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_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.
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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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