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[REPLAY] Invoking “Our Option” – Increased Use of Preferred Contractor Networks
What's the Scenario? with PLRB
This is a replay of an episode originally aired on Apr 15, 2025. 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...
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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...
info_outlineHomeowner Lisa claims she was asleep when she woke up to smoke alarms blaring. She safely evacuated her home, but the fire destroyed her garage and spread to part of her home. The adjuster requests that Alex determine the fire’s cause.
Notable Timestamps
[ 00:15 ] - The scenario outlines a garage fire claim and a need to investigate the cause of the fire.
[ 01:00 ] - When investigating a fire claim, is it origin and cause or cause and origin? Why?
[ 03:00 ] - NFPA 921 provides standards for fire investigators conducting origin and cause investigations.
[ 03:50 ] - Ring doorbell cameras or security footage is one source of origin and cause information. Footage may be automatically deleted, or the camera owner may refuse to cooperate.
[ 05:55 ] - The team discusses raccoons, dogs, and bike bandits caught by Ring cameras.
[ 08:15 ] - Garage fires can be hard to investigate because they often contain a large number of items and are often disorganized. These fires can burn quickly leaving little intact.
[ 11:05 ] - Neighborhood watch apps like "Citizen" can establish suspicious activity at the time of the loss. In this scenario, this leads to eyewitness reports about the cause of the fire.
[ 13:15 ] - Canvassing the neighborhood can help provide information, and experts can help investigate via forensic methods.
[ 14:10 ] - The insurance company determines that Lisa’s policy covers the fire damage, but liability may extend to the guests who knocked over the battery charger.
[ 14:35 ] - Tonda provides a recap of the scenario and the points above.
Your PLRB Resources
CE Course: Adjusting 21st Fire and Explosion Claims: Investigative Tools and Techniques - https://www.plrb.org/courses/adjustingfireclaims/
CE Course: Investigating and Resolving Different Types of Wildfire Losses - https://www.plrb.org/courses/investigating-and-resolving-different-types-of-wildfire-losses/
Wildfires Map (includes recent historical wildfires) - https://www.plrb.org/wildfires/
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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Send us your Scenario!
Please reach out to us at 630-509-8704 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 [email protected].
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).