Joe Suburbanite should understand will result in damage to his house. As an intentional act committed by the insured, it is excluded damage. If this insurance company came down on his side, there must have been some political wrangling behind the scenes. |
steve florig (Stormpro)
| | Posted on Saturday, May 13, 2000 - 9:15 am: | |
Handled a claim when I used to work for a major carrier and thought it would make an interesting coverage question for the forum.
Mr. Jones discovers he has snakes in his attic and not being fond of the little fellas he calls out the local Critter Control and they promptly charge him a few hundred dollars to remove said snakes. Mr. Jones is upset when a few days later the snakes are back!
Now Mr. Jones is quite fearful of the slithering little critters and decides to take action himself by using his .22 to try and send his unwelcome guests to a permanent dirtnap. As he is firing off his gun trying to kill the snakes the bullets pass through various parts of the ceiliings, gutters, fascia boards etc etc.
Mr. Jones has now successfully rid his home of the snakes and has ventilated a good part of his home in the process. He now calls his insurance company to see if they are "on his side".
What is your decision on this claim?
Is this a covered loss or not and why?
I will post the decision that was made on this claim at a later date. |
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