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trader
USA
236 Posts |
 Posted - 03/08/2004 : 05:51:24
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| Catastrophe Adjusters like Tony should never recommend payment of a non covered claim. |
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JimF
USA
1014 Posts |
Posted - 03/08/2004 : 07:12:43
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| Flynt's Corollary Theorem: Naive and/or inexperienced catastrophe adjusters should never recommend denial of a covered loss. |
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trader
USA
236 Posts |
Posted - 03/08/2004 : 07:35:05
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Right on Jim: Two greatest nightmares of adjusters: 1. Not recommending payment of a covered claim has catastrophic consequences for the carrier. 2. Recommending a non covered claim, only results in your termination .
Subrogation: Must have a tort. Must have negligence. Windstorms and power outage is neither. |
Edited by - trader on 03/08/2004 07:37:52 |
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dday
USA
3 Posts |
Posted - 03/08/2004 : 08:19:49
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quote:
Originally posted by WrightClaims
Hold on everybody!!! Lets not start bad mouthing anyone that got this question wrong. You all act like anyone in this business should know everything about every policy ever written. What you older, "seasoned" folk seem to forget is that new people are entering this field every day. I for one am very proud of the fact that our field is sought after by so many people. You can not expect a new person to our field to get every answer correct. Maybe they were testing themselves and just jumped in and gave it a try. Where is the harm in that?. Now if the people that got the question wrong are calling themselves "seasoned" adjusters, then there might be a problem.
Every time I log on and read the threads in the forum, I see the same "old folks" complaining about the "EDUCATION & TRAINING" that people are getting or failing to get. Let me remind you ladies and gentleman that it takes years and years to learn this industry and even you "seasoned" adjusters should be learning something new every day. If you are not, then you should hang up your boots and go play shuffle board in Florida.
Please quit badmouthing people who do not know as much as you (or in some cases) people who do not know as much as you think you do.
I agree that education and training are paramount for our industry, and I for one have completed just about every training course, IIA course and self-study course know to our field. I refuse however to get on the wagon and say that our profession is dying because to many "inexperienced" people are joining our ranks. For those of you who have a problem with this, WHAT DID YOU KNOW WHEN YOU FIRST STARTED".
Have a little compassion and stop talking about the bad in our field and focus on the good.
Verywell said |
Dan |
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dday
USA
3 Posts |
Posted - 03/08/2004 : 08:32:35
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quote:
Originally posted by CCarr
Strike one, with an inside curve!
Ruled a strike by virtue of the HO3 preamble language for Section I Exclusions as follows; (the capitals are the root of the called strike)
"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"
The intent of the preamble language, is as important as the actual exclusion. The preamble clearly sets out the parameters for the individual exclusion.
They define 'home plate', and hence as an armchair volunteer umpire, I call a strike.
Lets get back tote basics . Is not the basic dwelling policy to include fire and lightning. If lightning was the cause of a surge would that not be a covered item??? depending on the language of anything written it is up to the adjuster to interpret what the coverages are. |
Dan |
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william s cook
53 Posts |
Posted - 03/08/2004 : 08:39:27
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If adjusters instead of insurers were required to suffer the financial loss of an erroneous claim denial then the number of shooting from the hip denials would certainly have more significance to an inadequatly trained adjuster for the loss circumstances being adjusted. I make my living off of bad claim decisions of insurers, the sad part is that it is funded from the resources of the victims in many instances.
William S Cook
Public Adjuster |
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LarryW
USA
126 Posts |
Posted - 03/08/2004 : 21:49:00
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| I was taught that the exclusion of "Power Failure" as a cause of loss is meant to exclude damages caused by the power failure, such as refrigerated items or any other damages of such consequential nature. The ISO HO-3 form clearly states within that exclusion {But, if a Peril Insured Against ensues on the "residence premises," we will pay only for that ensuing loss.} I would submit that since the technician determined the damage was from a power surge, then we have to accept that as the cause of loss (unless we have evidence to indicate otherwise). Further, named peril no. 15 would seem to be a "peril insured against under the policy". The loss is covered. |
Larry Wright |
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LarryW
USA
126 Posts |
Posted - 03/08/2004 : 21:56:48
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| Justin's posts with the examples of coverage disclaimer letters from Farmers in Texas are great. However, I would caution anyone against using a form letter pertaining to a HO-B coverage form (wherein power surges are excluded)to deny a claim under a HO-3 policy form (wherein power surge is a specific named covered peril. |
Larry Wright |
Edited by - LarryW on 03/20/2004 12:59:22 |
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Linda
USA
127 Posts |
Posted - 03/08/2004 : 23:22:55
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| Why is the rock falling off? |
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william s cook
53 Posts |
Posted - 03/09/2004 : 06:24:05
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Rocks are falling off because of inadequate sealing by the contractor allowed water infiltration causing the substrate to weaken and release from framing where it was not properly attached.
Bill |
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Tom Toll
USA
154 Posts |
Posted - 03/09/2004 : 23:19:40
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| Bill, what substrate are you speaking of. What sealing are you talking of. What type of rock do you speak of. If any kind of rock, it has to be mortored in, so why does it have to have a sealer. Are you speaking of the clips to hold the rock to the wall, or what improper fastening are you speaking of. To have coverage you must first have a covered cause of loss to bring in the insuring peril. What peril would this be under any policy. Sounds like the insured may have a litigation situation against the contractor, if the rocks were not put up properly. They have no claim against their homeowner carrier. |
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william s cook
53 Posts |
Posted - 03/10/2004 : 08:02:43
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Tom
This house is several hundred miles from me and I have not seen the home as yet. The circumstances as described to me over the phone by the homeowner indicate that the rocks are decorative flat stacked rocks (probably end butted into a mastic) attached to an area on the front side of his home. The rocks are not structural in nature but a fancy finish on a fancy house. I think what the owner described to me as the substrate is OSB. According to the homeowner water has entered the home in the top portions and caused loss of structural integrity of the OSB in some area. The water has migrated to interior walls where it has caused damage to the interior sheetrock. If the water intrusion has caused damaged to the interior sheetrock that should be given consideration to be covered damage. If the water intrusion has caused damage to the OSB substrate that should be given consideration for coverage. When insured called agent to report the loss the agent said loss was not covered and he did not report it to the company. The insured then retained his on contractor and made repairs out of pocket for $15,000.00 to $20,000.00. Of course some wood was rotted that may fall under the exclusionary language of the policy. Some wood was delaminating that in my opinion is not excluded damage. Had the agent acted properly and reported the claim perhaps the adjuster would have seen it the same as I do and made a payment of the covered elements of the loss. When I posed the question to the forum I thought that the claim was denied by an adjuster because he told me "the company denied the claim". But as noted many adjusters that psoted would also have denied the claim. I am currently evaluating if it is financially worthwhile for me to get involved in this battle. If it were local to me I would sign him up for a third of recovery and tackle the project. Of course to confirm the actions of the agent could greatly impact the aspects and outcome of the claim.
1. I can become involved an charge him one third of recovery
2. If it is determined that insurers owe some portion of this claim that was denied without a complete investigation, that may be considered evidence of statutory bad faith in Florida.
3. If bad faith is established then the insurers are subject to pay the insured's attorney fees (in whatever amount is reasonable for the legal work done not related to the amount of the determined loss)and possible compensatory damages to the insured.
4. My fees for expert testimony can be recovered by the attorney as a part of his legal expense.
With due respect to your experience and knowledge I disagree with your statement that "to have coverage one must have a covered cause of loss" under homeowner policies.
The issues I presented provided good coffeetalk and postings, that may have been of benefit to some folks as we had ten times as many reads as we did responses.
William S Cook
Public Adjuster
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alanporco
USA
112 Posts |
Posted - 03/10/2004 : 22:59:28
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Still not clear on whether the policy covers interior water damage w/o a opening created by a covered cause of loss? If the policy excludes interior water damage unless there is a covered opening, there is no coverage! The fact that there is interior damage "should be given consideration to be covered damage." Excuse me, but there is a reason a policies have EXCLUSIONS - to tell you what isn't covered. An HO policy is designed to cover sudden and accidental occurrences. It is not a home warrranty policy. If the exterior facade was improperly installed, that is faulty construction and/or design. Neither of these is a covered cause of loss.
On the other hand, if the policy provides coverage for interior damage w/o a covered opening, you have one hell of a case. |
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LarryW
USA
126 Posts |
Posted - 03/11/2004 : 00:36:45
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Under standard HO policies, the structural interior water damage is covered with or without an opening unless excluded, which in this case it is not. Water damage to personal property is not covered without an opening caused by a covered cause of loss. Mold is excluded or limited, and construction defects are excluded. Bill, you are right, the construction defect exclusion serves to exclude coverage to correct the defect only. The construction defect was not the proximate cause of loss to the interior elements of the building, proximate cause of loss refers to the first link in an unbroken chain of events which cause the loss. This chain of events has a serious break due to the length of time which lapsed between installation of the rocks and the damage onset. Had the leakage occured from day 1 when the rocks were installed, then there may have been an unbroken chain. That's my take on it.
Also, many of the high-end homeowner's policies are endorsed to bring personal property to the coverage level of the dwelling (i.e. what we formerly called all-risk). |
Larry Wright |
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Catmandale
USA
67 Posts |
Posted - 03/12/2004 : 00:50:27
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Interesting discussion.
There is some controversy regarding "proximate cause" and "efficient proximate cause", at least where I live. They have been called at times the first cause, and also the most important cause, which may be vastly different.
The policies discussed have varied from ISO HO policies to two versions of the SF 7900 series. As I recall, the 7923 is the "standard" SF HO3 while the 7955 is the SF Homeowners Extra policy. Coverage is of course dependent on the policy form applicable.
The cause(s)of loss, according to Bill have yet to be fully determined, at least to him. It may be that the Insured has not yet told Bill the whole story, the Insured doesn't understand the whole story, or it hasn't yet been fully discovered through proper investigation.
To confirm or deny coverage requires more information of the damage, cause of loss, policy at hand, and applicable legal interpretations which may affect coverage. |
Edited by - Catmandale on 03/12/2004 00:51:36 |
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Is it Covered?
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