RE: House Fire--A simulated claim for discussion
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RE: House Fire--A simulated claim for discussion - 9/21/2006 4:59:32 PM
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racko
Posts: 228
Joined: 2/17/2006
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quote:
ORIGINAL: rass3742
Somewhere in this thread I read that the Proof must be filed within 60 days of the Date of Loss. While that is true under some policies, racko outlined that this scenario falls under an HO-3. The Proof deadline under an HO-3 is 60 days “after our request.” That, of course, is request by the insurance company.
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(1) No matter if it is a homeowner’s fire claim, a car accident, or any other loss arising from the same occurrence….if the same insurance company is involved in handling more than one of its named insureds' claims, for the same occurrence, each separate insured should be represented by a separate claims adjuster. That is the only way to ensure unbiased representation for the insured, with regard to their respective policy. You are correct though, you definitely want to document the damages of the neighboring properties.
(2) Tell me why you wouldn’t pay for the neighbor’s injury. Was he trespassing when he tried to help the insured? Could he be considered an invited guest under the circumstances? What does the policy say about “Medical Payments to Others?” Does it require negligence on behalf of the insured, to be extended to the neighbor?
We now have 2 correct answers (1&2 above), regardless of what the C&O reveals. I assume Rass is only referring to Mr Red Handed neighbor...and not his crippled Mrs. A separate adjuster is needed for the 3rd party claim with the same carrier, and even if that adjuster works out of your same office (which should not be allowed by the manager anyway, IMO)... each adjuster has to develop their own file evidence. This means separate C&O experts, and so on. No sharing of recorded statements, etc. Keep in mind that our 1st party insureds will be under no obligation to provide a recorded or written statement to their neighbors' adjuster(s). You, as the adjuster at the time of first contact with our 1st party should be sure to inform them to keep their lips locked until you meet.
The POL advice is correct also.
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RE: House Fire--A simulated claim for discussion - 9/21/2006 5:13:42 PM
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rass3742
Posts: 131
Joined: 7/6/2005
Home base: Spokane, WA
Status: offline
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That's a good clarification racko; I was only talking about the property damage to Mr. Red Handed's house. The liability to his injury and his wife's injury, are completely separate issues and should be handled by a separate liability adjuster.
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Things are never so bad they couldn't be worse.
Count your blessings.
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RE: House Fire--A simulated claim for discussion - 9/21/2006 5:34:24 PM
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rass3742
Posts: 131
Joined: 7/6/2005
Home base: Spokane, WA
Status: offline
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quote:
ORIGINAL: Angus99
Rass, thank you for your thoughts as i should have been a lot more clear and precise.
-I realized that im probably wrong in adjusting both the neighbors and the homeowners loss per the reason's you gave. You are absolutley correct.
-In regards to Neg./Liability on the insured for the neighbors injuries. Yes, again your right in regards to the Med Pay. I may pay the neighbors Meds up too the insured's Med Pay limit. However, where in Virginia, we are a Contrib. State (Contributory Negl. (sp?.). If the injured party is at least 1% responsible or contributed to his/her own injuries, then he/she may not have a successful claim. I do not know if Contrib. Negl extends to Med pay. Somebody help me(us) on this.
-Im really jumping the gun and thinking out loud here, but regardless of the cause of loss of loss, i do not think the homeowner could be Negl. for the neighbors injuries. Generally you pay Meds regardless of Negl. However, if the neighbor (claimant) files suit/claim for damages in excess of his Meds, i would think i would deny it at this point. My brief defense now is assumtption of risk. What duty did the homeowner breach in causing the neighbors injuries? At this point, i dont see any.
Regardless, thanks for you input and ideas/suggestions. I have only 6 years of adjusting experience and still consider myself a "Noob/Newbie" always love to learn form others.
Angus,
Good line of thinking. Right or wrong, relative to specific Virginia law, isn’t the point; the fact you are thoughtfully showing your thought process is what counts.
I totally agree with you that you would not owe any “general damages,” like pain & suffering, therefore would not have any “liability” under the policy. Med Pay, however, is usually “no-fault” (although that may differ from state to state). Under comparative negligence, your state apparently prohibits recovery with 1% negligence (again, state specific); but assuming that is the case, is the neighbor negligent, even 1%, for his injury? I suppose one could assume that if the house was on fire the front door might be hot; but not necessarily. We don’t know enough about what he witnessed (flames coming out every window and roof versus a little smoke rolling from under the eaves) to really opine on what the neighbor should have thought. That’s where a good recorded statement from the neighbor would be helpful.
Without getting into too confining a discussion, however, my guess would be that most policies, in most states, would probably pay Mr. Red Handed’s medical bills, up to the Med Pay policy limit, for any “special damages” he has incurred; but would owe nothing under liability. On-the-other-hand, I don’t think you would owe any of Mrs. Red Handed’s medical bills, even under Med Pay coverage, as according to racko’s outline, I don’t believe she was ever on the insured’s premises; which is also a condition of the Med Pay coverage.
_____________________________
Things are never so bad they couldn't be worse.
Count your blessings.
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RE: House Fire--A simulated claim for discussion - 9/21/2006 9:01:37 PM
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trader
Posts: 1200
Joined: 4/19/2004
Home base: Houston, TX
Status: offline
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Very good thinking guys. The C & O investigation is very important; BUT it is not required in each fire loss, just as a procedure.
If arson/for profit does not jump out on your investigation/observations. Or if some indication of subrogation is in play? Why is it required? These type fire losses are red flags when reported and assigned to specific adjusters to investigate and make recommendations. The cost of a C & O is never recommended unless indicated.
*Most section II claims are not worked by the property adjuster, but assigned to a casualty adjuster. Unless you are both.
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RE: House Fire--A simulated claim for discussion - 9/22/2006 8:31:36 AM
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Hammer One
Posts: 10
Joined: 6/18/2006
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Just a further comment on P/O/Ls....I was always taught to provide the Insured with a blank P/O/L, (when the appropriate time came to secure it), and have the Insured complete it. In doing so over the course of several years, I cannot remember an Insured EVER completing a Proof without asking for help in filling in the blanks....anyone else experience this?
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Hammer
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RE: House Fire--A simulated claim for discussion - 9/22/2006 10:38:28 AM
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trader
Posts: 1200
Joined: 4/19/2004
Home base: Houston, TX
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Probably only about 5% know how to complete. Usually business people who have had prior losses.
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RE: House Fire--A simulated claim for discussion - 9/22/2006 2:56:02 PM
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rass3742
Posts: 131
Joined: 7/6/2005
Home base: Spokane, WA
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quote:
ORIGINAL: Hammer One
I cannot remember an Insured EVER completing a Proof without asking for help in filling in the blanks....anyone else experience this?
Just about every claim I've handled, where a Proof was requested. You have to refrain though. I tell my insureds I can confirm Date of Loss, Claim Number, etc.; but they have to fill in the body of the Proof and if they aren't sure how, they need to consult an attorney. I know it seems unhelpful, but if you fill in the Proof for them, you have negated the reason for securing the Proof in the first place. In the event the carrier suspects fraud, or the like, it needs to be their representation of their loss.
_____________________________
Things are never so bad they couldn't be worse.
Count your blessings.
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RE: House Fire--A simulated claim for discussion - 10/3/2006 1:14:16 PM
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TexasCatTeam
Posts: 13
Joined: 8/7/2006
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A word of caution if I may. Don't enter into this claim trying to find a way to prove Arson. That is bad faith.
Good reading carry on. :)
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RE: House Fire--A simulated claim for discussion - 10/4/2006 11:47:09 PM
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Czar
Posts: 65
Joined: 4/19/2004
Home base: Columbus, Ohio
Status: offline
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quote:
ORIGINAL: trader
Probably only about 5% know how to complete. Usually business people who have had prior losses.
I would say that 5% is even a little high in regards to insureds that know how to fill out a POL. You want a blank look, give an insured a blank POL and tell them to fill it out. I have not had one carrier have a problem if I complete the POL for the insured. I send it along with a nice little letter with some good non-waiver wording, and something to the effect that in supplying the enclosed POL blank or completed in no way guarantees coverage or payment, and that I am only assisting them in presenting their claim to their insurance company. And I would never supply the insured a POL at the first inspection.
The only time that I see a POL submitted by the insured prior to a settlement of a claim is when their is a dispute in the amount and the insured is informed to do so either by an attorney or a PA. At that point the carrier can reject it giving their reasoning.
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RE: House Fire--A simulated claim for discussion - 10/5/2006 12:32:17 AM
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Czar
Posts: 65
Joined: 4/19/2004
Home base: Columbus, Ohio
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Initial contact/first inspection- assuming scene has been cleared by authorities. Walk around and "hold insured's hand" letting him tell you what happened while looking at the scene. The insured just had a fire and may have lost everything he owned.
Recorded/signed statement from insured at first meeting. Insured may not want to give the statement at first meeting, but it is important to stress to them that facts of the loss can be forgotten and lost forever even in a day or two. Cover dates, times, the new electric stove top, who lives in the house, who else might have access to the house, smoking, any problems in the neighborhood, etc.
Once facts are gained from insured discuss ALE, as this is usually a big question from the insured.
While at the scene, call the carrier to give an initial reserve and recommend a C&O. If you suspect that the insured started the fire, inform the carrier and let them make the call for an advance against their contents claim. If it appears accidental, then recommend advance.
Then obtain photos, starting with the area of origin and working out. Try to take photos in order and not jump back and forth from room to room. Let the insured know that you need to document the loss with photos and that you will answer any and all questions that he has when you are complete. Please don't touch anything. Spoliage. Take photos of any big ticket or strange item that can be recognized. Open closets to verify amount of clothing, unless it is around the area of the origin, then once again don't touch it.
Contents- Making sure first with the carrier that there is contents coverage, supply the insured with content inventory sheets. Explain how to fill them out. Also sympathize with them and let them know that it will take a while to complete and to go room by room and try to remember what they had in each room.
Then you deal with the neighbors. If Mr. Redhand is there when you arrive. Kindly tell him that you will address his issues when you are finished with the policyholder. Give them your information and obtain theirs. Let them know that you need to complete your investigation and if they need immediate action that they should contact their carrier. Let them know that no commitments can be made until your investigation is complete. During your discussion with the carrier, see if they want a statement from the neighbor and obtain if he is willing.
Then scope the house with the neighbors letting them give their input.
If a C&O is warranted, do not complete your scope until they have investigated. Learned this one the hard way. If a second trip is needed, so be it.
The rest is smooth sailing until you get into code upgrades, supplemental damage, and a contractor dragging his feet on the job.
Get fire report once prepared.
As far as an outcome...
Handle insured's claim to its conclusion once cause/coverage is confirmed/investigation complete. expect multiple calls every few days from the insured. More hand holding.
Assuming neighbors did not go through their own carrier, handle their losses. I have seen neighbor's damage paid on every fire I have had. If they went through their own carrier, wait on the subro package. As far as the 2 year old and 12 year old vinyl siding... doesn't really matter... sort of. Carrier owes for the damages. If the neighbors won't agree to only one side of their house then it is up to the carrier to extend more authority if they want to get it resolved.
As for the Redhand's injuries. Med pay should cover his medical expenses but not his wife's. If the fire was started intentionally by the insured, then the insured would be negligent for the wife's injuries and most likely Mr. Redhands, maybe. Mr. Redhand although was trying to do the neighborly thing, he assumed a risk when he attempted to go near the insured's house. He knew of the hazard and it was most likely open and obvious. At worst case, a reasonable person would or should know that if a house is on fire that a metal door would or could be hot. If the fire was intentionally started however, this would be a tough one to defend and would most likely get settled.
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RE: House Fire--A simulated claim for discussion - 10/5/2006 3:46:09 AM
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racko
Posts: 228
Joined: 2/17/2006
Status: offline
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Thanks for re-kindling this scenario. Nice job on most accounts, but you didn't tell us how/why the fire started and why you did what you did or how it all came to conclusion. I know, I follow your story, and understand where you started and ended..........but there could be other intervening substories, events, and so on. Those were all a part of my initial set up, but got lost along the way. Where are all the teacher's pets?
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RE: House Fire--A simulated claim for discussion - 10/5/2006 7:27:53 AM
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RandyC
Posts: 62
Joined: 12/30/2005
Status: offline
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quote:
ORIGINAL: Czar
If a C&O is warranted, do not complete your scope until they have investigated. Learned this one the hard way. If a second trip is needed, so be it.
At the point of which the adjuster sees something that convinces him a C&O is needed, should not the adjuster take a few pictures of that which alerted him? How extensive should these pictures be, and how quickly should he abandon his scope?
If arson is suspected that is one thing. If the suspicion is more in the area of civil subrogation, should the scope continue or should it all be immediately referred to more specialized forensic investigators?
Thanks,
RandyC
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RE: House Fire--A simulated claim for discussion - 10/5/2006 12:16:39 PM
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trader
Posts: 1200
Joined: 4/19/2004
Home base: Houston, TX
Status: offline
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Arson for profit are very tricky losses to handle. The fire department would be your best tip off, and then proceed by watching each footstep, do not try to close with one scope trip etc. Get the pro,s involved quick and look out for your principals interest first.
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