The Extra Diligent Homeowner
What's the Scenario? with PLRB
A 90 year old red maple hangs over the insured’s house. One of the branches looks like it might fall, and if it does, it’s going to cause some major damage to the sun room. The insured knows this and is a diligent homeowner. One day the weather forecaster says major storms are coming through later in the week – wind and flooding are likely – so the insured hires a tree company to remove the limb safely in advance and also pays to get sandbags down on the low side of his property facing the river. The weather forecaster was right, a big storm came through, but the insured’s...
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A Friendly Fire?
What's the Scenario? with PLRB
Old brick mansion in New Jersey with a fireplace that the insured uses in the winter. During a routine cleaning, the chimney sweep noticed some cracking in the chimney bricks. He says (1) it’s probably due to age and normal use because over time the heat from the fires takes a toll; he says (2) in his estimation the cracking has existed for 3+ years. Notable Timestamps [ 00:15 ] - He encourages the insured to submit an insurance claim anyway. Policy = ISO HO 00 03 05 11. The adjuster knows there is an exclusion for “cracking” but also knows that fire is a covered peril. Is...
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Even Underwriters Make Mistakes
What's the Scenario? with PLRB
The insured is a charitable organization. Times were tough; fundraising was stagnant. The insured was looking to save money, so they asked if they could lower their premiums by canceling their hurricane coverage. The underwriters agreed, and drafted a 1-page endorsement with an exclusion for named storms. Sure enough, the insured got hit with a hurricane the very next month. They submitted a claim anyways, now stating they don’t see any named storm exclusion in the policy. The adjuster looks but can’t find it either. Notable Timestamps [ 00:15 ] - It turns out the insurer forgot to...
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But That Roof was So Old!
What's the Scenario? with PLRB
Homeowner was an elderly widow in Texas who was not keen on moving into a retirement home, so she continued to live in her house by herself. As she got older, a lot of normal maintenance started to get ignored, including the roof – The shingles were old and looked like they were about to fall off any day. One day a windstorm came through the area, and sure enough, 20-30 shingles blew off. She called her insurance company. The adjuster reviewing the file thinks, wind is a covered cause of loss, but wear and tear and deterioration are not. He is wondering what to do when there are multiple...
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Dressing Room Distress
What's the Scenario? with PLRB
At a store, a female patron wanting to try on clothing secured the dressing area with a curtain. Another patron, the insured, engaged in allegedly assaultive conduct by rummaging, feeling, and grabbing the curtain in an attempt to make physical contact with the female patron. The insured also knelt down and used his phone to take videos or photos of the patron under the curtain. Notable Timestamps [ 00:19 ] - At a store, a female patron wanting to try on clothing secured the dressing area with a curtain. However, another patron, (who happens to be our insured) entered the store with various...
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Don't Click Those Links
What's the Scenario? with PLRB
Your friend clicked on a link in a questionable email. Now her computer is locked with a message saying it will unlock if she makes a bitcoin ransom payment. This is causing two problems for her: (1) Her computer doesn’t work now, and (2) She had 10 years worth of family photo albums stored on the hard drive, with no cloud backup. Notable Timestamps [ 00:15 ] - Today’s scenario involves ransomware. The computer wasn’t cheap, and those photos were priceless, so she wants her insurance company to make the ransom payment for her. The adjuster handling the claim is looking to see...
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There's Blood Everywhere...
What's the Scenario? with PLRB
A young couple lives together in St. Pete, Florida. Their friend was vacationing in Italy for a month and asked them to dog sit for her 3 year old pit bull rescue, who had a checkered past but was doing well lately. The couple took in the dog, and one night they threw a dinner party. Out of nowhere, the dog attacked one of the guests, biting him in the leg. In the resulting chaos, blood got all over the expensive white wool carpet. The man got his leg treated at the hospital, he was fine– not suing! – the dog was returned to the shelter and now the couple is making an insurance claim to...
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Oh No, There’s Asbestos
What's the Scenario? with PLRB
A derecho swept through Iowa damaging the insured’s siding, and it’s going to require a complete removal and replacement of the siding. The contractor informed the adjuster that the siding contains asbestos. It wasn’t disturbed by the windstorm and is safe now, but it will be disturbed when it’s removed, so that’s going to have to be done by specially-licensed professionals with hazmat suits according to procedure. The adjuster handling the claim is willing to pay for the siding replacement. However, she is not sure about all of those extra costs to handle and contain the asbestos....
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My Tenants Trashed My House
What's the Scenario? with PLRB
The insured bought a house in Oregon and took out insurance under a 2011 ISO HO3. He lived there for a month, but then moved back to California and started renting out the Oregon house to a local couple. Six months later, the couple disappeared with no trace and the house had been trashed. Walls were dirty; carpet was dirty; graffiti in the bathroom, hole in the bedroom wall; bottles and cans everywhere; dog urine. The insured wanted his homeowners insurer to pay for a full Coverage A cleanup and restoration. Notable Timestamps [ 00:16 ] - The homeowner rented out his house, then returned to...
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DIYer Did Their Own Repairs
What's the Scenario? with PLRB
The insured’s house in Rhode Island was destroyed in hurricane winds. The insured is a natural handyman (although his day job is an accountant), and he decided to rebuild the house himself from scratch, working diligently nights and weekends. Since he has a talent for this, materials & labor only ended up costing him less than the replacement cost estimate but more than ACV. Is he owed ACV, RC, actual cost, or policy limits? Notable Timestamps [ 00:15 ] - The insured’s home undergoes a total loss covered under the standard ISO HO3 with standard replacement cost and Coverage A limits of...
info_outlineA young couple lives together in St. Pete, Florida. Their friend was vacationing in Italy for a month and asked them to dog sit for her 3 year old pit bull rescue, who had a checkered past but was doing well lately. The couple took in the dog, and one night they threw a dinner party. Out of nowhere, the dog attacked one of the guests, biting him in the leg. In the resulting chaos, blood got all over the expensive white wool carpet. The man got his leg treated at the hospital, he was fine– not suing! – the dog was returned to the shelter and now the couple is making an insurance claim to replace their blood-stained carpet under Section I of their HO3.
Notable Timestamps
[ 00:16 ] - Today’s scenario involves an insured with a dog that was not theirs, with some history of aggression but not recently, injuring a guest to their home, where the injury is not at issue but the carpet is. It’s a complex situation!
[ 01:12 ] - Mike shares a harrowing tale and Alissha argues on behalf of the dog.
[ 03:40 ] - There’s an exclusion for losses caused by “animals owned or kept by an insured.” The dog could be considered “kept” by the insureds because they hosted it for months.
[ 04:40 ] - There is a case to be made that this exclusion is only for “normal” pet damage like chewing, drooling, vomit, pooping, etc. It is grouped in wear & tear, and a dog bite could be described as fortuitous. However, some courts have disagreed. See resources below for citations.
[ 07:19 ] - Losses “caused by” pets are excluded, but losses that “ensue from” or “result from” pets are covered. If a dog knocks over a candle, that could be an ensuing loss, whereas a dog drooling on something could be a cause. It’s a hairline distinction.
[ 10:03 ] - You can look at state case law for your particular state for prior rulings on ensuing loss.
[ 11:00 ] - Blood is arguably a liquid & contaminant under the pollution exclusion. Such claims often involve emotional considerations.
[ 12:50 ] - According to a recent Florida case, blood is not a pollutant. See resources below for citations.
[ 13:30 ] - If there’s a Coverage C Peril, the exclusion would not apply.
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Related Case: Bjugan v. State Farm Fire and Casualty Co., No. 13-35927, 2016 WL 1072207 (9th Cir. (Or.) 3/18/16) (unpublished) (U.S. Court of Appeals for the Ninth Circuit, applying Oregon law) [reviewed at PLRB, Prop. Ins. L. Rev. 9398 (2016)]. https://www.plrb.org/documents/bjugan-v-state-farm-fire-and-casualty-ins-co-2016/
Related Case: Nolan v. Auto-Owners Ins. Co., No. 301106, 2011 WL 5865522 (Mich. App. 11/22/11) [reviewed at PLRB, Prop. Ins. L. Rev. 8351 (2011)] (unpublished). https://www.plrb.org/documents/nolan-v-auto-owners-ins-co-2011/
Related Case: Fla. Farm Bureau Gen. Ins. Co. v. Worrell, No. 5D21-3196, 2023 WL 3130872, — So.3d —- (Fla. App. 5th DCA 4/28/2023) (Florida District Court of Appeal, 5th Dist., applying FL law) [reviewed at PLRB, Prop. Ins. L. Rev. (2023)]. https://www.plrb.org/documents/fla-farm-bureau-gen-ins-co-v-worrell-2023/
Coverage Question - Pet Dog Attacked Owner; Blood on Carpet - https://www.plrb.org/documents/pet-dog-attacked-owner-blood-on-carpet-pcq-2023-10-27-twh-b/
Coverage Question - Pollutant Exclusion: Deer Crashes Through Window and Blood Destroys Carpet - https://www.plrb.org/documents/pollutant-exclusion-deer-crashes-through-window-and-blood-destroys-carpet-pcq-2017-03-21-slc-b/
Coverage Question - Are Blood and Bodily Fluids Pollutants under Coverage A Dwelling? - https://www.plrb.org/documents/are-blood-and-bodily-fluids-pollutants-under-coverage-a-dwelling-pcq-2024-02-09-mrh-a/
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