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CCarr
Canada
1200 Posts |
 Posted - 05/08/2003 : 20:18:55
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Thanks again Steve for the input. "Barriers" to coverage come in many disguises. I know I have in different scenarios 'hit a wall' and got stuck on a point, that wouldn't let me look at 'all the pieces'.
In my carrier days, simpler days from years gone by, as a regional claims manager, I instituted a 'no denial' policy without my signature. Once the purpose and intent of that management policy was understood it worked well.
Obviously some claims have to be denied or acted upon more promptly than others regarding a coverage decision. However, when such was not the case, we would have 20 or 30 minute group sessions a couple times a week, where the handling adjuster would 'present' the scenario and his/her take on it, and then open it up to the group. It was a great way to get different views and get the group focused on how to look for coverage and interpret wordings; or cement among us that there was nothing we could do. Adjusters also learned quickly enough that sufficient details of cause and circumstances was imperative to allow informed decisions to be made. |
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steveh
USA
14 Posts |
Posted - 06/20/2003 : 07:16:16
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I have an update on this topic. Coverage was denied as follows:
No case law is known to exist on point but Court of appeals of North Carolina Sigmund W. Holcomb and wife Laura C. Holcomb v. United States Fire Insurance Company Case No. 8017 SC 878 the court goes into great detail to define a plumbing system. The insurance company position that a self contained , free-standing aquarium does not in any way qualify as a plumbing system.
In regard to "household appliance" They say Webster's dictionary defines appliances as "(1) the act of applying, application, (2) a device or machine for performing a specific task, especially on that is worked mechanically or by electricity (stoves, irons, ect.)".
While an aquarium operates by use of electricity, it performs no true work. It is the insurance company's opinion that an aquarium falls more into the category of decor or interior decorating.
I would appreciate you additional comments based on our previous discussion on this thread. |
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Russ
USA
75 Posts |
Posted - 06/20/2003 : 13:19:13
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I agree with Bill Cook. I believe water damage is only excluded for ground water (flood). Water damage from any other source would be covered for both A & C coverage under the all risk policy(HO3). The only problem I would have is the time between the date of loss and mitigating the damage.
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steveh
USA
14 Posts |
Posted - 06/20/2003 : 13:32:06
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Russ,
In North Carolina coverage C is named perils.
The insured was informed by the insurance company there was no coverage for personal property at the begining of the claim. |
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jlombardo
USA
212 Posts |
Posted - 06/20/2003 : 14:58:24
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I think that the denial of coverage is wrong and agree that the pump is an appliance...and it mostcertainly does work....it displaces water,creates turbulance and most of all it expends energy.....Is a TV an appliance????? It does not do any "work"...but then again what is work? I think that an mechanical piece of equipment does some type of work and the equipment uses energy to do so....By the way , what did the company call the pump....Furniture???
The fish tank did not pump the water out---it was merely a holding tank...the pump,through mechanical labor (work?) pumped the water out... |
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JimF
USA
1014 Posts |
Posted - 06/20/2003 : 15:31:09
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Steve:
Is Holcomb v. US Fire Insurance the court case for the instant situation or a cited opinion which has been ruled on in this case?
What was the year of the Holcomb v. US Fire case, and are you sure it is a NC Court of Appeals Decision? (Could you please check and confirm the Court Opinion Number?)
Thanks. |
Edited by - JimF on 06/20/2003 15:40:44 |
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steveh
USA
14 Posts |
Posted - 06/24/2003 : 08:35:27
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Jim,
It is Court of Appeals of North Carolina Sigmond W. Holcomb and Wife Laura C. Holcomb V.
United States Fire Insurance Company
No. 8017SC878 and the date is June 16,1981.
It deals with the courts opinion of a plumbing system. |
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steveh
USA
14 Posts |
Posted - 07/30/2003 : 09:56:21
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The personal property portion of this claim was denied by the company. The insurance company by their own admission state there are no court cases on point which is, the pump is a household mechanical appliance. Based on the information posted in this file, should the insured file suit against the insurance company or appeal to the insurance commsioner of that state?
Thank you in advance for you comments. |
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steveh
USA
14 Posts |
Posted - 08/07/2003 : 08:13:21
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Jim,
Were you able to find the court case?
For those of you that are interested I think the insured has chosen the path of attorney.
In my mind this is sad for our industry. We have attorneys advertising on the television in our area for clients that have encountered the graduates from the adjusting school. The add has a picture of a school with the instructor saying " Is there coverage? The adjusters say NO. Deny the claim!"
Unfortunately there are companies that seem to have their adjusters scope the losses with this mind set. When moving from the staff adjuster position of some companies to IA and working for other Insurance Companies the IA in some cases, has to re-evaluate their approach of coverage.
I know this appears to have started a new thread and is general in nature but I could not help but open this discussion.
I look forward to your comments! |
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CCarr
Canada
1200 Posts |
Posted - 08/07/2003 : 09:02:12
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Steve, what you mention is sad for our industry; I keep saying we are all perceived as a whole based on our lowest common demoninator. The TV ad you mention is even a worse portrayal of the value and function of an adjuster.
We are governed by what each specific carrier wants us to do and at times how we should do "it", or at least governed by the specific "manager" who is imparting his / her own methodolgy on behalf of the carrier or vendor.
I have often been concerned for the ingrained "attitude" of new adjusters - whether "graduates" of an adjusting school or otherwise. What they grasp and place in their memory and carve into stone as gospel in their early months or years of adjusting, is what they carry with themselves for many years.
Aside from individual (each person or carrier or vendor) interpretations of coverage, the basic attitudes of how to perform the function of adjusting and the goals of the job, should be the same and standard procedures for all in the industry.
Is there an "adjusting school" that ingrains new people in this industry to be minimalistic with coverage and scope of damages? Giving the legal profession some credit for "smarts", to portray such an image with a TV ad; there must be some validity in their "message". |
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KileAnderson
USA
875 Posts |
Posted - 08/07/2003 : 09:20:17
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| Clayton, are you suggesting that if a lawyer says it there must be some truth to it? Obviously you have different lawyers in Canada than we do down here and you've never heard of Johnnie Cochran. |
Edited by - KileAnderson on 08/07/2003 09:24:07 |
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CCarr
Canada
1200 Posts |
Posted - 08/07/2003 : 09:53:07
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Kile, I am aware of your disdain for the legal profession. However, with certain issues, what lawyers say does have a measure of validity from time to time.
However, my point regarding "validity" to the TV ad mentioned, lies within the many ramifications of the issues of libel. |
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jcc1138
12 Posts |
Posted - 08/17/2003 : 11:43:12
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Here is the definition from webster's:
One entry found for appliance.
Main Entry: ap·pli·ance
Pronunciation: &-'plI-&n(t)s
Function: noun
Date: 1561
1 : an act of applying
2 a : a piece of equipment for adapting a tool or machine to a special purpose : ATTACHMENT b : an instrument or device designed for a particular use; specifically : a household or office device (as a stove, fan, or refrigerator) operated by gas or electric current c British : FIRE ENGINE
Since the pump is a instrument designed for a specific use (i.e. pumping water in and out of the aquarium to be filtered of impurities), then the accidential discharge... is covered. When I looked at the exclusions, there is not one that applies to the situation at hand.
Given this, I would cover for the loss. I was taught many years ago, LET THE CLAIM SPEAK FOR ITSELF. We can easily run down the most elaborate reasons for some things to have happened and examine to smallest details the possible problems, but common sense and the "reasonable man" theory will help much more in a day to day basis.
P.S. www.m-w.com is a wonderful tool for figuring out what the meaning of a word is, when not specifically defined by the policy. |
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Noble R. Nash
USA
17 Posts |
Posted - 08/19/2003 : 17:50:44
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| Good discussion by all,each carrier must make the choice of making a test case that effects us all. Any ambiguity will favor the insured.I agree with jcc1138.Maybe we can midigate the loss by having a fish fry |
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AllCatMan
USA
39 Posts |
Posted - 08/19/2003 : 21:48:56
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but......what if water collected on ...TOP... of the cover of the aquarium and it failed and fell into the tank causing damage..........
hahaha! just had to throw that in Jim my friend. I have missed surfing the Caddo wave for a little while as Hurricane Elvis has had me hopping.
This may need to be on another post.... In fact I will put the question on another thread.
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Join in the Chat Room nightly 7cst/8est. |
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Water Damage
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