What's the Scenario? with PLRB
A restaurant experienced a power outage lasting over an hour and a half. Because of the outage, they decided to close for the rest of the evening, claiming lost revenue from missed dinner service. PLRB weather tools will help us explore outage duration, date and time, location, and eventual cause. As we investigate, we’ll encounter an efficient proximate cause issue, the electrical currents exclusion, and a fried squirrel. Notable Timestamps [ 00:00 ] - The episode sets up a real-world insurance scenario: a restaurant closes after a 90-minute power outage and claims lost revenue,...
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You're a new exhibitor, and you're excited and anxious about your first visit to the PLRB Claims Conference. How will you handle the rushes of attendees and the breaks between them? How will you build relationships that will last after you leave the Expo floor? What tone will you strike with members? Gemcor has been attending PLRB since 1984, just three years after our dad founded the company. It’s the one conference we commit to every single year, and today we'll share our perspective. Notable Timestamps [ 00:58 ] - In this scenario, a new exhibitor is hoping for success at the...
info_outlineWhat's the Scenario? with PLRB
For this holiday week, we’d like to prepare you for the upcoming PLRB Claims Conference, so we’re sharing a classic episode featuring some highlights on what to expect. You might notice some details specific to the original date of taping, but we’ve lightly edited it to keep it relevant. We’re looking forward to seeing you at the conference! A supervisor is leading a small but mighty teams of adjusters, and they're taking their team to Indianapolis this spring for the 2025 PLRB Claims Conference. The only problem? They’ve never been before and have no idea where to...
info_outlineWhat's the Scenario? with PLRB
The insured felt like she did everything right. She insured the ring when she bought it, kept it scheduled on her policy, kept up with maintenance, and filed a claim right away when it was stolen. She even submitted the original appraisal for $22,000 so the insurance company would know how much to write on the check. So she was shocked when the insurance payout was only $14,000. Apparently diamonds are cheaper today, but she thinks: "shouldn't the appraisal lock in the cost?" Notable Timestamps [ 00:45 ] - An insured may assume an appraisal amount guarantees payout, but jewelry claims...
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Swine & Dine Farms underwent a devastating loss when a ventilation system shut off, resulting in the deaths of 2,400 hogs. Swine & Dine didn’t own the hogs: they were contract growers raising the hogs for an “integrator,” the contract owner of the animals who is not suing for the value of the lost hogs. What liability coverage is available for these folks? Notable Timestamps [ 00:41 ] - A ventilation failure led to the suffocation of thousands of hogs raised by a Contract Grower. [ 04:47 ] - This scenario centers on farm commercial liability policies, not property...
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As you prepare your new year’s resolutions, take a moment to ask, “What’s your elevator pitch?” This holiday week, we’re sharing a classic episode featuring an inspirational and thought-provoking scenario that you can bring into your personal and professional life. 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...
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During this time of year as many people are exchanging presents, I’m sure you’re all wondering exactly how those various gadgets would be classified under the HO3 policy. So for this holiday week, we’re sharing a classic episode featuring an excellent coverage scenario. The insured, a father of 4, was out buying Christmas gifts for his children. This year he decided to splurge and buy each of them a drone and an Apple Watch. On his way back home, he stopped to get gas, and when he went into the minimart for coffee, a thief stole everything out of the back seat. The insured notified the...
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Sod's Country Farms was raising 65,000 chickens when a fire burned down the poultry house. After a detailed investigation, the cause of the fire was undetermined. To further complicate matters, Sod's Country Farms didn't even own the chickens themselves, but raised them for a vendor. They want to know if the property loss of the animals is covered-- and what policy would be most appropriate. Notable Timestamps [ 00:00 ] - A poultry house fire destroys 65,000 chickens, but the insured doesn’t own the birds. [ 03:30 ] - Contract Growing is common in agriculture, with farmers...
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Alex is a team leader working with a mix of experienced adjusters and brand-new claims professionals, some assigned to the field and others working behind a desk. Alex has to make sure his team has the training they need to approach their work with confidence. Luckily PLRB.org’s Education Hub has everything they need to succeed. Notable Timestamps [ 00:10 ] - The PLRB Education Hub supports team leaders like Alex with training for both new and experienced adjusters to build confidence in handling claims. [ 01:25 ] - Update #1: A new critical thinking course will help adjusters analyze...
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Jamie has been a property adjuster for some time now and is ready to graduate to larger and more complex losses involving hurricanes, construction defects, historic buildings, massive commercial structures, and more. Chris is a seasoned large loss adjuster looking to hone their practice in the casualty arena and network with others in their area. To address these questions, we’ll take them to the PLRB Large Loss Conference. Notable Timestamps [ 00:15 ] - The conference attracts adjusters ready to move into larger and more complex losses, giving them exposure to hurricanes, defects,...
info_outlineThe 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 to the property itself.
[ 05:01 ] - A "death clause" provides a grace period to ensure coverage for the legal representative of the deceased (such as the executor of the estate) with respect to the premises and property covered at the time of death. This provision allows the family time to address affairs following a death.
[ 06:15 ] – The grace period is not indefinite. Coverage under this clause typically ceases once the probate proceeding is finalized and the assets are distributed, as there is no longer a legal representative for the deceased. Some modern policies also include a hard cap, such as 180 days (approximately six months), for this grace period.
[ 10:20 ] – Insurance companies are generally not obligated to actively seek out information regarding a policyholder's death. Courts have affirmed that the responsibility lies with the policyholder or the person seeking coverage to notify the insurer of any changes to the situation.
[ 13:56 ] – Arguments appealing to "fairness" or doctrines like "mutual mistake" (where both parties are mistaken about a fact) typically do not succeed in court when the insurance company was unaware of the policyholder's death.
[ 17:33 ] – To prevent coverage lapses and ensure proper protection, it is critical for individuals or their families to contact their insurance agent or company to update policies, especially after a major life event like the death of a named insured.
[ 14:00 ] - Tim provides a recap of the points above.
Your PLRB Resources
Coverage Question: If Named Insured Dies, Does Non-Resident Legal Representative Have Duty To Maintain Heat?
https://www.plrb.org/documents/death-must-representative-maintain-heat/?search=duty%20to%20maintain%20heat%20representative
Ramsey v. Allstate Ins. Co. (6th Cir.) (2013)
https://www.plrb.org/documents/ramsey-v-allstate-insurance-co-6th-cir-2013/
Davis v. Westfield Ins. Co. (2022)
https://www.plrb.org/documents/davis-v-westfield-ins-co-2022/
Kantz v. Everett Cash Mut. Ins. Co. (2018)
https://www.plrb.org/documents/kantz-v-everett-cash-mut-ins-co-2018/
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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PLRB thanks Pilot Catastrophe Services for its Diamond Sponsorship of the 2025 Claims Conference. "Pilot provides a complete suite of services to handle claims arising from catastrophic events, small storms or daily claims." Visit pilotcat.com!
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.
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