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...
info_outline
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...
info_outline
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...
info_outline
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...
info_outline
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...
info_outline
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....
info_outline
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...
info_outline
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_outline
Wildfire Smoke Never Went Away
What's the Scenario? with PLRB
The insured is a homeowner in Oregon. There were wildfires in the forests around his neighborhood, but the fire never got closer than 3 miles from his house, so he never had to evacuate. Nevertheless, the smoke was thick in his area, and enough of it penetrated into the inside of the house to leave a faint but noticeable smoky odor that does not seem to be going away. The insured is requesting smoke remediation to be performed in his house and on some of his contents. Notable Timestamps [ 00:18 ] - The interior and exterior of the insured’s home was left with a smoky odor after a local...
info_outline
Is an Apple Watch a Watch? Is a Drone an Aircraft?
What's the Scenario? with PLRB
The insured, a father of 4, was out buying Christmas gifts for his children. This year he decided to splurge and buy each of them a drone and an Apple Watch. On his way back home, he stopped to get gas, and when he went into the minimart for coffee, a thief stole everything out of the back seat. The insured notified the police and submitted a claim under his ISO 1991-edition HO3. The adjuster considers this to be a covered Theft loss, but she knows there are specific provisions in the policy for watches and aircraft. Notable Timestamps [ 00:17 ] - A theft claim is submitted for four drones and...
info_outlineYour 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 whether this is covered, and if so, what actually can be done.
[ 01:06 ] - The team discusses what happens when you click on a suspicious link, and what’s supposed to happen when someone says “O-H…”
[ 03:45 ] - The computer falls under Coverage C as personal property, and so do the digital photos.
[ 04:41 ] - Theft is a named peril under Covegage C that likely applies. Vandalism might also apply.
[ 05:35 ] - Being unable to access something qualifies as a loss in this scenario.
[ 07:08 ] - There is a split in courts, but in EMOI Services, LLC v. Owners Ins. Co., 2022-Ohio-4649, 2022 WL 17905839. —- N.E.3d — (Ohio 12/27/2022) (Supreme Court of Ohio, applying Ohio law) [reviewed at PLRB, Prop. Ins. L. Rev. 11510 (2023)], encryption of files, caused by a ransomware attack on the policyholder’s computer system, was not direct physical loss or damage to "media" covered under an Electronic Equipment endorsement to a businessowners policy.
[ 08:30 ] - If data isn’t physical in “O-H…I-O,” the Electronic Data coverage in commercial forms could apply, if it would otherwise have no application.
[ 09:30 ] - Assuming the matter is covered, the insurer could pay ACV… but could they pay the ransom? It’s an open question.
[ 11:04 ] - Calculating ACV for the photos is subjective, but market value would likely be low.
[ 13:00 ] - One of the Special Limits of Liability caps “personal records” at $1,500.00.
[ 13:48 ] - Ransomware is becoming an new insurable niche, with potential new endorsements coming down the road: “cyber-extortion” coverage, etc.
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage Question - Loss of Use: Hacked Cell Phone, Ransom Demanded - https://search.plrb.org/?dn=73714
Coverage Question - Cyber Losses FAQs - https://search.plrb.org/?DN=67890
Webinar - Cyber Loss Case Scenarios - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0091
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/container.cfm?conlink=sec/cq/default.cfm) at no additional charge to you or your company.
Subscribe to this Podcast
Your Podcast App - Please subscribe and rate us on your favorite podcast app
YouTube - Please like and subscribe at @plrb
LinkedIN - Please follow at “Property and Liability Resource Bureau”
Send us your Scenario!
Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License.
Font: Metropolis by Chris Simpson. SIL OFL 1.1.
Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription).
Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
Ink Bleed 4: https://vfx.productioncrate.com/video-effects/footagecrate-inkbleed-4