| Author |
 Topic  |
|
NA
USA
114 Posts |
 Posted - 09/09/2002 : 09:06:53
|
Removed Why?
|
|
|
mgkmrp
USA
27 Posts |
Posted - 09/09/2002 : 12:35:13
|
I am also a "newbee"-i guess, but i kind of cringe at the term no matter how appropriate it may be. I have handled quite a few claims over the last 5 years(=actual adjusting time about 25 months)but have only cat adjusted, and have many shakey areas in the foundation of policy and insurance knowledge. This is not fair to storm managers nor myself, as i can never live up to my own expectations let alone the managers. And of course, there is not time to make up for defieciencys during a storm. I intend on reworking my knowledge base this winter and possibly for year or even two. If i find a good mentor type to work for, i will be staying there to get the repetitions and time put in which i so badly need in order to become a good adjuster.
---Back to the topic,a few of my assignments required a non waiver, and/or a reservation of rights-without knowing what exactly they meant, i got them signed. I am looking forward to this discussion, i have the time to sort out and understand what it means.
thanks for this forum. |
 |
|
|
Straw
13 Posts |
Posted - 09/09/2002 : 18:02:12
|
| In this senario I would inspect the damage as requested on Saturday A.M. when I could see the damage. If I suspected arson, I would inform the insured of his duties, explain that I need to have a C&O person determine the cause of fire before I could commit to coverage. At that time I would have the insured sign a nonwaiver ageement. That way the insured is aware that a coverage question exists and the insurer is protected from estoppel by reserving its rights to deny claim later in the investigation. Last but not least cover my position with everyone. I have found that if you can get the nonwaiver signed from the begining the claim flows smoother than when you send an ROR letter later. |
|
|
|
Red
24 Posts |
Posted - 09/09/2002 : 18:26:30
|
| Newt: Is your E AND O paid up?????? |
|
|
|
KileAnderson
USA
875 Posts |
Posted - 09/09/2002 : 18:31:58
|
| I would get a non-waiver signed so that the insured would know that just because I am inspecting the loss I am not necesarily extending coverage. |
|
|
|
Red
24 Posts |
Posted - 09/09/2002 : 21:29:48
|
| Jim: You do the same thing you do if you forgot your camera or film |
|
|
|
Newt
USA
657 Posts |
Posted - 09/09/2002 : 21:32:35
|
I didn't get it out of a book , I had it in school and I understood the object but not in detail. This is like a first grader trying to go high school , sorry for the interuption. I have asked questions and so far
I get questions. This gives me two questions I don't know the answer to.
I will wait and see what kind of answers you get, I think I have to get enrolled in that AIC course, it wiil keep me busy for a while . |
|
|
|
KileAnderson
USA
875 Posts |
Posted - 09/09/2002 : 22:10:01
|
| Yes Jim, I usually have a few pre-printed generic non-waivers and I have one on my computer that I can print out right on the spot if I misplace the pre-printed ones. If they refuse I would tell them that I can't do the inspection without it and if they still refuse I tell them I will talk to and probably return with a supervisor. |
|
|
|
olderthendirt
USA
370 Posts |
Posted - 09/09/2002 : 22:30:43
|
| It has always been my practice and understanding that when investigating a claim that if something occurs that raises an issue that may preclude coverage and that needs further investigation, I stop. If I had a non waiver I would explain the form and the need and required that it be signed before proceeding. Without the form I would excuse myself and return to base and contact my supervisor for instructions. (Some companies like ROR and some Non Waiver letters). To continue to investigate MAY give rise to an estoppel. The insured would be advised that I need to get direction from the company before proceeding. ps. If you work mold the non waivers fly fast and furious. I have had situations were I have stopped in the middle of a statement, or even at the door upon arrival, and have left. Better safe and road weary then a call to the E&O. |
|
|
|
CCarr
Canada
1200 Posts |
Posted - 09/09/2002 : 23:59:22
|
Well James, I was sitting putting some notes and thoughts to paper getting ready to consider responding to the first post of this thread, then I see scenario #1, then by the time I got back to it; others have got well into the second page.
I have found myself well within the scenario you have offered up, numerous times; but not wearing the boots of an I/A, but rather the shoes of a staff adjuster. You have made this a very real scenario, for anyone who doubts that these situations may not occur.
Yes, you go to the loss site, preferably Friday night, and hopefully with useful daylight.
Going down the stage you set, we see we have a serious fire, and after a brief "look" and "listen" (note the absence of my "talking"), "red flags" start to appear that are not yet defined.
These "red flags" come in many and varied designs - perhaps there is an absence of pictures / art on the walls, perhaps the wife and kids are gone for a few days, perhaps the gun cabinet is empty, perhaps the family car was parked further away from its' normal "oil spot" location close to the house in the drive, perhaps there are two areas of solid burn or possible origin with only exposure damage between those areas, or perhaps it is as Jim speaks of the insured's behavior - a manner that you can distinguish from trauma to that of evasiveness beyond that of the normal distrust for insurers. This list can go on and on, but when several of these "red flags" start to get your attention - it is time to react.
So, there you are, all alone in the stated scenario, nobody to lean on? No, not quite. As the enjoyment of my Friday lunch starts to leave me and be replaced yet again with new hunger, I remember that nice C&O fella I met at lunch, (that in my employer altered scenario)in the presence of my boss the Claims Manager.
Again, I emphasize, in this very real scenario, I have not talked much. I introduced myself, gave my card, told the insured that I had been assigned to investigate the loss (I purposely would not use the word "settle" - specifically use "investigate") and report the details to my boss (regardless of what authority I had - I would not expose it at this point). I asked the insured to walk around the perimeter of the dwelling with me and tell me about the house what happened. Nothing more. No point trying to be his next best friend or create comfort for him by reassuring him you had the checkbook with you to put things right. Because - you don't know yet if you want him for a "friend", and you don't know yet what actually happened that may preclude you from ever writing a company check. It is on this little tour that the "red flags" were heard or seen.
By the time we are back to his drive, I probably have answered fewer questions than he has, and on most others simply said "I don't know now". Notice, I have not mentioned, nor touched my camera.
I now excuse myself, and tell the insured I have to go to my truck and make a few calls; and I may be some time.
I am not alone, C&O fella , or otherwise. I want to talk to the handling Fire Department, even if the shift has changed, their log book will have sufficient info for the present OIC to refer to. I'll find from there if the local police responded and why; and that may be the next call. Because of the lunch Jim threw into the picture, my next call is then likely to that C&O fella (they are always reachable - their livelihood depends on it), and tell him all I saw from the perimeter exterior and all I heard from the insured, FD and PD. What I want to know from him is his opinion whether (based on the above) I should have the premises secured and the scene protected.
So, after that call, unless any others would logically follow and be available, I grab my clip board again, pull out a Non Waiver form from under my writing pad (every day I was in the field I had more than one of this form with me and numerous others - it should be a mandated prerequisite for the "field kit"), take a deep breath and go see the insured - for simplicity - the only Named Insured on the policy.
I don't have all the technical reasons at my finger tips anymore, but I am going to attempt to complete the NW with the insured. Because the loss has to be investigated, and because in doing so if it is determined by that investigation that the policy could not respond; then I don't want (nor does my employer) the actions I took during that investigation to preclude the insurer from exercising its' rights later in - for example - denial of the claim.
I don't think one is ever "comfortable" in making these crucial decisions, but I would not hestitate to do any of the aforementioned, or the following.
Standing with the insured in his drive, (note - I haven't been there a 1/2 hour yet - hello I'm your adjuster, a walk around and brief chat, time spent alone in my truck making calls) I would tell him I was going to complete a NW form. The next question from him is what is that, as opposed to why (if he asks why, that likely just raised another "red flag" for the list). I do not tell the insured "I must" complete the form or anything close to that - that just spells intimidation. I tell him the answer why is best found in the text of the form, I go down the form slowly and clearly, but do not offer any interpretation or opinion on its text. My general summation - if required - says that the NW allows the insurer to investigate the claim without its rights under the policy being affected by that investigation. If asked by the insured if I think he is involved, the answer is simple - "I don't know, now". If he is stupid enough to ask (and they have), if I was what does this form mean - then from my back pocket I pull out the policy wording for his policy and find the chapter and verse that would deal with that exclusion and point it out to him only and let him read it; then as he stared at that tell him that if the investigation after the NW is completed revealed such an act by the insured - that investigation would not prevent us from relying on such policy wording. Where there is reluctance to sign the document, I never "push" or "badger" - again that is only intimidation. In such cases I tell the insured, that I will be leaving the site and that (because its' Friday night) he will have another document hand delivered (we always did that as opposed to registered mail - that method of service has the same legality as it would hand delivering a notice of cancellation) to him Monday, and that delivered document would be a company executed Reservation of Rights Letter that carried the same intent as the NW; but that he may want to discuss it with a lawyer before discussing it with the company any further. If he won't willingly sign the NW - I have to leave - to do otherwise simply contravenes what I have been trying to explain.
I'm sorry I went on so much, but I wanted to make some notions quite clear. Regarding the ROR, other than the example of its use as noted in this scenario, I have found it used more in commercial losses with corporate entities, than residential. Often when the first notice of loss brings with it allegations of misrepresentation and other breaches of Statuatory Conditions, the carrier will execute an ROR and have the handling adjuster deliver it to the insured as part of the preamble or by registered mail and await contact from an insured or their representative.
Excellent thread Jim, this is real claims "stuff", the type of work that keeps one interested and constantly challenged to keep abreast of what the right thing to do is. I look forward to your critique or from others, for the benefit of all. |
|
|
|
Red
24 Posts |
Posted - 09/10/2002 : 00:37:05
|
| Clayton: Darn good post. You hit on something that I wanted to commend you on and that is we adjusters need to know when to open our mouth and more importantly when to keep it shut. Good job |
|
|
|
TomToll
USA
87 Posts |
Posted - 09/10/2002 : 00:46:06
|
While working Ark. Ice Storms, we were on the road and were called by the vendor to inspect a loss while in the area we were in. Information (basic) was given to us on the road. We did not have a non-waiver form with us. We had called the number given and it was the insured's Mother. She explained to us that the house was in her name, but the policy was issued to her son who was living in the house. Well now, that certainly raises some questions of insurable interest, so we felt a non-waiver was in order. What to do, what to do. Then we realized that we have a non-waiver with us at all times. It is in the MS/B Integriclaim program. We opened the non-waiver, got out some notebook paper and wrote it out verbatum.
We explained to the insured that anytime a question of insurable interest or any other discrepency is observed prior to starting an inspection/investigation, that the non waiver is required to protect the rights of the insuring company and its investigating representative.
If an inspection or investigation is started and a discrepancy is discovered that could possibly prejudice the rights of your company, stop and get a non waiver form signed. If you can't get the non waiver signed, leave, and suggest the company send a reservation of rights letter to the insured.
A number of years ago, while flying to St. Louis in my Skylane to investigate a crash that killed several people, I was to take a non waiver from the owner of the plane. He was not an occupant and had loaned the plane to a friend, who was killed while acting as the pilot in command. Unfortunately I had picked up the wrong box that contained all the forms I used when investigating A/C losses. When I got there, the first thing I did was get into the box to grab a non waiver and several other forms for signature. Wrong box. What was I to do, as I had flown from NLR to St. Louis and did not have time nor the inclination to fly back just for a non waiver. I called an adjusting firm, several of them in fact, in St. Louis, and asked if they would fax a non waiver to the airport. I had the non waiver signed and proceeded with the investigation. By the way, the friend had allowed his class III medical to expire and under that circumstance, was not a licensed pilot. I was very glad the non-waiver was in file.
We should always have necessary forms with us at all times. Just leave them in a box somewhere in your vehicle. But always remember, your lap top also has many of the forms and if you still know how to write, put it to paper and get on with your business. |
Tom Toll |
|
|
|
Newt
USA
657 Posts |
Posted - 09/10/2002 : 08:28:42
|
Jim, And all ,beautiful Job, I got a lot of questions answered and especially some things that will keep me out of trouble. I had one question about the forms and you read my mind. The loading of forms/letters in the computer or on a cd if you don't have the storage space.
My mistake which could have gotten me into trouble is not fully reading and understanding the question. I started my reply before the rest of the story. I think this is because I have part of the index without the book, if that makes sense.
Letters of reservation/non-waiver agreements like estoppel are things I knew the use of but not the occasion and how. So much to learn .
I think this forum will certainly reinforce the AIC, I think the AIC will be an excellent index,
if nothing else I'll get a good ref. library started. |
|
|
|
jlombardo
USA
212 Posts |
Posted - 09/10/2002 : 08:34:58
|
I agree that the non-waiver would be of the nutmost importance in this matter. In this case, explaining the non waiver would be done in a two fold fashion: I would advise insured that the non-waiver is needed because I am a storm adjuster and there to handle storm claims and not sure if the Carrier would want me to handle the loss or one of their staff---Basically my assignment is questionable. I would tell the truth about a non waiver--would not call the insured an arsonist--I would advise insured that the non-waiver is necessary since the origin of the fire is unknown and therefore we do not know if there is coverage for the loss...we don't want to deny coverage and we don't want to confirm coverage and we don't want to mis lead the insured....and that is why we wnt the insured to sign the non-waiver---we put the cards on the table in front of the insured.If he does not want to sign the non-waiver, then the only thing I would to is to advise him that I can't do any thing except take pictures...until advised by the Carrier. I would suggest remind him that it is his responsibility to protect his property from further damage....whether there is coverage or not.
Inregards to not having a blank non waiver handy, there are a couple of ways to handle. If you have one that has already been signed at a different loss,copy the wording and proceed from there. If a non-waiver is not available---wing it---write up your own non-waiver--cover all the necessary points---get the insured to sign it,date it, and aneighbor to witness it.
The reason for the photos would be to preserve the damage caused by the fire loss....I think that at this point, I would carry myself back to the storm amnager's den of inequity, and roust him out of bed, bar, or wherever...prior to going out on the loss, i would have called the vebdor's emergency number at their H.O as well as the 24 hr claims service number for the Carrier. |
|
|
|
Newt
USA
657 Posts |
Posted - 09/10/2002 : 09:38:34
|
Dang Jim, you read my mind again, I had moved on and got to thinking,estoppel, estoppel.
I came back and you did again. I had my question all ready, OK I'm all ears. Thanks All Ya'll. |
|
|
|
Newt
USA
657 Posts |
Posted - 09/10/2002 : 09:57:04
|
All defences are stopped and the situation or condition is allowed to continue as is. I'm
sure this is not the rest of the story, or even what you are looking for. I am trying and you guys are locked and loaded so shoot(not me). |
|
|
|
Topic |
|
|
|
Non-Waivers and ROR's
Forum Locked
