I Burned Tomatoes So I Need a New Deck
What's the Scenario? with PLRB
The insured was making fried green tomatoes when they had to help a neighbor with an emergency. The tomatoes caught fire, and damaged the kitchen. The city building inspector came to sign off on the kitchen repairs, and noticed the rear deck was improperly constructed. Notable Timestamps [ 00:27 ] - The policyholder is asking her insurance company to include fixing the deck as part of her fire claim. Since the deck wasn’t touched by the fire, the adjuster denied it. Now the public adjuster is coming back seeking coverage for the deck under the Ordinance or Law Additional Coverage. [...
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That Cosmetic Damage is Excluded!
What's the Scenario? with PLRB
After a storm, a warehouse roof seems to leak more often, and a manager notices some water pooling on the edge. The adjuster’s inspection reveals only minor dents, and the policy has a cosmetic damage exclusion. The manager argues the damage is not cosmetic. Notable Timestamps [ 00:19 ] - The manager even hires an expert to contest coverage. [ 01:25 ] - Tim and Mike discuss the leaks in the PLRB offices. [ 02:46 ] - See prior episode "That Damage is Just Cosmetic!" for the version of this scenario with no exclusion. [ 03:50 ] - When cosmetic damage exclusions first debuted, many courts...
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That Damage is Just Cosmetic!
What's the Scenario? with PLRB
One day a hailstorm hits a bike manufacturer's warehouse, and the property owner is overwhelmed by the loud sounds of the hail hitting the metal roof. But when the adjuster gets up on the roof, the dents turn out to be minor, arguably cosmetic. Notable Timestamps [ 00:18 ] - Despite the dents appearing to be cosmetic, the insured requests a new roof. [ 01:08 ] - Jeff and Mike compete for the best "dad joke." [ 01:53 ] - The hail was "direct" and "physical", but was it a "loss"? If the roof is now leaking, that would qualify as damage because it is a loss of functionality. Without a leak, it's...
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Game Show Time! What Kind of Vehicle Is It?
What's the Scenario? with PLRB
Anytime something with wheels leads to a claim, Parker's colleagues come to Parker to find out whether the claim should fall under the CGL policy or the auto policy… or a secret third option. Notable Timestamps [ 00:22 ] - Mike details the above scenario. [ 01:15 ] - An "auto" would usually be covered under Business Auto policy, whereas "mobile equipment" would typically be covered under CGL. [ 02:20 ] - "Auto" means: 1. A land motor vehicle, "trailer" or semitrailer designed for travel on public roads; . . . However, "auto" does not include "mobile equipment". [ 03:15 ] - For the full...
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Who's Been Living in My House?
What's the Scenario? with PLRB
The named insured has retired and moved to his condo in Florida. His adult daughter accepted a new job in the city her father is leaving, so she and her two children have moved into the insured dwelling. A fire occurred destroying the entire home and all of its contents. Notable Timestamps [ 00:37 ] - John details the above scenario. [ 02:30 ] - Who is "You"? "You" is the named insured or insureds indicated in the Declarations, and the spouse of that person if the spouse is a household resident. [ 03:45 ] - How does the insurance policy define "y'all"? Or "youse"? [ 04:11 ] - "Residence...
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Surface Water on a Roof? It’s Those Kids Again!
What's the Scenario? with PLRB
Tree-lined residential drive in Boston, MA. The neighborhood kids were playing baseball in the street, and the big kid hit a home run; ball landed on the roof. It was a flat roof with a drain in the middle of it. The ball somehow rolled right onto the drain and completely blocked the top of it. The poor homeowner had no idea, and heavy rains came through that night, causing several inches of water to build up on the roof, eventually finding its way inside the house. This caused $20,000 in water damage to the interior of the building, and the insured is looking for coverage. Notable...
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What's Your Personal Elevator Pitch?
What's the Scenario? with PLRB
A claims adjuster is out at a party when they are asked: “So, what do you do for a living?” Our adjuster responds with just: “I’m in insurance claims.” That’s an “Oh no” moment. Turns out their cousin had a terrible experience on a claim and our adjuster is going to hear all about it, ending in: “You claims people are all cheaters!” Notable Timestamps [ 00:36 ] - Today's scenario begins as an interpersonal encounter about explaining your career in insurance, but the elevator pitch is applicable even on claims. [ 02:05 ] - What our claims professional needed was an...
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How to DECIDE to Handle a Claim
What's the Scenario? with PLRB
Mungle’s Crackers manufactures crackers shaped like exotic land and sea animals, among other food products. Apparently there was a bad batch of their latest line of Platy-Pies, because reports of moldy bags of pastries covered their social media and they had to recall many bags of the high-fructose treats. One angry customer got ill after his snack and has already filed a lawsuit against the company. Notable Timestamps [ 00:15 ] - Today's scenario will be Mike's debut as a host! [ 00:37 ] - This Notice of Loss landed on the desk of our adjuster Ralph, who is relatively new to insurance and...
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The New PLRB.org
What's the Scenario? with PLRB
An adjuster is assigned a property loss claim. The insured’s house is in South Zanesville, Ohio on Cinema Drive, and they experienced hail damage to a portion of their roof on June 16. Their homeowners policy was only recently purchased on June 1 of this year. This claim brings up a number of questions, and luckily the adjuster is an employee of a PLRB member company, so they log on to PLRB.org. When they log in using their company email, they realize that PLRB.org has recently been upgraded with a new look and a member-structured approach. How can the member use the new PLRB.org to answer...
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That's a High Water Bill
What's the Scenario? with PLRB
Homeowner is relaxing one night, and all of the sudden there was a huge clap of thunder. It was so loud she thought it might have hit the house or somewhere in the yard … but everything looked ok. Six weeks later she got her normal water bill in the mail (billed quarterly), and to her surprise, it was outrageously high – $4,500. She knew she wasn’t taking that many showers and thought there must be a leak, so she called a plumber who came over, scoped a camera, and found a big leak underground next to the house. It looked like the underground pipe had burst open, not just deteriorated....
info_outlineOld 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 there coverage for the chimney?
[ 01:18 ] - Trivia Time! How many fireplace-related deaths happened in the United States?
[ 04:18 ] - The "cracking" exclusion appears alongside other long-term normal-usage exclusions and would normally be considered in that context.
[ 06:18 ] - But, could we say that FIRE was the proximate cause in order to find coverage? Not necessarily. Courts created a distinction between "friendly" fires like stoves or fireplaces vs. "hostile" fires that "escape" their enclosures.
[ 08:55 ] - See Karadontes v. Continental Ins. Co., 354 A.2d 696 (N.J. App. 1976).
[ 09:40 ] - The fact that the "date of loss" when the cracking began was three years ago likely does not mean the insureds provided late notice. Courts created the discovery rule for cases such as this, starting the clock at the time the loss was discovered.
[ 12:50 ] - Who would notice a crack in their fireplace?
[ 13:50 ] - In civil law, the preponderance of the evidence standard applies, so in this case the chimney sweep's claims would likely be accepted.
[ 15:00 ] - Only sudden or accidental soot or smoke is typically covered.
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Chimney Damage-Faulty Maintenance or Covered Fire Loss? – Claims Magazine - https://www.plrb.org/documents/chimney-damage-faulty-maintenance-or-covered-fire-loss-claims-magazine/
Thermal Cracking Inside Chimney – Fire or Wear and Tear? – PCQ.2023.08.19.twh.a - https://www.plrb.org/documents/thermal-cracking-inside-chimney-fire-or-wear-and-tear-pcq-2023-08-19-twh-a/
Windstorm: Downdraft Into Chimney Disperses Soot – PCQ.2018.04.30.rcw.b - https://www.plrb.org/documents/windstorm-downdraft-into-chimney-disperses-soot-pcq-2018-04-30-rcw-b/
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.
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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).
Wall Cracking 3: https://vfx.productioncrate.com/video-effects/footagecrate-wall-cracking-3