Go to previous topic
Go to next topic
Last Post 11/25/2009 1:35 AM by  rickhans
Three Trade Rule for O&P
 35 Replies
Author Messages
wscook
Member
Member
Posts:68


--
11/20/2009 1:11 PM

    Rules of thumb with no validity should not be a part of our industry,

    The rule of three trades being necesary for a repair to cause the inclusion of Overhead and Profit on payment of a loss.  I have been around campus for quite a few years and have usually applicd that logic to establishing the entitlement to the O&P provisions.  I challenge the old timers to show me where that logic originated or who originated it.  I seem to recall in past readings that a SF claims examiner in the midwest denied O&P for lack of three trades in a repair settlement and it has been adopted as an industry standard.  Why not two trades/  Why not four trades?  Things are quite in the forum so this should create some dialog.

    William S Cook

    Florida PA

    William S Cook Public Adjuster/Umpire/Appraiser
    Tags: Popular
    0
    ChuckDeaton
    Life Member
    Senior Member
    Senior Member
    Posts:1110


    --
    11/20/2009 4:20 PM
    Lets go back a bit, first will someone define a "trade". To qualify as a "trade" does the practitioner need a license?
    "Prattling on and on about being an ass with experience doesn't make someone experienced. It just makes you an ass." Rod Buvens, Pilot grunt
    0
    Ol' Ghost
    Member
    Member
    Posts:279


    --
    11/20/2009 4:49 PM
    It started out on the theory that the Insured could reasonably handle calling out two maybe three tradesman for a typical small loss. For example our old friend, the peril of Wind & Hail. The roof is damaged, the Insured can call the roofer. Also, the fence blew down, so a simple call to the fence company is within a reasonable persons capability. The A/C condensor has some dents, so he can call the A/C company to come out to comb the fins. That's the magic three trades, but the whole loss is within the reasonable capabilities of the Insured sitting down and calling the local tradesmen. So, the application of O&P is not reasonable to be included.

    Next comes the interior water loss. There is damage to a ceiling, a couple of electrical fixtures, and some attendant carpentery. Three trades involving a ccoordination of the work and the Insured, while a normal capable person, cannot be reasonably expected to arrange the activities of the tradesmen, so the services of a coordinator, sometimes called a General Contractor is needed. Now, the General Contractor is due a fee. That fee has traditionally been set at 20-21% of the various subcontractors total bills.

    That's what I was taught.

    Ol' Ghost
    0
    Tom Toll
    Moderator & Life Member
    Senior Member
    Senior Member
    Posts:1865


    --
    11/20/2009 6:36 PM

    You drove the nail straight in Ghost. That's the way it is and should be and has been all the years I have been doing this mess.

    Success is not final, failure is not fatal: it is the courage to continue that counts.
    0
    Leland
    Advanced Member
    Advanced Member
    Posts:741


    --
    11/20/2009 7:15 PM
    It's a guideline, not a rule as far as I'm concerned. If an adjuster has a claim with one or two trades, and he or she takes about one second to consider whether a general contractor is necessary, then a good faith adjustment has occurred.

    Don't put yourself in a situation where you are being deposed on a $200,000 two trade loss and you have to admit you never even considered allowing for a general contractor.

    Considering 10 & 10 and deciding it's not needed = good.

    Not bothering to consider it for at least one second = bad.

    Its theoretically possible that a two trade loss would need a general contractor, but I can't think of two many examples.

    How about wallpaper on a 30' wall?

    Would it be reasonable to pay for a general contractor (to set up scaffolding?)

    I don't know the answer to that particular example, but I do know that thought needs to go into our decisions.

    0
    dcmarlin
    Member
    Member
    Posts:110


    --
    11/20/2009 8:37 PM
    I agree with ya'll. You have to look at the job as a whole, as well as the capabilities of the insured, and not just number of trades.

    Let's say you have a small water leak in a bathroom. You have a drywall repair and painting as well as electrical, to remove and reset a light fixture, and plumbing to remove and reset the toilet. Although you have four "trades" involved, most will have a "man with a pickup" complete the entire job. Thus, in most situations, I see no reason to add O&P.

    Now, you have a claim with the same four trades involved but in an apartment building damaging 20 units. In this case, O&P is probably warranted as a GC should be used due to the coordination required.
    Gimme a bottle of anything and a glazed donut ... to go! (DLR)
    0
    Bobabooey
    Member
    Member
    Posts:140


    --
    11/20/2009 10:19 PM
    They don't care about what is right. They just want more money for nothing. The push is to put O&P on roof claims so the roofers can say "look at that 1 inch water stain by the fireplace. That is paint drywall and insulation damage. Now you owe me 20% more on the $20000 roof I am replacing". Just more theft.

    Why not just let contractors and PA'S write the estimates to begin with? Because we would be gutting every house that had a roof leak.
    0
    jdacree
    Member
    Member
    Posts:161


    --
    11/20/2009 10:51 PM
    Two trades, three trades, no trades, whatever, In the first case as someone mentioned above contractors and PA's want that in the claim. They get paid on the total soze of the claim, as do some SANTA CLAUSE adjusters. Avrice is and will be a part of any business dealing where the compensation is based on the dollar amount of the transaction.

    Now as to how O&P should be allowed, Ol ghost gave a good explanation of a need to coordinate activities between groups of workers, which is quite correct. Some person GC or otherwise is going to have to stay on the phone and keep the ball rolling, that time is worth something.

    Someone mentioned that some guy in a pickup truck is going to do all of the work. That guy in the pickup, if he has sheetrock repair, tape and float, then oil based paint is going to make multiple trips both to the job site and forthe materials may have to go to mutiple locations to get the materials. As with the GC that time is worth something.

    Someone mentioned that you have to look at the capabilities of the insured. Old Aunt Martha, that only has a need to cut up and haul off the tree that crushed the outhouse (which has not been used in 40 years), has absolutly NO CLUE what to do, so she calls her nice nephew that can get anything done. His time is worth something even though he wold never dream of charging her, or telling her to call and hire a GC.

    In all of the cases above, a coordination of activities has to take place to get the property repaired. In the examples above we have multiple trades, few trades and no trades, but the basic concept of the need to coordinate is present. Also all of the discussions, save one, indicates a need for the adjuster to determine the amount of coordination required.

    That need for determination on the site by the adjuster eliminates any possibility of standardization. I feel as was stated above that the adjuster has to THINK and analyize each claim. With that action he can follow another unwritten rule if this was his policy and his property, what fair and reasonible decision would he make based on all of the items to consider.
    Jim Acree Stupidity is the art of not trying to learn Ignorance is the lack of opportunity to learn I am ignorant
    0
    Ol' Ghost
    Member
    Member
    Posts:279


    --
    11/20/2009 11:16 PM
    Jim, while you were composing this post, you should have been on the phone setting an appointment to try and sell another roof. If your boss finds out you're here, he'll be pissed. Then, you will be back home with lots of spare time to compose CADO entries.

    Ol' Ghost
    0
    jdacree
    Member
    Member
    Posts:161


    --
    11/20/2009 11:51 PM
    Ol Ghost, I am multi-facted. I set two appointments while composing. My "Boss" already knows that I am on this site, and getting a balanced set of answers relative to what I see in the field. While being uncomfortable with my quest for knowledge, from outside the "clan" he is aware of my position. The company pays me a commision for what I sell. They supply advertising literature, and maintain a company web site for tracking leads and sales. They pay to put thier logo on my truck and polo shirts with thier name on it. I pay all other sales related expenses. Based on the above I am self employed, and he is aware that if he does not like the way I perform my duties, or I do not turn in my paperwork to suit his guidelines he is free to cut me loose. In all other aspects of how I go about doing my business, he can keep his opnion to himself, and he has been told that in more than one conversation.

    He is well aware that I do not use the standard tatic employed by some roofing salesmen of marking up everything on the roof then asking the adjuster to tell me what that is if it ain't hail. I will not stand in public and act that ignorant.

    I feel that my independence and maverick attitude have offended you. For that I am sorry in that we have never met, in other than honest conversation. Should we ever have to meet in our diverse capabilities, on a roof, I will surly endeavor to stay on the upslope from you. I do thank you and all of the others that have responded to my various questions and comments. I AM obtaining the goal that I came to Colorado for, that being to learn as much about what wind and hail can do to a roof and other structures as I possibly can. I do not care where that education comes from, either contractors or adjusters. I feel that I have the intelligence to seperate the BS from the fact, and then apply that fact to the needs of all parties involved.

    Opps there goes the phone. may be another appointment, Acree out, good night.
    Jim Acree Stupidity is the art of not trying to learn Ignorance is the lack of opportunity to learn I am ignorant
    0
    Ray Hall
    Senior Member
    Senior Member
    Posts:2443


    --
    11/21/2009 1:47 AM

    I think I disagree with all the post. Unit prices came about in the late 1950's. The first auto estimates I looked at were parts, labor and material. The first property estimates from the pick up truck carpenter who did much of the small repair work in this area was in board feet, # of nails . gallons of paint , rolls of wallpaper and hours of labor, then profit was the last figure.

    Contractors began calling themselves "insurance conttractors" and worked on 1/3rd material cost, 1/3 labor and 1/3 profit in an metro area like greator Houston or 1 hours drive. Extra expense was an add on. The price list were published by all the "insurance contractors" and sent to ever property adjusters office and the adjuster used one or more of these published prices to write his scope to see if the contractor was between the ditches. In the event of a large catastrophe about 15 to 20 contractors and asjusters met as soon as the wind stopped and worked up a price list for all the local and all of the out of town adjusters to use as a price guide. 

    In the late 80's we began to see a few DOS programs that were only word processors with an adding machine. All were designed to have the unit price changed by the estimator. We were still thinking 1/3, 1/3. 1/3 after doing it this way for over 30 years. Then along comes one program for adjusters that added a feature from the contractor program called O&P of 10+10=21% or 20% take your choice. The vender system recruited from the contractor ranks and this program with a unit price of .45 to clean a small ash tray became very popular for the "complete estimate"

    Catastrophe adjusters, were brain washed by the vendors and carriers by rejecting files that was not  the most used  contractors estimate as it was not in the correct data base, therefore it was incorrect. Very qualified adjusters were not permitted to change the data base on a very problomatic loss to get it closed.

    This monster was created by the carriers, who hired adjusters to stop the phone's from ringing and leave the hard cases for the clean up team after the worms fell by the wayside. In my opine ever software program has all the cost in the unit price(if the unit price is the market price) and ever estimate should have a gross profit of between 30 to 40% for all general contractors who are begging for this work. This lawsuit should have never been filed as it was not the contractors who would not do the work. It was the greedy insurards who wanted "more" of the dumb insurance carriers money, who allowed this myth to grow into this monster "its owed if you have three trades"

    I have the feeling I may see this post on the big screen someday soon.

     

     

     

     

    0
    okclarryd
    Veteran Member
    Veteran Member
    Posts:954


    --
    11/21/2009 4:04 PM
    Hang in there, Jim.

    Put on some more o' that "tough-skin" ointment and call us in the morning.
    Larry D Hardin
    0
    Joeblack
    Guest
    Guest
    Posts:47


    --
    11/21/2009 6:47 PM

    I first heard of this concept in 1979. Where and when it originated, I don't know. It had probably been around for years even at that time.

    I have always been of the impression that the reason for this "rule" was that an insured did not need a general contractor to plan, schedule or run the repairs if only two trades were involved, unless the repairs were very unusual or complicated.

    For instance, if the only damage is to a roof, the insured surely doesn't need a general contractor to get the roof replaced. Just call a roofing company.

    I, personally, don't have a problem with this procedure.

    0
    jdacree
    Member
    Member
    Posts:161


    --
    11/21/2009 9:19 PM
    Thanks OKCLARRYD. I bought my tough skin ointment in 55 gallon barrels after my fist post and question on this site. The person that I responded to , realizing it or not, has given me the best crash course on overcoming objections that I could ever find. While NOT ANSWERING one question in the posts of his that I have read, the information presented is very good at presenting every argument that can be consieved to NOT answer a question. I will continue to enjoy posting on this site, asking questions, exploring my new information (knowledge) in the form of input to a question, and comparing the information gained here to the information from the "blue team". As stated I am here to learn, and I am learning a lot. Thanks again for all of the answers, constructive critism, and the crash course in overcoming objections.
    Jim Acree Stupidity is the art of not trying to learn Ignorance is the lack of opportunity to learn I am ignorant
    0
    BobH
    Veteran Member
    Veteran Member
    Posts:759


    --
    11/21/2009 10:36 PM

    Bob H
    0
    RJortberg
    Member
    Member
    Posts:147


    --
    11/23/2009 1:25 AM

    Jim- my only advice is to use spell check (and sunscreen, but that one came from a Dave Berry commencement address, so I can't take credit for that). To use spell check, you go to edit your post (once posted), and then click on the spell check icon. Good luck with your time in the barrel.

    0
    johnpostava
    SIMSOL.com
    Member
    Member
    Posts:141


    --
    11/23/2009 9:06 AM
    Let this adjuster/software guy chime in (since I have been asked by many attornies on this subject). I have done research and can not find the "Three Trade Rule" (TTR) printed anywhere in insurance-related references. The TTR is just a rule-of-thumb but still needs to be considered on every loss. At the least it should be mentioned (sometimes in detail) in every narrative and/or short form report (why it was included or not included in the estimate). I have paid OP on one-trade losses if the NI (named insured) is too old to adequatly manage the repair and if it is commecial loss where additional supervision was needed. Here's a question for the PA's out there...If an NI has a multi-trade loss and is managing his or her own repairs, how much, if any, should the NI be allowed for "overhead" to manage the job (call the vendors, be there for their appointments, examine their progress, etc.)? Of course, no NI can "Profit" from an insurance claim but what about their efforts and time bringing the risk back to pre-loss condition without the use of a general contractor?
    0
    claims_ray
    Member
    Member
    Posts:293


    --
    11/23/2009 10:24 AM
    I have paid an insured the typical 10% overhead on a claim for acting as their own GC. The only way I was allowed to do this was with a signed affidavit. The insured had requested profit as well however as John has noted above this was not going to fly.

    How many of you are ever instructed not to include O&P unless or untill a contractor is involved and it is being requested or if the claim is over a certain dollar amount with TTR?

    Should this be or should it be the adjuster's common sense and experience to include O&P if and when they believe it is necessary?

    Is O&P limited to GC's or all contractors?

    I have come across numerous contractors that have not requested O&P and one that requested it after submitting his bill for work that had already been performed.
    0
    Leland
    Advanced Member
    Advanced Member
    Posts:741


    --
    11/23/2009 10:32 AM
    Some carriers are perfectly comfortable paying 10 and 10 to the insured's that do their own work. The theory is that the value of the loss is equal to what a contractor would charge, everything included. Under this way of thinking, the insured is not "profiting" from the loss, just getting paid the market value.

    Maybe it's based on California case law, I don't know. (Maybe I will find out).

    I know some carriers that will pay only the "O" but some will pay both the "O" and the "P" to owner builders.

    It's always a good idea to ask the carrier how they want it done.

    0
    Ray Hall
    Senior Member
    Senior Member
    Posts:2443


    --
    11/23/2009 11:05 AM

    Why should the insurance property re-contruction industry be any differant from most all of the other services offered to the public. Have you ever seen an auto estimate on a collision with O &P added to the bottom line. Have you ever seen a legal fee bill with O & P added. I still contend the price guides, the sodtware estimating programs used in insurance property claims have  a  built in P & O of at least 33.3 for profit & overhead. If they do not ever loss since the first computer generator estimatge is if prima facia evidence of deliberate fraud by the carriers and price fixing which is also deceptive trade practice.

    0
    wscook
    Member
    Member
    Posts:68


    --
    11/23/2009 11:56 AM
    Posted By johnpostava on 23 Nov 2009 09:06 AM
    Let this adjuster/software guy chime in (since I have been asked by many attornies on this subject). I have done research and can not find the "Three Trade Rule" (TTR) printed anywhere in insurance-related references. The TTR is just a rule-of-thumb but still needs to be considered on every loss. At the least it should be mentioned (sometimes in detail) in every narrative and/or short form report (why it was included or not included in the estimate). I have paid OP on one-trade losses if the NI (named insured) is too old to adequatly manage the repair and if it is commecial loss where additional supervision was needed. Here's a question for the PA's out there...If an NI has a multi-trade loss and is managing his or her own repairs, how much, if any, should the NI be allowed for "overhead" to manage the job (call the vendors, be there for their appointments, examine their progress, etc.)? Of course, no NI can "Profit" from an insurance claim but what about their efforts and time bringing the risk back to pre-loss condition without the use of a general contractor?


    As a PA I have a rule of thumb that if the NI paid a premium for replacement cost in the event of a loss, then it would be a fraud on the insured to deny him the entitlements that he paid EXTRA  permiums for.  It is already accepted, by the contract terms, that he can be better off with new for old, which is a profit in every sense of the word.  Wait a minute.... that is a contractual condition and my rule of thumb would not be needed.  Where in any known legally drafted contract can a RULE OF THUMB be considered by the courts.  I look forward to the time when either Simsol, Xmate, Msb or Powerclaim claim will have a line item for RULE OF THUMBS, considering that the plural is effective as there may be more than one RULE OF THUMB.  Suppose the NI has decided tht he did not wish to repair his home and in the alternative discount the price by the cost of making replacement cost of repairs.  He paid a premium to get full cost of repairs and has incurred the loss when he discounted the price to the new purchaser.  If the industry is willing to acceept RULES OF THUMBS please advise as I would like to register a few that would serve my interest outside the contract terms, but only with the understanding and condition that they will never be identfiable as to where they came from.
     

     

    William S Cook

    Public Adjuster

    William S Cook Public Adjuster/Umpire/Appraiser
    0
    Leland
    Advanced Member
    Advanced Member
    Posts:741


    --
    11/23/2009 12:48 PM
    Actually there is one original "rule of thumb" which used to be a principle of common law in England, where the term came from. Look it up, its too controversial for me to post it here.
    0
    Tom Toll
    Moderator & Life Member
    Senior Member
    Senior Member
    Posts:1865


    --
    11/23/2009 1:37 PM

    A rule of thumb is a principal with broad application that is not intended to be strictly accurate or reliable for every situation. It is an easily learned and easily applied procedure for approximately calculating or recalling some value, or for making some determination. This is our interpretation of the rule of thumb.



    If you look up the rule of thumb, as suggested, you're going to find many applications and purposes to the term in many types of society and countries. So, there is no set rule or law that determines what the rule of thumb is.



    Success is not final, failure is not fatal: it is the courage to continue that counts.
    0
    Leland
    Advanced Member
    Advanced Member
    Posts:741


    --
    11/23/2009 1:57 PM
    I was half joking, supposedly the only time "rule of thumb" was used as a legal term, and the supposed origin of the term, was a court ruling that a man could beat his wife with a stick as long as it wasn't wider than his thumb. This "rule of thumb" was apparently referred to in later U.S. cases. I looked it up just now after posting, and it appears that the origin of "rule of thumb" is actually much older than that, and as you say, has many different meanings and possible origins. So there is a story that "rule of thumb" is from an actual court case, but that may actually be a legend.

    For what it's worth I used to use my thumb to approximate an inch- the first big wrinkle on my knuckle to the edge of my nail is about one inch.

    0
    Medulus
    Moderator
    Veteran Member
    Veteran Member
    Posts:786


    --
    11/23/2009 2:00 PM

    I am playing catch up here, and was reading this post as a short break between handling a couple of complex claims. So I may have missed something along the way. With that disclaimer, however, I find myself agreeing most with Leland - especially his first post on this thread.

    Back in the mafia areas of Pennsylvania an adage arose that said, "There are no laws; only rules." Actually, the rules became a sort of unwritten law. The same thing has occurred with the three trade rule. If I were working for one of the big companies, they would be pounding the rule into me as if it were a law. However, at this point in time, I don't work for one of the big companies. That means my supervisor and I make the decision when to add overhead and profit. And my rule is: Does it make sense to add overhead and profit to this job? Except where the courts have ruled otherwise, overhead and profit is only owed if overhead and profit is incurred. This is a corollary of the principal of indemnity. If the three trades involved are HVAC, roofing, and fencing - and the insured calls three separate contractors - overhead and profit is not owed. Also, there may be twelve trades, but the insured may call a separate electrician. Then overhead and profit would be owed on most of the job, but not on the electrical work. If the insured calls out a water remediation company and then later calls a general contractor to do the repairs, O&P would not be owed on the water remediation service. But if the insured calls a general contractor first, and the general contractor calls the water remediation folks, then O&P may apply to the entire job, including the water remediation.

    What we need to keep in mind is that we have a legal standing of one with "superior knowledge" (I can hear the mocking laughter even as I write that phrase). The insured is not generally expected to know that he or she should call a single contractor on one job but a general contractor on another job. This should be part of the explanation given to the insured by the adjuster. If the only damage is to a roof, the adjuster should be explaining to the insured that he or she should call a roofing contractor rather than a general contractor. If this is not explained to the insured, and the insured throws open his yellow pages to Contractors and picks one at random, picking a general contractor who then calls his roofing subcontractor to come and do the work, then what court is going to say the insured should be stuck paying the Overhead and Profit? A good adjuster is going to explain to the insured how to proceed after the inspection. This should take about an extra minute before we run on to the next inspection. This type of communication is what is expected of us, and this is part of why they "pay us the big bucks". And it will save a multitude of headaches for the staff adjuster left to deal with the clean up of the cat event. The insured is not expected, under the law, to be an expert in construction and insurance. We are supposed to be, and we are - to varying degrees. When the claim goes to court there is a pre-supposition that we have this "superior knowledge", so we should be using it in the field to assist the insured in getting repairs done without incurring additional costs beyond their deductible.

    If anyone has any information on the recent settlement in Oregon involving Nationwide and concerning O&P not paid by Nationwide, I would be interested in finding out more about that case. What I know is that Nationwide did not pay O&P over a course of years on certain claims. A class action suit was brought which Nationwide settled out of court by agreeing to pay 20% more on the involved claims. I don't know more than that. Perhaps someone here does.

    Seems I did it again.  I set out to post a couple lines and ended up writing a small book.  Sorry, all.

    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
    0
    Leland
    Advanced Member
    Advanced Member
    Posts:741


    --
    11/23/2009 2:10 PM
    And, like always, case law on things like this varies from state to state. Not to mention flood claims, which is Federal....
    0
    Leland
    Advanced Member
    Advanced Member
    Posts:741


    --
    11/23/2009 2:38 PM
    When an adjuster applies good faith and analyzes whether overhead and profit is applicable, the adjuster is usually relying on his or her experience and knowledge of the construction world.

    By comparison, when carriers have a coverage question they often turn to an outside expert, their attorney, and get a written opinion. By using a third party opinion, its not nearly as likely to incur a bad faith claim.

    It's generally not bad faith to rely on experts.

    Adjusters can follow a similar procedure when analyzing whether to apply overhead and profit. It may be appropriate to send the question to one or more contractors and ask them if they think the O&P is needed. If they say no, and put in in writing, the adjuster can, in good faith, not include the O & P.

    Imagine the scenario alluded to above where the contractor finds a tiny water stain on the drywall to try and add 10 & 10 to a $200,000.00 roof repair.

    If the adjuster verifies with one or more other roofers that an extra $40,000.00 of O& P is not justified, it will be much harder for the insured to allege otherwise or successfully claim bad faith.

    If the adjuster just "knows" that the extra $40,000.00 is unjustified, and simply says no without documentation from a third party, he may be 100% dead on accurate but he will have a harder time defending himself down the road. It doesn't always matter what the adjuster "knows" but what he can "prove" or "document".

    The flip side of the coin of course is if the third party roofer comes back and says the $40,000.00 is fair....
    0
    wscook
    Member
    Member
    Posts:68


    --
    11/23/2009 2:38 PM

    Well it appears we have a consensus of thoughts.  We all have differing opinons.   Who will be the first expert to admit that they opine that the RULE OF THUMB has a place in a contract of insurance. I need your participation  in a court case that I am currently involved in. I looked in my policy definitions, nothing there in any of my sample policies about three trades or ruls of thumb.  I then looked in my two  Blacks Law dictionary, nothing there.  I looked on the internet at google and wickipidia,  only ancient ancient history about beating your wife or distance from the coast on a chart.  None of the sources had any mention of rule of thumb or three trade rule applicable to a contract of insurance or reducing the entitlements in a contract.  As of this point in time the thread had almost 1400 eyeballs looks and not one opinion among all of the professionals that participate in this forum to provide any validity to RULES OF THUMB as it may LEGITIMATLY apply to  a claim payment.  Mr. Postava says it should be noted in an estimate as to why O&P was addressed under the three trade rule.  I think that is an excellent idea rather than orally explaining to an insured that it is just kind of an industry practice that is applied when the moon is in the seventh house or for whatever reason can be conjured at the time, based on an individuals RULE OF THUMB interpretation.

     

    William S Cook

    Florida PA

    PS

    Thanks Roy for allowing me represent the dark side and  address some issues on some occsions

    William S Cook Public Adjuster/Umpire/Appraiser
    0
    Medulus
    Moderator
    Veteran Member
    Veteran Member
    Posts:786


    --
    11/23/2009 2:58 PM
    One of these days, we're going to be on opposite sides of the same claim, Sir Cook. We'll surely have fun, then. Won't we? I value your participation here.
    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
    0
    Leland
    Advanced Member
    Advanced Member
    Posts:741


    --
    11/23/2009 3:17 PM
    Mr. Cook, I love your contributions to this community, but like I was implying above, a "rule of thumb" or any other usual or customary practice in a particualr industry could be the basis for a fair settlement, even though the wording doesn't appear in any policy.

    For example, union painters are often taught that all intersecting surfaces must be caulked, prior to painting. This "trade practice", like a rule of thumb, is not spelled out in any policy I have ever seen. Are you suggesting that insurance companies should not pay for caulking anymore? Your argument cuts both ways.

    What exactly is "workmanlike manner"? - that's a popular term from case law.

    I think the issue of "rules of thumb" is not whether it's OK to use them but when to use them and who to ask.

    As always the true value of the loss is the reasonable price a licensed contractor would charge, in an arm's length transaction, to restore the property to the pre loss condition in a workmanlike manner, using legal employees, while carrying liability insurance etc. If that honest contractor (and/or similar contractors) says the job needs O&P then it probably does. If he says it doesn't, it probably doesn't.

    Obviously there are always going to be differences of opinion but if the going market pricing for $200,000.00 roofs with $500.00 ceiling stains is no O&P then O&P is not owed. If the market pricing is O&P on that kind of loss, then O&P is owed.

    We can talk theory and software etc all day long, but it's real hard for me to imagine some roofers sitting around at the restaurant insisting that an insurance company was unfair for not paying an extra $40,000.00 for the example I gave.

    And who knows, I wouldn't be surprised if the experienced roofers had a rule of thumb: "For any interior work under $1000.00 I don't ask for 10 & 10".

    If, hypothetically, two or more roofers agreed with that rule of thumb I would be inclined to make my payment recommendation agree, and I wouldn't feel awkward quoting them in my report or even my letter to an esteemed Public Adjuster such as yourself.

    And of course, since it is a free country (still) you can try to find a roofer that will say the opposite.
    0
    rickhans
    Member
    Member
    Posts:111


    --
    11/23/2009 3:45 PM

    I have posted entries on a few threads about the O&P subject with a lot of detail, explaining that there have been multiple suits and rulings around the U.S. that say it is owed to the insured whether or not they hire a contractor, do the work themselves, or even don't do the repairs.  Here is the first quote that I have posted, although this is just part of a longer article.  The link takes you to the Merlin Law Group web site where Chip Merlin posted the article, and at the end allows it to be sent to others, so I assume it is ok to post here.

    Hopefully this will clear up the misunderstanding where some have expressed the opinion that the homeowner is not entitled to overhead and profit, although I am sure some will not agree with the various court descisions.  As to the question about the Nationwide lawsuit in Oregon, the lawsuit was class action nationwide against nationwide, so far as I know.  I know that Texas, Ark, and Ok were included because I received notfication of the lawsuit for properties I own in Texas and Oklahoma although I declined to be part of the class since I had never had a claim other than for hail with Nationwide. The following article, I think, clearly states the position that the Texas Dept. of Ins. takes in this matter, as do several other states based on rulings that I have studied.

    http://www.propertyinsurancecoverag...attention/

     

    "On June 12, 1998, the Texas Department of Insurance issued Bulletin #B-004598, indicating that the deduction of a prospective contractor’s overhead and profit and sales tax, in determining the actual cash value under a replacement cost policy, is improper. The Department noted that the wrongful interpretation of language in the Texas Standard Homeowner’s Policy generated two class action lawsuits and various inquiries to the Department’s position on the matter.

    In explaining its reasoning, the Department noted that “there is no situation in which the deduction from replacement cost of depreciation and contractor’s overhead and profit and/or sales tax on materials will be the correct measure of the insured’s loss.”

    Further, the Department noted that insurance companies are not allowed to charge premiums in excess of the risk to which they apply. Thus, under a replacement cost policy, the value of the contractor’s overhead and profit, as well as sales tax on building materials, are included in the premium, and if the insurer receives a premium on insurable values which loss may never be paid, “the insurer reaps an illegal windfall.”

    Finally, the Department dispensed with the common argument that contractor’s overhead and profit, as well as sales tax on building materials, should be excluded from Actual Cash Value settlements because the insured has not incurred these expenses as illogical:

    "Using this logic, an insured who opts not to repair or replace damaged property would not incur any of the expenses necessary to repair or replace the damaged property, including the costs of building materials, and would collect nothing under an actual cash value loss settlement. This result would be contrary to the purposes of the subject insurance policy."

    In 2009, this rule still applies, and insurers that violate it can expect to be sued. "

     

    P.S.  I hope my spelling is correct - I have never been able to get spell check to work on this web site, even after trying the suggestion made earlier.  I am using edit at this time to add this P.S. line and still can not get spell check to run, even if I highlight the content. Anyone have any other suggestions?

     

    0
    rickhans
    Member
    Member
    Posts:111


    --
    11/23/2009 4:45 PM

    Here is a link to the web site for the Burgess class action law suit in Oklahoma against Farmers for failure to pay o&p to home owners from 1994 to 2009 with details of the settlement agreement.

    http://www.burgess-class.com/FAQs.aspx

     

    This link further explains the lawsuit against Nationwide. The article references an identical lawsuit originating in Penn. against them, and the fighting going on in the Arkansas court prior to the settlement being reached.

    http://www.setexasrecord.com/news/2...nationwide

    Here is a recent article about TWIA acknowledging the Texas rule stated explained in the prior post, although they are acused of voilating the rule.  Also included are updates on several  other disagreements and lawsuits. 

    http://www.chron.com/disp/story.mpl...11938.html

    Following is a link to an appeals court ruling in AZ on the exact same issue in favor of the insured.

    http://www.lang-baker.com/publications/constructionadvisor/contractorfees.htm

    The list goes on but I will stop with these. This should create more discussion.

    0
    BobH
    Veteran Member
    Veteran Member
    Posts:759


    --
    11/23/2009 5:17 PM
    can not get spell check to run

    I have been using a free spellchecker for 2 years from http://www.iespell.com and it works very well for forums, anything you type in a web environment.  It simply puts a spell check icon on the tool bar (I am using Internet Explorer).

    For what it's worth, I agree with you on the issue of "ignore who is doing the work, focus on the scope of repair in terms of deciding O&P or not".  Actually my opinion is worthless, but 3 very large carriers I do work for have an opinion - and it's their sandbox.

    Bob H
    0
    rickhans
    Member
    Member
    Posts:111


    --
    11/23/2009 7:53 PM

    I go to thinking that I should clarify one issue pertaining to O&P for those who don't know.  The payment of profit can be excluded within the policy then these rulings would not apply.  One example is builder's risk policies. I have adjusted some that exclude profit from a property damage claim and it makes sense.  I believe the thinking is that the builder will make his profit when the house is sold but not when he has to re-do construction to fix the insured damage.  Including overhead depends on the circumstances of each case and the specific terms of the coverage that can vary from one customer to another.

    0
    Ray Hall
    Senior Member
    Senior Member
    Posts:2443


    --
    11/24/2009 1:45 PM

    Measurable unit prices should have all the cost for a merchant to make a profit and stay in business. Ever item for sale has an asking price and a selling price. Many times they are not the same. If insurance companies use estimating programs to have "a unit price" for an auto repair job and a price for a dwelling repair job the public should not have any problems shopping the "estimate" around for the bottom line price or the discount off the bottom line price.Start the process of an insurance claim at the "fair price" in the data base and not pay more or less to the public. The true principle of INDEMNITY will come back to the insured who does their own shopping for what ever reasons.(get what you pay for)

    The real adjuster then has to allow for some legetimate expense on the bottom of the estimate, such as special order, travel time, overtime, grade of workmanship etc.

    This would stop these lawsuits and out cry  about O & P which is driven by greed from the insureds, PA's, Lawyers and also the IA's on Fee bills who make 20% more on each file.

    ** Do you old timers remember the problems we had with roofers, who stated on ever estimate that we missed the roof measurements before we started drawing a diagram and making it a part of the file, thanks to the leader State Farm.

     

     

    0
    rickhans
    Member
    Member
    Posts:111


    --
    11/25/2009 1:35 AM

    Ray,

    I apologize in advance but I have to respectfully disagree with you on your last posting, although it is a possibility I am misunderstanding you, as that has happened before.  I don't consider it greed at all to want to receive enough to compensate me as a contractor or as a homeowner for the total cost to do a renovation.  I have been a renovation contractor since 1975 (and was contracting for several years before getting into insurance renovation).  It is much more difficult to make a profit on an insurance claim job than it is to build an addition to a house for someone.  There is very little, and many times no profit in the line items when a subcontractor is used to do the job. The overhead does not cover anything other than very basic business costs such as office, truck, phone, and similar related expenses.  Workers comp is so high that in the future I will probably have to add a line item in the estimate to cover it and the liability insurance. Both are directly proportional to the labor paid out except when a sub carries his own workers comp, which is almost never, and the liability which is carried by the trade subs (elec, a/c, plumbing) but not by the drywall and trim subs.  Some painting subs carry liability, some don't.There have been times when I could get 20% for overhead, but most carriers won't agree to it.

    I believe that these court rulings, at least for the most part, are correct.  There is no reason why the homeowner should lose money if he fails to do the repairs then sells his house as is which is what happens as I have detailed on other threads on this subject.  As to letting competition drive the prices, I don't see how that can work.  Most contractors in residential renovation don't do competitive bidding because it won't work.  If I get called first and get an agreement to do the job if the settlement is sufficient for me to do the job, another contract is not going to give a bid if mine is agreed to by the homeowner and adjuster.  Why would they?  The insurance company is only going to pay what the first contractor bids if his price is right.  If an agreement can't be reached, then the insured might be told to find another contractor, otherwise the first contractor gets the job.  I don't think any contractor will spend the time to work up a bid for the insurance company knowing that one has already been agreed to. I don't see that this has anything to do with greed.

    I have seen a couple of court rulings that went further into detail than these, stating that a homeowner is as much entitled to income as any contractor would be when he does the work. No one can micromanage the claim and determine what the homeowners occupation is and what his normal income is to say that he is not entitled to some of the claim funds just because he is the insured. Also, the policy does not define what the overhead is to cover, and a homeowner certainly has overhead as was explained in one of the rulings that I posted a link to.  I Think the Texas regulation and rulings on this issue are quite clear too, so I don't understand why some of the other adjusters believe otherwise.  Again, maybe I am misunderstand you and a few other adjusters.

     

    0


    ---