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Last Post 08/05/2016 8:07 PM by  commguy01
Is it us(cat.adjusters) or Them?(law firms)
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Ray Hall
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06/17/2009 10:23 PM
    This is hurricane IKE specific. I do not know how many property losses were filed. About 15 law firms are running TV adds for low settlements, tag team adjusters and other slogan in the Houston-Beaumont area.From the adds you are led to think thousands of people have reopened their claim by one law firm
     
      ** I have edited my post of 6.17.09. I know law suits are being filed as I was named for the first time in my adjusting career. If the catastrophe adjusting industry chased policy holders to law firms with valid bad faith law suit allegations . What did we do wrong?
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    Tom Toll
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    06/18/2009 12:19 PM
    Ray, are most of these suits flood related and if not, what are the allegations?
    Success is not final, failure is not fatal: it is the courage to continue that counts.
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    Ray Hall
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    06/18/2009 5:03 PM
    Not flood related. Low ball estimates and being "unfair" I can,t comment much.
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    Roy Estes
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    06/22/2009 8:24 AM
    Posted By Ray Hall on 18 Jun 2009 05:03 PM
    Not flood related. Low ball estimates and being "unfair" I can,t comment much.


    I am sure the economy has something to do with the influx of law suit filings. Insurance has become a target of Lawsuits for many as a ways and means of obtaining money. This has become evident in all facets of Insurance claims. Sadly enough we are all susceptible to being named in such suits. Contractors wanting more profit, Insureds Getting settlements and not performing proper repairs as per policy, etc, etc.
     
    Sadly enough this is what things are coming to in these economic times.
    "Each of us as human beings has a responsibility to reach out to help our brothers and sisters affected by disasters. One day it may be us or our loved ones needing someone to reach out and help." RC ESTES
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    Ray Hall
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    06/22/2009 10:45 AM
    The Texas IKE lawsuits are not an economic thing, or being driven by "recession". This is a new ball game, treble and punitive damages + attorney fees.
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    katadj
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    06/22/2009 11:53 PM
    Sadly, many of the claims and resultant suits, demands for appraisal, and other related tactics, are naught but the resurrection
    of the 2004-05 debacle, which we experienced in Fl.

    Many of the IKE claims were Mal adjusted and many also were the result of the changes made by some of the carriers, one being that of last resort.

    It has become well known that the process of review was done by personnel who had little or NO property experience, and also many had never
    been in the field.

    Having experienced first hand the lack of quality control, the redundant rejections, the dumbing down of the examiners expertize, this comes
    as no surprise.

    There is one law firm that has over 1000 claims against one (1) Carrier, and the initial findings do not bode well for that carrier.

    It is not dissimilar to one carrier admitting recently, in open court, in Mississippi, under oral argument that they purposefully placed wind coverage
    unto the backs of the NFIP, which by the way , is paid for by you and I , with tax dollars. ( That notice was posted here on CADO,
    in the news section a few weeks ago.

    Why is it OK for the carrier to burden the NFIP, and consequently, ourselves, with false claims? Follow the money and all answers are the same, GREED.

    The intentional non -payment of just claims is pure and unequivocal fraudulent behavior, In my opinion.
    "Anyone who has never made a mistake has never tried anything new... Albert Einstein"
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    kmerian
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    06/22/2009 11:58 PM
    I can only speak for what I have seen, but most of the claims are merely arguments of flood vs. wind. Mostly what it seems to me, is that the TWIA and NFIP are trying to pass their damages onto each other. The loser is of course the consumers., as TWIA is paid for by Texas policyholders and the NFIP is paid for by taxpayers.
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    Ray Hall
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    06/23/2009 1:31 AM
    Probably no more than 10% of the losses in Orange, Jefferson, Chanbers, Galveston and Harris County had a wind and flood policy claim, so this leaves 90% to wind only and TWIA had most of the coverage> I have to confess I was not working on Bolivar.
     
    The wind carrier can never walk away from a property that has both wind and flood damage. You could not walk away yesterday or today. I never could understand the MS.coast decisions in Katrina.
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    Ray Hall
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    06/23/2009 1:46 AM
    Posted By Ray Hall on 23 Jun 2009 01:31 AM
    Probably no more than 10% of the losses in Orange, Jefferson, Chanbers, Galveston and Harris County had a wind and flood policy claim, so this leaves 90% to wind only and TWIA had most of the coverage> I have to confess I was not working on Bolivar.
     
    The wind carrier can never walk away from a property that has both wind and flood damage. You could not walk away yesterday or 2009. I never could understand the MS.coast decisions in Katrina.

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    ChuckDeaton
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    06/23/2009 9:22 AM
    An adjuster could work through a career and not come across a situation where the anti-concurrent causation clause applied.

    It amazes me that, as applied to the Mississippi Katrina occurrence, experienced adjusters, from mutual insurance companies, denied otherwise covered losses, based on an anti-concurrent causation clause. Clearly the wind loss and the flood loss did not occur at the same instant.

    As I have never handled a claim that involved the anti-concurrent causation clause will some one step up to the plate and make an explanation.
    "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
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    Tom Toll
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    06/23/2009 1:01 PM

    Is anti-concurrent cause language 'unethical'?

    I saw this question discussed at a recent post on Sam Friedman's blog at National Underwriter.  Plenty of comment by readers, both pro and con.  You might be able to predict what I think.  The question itself arises from a misconception of what anti-concurrent cause language is and what it addresses -- in other words, I don't believe the question makes sense.  Is the notion of exclusions in insurance policies unethical?  Is the notion of covering collapse but defining collapse extremely narrowly, and excluding many causes of collapse, unethical?  Is it unethical to define a policy's coverage as excess to any other available insurance? Is it unethical to define ongoing property damage as uncovered if any part of it began before the policy period commenced?  Is it unethical to define an intentional act as one that is expected and intended by any insured, meaning one who did not intend the harm is excluded from coverage along with the one who did?  Answer all these questions, and then we can have a debate about the ethics of anti-concurrent cause language.  

    As the above questions make plain, insurance policies contain all kinds of provisions that normal people don't expect or think about.  So do other contracts.  You ever gone on a cruise?  Chances are your ticket contract contained a forum selection clause stating you have to sue in Florida if you have a beef with the cruise line.  Does the average person have a clue about choice-of-law provisions in contracts or their significance?  How many investors anticipate that they will have to engage in NASD arbitration instead of going to court? 

    The issue is not one of ethics, but public policy.  If a contractual provision is not against public policy, there is nothing wrong with including it in the contract.  Anti-concurrent cause language merely defines the causation analysis that must be used by the court.   Other potential choices for causation analysis, such as efficient proximate cause or concurrent cause analysis, were neither carved into stone tablets by God, nor have courts found the specific type of causation methodology used in property insurance causation to be a mandatory contract rule, or in other words, a matter of public policy. 

    To all who would say anti-concurrent cause language is unethical, answer these questions. Why is the efficient proximate cause methodology of defining the cause of a property loss superior analytically to the methodology contained in anti-concurrent cause clauses?   What endows efficient proximate cause with greater moral stature than anti-concurrent cause methodology? For property insurance contracts with no defined method of analyzing property loss causation, is it ethical not to reveal to the consumer that the default method will be efficient proximate cause?  Come on, I don't really need to go on, do I?  You can see the whole ethics argument can be shredded like cheesecloth without even breaking a sweat.  Who can answer these questions, and having answered them, will anyone then argue to me that anti-concurrent cause language is unethical?  

     

    Success is not final, failure is not fatal: it is the courage to continue that counts.
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    Tom Toll
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    06/23/2009 1:12 PM
    MAY 2007 | VOLUME 9, ISSUE 5

    FEATURE STORIES

    Beware of Anticoncurrent Causation
    Clauses--They Can Erase Your Property
    Insurance Coverage

    By Finley Harckham

    Before there were viruses that spread over the Internet to corrupt computers and other
    data, there were provisions in property insurance policies that have a similar impact.
    Known as anti-concurrent causation clauses, they appear in a preamble to the exclusion
    section of policies and are intended to bar coverage beyond instances where there is an
    excluded cause of loss, to every situation in which an excluded peril is only one cause, or
    is even the result of a covered cause of loss. Those provisions lie at the heart of the wind
    and rain versus flood debate raging in the Gulf Coast in the wake of Hurricane Katrina,
    but their reach goes much further. In fact, if applied as written, some of those clauses can
    render most property and business interruption coverage practically illusory.
    Policyholders must be alert to the presence of those clauses when buying property
    coverage, and aware of how the courts are interpreting them when claims are made.

    Anticoncurrent Causation Clauses--The Most Common
    to the More Onerous

    A number of different anticoncurrent causation clauses are in use today, and some are
    more onerous than others. One of the more commonly used clauses is found in the
    Insurance Services Office Causes of Loss-Special Form (CP 10 30 04 02). It states:

    We will not pay for loss or damage caused directly or indirectly by any of the following.
    Such loss or damage is excluded regardless of any other cause or event that contributes
    concurrently or in any sequence to the loss.

    Following that provision is a list of exclusions. This provision bars coverage whenever an
    excluded peril directly or indirectly causes damage. Although this is a very unfavorable
    clause for policyholders, unlike other forms at least it is limited in scope to excluded
    causes of loss, which in many instances will leave room for argument over whether an
    event was a cause or an effect.

    A more problematic clause is found in State Farm property policies. It provides:

    We do not insure under any coverage for any loss which would not have occurred in the
    absence of one or more of the following excluded events. We do not insure for such
    losses regardless of: (a) the cause of the excluded event; or (b) other causes of the loss; or
    (c) whether other causes acted concurrently or in any sequence with the excluded event to
    produce the loss; or (d) whether the event occurs suddenly or gradually, involves isolated
    or widespread damage, arises from natural or external forces, or occurs as a result of any
    combination of these.

    That clause is followed by a number of exclusions. Unlike most policies, the exclusions
    are not limited to "perils," but include "events" that occur along with causes of loss.

    The "Purported" Intentions of Anticoncurrent
    Causation Clauses

    Anticoncurrent causation clauses are so named because they are intended, among other
    things, to be a response to the rule in most jurisdictions that in instances of concurrent
    causation--where multiple forces independently cause a loss, one of which is a covered
    peril and the other is not--the insurance policy must respond. For example, in one case a
    policyholder modified a gun to have a hair trigger, and then put the gun in a car which he
    drove recklessly. The gun discharged, injuring a passenger. The insured's homeowner's
    policy did not cover liability resulting from the use of automobiles. In awarding coverage
    under that policy the court reasoned that although "multiple causes may have effectuated
    the loss [that] does not negate any single cause"--in that case, the covered negligence in
    modifying the gun. See State Farm Mut. v. Partridge, 514 P. 2d at 130-131 (1973). An
    anticoncurrent causation clause would reverse the ruling in that case and bar coverage
    because an excluded peril, the use of an automobile, was a cause of the loss.

    However, at least some anticoncurrent causation clauses are intended to go beyond
    reversing the concurrent causation rule, to bar coverage when an excluded event is
    merely a consequence of a covered cause of loss, or follows damage caused by an insured
    peril. As one court explained in the context of a Hurricane Katrina claim of a family that
    had coverage for wind and rain, but not flood, if the anticoncurrent causation clause in
    the family's policy was enforced, it "would mean that an insured whose dwelling lost its
    roof in high winds and at the same time suffered an incursion of even an inch of water
    could recover nothing..." Leonard v. Nationwide Mutual Ins. Co., 438 F. Supp. 2d 684 (S.
    D. Miss. 2006).

    There are many other scenarios in which coverage could be forfeited under an
    anticoncurrent causation clause. For example, when a covered wind and rain event causes
    the interior of a building to become damp, and mold develops, if dampness or mold are
    excluded, there would be no coverage even though mold was the effect, not the cause, of
    loss. Likewise, when a broken water pipe under a home, which is a covered cause of loss,
    washes away soil beneath the foundation, the resulting damage would be barred from
    coverage if the policy contains an anticoncurrent causation clause and an earth movement
    exclusion. See Kula v. State Farm, 628, N.Y. S. 2d 988 (4th Dep't 1995).

    The Three Rationales Applied by the Courts

    Anticoncurrent causation clauses have been the subject of numerous lawsuits in which
    policyholders argue that it would be unfair or unlawful to allow such provisions to
    eviscerate their coverage. Some of the clauses have been upheld under the laws of a
    number of states, including Alaska, Arizona, New York, Nevada and Utah, and
    invalidated under the laws of other states, including California, Mississippi, West
    Virginia and Washington. However, most of the cases involve the State Farm provision
    quoted above. That provision is broader than the ISO form and some other clauses, so
    cases interpreting it may not have wider application. Adding to the uncertainty, in a
    number of states there are no cases interpreting any of the clauses.

    As a general rule, the courts have applied three rationales when deciding this issue, which
    may give some indication of how courts will act in other jurisdictions. First, some states,
    including California and Washington, have adopted a statutory or common law rule that
    insurance policies must provide coverage if the efficient proximate cause of loss is a
    covered peril. Courts in those jurisdictions have held that anticoncurrent causation
    clauses violate that rule, and therefore are unenforceable.

    Second, under the law of many states, an insurance policy must be interpreted in a
    manner that is consistent with the reasonable expectations of the policyholder. This
    doctrine is intended to compensate for the fact that most insurance policies are contracts
    of adhesion, drafted by the insurer and sold on a take it or leave it basis. Some courts,
    such as those in Mississippi, have concluded that anticoncurrent causation clauses are
    unenforceable because they defeat the policyholder's reasonable expectations of coverage
    when a covered peril is the proximate cause of loss. However, other courts, including
    those in Alaska, have found the clauses to be enforceable under the reasonable
    expectations doctrine. Those courts have concluded that the clauses are clear and
    unambiguous, and therefore policyholders could not reasonably expect coverage for risks
    excluded by them.

    Third, other courts which enforce these clauses do so under the laws of states which lack
    a proximate causation rule and which reject the reasonable expectations doctrine in favor
    of a rule that insurance policies are to be interpreted under the same rules as all other
    contracts. To these courts, anticoncurrent causation clauses are enforceable because they
    are clear and unambiguous, and entered into by parties who are free to contract as they
    wish.

    Not all property policies contain anticoncurrent causation clauses. Avoiding those
    provisions should be a high priority when selecting coverage.

    Conclusion

    When a loss occurs, policyholders should keep two things in mind when evaluating
    coverage in light of an anticoncurrent causation clause. First, the different clauses in use

    may lead to different results depending upon the facts of a claim. So, do not assume that
    just because a court has enforced one clause it would hold that another clause bars
    coverage. Second, not all courts will enforce these clauses. Moreover, in many instances
    more than one state's law is potentially applicable to a loss. So, the policyholder should
    examine the laws of all states which might be applied to determine whether a viable
    claim exists. For example, a policyholder headquartered in California might get the
    benefit of that state's law rejecting the enforceability of anticoncurrent causation clauses
    for a loss suffered at a facility in Arizona. Policyholders must be as resourceful in
    securing coverage as insurance companies are in denying it.

    ABOUT THE AUTHOR

    Finley Harckham is a senior shareholder in the New York office of Anderson Kill &
    Olick, P.C. Mr. Harckham is also the president of Anderson Kill Insurance Services
    (AKIS), a non-legal subsidiary of AKO which assists clients with risk management
    services, and Anderson Kill Loss Advisors (AKLA), a non-legal subsidiary of AKIS
    which assists policyholders with property loss and business interruption claims.

    Reprinted with permission from the March/April 2007 issue of Policyholder Advisor,
    published by Anderson Kill & Olick, P.C.
    Success is not final, failure is not fatal: it is the courage to continue that counts.
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    Roy Estes
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    06/23/2009 7:09 PM
    Posted By Ray Hall on 22 Jun 2009 10:45 AM
    The Texas IKE lawsuits are not an economic thing, or being driven by "recession". This is a new ball game, treble and punitive damages + attorney fees.


    I dont know about that Ray. Seems when the economy is downward, Lawsuits of claims are Upward. SIU Is Up, Hazard and Business Risk is up. Workers Comp Claims Are up.
     
    See Articles
     

    National Insurance Crime Bureau Data Shows Increase in Fraudulent Claims Linked to Poor Economy

    Suspicious car fires up 27 percent, slip and falls up 77 percent and hail damage claims soar 407 percent

     

    DES PLAINES, Ill., April 28 /PRNewswire-USNewswire/ -- Is the poor economy driving people to commit insurance fraud? While there has been considerable speculation within the insurance industry, law enforcement and the news media that money woes have forced some people to break the law in order to collect on insurance policies, to date, there has been no solid statistical evidence to back up that speculation.

     But a new report by the National Insurance Crime Bureau (NICB) clearly shows an increase in the number of questionable claims (QCs) related to possible cases of insurance fraud during the past year as the economy continued its downward spiral. An analysis of QCs submitted by the more than 1,000 NICB members companies in the first quarter of 2009, versus the first quarter of 2008, shows a definite increase in claims related to what is termed "opportunistic fraud."

     AND
     

    Bad Economy Means Higher Insurance Claims

    Coincidence Or Fraud? Industry Suspects Rip-Offs

    POSTED: 12:51 pm MDT April 28, 2009
    UPDATED: 4:52 pm MDT April 28, 2009

     As things get tight at home, one industry fears some people may be trying to wring every last dime from their last resort against unexpected loss: the insurance company.

     Insurance hail claims saw the biggest spike, jumping an incredible 407 percent in the first quarter of 2009 versus 2008. According to the report by the National Insurance Crime Bureau released Tuesday, the number of questionable claims that could indicate insurance fraud skyrocketed across the United States as the economy tanked.

    <!-- Begin Ad tag: square-->[script removed] IBSYS.ad.AdManager.registerPosition({ "iframe": false, "addlSz": "", "element": "ad_N312E3122.2E18", "interstitials": false, "beginDate": "", "endDate": "", "getSect": "yes", "name": "square", "qString": "", "width": "300", "height": "250", "section": "", "useId": "19313652", "interactive": false, "useSameCategory": false, "topic": "", "swSectionRoot": "", "useZone": "", "containerType": "page", "containerID": "88716", "type": "DOM" }); [script removed] [script removed] <!-- End Ad tag: square-->

     The broader category of catastrophe -- including tornado, hail, wind and fire -- saw a 463 percent spike.  A homeowner with relatively minor hail damage may now be trying to stick the insurance company for an entirely new roof, for example. Suspicious disappearance or loss of jewelry was up 39 percent. Slip and fall claims were up 60 percent. Suspicious vehicle fires jumped 27 percent.  Material misrepresentations in depositions or recorded interviews was up 55 percent.  “Desperate times sometimes cause people to take desperate measures,” said Joe Wehrle, NICB’s President and Chief Executive Officer. “Unfortunately, committing insurance fraud is not the solution to anyone’s problems, it only leads to more problems if you’re caught."

     Some people think it is ok to cheat an insurance company, but the fact is, they are breaking the law, risking jail time, and causing everyone else to pay more for their insurance coverage,” he said. The NICB, based in Des Plaines, Ill, said the numbers back up what insurance agents have been saying for months: that the recession has turned typical claims into larger ones or even caused some to try and cash out of a high car payment.

     The report covers claims that were previously reviewed by the more than 1,000 individual insurance companies and self-insured groups and classified as possibly fraudulent. According to the Rocky Mountain Insurance Information Association, Colorado is one of only four states where fraud is not a specific crime. "So we don't have conviction stats specific to fraud in Colorado. Fraud is often considered a victimless crime but we all pay for it through higher insurance rates," said Carole Walker, Executive Director of the RMIIA. "People should also be aware that companies have special investigators dedicated to fraud and they work in cooperation with law enforcement."

     
    Ike was no Diffrent! The Path of IKE on up to Columbus and the great Lakes all States has experienced Higher Claim Settgelments, and Much Higher Litigation. No Doubt Lawyers have something to do with it all, but the economy I feel contributes a great deal! Just My opinion
    "Each of us as human beings has a responsibility to reach out to help our brothers and sisters affected by disasters. One day it may be us or our loved ones needing someone to reach out and help." RC ESTES
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    BobH
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    06/23/2009 7:21 PM
    Yeah, I remember working claims in the early '90's during a recession.
    Opportunistic Insd and Claimants gave me job security.
    Bob H
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    ChuckDeaton
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    06/23/2009 7:55 PM
    My question regarding the anti-concurrent causation clause is day to day. Wind is a covered peril and wind blows the roofing off. Once the roofing is off, water leaks into the risk and causes mold, which is excluded, by endorsement. Does the anti-concurrent causation clause kick in? Should the loss be denied, wind and mold?
    "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
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    Roy Estes
    Member
    Member
    Posts:155


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    06/23/2009 9:32 PM
    Posted By ChuckDeaton on 23 Jun 2009 07:55 PM
    My question regarding the anti-concurrent causation clause is day to day. Wind is a covered peril and wind blows the roofing off. Once the roofing is off, water leaks into the risk and causes mold, which is excluded, by endorsement. Does the anti-concurrent causation clause kick in? Should the loss be denied, wind and mold?
    IT IS UTMOST OF IMPORTANCE WHEN MAKING ANY COVERAGE DECISION, ON ANY LOSS, THAT THE INITIAL CAUSE OF LOSS  IS DETERMINED ...... Chuck the cause of loss is wind in that scenario, Covered Loss! Anti Concurrent Causation does not apply! Bottom line,  if a covered cause was a substantial factor in producing the injury or damage, the loss is covered, even though an excluded cause also may have been a substantial factor.


     
    "Each of us as human beings has a responsibility to reach out to help our brothers and sisters affected by disasters. One day it may be us or our loved ones needing someone to reach out and help." RC ESTES
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    Ray Hall
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    Posts:2443


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    06/23/2009 9:41 PM
    Back in the mold gold days in Texas was when the mold exclusions and mold limit's came about. We (adjusters) have always paid to clean a surface that can be refinished and look as good as new. Its really no value to any one to determine which mold is on the wall now. Health concerns and move out just because of the mold is no longer a big factor in water losses.
     
    Well I stand corrected on the economy causing the losses to increase. I will take all the slip and fall cases I can handle in this  area as well as burglary losses .Both have paid a lot bills for me during non weather events. I still think both attorneys will milk ole IKE losses like a large jersey cow stuck in a door. This will be a windfall for both insureds and attorney,s as the repair money has been paid .
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    Medulus
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    06/25/2009 11:54 AM
    Because I have not read a State Farm or Nationwide policy in some time, I will not speak to those. For the last year and a half I have been dealing exclusively with commercial policies that have a CP 1030 04 02 Special Causes of Loss form attached. The "anti-concurrent cause" language of that policy states:

    "1. We will not pay for loss or damage caused directly or indirectly by any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss."

    Following this are the list of exclusions. The article Tom copied above sounds like plaintiff counsel propaganda. The clause is very easily interpreted to mean we will not pay for damage due to an excluded cause of loss even if there is also present damage from a covered cause of loss. This clause was made necessary by decisions such as those in Florida and other jurisdictions that might require the wind carrier to buy the whole claim if even one roof shingle was blown off, but flood waters 18 feet deep inundated the house. Like many clauses of the policy (Case in point, the $15,000 mold remediation sublimit) this language was not inserted into the policy in order to cheat or defraud anyone. It was written into the policy to keep the courts from capriciously granting excessive coverage for losses the carriers never intended to cover, risks that would have needed a much higher premium if the carrier had known they would be required to cover them. It was court decisions that made this language necessary, not the other way around.

    The intention of the anti-concurrent clause is not to take away coverage for covered causes of loss or coverage for losses that are in an unbroken chain of events originating with a covered cause of loss and proceeding directly from that cause of loss. It was intended to prevent payment of non-covered losses just because there happens to also be a covered loss that occurs at the same time or virtually the same time.

    Steve Ebner CPCU AIC AMIM

    "With great power comes great responsibility." (Stanley Martin Lieber, Amazing Fantasy # 15 August 1962)
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    commguy01
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    08/05/2016 8:07 PM
    Can someone tell me how long we are obligated to keep file records pertaining to Ike losses. I'm being asked for records eight years old.
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