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KileAnderson
USA
875 Posts |
 Posted - 09/10/2002 : 10:38:54
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This past summer I was working a wind storm and I got a call from an agent. He said he had an insured that had already replaced his roof and turned in the contractors invoice expecting to be paid for it. He never filed a claim. He just went ahead and replaced it. I tried calling the insured several times just to touch base but he was one of those busy guys who can never be contacted. I left office #, cell # and pager #. He called my office once and left a message with his cell phone # but still after a week I could not get in touch with him.
I had the invoice from the contractor for the roof replacement. It stated 26sq of shingle and felt removed and replaced with 30lb felt and 300lb architectual shingles replace some wood and disposal fees. Pricing seemed reasonable. It was dated the day after the date of loss. One day I noticed I was right around the block from the said property. When I was done with the claim I was working on I went to the property.
It did indeed have a new roof. I knocked on the door and no one was home. As I'm standing on the porch waiting for the door to be answered I noticed in the window a building permit from the township. It said "remove and replace roof shingles. The date said "April 8- May 8, 2002". While it was refreshing to see that the contractor had actually pulled a permit the problem was the DOL was May 13th. 5 days after the permit expired and a good 35 days after the permit was pulled.
Since I was there I took some quick measurements and the actual measurements on the roof was 16 sq. Not 26 as stated on the contractors invoice. I pulled out my cell phone and called the contractor. He was a big help. I asked when he did the work. He pulled out his day timer and told me he did the work in mid April. Presented my facts to the storm manager and a ROR letter went out immediately. Needless to say, after receiving that letter he was the easiest man in the world to get in touch with. He was calling every hour on the hour. Claim went to SIU and I never heard the out come.
Just thought you may like to hear a real life ROR situation. |
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Russ
USA
75 Posts |
Posted - 09/10/2002 : 10:48:19
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| Jim, I have learned to carry all my open claims with me on the road and in a file I keep Non-Waiver agreements,Advance payment agreements, Lightening affidavits, mold questionaires,and Proof of Loss . Each Vendor has their own special forms they use and I try to keep them all with me, along with maps, extra camera and film, Batteries, Rolaids!!!Keep up the good work and have a great day!!!Russ |
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olderthendirt
USA
370 Posts |
Posted - 09/10/2002 : 11:03:07
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| Kile, not to pick on you but a good example. You knew that there was something wrong on the loss as soon as you saw the permit, the unreachable insured and reported repair date one day after storm were flags. You called the contractor, but then you measured the roof. If the insured had come home and found you on the roof, could he have argued estoppel? And could he have claimed trespass? At what point do we have to stop all investigations? And do we have a right to climb a roof without contacting the insured? (I know adjusters who do this regularly). |
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ALANJ
USA
159 Posts |
Posted - 09/10/2002 : 11:18:39
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Jim:
I am enjoying reading about waiver and estoppel. There is a little more to estoppel then what has been posted. The insured must act or do something overt based upon the actions or non actions of the insurance company or adjuster before estoppel comes into play. As you stated estoppel is an action or pleading in equity.
A good example of estoppel would be an insured replacing their roof based upon the representations of the adjuster or co that they would pay for it. Insured replaced roof based upon repersentations of co. and adjuster. Company would be estopped from not paying claim.
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KileAnderson
USA
875 Posts |
Posted - 09/10/2002 : 11:29:49
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Mark,
I never actually set foot on the roof. I did the old adjusters trick of counting tabs, something that I would never do if I was actually putting together an estimate, but I did it just to double check the invoice from the contractor. If my tab counting method had been only a square or two different I would have contributed it to the obvious inaccuracy of the method but since it was 10sq off I had to assume that some padding was going on. I sat in my truck across the street and counted the tabs and did the math. The house was on a corner lot so I could easily see all 4 sides. |
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Todd_Summers
USA
69 Posts |
Posted - 09/10/2002 : 11:49:09
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| What about extending ALE benefits until coverage can be determined ? |
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CCarr
Canada
1200 Posts |
Posted - 09/10/2002 : 11:55:48
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Joe, this follows Jim's request, and I will comment on your post. It is solely done with the intent to create a "benchmark" of handling claims as was laid out in the specific scenario Jim provided. As we were given a scenario to frame our approach within, I will direct my thoughts within the parameters of that scenario.
You say to the N/I that the NW is needed, ".... because I am a Storm adjuster .... your assignment is questionable ....".
It is likely you showed up at the N/I property because you were assigned the loss, and further your FNOL would likely say it was a fire loss. Therefore, whatever "type" of adjuster I was known as, I would see no value in telling the N/I. I do not think it is customary for adjusters to introduce themselves, regardless of the class of claim being dealt with, as; ".... I'm a property casualty adjuster, or I'm an umbrella adjuster ....". You are an "adjuster", and in my opinion, that is suffice as to your rank and file, other than who you are employed by and / or for what carrier.
If you identified yourself as a "storm adjuster", to give yourself some comfort that the N/I would develop some belief that you may not ultimately handle this loss (visa - a perceived conflict between "storm adjuster" vs fire loss), I suggest that approach could later take you down a rough road. The facts will come out at some point that you were the assigned adjuster that showed up at the door. To suggest or create the impression that your assignment is questionable, at best I think has little value to the exercise ahead of you, with the presented scenario; and at worst could be alleged with some foundation to be misrepresentation or misleading by you.
Yes, certainly, no adjuster should ever "label" an insured; be it arsonist or any other label, be at the outset of your dealings with the N/I or at any other time. To do so, and if heard coming from your lips, would certainly end an adjuster's career and likely set that adjuster down a slippery path to financial ruin.
I take from your comments, or sense from them that you may feel a NW is necessary on many, if not all claims - other than apparent weather related damage claims. That is, I sense you would have a frequency of obtaining a NW for every fire claim and most burglary claims, etc. That practice would soon find you with an unmanageable backlog of files, for various reasons. Every fire claim you attend - you do not know the cause of at the outset or likely ever, and hence your conclusion for the NW if you can not relate cause to coverage. That should be the topic of another thread, however, for this scenario the NW is required because of the "red flags" you saw and heard during your general and cursory review, early in your attendance.
I personally would only tell a N/I the NW was a form I wanted to review and sign with him, for the reasons I stated in my previous post relative to this scenario. I understand it is a "phrase", but I have no "cards to put on the table ....". I simply do not want my investigation to erode the carrier's rights, at a later date.
If the N/I will not sign the NW, I think it is dangerous to take any pictures. Photographs are evidence. Evidence results from an investigation. You said you could not investigate without a signed NW. You will see the conflict here that a plaintiff attorney will chew you up with.
In regards to any field adjuster ( any - staff, cat, I/A) not having a supply of required field forms with them, which would include a NW - it is as wrong as a field adjuster leaving home in the morning - knowing you are a field adjuster - and not wearing your safety boots or having them with you. This is a prerequisite for any field adjuster, as important as the clip board, writing paper, camera, work boots, hard hat, coveralls, etc etc. Many commercial loss sites will prohibit you from entry to the premises due to WC regs, if you do not wear approved safety boots, hard hat, and some (depending on use and occupancy) safety glasses.
To, ".... wing it .... write up your own NW ...."???? I suggest that should not be done, and in fact I doubt it could be done. The NW is a legal document, with language developed over the years, to at best provide a legal framework for its' intent, just inches better than the last time it took a beating in court. I would be very, very, very impressed, if anyone - lawyer or adjuster - could pick up a pad or dictaphone and from memory and verbatim - dictate or write out a full NW agreement. Count me out on that.
Your concluding paragraph, you start (aside from touching on the photos again, which I do hope you see my viewpoint) by saying you are leaving the scene to find that manager (storm or otherwise); but you go on ".... wherever - prior to going to the loss ....". You were assigned the loss, withe the FNOL stating it was a serious fire, cause unknown. You are making this/these pre-attendance calls to your supervisor(s) for a quick refresher in things to think about, things to watch for, things to listen to, things not to do; or to say the claim is not for me. Any adjuster will be respected for a job well done, regardless of the complexity of the loss; and an equal amount of respect should be garnered to the adjuster that backs away from a loss they feel they are going to get in over their heads with. The opposite of those two positives is applicable to an adjuster who for whatever reason(s) improperly handles the loss.
You do not know what is awaiting you at the site - so those calls are just to tune your mind towards issues that should be considered when you attend.
I do hope my comments provoke everyone to think about claims handling techniques. |
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mgkmrp
USA
27 Posts |
Posted - 09/10/2002 : 12:02:16
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| WOW, hats off to the adjusters who spendso much time providing such clarity! |
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Newt
USA
657 Posts |
Posted - 09/10/2002 : 14:15:35
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I have a question, in case you are given a claim, the customer is anxious to get his claim settled and after you arrive at the site you discover, The fire marshall, the police or forensics have not completed their work and can't give you a date/time when they will finish.
This is in the case of fatality/fire or explosion. I would let my supv. know, I think it would be expected. If some of you could give me a run down of your experience, I know also the supervisor will give further instructions or at least I think he would.
This would also be the time to get the NW agreement signed, right?
I think one would try getting this signed before calling in.
Would you also get info for your I log from the authority doing the investigation and how would you handle this? |
Edited by - Newt on 09/10/2002 18:08:38 |
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Newt
USA
657 Posts |
Posted - 09/10/2002 : 14:43:20
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PS Could this happen if the case was re-opened without the knowlege of the carrier?
If I could not locate the supv. I would notify the carrier on his behalf. Would that be acceptable to the supv or carrier?
Ditto Mike, Got any better we couldn't stand it. |
Edited by - Newt on 09/10/2002 18:02:30 |
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Newt
USA
657 Posts |
Posted - 09/10/2002 : 18:35:21
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I re-phrased my questions before you answered, I know how they sounded, wanting a hand holding.
I had a two hour battle with dns problems and couldn't get back on to edit.
What I meant was a reopened investigation by authorities. I could see this as a possibility.
I got an idea how busy everyone is yet in this case I think the supv would want to be up-dated. I would think the NW agreement would be imperitive because you do not have any information from the authorities on closure of their investigation.
The reason my questions sound stupid because they are, for that reason I don't care to go out before I can produce without the hand holding. The whole purpose for my being here is picking brains and knowing before I go there and make folks miserable. So if you don't mind I'll make you guys miserable and I really appreciate it too. |
Edited by - Newt on 09/10/2002 19:02:25 |
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Newt
USA
657 Posts |
Posted - 09/10/2002 : 19:31:07
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I was thinking of case and not the claim reopened. You answered one question in that the authorities usually cooperate , I wondered about this. And I was thinking the case as being suspect by the authorities of wrong doing in other words if a case is reopened it means they must have additional evidence. Maybe I will learn insurance jargon before I drive everyone nuts. You got most everything answered Jim thanks. I will be back In a few days, gotta go attend a seminar . I place a lot of value on this forum, I learned more today than any day yet.
I will read every post when I get back and will no doubt save a lot of them. I got to make my self a black book except it will be red. |
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TomToll
USA
87 Posts |
Posted - 09/10/2002 : 19:52:28
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For those who wonder what a non waiver is. This is the wording of the one we use from MS/B. There are non waivers with different wordings, but all mean the same. Read the form carefully and you will see that it is self explanatory. If a questionable situation arises, it never hurts to have a signed non waiver in file. It certainly does not jeopardize an insured's claim, unless a breach occurs.
Non-Waiver Agreement
Whereas, Joe Blows Balloon Factory
of 123 Hot Air Drive,Windy Bluff, TX, hereinafter called the Insured, holds a policy of insurance, number 2002, issued by Lighter than Air, Inc., herein after called the Company, and whereas an accident or occurrence happened on or about 7/5/2002, at123 Hot Air Drive in connection with which the insured is claiming benefits under said policy, now therefor:
It is hereby agreed by and between the Insured and the Company that no acts heretofore or hereafter taken by the Company, by and through its representatives, and at such time and in such manner as it deems advisable, in investigating said accident or occurrence or in any determination of damages resulting therefrom, shall operate in any way as a waiver, or invalidate any of the conditions, of said policy and in the event any suit has been or shall be filed against the Insured growing out of said accident or occurrence should the Company elect to defend said suit, such defense by it shall not be construed as a waiver of any of the conditions of said policy.
It is the intention of this agreement to provide for an investigation of said accident or occurence and a determination of damages resulting therefrom without in any way affecting, impairing or adding to the liability of the Company under said policy or under any statues or the common law, and in no way heretofore or hereafter taken by the Company hereunder shall be construed as an admission of its liability or coverage.
Executed in duplicate this ______ day of ____________, 2002, at ______________________
1. Witness: 1._______________________________________
By_______________________________________
2. Witness: 2._______________________________________
By______________________________________
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Tom Toll |
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Jim Lakes
USA
37 Posts |
Posted - 09/10/2002 : 20:40:50
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James,
You asked and you shall receive.
I, just today, was requested to get a Non-Waiver from an insured that turned in a hail claim from a storm of 10/21/2001. Just to cover all bases I have a form on my computer that I use for three different forms. It is as follows:
NON-WAIVER
AND
CLAIMS AUTHORIZATION AND CONSENT FORM
The undersigned, having reported a loss to ________________________________
(Insurer), for damage to property located at ______________________________,
thereby consent(s) and agree(s) that the said insurer, its employees, agents and independent contractors may enter upon, inspect and search the above-described
premises, or any property appurtenant thereto, and may remove, test, examine and retain custody of materials in or on said property as evidence on any occasion or occasions until such time as the insurer receives notice in writing to the contrary. It is further acknowledged that nothing herein shall otherwise waive any rights of the undersigned or insurer and that this consent does not constitute a determination of any coverage or waiver of any policy requirement.
Signed: ________________________________
(Insured)
Signed: ________________________________
(Company Agent/Representative)
Date: _________________________
Witnessed: __________________________
This form has been used for years and by many companies. It basically, covers all bases and provides the protection that the carrier is looking for in that it commits them to nothing.
The claim I worked today, the insured did not want to sign it at first. I then proceeded to explain that I would not enter the property or attempt to adjust the claim until they did. Upon hearing this, they signed.
A brief explanation as to its meaning. It gives you the permission to inspect the claimed damages without committing to coverage, damage, cause, or value/amounts. By signing, the insured attests to the fact that they understand that fact and that because of signing; it waives nothing in the policy or changes any coverage.
We could go on but will leave for others to contribute.
Jim Lakes, RPA
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Straw
13 Posts |
Posted - 09/10/2002 : 22:54:28
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| Sorry, I have not been here for the last few days, had to work. This is a great discussion many good points. You guys are are teaching me a lot. Newt,I wish I had a extra copy of the AIC 33 text to send you. However, I can't part with mine after eight years I still keep it as a well used part of my library. Jim, I like your NW. My first post was short and not real detailed but it did start some discussion on the NW. Can I add at this point my thoughts on the ROR, can anyone tell me why an I/A should ever send an ROR. Jim Flynt your last senario is great, I have this exact thing on going in Wichita Ks the DOL was 18 months ago and there is a fatality involved so I will be real interested in this discussion. I was not the original adjuster on this claim, I received it through atrition I have been on this since Sept. of last year. There is a 6' file on this claim. I will not bore anyone will details. BACK To Topic there was no NW or ROR sent By Company on this claim so now the insurer is ???? |
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Non-Waivers and ROR's
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