Webinar Wednesday: Condominium CAT Claims Webinar - July 31, 2014

THIS WEEK WE RECOMMEND* THE FOLLOWING WEBINAR:

About Careers Events Diversity Alumni Contact Blogs

People Industries Practice Areas Experience Offices News & Resources

Thursday, July 31, 2014 11:30 – 12:30 p.m. EST 10:30 – 11:30 a.m. CST 9:30 – 10:30 a.m. MST 8:30 – 9:30 a.m. PST Who Should Attend: All levels of claims professionals – both in-house and independent – who conduct loss investigation and adjustment activities on behalf of first-party property insurance carriers. What You Will Learn: ·         Challenges: What types of property and business income losses will arise from CAT-related damage to condos? ·         Communication, Cooperation  & Coordination: How do you minimize coverage gap disputes between the Homeowners' Association's Insurers and the individual member policyholder and their respective carriers? ·         Matching Issues: How much, how far, and how close is near enough? ·         Unique Issues: What is the impact of “pair and set” and “consequential reduction in value” provisions on coverage and overall loss payment? ·         Stigma Damages: Are such claims a new silver bullet for insureds to use to increase coverage or are they shooting blanks? Please click here to register for our webinar.

Speakers: Ronald E. Tigner Member Global Insurance Department (832) 214-3935 rtigner@cozen.com Stacey S. Farrell Member Global Insurance Department (404) 572-2027 ssfarrell@cozen.com

*This posting is for informational purposes only, as a courtesy to our reading audience. Provencher & Company has in no way been compensated for the sharing of this information. The use of or enrollment in any classes, seminars, training, etc. in no way constitutes or implies any endorsement of the provider of said programs. Provencher & Company shares no financial obligation to attendee or organizer.

Raiders of the Lost Profits - Part Four: Pit of Snakes - Establishing Period of Restoration

Pit of Snakes - Establishing Period of Restoration

There is a difference between Period of Restoration and Period of Suspension just like there is a difference between a king snake and a king cobra.  And there are also total suspensions and partial resumptions.

Although many factors may impact the Business Income evaluation period as the claim progresses (such as valid delays, covered Ordinance or Law, delay in payment by the carrier, contractor availability, negotiated POR), the Period of Restoration is defined as the reasonable amount of time it should take to repair or replace the damaged property (including business space even if not owned by the insured or covered under the insured’s policy).

Many times, the process of determining a final Period of Restoration (POR), the adjuster should always evaluate the initial POR based on the reasonable time period and state that in his or her report to HQ.  Some consideration for adjustment time should be acknowledged separately.  If additional time should be considered or if actual suspension period should be considered, make that a separate acknowledgment so our client, as well as your partners in the Business Interruption office, can tell the difference.

Don’t fall into the snake pit!  Define exactly what you mean when you outline the Period of Restoration. 

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Introduction: Introduction to Inspection for BI

Part One: The Secrets of Daily Loss Inspection

Part Two: Adventures in CAT Inspections

Part Three: Search for the Grail:Covered Cause of Loss vs. Actual Cause of Loss

Part Four: Pit of Snakes:  Establishing Period of Restoration

Part Five: Reporting to HQ:  Here’s What We Know So Far

Written & Contributed by:

Kandy Ray

This place does not come with a defibrillator....

Have you ever been to the fabulous Decatur Diner in West Ocean City, MD? 

Their retro style diner has quickly become a local landmark and popular destination stop for thousands of resort visitors and local residents looking for a freshly made home cooked meal. They are open from dawn to dusk serving breakfast, lunch and dinner 7 days a week, all year round - really, could you ask for more? Located in Ocean City, MD you can find them off of Rt. 50 on Rt. 611, just minutes from downtown Ocean City, Ocean Pines & Berlin, MD.

This is the kind of place that brings back memories of a simpler time - where friends and neighbors gather each morning and discuss events of the day over a hot cup of coffee, things are less hectic and life is good. The retro style decor of checkerboard floors and red leather stools and the diner counter add to an atmosphere that just begs you to sit back and relax while enjoying one of their many fine meals. Co-owners, chef’s and brother’s Bill & Matt Rados have done a fabulous job of using only the finest ingredients for each dish and credit much of their restaurant’s growing success to those top quality ingredients & their outstanding personal service to each and every customer who comes through their doors.

Entrees include:

PRIME RIB (Slow roasted w/ queen & king portions!)

PORTERHOUSE PORK CHOP (House breaded and flash fried w/ gravy!)

FRESH FISH (Served pan seared or fried)

OVEN ROASTED BBQ CHICKEN (Oven roasted & served w/ Sweet Baby Ray’s!)

EGG PLANT or CHICKEN PARMESAN (Hand breaded; topped w/ marinara & provolone)

SPAGHETTI & MEATBALLS (With our fresh homemade marinara sauce)

Daily Breakfast Specials Feature:

Eggs Benedict

Eggs Benedict with Crabmeat

Homemade Chicken Fried Steak & Eggs

Creamed Chipped Beef

Country Sausage Gravy & Biscuits

Fried Chicken & Waffles (Meaty Wings on a Belgian Waffle)

OMELETTES stuffed with: Cheese (Swiss, Cheddar or American), Bacon, Pork Roll, Ham, Scrapple or Sausage, Fresh Crab Meat, Surf & Turf,Chipped Beef or Sausage Gravy, Home Fry, Cream Cheese & Tomato, Western or Veggie Style,

or “Build Your Own” Omelet (Your own combination of just about anything on the menu!)

The Decatur Diner is just minutes from downtown Ocean City, 

Ocean Pines & Berlin, MD at it’s convenient new location on Rt. 611, 

less than 1 mile south of Rt. 50 in West OC.

What was on the menu for our last visit? Well it was The Pipeline of course! Piled high w/ home fries, egg, onions, sausage, cheese, & gravy. We got one with sausage gravy on it, you can also get cream chipped beef on it.

This thing does not come with a defibrillator though after indulging in it, you may want to have one close by!

Insurance Bad Faith and Coverage Conference

Save the Dec. 4 and 5 for the CLM's Insurance Bad Faith and Coverage Conference The CLM will be hosting its expanded Insurance Bad Faith and Coverage Conference on December 4 and 5 in New York City. This perennial favorite conference brings together hundreds of participants, most of whom are industry-leading professionals, to discuss cutting-edge insurance bad faith and coverage topics. The conference planning committee is busy putting together the best conference to date. Past CLM Insurance Bad Faith and Coverage conferences included executives from the following companies: ACE Advanced Disposal AIG ALEXI Professional Services, Inc. Allstate Amerisure Arbella Argo Group US AXA Insurance Company AXIS Insurance Canal Insurance Carolina Casualty Claim Insights, Inc. CNA Fireman's Fund Homesite Group Infinity Insurance Liberty Mutual Navigators OneBeacon PLS Claims QBE RiverStone Resources Sedgwick CMS State Farm Summit Consulting Tower Hill Insurance Travelers Universal North America Zurich North America As an added bonus, the CLM Holiday Party will be held the evening of December 4 in Rockefeller Plaza. There is no cost to attend this great networking event and priority registration is given to those registered for the Insurance Bad Faith and Coverage Conference. Registration will open on September 4, but mark your calendar today! CLM Insurance Bad Faith and Coverage Conference December 4 and 5 New York City

171 West 71st Street, 10th Floor, New York, NY 10023

*This posting is for informational purposes only, as a courtesy to our reading audience. Provencher & Company has in no way been compensated for the sharing of this information. The use of or enrollment in any classes, seminars, training, etc. in no way constitutes or implies any endorsement of the provider of said programs. Provencher & Company shares no financial obligation to attendee or organizer.

Webinar Wednesday: Ten Things You Should Know About Social Media in Claims and Litigation

THIS WEEK WE RECOMMEND* THE FOLLOWING WEBINAR:

Ten Things You Should Know About 

Social Media in Claims and Litigation

The purpose of this webinar will be to introduce attendees to several things about the impact of social media on claims and litigation. We will cover where to look for social media information, how to look, ethical considerations, Federal Rules of Civil Procedure regarding social media, and spoliation. If you ever have concern that one of your claimants or plaintiffs is misrepresenting the nature and extent of their injuries, this webinar is for you.

Date: Wednesday, September 10, 2014

Time: 12:00 PM - 12:30 PM EDT

 

PRESENTED BY:

*This posting is for informational purposes only, as a courtesy to our reading audience. Provencher & Company has in no way been compensated for the sharing of this information. The use of or enrollment in any classes, seminars, training, etc. in no way constitutes or implies any endorsement of the provider of said programs. Provencher & Company shares no financial obligation to attendee or organizer.

Raiders of the Lost Profits - Part Three: Search for the Grail

He chose poorly…

Covered Cause of Loss vs. Actual Cause of Loss

Or better yet, Covered Cause of Loss vs. Actual Cause of Loss vs. Perceived Cause of Loss.  This is what our adjuster must help us decipher.  The ‘covered’ causes of loss possible for business interruption/loss of income can range from slightly different to radically different than for your property assignment. That said, the business interruption/loss of income coverage is not necessarily actuated by the ‘covered’ cause of loss.  So…documenting both the covered and actual cause of loss is essential during the property adjuster’s inspection:

• Take photos of ALL the physical damage – including that which is ‘not’ damaged and that which is ‘not’ covered property 
• Business Interruption coverage can be actuated by a ‘covered’ cause of loss to the business space even if the structure itself is not covered under the insured’s policy
• Conversely, if only BPP was damaged and there was no damage to the business space, coverage may be actuated only to the extent that of physical damage to BPP from a covered cause
• Get the contact information for the landlord, and/or a lease
• Note the use of the structure
• Note any power outage, whether it is on or off-premises and inquire if the cause of the outage is known at the time of inspection – get the name of the insured’s power supplier
• Note damage in the area.  Is damage widespread or confined to the insured’s specific area?  Was there a mandatory evacuation order in force during the interruption in business operation.  If so, inquire if a copy of the order is available
• Note the existence of any multiple entities
• For losses involving commercial or habitation rental properties, note units vacant at the time of the loss as well as any relocation activity for the tenants and make sure the unit designations reported as damaged match the insured’s unit reference
• ASK THE INSURED WHY THEY BELIEVE THE BUSINESS IS SHUT DOWN

Observation and documentation of the business activity at the time of your inspection and inquiry about the activity between the loss date and your inspection will go a long way in making the Business Interruption process easier for us at the Business Interruption office, as well as easier for our client and for the insured.

BI Unit Workflow -Interface with Prop Adjuster Part One

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Raiders of the Lost Profit series:

Introduction: Introduction to Inspection for BI

Part One: The Secrets of Daily Loss Inspection

Part Two: Adventures in CAT Inspections

Part Three: Search for the Grail:Covered Cause of Loss vs. Actual Cause of Loss

Part Four: Pit of Snakes:  Establishing Period of Restoration

Part Five: Reporting to HQ:  Here’s What We Know So Far

Written & Contributed by:

Kandy Ray

Funeral Processions and the Right-of-Way

Have you ever been in a funeral procession and run through a red light? Better be careful where you do so or the police may surprise you with a ticket. This article highlights this issue and provides a State-by-State analysis of these laws.

A funeral procession is a convoy of friends, relatives, and family members following the hearse from the funeral home to the burial site. Through the ages it has varied from people walking and carrying the deceased, to the modern entourage of limousines and automobiles. Most states have enacted statutes governing the procedures and traffic laws governing a procession as well as the legal requirements for yielding to one. Quite often, all vehicles in the funeral will be marked with a purple funeral flag issued by the funeral home. All drivers will be told to turn their headlights on. 

The hearse will be the first vehicle in the procession followed by the spouse, children, immediate family members, and friends. In most states the lead vehicle must observe all traffic lights, but when the lead car has proceeded through an intersection, the rest of the funeral train may proceed without stopping. The procession is often accompanied by law enforcement vehicles to ensure the safety of the procession when running a red light. Cars traveling in the opposite direction of a procession may yield out of respect, if they want, but in most states, they don’t have to yield, slow or stop at all. Clearly, this is a recipe for disaster.

Click here to see a complete listing of laws by state, and to read the rest of this article published by Claims Journal. 

Liability: Dissecting a Bodily Injury Evaluation

"General Liability investigations often hinge on key elements developed by the investigator. Any one of the facts you obtain will direct your determination of liability and damages. This article addresses the key elements to include in your investigation." 

Brian Single

Sr. Claim Examiner

Provencher & Company

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Dissecting a BI Evaluation
Determining liability is a critical element of the investigation

One of the most complex aspects of claims adjusting is that of bodily injury investigation. In this article, we are going to simplify the process and share key elements of the investigation that will ultimately drive outcomes.

Provided that coverage is in line, the immediate task at hand for new claims is to determine liability. It is important to remember that a claimant must prove both liability and damages in order for him to be legally entitled to compensation. 

Liability is crucial because comparative negligence is so often overlooked. When speaking with claims executives, they often lament the frequency at which claims are settled at either 0% or 100% with the occasional 50% sprinkled in for good measure. The reality is that roughly 3% of all claims are settled with a comparative negligence assessment. When compared to the more than 50% of all cases adjudicated by juries in which comparative negligence is assessed, a huge opportunity for organizational improvement emerges. Continue reading....

This article, in it's entirety, was originally published by Property Casualty 360  

Trial by Fire: Junk Science

As every adjuster knows, finding the cause of a fire can help pursue subrogation or aid in the criminal investigation of those deemed responsible. However, with a more thorough knowledge of the science behind fires, what most of us were taught has radically changed. The following story is an example of how old science convicted an innocent man and how the new science helped free him.

What remained of the Gavitt’s home after a fire on March 9, 1985

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For the 26 years David Lee Gavitt sat in a Michigan prison, he told everyone who would listen that he did not set the fire that killed his wife and two baby girls. Nearly 25 years would pass before some of the nation’s top fire experts would tell him they believed him.

“David’s case was the classic example of a bad arson case,” said John Lentini, a leading fire scientist who reviewed Gavitt’s case during the effort to get his conviction overturned. “People jumped to conclusions.”

Since Gavitt’s conviction in 1986, the field of fire investigation has been turned on its head. Scientists and investigators have discovered that features long considered signs of a fire intentionally set, in fact also occur during accidents. This has prompted the re-examination of arson convictions across the country that may have been based on bad science.

To read the story by NBC.com in its entirety, click here. 

Failure to File a Proof of Loss is Fatal

If you think a proof of loss is just a piece of paper that is required by insurance companies, think again.  As the following policy holder found out, failing to complete that proof of loss can have wide-reaching effects. 

Failure to File a Proof of Loss is Fatal, and the Defense Does Not Require a Showing of Prejudice

by Dick Bennett

On June 3, Connecticut’s intermediate level appellate court held that the failure of a policyholder to file a sworn statement in proof of loss was fatal to his claim.  Palkimas v. State Farm Fire & Casualty Co., 150 Conn.App. 655, 2014 Conn.App. LEXIS 244 (June 3, 2014) rejected the insured’s arguments that prejudice need be shown, holding that while the insurance company may well need to make a showing of prejudice in cases involving the belated submission of a proof, its burden to make such a showing never arises in cases in which the insured has never submitted such a document.

Richard Palkimas was insured under a homeowner’s policy issued by State Farm Fire & Casualty Company, and he sustained two losses.  The first occurred in September 2006, “when workers negligently used a toilet that had been blocked off resulting in a buildup of sewage, and the breaking and rupturing of a sanitary pipe, as well as the spreading of sewage and fecal matter throughout the home.”  Then in January of the following year, the policyholder discovered that “freezing temperatures caused substantial damage to [his] home, including fracturing of the plaster walls and building structure.”

The insured made claim for both events, and he hired a public adjuster to negotiate with State Farm on his behalf.  It was undisputed, however, that he never filed a sworn statement in proof of loss in connection with either claim.  The insurer ultimately denied coverage for both, contending that the policyholder’s failure to submit a proof meant that he had failed to satisfy a condition precedent to coverage under the contract of insurance. Read Entire Article

Raiders of the Lost Profits - Part Two: Introduction to Inspection for BI - Adventures in CAT Inspection

Introduction to Inspection for BI:

Adventures in CAT Inspection

The issues we deal with in every storm, with respect to Business Interruption, are Civil Authority, Off-Premises Power Outage and Spoilage, all of which sound innocuous but can get mired down in other issues such as wind vs. flood and covered cause of loss vs. actual cause of loss.

But it’s the storms with large scale devastation that sometimes finds us shouting, “CATs!  I hate CATs!”

Some of the additional issues we faced in both Katrina and Sandy were:

•Issues with insured type:  high profile attorney firms, CPA’s, plastic surgeons, bed & breakfasts, multi-location damage, multi-unit, multi-complex and multi-use habitation losses
•Other convoluting issues such as:  high profile agents, public adjusters, total loss of financial documentation
•Issues resulting from lack of communication with insured to manage expectations with respect to: Covered Cause of Loss, Period of Restoration, Extra Expense, Time Deductibles, and Coinsurance
•And finally, issues resulting from inadequate inspection and reporting

Yes, there are a lot of reasons to hate CATs, but BI doesn’t have to be one of them!!  And that begins with inspection of the loss.  Slightly different than inspection for daily claims, inspection for BI after a catastrophe is simultaneously focused on both physical and non-physical damage, actual causes of what might be multiple factors that shut down (either fully or partially) a business and what actuates coverage.

To help you complete your mission and move on to other important missions, we have developed a simple worksheet that can provide the basis for your reporting on Business Interruption and a tool we at the Business Interruption office can use to pick up the claim complete our part of the claim mission.

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Business Interruption Checklist: CAT Inspection

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Raiders of the Lost Profit series:

Introduction: Introduction to Inspection for BI

Part One: The Secrets of Daily Loss Inspection

Part Two: Adventures in CAT Inspections

Part Three: Search for the Grail:Covered Cause of Loss vs. Actual Cause of Loss

Part Four: Pit of Snakes:  Establishing Period of Restoration

Part Five: Reporting to HQ:  Here’s What We Know So Far

Written & Contributed by:

Kandy Ray

Leading-edge "Certificates of Insurance Bill" signed in Connecticut

It's a start. Certificates of Insurance are one of the most misleading documents in the insurance industry. As the attached article reflects, some states are addressing these pesky items and enforcing change. I hope that the trend catches on!

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Connecticut Gov. Dannel P. Malloy recently signed into law H.B.5248 that prohibits the inappropriate use and issuance of certificates of insurance.

The Professional Insurance Agents of Connecticut Inc., an industry association which has been an active supporter of H.B.5248, applauded the bill’s signing. The association said insurance producers in Connecticut have often been pressed by third parties to issue certificates of insurance that seem to expand or amend the policy or make representations about the policy’s fitness for specific contracts, or issue non-certificate advisory documents attempting to make similar statements.......

The article goes on to say: “PIACT applauds Gov. Malloy for his leadership in recognizing the importance of this law,” said Professional Insurance Agents of Connecticut President Peter Frascarelli. “It allows diligent and responsible professional, independent insurance agents to refuse to issue inaccurate certificates of insurance without being put in an awkward position in which they may be perceived as not helping out their clients.” 

To read the article by Insurance Journal in its entirety and to learn more about this trailblazing bill, click here. 

Contributed by:

Brian Single

Sr. Claim Examiner