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olderthendirt
USA
370 Posts |
 Posted - 09/10/2002 : 23:07:36
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| As an independent adjuster I would NEVER sign a ROR nor would I sign a denial letter. Iwould happly write the letters ( if I was on time and expences)but they should be signed by an employee of the company. |
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CCarr
Canada
1200 Posts |
Posted - 09/10/2002 : 23:56:02
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Newt, this commentary refers specifically to your 9/10 posts of 14.15 and 14.43, and Jim's comments and request that immediately followed.
First, please go back to your post - maybe last week - where you declared you were 1/4 of the way towards your goal, and refresh yourself. Then, please find my response to that, wherein I suggested you take another look at the map that carries the path of the journey you are on. Review my thoughts about the next 3 quarters of your journey and how I suggested they would each be 10/4's long, relative to your first 1/4 journey. Have a good look at that Newt and please read Jim's comments (post #51) again. With the nature of the material that has come out on this thread, do you yet have any notion of what is being suggested, by me anyway?
I will give you my technical input on your two posts referred to above, then get back to your "journey".
You ask, ".... claim assigned, customer anxious .... FM, PD on site and not finished, don't know when they will be finished ....".
It does not matter, with your example, if it is a fatality, fire, or explosion. First, if there is yellow tape across your path at any time you access the property - do not cross it. If the FM or PD are on site, you likely will not be allowed on site - that is referred to as a secured site, and your access to it would / could contaminate it or erode its' integrity. Some official will come out of the structure at some point, and if he is not in too bad of a humor, you may catch his attention and have a brief and general chat. Do not expect anymore, at that time. I guess I should add, to get off on the right foot with these "authorities" (not "forensics"); even in the absence of yellow tape - do not just wander into the subject structure. Knock at the doorway, even if it is a burnt out hole, and wait for someone to acknowledge you a/o invite you in; and then quickly identify yourself.
So, your initial visit, under your example, will be brief. The insured's anxiousness can not sway you from limiting your conversation with him to the likes of, ".... I don't want to do anything until the authorities are finished, I'll call back tomorrow ....". Then leave.
Yes, your initial report (verbal or written) to your Sup is warranted (he planned for you to be there most of the day) that day or first of next. But, this is not a "major" issue at this time. If, as one of your examples, it was a fatality, the authorities are mandated to do a thorough site investigation. Other examples have other reasons - don't try and make to much out of it at this time.
You would advise your Sup (perhaps only through your daily file notes) that, ".... I attended site 9/10 9.00 AM, confirm structure is heavily damaged by fire, FM & PD on site, site not accessible by me, access date u/k, introduced myself to FM, met insured and advised him I could not start investigation until we had site access, will follow up tomorrow, cause still u/k and was not discussed ....".
Why are you getting a NW? With the specific example you gave, what concerns do you have - at that time? You have no idea what happened or why - at that time. Nothing yet has caused you concern that should turn you to a NW. Investigations by authorities at fire sites is common, it is what they turn up - that will cause you to react and turn left or right in how you will manage your handling of the loss.
What other instructions is your Sup going to give you, if you reported as per my file notes example? perhaps it would be that quick refresher I mentioned in response to Joe's post, but do not expect or plan for your hand to be held.
This now takes me to the "corporate side", regarding your two posts.
First, unless you have an excellent relationship with your Sup (likely a vendor manager), and unless the person you call directly at the carrier is at least your brother in law, or failing that the first cousin of your vendor manager - do not ever do it with the example and issues you have presented. To do so, at best, will immediately and seriously erode your relationship with your Sup; and provide plenty of reason to send you home. To do so, at worst, quickly reveals to all "important people" - your vendor manager and the paying client the carrier - that you are a junior (at best) handling a serious fire loss; and as well quickly provides plenty of reasons to send you home.
Newt, please understand, this process by scenario that Jim is offering to us, is not a real life soap opera playing out on your computer, it is not a developing screenplay for a good movie that you are injecting plot into, it is not an interactive mystery game.
With your commendable enthusiasim for this profession, you are allowing yourself to jump too far and too fast in your "journey" to get ready to hit the road.
You must get some basics and a foundation in insurance principals firmly seated in your mind, before you start seriously exploring the many and varied directions one could take on these examples. Each direction on a claim is determined from the last "stone" turned, and ever so much care must be taken to ensure that direction is not misjudged by leaving one or more stones unturned.
Let me bear my soul for a moment, perhaps as an example of what I think is your best direction to achieve the basics and foundation in claims.
I'll fluff for a moment and say I know somethings about claims, both the macro and micro picture; I should, it has been my basic interest and livelihood for over 30 years. I also had the opportunity to get to know somethings about Loss Control, but that is in a minority relative to claims. Both claims and loss control are components of Risk Management. I find Risk Management fascinating, but the world of RM is broad and varied. I would not participate in an RM website forum such as we are blessed with here. I would certainly absorb everything I could from it on an ongoing basis; and as I subscribe to a number of claims periodicals and have a pretty good claims library - I would do the same if RM was where my bread was being buttered.
So, it just happens, that today I finally received a new book I have been after for awhile - ARM 54, Essentials of Risk Management, Vol1, 3rdE, AICPCU. Now I am excited that I can take my claims background and a fair knowledge of loss control - and learn something about RM, and try and develop a basic foundation of RM processes and analysis. Only after that would I venture into the fray of an open forum with any commentary or reasoned questions. But, that is me.
In summary Newt, if you got to a storm site via deployment in 2003, and asked the amount and type of questions you do; you would not last long and you would not be asked back. Honestly, that would be a terrible way to dampen your enthusiasm.
I have always enjoyed training, as long as the participants were willing, and was talked into and subsequently enjoyed being an instructor for a few years for our Insurance Institute, in addition to my day job at the time where training was a never ending endeavor with staff adjusters. One of the key elements of training is to have a structured plan. You must walk before you can run. It is a trainers obligation to ensure that people do not get ahead of themselves. You are your own personal trainer on this journey - put the brakes on and add some discipline to your self study plan. Avoid what will inevitably happen, if you do not. |
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Straw
13 Posts |
Posted - 09/11/2002 : 01:28:31
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| Jim, I would love to talk to you about the Wichita abortion, but not on a forum, it is in pre-trail there are more C&O's and legal eagles than I can keep track of. we have plumbers,(ask me about this the house blew up) contract hit people and pissed off realitives involved. I love this job !!! back to the topic this forum is the most stimulating group I have found in a long time, please let's keep it going. P.S. my name is Darrell CADO told that name was taken when I signed on. |
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Russ
USA
75 Posts |
Posted - 09/11/2002 : 07:05:08
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| Jim, I think your doing a fantastic job and I'm glad a lot of the more experienced Adjusters are taking time to give examples of what they do in situations like these. CADO Has a wealth of Adjusting talent and a new adjuster can learn more on these pages than in any book. Keep up the good work!! |
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jlombardo
USA
212 Posts |
Posted - 09/11/2002 : 07:47:14
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| To CCARR--thank you for your review of my post.....pleasde review the original post and you will note that the FNOL did not specify the damages nor that infact this was a fire loss....I was also under the impression that this occurred under a CAT type of situation , since reference is made to the "storm and local claims office".....I was further under the impression that Jim, had once again , thrown us into a situation where we were "it" and to handle this situation with the circumstances given....It has been my experience that whe at a Cat site,if you receive a claim that is not related to the Cat, that you bring it to the attention of the the Cat manager prior to handling...I have seen that usually the Cat manager or Carrier rep, will pull the loss and assign to the local office for handling.....but again, I was merely trying to answer the questions within the parameters established by Jim .....no I do not take a lot of Non-waivers.....no I do not call insured's arsonists.....I did not say that.....no I do not have all the answers, which is why I review CADO at least twice a day....As a matter of fact, I felt that your review was unnecessarily caustic and I feel that it does not reflect the spirit of the CADO forums....It is not a question of knowledge, but the presentation to those of us that truly respect folks that have earned their stripes...respect is earned,not demanded....... |
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Newt
USA
657 Posts |
Posted - 09/11/2002 : 08:35:18
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Clayton, I found your remarks most informative, and you painted a good picture of the problem I had with the claim site. I will remember the advice you gave . I did not mean to give the impression that I would be a full fledged adjuster at one year, at that time I planned to be a adjuster in training. I do think I need to study a year before I start looking toward the field. If people like you who are willing to give advice , then In want to hear it. If I have questions I would like to ask them and if I did not participate and did not ask questions, I might as well read a book. I hope this site is not intended just for pros, or
just for a few to participate in. I realize my questions seem dumb, but I was always told there is no such thing as a dumb question.
The only problem I have had to get use to here is, no matter how sincere
a person is in asking questions they are chastised for how much trouble they cause. There is always remarks about being sent home first and "hope you got your E&O payed up", and for the interest in learning, I indure this, I don't mind the hazing.
If as you say, I should refrain from any participation in these special topic forums , even when I thought it had stalled, and others feel the same way then I think I could find a more friendly atmosphere.
It is certainly not my intent to make enemys and not the purpose of anyone who joins a proffessinal organization, I would think.
I will say again, I will study real hard for a year, then the education begins. I have set goals for my self and intend to see them through,
obsticles are the chance to excell.
I DO TEND TO JUMP INTO THINGS WITH BOTH FEET, I am intense in every thing I do. In the past 15 weeks I have made three trips to Texas, drove 105 miles each way to school, and managed to keep mowing my 7 acres of grass. The grass is the worst of it.
I have to leave now for Mobile,Al for a couple of days. I would like to know more about Fema and SBA. These are options for people without coverage or denied claims , but most of all I want to learn something about their pocket computer and how they are using it. |
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Catmannn
42 Posts |
Posted - 09/11/2002 : 08:35:44
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This is one of the best threads on CADO I have read in a long time, thanks.
When I have been assigned a loss, cat or branch claims, that states water in a basement I always include a N/W in my claim file. This is the only way to start this style of loss.
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olderthendirt
USA
370 Posts |
Posted - 09/11/2002 : 11:23:12
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Jim I strongly believe that by it's nature a ROR should be signed by an authorized employee of a company, not an "independent" field grunt like ourselves. If we have any insurance lawyers reading this maybe they could comment.
Newt, books will only take you so far, then it's time to jump in. Don't wait to long before (weather permiting) getting into the field. Also, it would be a shame not to have your posts on any thread, questions asked and thoughts from those who are learning cause the rest of us to think and refresh ourselves on important topics. |
Edited by - olderthendirt on 09/11/2002 11:24:11 |
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CCarr
Canada
1200 Posts |
Posted - 09/11/2002 : 12:44:54
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In my carrier days, whenever a loss was assigned to an I/A, the relationship was established that if the I/A felt there was a need for a NW, they obtained it without direction from the carrier. Occasionally, in discussions with the I/A about their field investigations, we would constructively debate the issue, or in assignment discussion before they headed out, the relevance of a NW would be bantered about. However, whenever a NW was appropriate on an I/A handled loss, the I/A completed that process.
When requirements - under the same reporting structure - determined that a ROR was necessary, the carrier always executed the letter. It was done as a letter on corporate letterhead, and either provided to the I/A for hand delivery, or sent registered mail. To me, that was the logical and practical process to follow; as opposed to any legal requirement for that manner of issuance. |
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olderthendirt
USA
370 Posts |
Posted - 09/11/2002 : 14:07:41
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| A non waiver is a document personally explained to the insured before signing ( in theory) while a ROR is a complex document (often running several pages). Most ROR's I have seen are difficult to understand, and to the insured very confusing. I would think that an ROR would be easier to challenge in court, and as I am not an officer of a company I do not want my squiggle on the letter. If I wrote and signed an ROR would it be my E&O if challenged in court? I am far more comfortable with the NW. Jim we deny claims face to face or on the phone, but should we send and sign denial letters? |
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Red
24 Posts |
Posted - 09/11/2002 : 14:15:31
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Newt:
When I tell you "I hope your E AND O insurance is paid" it is NOT a meant as a put down. I am hoping you will go back to your statement and see if you can figure out what you have said in your statment that might give that as a triggered response. It is meant for you to learn. We don't want you to take your marbles and go home each time someone makes a response to you. We are trying to help you learn so you don't end up in Big trouble as that is what could happen. You are going to learn more by us making you think than if we just give you answers to questions where you don't understand the full picture. |
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Red
24 Posts |
Posted - 09/11/2002 : 14:23:47
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Jim:
I would not sign a ROR, unless I was an employee of the company involved. It is and should be from the carrier and signed by them. I would hand deliver if requested but I would prefer they send with return receipt requested then I am out of the picture and they have verification from the post office that they did infact get it and when they got it. I also will not send out denial letters. Again that is the companys job and we are taught and it is drilled in our heads we can not confirm or deny coverage. We can recommend to the carrier but our responsibility stops there. I have infact had a vendor that was ask by a carrier for us to send out denial letters on claims. I would not do so. |
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CCarr
Canada
1200 Posts |
Posted - 09/11/2002 : 16:24:25
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ROR - Mark does it up and hand delivers, would have been fine with me; as per my stated reasoning that I was not / am not aware of any legal requirement for the insurer to issue any RORs.
Certainly, with the initiative Mark has displayed in your weather example, it would be appreciated and remembered.
The ROR may have jurisdictional wording, i.e by State, or perhaps only by country. The Canadian version is standard - other than likely Quebec - for many and varied reasons. I leave it to you to comment likewise on the USA.
Therefore, considering the intent of both the NW and the ROR, I can not envision where an I/A intiated ROR could place him and his E&O at risk; given the document and its' issuance were satisfactory.
Now, time for your scenario of the "weakest" adjuster. Far fetched you say, but I'll tell you I have lived the experience twice that I can recall from the standpoint of a carrier - and it was much as you describe it.
The story would take a lot of space to lay out, but looking back now and even a few days after the events; it is quite humorous. Fortunately, in each case - both commercial losses, the circumstances were such (i.e the cause of loss, reasonable integrity of the site two days later, and a professional insured) that the carrier reserves were not affected by the run away adjuster; and hence nor was the E&O of the vendor not at the risk do what they were assigned and accepted to do.
Suffice to say steps were put in place to the carrier satisfaction, that such instances would have a tough time to surface again.
In hindsight (and isn't that a dangerous vision), even a couple days after the event, it was reluctantly concluded, that perhaps the run away adjuster was the lesser of the two evils. The inexperienced fellow should never have even headed to the scene. His attendance could have set off a chain of events that would only dig a deeper hole; whereas no attendance for the weekend, at least didn't leave us chewing on leather from well meaning but misguided investigative a/o adjustment practices.
Things like that situation, scare the hell out of a claims manager, as I know it did the vendor manager. The story could have had a much worse ending for all parties concerned, including me. |
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Jim Lakes
USA
37 Posts |
Posted - 09/11/2002 : 17:19:12
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Jim,
You asked and here I am.
I use a standard form for both, including the “Right to inspect” form. Below:
NON-WAIVER AGREEMENT
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: __________________________
I have been using this form for many years and have never had a carrier reject its use.
It is strange that just yesterday a carrier requested I get a Non-Waiver from an insured on a loss that was just reported with a loss date of 10/21/2001. At first when I asked the insured to sign it they refused and when I started to leave they changed their mind and signed it.
I most often tell the insured that by signing this form it commits the client to nothing and does not change any of the policy language or content of the policy. It simply states that the insured is made aware of no commitments for damages claimed and gives the carrier the right of inspection without commitment to coverage, cause, damage, or value/cost.
I will leave further definition to your expertise.
Thanks,
Jim Lakes, RPA
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ALANJ
USA
159 Posts |
Posted - 09/11/2002 : 21:23:06
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Jim:
Usally when a NW or ROR is involved, a rec. or written statement is sure to follow. Are you going to discuss this on this thread?
I think there is nothing wrong with an IA signing a ROR letter. It should be signed by Joe Adjuster for ABC Adjusting for XYZ Insurance Co. I would just note in my file that XYX Co. had been provided a copy, reviewed copy and instructed you to send it on their behalf.
Some of the earlier post discussed leaving the scene when the insured refused to sign the NW. In some but not in all situations an alternative is available. Take a Rec. statement on the scene from the insured. Establish all the facts while they are still fresh in the insureds mind. (Or whatever the story of the day may be.) During the statement you can explain to the insured that you are investigating this under a NW and your presence at the risk or anything you are doing should not be considered a waiver. There is nothing like tape. Then after you get to the office you can send a ROR.
Just a few thoughts between episodes of the Weather Channel. I sure miss John Hope. |
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Non-Waivers and ROR's
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