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Last Post 07/09/2009 6:13 PM by  Medulus
The Case of the Missing Money
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Author Messages
Founding Member

09/18/2008 8:25 AM

Still have a couple questions that come into my mind on this one.  We have determined that money is a covered item I believe.  I think that we may have determined that Guido would have been a covered person under the policy/endorsements had he taken the money, etc.  Remember that a complete investigation is required on a case like this and those who said no ROR needed, to go ahead and deny up front based facts as presented may have been premature.  How often are theft/mys dis. claims denied upfront with no investigation/R/S/ police report, etc.  Steve, what did Guido state in his R/S about the theft of the $? That it was in the car at the time he got out to look at the accident, and he placed it under the seat? Then he got back in and drove to work and it was gone. Does he swear someone got into the car and took it while at accident? What did he tell the police about that? I am assuming there were no broken windows on the car when he got back to it, or smashed door locks as he would have noticed that right away probably and it would be noted on the police report. What did the car look like when you investigated it afterward (going back to that investigation thing that is stuck in my claw)? I would venture to guess that Guido is not going to tell you he took the $ or handed it off to someone else. Based on the piecemeal stuff you fed us, his testimony is going to be that someone got it out of the car at the scene of the accident while he was trying to see if he could help.

That is how I look at the circumstances of this case. Anyone who denied upfront without all the facts (coverages or investigation) is way to quick to pull the trigger. ROR, with at least all the parts originally quoted initially involved, and maybe adding in some clarification, or backing out some based on the enhanced endorsement language. Anyone still see any areas that may raise any questions of coverage that the agent's assertions don't cover? Steve, I agree with your analysis of the the three bullet points that the agent brings up. Roy, I know we all do it ourselves, but it is dangerous when we say things like "Enhancement endorsement's involving monitory instruments have very low Limits Of Liability and HIGH Deductible amounts and accompanied by a schedule." I recently made a similiar comment on the forums about "most policies have language in the flood exclusion about if a fire ensues..." Reliance on those type of blanket statements w/o benefit of reading the coverages actually involved will get one nailed far too often.


07/01/2009 12:24 AM
I am jumping in here kind of late, but this is the first night  I have had time to catch up on the forums on CADO.  As to the statement made early on in this thread that this subject does not apply to adjusters, I respectfully disagree.  Although I can't go into detail because I am still involved to a certain extent, I worked IKE and ended up writing estimates and reports and investigated over 40 theft claims that was claimed to be a result of the hurricane and the lengthy power outage.  These claims started with adjusting assignments for wind and water damage.

Just because an adjuster is working a cat, nothing really changes in our approach to adjusting claims and be prepared to handle any type of coverage issue besides storm that is encountered in commercial and residential sites.  I have found defective construction in the past and turned it into a subrogation claim while working a cat, and found hazardous conditions within houses that were created by the homeowner and had to be dealt with.  A cat adjuster has to be ready for anything.  I found this thread to be informative and educational.
I had a restaurant client for whom I developed and maintained POS computer systems for many years. He had almost this same scenario.  I don't remeber how his insurance claim turned out, but it was determined that the employee stole the money bag. However I don't think she confessed and did not go to jail that I can remember, but her career as a restaurant manager was no more.
Veteran Member
Veteran Member

07/09/2009 6:13 PM
Good point, Rick.

Plus...anyone ever heard of the LA riots? A whole bunch of catadjusters worked the thefts, fires, and vandalism associated with that event.

"With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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