RE: Claim Scenario for Discussion
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RE: Claim Scenario for Discussion - 10/2/2006 5:09:14 PM
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Janice_Toll
Posts: 78
Joined: 4/19/2004
Home base: Austin, AR
Status: offline
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Could we now get some more comments from experienced adjusters?
_____________________________
Janice R. Martin-Toll
You rest, you rust!
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RE: Claim Scenario for Discussion - 10/2/2006 7:39:15 PM
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swink_d
Posts: 259
Joined: 4/19/2004
Home base: Lexington, NC
Status: offline
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Well I had a long reply
but evidently took to long to post and the forum timed me out.
I am not experienced
So I will just say coverage begins with a covered peril..
added
All the interior and contents are covered.
The emergency tarping is covered.
Fido is not.
Mrs Smiths ALE is covered ( for the purpose of discussion going with what the policy says) as an accrued expense
- Motel Bills- food receipts for her- and mileage as accrued basis to drive the additional 14 miles to work and mileage to her home to work on it
Mrs Smiths boyfriends can be allowed minimum wage for the mitigation.
None of the material removed before the peril is covered.
< Message edited by swink_d -- 10/2/2006 7:53:47 PM >
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RE: Claim Scenario for Discussion - 10/2/2006 8:03:18 PM
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PORTASATGUY
Posts: 316
Joined: 9/15/2005
Home base: Homeless
Status: offline
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SINCE HO3 IS "ALL RISK" and a BROAD FORM Policy, and Very Typical I WOULD
- At time of receipt of loss notice, I would review coverages, amounts, deductible, and DEC sheet. UNDER THE ASSUMPTION THIS IS A BASIC HO3 POLICY, and there are NO EXCLUSIONS. I WOULD PROCEED AS A COVERED LOSS.
- Create Activity Diary for Claim, and Notate Conversations, Times, Dates and Names, Create Claim File with Loss Notice, Activity Diary, and Notes if any.
- Call insured, Listen to how loss was caused her story, verify coverages, verify mortgage information and make Appointment to meet and Scope Loss, have insured write an entire contents list and verify contents with possible pictures (Offer Contents Worksheet via Email or Fax) , Previous Lists, and or Receipts. And List Pricing thereto preferably on a computer. And Identify anything in personal contents that are Salvageable through cleaning, Refinishing, refurbishing, and or anything other than replacement. (Remember Coverage "C" is 50% of Coverage "A".) Also Discuss Mitigation And the Responsibility of the Insured to "PROTECT AGAINST FURTHER DAMAGES" Explain Policy Coverages & Limits with emphysis on Coverage "A" (Dwelling) Coverage "C" (Contents) and Coverage (D) ALE (REMEBER COVERAGE "D" IS 20% OF Coverage "A") . Update Activity Diary, Give all My Contact information
- Show up at scheduled appointment, Take Pictures of Front Right and Front Left of dwelling, Go to Door, Knock and introduce myself. Explain the Procedure Of my Inspection (ROOF, FRONT ELEVATION, RIGHT ELEVATION, BACK ELEVATION, LEFT ELEVATION, INTERIOR Starting From Front Door, them onto the right side of Interior, Room to Room Damaged or Not) Take PLENTY OF PICTURES Whether Damaged or not. Document all Damages, Obtain Contents List as mentioned in Initial Call, REVERIFY CAUSE OF LOSS, Obtain Expenses Paid out for "COVERAGE "D" Which is Usually 20% of Coverage "A" under these Above Assumptions and provided there are No named Exclusions on Dec Sheet. Make sure all My Diagrams, Dimensions, Comments, Notes, Contents list, Receipts for Loss of Use, and Mitigation were in order. Finally Explain to Insured How We will Proceed, and explain how the recovery will begin, Including finding reputable contractors to perform the Work Needed. ( make Sure I saw All contents and determined if there is any Salvage Values, or Salvageable Cleaning that could be done to salvage, or save Contents with pictures thereto, Tile Floors etc. Make sure I have Many Pictures. And explain to Insured to Proceed with Roof Repairs. Leave My Contact information, And the Information of The Carrier and reiterate the Recovery Process. Excuse Myself, and inform Insured Ill be In Contact With them as soon As I Write the Estimate. Explain What was discovered, Obtain Agreed upon Scope, Determine that Insured is Happy with Scope of Loss, and All Issues are Answered Covered, And Update Activity Diary Notes with all pertinent Information.
- Write Estimate, Utilizing Proper Depreciation and determinations of Recoverable or Non Recoverable, Research Pricing on Contents List Price Contents List with verification of Replacement costs evidencing reinforcement documents, Upload Pictures, Scan and Upload Receipts, Fill out Proper Reports, Update Activity Logs, Create Invoice, Property Appraisal reports, PDF Stack Reports in Order of Invoice, Property Appraisal Report, Completed Activity Diary, Completed Estimate, All Diagrams, and Elevations with measurements thereto, All Supporting Documents of Value's, Risk Review Report, And Finally All Supporting Pictures in Order of Inspection, Numbered Dated, And With Comments Supporting Claim.
- Call Insured, Discuss Finding, Facts And Figures, Have Insured Agree with Scope, Estimate, And Dollar Amounts. Explain This is all Subject to Carrier Approval, Close Claim And Upload to Carrier or IA Vendor.
THEN I WOULD CALL WHO I WAS WORKING WITH AND ASK THEM "WHERE IS MY CHECK" ; )
THATS WHAT I WOULD DO. AND IF I HAD ANY QUESTIONS I WOULD CALL MY STORM MANAGER, UNLESS I WAS THE STORM MANAGER ; )   
But thats Just me!
_____________________________
R. Estes
Life is short LIVE IT!
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RE: Claim Scenario for Discussion - 10/3/2006 9:38:48 AM
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misty
Posts: 5
Joined: 8/13/2006
Status: offline
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Between Randy C, Rass and Portasataguy, the claim is well covered. There are some things that I would like to bring up for thought.
First, using a contractor. Check with the carrier to see if they have a list of contractors. If so, have one of them meet you at the loss to go over the claim and agree on all visable damages. This can ease the insured's mind as to what needs to be done. Remember to tell the insures that she is under no obligation to use this contractor. They are only there as a professional set of eyes. If the carrier does not have a list and will not allow a contractor to be called out by you, then do your scope, measurements and photos. In either case, go over everything with the insured everything you see.
Second, on the contents. Call the carrier to see if a contents restoration company can meet with you at the loss. Sometimes a clean water loss will not result in as much contents damage as thought. Again, advise the insured that she is under no obligation to use this vendor. The insured may have items that are very dear to her and if they can be restored, you make the insured happy.
Third. The laminate floor. Since it is laminate, that means that usually the flooring is not pure hardwood. there is normally a pad underneath this used as a creak reducer. This can hold in water. In today's world, anything that can hold water against wood type products can bring up the M word (mold). Be very careful. If possible, get a flooring person out to gently remove some of the planks to see what is under there.
Fourth. Pets under ale. While the policy says that pets are not covered under C and A will not cover loss caused by pets, Cov D stated that the insured is covered for over and above normal expenses. Some companies will consider having to board the pets an additional expense. Check with the carrier.
Finally, as has been said before, the loss will be presented to the carrier for their review and acceptance. Payment is up to the carrier. Lots of good information by the folks.
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RE: Claim Scenario for Discussion - 10/5/2006 12:28:10 AM
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PORTASATGUY
Posts: 316
Joined: 9/15/2005
Home base: Homeless
Status: offline
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I beleive in the KISS method, Sometime WE as Adjusters CREATE PROBLEMS FOR OURSELVES, Like calling or suggesting insured to call a contractor, or specialist, to reiterate your findings. Its Likely that the insured will call Contractors For Bids anyway. ON VERY RARE OCCASIONS there are suppliments.
To all you Good People out there a big huge KISS to you!
Just my opinion is all!
_____________________________
R. Estes
Life is short LIVE IT!
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RE: Claim Scenario for Discussion - 10/5/2006 1:33:11 AM
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texascatadjuster
Posts: 9
Joined: 10/24/2005
Status: offline
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KISS -Keep It Simple Stupid
My thoughts exactly Roy as a qualified adjuster we should not require backup from a contractor of our scope. The insured should feel confident in our ability if you do our job correctly.
Get exercise Janice makes for interesting reading
_____________________________
We have enough youth. How about a fountain of SMART?
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