The CLEAR Approach to Difficult Conversations
What's the Scenario? with PLRB
Mia is a mid-level claims specialist with about five years’ experience in the job. One afternoon, she gets a call from a customer named James. He’s frustrated—bordering on furious. He’s been waiting for an update about his property claim, and from his perspective, no one communicated anything. He feels ignored. He’s escalating. Mia can tell this is going to be a difficult conversation. But instead of reacting defensively—or shutting down—she mentally runs through the CLEAR model. Notable Timestamps [ 00:30 ] - The "CLEAR Method" module, developed with Equis Consulting,...
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How Particular is "That Particular Part"?
What's the Scenario? with PLRB
Messy Masonry, Inc. was hired as a subcontractor on a new home construction. Their job was to install two giant bay windows overlooking a lake, but they ended up splashing mortar on one of them. When they attempted to scrub it off, the window was scratched. As for the other window... another subcontractor, Outside the Lines Painting, was hired to paint the window frames, but accidentally sanded part of the windows in that process. The homeowner found the scratches months later. Notable Timestamps [ 00:00 ] - A construction scenario involves Messy Masonry splashing mortar and scratching...
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The Lab-Grown Mismatch: One Earring, One Surprise
What's the Scenario? with PLRB
An insured filed a claim for a lost diamond earring. The stud and its match were scheduled as 1.00 Carat each, “I” color and SI clarity, for $8,000. Her insurer asked Gemcor create a match. When we received the mate, we ran our standard test and found something unexpected: the diamond wasn’t natural. It was lab-grown. In the years since its purchase, the replacement cost for lab-grown diamonds has plummeted. But the insured believed they were both natural, and wants a natural replacement. Notable Timestamps [ 00:58 ] - A client filed a claim for a lost diamond earring, but the...
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"You Can't Salvage My Mother's Ring!"
What's the Scenario? with PLRB
An insured brought her diamond ring to a local jeweler for a routine cleaning. The jeweler found damage and recommended filing a claim. Our team checked the original appraisal on file, which raised questions about the identified break. However, close analysis confirmed a different break in the girdle. The insured was entitled her to a like-kind replacement or cash if she surrendered the chipped stone. But, the insured does not want to surrender the diamond for sentimental reasons. Notable Timestamps [ 00:52 ] - The insured's diamond had a girdle break, and while entitled to replacement,...
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Suicide, Arson, and the Intentional Loss Exclusion
What's the Scenario? with PLRB
Warning, this scenario mentions suicide. The insured's 21-year-old son lives with them and suffers from depression. While the insured parents are away, their son goes through a breakup and decides to kill himself. He gets very drunk and douses the entire first floor in the gasoline they use for their lawnmower. He turns over a candle and goes upstairs to pass out. A neighbor called the police in time, and the young man was saved-- but the resulting fire consumed the house. Notable Timestamps [ 00:10 ] - John shares a serious scenario that raises pertinent coverage questions. [ 01:22 ] -...
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Don’t Fall Down the Building Codes Rabbit Hole!
What's the Scenario? with PLRB
The adjuster on a hail claim receives a long list of line items that are "required by code." Once the old shingles are torn off, they find rot and gaps in the sheathing, and the contractor says a thicker sheathing is now required by code. Notable Timestamps [ 00:10 ] - Ice barriers, drip edges, a double felt underlayment... Searching the internet only leads the adjuster spiralling down a rabbit hole. [ 01:30 ] - What internet rabbit holes have you gone down? [ 04:28 ] - With PLRB's updated Address Report, members can provide an address and specify details such as rafter spans. [...
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Posthumous Premium Payor
What's the Scenario? with PLRB
The 100-year-old named insured died of natural causes. His daughter, the executor, inherited and moved into the home, continuing to pay the same bills—including insurance premiums. Four years later, a fire occurred, but the policy still listed her late father. Can it pay out? Notable Timestamps [ 00:10 ] - The daughter continued to pay the premiums, but did not contact the insurance company to advise them of her father's death. [ 01:30 ] - Trivia Time! Who was the oldest living person? [ 04:06 ] – Insurance policies generally follow the insureds, as defined by the policy, as opposed...
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Sugar, Spice, and Everything Sand: The CGL Auto Exclusion
What's the Scenario? with PLRB
A concrete foundation is crumbling due to a truck's sugar-contaminated sand delivery. Now, a court case hinges on whether the CGL auto exclusion applies: Did the damage occur in the truck or on the job site? Notable Timestamps [ 00:30 ] - At the outset, it seems the question (of whether the CGL or the BAC policy applies) turns on whether the damage occurred on the job site, at the concrete plant, or on the sand delivery truck. [ 05:01 ] - Sugar can be used in small, controlled amounts to delay concrete setting time, but higher concentrations can prevent proper curing. The contamination in this...
info_outline![[REPLAY] Detached Garage Converted to AirBNB show art](https://assets.libsyn.com/item/37484330?height=50&width=50)
[REPLAY] Detached Garage Converted to AirBNB
What's the Scenario? with PLRB
This is a replay of an episode that originally aired on March 19, 2024. An insured’s detached garage burns down in a covered lightning strike, and somehow it’s not covered just because of a little side hustle? The PLRB crew hunt for coverage and find what the insurer can pay out on when an insured rents out their property without updating their insurance company. Notable Timestamps [ 00:17 ] - The insured remodeled their detached garage for use as an AirBNB rental, but never notified their insurer. The garage burned down, and the insured files a claim for the...
info_outline![[REPLAY] I Crashed My Bike Into a Tree show art](https://assets.libsyn.com/item/37403940?height=50&width=50)
[REPLAY] I Crashed My Bike Into a Tree
What's the Scenario? with PLRB
Is a recycle bin a “vehicle”? Does a car antenna ripping a coat fall under the Vehicles peril? How about a poorly secured wedding dress in the backseat of a convertible? If you occasionally win a biking competition, does the loss of your bike trigger business property coverage? Join Mike, Tim, and Alissha for the lightning round and discuss bikes, eBikes, sleds, boats, and more. Notable Timestamps [ 00:15 ] - The insured is an avid cyclist who occasionally wins money from his hobby. Another cyclist cut him off and he crashed his bike into a tree while at a park, destroying...
info_outlineJohn, 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 according to insure.com as of May 25. Which was the cheapest?
[ 02:22 ] - Michigan's standard PIP statute under MCL § 500.3114 dictates that the named insured generally collects benefits under their own auto insurance policy, not the policy covering the vehicle involved in the accident.
[ 02:49 ] - There are exceptions to the Michigan PIP priority rule, including when an insured is injured as an occupant of a vehicle owned by or registered to their employer or while a passenger in a vehicle used in the business of transporting passengers.
[ 04:04 ] - For John's first injury (slip and fall), regarding the "owned by employer" exception, a Michigan appellate court in the reviewed case held the truck was owned by both John (the driver/title holder) and the leasing company (Shoulder Trucking).
[ 05:36 ] - The court in this scenario found that he was an employee of himself as an independent contractor, leading his commercial insurance carrier to take priority.
[ 07:09 ] - For John's second injury (shuttle van), the key statutory exception language relates to being a passenger in a vehicle "used in the business of transporting passengers".
[ 07:52 ] - The phrase "in the business of transporting passengers" is construed in Michigan using a two-prong test from a seminal case: 1) whether transporting passengers was the primary purpose for the vehicle's use, and 2) whether the transportation was incidental to the overall business or activity.
[ 08:55 ] - Applying the two-prong test to the mechanic's shuttle van involves considering factors like whether the service was free (suggesting incidental) or regularly offered (suggesting primary purpose or not incidental). The court in the case discussed did not decide this issue for the shuttle van, sending it back to the finder of fact.
[ 09:39 ] - Brennan provides a recap of the scenario and the points above.
Your PLRB Resources
Case Law Review: Smith v. Farm Bureau Mut. Ins. Co. of Mich. (2025) https://www.plrb.org/documents/smith-v-farm-bureau-mut-ins-co-of-mich-2025/
Case Law Review: Miclea v. Cherokee Ins. Co. https://www.plrb.org/documents/miclea-v-cherokee-ins-co/
PLRB State-By-State Survey on PIP, Michigan → “Priority” https://www.plrb.org/documents/michigan-pip-compendium/#priority
Case Law Review: Bender v. USAA Gen. Indem. Co. (2025) https://www.plrb.org/documents/bender-v-usaa-gen-indem-co-2025/
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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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