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Louise
USA
2 Posts |
 Posted - 06/07/2003 : 08:22:27
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One of the common ways to build a pool and ato work on one that is in an area with high ground water is to make a hole in the bottom of the pool so the ground water will not float the pool. There is a high risk of a pool floating out of the ground when it is empty.
You should have a trusted pool expert check the hole in the pool to make sure it was an accidental event. To make a hole in a pool requires a lot of work. Have you ever tried to cut a hole in a concrete culvert? It takes a lot of pounding. |
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Newt
USA
657 Posts |
Posted - 06/07/2003 : 18:50:53
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I understood the weight of the water was what triggered the collapse.
Back to the scenerio presented, I don't read any coverage into it. I just imagined I missed something. I do see the personal property.
My idea on this pool is that it had to be empty when it floated and the crack or hole was after the fact or during the floating. Concrete does not have the bouyency to float even in sea water unless it displaces enough water to overcome the difference in specific gravity. The water could not have drained out if there was enough pressure for the outside or ground water to float at least 12 tons even for a small pool.
I had to come out to the office and read for my self and this is a call the carrier would have to make, I would report it as I saw it, with documentation and if the carrier wanted to pay for part of the claim, that covered the soffit and trim on the house they could. Someone can fill me in on these type claims, do any of you make your reports as you would as if there were coverage. |
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JimF
USA
1014 Posts |
Posted - 06/07/2003 : 19:45:56
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Newt, any claim decision, I suppose, is one that the carrier ultimately has to make.
BUT, that notwithstanding, is not an excuse nor does it allow the adjuster off the hook, so to speak, in making a recommendation for coverage OR for denial in the adjuster's claim report to the carrier.
You see, the problem is this: if you cannot clearly understand the policy well enough to make a recommendation to the carrier, then you have left your insured high and dry without an answer as to coverage status as well. That is not to say that you shouldn't consult with the carrier, and as early in the process as is possible on complex or confusing claims, but in the instant scenario, I think you, and perhaps other adjusters are really reading too much into this claim scenario and making it more difficult to understand than it really is.
Remember the "3 C's" which Jim Lakes has shared with us: Cause, Coverage and Cost.
On any claim:
What was the Cause?
Is there Coverage?
What is the Cost of Damages?
It is clear to me that both you and Clayton would be well served to apply the first two of the "3 C's" methodology to this claim rather than trying to look at the claim starting in the middle or from a conclusion and then working backwards. That's what has confused you both and leads you to see coverage trees without seeing the denial forest under this claims scenario.
If it is clear on any claim (and I am comfortable that is the case in the AllCatMan scenario) that there is no coverage, then the adjuster needs to report his findings to the carrier with the 'adjuster's recommendation' along with this adjuster's reasoning for a recommendation for denial.
A typical adjuster report to the carrier will read: "adjuster recommends payment in the amount of...." OR the report will read something like "adjuster recommends denial for this claim based on....." (and then establish) the basis for your denial recommendation.
The problem you seem to be encountering in your thinking, is in thinking of the damage to the soffit and trim as if it were a separately covered item damaged from some event unrelated to the AllCatMan scenario's initial (non-covered) triggering event.
Unfortunately, the soffit and trim damage ENSUES from a damage event which is NON-COVERED due to either lack of a covered peril and/or for reasons of exclusions within the policy, thus making the soffit damage NON-COVERED as well.
Now suppose you are out on a storm and encounter this claim, and really don't know what to tell your insured about coverage nor how to report this claim to your employing carrier with a recommendation.
So, you ask your two best adjuster friends out on the storm with you, what their recommendation would be. Unfortunately, one takes Clayton's position of coverage and the other takes the position of denial which I have laid out.
Now, what are you going to do?
(Might I suggest you return to read the policy language for starters?)
In the end, it is incumbent on each and every adjuster to so clearly understand policy language and the interpretation thereof, so as to advise insureds properly on their coverage as well as being able to communicate claim resolutions to carriers by speaking the same language (the language of the policy).
Newt, I think it also would behoove you to study the topic of proximate cause in more detail so that you clearly understand initial damage events and how they impact a further series of resulting or ensuing damages, especially when the initial damage event is non-covered resulting in ensuing damages being non-covered as well.
Hope this helps Cuz! |
Edited by - JimF on 06/07/2003 22:21:24 |
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ALANJ
USA
159 Posts |
Posted - 06/08/2003 : 09:10:00
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| In Alabama, water that collects on the pool cover would be considered surface water. Several cases on point. I feel most states would follow with similar case law. I do not feel this loss is covered. |
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CCarr
Canada
1200 Posts |
Posted - 06/08/2003 : 13:34:25
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I've gone back and re-read Mikey's scenario, and my 6/6 10.33 post in response to that.
This loss would not have happened if the patio stone edging did not lift and catapult into the pool - whether this was caused by a force pulling against the patio stone edging from the accumulated water on the pool cover or kids jumping on a dry pool cover using it as a quasi trampoline.
The patio stone edging is part of the Coverage A&B all risk Section I - Perils Insured Against. A search of the exclusions within that does not provide me with anything to deny coverage with.
It was not #1, a collapse of the patio stone edging, there was no pressure or weight of water ".... to a .... patio", and it was not a mechanical breakdown.
I see no exclusion that is applicable for the lifting of the patio stone edging that started the chain of damages. |
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JimF
USA
1014 Posts |
Posted - 06/08/2003 : 15:36:35
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Clayton, I swear, are we looking at and addressing the same claims scenario?
And if we are, how can you possibly say that there are no policy exclusions which would make this a non-covered loss? Again, are we reading and looking at the same HO-3 (04 91) policy?
Let's go back and refresh memories here by taking another look at the claims scenario which AllCatMan presented on 06/04/2003 as follows (and note emphasis mine):
WHAT IF..........
THE POOL HAD A COVER THAT WHEN FILLED AND OVERLOADED BY RAIN PULLED THE EDGING STONES AWAY AND INTO THE POOL, WHICH RESULTED IN A HOLE IN THE BOTTOM, WHICH RESULTED IN THE POOL DRAINING AND THEN FLOATING UP AND CAUSING ALL OF THE AFORE MENTIONED DAMAGES IN THE PREVIOUS SCENERIO...........????
JUST A THOUGHT.
Now my first question to you is where in the above scenario does it not say that the initial causation was not the pool cover pulling the edging stone away and into the water?
WHERE does it not say that Clayton? Please quote the language you are reading that I miss.
Secondly, AllCatMan, since you were the person who made this post and presented this scenario, are we clear to understand that your question to us was whether this claim would be covered IF the pool cover pulled the edging stone away and into the water, thus initiating the damage chain of events?
Clayton, if you did not understand the AllCatMan scenario to mean that the initial causation event was pressure and weight of water on the pool cover causing the edging stone to give way and fall into the pool, then why did you even address the pool cover as an issue in 5 statements in your post of 06/06/2003 analysis {statements: (b) (c) (d) (e) and (f)}?
Further Clayton, why did you then go even forward in making the following statement in your 06/06/2003 response?:
However, the pressure or weight of water was on the pool cover, not directly a pressure or weight of water in or on the empty pool
and further:
Therefore, I would tend to say that the pressure or weight of water on a pool cover that was fastened to the patio stone edging, that caused some of that patio stone edging to fall into the empty pool
with your following conclusion:
is not an excluded loss
Indeed, unless I am the lousiest reader in America, I read AllCatMan's question to mean that the initial causation event was as he said a cover that when filled and overloaded by rain was the initial causation, which even you addressed.
Are you now saying, that you can find NO POLICY EXCLUSIONS in the HO-3 (04 91) which would exclude such a loss? A simple YES or NO will suffice.
Finally, please quote the policy language from an HO-3 (04 91) wherein you can find a Named Peril (under Coverage C Perils) wherein "weight of water" is a covered peril. Please share that language with us, as I cannot find it anywhere within the 04 91 Edition of the HO-3.
And if "weight of water" is not a Named Peril under Coverage C, and if weight of water (under AllCatMan's scenario) was the initial causation event, THEN THERE IS NO COVERAGE FOR THIS LOSS under his scenario.
Not even close and no cigar!
I yield to no one in my great respect and high regard for Clayton and his knowledge and experience, but under the AllCatMan scenario, Clayton is not even close by a mile. There simply is no coverage and it really is simple, as I have said, when you take your blinders off, read the policy entirely, and understand why.
There is clearly nothing ambiguous about the HO-3 (04 91) policy language if AllCatMan's scenario relies on "weight of water" to "pool had a cover" as the initial causation.
I will address the scenario which you now present, which is different than the one posted by AllCatMan, in your post of 06/08/2003 under my next posting below. In your new scenario, you seem to be saying that the edging stone just catapaulted into the water without ANY causation, or at least none that you established in your scenario, thus preventing anyone from addressing coverage or denial other than by way of assumptions. For every effect, there must be some causation, and absent collapse, disintegration, latent defect, inherent vice, design/installation flaw, or deferred maintenance, I cannot begin to contemplate a causation without cause, and await your clarification on what you intended in your 'new' scenario.
I still suggest, in the strongest possible way, that the AllCatMan scenario is clearly and unambiguously not covered simply because the initial causation is not a covered peril and further because of policy exclusions for swimming pools, patios, and collapse; as well as the obvious latent defects, inherent vice, deferred maintenance, design/installation flaws, surface water/flooding, or disintegration which Clayton would have to argue and rely on short of explaining how a loss occurs without causation. |
Edited by - JimF on 06/08/2003 19:27:45 |
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JimF
USA
1014 Posts |
Posted - 06/08/2003 : 15:49:27
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| Removed temporarily for editing by Poster. |
Edited by - JimF on 06/08/2003 16:11:49 |
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CatDaddy
USA
310 Posts |
Posted - 06/08/2003 : 17:46:27
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See boyz, I told you it was one of those situations that was subject to some interpretations. Flood? Collaspe? Covered? Not covered? Is stone edging a patio or pavement? Is the cover part of the pool? What if it was a blue tarp and not an actual pool cover? You can put a boat cover over a car. Is it part of the car? Jeepers!
I can see your points Jim and they are good ones. I had not looked at the Collaspe language. I was deep in the Surface Water. I am on the fence again.
(Will someone come take my place in Jackson, Tennessee. I need a break.)
CD |
Edited by - CatDaddy on 06/08/2003 17:47:59 |
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JimF
USA
1014 Posts |
Posted - 06/08/2003 : 18:18:36
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CatDaddy, you see the problem with this damn pool cover is simply this:
If one argues that it is not part of the swimming pool, then it must be considered personal property subject to the Coverage C Named Perils, in which case there would be no coverage as weight of water is not a Coverage C cause of loss.
On the other hand, if one argues that the pool cover is part of the swimming pool, then this also becomes a non-covered loss based on the Coverage B exclusions.
Either way, the pool cover simply "ain't" covered for/from a weight of water causation in the instant situation wherein AllCatMan has said the whole loss chain began/begins with weight of water on the pool cover!
The pool cover isn't covered as a Named Peril if one argues it is personal property, and it isn't covered by way of exclusion if one argues it is part of the pool.
Now is it clear? |
Edited by - JimF on 06/08/2003 19:32:50 |
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sbeau4014
USA
53 Posts |
Posted - 06/08/2003 : 19:32:07
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Wes,
I had a identical incident about 3 yrs ago on an olympic size pool at a country club that had the deep end pop out of the ground about 4-5' and the shallow end about a foot. Destroyed the pool and almost all the deck around. Under the commercial package policy it had the standard surface water.... exclusion and wasn't covered. I recommended that the Board at the CC go after the pool repair company as I found out that it is somewhat common practice in that area (Houston area with higher water tables) that the repair company will drill some pressure relief holes in the bottom of the pool if the water will be out for any time at all. The heavy rains that floated this out of the ground was forecast and was not a fluke. Needless to say, they had a sizeable uninsured loss and I know they did collect some from the liability carrier for the pool co, but I'm unsure to what degree. Underground fuel tanks will do the same thing if drained too much in high water tables. |
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CCarr
Canada
1200 Posts |
Posted - 06/08/2003 : 21:27:35
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Jim, I see nothing wrong in having different interpretations a/o opinions with regards to coverage with this scenario. However, I am quite sure we are both considering the same scenario that Mikey has put before us.
I don't have much more to say or say differently, but perhaps I note the crux or origin of our difference in your 18.18 post - the cover on the pool, a.k.a. the "pool cover".
I had to go back and look yet again at Mikey's "what if" post, and I still note that there is no mention al all of any damage to the "pool cover".
Without case law to establish otherwise, there will be those that feel the pool cover is a "swimming pool", and those like myself that do not feel the pool cover comes within the definition of "swimming pool". As well, there will be two camps of thought relative to whether the water accumulated on the pool cover has any relationship to "surface water".
However, the first thing damaged in this claim is the patio stone edging - there is no mention of damage to the pool cover or its fasteners.
Again, within Section I - Perils Insured Against, for Coverage A&B, the pulling up of the patio stone edging and the resultant hurdle of some into the pool is covered; unless I can fit one of the 3 exclusions and their parts into this scenario. It is certainly not a collapse, and the accumulated water on the pool cover with its fasteners attached to the patio stone edging, is not; ".... pressure or weight of water .... to a .... patio".
When I think of the pool cover attached with fasteners to the patio - why don't I call the pool cover the "patio"; if that was the case then the pressure or weight of water would be to the "patio" as the pool cover is the "patio". Isn't that the same logic as those that see the pool cover as the "swimming pool"? We may call it a 'pool cover', but it is sitting over the swimming pool but attached to the patio.
Anyway, in the absence of an exclusion within the P.I.A. of Coverage A&B for the pulled up and catapulting patio stone edging, I then explore Section I - Exclusions where I don't think anyone could logically bring "flood" into the discussion, and again in the absence of case law to more clearly define "surface water" in the relevant jurisdiction - the water that lies on the pool cover is not surface water within the context of exclusion (c1).
We differ on this, so be it, I don't see the point in thrashing it around more; maybe others will take up the discussion with or against your view.
Now Lannie, you are going to hurt yourself climbing on and off the fence.
** By edit, I have not changed any wording of this post, but simply tried to emphasize a few phrases, which might assist in understanding another view of the 'Domino game'. |
Edited by - CCarr on 06/13/2003 07:50:02 |
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JimF
USA
1014 Posts |
Posted - 06/08/2003 : 22:00:58
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Clayton:
This really is simple:
I'll concede that surface water is not at issue under the AllCatMan scenario. Whether there was or was not surface water is irrelevant to a determination of coverage.
Next. The pool cover is irrelevant as well in the following sense:
If the pool cover is part of the swimming pool and the weight of water was the causation, then this is a non-covered loss.
If the pool cover is part of the patio and the weight of water was the causation, then this is a non-covered loss.
If the pool cover is part of the pavement and the weight of water was the causation, then this is a non-covered loss.
If the pool cover is personal property (Coverage C item) and weight of water was the causation, then this is a non-covered loss.
If the pool cover was anchored to the veneer (edging stone) instead of the underlying concrete base, then the edging stone patio was either improperly designed or improperly installed in violation of building codes, which would also result in a non-covered loss.
If the pool cover IN ANY WAY, SHAPE, FORM OR FASHION was the initial triggering event for the ensuing chain of events, then this is a non-covered loss.
If the edging stone simply catapaulted into the pool (as you suggest) WITHOUT some EXPLAINABLE AND/OR DEFINABLE causation, then this is a non-covered loss, as it would not be an accidental loss, but rather the byproduct of some issue having to do with latent defect, inherent vice, improper design, etc.
So the bottom line in you determing coverage, me determing coverage, others determining coverage, the vendor determining coverage, and the carrier determining coverage is simply this:
Clayton, please explain to all of us: WHAT IN THE HELL CAUSED THE EDGING STONE TO 'CATAPAULT' INTO THE SWIMMING POOL?
Wind?
Hail?
Lightning?
Surface water?
Vandalism?
Weight of Water?
Hydrostatic Pressure?
Latent Vice?
Inherent Defect?
Improper Design?
There simply MUST be a reason. Otherwise, this would be a non-covered loss de facto.
Surely Clayton, you can provide us with just ONE EXPLANATION of causation, and if not, then I think we both could agree you need to recommend to the carrier that they hire an engineer who CAN make such a determination and you or any other adjuster should refrain from making ANY coverage determinations until then!
You are correct, that AllCatMan's scenario did not note any damage to the pool cover, yet that is not only important but imperative in that without damage to the pool cover (from a Coverage C peril) there can be no ensuing covered chain of covered events.
You fail in advancing your comment, that the first thing "damaged" was the edging stone by not providing us with any reasonable explanation of why the edging stone so mysteriously just up and decided to catapault or jump into the pool. I suggest that save the explanation provided directly by AllCatMan in presenting his scenario, would in fact essentially rely on flooding (which is not covered) or any one of the other excluded causes of loss: inherent vice, latent defects, deferred maintenance, improper design/installation, collapse or others, all of which are clearly excluded. If there is ANY reason that you can POSSIBLY think of which would explain why this edging stone would suddenly "catapault" into a pool WITHOUT SOME EXPLANATION, please, please, please share your reasoning with us.
Again, it is simple, this is not a covered cause of loss, for the simple reason that (1) there is no Coverage C Named Peril which would cover the initial triggering loss assuming "weight of water" was the cause of loss to the pool cover (assuming pool cover is treated as personal property) OR (2) if weight of water is the cause of loss without regard to the pool cover then it is otherwise excluded by Coverage B Exclusions OR (3) if the stone edging constituted a "collapse" this is a non-covered loss by way of the collapse exclusions OR (4) your suggestion that the edging stone simply catapaulted into the swimming pool without any distinct "cause" is simply not only astounding but incredulous, and would clearly fall into categories of defect, vice, maintenance, design, installation, all of which are simply excluded.
Finally in the end Clayton, you say that the first thing damaged under the AllCatMan's scenario was the edging stone.
To allow me and others here to determine coverage or denial for this claim, under your scenario of the edging stone being the first item damaged, PLEASE EXPLAIN TO US WHAT DAMAGED THE EDGING STONE?
There is not a claims manager for an insurance carrier anywhere in America that would not ask THAT question of an adjuster, and for you to suggest that there is coverage for this loss, then you simply owe that claims manager and the rest of us YOUR REASON for the DAMAGE to the edging stone.
Until then and only then, can anyone (including your carrier) make a proper and reasonable determination of coverage.
I note finally, your failure to answer any of the specific questions I have posed while you attempt to change the focus of the initial scenario, and while suggesting an end of the discussion due to your perception that this is an ambiguous coverage question. A point with which I simply beg to disagree with entirely.
Please Clayton, for God's sakes, just simply go back to the 1st of Jim Lake's "3-C's" and tell us WHAT caused this loss! (Cause, Coverage, Cost) |
Edited by - JimF on 06/08/2003 22:44:50 |
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CCarr
Canada
1200 Posts |
Posted - 06/08/2003 : 22:38:01
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The "patio" made of stone edging, a.k.a. the stone edged patio, is covered property as, ".... described in Coverages A and B ....". There was a direct and physical loss to that "patio" when some of its stone edging lifted and subsequently damaged the patio and some unknown number of pieces of stone edging separated from the patio. Section I - Perils Insured Against says, "we insure against" - 'that'; subject to the "however".
That is the nature of all risk coverage as I see it. It is not like a named perils or specified peril coverage, where I have to find and label a cause that is named or specified. This is all risk coverage subject to, ".... we do not insure, however for loss .... caused by ....". The loss is covered (all risk) unless I can substantiate an excluded cause; which I can't with the scenario presented. |
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JimF
USA
1014 Posts |
Posted - 06/08/2003 : 22:52:49
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Clayton, if the stone edging lifted and fell into the pool because it was improperly installed would this be a covered cause of loss?
Clayton, if the stone edging lifted and fell into the pool because it was improperly designed would this be a covered cause of loss?
Clayton, if the stone edging lifted and fell into the pool due to latent defect would this be a covered cause of loss?
Clayton, if the stone edging lifted and fell into the pool due to inherent vice would this be a covered cause of loss?
Clayton, if the stone edging lifted and fell into the pool due to weight of water would this be a covered cause of loss?
Clayton, if the stone edging lifted and fell into the pool because of collapse would this be a covered cause of loss?
Clayton, if the stone edging lifted and fell into the pool because of inadequate maintenance would this be a covered cause of loss?
Clayton, if the stone edging lifted and fell into the pool because of settling, shrinking, bulging or expansion would this be a covered cause of loss?
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Edited by - JimF on 06/08/2003 23:02:55 |
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CCarr
Canada
1200 Posts |
Posted - 06/09/2003 : 07:48:13
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Well as expected, this 'discussion' has now deteriorated to the point where I no longer wish to participate in it.
My final comment to this thread is a simple guideline with respect to the elusive issue of coverage for any loss - and is as noted in the last paragraph of my previous post.
Again, with Mikey's scenario, with this Coverage A&B being all risk, I am not looking for a 'covered cause of loss'; instead I am looking at what happened to see if that is one of the exclusions noted to the all risk coverage. Again, that is quite a different exercise than that which is considered when a named peril or specified peril coverage is applicable. When N/P or S/P coverage is in force, I then must look for a 'covered cause of loss', because that type of coverage tells me the limited number of covered causes of loss that are applicable.
Jim, I think the questions in your 6/8 22.52 post are silly in relation to the original discussion of Mikey's scenario.
Obviously, anyone should / could answer "no" eight times to whatever point you are trying to make. If my coverage opinion should have been prefaced or qualified with any or all of these eight things; so be it. However, I don't think the scenario first presented by Mikey, was intended to turn into an engineering study on the cause or origin of the eight things you brought forward in your last post.
No point in directing any further issues on this thread to me. |
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Floating Pool
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