![[REPLAY] The Stairs Made Me Trip and Fall! show art](https://assets.libsyn.com/item/43283964?height=50&width=50)
[REPLAY] The Stairs Made Me Trip and Fall!
What's the Scenario? with PLRB
We’re taking a break this week after our first-ever Knowledge Exchange. This collaborative learning event took place at PLRB headquarters and featured building codes topics, so this week we’ll share a classic episode from the PLRB Building Codes team. Surveillance video shows a woman wearing a salon cape exiting through the front door of a hair salon. She spends a few moments in front of the salon examining her hair in a large handheld mirror. On reentry, she stumbles on the second and falls. Notable Timestamps [ 00:32 ] - This is not her first time at the salon, and not her first...
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Mirror, Mirror, on the Circuit Breaker?
What's the Scenario? with PLRB
A kitchen fire damaged some cabinets and the microwave above the stove, and the insured hired a contractor to make the repairs. When the contractor needed to temporarily kill power to the outlet above the stove, they asked the insured where the breaker box was - only to be led to a basement bathroom, where opening the medicine cabinet mirror revealed the home’s electrical panel mounted behind it. Now the contractor is refusing to proceed until the insured’s entire electrical system is brought up to code. Notable Timestamps [ 00:43 ] - This scenario features a...
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Ice Shove Damaged My Boathouse!
What's the Scenario? with PLRB
The insured enjoyed having a lakeside home in the summer, where they could take a cruise on their boat in the evenings. But one winter, the frozen lake shoved ashore massive ice slabs, crushing a metal boat lift that had been stored on the shoreline for the winter. The lateral ice pressure then smashed into a permanent boathouse, buckling the vinyl siding, breaking through windows, and splitting the wooden framing. Ice chunks spilled onto the personal property left inside as well. The homeowner was left wondering whether they'd be frozen out of coverage for this loss. Notable Timestamps...
info_outline![[REPLAY] A Storm Spoiled My Insured's Fish show art](https://assets.libsyn.com/item/42872430?height=50&width=50)
[REPLAY] A Storm Spoiled My Insured's Fish
What's the Scenario? with PLRB
Welcome to “What’s the Scenario? with PLRB”, where we explore claims & coverage scenarios relevant to insurance professionals. I’m Brennan McLoughlin, and we’re taking a break this week after another successful PLRB Regional Innovation Summit. This week we’ll share a follow-up episode from the PLRB Weather team. A small grocery store specializes in farm-to-table meat and fish, locally sourced and priced at the high end of the market. After accepting their week’s shipment on a Wednesday evening, thunderstorms led to a power outage that spoiled the fish. Notable...
info_outline![[REPLAY] Cyclones, Insurance & A Bowl of Spaghetti (Models) show art](https://assets.libsyn.com/item/42872415?height=50&width=50)
[REPLAY] Cyclones, Insurance & A Bowl of Spaghetti (Models)
What's the Scenario? with PLRB
Welcome to “What’s the Scenario? with PLRB”, where we explore claims & coverage scenarios relevant to insurance professionals. I’m Brennan McLoughlin, and for this holiday week we’ll be sharing a classic episode from the PLRB Weather team. A CAT Manager is making preparations for her CAT team in advance of Hurricane Francine, which approached the Louisiana coast in the second week of September, 2024. She reads something about spaghetti models, and something about Fast Track cyclones? Notable Timestamps [ 00:36 ] - The building owner submits the claim to their...
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Oops! Is a Contractor's Work Ever Really Done?
What's the Scenario? with PLRB
A contractor was hired to renovate a kitchen. The homeowner was thrilled with the results, but asked for a few final punch-list items: adjusting the cabinet doors and replacing a damaged drawer pull. To reach the cabinets, the contractor moved the refrigerator, but failed to securely reconnect the ice maker supply line before leaving. Two days later, the homeowner discovered water throughout the kitchen and adjacent rooms after the line separated, damaging the newly renovated space and the surrounding flooring. Notable Timestamps [ 00:45 ] - Mike sets up today's scenario: a...
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Wait, the PACE Exam has Mock Claim Documents?
What's the Scenario? with PLRB
A homeowner reports that the central air conditioning system stopped working during a summer heat wave. They sent their contractor's invoice to their insurance company. The adjuster has to review the invoice, the Declarations Page, and policy excerpts to handle the claim. But this isn’t a real claims file; this are mock claims documents as used in the PACE Designation Exam. Today we’ll explore how authentic assessment is leveraged to test real-world skills, and you can try your luck with this sample question. Notable Timestamps [ 01:24 ] - The exam includes basic recall questions that...
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Can You Pass the PACE Designation Exam?
What's the Scenario? with PLRB
An adjuster has decided to level up their career by earning their PACE-P Designation. They’ve completed the comprehensive educational program, prepared with the study guide, and are now sitting down to take the remotely proctored exam. Are they ready for it? Are you? Notable Timestamps [ 00:00:34 ] - The podcast explores the scenario of an adjuster who has completed an educational program and a study guide, and is now preparing to sit for the remotely proctored PACE Designation Exam. [ 00:04:04 ] - The PACE Designation program begins with an onboarding curriculum, consisting of three core...
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Help! I Need to Study for the PACE Designation Exam!
What's the Scenario? with PLRB
An adjuster has decided to level up their career by earning their PACE-P Designation. They’ve completed the comprehensive educational program, but don’t feel quite ready to sit down and take the PACE Designation Exam. So they download the PACE Study Guide and get started. Notable Timestamps [ 04:23 ] - The PACE Designation Program provides a comprehensive foundation of knowledge and practical skills tailored for claims professionals to succeed. [ 06:41 ] - Members can complete the Core Curriculum, the Personal Lines Property Track, and the Claims Intensives at no additional cost, and...
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Oops! What is “That Particular Part”?
What's the Scenario? with PLRB
A plumber was hired to perform work on a pipe on an insured home. In the course of that work, the plumber accidentally smashed his wrench into the pipe, damaging it. The water damaged nearby drywall and carpet. Notable Timestamps [ 00:44 ] - The j(5) exclusion specifically applies to property damage on that particular part of real property where operations are directly being performed. [ 01:14 ] - In contrast to the j(5) exclusion, the j(6) exclusion applies to any property that requires restoration, repair, or replacement because the work was performed incorrectly. [ 02:44 ] - If a plumber...
info_outlineA 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 preventative actions worked – no damage.
Notable Timestamps
[ 00:15 ] - Now the insured wants his insurance company to reimburse him for the tree expenses and the sandbag expenses. He tells the adjuster, “I saved you from having to pay way more on repairs; I had wind coverage and I even had flood coverage. All I’m asking for is reimbursement of my costs.”
[ 01:40 ] - Of the three, only Tim is extra diligent.
[ 03:50 ] - Policies don't cover pre-storm expenses. Insurance policies typically cover fortuitous losses. The lack of coverage for preventative measures came up a lot during coverage.
[ 05:20 ] - Insurers have a duty to mitigate a loss, but there has to be a loss. It's a duty to prevent "further" damage.
[ 07:06 ] - So should insureds just let losses occur? It's a moral hazard...
[ 08:30 ] - Let's say a different tree branch fell on the house the day before & caused a covered loss. The removal of other branches would mitigate the loss, which would be reimburseable.
[ 10:37 ] - Could it be considered faulty maintenance if the insured DIDN'T prevent the foreseen loss?
[ 13:25 ] - Consider the insured asking the insurer if they would pay for a portable generator to prevent a pipe freeze. Insurance companies are allowed to pay for such a thing, if they wanted to.
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Pre-Storm Expenses To Protect Property - https://www.plrb.org/documents/pre-storm-expenses-to-protect-property/
Preventative Measures: Sandbagging - https://www.plrb.org/documents/preventative-measures-sandbagging/
PLRB, Duty to Protect Did Not Cover Removal of Fire Damaged Tree Where Dwelling Wasn't Damaged – PCQ.2018.08.01.jak.a – https://www.plrb.org/legacy-documents?DN=67261
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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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.
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