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Tom Joyce (Tomj)
Posted on Wednesday, April 26, 2000 - 9:35 am:   

An excallent primer (am I showing my age) or study guide was the question and answer section of the FC&S that came with the monthly updates. Good questions with the information to back up the answers. If any of the newer adjusters has any contacts that still receives the paper monthly updates, beg, borrow or whatever, its worth the time and effort.
Jim Flynt (Jim)
Posted on Wednesday, April 26, 2000 - 6:23 am:   

Russ. This is Miami! Remember? M-I-A-M-I

Some of you may know what I mean by urging Russ to take another look at this claim.

Now Russ, go back and look at a couple of things you may have overlooked:

Mr. Gonzalez had two of us buddies over for a little game of Bluff when the damage occurred. Not only were these two gentlemen friends of Mr. Gonzalez, they are also lawyers: Manny Diaz and Kendall Coffey. During the course of a "scuffle" Mr. Diaz's $500.00 watch was damaged and he demands payment under Mr. Gonzalez HO policy. He says if the insurance company doesn't pay for his watch, he is going to sue. How do you answer him?

Secondly Russ, there is a crowd building outside of Mr. Gonzalez house. They are already quite angry. Mr. Gonzalez says you do not want to go out there and leave my house without finding a way to pay for the damages for my claim. You are having a bad day, as your cell phone battery is dead, and his phone is in use, so you can't call your supervisor. He suggests you take one more look at the HO-2 policy or he is going to advise the crowd outside that you, acting as agent for the carrier, have denied his claim. He suggests if you survive the crowd's response, then Mr. Diaz and Mr. Coffey are fully prepared to litigate this claim and sue you personally for what he describes as "bad faith." He tells you that Diaz and Coffey are meaner than a couple of junk yard dogs in court, and are not particularly fond of adjusters from Iowa.

Oh Boy. Russ. You are in a mess. And, I am not there to help you (Russ and I are professional associates and long standing friends). Sorry Pal, you are on your own on this one! What in the heck are you going to do?

May I suggest you go back one more time and reread the HO-2 policy and TRY TO FIND SOME COVERAGE for this loss. (You wouldn't turn down a claim for hail damage while ON a two story roof with an insured bigger than you, WOULD YOU Russ?)

Folks outside are getting edgy, the two lawyers inside smell big money from an insurance company, several members of the press have their television cameras on outside to get your public response on insurance coverage, you can't remember whether you heeded your Mama's advice when you dressed this morning to always wear clean underwear without holes in them in case you ever had to go to the hospital emergency room, and this is just not turning out to be your day, to say the least.

After all, this is real life and not just some textbook exercise in policy. WHAT ARE YOU GOING TO DO?

If you live to survive this claim Russ, I'll buy the first couple of rounds of beers! With a little luck, perhaps I can talk Roy into buying a couple of rounds too, just to hear your story.
Russ Lott (Russ)
Posted on Wednesday, April 26, 2000 - 2:50 am:   

The loss has no peril applicable that I can find. The only two perils that are close are
4. Riot or civil commotion.

8. Vandalism or malicious mischief.

I don't believe either would apply because of the legal instrument attached to the breakin.

Sorry Mr. Gonzalez your policy does not cover the loss as presented.

But if your agent sold you a new and improved HO3 coverage would be afforded for the damage as there is no exclusion applicable. Ordinance of law exclusion only applies to building regulation.

That is the way I read the policy any differences of opinion? Gotta go have a homebrew.
Jim Flynt (Jim)
Posted on Tuesday, April 25, 2000 - 11:30 am:   

Geeze. Where are all of you Old Timers and Adjusting Pros? Where are all of the Newbees who want to shine?

You guys must be too busy eating those Phantom Burgers to worry about policy language and coverage questions!

Getting some of you to try your hand at answering these coverage questions is like pulling teeth.

What's the matter? Are they too easy?

We all can stand to learn the policies a little better, no matter how long we have been doing this, and one of the best ways is through the use of these kinds of examples. It seems to me that by asking these types of questions, we all can learn to handle the tougher coverage questions properly here so we don't make mistakes out there when we are in front of the Insured.

I am planning to put even more coverage questions up on this board in the days to come. Is that a good idea or a bad idea? Do you find this type of post helpful and/or educational for you?

Would these examples be more helpful if we posted the proper answer at the bottom of the post after the question is posed? What do you think?
Jim Flynt (Jim)
Posted on Monday, April 24, 2000 - 11:29 am:   

OK. Here's a New Coverage Question for you:

This morning you are assigned an HO-2 claim for a property located on 2nd NW Street in the Little Havana section of Miami, Florida for damages to a front door, a bedroom door, a closet door, and some contents damage due to a "police action" in the course of enforcement of a search warrant. The Insured is Mr. Lazaro Gonzalez. You are asked to inspect the loss, scope the damage, and settle the claim with the Insured IF there is a covered cause of loss.

Please discuss coverages which may or may not be available for property damage to the risk; and damage to the contents under the HO-2 policy.

Would coverages change if the Insured was covered by an HO-3 policy? Why or why not?
Donald W. Mathews (Dmat)
Posted on Thursday, April 27, 2000 - 11:58 pm:   

Man-O-Man. My wife read my post and ripped me about misspelling words and not catching them. That's what I get for having an English teacher with a masters in the house. Guess I was in such deep thought when posting it that I just plain mistyped or missed keys and overlooked them. Do I have all's pardon on this one?
Donald W. Mathews (Dmat)
Posted on Thursday, April 27, 2000 - 11:19 am:   

OK gang, I'm taking my shot at Little Havana.
Based on the information provided in the form of an HO-2 policy which is an AVC-Named Peril type policy and the question posed as written by Jim, the damage sustained apon the entry by a governmental agency in NOT covered. Only in the case of prevention to the spread of fire is coverage granted apon the direction of a governmental agency ordering the distruction of the property to achieve such results of prevention of the spread of fire. The coverage would only apply in case of fire anyway.
The coverage would change in this case under an HO-3 since this policy is an All-Risk policy. Under Sec. 1 - Exclusions of an HO-3, there are no exclusions of coverage in this policy for declaired governmental actions for any reason except Acts of War or Nuclear Hazards.
Content coverage would not be allowed since under Sec. 1 - Perils Insured Against, acts by a governmental agency is now named as an insured against item. It is excluded under the Sec. 1 - Exclusions as listed above. Now if there is a HO-101 Endorsement on the policy, then the content damage is covered.
Regardless to who is inside or outside the residence, the policy must be enforced as written and accepted by the homeowner(Insured)regardless to the jears, shouts, words etc. expressed by the crowd or friends gathered. There again, you are there to inspect the loss, scope out the damage and try to make a settlement with the insured and only the insured. The Ins. company always has the last word on all decisions once the report of the loss, scope of damage and the proposed settlement is filed with them.
OK, now you'll can have fun, tearing, ripping, slashing and generally having a good laugh if that is the case. At least I'll know how to handle a file like this if it ever comes up in the future not only to me but for anyone else. I only am posting what I can find in the sample policies that I have on hand. More than likly misse something but this is a method to learn more about what not to miss on a policy.
Jim Flynt (Jim)
Posted on Thursday, May 04, 2000 - 4:17 pm:   

Donald, I see what you are saying with regard to "property covered" (under the provisions of Section I Property Coverages) BUT the problem is that the Coverage C Perils Insured Against still apply, thus there would be no coverage available under the provision you have outlined, as the loss was not from a covered peril.

May I suggest you look under Section II - Liability Coverages for the answer that I am suggesting and try again.
Donald W. Mathews (Dmat)
Posted on Wednesday, May 03, 2000 - 11:29 pm:   

Little Hanava Revisited: Within an HO-2 policy under Section 1-Property Coverage Sub Par. Coverage B (Personal Property)Item # 2.b it states: at your request, property of others while the property as on the part of the residence premises(underlined) occuiped by an insured (underlined)-- Thus is this situation Mr. Diaz's watch is/would be covered under the insured policy at the insured's request since the watch was damaged at and on the insured's premises with a limit of $500.00 as per policy limits.
We can look at the damage to the watch under unreported damage to the insurancec agency that was overlooked due to the manner in which the other reported damage occured.
Don't see any argument on the coverage, just failure on the insured to report all damages on the first report. That's why we must look at everthing very carefully and note all found damages on the scoping and question the insured about being sure that they have not forgotten anything so as to close their file and claim as quickly as possible.
One last thing for Jim. Please do not insult the other clan. My last name has only one(1) "T" in it and don't/want claim my side.
Jim Flynt (Jim)
Posted on Tuesday, May 02, 2000 - 1:25 pm:   


Donald Matthews is correct that there is no coverage for the Coverage A property damage based on the exclusions as he mentions as well as the damage not falling under any of the definitions of "riot" or "civil commotion" (note the policy does not define these terms).

I do however suggest to you that there IS coverage for the $500.00 watch which is owned by Mr. Diaz.

Can anyone tell me how or why I could possibly take that position on coverage and make such a statement? (I will give you one hint: President Clinton and Janet Reno in their public statements gave me a leg to stand on to make my argument FOR coverage for the $500.00 watch).

I will wait to see if anyone else buys my argument and finds coverage in the same manner that I do. After all, that is part of our job, to try and find coverage for the insured.

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