Tree Roots Blocked Up My Kitchen Sink
What's the Scenario? with PLRB
The insured's kitchen sink wasn’t draining well. A plumber scoped the line and found tree roots blocking it. The only fix is to dig up and replace the pipe. The adjuster checked the HO3 (2011) exclusions but didn’t find one specifically for tree roots. Do others apply? Notable Timestamps [ 00:45 ] – The adjuster checks the ISO HO3 (2011) policy but finds no explicit exclusion for damage caused by tree roots. [ 04:44 ] – Tree root damage exclusions can exist in some policies, but are rare. If clearly written, they’re usually enforceable. [ 05:30 ] – Lacking that, adjusters must look...
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Murder Mystery: Diminution in Value
What's the Scenario? with PLRB
A wealthy couple is murdered after a glamorous party—jewelry stolen, town abuzz. Their estate files an HO3 claim for the stolen jewelry and loss in home value due to the stigma. But does the policy cover reputational "diminution in value"? Notable Timestamps [ 00:37 ] - The scenario involves a wealthy couple poisoned in their mansion, with jewelry stolen and a claim submitted under their HO3 policy ISO 2011 edition. [ 01:39 ] - Trivia Time! Who are the six main characters of the board game Clue? [ 03:40 ] - Diminution in value refers to a property's market value being less than before...
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Michigan PIP Puzzles
What's the Scenario? with PLRB
John, a self-employed trucker, injures himself fixing his rig “Betsy” (1st PIP claim). Later, he’s hurt again when a mechanic’s shuttle van crashes (2nd PIP claim). Two accidents, two PIP claims—one while working, one as a passenger—make for a rough day. Notable Timestamps [ 00:17 ] - John has two injury claims in Michigan: a slip and fall while working on his truck (Injury 1) and being rearended while a passenger in a mechanic's shuttle van (Injury 2). [ 01:02 ] - Michigan was once the most expensive state for car insurance but has fallen to the sixth most expensive...
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Your Insurance Policy Will Decide When You’re Done Ridesharing
What's the Scenario? with PLRB
A "FastFeast" driver ends their shift but forgets to log out of the app. On the way home, they crash—and their insurance denies the claim. Why? They were still “on the job.” In the gig economy, one tap can mean the difference between coverage and denial. Notable Timestamps [ 00:01 ] - The core scenario involves a driver for the delivery app FastFeast who had an accident on the way home after their shift and whose insurance claim was denied because they were still logged into the app. [ 02:07 ] - A ghost kitchen is a delivery-only establishment with no physical storefront that...
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My Insurance Policy has a Death Clause!
What's the Scenario? with PLRB
Our insured, a widow with two adult kids, dies in a house fire. Her son, who planned to move out soon, escapes unharmed. Her daughter, who lives out of state but stores a drum set in the basement, is the executrix and returns home to handle next steps and insurance. Notable Timestamps [ 01:00 ] - The son planned to move into his girlfriend’s apartment by the end of the month [ 02:00 ] - The death clause in the HO3 form is explained as a critical provision ensuring the dwelling remains covered after the named insured's death until the estate can be settled. [ 03:00 ] - The policy...
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Does a Windstorm Deductible Apply to My Spoiled Cheesecakes?
What's the Scenario? with PLRB
A windstorm-caused power outage at the Cheesecake Manufactory led to the spoilage of hundreds of cheesecakes and a business income loss. The adjuster is questioning if the windstorm deductible applies to the claim, despite the power outage being the direct cause of the spoilage. Notable Timestamps [ 00:00 ] - The scenario presented involves a windstorm that caused a power outage, leading to spoiled cheesecakes and a claim for spoilage and lost business income, raising the central question of whether the windstorm deductible applies given the chain of events. [ 01:30 ] - Trivia: Where...
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My Cheesecakes Spoiled After A Windstorm-- or a Windy Storm?
What's the Scenario? with PLRB
A windstorm knocks over a power line, causing hundreds of cheesecakes at a local restaurant to spoil. The owners have to close for a few days as they manufacture more. Their adjuster wants to know how to investigate the storm and power outage. Notable Timestamps [ 00:20 ] - The loss of desserts is always tragic, even lemon merengue. [ 01:00 ] - Trivia: Which variety of cheesecake contains "quark"? Or should we say "Weißkäse"? [ 01:50 ] - PLRB.org features a Weather and Catastrophe hub designed for insurance professionals and not for cat enthusiasts. [ 02:17 ] - Users can get a full...
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A Flipped Van, a Plumber on Shrooms, and the BOP Policy
What's the Scenario? with PLRB
A plumber drove the company truck the wrong way on a busy highway for some time before he realized, panicked, swerved, and flipped the truck. Police believe he was on illegal drugs, although he disputes it. His employer claims equipment damage under their BOP policy. Notable Timestamps [ 00:25 ] - The plumber (the business) is now making a claim under their businessowners policy, BP 00 03 07 13, for the $50,000 worth of plumbing equipment and parts damaged in the accident. [ 01:45 ] - This episode was filmed at the 2025 PLRB Claims Conference in Indianapolis, right in the middle of the Expo...
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The Appraisal Process – Is it Still Useful to Resolve Disputed Claims?
What's the Scenario? with PLRB
An adjuster working on a complex property damage claim closes the file, having paid out on the claim. Then they receive a notice that the insured is demanding appraisal. They call up the insured, only to find out that the insured has no idea what’s going on. About Our Guest Steven J. Badger, Partner, Zelle LLP [email protected] https://www.linkedin.com/in/steven-badger-467b0322/ Notable Timestamps [ 00:20 ] - The insured signed a form on a tabet, presented to them by the contractor, without realizing it authorized a later appraisal demand. [ 01:13 ] - Steve shares an anecdote about his...
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Invoking “Our Option” – Increased Use of Preferred Contractor Networks
What's the Scenario? with PLRB
A Texas adjuster gets an assignment for a simple hail damage claim. He anticipates having to argue with the roofing contractor, debate whether overhead and profit is owed, deal with the supplementing company, receive an appraisal demand, and finally face a lawsuit. About Our Guest Steven J. Badger, Partner, Zelle LLP [email protected] https://www.linkedin.com/in/steven-badger-467b0322/ Notable Timestamps [ 00:20 ] - Because of his years of experience, he knows that the 30 square comp shingle roof should cost about $20,000 to replace. (Amount provided is for reference and...
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/
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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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