What's the Scenario? with PLRB
Formerly "PLRB on Demand", this podcast feed is being rebooted as “What’s the Scenario? with PLRB.” Each week you’ll find a 20-minute episode that addresses a claims or coverage scenario and answers interesting insurance questions. Our PLRB team of Alissha Watley, Mike Brode, and Tim Havlir will discuss terrorism, pandemics, fireworks, NFTs, aggressive contractors, phone scams, matching, vacation rentals, and more. Stay subscribed to this feed and check back in the new year for a new podcast. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at youtube.com/@plrb/ LinkedIn - Please follow at “Property and Liability Resource Bureau” Send us your scenario! Please reach out to us 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]. If you send us an audio clip, we may use the audio in the show, though again we will only include material we can anonymize. 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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The PLRB Insurance Services Expo & You
04/08/2025
The PLRB Insurance Services Expo & You
Let’s say you’re a service provider in the insurance industry. You’ve been attending PLRB Conferences for a few years, and you’re thinking about taking the next step to increase exposure and build relationships with the right people in the industry. Notable Timestamps [ 01:20 ] - Exhibiting and sponsoring at the PLRB Claims Conference can be an impactful option, and PLRB has a variety of offerings to help each service provider reach their goals. [ 01:50 ] - For our trivia question today, last year at the Claims Conference we had over 3000 attendees, and over 950 of those were insurance company staff. Of those, how many do you think were senior staff? [ 04:05 ] - The Insurance Services Expo includes a wide variety of exhibitors and sponsors, from traditional segments like independent adjusting and forensics to technology services like claims management software and AI solutions to other ancilliary services. [ 05:22 ] - Among other benefits, exhibiting and sponsorship can provide visibility, stature, and credibility as service providers build strong relationships in the industry. [ 06:30 ] - A variety of sponsorship opportunities are available to fit the needs of different service providers, from physical branding to digital signage to booth services. [ 07:50 ] - Service providers take full advantage of the benefits of the conference by attending educational sessions, doing their own entertaining, and making connections in the Expo. [ 08:37 ] - Unique opportunities like Wifi sponsorship and keycard sponsorship provide novel avenues to make connections with attendees. [ 09:15 ] - Return On Investment is a top concern for many service providers, and building relationships over time at the PLRB Claims Conference is often a fruitful experience for those who make the investment. [ 10:28 ] - The 2025 Claims Conference in Indianapolis provided plenty of space for conferencegoers to make connections. [ 11:50 ] - Many new offerings are anticipated, including-- as a show notes sneak peek-- creative services like social media templates and press releases. [ 13:30 ] - Tom provides a recap of the scenario and the points above. Your PLRB Resources Email [email protected] Contact Tom O'Dowd at [email protected] Prospective Sponsors: https://web.cvent.com/event/aa96efc9-539f-4558-bb0b-c31895d0abbf/websitePage:f7750b7c-c5d4-47e9-b3ba-24b0f244d6c8 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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The Police Shot My Heating Oil Tank (and a Burglar)
04/01/2025
The Police Shot My Heating Oil Tank (and a Burglar)
In the middle of the night, a burglar broke into the policyholder’s house. Nearby police arrived, and the suspect was apprehended. Debbie filed a claim for the police’s bullet holes in her house and cleanup of heating oil spilled when a bullet hit the tank. Notable Timestamps [ 00:15 ] - The bullet holes were all from police guns. 150 gallons of heating oil spilled in the basement. [ 01:40 ] - Heating oil tanks are most commonly found in what region of the United States? [ 03:30 ] - Tim reads through the Pollutants exclusion. Heating oil is most likely going to be considered a pollutant. [ 04:45 ] - When pollutants are released, it's usually caused by something else. This policy narrows down the analysis by listing the perils covered in Coverage C. [ 05:55 ] - Let's run through the Coverage C perils... how about explosion? There was a trial-level court case from Pennsylvania in the '90s that held a gunshot could be considered an explosion for the named peril. [ 07:55 ] - "Riot and civil commotion" probably envisions multiple people, or at least a larger area. [ 09:00 ] - Is it finally time for malicious mischief? No, it was the bullets from the police, and they were not causing the mischief. [ 09:30 ] - The peril for theft includes attempted theft, so this peril is a possibility. [ 10:45 ] - "Sudden and accidental tearing apart, cracking, burning or bulging of a steam or hot water heating system"... was the heating oil tank part of the hot water heating system for the home? [ 12:00 ] - Volcanic eruption? Probably not, but it is valuable to step through the policy to look for coverage. [ 13:13 ] - The governmental action exclusion applies to the destruction of covered property by order or governmental or public authority. [ 14:00 ] - "Order" usually means a search warrant, or something more formal than what occurred in this scenario. [ 14:45 ] - If the police officer's conduct exceeds the scope of the warrant, that may fall outside of the exclusion as well. [ 16:15 ] - Tim provides a recap of the scenario and the points above. Your PLRB Resources Coverage Question: Governmental Action Exclusion – Raid Pursuant to Warrant - https://www.plrb.org/documents/governmental-action-exclusion-raid-pursuant-to-warrant-pcq-2023-04-30-twh-a/?search=governmental%20action Coverage Question: Governmental Action or Civil Authority Exclusions Not Applicable Where Damage from Apprehending Suspect - https://www.plrb.org/documents/governmental-action-or-civil-authority-exclusions-not-applicable-where-damage-from-apprehending-suspect-pcq-2020-08-18-eks-a/?search=governmental%20action Annotation: Pollutants; Smoke from Industrial Operations (HO131) - https://www.plrb.org/documents/pollutants-smoke-from-industrial-operations-ho131/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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[REPLAY] Join Us at the 2025 Claims Conference
03/28/2025
[REPLAY] Join Us at the 2025 Claims Conference
Joining us next week? Enjoy this replay of our recent episode on the Claims 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 start. Notable Timestamps [ 00:15 ] - One more salute to our once and future host, Alissha Watley. [ 00:40 ] - Our team of claims professionals is headed to Indiana Convention Center in Indianapolis, IN for the 2025 PLRB Claims Conference, held on March 31 to April 2. [ 01:50 ] - The team reminisces about past conferences and tornado alarms. [ 02:40 ] - Stop by the registration desk to get your badge. If you're in town on Sunday, check out the Orientation for First-Time Attendees, and then the Claims Conference Welcome Reception. [ 04:17 ] - On Monday morning, kick off with the general session "The Power of Uncertainty" by Renee Bruns of Renee Bruns Coaching & Consulting, LLC. [ 04:40 ] - The Insurance Services Expo is a great place to connect with new products and service providers. [ 05:11 ] - PLRB will be hosting a booth at the Claims Conference, featuring lightning talks from PLRB staff and guests. [ 07:30 ] - Select from over 100 educational sessions to choose from, across 14 educational tracks. Get your CE Credits and the training you need to succeed. [ 10:30 ] - Lunchtime! The lunch hour is a great chance to check out the Expo hall and build connections. Who said there's no such thing as a free lunch? [ 11:36 ] - On Tuesday, check out PLRB Presents for short impactful talks; Future of Insurance for a thought leadership panel hosted by PLRB CEO Bryan Falchuk; and the Women's Walk coordinated by Girls Give Back. [ 13:00 ] - On Wednesday, stick around for a Backyard BBQ Luncheon. [ 14:16 ] - Register at PLRB.org under the Events tab. [ 15:05 ] - Mike provides a recap of the scenario and the points above. Your PLRB Resources Visit plrbclaimsconference.org or download the PLRB app to register, find a hotel, sign up for your sessions, and more. 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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Investigating a Garage Fire
03/25/2025
Investigating a Garage Fire
Homeowner 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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It’s Getting Smokey in Here
03/18/2025
It’s Getting Smokey in Here
Homeowner Jane Thompson lived 20 miles from the large Badone wildfire. One week after the fire department fully contained the wildfire, Jane called Evergreen Mutual and reported a strong smoke odor throughout her home. Notable Timestamps [ 00:20 ] - Jane also noticed discoloration on her walls and soot on her furniture. Jane was understandably concerned about her family’s health and potential long-term damage to her home and personal property. [ 01:10 ] - Can you name at least four of the major wildfires that have occurred in the US since 2016? [ 03:25 ] - The adjuster might focus on the HVAC system, walls, and attic as these are the most likely to show signs of smoke infiltration and fire-related damage: smoke and soot can get pulled into the HVAC system; porous materials like drywall can absorb smoke; attics often have exposed insulation, which can easily trap soot and smoke particles. [ 05:25 ] - A wipe test can reveal a layer of soot in areas not typically exposed to household pollutants, like inside closed cabinets. [ 06:34 ] - Documentation and photographs are essential to fire and smoke investigation and claims. [ 07:50 ] - Weather and fire reports can trace the wildfire’s smoke plume trajectory. [ 08:20 ] - NOAA can provide satellite imagery and local air quality index reports on the applicable area. [ 09:20 ] - PLRB.org's Weather / CATs hub provides weather data and analysis, including wildfire bulletins and address searches. [ 10:33 ] - Public cellphone location data can corroborate the timeline of smoke exposure, e.g. a spike in wildfire evacuation alerts and reduced activity in the area. [ 11:30 ] - Industrial hygenists can perform environmental testing that can detect char and ash particles consistent with materials burned in the nearby wildfire. [ 12:02 ] - Tonda provides a recap of the scenario and the points above. Your PLRB Resources CE Course: Adjusting 21st Century 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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Hand Me That Certificate (of Insurance)!
03/11/2025
Hand Me That Certificate (of Insurance)!
Just before purchasing a policy, the insured subcontractor says “I need to provide something called a ‘Certificate of Insurance’ to my general contractor,” and add them as an additional insured. What issues does this create from an underwriting or claims perspective? Notable Timestamps [ 00:15 ] - The adjuster is giving him the Coverage A limits to rebuild the house. But he is also making a claim for Fair Rental Value (Coverage D). ISO HO 00 03 05 11. Is there coverage? [ 01:07 ] - The team diagrams the parties. [ 01:43 ] - Employees, officers, and directors generally qualify as insureds while acting within the scope of their authority. [ 03:36 ] - Endorsements may limit coverage for the additional insured to claims for vicarious liability of the named insured. [ 04:35 ] - First, we must examine whether the insurer owes the additional insured a duty of defense and indemnification under the liability policy. The prime contractor is an insured for purposes of this analysis. [ 06:00 ] - Second, we examine whether the prime contractor’s tender of the defense under the indemnification provisions of the subcontract constitutes a covered claim against the named insured under the liability policy. The prime contractor is a claimant for purposes of this analysis. [ 07:55 ] - Certificates of Insurance typically include the name of insured, the policy dates, the policy identification number, the coverage type, and limits. [ 08:35 ] - What happens when the Certificate and the policy come into conflict? [ 10:35 ] - Certificates of Insurance usually state: “THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES." [ 11:17 ] - Let's say the endorsement making the Certificate-holder an additional insured was accidentally omitted from the policy. Case law is inconsistent, but the Certificate's disclaimer is often upheld. [ 12:41 ] - Let's say the agent made representations on the policy. This would raise issues of actual authority (less likely) and apparent authority (possible). [ 14:53 ] - Brennan provides a recap of the scenario and the points above. Your PLRB Resources CE Course: Underwriting Issues in Insurance Claims - https://www.plrb.org/courses/underwriting-issues-in-insurance-claims/ Handout: https://www.plrb.org/wp-content/uploads/2024/10/UnderwritingIssues-Scenarios.pdf Coverage Question: Is a General Contractor Entitled to a Defense Based Solely on a Certificate of Insurance? - https://www.plrb.org/documents/is-a-general-contractor-entitled-to-a-defense-based-solely-on-a-certificate-of-insurance-2005-06-21/ Related Case Law: Mingji Ave4 Realty, LLC v. Colony Ins. Co. (2024) - https://www.plrb.org/documents/mingji-ave4-realty-llc-v-colony-ins-co-2024 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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My Insurance Company Forgot to Bill Me...
03/04/2025
My Insurance Company Forgot to Bill Me...
The insured signed up for a “retrospective rating plan.” Under this plan, the insured promised to reimburse Unforgettable for its paid losses. The insurance company discovered invoices left unsent due to a computer programming error. Notable Timestamps [ 00:15 ] - Total Surprise Transportation promised to reimburse Unforgettable Insurance for its paid losses, including "Allocated Loss Adjustment Expenses." [ 01:25 ] - Tim asks for his paycheck to be decreased, and Brennan gets paid to buy a workbench. [ 02:43 ] - Usually premiums are calculated based on industry knowledge and similar businesses. Under a retrospective rating plan, an initial premium is assessed, then adjusted based on the insured’s actual losses. [ 03:55 ] - “Allocated Loss Adjustment Expenses” or ALAE are the costs associated with specific claims, and the “Unallocated Loss Adjustment Expenses” refer to more general overhead that goes into running the claims department. [ 05:09 ] - These plans allow the insured to hang onto their cash right up until the claim settles, rather than spending their reserves throughout the process. [ 05:58 ] - To successfully invoke laches, a defendant must prove the plaintiff delayed filing suit an unreasonable and inexcusable length of time from the time the plaintiff knew or reasonably should have known of its claim against the defendant; and (2) the delay resulted in material (financial) prejudice or injury to the defendant. [ 08:50 ] - Equitable estoppel prevents one party who has made certain representations from taking unfair advantage of another when the party making the representations changes its position to the prejudice of the party who relied upon the representations. [ 10:24 ] - Under the clean hands doctrine, a court sitting in equity will not provide shelter or aid to a party who seeks the benefit of their own wrongdoing. The doctrine generally does not apply to law actions like a breach of contract claim. [ 11:33 ] - Who really has clean hands here? What would the impact be on the insured's financial situation? The team discusses fairness in this context. [ 12:52 ] - Brennan provides a recap of the scenario and the points above. Your PLRB Resources CE Course: Underwriting Issues in Insurance Claims - https://www.plrb.org/courses/underwriting-issues-in-insurance-claims/ Handout: https://www.plrb.org/wp-content/uploads/2024/10/UnderwritingIssues-Scenarios.pdf 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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Singer Sings Against Assailant to Get a Defense
02/25/2025
Singer Sings Against Assailant to Get a Defense
A concert attendee filed suit against a band's lead singer based on the singer's alleged "onslaught" of blows to the attendee's face, head, and body over a dispute. However, the singer's claimed that the confrontation only became violent when the attendee threw the first punch. Notable Timestamps [ 00:25 ] - The singer tendered the suit to his insurer, who agreed to defend under a reservation of rights, but is there a duty to defend? [ 01:25 ] - Seventies, eighties, nineties? The crew chats concerts. [ 02:30 ] - This scenario is based on New York Marine and General Ins. Co. v. Ness, 2021 WL 510624 (E.D. Cal. 1/12/21), linked below. [ 03:30 ] - "Four Corners" means looking only at the Complaint, and "Eight Corners" means looking at the insurance policy as well. Both phrases refer to ignoring outside evidence and focusing on the claims made for the purposes of determining the Duty to Defend. [ 04:30 ] - The court determined that the insured's claims raised a factual issue about the insured's intent. The exclusion for Expected or Intended Injury would not apply in cases of self-defense. [ 05:45 ] - The court found that when there are extrinsic facts from the insured, it is incorrect to assume that only the attendee's allegations matter, so they found a duty to defend. [ 06:15 ] - Courts might sometimes punish "creative pleading", but nevertheless often Complaints will include allegations of negligence, which in this case would have prevented a coverage dispute. [ 08:30 ] - States treat "extrinsic evidence rules" differently. Texas courts allow evidence that solely addresses coverage and does not contradict the facts in the Complaint. This scenario would fail the second prong. [ 09:45 ] - Florida would not permit an insurer to allege extrinsic evidence to dispute the duty to defend, whereas Hawaii or New York might. Some caselaw suggests that if an exclusion clearly applies, extrinsic evidence may be allowed. [ 12:20 ] - Expediency drives many of these rules, as well as insurers' decisions between Declaratory Judgment and denial. [ 13:20 ] - One South Carolina case required an insurer to look at extrinsic evidence. [ 14:30 ] - Can an insurer use an endorsement to permit the introduction of extrinsic evidence in disputes about the duty to defend? A Washington court has yet to answer this question in Developers Surety and Indemnity Co. v. Alis Homes, LLC, 2018 WL 1792182 (W.D. Wash. 4/16/18), reviewed at PLRB, Com. Liab. Ins. L. Rev. 5511 (2018). https://www.plrb.org/legacy-documents?DN=66854 [ 15:40 ] - A California case held that extrinsic evidence could establish a duty to defend-- that's this scenario, linked below. [ 17:35 ] - Michele provides a recap of the scenario and the points above. Your PLRB Resources On the admissibility of extrinsic evidence regarding an insurer's duty to defend, Commercial General Liability Policy Annotation Key GL37 - https://www.plrb.org/legacy-documents?DN=43173 Expected or intended injury exclusion, see Commercial General Liability Policy Annotation Key GL71 - https://www.plrb.org/legacy-documents?DN=43211 Law Review California Federal District Case - https://www.plrb.org/documents/new-york-marine-and-general-ins-co-v-ness/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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Shooter Shatters Funeral Reception
02/18/2025
Shooter Shatters Funeral Reception
A restaurant was hosting a funeral lunch. During the lunch, a gunman entered and shot an individual who was not related to the funeral reception, but who was in eyeshot of lots of the patrons and children. The victim survived & the gunman fled. Notable Timestamps [ 00:24 ] - The insured restaurant has a CGL policy and sought coverage after a group of the patrons filed a lawsuit against the restaurant alleging emotional distress [ 01:50 ] - The coverage crew discuss The Godfather and their favorite mob movies. [ 02:45 ] - Bodily Injury under the CGL policy is usually defined as "sickness or disease sustained by a person, including death, resulting from any of these at any time." [ 04:50 ] - "O-H..." In Ohio, the case law is clear-cut: emotional distress does not qualify as bodily injury. Not even if a murder happens at a funeral. [ 07:15 ] - If ulcers or other symptoms arise after an upsetting scene, that would greatly increase the likelihood of the claim being considered "bodily injury." [ 08:20 ] - "...I-O" 31 states follow Ohio's lead. [ 09:30 ] - A California court found that "dry mouth" established bodily injury. How about embarrassment? High blood pressure? Case law can be found for many types of "bodily injury." [ 12:00 ] - If the gunman made physical contact with a bystander, that is a factor courts look to that could strengthen the case for bodily injury. [ 13:25 ] - A scenario where a claimant alleges their alcoholism was caused by his termination from a job presents a gray area, though the little case law available suggests psychological or psychiatric trauma may be too attenuated from the loss. [ 15:05 ] - Sleeplessness qualified as bodily injury in a New Hampshire case, and did not qualify in a New Jersey case. Seattle courts are still undecided. [ 16:55 ] - "Fuzzy" is a technical legal term. [ 17:25 ] - Michele provides a recap of the scenario and the points above. Your PLRB Resources CGL’s bodily injury definition, see PLRB Commercial General Liability Policy Annotations / GL7 – Bodily Injury Defined: https://www.plrb.org/documents/gl7-bodily-injury-defined/#_Ohio Coverage Reply, Is Emotional Distress a Bodily Injury? https://www.plrb.org/documents/is-emotional-distress-a-bodily-injury-in-ohio-cq2024-11-25fjg/?search=bodily%20injury Coverage Reply, Would Negligent Infliction of Emotional Distress Be Covered under a CGL Policy? https://www.plrb.org/documents/would-negligent-infliction-of-emotional-distress-be-covered-under-a-massachusetts-cgl-policy-2022-01-06/?search=bodily%20injury%20emotional 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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Here Comes Fair Rental Value in the Backstretch
02/11/2025
Here Comes Fair Rental Value in the Backstretch
The insured owns a house in Louisville, KY, near Churchill Downs. Every year, prior to the first Saturday in May, he rents his house out for two weeks. He secured a renter for $3,000. However, a week before the Derby, his home was destroyed in a fire. Notable Timestamps [ 00:15 ] - The adjuster is giving him the Coverage A limits to rebuild the house. But he is also making a claim for Fair Rental Value (Coverage D). ISO HO 00 03 05 11. Is there coverage? [ 01:36 ] - Trivia Time! The Kentucky Derby was first run in what year? 1898, 1920, 1842, or 1875? [ 03:30 ] - Fair Rental Value is covered if a covered loss makes that part of the residence premises rented to others or "held for rental" not fit to live in. [ 05:20 ] - "Held for rental" could apply to someone advertising a rental, or someone with a contract for rental (even if breached due to the loss). [ 06:16 ] - Fair Rental Value can mean a much higher price than most equivalent units, if it's the week before the Kentucky Derby. [ 07:29 ] - Fair Rental Value can be informed by prior history of unit rental price for that specific unit or similar nearby units, and it can be affected by the time of year or even the significance of sporting events. [ 08:50 ] - The sporting event's impact on pricing would not be affected by the renter's intent to attend or not. [ 09:25 ] - Claiming ALE is likely inconsistent with claiming FRV. Did the insured intend to live in the house, and therefore they need ALE to make them whole for the living space they lost? Or did the insured intend to rent the house, and therefore they need FRV to make them whole for the rental they lost? [ 11:32 ] - A partial use, partial rental situation might justify claiming both ALE and FRV. [ 12:35 ] - The paucity of caselaw on Fair Rental Value means that uncertainty is high but variation among the states is low. [ 13:15 ] - The 2022 ISO HO form made significant changes relating to homesharing apps, and excluded coverage for FRV specifically when homesharing activities are involved. [ 14:45 ] - Tim's "policies in his pocket" are color-coded! [ 15:55 ] - If the home was repaired prior to the Derby, but the tenant had cancelled, FRV would likely not apply. The relevant ISO policy specifically excludes coverage for cancellations of agreements. The end of the Period of Restoration closes the window on FRV. [ 17:25 ] - Tim provides a recap of the scenario and the points above. Your PLRB Resources Fair Rental Value For Home Up For Rent At Time of Loss – PCQ.2013.06.11a (Cov Question) - https://www.plrb.org/documents/fair-rental-value-for-home-up-for-rent-at-time-of-loss-pcq-2013-06-11a/ ALE: Travel Costs to Rental Property – PCQ.2014.05.09a (Cov Question) - https://www.plrb.org/documents/ale-travel-costs-to-rental-property-pcq-2014-05-09a/ Fair Rental Value (HO38) (Annotation) - https://www.plrb.org/documents/fair-rental-value-ho38/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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A Bank Robber Fried My Toaster
02/04/2025
A Bank Robber Fried My Toaster
A bank robber in a high speed chase from the police and smashed into a tree on the insured's premises. A large limb fell on power lines, and the insured's home sustained a power surge. The insured claims electrical damage to his refrigerator, toaster, and TV. Notable Timestamps [ 00:20 ] - The adjuster sees the insured had a standard ISO HO 00 03 05 11. Is there coverage for these household items under that form? [ 01:35 ] - Trivia time! This 1967 American film starring Warren Beatty and Faye Dunaway follows the exploits of bank robbers in the Depression-Era South. [ 03:00 ] - Coverage A generally applies, in part, to electronics permanently attached to the realty-- if you turned the house upside-down and shook it, what would NOT fall out? [ 04:36 ] - Coverage A or Coverage C factors: 1. actual physical annexation to the property, 2. application or adaptation to the use or purpose to which the realty is devoted, and 3. intention (or lack thereof) to make it a permanent installation. [ 05:11 ] - If the insured was moving to a new home, what would they leave behind? Not the toaster or, with any likelihood, the television. Even wall-mounted televisions are easily removed. [ 07:00 ] - This refrigerator has an ice maker, so it's linked to the plumbing. It's often not taken upon moving. [ 07:35 ] - Coverage B only comes into play if you're storing your lawnmower in a refrigerator. [ 08:36 ] - Sometimes refrigerators are built in to match the surrounding cabinets. [ 09:30 ] - We'll assume these fall under Coverage C, and that the insured isn't living in that backyard fridge to get Coverage D to apply. [ 10:30 ] - Proximate cause analysis would apply to this complex chain of causation, but most adjusters would likely give the insured the benefit of the doubt if any named peril played a meaningful role in bringing about the loss. [ 11:00 ] - Malicious mischief? It's a consideration, but sorry Mike, there are other intervening causes here. [ 12:05 ] - Going through the options, several named perils might apply: Artificially Generated Electrical Current, Falling Objects, or Vehicles. [ 13:00 ] - Sudden and Accidental Damage from Artificially Generated Electrical Current sounds like it should apply, but the text says it does not apply to objects with electronic components. [ 14:18 ] - The Vehicles peril just says "vehicles." [ 15:00 ] - If the insured is driving, you might run into an intentional loss exclusion issue, and innocent co-insured concerns. [ 16:00 ] - The insured can get paid for the tree, even though the list of perils is shorter for that particular coverage, because the loss was caused by a vehicle not owned or operated by a resident. [ 17:35 ] - Tim provides a recap of the scenario and the points above. Your PLRB Resources Power Surge Damages Appliances- PCQ.2006.06.01a - https://www.plrb.org/documents/power-surge-damages-appliances-pcq-2006-06-01a/ Artificially Generated Electrical Current (HO77) - https://www.plrb.org/documents/artificially-generated-electrical-current-ho77/ Does Additional Coverage Apply To Tree Struck By Insured Vehicle After Collision?- PCQ.2012.04.17a - https://www.plrb.org/documents/does-additional-coverage-apply-to-tree-struck-by-insured-vehicle-after-collision-pcq-2012-04-17a/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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You Can Take the CL Out of the CGL...
01/28/2025
You Can Take the CL Out of the CGL...
This claim involves contractual issues between a general contractor and an electrician. The electrician got his wires crossed and caused some damage, and now there’s lawyers throwing around phrases like “contractual indemnity” and “additional insureds” and “insured contracts.” Notable Timestamps [ 00:34 ] - Nate is a longtime personal lines adjuster switching to commercial lines and taking over a claim from a retiring adjuster. [ 01:40 ] - Call (630) 509-8704 to leave a voicemail with your anonymous adjuster story! Mike shares his own story! What can you do about a drunken sailor... [ 04:00 ] - CGL policies typically exclude liability assumed under a contract. Typically, two-party contracts are not occurrences because a breach of contract is not a matter of chance or fortuity. The GL policy is not a performance contract or a guarantee of work product or quality. [ 06:35 ] - However, CGL policies have an EXCEPTION to the EXCLUSION that keeps out two-party contracts. The exception permits coverage for "insured contracts"-- basically three-party contracts like the one where a general contractor contracted with an insured electrician, and then the homeowner's property got damaged. [ 09:15 ] - Contractual indemnity is created by a contract to assume another party's tort liability, whereas an additional insured is created by an endorsement in the insurance policy specifically naming the party to be insured. [ 11:32 ] - An Additional Insured endorsement may include some limitations, but otherwise the named additional insured has the same rights as the insured who signed up for the policy. [ 11:55 ] - Additional Insured have broader rights than a contractual indemnitee, but they also have broader responsibilities: the same responsibilities as the original insured to cooperate, act timely, etc. [ 13:21 ] - A contractual indemnitee can refuse responsibilities like providing certain documents, but miss out on perks like getting a defense provided by the insurance company. [ 14:45 ] - The CGL policy provides these differing options as a way of providing flexibility for different situations. [ 15:12 ] - Not to get "distracted", but the CGL also carves out an exception for "sidetrack" agreements-- agreements pertaining to the train tracks extending out of factories and warehouses. [ 16:50 ] - Mike provides a recap of the scenario and the points above. Your PLRB Resources 50-State survey on Indemnity Agreements - https://www.plrb.org/documents/agreements-to-indemnify-and-general-liability-insurance/ CE Course on Contractual Indemnity and Additional Insured Liability - https://www.plrb.org/courses/contractual-indemnity-and-additional-insured-liability/ Advanced Issues: Road Trip Through the CGL Policy recorded webinar - https://www.plrb.org/courses/advanced-issues-road-trip-through-the-cgl-policy/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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Join Us at the 2025 Claims Conference
01/21/2025
Join Us at the 2025 Claims 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 start. Notable Timestamps [ 00:15 ] - One more salute to our once and future host, Alissha Watley. [ 00:40 ] - Our team of claims professionals is headed to Indiana Convention Center in Indianapolis, IN for the 2025 PLRB Claims Conference, held on March 31 to April 2. [ 01:50 ] - The team reminisces about past conferences and tornado alarms. [ 02:40 ] - Stop by the registration desk to get your badge. If you're in town on Sunday, check out the Orientation for First-Time Attendees, and then the Claims Conference Welcome Reception. [ 04:17 ] - On Monday morning, kick off with the general session "The Power of Uncertainty" by Renee Bruns of Renee Bruns Coaching & Consulting, LLC. [ 04:40 ] - The Insurance Services Expo is a great place to connect with new products and service providers. [ 05:11 ] - PLRB will be hosting a booth at the Claims Conference, featuring lightning talks from PLRB staff and guests. [ 07:30 ] - Select from over 100 educational sessions to choose from, across 14 educational tracks. Get your CE Credits and the training you need to succeed. [ 10:30 ] - Lunchtime! The lunch hour is a great chance to check out the Expo hall and build connections. Who said there's no such thing as a free lunch? [ 11:36 ] - On Tuesday, check out PLRB Presents for short impactful talks; Future of Insurance for a thought leadership panel hosted by PLRB CEO Bryan Falchuk; and the Women's Walk coordinated by Girls Give Back. [ 13:00 ] - On Wednesday, stick around for a Backyard BBQ Luncheon. [ 14:16 ] - Register at PLRB.org under the Events tab. [ 15:05 ] - Mike provides a recap of the scenario and the points above. Your PLRB Resources Visit plrbclaimsconference.org or download the PLRB app to register, find a hotel, sign up for your sessions, and more. 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” 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).
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Installation Floaters? I Still Don’t Own a Boat!
01/14/2025
Installation Floaters? I Still Don’t Own a Boat!
In our last podcast, thieves cut into a job site and stole a variety of tools, equipment, and materials. The general contractor had hired a subcontractor to install the plumbing system. Copper piping to be installed at the job site and owned by the sub were also stolen. Notable Timestamps [ 00:45 ] - Last week's scenario is expanded to discuss the impact on subcontractors. [ 01:50 ] - The PLRB crew discusses inside jobs, boats, and gap coverage. [ 02:50 ] - Subcontractors more often prefer Installation Floaters as opposed to Builders Risk. [ 04:00 ] - The Installation Floater form generally covers materials, fixtures, and equipment that will become a permanent part of the completed project. [ 05:30 ] - The coverage typically ends once the items are installed. So, these copper pipes would be covered under an installation floater. [ 08:00 ] - Despite the name "floater," waterborne equipment is specifically excluded. Unless Mike opens up a seafood restaurant with some unusual decor... [ 09:13 ] - The Contractors Equipment form covers mobile machinery used by a contractor or subcontractor as part of their construction work. [ 10:50 ] - The Motor Truck Cargo form provides coverage for the cargo or goods being transported by a trucking or freight transportation company: the risks associated with transportation. [ 12:32 ] - The trucking company might be liable for the panels because they were on their truck, but they might be covered under their Motor Truck Cargo coverage, depending on its delivery status. [ 13:30 ] - Jeff provides a recap of the scenario and the points above. [ 16:20 ] - A very special (and hopefully temporary) farewell to PLRB's longtime podcast host, Alissha Watley! Your PLRB Resources Inland Marine – Prop. Q&A 187 - https://www.plrb.org/documents/inland-marine-prop-qa-187/ Discussion of the definition of equipment and machinery - PLRB, Commercial Property Forms Annot. Key CP941 - https://www.plrb.org/legacy-documents?DN=46384 Installation Floater Coverage - https://www.plrb.org/documents/installation-floater-coverage/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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Inland Marine? I Don’t Even Own a Boat!
01/07/2025
Inland Marine? I Don’t Even Own a Boat!
Thieves cut through a fence to access the insured general contractor's job site’s and stole tools, a forklift, a pallet of marble tiles, and a truck loaded with precast concrete wall panels. Notable Timestamps [ 00:30 ] - The insured finds out that these losses are not covered under their standard CP forms. [ 01:45 ] - The team discusses impressive thieves, the defintion of a CP policy, New Year's Resolutions, and vision boards. [ 05:13 ] - The CP/BPP form generally applies while the property is on or within 100 feet of the premises described in the policy’s declarations. The job site is not the insured's listed place of business. [ 07:05 ]- A Property Off Premises Coverage Extension exists, but applies only to property that is temporarily at a location the insured does not own, lease or operate. [ 07:45 ] - Here, GC’s marble tiles and precast panels were not temporarily at the job site – they were going to be permanently installed there. [ 08:30 ] - GC arguably “operated” the jobsite, as it had control over the site, including access etc. [ 09:20 ] - The coverage extension also contains an exclusion for property in or on a vehicle, so that applies to eliminate coverage for the panels on the truck. [ 09:40 ] - GC could have protected this property via Inland Marine Insurance. [ 10:20 ] - Originally, “marine” insurance policies were written when virtually all commercial goods were transported by boat. However, due largely to the development of railroads, marine insurance was extended to provide “warehouse to warehouse” coverage. [ 11:04 ] - While there are a number of inland marine forms, the most common are Builders Risk, Installation Floater, Contractors Equipment, and Motor Truck Cargo Liability. [ 12:10 ] - Builder’s risk insurance covers buildings and other structures during the course of construction, including materials and supplies that will become a permanent part of the buildings or the structures, while on the jobsite or on the way to the jobsite. [ 14:10 ] - Under the claim scenario here, the pallet of marble tiles and precast concrete wall panels would be covered, but not the the generators, concrete saw, or forklift, since they are not materials or supplies. [ 15:10 ] - Jeff provides a recap of the scenario and the points above. Your PLRB Resources Inland Marine – Prop. Q&A 187 - https://www.plrb.org/documents/inland-marine-prop-qa-187/ Form – AAIS IM 7050 09 08 – Builders Risk - https://www.plrb.org/documents/form-aais-im-7050-09-08-builders-risk/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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[REPLAY] The Coverage Contrarian: CGL Coverage for Engine Servicing and Workmanship
12/31/2024
[REPLAY] The Coverage Contrarian: CGL Coverage for Engine Servicing and Workmanship
For the next two weeks over the holidays, we’re going to feature some excellent podcasts from before we rebranded as “What’s the Scenario? with PLRB.” These segments were called “The Coverage Contrarian,” and they featured PLRB coverage attorneys Michele Hunter, Eric Friedmann, and Frank Gagliardi as they argued vociferously about coverage issues big and small. This week, we’ll explore the scenario of an insured repair business that repaired a valve on a large boat so poorly that the whole engine was damaged. Let’s listen in. Key Takeaways The critical inquiry in a defective or faulty workmanship case is, the scope of the insured's agreed upon, contracted work. Under the majority view, the damage to the engine would likely be considered damage to other property, because the insured was not hired to work on the whole engine itself. Under the minority view, working on an interconnected part of an engine would be considered working on the engine as a whole. Your PLRB Resources PLRB on Demand (Classic Podcast Episodes) - https://www.plrb.org/education/education-resources/?general_index%5BrefinementList%5D%5Blms_type%5D%5B0%5D=Podcast&general_index%5BsortBy%5D=general_index%3Apublished_on%3Aasc 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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[REPLAY] The Coverage Contrarian: E-Bike Coverage Under a Homeowners Policy
12/24/2024
[REPLAY] The Coverage Contrarian: E-Bike Coverage Under a Homeowners Policy
For the next two weeks over the holidays, we’re going to feature some excellent podcasts from before we rebranded as “What’s the Scenario? with PLRB.” These segments were called “The Coverage Contrarian,” and they featured PLRB coverage attorneys Michele Hunter, Eric Friedmann, and Frank Gagliardi as they argued vociferously about coverage issues big and small. This week, we’ll explore the scenario of an e-bike slamming into a tree. Key Takeaways In any coverage issue involving an E-Bike, the first step is to consider the jurisdiction you're in, and whether that particular state excludes E-Bikes from its definition of "motor vehicle." If an E-Bike is not considered a "motor vehicle," there is no coverage, and no reason to consider the motor vehicle exclusion. And the second EQUALLY IMPORTANT step is to see whether the particular Homeowners policy has coverage for "motorized vehicles" or "recreational motor vehicles." Because then, there may be coverage for an E-Bike accident on the insured premises or for a rented E-Bike. Your PLRB Resources PLRB on Demand (Classic Podcast Episodes) - https://www.plrb.org/education/education-resources/?general_index%5BrefinementList%5D%5Blms_type%5D%5B0%5D=Podcast&general_index%5BsortBy%5D=general_index%3Apublished_on%3Aasc 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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There's a Gap in My Roof!
12/17/2024
There's a Gap in My Roof!
The insured's roof will need to be replaced. Upon removal of the asphalt shingles, the roofing contractor finds that the existing roof deck has gaps. Now, the contractor is requesting removal of the existing spaced sheathing and installation of new half-inch OSB. Notable Timestamps [ 00:30 ] - The scenario concerns the devastation that followed Hurricane Helene. [ 01:15 ] - Mike shares a story about getting stranded up on a roof, and Rosen shares his childhood shenanigans. [ 03:49 ] - A riddle: What kind of house is fully enclosed but it has no roof? [ 06:00 ] - The deck holds the roof covering. In some cases it can be boards, and spaced decking or skip sheathing is where there is a "skip" between each panel. [ 07:00 ] - Spaced sheathing is most common with coverings made from wood, e.g. cedar shake wood shingles, to provide ventilation to prevent improper curing and bending. [ 07:14 ] - Spaced sheathing is not compatible with asphalt shingles. [ 08:20 ] - The issues arise when cedar shake is covered with asphalt shingle, but then a storm requires removal of the shingle & shake. [ 09:20 ] - Some contractors propose removing all the sheathing, but a three-eighth inch overlay can be installed over the spaced sheathing. [ 11:10 ] - Without some small gap between the planks, seasonal changes would cause expansion and contraction that lead to bowing. Gaps that are too large can lead to nails not being attached to anything securing it. [ 13:30 ] - The industry consensus seems to prefer gaps between one-eighth inch and one-quarter inch. [ 14:25 ] - There's a misconception that planked sheathing cannot be used with asphalt shingles, but IRC R803.1 disagrees. [ 15:40 ] - Rosen provides a recap of the scenario and the points above. Your PLRB Resources Recorded Webinar: Asphalt Shingle Roofs: Top 10 Code Questions - https://www.plrb.org/courses/asphalt-shingle-roofs-top-10-code-questions/ Clickable Diagram: Residential Roof Toolkit - https://www.plrb.org/building-codes/building-component/#roof_toolkit Spaced Sheathing Does the Deck Need to be Replaced - https://www.plrb.org/documents/sheathing-spaced-sheathing-does-the-deck-need-to-be-replaced/?search=sheathing%20gap 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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Will Insurance Pay for the Minibar?
12/10/2024
Will Insurance Pay for the Minibar?
The named insured's home underwent a total loss. The insured wants coverage for a place to stay while his home is being rebuilt. The insured wants to know the scope of Loss of Use coverage, and exactly how many bags of M&Ms he can snag from the minibar. Notable Timestamps [ 00:25 ] - The insured also lives with his girlfriend, which may come into play later. [ 01:00 ] - Are minibars even a thing anymore? [ 02:23 ] - ALE is triggered when the insured premises is unfit to live in, and applies to any necessary increase in living expenses incurred to maintain its normal standard of living. [ 03:50 ] - “Expenses” could include house rental, meals, drink, tips, transportation, heating, lighting, laundry, etc., but the insured must be able to show an increase in expenses. [ 04:37 ] - ALE is not intended to cover a shortfall in personal property coverage. [ 05:30 ] - ALE is analogous to Extra Expense under commercial policies, but Extra Expense can be more expansive. [ 06:40 ] - Is alcohol a daily expense? ALE can include laundry, restaurants and tips, etc. if it can be shown the expense is more than normal. [ 07:40 ] - The live-in girlfriend would be considered a member of his household, but ALE only applies to the insured's additional expenses. [ 09:30 ] - In 2022, ISO added some language to allow ALE to cover expenses by residents of the household who are relatives or dependents. [ 10:55 ] - The girlfriend may have to prove her residency. [ 12:10 ] - ALE only applies when there is a covered cause of loss. [ 13:10 ] - If the home is only partially fit to live in, an insured can still incur ALE. If the kitchen is uninhabitable, ALE may cover restaurants. [ 14:30 ] - If a guest's visit was planned pre-loss, the insured's expenses for the guest may be covered. [ 16:30 ] - Pet boarding expenses are also likely included in ALE expenses. [ 17:35 ] - John provides a recap of the scenario and the points above. Your PLRB Resources PLRB, Homeowners Annot. Key HO37 - https://www.plrb.org/legacy-documents?DN=77 Adjuster Resource Sheet: ALE Claims - https://www.plrb.org/documents/adjuster-resource-sheet-ale-claims/ ALE or FRV: Insured Decides to Stay on Premises in Cottage But Loses Rent from Current Tenants - PCQ.2024.03.22.slc.a - https://www.plrb.org/documents/ale-or-frv-insured-decides-to-stay-on-premises-in-cottage-but-loses-rent-from-current-tenants-pcq-2024-03-22-slc-a/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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Getting Mileage Out of That (Insurance Claim)
12/03/2024
Getting Mileage Out of That (Insurance Claim)
The insured landlord spent considerable expense driving back and forth to the loss site in order to check on the contractors and make sure the building repairs were going smoothly. The insured submits their mileage to the adjuster for reimbursement. Notable Timestamps [ 00:30 ] - The team celebrates the fiftieth episode! Sort of. [ 01:38 ] - In this scenario, the insured requests payment for driving back and forth to the loss site, which was his decision. [ 03:34 ] - Can we find coverage here? We can try three avenues... [ 04:11 ] - First, it's not really part of the building repair (and therefore replacement cost) unless the insured was assisting in the repair. [ 05:25 ] - Second, it doesn't really fall under Extra Expense because he is not attempting to reduce the Period of Restoration. [ 06:50 ] - Third, it doesn't qualify as an attempt to prevent further damages. [ 07:40 ] - Another consequential loss scenario: The insured discovers their passport is stolen! The insured must travel to obtain a new one, and wants payment for that travel. [ 08:40 ] - Likely, yes; it's required to replace her lost contents. [ 09:15 ] - Can she take a helicopter? A reasonableness standard would likely apply. [ 10:15 ] - A trophy deer head is damaged, and would like the cost of a hunting trip to replace it himself. But, sentimental value is not part of ACV. [ 13:00 ] - A customer in Japan opened a cattle hide that had been shipped internationally, and discovered water damage. The insured who sent the hides flew to Japan to maintain the customer's good will, and wants that plane ticket reimbursed. [ 14:30 ] - It seems to fall under Extra Expense, yet in this claim the insured's business did not shut down, so business income does not apply. The court argued that the damage to the reputation was consequential damage and not covered. [ 16:30 ] - Tim provides a recap of the scenario and the points above. Your PLRB Resources PLRB, Indirect Losses Or Expenses - https://www.plrb.org/documents/indirect-losses-or-expenses/ Death – Does A.L.E. Apply to Representative and Family Members While Repairs Are Ongoing? PCQ.2020.10.08.jch.a - https://www.plrb.org/documents/death-does-a-l-e-apply-to-representative-and-family-members-while-repairs-are-ongoing-pcq-2020-10-08-jch-a/ ALE for Mileage to Visit Hospital - in Additional Living Expenses (HO37) Annotation - 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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Anti-Concurrent Air Conditioning?
11/26/2024
Anti-Concurrent Air Conditioning?
Cassie and her neighbor were constantly on each other's nerves. One night, the neighbor snuck onto Cassie's property and jammed a stick into the A/C condenser fan blades out of spite, causing the mechanicals on the unit to break down. Notable Timestamps [ 00:29 ] - The adjuster's manager points out the exclusion for mechanical breakdown, prefaced by anti-concurrent causation language. The adjuster still feels this loss was in the nature of a vandalism loss and should be covered. [ 01:45 ] - Trivia question! What sitting US Senator was assaulted by his neighbor while mowing his lawn? [ 02:45 ] - Mike & Brennan get into their history of neighbor feuds and doggie disputes... [ 04:04 ] - The "Anti-Concurrent Causation" preface deals with the multiple causation problem. The default approach is to determine which cause is dominant or proximate, but where a policy has the "Anti-Concurrent Causation" preface, that's not the approach. [ 05:35 ] - Tim pulls the policy out of his pocket and reads that exclusions that follow the A.C.C. preface are excluded "regardless of any other cause..." [ 07:00 ] - In four jurisdictions (AL, CA, WA, WV), the A.C.C. preface is disregarded. [ 07:40 ] - There is an argument to be made that mechanical breakdown is in the chain of events, and therefore the exclusion applies regardless of the vandalism cause. [ 09:11 ] - An insurance company can choose to draft their policy this way and exclude this loss. [ 10:44 ] - Usually when you think mechanical breakdown, you think of a machine reaching the end of its life, wearing out, as opposed to sudden damage. [ 11:23 ] - It is very rare to see the mechanical breakdown exclusion paired with the A.C.C. preface, likely due to this unintuitive situation. The A.C.C. preface is usually intended for exclusions more subject to misapplication, such as flood. [ 12:55 ] - The way this policy is drafted, any time a machine breaks down it would eliminate coverage... even during a fire? Would a court uphold that? [ 13:30 ] - Tim provides a recap of the scenario and the points above. Your PLRB Resources Mechanical Breakdown Exclusion and the Anti-concurrent Causation Preface – PCQ.2024.09.26.twh.a - https://www.plrb.org/documents/mechanical-breakdown-exclusion-and-the-anti-concurrent-causation-preface-pcq-2024-09-26-twh-a/ PLRB, Homeowners Annot. Key – Mechanical Breakdown, Latent Defect, Inherent Vice (HO129) - https://www.plrb.org/documents/mechanical-breakdown-latent-defect-inherent-vice-ho129/ Anti-Concurrent Causation Preface (HO78) Annotation - https://www.plrb.org/documents/anti-concurrent-causation-preface-ho78/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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A Bouncer Tossed Me From a Speakeasy
11/19/2024
A Bouncer Tossed Me From a Speakeasy
At the downtown speakeasy, there’s jazz in the air and the moonshine is reasonably priced. Maybe too reasonably priced, because a few of the speakeasy’s patrons are getting belligerent. Soon half the bar is fighting, and the bouncer flips his assailant to the ground. Notable Timestamps [ 00:34 ] - When the bouncer flips the assailant, he is on his way to defend a waiter and trying to defend himself. [ 01:30 ] - The crew discusses hidden speakeasies... [ 04:00 ] - The legal backdrop is that the injured patron is arguing that the speakeasy's insurer has more money to settle the claim-- the general $1M limit, not the smaller endorsement's limit of $25K. [ 05:00 ] - The endorsement for Assault & Battery covers damages paid out arising out of assault and battery, up to $25K. [ 06:15 ] - The Expected or Intended Injury Exclusion does exclude injury “expected or intended from the standpoint of the insured." If you throw someone into a table, you probably expect them to be injured. [ 07:00 ] - But, there’s an exception to the exclusion! It doesn’t apply to bodily injury “resulting from the use of reasonable force to protect persons or property." [ 07:35 ] - The patron argues that the coexistence of these two clauses creates an ambiguity. [ 09:30 ] - The court in Scottsdale v. Speakeasy rules that the existence of the exception to the exclusion did not preclude applicable endorsements. [ 11:00 ] - The patron argued that the bouncer did not mean to hurt him, so it wasn't an "assault." The court ruled that the bouncer did intend to throw him, and that falls under the endorsement. [ 12:30 ] - Brennan provides a recap of the scenario and the points above. Your PLRB Resources Scottsdale Ins. Co. v. Speakeasy Bar & Grill, LLC (2024) 2024 U.S. Dist. LEXIS 167125 (S.D. Ind. 9/16/24) - https://www.plrb.org/documents/scottsdale-ins-co-v-speakeasy-bar-grill-llc-2024/ Commercial General Policy Annotation Key GL71 – Expected or Intended Injury Exclusion - https://www.plrb.org/documents/gl71-expected-or-intended-injury-exclusion/ Does the “Expected or Intended” Exclusion Apply to the Employer for an Employee’s Assault? – CCQ.2023.06.28.jrm - https://www.plrb.org/documents/does-the-expected-or-intended-exclusion-apply-to-the-employer-for-an-employees-assault-ccq-2023-06-28-jrm/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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Fighting Fry Cooks Take It Outside
11/12/2024
Fighting Fry Cooks Take It Outside
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 claims seeking damages for bodily injury, if caused by an occurrence. [ 04:35 ] - The concept of an occurrence is related to fortuity, as in, insurance is generally intended to cover accidents, not purposeful actions. [ 05:20 ] - The definition of occurrence and the Expected or Intended Injury Exclusion usually operate to preclude defense of an employee for their assaults... [ 06:00 ] - ...but the employer is often sued for negligent hiring, negligent background investigation, negligent training, negligent supervision, etc. [ 07:15 ] - The policy in this scenario only covered employees for acts within the scope of their employment. [ 08:15 ] - In the case upon which this scenario was based, the court held in favor of the insurer even though negligence was alleged, because the crux of the complaint centered on intentional conduct unrelated to business operations. [ 10:30 ] - Nevada law supports the interpretation that there is no occurrence under these facts, so the action taking place off-premises likely did not impact the result. [ 12:22 ] - Brennan provides a recap of the scenario and the points above. Your PLRB Resources Safety Nat’l. Cas. Corp. v. Bender (2024) 2024 U.S. Dist. LEXIS 159524 (D. Nev. 9/4/24) - https://www.plrb.org/documents/safety-natl-cas-corp-v-bender-2024/ GL17 – Occurrence/Accident Defined - https://www.plrb.org/documents/gl17-occurrence-accident-defined/ Can There Be an “Occurrence” When the Insured’s Employee Deliberately Strikes a Customer With a Baseball Bat? 2022.01.18 - https://www.plrb.org/documents/can-there-be-an-occurrence-when-the-insureds-employee-deliberately-strikes-a-customer-with-a-baseball-bat-2022-01-18/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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Slip and Fall Slipped Insured’s Mind
11/05/2024
Slip and Fall Slipped Insured’s Mind
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 these provisions in line with a reasonableness standard. [ 04:00 ] - Breach of this policy provision can give the insurer the right to deny coverage, so claims are often reported even prior to suit being filed. [ 05:11 ] - In Illinois, courts examine factors including the wording of the notice provision, the sophistication of the insured, the diligence of the insured, and prejudice. [ 07:33 ] - Some states (but not IL) require the insured to show prejudice-- in layman's terms, some impact beyond a technality. [ 10:50 ] - Even if the insured feels that the snow plow company should be at fault, the insured must still comply with the insurance contract. [ 12:27 ] - There's no universal bright-line rule on the amount of time: cases range from finding breach at three months, to finding no breach at two years. [ 13:37 ] - Courts would also consider factual situations like difficulties with mail. [ 14:10 ] - Typically in lawsuits lack of knowledge of a contract is not a defense, but in this case the sophistication of an insured is a factor. [ 16:14 ] - Michele provides a recap of the scenario and the points above. Your PLRB Resources 50 State Survey – Late Notice - https://www.plrb.org/documents/table-of-contents-late-notice/?search=late%20notice Commercial General Liability Policy Annotation Key GL25, Late Notice - https://www.plrb.org/documents/gl25-notice-to-insurer/ Commercial General Liability Policy Annotation Key GL26, Notice Prompt And As Soon As Practicable - https://www.plrb.org/documents/gl26-notice-prompt-as-soon-as-practicable/ PLRB Coverage Reply, Is Prejudice Required to Deny a Claim for Late Notice? - https://www.plrb.org/documents/is-prejudice-required-to-deny-a-claim-for-late-notice-2022-09-30/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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A Storm Spoiled My Insured's Fish
10/29/2024
A Storm Spoiled My Insured's Fish
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 reports in a grid with 1km x 1km squares. [ 05:55 ] - The data can only demonstrate a probability that an outage occurred at the selected address. [ 06:50 ] - The data does not include the cause of the power outage. [ 07:00 ] - The lightning report data includes satellite data during a given 1-hour period for both in-cloud and cloud-to-ground lightning. [ 09:40 ] - These reports can be used to confirm causality in a claim. [ 10:24 ] - Tim & Mike chime in! Food spoilage claims can lead to confusion because the clauses frequently change. In these situations, it's best to read the policy carefully. Is there a distinction between on-premises and off-premises? Does it mention power failures as well as power surges? Is there an ensuing loss clause? The policy may also have an endorsement for food spoilage. [ 12:43 ] - CP and BP form have an exclusion for artificially-generated electrical current, which would not apply in a lightning claim. [ 03:24 ] - Andrew provides a recap of the scenario and the points above. Your PLRB Resources Get a Power Outage Report - https://www.plrb.org/weather-cat/power-outage-reports/ Get a Lightning Report - https://www.plrb.org/weather-cat/researching-lightning-data/ Adjuster Resource Sheet: Food Spoilage Claims Under Commercial Forms for Property Adjusters - https://www.plrb.org/documents/adjuster-resource-sheet-food-spoilage-claims-commercial/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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Cyclones, Insurance & A Bowl of Spaghetti (Models)
10/22/2024
Cyclones, Insurance & A Bowl of Spaghetti (Models)
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 ] - Hurricane Francine caused a great deal of damage to homeowners and businessowners by the Louisiana coast. [ 04:35 ] - Andrew shares some screenshots, available on the YouTube version of this podcast. [ 05:02 ] - An error cone is shown, demonstrating the suspected path of the hurricane. [ 05:28 ] - Spaghetti models show the various paths Francine might have taken. [ 05:46 ] - Peak storm surge forecasts color code area by feet of storm surge. [ 06:44 ] - The "Best Track" includes line, point data, and cumulative wind history. [ 07:20 ] - Spaghetti models are a forecasting tool that provides multiple expectant paths. Tracks closer together indicate certainty. These are available on PLRB.org or via API. [ 08:33 ] - Andrew demonstrates how spaghetti models can change over time. Error cones may be superimposed on the spaghetti models. [ 10:17 ] - Storm surge is the rise in seawater caused solely by the storm's winds pushing the water onto shore. Soup gets involved now. [ 11:15 ] - Best Track is a representation of the tropical cyclone's direction and intensity. The Best Track wind swath shows how the storm changed. [ 12:10 ] - Catastrophe Managers can use these forecasting tools in resource allocation. Best Track data can assist in estimating claim ratios. Claims Adjusters can use Best Track data to assist in claims decisions. Underwriters can use this historical data in risk assessment. [ 13:19 ] - Andrew provides a recap of the scenario and the points above. Your PLRB Resources Tropical Storm Francine: https://www.plrb.org/weather-cat/2024-francine/ Spaghetti Models: https://www.plrb.org/documents/view-tropical-cyclone-track-spaghetti-models/ Best Track Data: https://www.plrb.org/documents/view-national-hurricane-center-tropical-cyclone-best-track-maps/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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Bumping Brewery Bollards
10/15/2024
Bumping Brewery Bollards
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 for? How many Clydesdales are hitched to the Budweiser wagon? Lite beer was introduced into the U.S. in what decade? [ 04:15 ] - A bollard is a short pole or stump placed to prevent vehicle access without preventing pedestrian access. These may be seen at the entrances to bike paths, or out in front of buildings or arenas. [ 05:40 ] - Under the CP form, a bollard would initially fit under building coverage as an external fixture. Fences are excluded except for certain types of losses (not including this kind of loss). [ 07:30 ] - A line of bollards, like a fence, is something like a barrier that marks a boundary. But, there is no continuity between posts, and it does not prevent pedestrian access. [ 09:11 ] - A historic moment: the team agrees on something! [ 09:37 ] - Courts typically do not construe ambiguous exclusions broadly. "If it's gray, you must pay." [ 10:40 ] - Declarations Pages are typically more detailed in CP forms, and often include small structures. However, at least one court chose not to penalize an insured for failing to list a series of (light) posts. [ 12:26 ] - If a Declarations Page lists most structures specifically but omits some, that may create an issue for the insured. [ 13:25 ] - Strong subrogration potential exists here against the driver. [ 14:30 ] - A cement block wall was considered a fence... at least according to a 1959 case, and under a grant of coverage which is typically construed more broadly. [ 16:40 ] - Tim provides a recap of the scenario and the points above. Your PLRB Resources Bollards: Do They Qualify As Fences? – PCQ.2017.05.09.twh.a - https://www.plrb.org/documents/bollards-do-they-qualify-as-fences-pcq-2017-05-09-twh-a/ Annotation: Property Outside Buildings (CP622) - https://www.plrb.org/documents/property-outside-buildings-cp622/ Chippewa Country Valley Festival v. Little Black Mut Ins Co (2002) - https://www.plrb.org/documents/chippewa-country-valley-festival-v-little-black-mut-ins-co-2002/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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The Stairs Made Me Trip and Fall!
10/08/2024
The Stairs Made Me Trip and Fall!
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 within an acceptable range. [ 05:40 ] - The tread depth is likely compliant, even if they are longer than usual. [ 06:07 ] - The riser heights are not uniform, which may present a code issue. [ 06:45 ] - In this case the 2018 IBC applied, and handrails are required on both sides. No handrails were present here. [ 07:17 ] - The term "Legacy Code Exceptions" is typically preferred to describe when a code does not apply because the structure was built prior to the code's establishment. [ 08:30 ] - A "triggering event" such as remodeling or occupancy change can mean that a legacy code exception would not apply. It also may not apply if something else, e.g. deterioration, made the area unsafe. [ 09:18 ] - In some cases, an exception to a building code may be made if the structure of the building does not permit the code requirement, e.g. handrails. [ 10:22 ] - In some states, if the steps were not up to code, the salon is negligent automatically or "negligent per se." In other states, evidence of code violation means there is a presumption of neglience; finally, other states merely find a code violation to be evidence of negligence. [ 11:30 ] - Even in "negligence per se" states, establishing that the negligence existed is not the same as demonstrating that the negligence caused the injury as opposed to an intervening factor, e.g. the insured's behavior. [ 12:33 ] - Ruth provides a recap of the scenario and the points above. Your PLRB Resources Address Report: Find a code adoption for insured's address with link to code book - https://www.plrb.org/building-codes/building-component/ Commercial Stairs Diagram: Interactive diagram with excerpts from code for each of the main components of stairs - https://www.plrb.org/building-codes/building-component/ Legal Duty Created by Building Codes: State-by-state analysis of case law and defenses - was the insured negligent based on failure to comply with building codes? - https://www.plrb.org/documents/overview-of-duty-created-by-building-codes/ Ask a Code Question - https://www.plrb.org/building-codes/ask-plrb-building-code-question/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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I Burned Tomatoes So I Need a New Deck
09/24/2024
I Burned Tomatoes So I Need a New Deck
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. [ 01:47 ] - Tim talks traditional Tennessee recipes. [ 03:07 ] - The fire is likely covered, even if the homeowner left the skillet unattended. [ 03:50 ] - To paraphrase, Ordinance or Law Additional Coverage covers increased costs due to enforcement of ordinance or law for the portion of "the undamaged part" of a covered building "necessary to complete" the repair of the damaged part. [ 06:00 ] - If the inspector had insisted on fire alarms, the argument that the "necessary" language applies would be stronger. [ 06:30 ] - In Chattanooga Bank Associates v. Fidelity & Deposit Co. of Maryland, 2004 WL 187409 (E.D. Tenn. 2004) [reviewed at PLRB, Prop. Ins. L. Rev. 6657 (2004)], Ordinance or Law coverage did not extend to code violations discovered in areas that were not affected by fire damage. [ 07:10 ] - It seems city inspectors do sometimes withhold permits for seemingly unrelated code violations. [ 08:10 ] - An inspector's order is likely considered an "ordinance or law" though it is not, strictly speaking, either one. Compare to the demand of a private HOA, which would not be an ordinance or law. [ 09:11 ] - If something is built prior to a code change, it typically only needs to be updated when it is remodeled. The correct term for this is "Legacy Code Exceptions." [ 10:30 ] - Commercial "ordinance or law" Additional Coverage forms specifically do not include violations that existed prior to the loss, but personal forms are often silent on that point. [ 11:30 ] - The contractor who built the deck could be considered negligent, but the policy's faulty work exclusion may or may operate to override Ordinance or Law coverage. [ 13:43 ] - It can be difficult to determine that a deck is out of code! [ 14:30 ] - Tim provides a recap of the scenario and the points above. Your PLRB Resources Chattanooga v. Fidelity - https://www.plrb.org/documents/ordinance-or-law-ho149/ Webinar: Cracking the Code: Navigating the Complexities of Ordinance or Law Coverage - https://www.plrb.org/courses/cracking-the-code-navigating-the-complexities-of-ordinance-or-law-coverage/lessons/cracking-the-code-navigating-the-complexities-of-ordinance-or-law-coverage/ Adjuster Resource Sheet: Ordinance Or Law Issues - https://www.plrb.org/documents/adjuster-resource-sheet-ordinance-or-law-issues/ State-By-State: Tennessee: Faulty Workmanship - https://www.plrb.org/documents/tennessee-faulty-workmanship/ Tennessee Mountains Stack Cake Recipe - https://www.food.com/recipe/tennessee-mountains-stack-cake-46814 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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).
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That Cosmetic Damage is Excluded!
09/16/2024
That Cosmetic Damage is Excluded!
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 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. Your PLRB Resources For Regulatory Bulletins and State-By-States, check out PLRB's hubs, e.g. https://www.plrb.org/property-lines/ 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. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us 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). Hail Sounds: Buckine. Freesound.org. https://freesound.org/people/Buckine/sounds/574928/
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