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_outline
Oops! Whose Fault is Faulty Workmanship?
What's the Scenario? with PLRB
A general contractor installs a commercial storefront window system. Because the flashing is installed incorrectly, rainwater enters the building during the first storm. The building owner sues the contractor, seeking the cost to remove and replace the defective window system and repair the water-damaged drywall and flooring inside. The contractor tenders the suit to its CGL insurer. Notable Timestamps [ 00:00:34 ] - A contractor faces a lawsuit after incorrectly installing window flashing that leads to water damage inside a building. [ 00:04:48 ] - A central issue in these claims is...
info_outline
Is Losing a Horse Bodily Injury?
What's the Scenario? with PLRB
Emma’s cousin Mark moved to the big city and left his horse at Emma’s ranch. For five years, she took care of the horse like it was one of her own. One day Mark took offense at one of Emma’s social media posts, and quietly removed the horse without her knowledge, believing he was the rightful owner. Emma was devastated and sued Mark, alleging emotional distress, mental pain and suffering, and loss of consortium. Mark’s insurer denied his defense on the basis that no bodily injury was claimed. Notable Timestamps [ 00:00:33 ] - The scenario involves a woman who sued her cousin for...
info_outline
Your Neighbor's Attitude is Not an Occurrence
What's the Scenario? with PLRB
The insured has spent months in an escalating dispute with his neighbor over the neighbor’s alleged violation of HOA rules and garish lawn decorations. Finally, the insured takes things too far by aiming his sprinkler at the neighbor’s newly painted shed, ruining an expensive paint job. The insured has been sued, and wants their insurance company to defend them in the lawsuit. Notable Timestamps [ 00:00:32 ] - This scenario involves an insured causing damage by ruining a neighbor's painted shed with a sprinkler, and expecting a defense. [ 00:01:17 ] - The PLRB's Frontlines newsletter is a...
info_outline
Playing Defense Against Negligence Claims
What's the Scenario? with PLRB
During a recreational adult hockey league practice, the goalie skated backward into the crease after a drill and grabbed the top crossbar of the net while stretching and joking with other players. The ice had recently been resurfaced, and the net had not yet been properly secured to the ice. As the goalie leaned his body weight onto the frame, the goal tipped backward and struck him. In a negligence claim between the goalie and the arena, which team takes the blame? Notable Timestamps [ 01:03 ] - Establishing negligence requires meeting four elements, which include having a duty owed, a breach...
info_outline![[REPLAY] My Son Set Off Fireworks in My House show art](https://assets.libsyn.com/item/41827180?height=50&width=50)
[REPLAY] My Son Set Off Fireworks in My House
What's the Scenario? with PLRB
As we hit our next holiday week and listen to the sounds of fireworks, we’d like to share a classic episode featuring the insurance implications of fireworks. So fire up the grill, and put this episode on the speakers. Is there an exclusion for stupid? Join Alissha, Mike, and Tim to discuss bad decisions, wedding rings stuck on fingers, dumpster fires, and whether the choice to set off a firework inside a house is considered “intentional” under the policy. Notable Timestamps [ 00:17 ] - The insured’s son set off a firework in the house for the excitement, causing...
info_outline
When the Claims Executive Became the Claimant
What's the Scenario? with PLRB
As a claims executive leader, Awais Farooq built and oversaw coverage frameworks, liability investigations, reserve governance, and total loss protocols. He believed that institutional fluency would make his own claim predictable. Then he struck a deer on his motorcycle and suffered a significant leg injury. His claim was segmented across bodily injury, property damage, and total loss. Each function operated correctly. Yet without a single point of ownership, the experience felt operationally sound but emotionally fragmented. Notable Timestamps [ 00:37 ] - Awais Farooq experienced a motorcycle...
info_outline![[REPLAY] Herding Weather/CATs show art](https://assets.libsyn.com/item/41596575?height=50&width=50)
[REPLAY] Herding Weather/CATs
What's the Scenario? with PLRB
Right now we’re traveling back from this week’s successful Eastern Regional Conference. So this week, as we head into summer, we’re sharing an episode on how to take advantage of all the services that the PLRB Weather/CATs department has to offer. A supervisor leads a team of very needy CAT adjusters! Over the course of the year, the supervisor fields many questions as it comes up in their claims. Was there hail on X date? Was there lightning in the area? This hurricane is coming soon, where can I get news about it? Winter weather caused a slip and fall!! Where can I find...
info_outline
Rounding the Bases to Establish Negligence
What's the Scenario? with PLRB
We’re calling “foul ball!” A spectator at a local minor league baseball game was injured when a foul ball zipped through a tear in the safety net and broke his arm. The spectator claims that the stadium owed him a safe environment, that it knew about the tear and didn’t fix it, and that the mascot wasn’t even that funny. To score, our litigant is going to have to run all four bases of the core elements of negligence: duty, breach, causation, and damages. Notable Timestamps [ 00:00 ] - A foul ball injury at a minor league game sets the stage for a negligence analysis, focusing on...
info_outline
My Cat Set My House On Fire
What's the Scenario? with PLRB
A cat jumps on the stove to get leftovers, accidentally turns a burner, and starts a kitchen fire. The homeowner has heard of an exclusion that applies to damage caused by animals owned or kept by an insured, and is concerned that the fire will not be covered. Exactly how mad should the homeowner be with their cat? (And how long can they stay mad at that face?) Notable Timestamps [ 00:00 ] - A kitchen fire caused by a pet can initially alarm insureds who may believe the animal exclusion automatically bars coverage for any damage involving their cat or dog. [ 00:53 ] - The discussion highlights...
info_outlineHomeowner 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. The homeowner immediately knew what happened: lightning damaged the pipe 6 weeks ago.
Notable Timestamps
[ 00:15 ] - The insured wants coverage for 3 things: (1) the water bill, (2) the plumber’s invoice for the camera inspection, and (3) repairing the underground pipe, including the cost to dig out the land and replace it with sod to access the pipe. Policy = ISO HO 00 03 05 11
[ 01:45 ] - Trivia Time! Where is the lightning capital of the United States? What is the study of lightning called?
[ 03:35 ] - Now for a multiple choice: Is it Coverage A, Coverage B, or Coverage C? The answer is likely C! The water lost is personal property.
[ 04:18 ] - Newer policies state that water is Property Not Covered, but older ones don't. This only applies to homeowners losses; commercial properties have an exclusion that likely applies.
[ 06:00 ] - Whether Lightning or Accidental Discharge from a Plumbing System (or Zeus?), this is likely a covered cause of loss.
[ 07:00 ] - Once the insured demonstrates a direct physical loss, the burden shifts to the insurance company. So, if the insurer wants to investigate further, the insurer would pay for that.
[ 08:45 ] - As long as the insured's investigation (the plumber's investigative camera-scoping) was reasonable, it is likely covered even if it occurred prior to the claim being filed.
[ 10:00 ] - The pipe replacement is covered, and replacement costs generally include anything required to get to the repair. Land is typically Property Not Covered, but it's not the land that suffered the loss. The cost of digging to the pipe to repair it is likely covered.
[ 11:05 ] - But what if camera-scoping didn't work, and digging to the pipe was part of the investigative process? And, what if the damage to the pipe turned out to be wear and tear? In that scenario, tear-out costs would likely not be covered.
[ 12:15 ] - No case law advises on what is needed regarding replacing the land.
[ 13:00 ] - In the wear-and-tear scenario, a specific provision may apply to lead to coverage for tear-out costs, e.g. if water damage was caused by the leak.
[ 14:30 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Constant Or Repeated Seepage Or Leakage Of Water — Burden Of Proof – PCQ.2022.06.27.jem.a - https://www.plrb.org/documents/constant-or-repeated-seepage-or-leakage-of-water-burden-of-proof-pcq-2022-06-27-jem-a/
Structure Settled After Water Escaped From Pipe – Earth Movement, Water Exclusion – PCQ.2022.04.13.twh.b - https://www.plrb.org/documents/structure-settled-after-water-escaped-from-pipe-earth-movement-water-exclusion-pcq-2022-04-13-twh-b/
Water Exclusion Might Not Include Metered Water – PCQ.2018.02.26.dwf.a - https://www.plrb.org/documents/water-exclusion-might-not-include-metered-water-pcq-2018-02-26-dwf-a/
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/ask-plrb/) 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 scenario@plrb.org.
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).