Fighting Fry Cooks Take It Outside
What's the Scenario? with PLRB
It's not easy work standing over a hot fryer making french fry rings all day, so today's fry cook isn't in the best mood when the cashier starts complaining. After the lunch rush, the employees sneak out and step over to the neighboring gas station parking lot for a fistfight. Notable Timestamps [ 00:26 ] - At DonutBurgers, two employees are still on the clock and in their uniforms when they leave the premises for a fight. [ 01:39 ] - Cold or hot? Curly or shoestring? Salt or no salt? The team discusses the best fast food fries. [ 03:25 ] - Insurance generally covers defense against...
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Slip and Fall Slipped Insured’s Mind
What's the Scenario? with PLRB
A restaurant hired a plowing service. One night, before the service plowed the lot, a grandmother exits her car, slips and falls, and breaks her hip. The woman sues, but the restaurant did not report the injured woman’s claim to their insurer for six months. Notable Timestamps [ 00:26 ] - By the time the insurer learned of the loss, the injured person had already obtained a judgment against the insured. [ 01:35 ] - How do you walk on ice? [ 03:28 ] - A CGL's notice provision likely requires "immediate notice", "notice as soon as practicable", or "prompt notice". Courts interpret...
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A Storm Spoiled My Insured's Fish
What's the Scenario? with PLRB
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 Timestamps [ 00:36 ] - Another insured claims their back shed was hit by lightning, damaging expensive equipment. [ 01:32 ] - The team discusses tips for what to do during a power outage. [ 02:47 ] - On PLRB.org, on the Weather Hub, you can click Power Outage Report and enter in an address and date to see historical power outage...
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Cyclones, Insurance & A Bowl of Spaghetti (Models)
What's the Scenario? with PLRB
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 property insurer, looking for coverage for a new bollard. They have a standard CP 00 10 10 12, which does not include coverage for fences if the cause of loss was an accidental vehicle crash. [ 01:21 ] - The PLRB team discuss pasta recipes. [ 02:47 ] -...
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Bumping Brewery Bollards
What's the Scenario? with PLRB
A brewery owner had bollards installed outside the building for safety purposes. One day a teenager veered off the road into one of the bollards, damaging it and the car. The adjuster is wondering if there should be no coverage on the basis that a bollard is a fence. Notable Timestamps [ 00:26 ] - The building owner submits the claim to their property insurer, looking for coverage for a new bollard. They have a standard CP 00 10 10 12, which does not include coverage for fences if the cause of loss was an accidental vehicle crash. [ 01:34 ] - Trivia time! What is a "pub" short...
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The Stairs Made Me Trip and Fall!
What's the Scenario? with PLRB
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 time through the door that day. [ 01:16 ] - Tripping and falling is a common experience. [ 02:45 ] - The team watch & react to the video (only available for staff). [ 04:08 ] - Ruth details the layout of the step. [ 05:03 ] - The riser heights are...
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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...
info_outlineAfter 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 found the clause ambiguous.
[ 05:13 ] - Let's say there's no leak, just pooling. In Dragoo v. Allstate Veh. and Prop. Ins. Co., No. 4:16-CV-984-O, 2018 WL 1536639 (N.D. Tex. 1/05/18), cosmetic damage was read as damage that "only changes its appearance."
[ 06:30 ] - If the damage increased the likelihood of future damage, that may not be considered cosmetic.
[ 07:20 ] - In Fisher v. Am. Fam. Mut. Ins. Co., No. 17-CV-01949-MEH, 2019 WL 142204 (D. Colo. 1/09/19), the exclusion applied to components that would not "(1) prevent water from entering the building; or (2) perform any other intended function." The second clause was found to potentially include aesthetics.
[ 08:00 ] - In Valleyview Church of Nazarene v. Church Mut. Ins. Co., No. 2:20-CV-222-Z-BR, 2023 WL 4504595 (N.D. Tex. 6/13/2023), the policy read "cosmetic damage means that the wind and/or hail caused marring, pitting or
other superficial damage that altered the appearance of the roof surfacing, but such damage does not prevent the roof from continuing to function as a barrier to entrance of the elements to the same extent as it did before." This was found to be not ambiguous.
[ 09:11 ] - In J&S Welding, Inc. v. Liberty Mut. Ins. Co., No. 1:22-cv-01122-STA-jay, 2023 WL 6150730 (W.D. Tenn. Sept. 20, 2023), the court said that testimony about the functionality of a metal roof qualified as a matter of scientific, technical, or other specialized knowledge.
[ 12:07 ] - Check for Cosmetic Damage Regulatory Bulletins, e.g. https://www.plrb.org/documents/2017-regulatory-cosmetic-damage-exclusions-wy/ or https://portal.ct.gov/cid/-/media/cid/1_protertycasualty/aerial-imagery-notice.pdf
[ 14:30 ] - Jeff provides a recap of the scenario and the points above.
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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.
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).
Hail Sounds: Buckine. Freesound.org. https://freesound.org/people/Buckine/sounds/574928/