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That's a High Water Bill

What's the Scenario? with PLRB

Release Date: 07/16/2024

[REPLAY] The PLRB Expo: Connection & Community show art [REPLAY] The PLRB Expo: Connection & Community

What's the Scenario? with PLRB

Right now we’re gearing up for next week’s PLRB Claims Conference. So this week, we’re sharing a recent episode discussing how to make the most of the PLRB Insurance Services Expo.   You're a new exhibitor, and you're excited and anxious about your first visit to the PLRB Claims Conference. How will you handle the rushes of attendees and the breaks between them? How will you build relationships that will last after you leave the Expo floor? What tone will you strike with members? Gemcor has been attending PLRB since 1984, just three years after our dad founded the company. It’s...

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What's the Scenario? with PLRB

An adjuster starts to close the file on a roofing claim. The adjuster had worked closely with the roofing contractor and saw the claim through to its resolution, with the contractor getting paid in full. Then the adjuster receives an invoice with a supplement, from a company in another state. Upon calling the insured, they had no awareness of this company. Today Steven Badger from Zelle LLP will address these and other topics as we continue our discussion on “hot topics” in hail claims. Notable Timestamps [00:01] - Some in the industry describe the “reclaim game” as when an insured...

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Steven Badger from Zelle LLP joins us to talk about all the “hot topics” in the always interesting world of hail and other weather-related claims.  Steve will cover all the emerging trends in these claims, including current fraud and other abuse schemes, and provide his recommendations on how to address the common issues. He will also talk about what he is seeing with recent expanded use of the appraisal process.  Finally, Steve will talk about how his clients are addressing these issues through underwriting and policy wording changes. Notable Timestamps [ 00:07 ] - The episode...

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The insured lives in a single-family home in Austin, Texas. While hanging a shelf on the wall in one of the bathrooms, the owner drilled right through the metal stud, directly into a plumbing pipe, causing water damage to the wall and to the carpeting on the floor. (Yes, you heard that correctly, carpeting…in the bathroom!) Should there have been some type of pipe protection near the stud? And, does code even allow carpeting in a bathroom?   Notable Timestamps [ 00:08 ] - The scenario involves a homeowner drilling into a metal stud and puncturing a plumbing pipe, causing water damage to...

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[REPLAY] The PLRB Insurance Services Expo & You show art [REPLAY] The PLRB Insurance Services Expo & You

What's the Scenario? with PLRB

For this holiday week, we’d like to prepare you for the upcoming PLRB Claims Conference, so we’re sharing a classic episode featuring some highlights on what to expect. You might notice some details specific to the original date of taping, but we’ve lightly edited it to keep it relevant. We’re looking forward to seeing you at the conference!    Let’s say you’re a service provider in the insurance industry. You’ve been attending PLRB Conferences for a few years, and you’re thinking about taking the next step to increase exposure and build relationships with the right...

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Herding Weather/CATs show art Herding Weather/CATs

What's the Scenario? with PLRB

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 information on wildfire perimeters and California evacuations? For help herding all these cats, we’ll head to PLRB.org.   Notable Timestamps [ 00:00 ] - The episode introduces a scenario where a supervisor fields constant weather-related questions from cat...

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A restaurant experienced a power outage lasting over an hour and a half. Because of the outage, they decided to close for the rest of the evening, claiming lost revenue from missed dinner service. PLRB weather tools will help us explore outage duration, date and time, location, and eventual cause. As we investigate, we’ll encounter an efficient proximate cause issue, the electrical currents exclusion, and a fried squirrel.   Notable Timestamps [ 00:00 ] - The episode sets up a real-world insurance scenario: a restaurant closes after a 90-minute power outage and claims lost revenue,...

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The PLRB Expo: Connection & Community show art The PLRB Expo: Connection & Community

What's the Scenario? with PLRB

You're a new exhibitor, and you're excited and anxious about your first visit to the PLRB Claims Conference. How will you handle the rushes of attendees and the breaks between them? How will you build relationships that will last after you leave the Expo floor? What tone will you strike with members? Gemcor has been attending PLRB since 1984, just three years after our dad founded the company. It’s the one conference we commit to every single year, and today we'll share our perspective.   Notable Timestamps [ 00:58 ] - In this scenario, a new exhibitor is hoping for success at the...

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[REPLAY] Join Us at the Claims Conference show art [REPLAY] Join Us at the Claims Conference

What's the Scenario? with PLRB

For this holiday week, we’d like to prepare you for the upcoming PLRB Claims Conference, so we’re sharing a classic episode featuring some highlights on what to expect. You might notice some details specific to the original date of taping, but we’ve lightly edited it to keep it relevant. We’re looking forward to seeing you at the conference!    A supervisor is leading a small but mighty teams of adjusters, and they're taking their team to Indianapolis this spring for the 2025 PLRB Claims Conference. The only problem? They’ve never been before and have no idea where to...

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What's the Scenario? with PLRB

The insured felt like she did everything right. She insured the ring when she bought it, kept it scheduled on her policy, kept up with maintenance, and filed a claim right away when it was stolen. She even submitted the original appraisal for $22,000 so the insurance company would know how much to write on the check. So she was shocked when the insurance payout was only $14,000. Apparently diamonds are cheaper today, but she thinks: "shouldn't the appraisal lock in the cost?"   Notable Timestamps [ 00:45 ] - An insured may assume an appraisal amount guarantees payout, but jewelry claims...

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More Episodes

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. 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/

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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 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.

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