PLRB on Demand: Recent Episodes
PLRB
A plumber was hired to perform work on a pipe on an insured home. In the course of that work, the plumber accidentally smashed his wrench into the pipe, damaging it. The water damaged nearby drywall and carpet.
Notable Timestamps
[ 00:44 ] - The j(5) exclusion specifically applies to property damage on that particular part of real property where operations are directly being performed.
[ 01:14 ] - In contrast to the j(5) exclusion, the j(6) exclusion applies to any property that requires restoration, repair, or replacement because the work was performed incorrectly.
[ 02:44 ] - If a plumber accidentally breaks a pipe while working on it, fixing the pipe is probably excluded, but resulting damage to nearby drywall and carpet may be covered.
[ 04:32 ] - General liability insurance typically isn't meant to cover general carelessness.
[ 08:29 ] - Courts interpreting exclusions broadly might deny coverage, reasoning that the particular part being worked on encompasses the entire project or property.
[ 10:50 ] - When courts interpret exclusions narrowly, they restrict the exclusion to just the defective part being worked on, which can result in broader insurance coverage.
[ 13:49 ] - For a botched oil change causing engine failure, a narrow interpretation excludes only the oil and filter, while a broad view excludes the whole engine.
[ 15:07 ] - Defective workmanship that results in damage to other property, or to work that is not the insured's own product, can be considered a covered occurrence.
Your PLRB Resources
Adjuster Resource Sheet: Faulty Work https://members.plrb.org/documents/adjuster-resource-sheet-faulty-work
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
A general contractor installs a commercial storefront window system. Because the flashing is installed incorrectly, rainwater enters the building during the first storm. The building owner sues the contractor, seeking the cost to remove and replace the defective window system and repair the water-damaged drywall and flooring inside. The contractor tenders the suit to its CGL insurer.
Notable Timestamps
[ 00:00:34 ] - A contractor faces a lawsuit after incorrectly installing window flashing that leads to water damage inside a building.
[ 00:04:48 ] - A central issue in these claims is determining if an insurance company actually owes defense and indemnity when a contractor's work causes property damage.
[ 00:06:26 ] - Commercial liability insurance is designed to cover unpredictable accidents and occurrences rather than serving as a guarantee for a contractor's faulty work.
[ 00:08:53 ] - Under the majority legal view, such as in Alabama, faulty workmanship does not qualify as an occurrence because the work was done purposefully without fortuity.
[ 00:10:00 ] - A growing minority view, seen in states like Pennsylvania and Colorado, broadly interprets these incidents as accidents unless the contractor intended the damage.
[ 00:10:55 ] - Even if a situation qualifies as an occurrence under a state's laws, insurers may still rely on specific policy exclusions, like j(5) and j(6), to limit coverage.
[ 00:11:26 ] - While the majority view denies indemnity for faulty workmanship itself, defective work that damages other property can still be classified as an occurrence.
Your PLRB Resources
Adjuster Resource Sheet: Faulty Work https://members.plrb.org/documents/adjuster-resource-sheet-faulty-work
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 scenario@plrb.org.
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).
Emma's cousin Mark moved to the big city and left his horse at Emma's ranch. For five years, she took care of the horse like it was one of her own. One day Mark took offense at one of Emma's social media posts, and quietly removed the horse without her knowledge, believing he was the rightful owner. Emma was devastated and sued Mark, alleging emotional distress, mental pain and suffering, and loss of consortium. Mark's insurer denied his defense on the basis that no bodily injury was claimed.
Notable Timestamps
[ 00:00:33 ] - The scenario involves a woman who sued her cousin for emotional distress and mental suffering after he quietly removed his horse from her ranch.
[ 00:04:37 ] - At this stage of litigation, the focus is not on whether the cousin owes damages, but strictly whether his insurance owes him a legal defense.
[ 00:07:29 ] - The plaintiff's complaint relies entirely on emotional damages like loss of consortium and mental pain, notably lacking standard liability allegations like property damage.
[ 00:08:57 ] - The defining legal question is whether pure mental pain and emotional distress can satisfy the standard insurance definition of a bodily injury, sickness, or disease.
[ 00:12:11 ] - In jurisdictions following the majority rule, such as Ohio, courts have established that pure emotional distress or PTSD without physical harm does not equal bodily injury.
[ 00:15:56 ] - Alternatively, courts in minority rule states like New York view emotional trauma as potentially equal to physical injury because they find standard policy language ambiguous.
[ 00:18:28 ] - To satisfy the bodily injury requirement in a majority state, the plaintiff must usually demonstrate physical manifestations of their distress, such as headaches or nausea.
[ 00:23:14 ] - Insurance professionals can utilize PLRB.org's 50-State Surveys on emotional distress as a convenient tool to quickly check the controlling case law and rules within specific states.
Your PLRB Resources
50-State Survey - Emotional Distress as Bodily Injury https://members.plrb.org/documents/50-state-survey-introduction-emotional-distress-as-bodily-injury
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 scenario@plrb.org.
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).
The insured has spent months in an escalating dispute with his neighbor over the neighbor's alleged violation of HOA rules and garish lawn decorations. Finally, the insured takes things too far by aiming his sprinkler at the neighbor's newly painted shed, ruining an expensive paint job. The insured has been sued, and wants their insurance company to defend them in the lawsuit.
Notable Timestamps
[ 00:00:32 ] - This scenario involves an insured causing damage by ruining a neighbor's painted shed with a sprinkler, and expecting a defense.
[ 00:01:17 ] - The PLRB's Frontlines newsletter is a valuable resource for staying updated on recent case law regarding property, auto, and liability insurance.
[ 00:05:29 ] - An insurance company's duty to defend is crucial because fighting even a completely invalid lawsuit still requires spending money on legal fees.
[ 00:07:32 ] - Courts have ruled that erecting a malicious spite fence is a deliberate action, meaning it is not an accidental occurrence covered by insurance.
[ 00:13:01 ] - Bizarre accidents, like special low-efficiency windows melting a neighbor's vinyl siding by focusing sunlight, can potentially be covered occurrences.
[ 00:16:53 ] - Determining whether mistaken actions count as occurrences depends heavily on specific state jurisdictions.
[ 00:20:19 ] - If an individual intentionally punches someone, there is usually no occurrence, regardless of whether they intended to cause a severe injury like a broken jaw.
[ 00:24:03 ] - Liability insurance only covers fortuitous losses, so if a primary action isn't an occurrence, exclusions for intentional acts do not require analysis.
Your PLRB Resources
HO651 - Occurrence Definition https://members.plrb.org/documents/ho651-occurrence-definition
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 scenario@plrb.org.
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).
During a recreational adult hockey league practice, the goalie skated backward into the crease after a drill and grabbed the top crossbar of the net while stretching and joking with other players. The ice had recently been resurfaced, and the net had not yet been properly secured to the ice. As the goalie leaned his body weight onto the frame, the goal tipped backward and struck him. In a negligence claim between the goalie and the arena, which team takes the blame?
Notable Timestamps
[ 01:03 ] - Establishing negligence requires meeting four elements, which include having a duty owed, a breach of that duty, a proximately caused injury, and damages.
[ 02:20 ] - Even when negligence is successfully established during litigation, there are still potential defenses available, such as assumption of risk and contributory negligence.
[ 04:50 ] - The assumption of risk doctrine might still apply even if a player is violating a rule during a game, as participants generally expect potential injury during physical activities.
[ 07:11 ] - Some states utilize contributory negligence, which can technically bar a plaintiff from any recovery if they are found to have contributed at all to the incident.
[ 11:03 ] - Comparative negligence rules vary, with some states allowing recovery if a person is up to 50% liable, while others require the individual's negligence to be 49% or less.
[ 11:51 ] - Under a pure comparative standard, an injured person who is found to be 90% at fault for an incident can still recover the remaining 10% of their respective damages.
[ 14:34 ] - In cases involving severe injuries, juries can sometimes be influenced to make decisions inconsistent with the letter of the law.
[ 16:29 ] - The outcomes of these negligence defenses heavily depend on the specific state where the case is taking place, the laws that apply, and the overall makeup of the jury pool.
Your PLRB Resources
Negotiation Strategies in Bodily Injury Claims https://members.plrb.org/education/courses/negotiation-strategies-in-bodily-injury-claims
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 scenario@plrb.org.
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).
As we hit our next holiday week and listen to the sounds of fireworks, we'd like to share a classic episode featuring the insurance implications of fireworks. So fire up the grill, and put this episode on the speakers.
Is there an exclusion for stupid? Join Alissha, Mike, and Tim to discuss bad decisions, wedding rings stuck on fingers, dumpster fires, and whether the choice to set off a firework inside a house is considered "intentional" under the policy.
Notable Timestamps
[ 00:17 ] - The insured's son set off a firework in the house for the excitement, causing fire damage. The homeowners file a property claim.
[ 01:26 ] - Alissha, Mike, and Tim discuss their opinions on fireworks, sneaking over the state line, exploding toys, dog ownership, and dumpster fires.
[ 04:12 ] - There's no exclusion for "stupid" (i.e. negligence), at least not prior to the loss.
[ 07:34 ] - There is an exclusion for intentional loss. "Intent" usually applies both when the actor intends the consequence, and when they know the consequences are substantially certain to result.
[ 08:46 ] - The fact that the son was intoxicated would not establish an insanity defense.
[ 10:36 ] - The son was living in the house, even though he spent much of the year at college, and would be considered an insured so no subrogation is possible.
[ 11:50 ] - For very young children, their young age can imply that they are not appreciating the consequences of their actions and that can speak to intent.
[ 13:04 ] - The team discusses scenarios where an adult intentionally set a fire so that her husband could heroically put it out, where someone breaks a ring to get it off their swelling finger, and where someone smashes a window to break into their own house.
[ 17:24 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Homeowners annotation on the intentional loss exclusion - https://search.plrb.org/?dn=37&src=gsa
Does a Farm Policy Cover Injury to a Semi Driver Caused by Water Balloons Tossed from Insured's Vehicle? - https://search.plrb.org/?dn=17362&src=gsa
Cutting Off Ring That is Stuck On Swollen Finger… Intentional Loss? - https://search.plrb.org/?dn=67944&src=gsa
Is Damage to Property of Others Coverage Available Under a Homeowners Policy for a Window Broken by the Insured Tenant's Son at a Rental Property? - https://search.plrb.org/?dn=73010&src=gsa
CE course on Intentional Versus Negligent Conduct For Casualty Adjusters - https://www.plrb.org/public2/dislearn/description.cfm?mod=p0056
CE course on Subrogation Claims - https://www.plrb.org/public2/dislearn/description.cfm?mod=p0050
Webinar on Fire Loss Investigation Strategies - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0024
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://thenounproject.com/icon/firework-152487/
https://thenounproject.com/icon/firework-1758560/
As a claims executive leader, Awais Farooq built and oversaw coverage frameworks, liability investigations, reserve governance, and total loss protocols. He believed that institutional fluency would make his own claim predictable. Then he struck a deer on his motorcycle and suffered a significant leg injury. His claim was segmented across bodily injury, property damage, and total loss. Each function operated correctly. Yet without a single point of ownership, the experience felt operationally sound but emotionally fragmented.
Notable Timestamps
[ 00:37 ] - Awais Farooq experienced a motorcycle accident that resulted in a claim that was handled with operational soundness but felt entirely emotionally fragmented.
[ 04:29 ] - The accident occurred close to home when Awais encountered a deer on the road, attempted to turn around to avoid it, but unfortunately crashed into another deer.
[ 06:24 ] - Despite the insurance company being highly digitally advanced with text message communications, Awais had to navigate three separate adjusters who did not communicate with one another.
[ 08:01 ] - A major gap exists in the insurance industry where automation and process improvements often overlook the end consumer, losing track of the primary goal to restore the person completely.
[ 12:52 ] - Awais channeled his frustrations into writing a book titled The Future Isn't Fully Automated, which explores how technology must integrate with essential human connection in claims.
[ 13:39 ] - The claims journey consists of information gathering, documentation, and decisioning; streamlining the first two phases can empower adjusters to focus primarily on delivering decisions.
[ 15:00 ] - Awais discusses the possibility of an individualized user experience akin to Amazon, ensuring that claimants have a single point of contact rather than feeling like one of millions of claims.
[ 17:00 ] - A technically compliant claim can still fail the human experience test.
Your PLRB Resources
https://www.linkedin.com/in/awais-farooq/
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 scenario@plrb.org.
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).
Right now we're traveling back from this week's successful Eastern Regional Conference. So this week, as we head into summer, we're sharing an episode on how to take advantage of all the services that the PLRB Weather/CATs department has to offer.
A supervisor leads a team of very needy CAT adjusters! Over the course of the year, the supervisor fields many questions as it comes up in their claims. Was there hail on X date? Was there lightning in the area? This hurricane is coming soon, where can I get news about it? Winter weather caused a slip and fall!! Where can I find information on wildfire perimeters and California evacuations? For help herding all these cats, we'll head to PLRB.org. Notable Timestamps
[ 00:00 ] - The episode introduces a scenario where a supervisor fields constant weather-related questions from cat adjusters, highlighting the need for a centralized, reliable source for hail, lightning, hurricanes, wildfires, and more.
[ 02:15 ] - The team previews multiple scenarios—winter storms, hail, lightning, power outages, tornadoes, hurricanes, and wildfires—showing the breadth of searchable weather data available to support claim investigations.
[ 03:16 ] - Using a winter slip-and-fall in Iowa City, Iowa, the report pulls verified storm data from the National Weather Service, including freezing rain reports and hourly observations to validate conditions on the date of loss.
[ 07:42 ] - For hail damage in Illinois, radar-derived data and verified hail reports allow adjusters to map proximity, estimated hail size, and associated severe thunderstorm warnings tied to a specific date and address.
[ 09:53 ] - Lightning reports provide daily probability percentages and satellite detection data, helping assess commercial equipment claims while noting limits in resolution and cloud-to-cloud versus cloud-to-ground distinctions.
[ 12:25 ] - Power outage searches archive data every ten minutes via PowerOutage.us, identifying outage timing, affected customers, and likely storm causes—critical for business interruption investigations.
[ 14:09 ] - A tornado case study of the Mayfield event demonstrates wind reports, damage points, and EF-scale path polygons, enabling precise analysis of storm track and intensity relative to a property.
[ 17:31 ] - Wildfire tools include historical perimeters like the Garnett Fire, evacuation zones, thermal hotspots, smoke analysis from National Oceanic and Atmospheric Administration data, and hurricane spaghetti models—underscoring a single portal for comprehensive weather intelligence.
[ 17:49 ] - Dylan summarized upcoming PLRB Weather/CATs developments.
Your PLRB Resources
Weather/CATS Hub - https://members.plrb.org/weather-cat/
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 scenario@plrb.org.
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).
We're calling "foul ball!" A spectator at a local minor league baseball game was injured when a foul ball zipped through a tear in the safety net and broke his arm. The spectator claims that the stadium owed him a safe environment, that it knew about the tear and didn't fix it, and that the mascot wasn't even that funny. To score, our litigant is going to have to run all four bases of the core elements of negligence: duty, breach, causation, and damages.
Notable Timestamps
[ 00:00 ] - A foul ball injury at a minor league game sets the stage for a negligence analysis, focusing on whether the stadium failed to maintain a safe environment after allegedly knowing about a damaged safety net.
[ 05:02 ] - The first element of negligence is duty. A stadium generally owes spectators a duty of reasonable care, especially when protective measures such as safety netting are installed for fan protection.
[ 05:40 ] - The second element is breach. If stadium personnel knew about a tear in the net and failed to repair it, that omission may constitute a breach of the duty owed to spectators.
[ 08:56 ] - Causation requires a direct connection between the breach and the injury. The claimant must show the foul ball passed through the known defect and that the injury was a foreseeable result.
[ 10:14 ] - A claimant's own actions can affect the analysis. Attempts to catch a foul ball, distraction, or impairment could introduce comparative or contributory negligence issues depending on state law.
[ 11:24 ] - Damages are essential to a negligence claim. Even if a duty existed and was breached, recovery is unlikely without a measurable injury, financial loss, or other legally recognized harm.
[ 12:11 ] - A personal auto accident example illustrates that negligence claims can fail despite a breach of duty when no injury or property damage occurs. Reaching only part of the negligence analysis is not enough.
[ 13:15 ] - The discussion highlights how emotional distress claims can complicate matters. Jurisdictions differ on whether symptoms without clear bodily injury satisfy policy language or legal damage requirements.
[ 14:43 ] - Not every liability case follows ordinary negligence rules. Certain ultra-hazardous activities or situations involving strict liability may shift the focus away from proving the traditional four negligence elements.
[ 16:21 ] - The key lesson is that successful negligence claims require all four elements: duty, breach, causation, and damages. Missing any one element can prevent recovery, regardless of the strength of the others.
Your PLRB Resources
Introduction to Negligence Concepts https://members.plrb.org/education/courses/introduction-to-negligence-concepts
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 scenario@plrb.org.
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).
A cat jumps on the stove to get leftovers, accidentally turns a burner, and starts a kitchen fire. The homeowner has heard of an exclusion that applies to damage caused by animals owned or kept by an insured, and is concerned that the fire will not be covered. Exactly how mad should the homeowner be with their cat? (And how long can they stay mad at that face?)
Notable Timestamps
[ 00:00 ] - A kitchen fire caused by a pet can initially alarm insureds who may believe the animal exclusion automatically bars coverage for any damage involving their cat or dog.
[ 00:53 ] - The discussion highlights how insureds may hesitate to disclose that a pet caused the loss because they fear the claim will be denied under the policy language.
[ 03:39 ] - Investigating unusual fire losses often requires origin-and-cause experts, especially when evidence suggests a stove burner was turned on without any appliance malfunction.
[ 05:07 ] - The key distinction is that animal-caused property damage itself may be excluded, while the resulting fire can still qualify as a covered peril under the policy.
[ 05:50 ] - Claims involving uncommon exclusions remind adjusters to carefully read the actual policy wording instead of relying on assumptions about what is or is not covered.
[ 06:12 ] - Ordinary pet damage like chewing, scratching, or staining is different from a sudden accidental event such as a kitchen fire.
[ 07:24 ] - Adjusters generally approach claims by looking for coverage where it exists.
[ 08:45 ] - Animal exclusions are often intended to address ongoing maintenance-type damage rather than fortuitous accidental losses.
[ 10:10 ] - While some courts have interpreted animal exclusions broadly, the cited cases involved extreme situations with dozens of pets causing extensive property damage.
[ 11:54 ] - Maintaining good communication and rapport with insureds can help overcome misconceptions about coverage and encourage honest discussion during the investigation.
Your PLRB Resources
Birds, Vermin, Rodents, or Insects; Animals Owned or Kept (HO133) https://members.plrb.org/documents/birds-vermin-rodents-or-insects-animals-owned-or-kept-ho133
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 scenario@plrb.org.
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).
Wildfire claims are emotional, public, and inconsistent across carriers, so adjusters often become the face of "no." Using a real fire example, we'll explore empathy, advance payments, uneven guidance, social media comparisons, and follow-through as tools to protect our reputation.
Notable Timestamps
[ 00:09 ] - Wildfire claims can be highly emotional and public, and adjusters often become the visible representative of difficult coverage decisions.
[ 01:28 ] - PLRB recognizes Outstanding Claims Professionals not only for technical skill, but also for restoring lives and setting standards in customer service.
[ 03:03 ] - Social media, neighborhood groups, and AI tools now shape insured expectations, creating more questions and adding complexity for adjusters.
[ 05:16 ] - Policyholders often see claim differences as inconsistency where it may simply represent variation in policies, property details, and carrier practices.
[ 06:54 ] - Adjusters build trust by explaining policies in everyday language instead of relying on technical wording or policy jargon.
[ 09:29 ] - Starting conversations with what can be done, rather than limitations, helps reduce tension and discourages adversarial reactions.
[ 10:28 ] - Advance payments and early support for housing and immediate needs can ease stress and strengthen the insured-adjuster relationship.
[ 14:58 ] - Consistent communication matters; policyholders often prefer hearing "I don't have an answer yet" over silence or missed follow-ups.
[ 16:48 ] - Listening for recurring concerns allows adjusters to anticipate needs, act proactively, and create more confidence in the claims process.
Your PLRB Resources
CE Course: Investigating and Resolving Different Types of Wildfire Losses https://members.plrb.org/education/courses/investigating-and-resolving-different-types-of-wildfire-losses
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 scenario@plrb.org.
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).
[REPLAY] This week, check out a podcast featured in PLRB's new PACE Program:
"The new PLRB Advanced Coverage Education (PACE) designation is more than a credential. It's a powerful way to strengthen your claims expertise.
PACE begins with a Core Curriculum that builds a foundation in insurance basics and the claims process. From there, professionals can grow through Business LineTracks that support field-specific development, and Claims Intensives that dive deeper into essential topics like fraud and ethics.
Developed with PLRB's long‑standing commitment to high‑quality education, PACE helps claims professionals work with greater clarity, consistency, and confidence. And because certification courses are included in PLRB Membership, with discounted designation fees, it's a valuable investment in both employee development and organizational success.
PACE supports professionals at every stage of their careers and helps teams work more confidently and efficiently."
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 scenario@plrb.org.
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).
The roof of a 100-year-old farmhouse suddenly collapses under the weight of water. The building was insured under a farm policy that, in this case, only provided coverage for personal property and not the dwelling or real property. The insured claims that the carpet, water heater, and even ceiling tiles are all personal property, and therefore covered! What is a fixture?
Notable Timestamps
[ 00:00 ] - The episode explores how fixture disputes affect insurance coverage, using a collapsed farmhouse roof scenario where coverage depended on whether damaged items qualified as personal property or part of the dwelling.
[ 01:18 ] - The hosts announce the launch of the PACE Program, highlighting it as a new educational resource now available for insurance professionals looking to expand their industry knowledge.
[ 03:00 ] - Whether something is a fixture can impact both available coverage and policy limits.
[ 06:24 ] - Built-in shelving and ceiling fans are discussed as likely fixtures because they are permanently attached, difficult to move, and generally intended to remain with the property over time.
[ 08:06 ] - Portable appliances like air fryers and mini fridges are contrasted with fixtures because owners clearly intend to take them when moving, making them easier to classify as personal property.
[ 09:51 ] - Wall-to-wall carpeting illustrates the gray areas in fixture analysis, as courts may examine attachment methods, customization, and whether the carpet could realistically be removed and reused elsewhere.
[ 12:22 ] - Furnaces and water heaters seem like obvious fixtures, yet disputes can still arise when tenants claim ownership and argue they intended to remove the equipment when leaving the property.
[ 16:52 ] - Decorative ceiling tiles from a 100-year-old farmhouse became the focus of a court case, where the court ultimately ruled they were fixtures because they enhanced the property and were intended to stay with the home.
[ 21:31 ] - The closing takeaways emphasize that courts analyze factors like physical attachment, ease of removal, and the parties' intent when determining whether property qualifies as a fixture under insurance policies.
Your PLRB Resources
Check out the PACE Program! https://www.plrb.org/pace-program/
Dwelling - Coverage A (HO11)
https://members.plrb.org/documents/dwelling-ho11#toc26
Pierce v. State Farm Fire & Cas. Co. (2020)
https://members.plrb.org/documents/pierce-v-state-farm-fire-cas-co-2020
Tenant Improvements & Betterments in Commercial Cases
https://members.plrb.org/education/courses/tenant-improvements-amp-betterments-in-commercial-cases
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 scenario@plrb.org.
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).
A foot of stormwater in your home, and a contractor saying "Let's dry it in place?" That was the scenario explored in Courtney Makris' PLRB Presents talk "When the Storm Hits Home: Courtney's Personal Journey through Hurricane Helene," and today Mike & Brennan will look at that scenario through the lens of the Categories & Classes of water, with the help of a PACE Program exercise.
Notable Timestamps
[ 00:06 ] - The episode introduces a real-world water loss scenario tied to a major storm, highlighting how widespread damage and contractor recommendations can complicate mitigation decisions for adjusters.
[ 01:05 ] - The discussion draws from a hurricane case study and shifts focus to how water "categories" and "classes" relate to the standards guiding mitigation decisions.
[ 04:24 ] - Water losses are a major focus in claims education, covering issues like pipe breaks, backups vs. overflows, and wind-driven rain—showing how varied and complex water damage scenarios can be.
[ 05:11 ] - Not all water is equal; category classifications depend on contamination levels, meaning the source and exposure history of water directly impact risk and required remediation.
[ 06:02 ] - Category 1 water can be clean and sanitary, Category 2 introduces contaminants that may cause illness, and Category 3 can be highly hazardous, often containing toxic or pathogenic substances.
[ 07:25 ] - Practical examples like dishwasher discharge illustrate how the same appliance can produce different water categories depending on whether the source is incoming clean water or outgoing waste.
[ 10:36 ] - Even seemingly clean sources like rainwater can shift categories based on contact with materials or time sitting stagnant, emphasizing that context and exposure matter.
[ 12:20 ] - Floodwater is nearly always Category 3 due to contamination from ground contact and stagnation, making it especially dangerous despite common public perceptions.
[ 14:46 ] - Water "class" differs from category by focusing on how much water is present, how deeply it's absorbed, and how difficult it is to dry.
[ 19:01 ] - Mitigation strategies vary widely: clean water may allow simple drying, while contaminated water often requires removal of materials like drywall and insulation.
Your PLRB Resources
Check out the PACE Program! https://www.plrb.org/pace-program/
When the Storm Hits Home: Courtney's Personal Journey through Hurricane Helene https://youtu.be/2VE7i_0KAKc
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 scenario@plrb.org.
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).
A fire broke out in the insured's basement, where various household and personal items were stored. The insured husband is a recreational pilot. His wife is an accountant. Their two children and dog also live in the home with them. The fire caused heavy smoke and heat damage throughout the basement and adjoining utility room. The insured provided a personal property inventory form listing everything believed to be damaged or destroyed. What falls under Property Not Covered? In this preview of the PACE program's personal lines course, we'll explore the basics of the different roles in the insurance industry.
Notable Timestamps
[ 00:07 ] - The scenario introduces a basement fire damaging stored personal property, setting up a practical lens for analyzing what items may or may not be covered under a homeowners policy.
[ 03:10 ] - The PACE program is designed to guide learners through the full claims lifecycle, from coverage analysis to investigation and resolution, providing both foundational and advanced insights.
[ 06:15 ] - Understanding home construction elements like plumbing, roofing, and wiring can directly impact coverage analysis, as these features often influence cause, scope, and policy interpretation.
[ 07:20 ] - A key distinction: exclusions focus on why damage occurred, while Property Not Covered provisions focus on what was damaged.
[ 08:05 ] - Policies may list numerous categories of Property Not Covered, including animals, motor vehicles, aircraft parts, and certain business or digital assets.
[ 10:45 ] - Personal property inventories are critical documents in claims handling, requiring adjusters to evaluate each listed item against policy language and applicable coverage limitations.
[ 13:40 ] - Some items, like pet-related supplies, may be covered even when the pet itself is not, highlighting the importance of distinguishing between living property and associated goods.
[ 17:30 ] - Virtual currency presents valuation and verification challenges, which is why it is typically listed under Property Not Covered and may require specialized coverage or endorsements.
[ 19:45 ] - Property Not Covered likely applies to aircraft parts regardless of how they are intended to be used.
[ 21:10 ] - Generally speaking, ambiguities favor the insured, but ambiguity only occurs when terms are reasonably open to multiple meanings.
Your PLRB Resources
Sign Up for Updates on the Designation Program! https://2it6qrau8fd.typeform.com/pacedesignation
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 scenario@plrb.org.
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).
A major storm hits the city. Sarah's bakery suffers roof damage, water leakage, and equipment loss. Sarah has heard lots of insurance job titles thrown around: policyholder, agent, broker, adjuster, underwriter, actuary-- who are all these people? In this preview of the PACE program's core on-boarding course, we'll explore the basics of the different roles in the insurance industry.
Notable Timestamps
[ 00:00 ] - The episode opens with a storm-damage scenario at Sara's bakery, setting up a practical lens for understanding insurance roles and how multiple professionals intersect during a single claim event.
[ 00:59 ] - The lighthearted "Dec Page" segment underscores how real-world disruptions—like severe Midwest storms affecting travel—mirror the unpredictability that drives many insurance claims.
[ 04:42 ] - The PACE program is practical and scenario-driven, aiming to demystify industry jargon and help both newcomers and experienced professionals apply concepts across claims and underwriting contexts.
[ 06:25 ] - The "insurer" is the insurance company, while the "insured" is the policyholder.
[ 08:02 ] - Insurance roles are tied to broader processes, including application, underwriting, claims handling, and premium rating, reinforcing that each role fits into a larger operational lifecycle.
[ 10:11 ] - Agents typically represent the insurer (sometimes as captive or independent), while brokers represent the policyholder, helping match complex risks with appropriate carriers.
[ 12:13 ] - Agents and brokers often remain involved beyond policy purchase, serving as trusted first contacts when a loss occurs and guiding policyholders through the claims process.
[ 14:08 ] - Adjusters and claims professionals evaluate damage, determine coverage, and help restore policyholders, while TPAs and independent adjusters may be hired to handle claims on behalf of insurers.
[ 16:46 ] - Because titles vary widely, professionals are encouraged to clearly introduce their role to policyholders, improving understanding and trust during what can be a confusing claims experience.
[ 18:15 ] - Final takeaways reinforce core distinctions (insurer vs. insured), note that definitions may vary by policy, and highlight the importance of understanding agents, brokers, adjusters, and TPAs.
Your PLRB Resources
Sign Up for Updates on the Designation Program! https://2it6qrau8fd.typeform.com/pacedesignation
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 scenario@plrb.org.
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).
A claims supervisor with plenty of adjusting experience is looking to open doors to new opportunities with a credential that will signal their advanced claims knowledge. They're also responsible for onboarding some new adjusters who are brand new to the field of insurance, and need to get ready to handle claims. As PLRB members, they'll have access to the PACE Designation Program, which can equip participants with the skills and confidence needed to excel in key areas of claims handling.
Notable Timestamps
[ 02:07 ] - Introducing a fun new segment called "The Dec Page," our hosts reflect on the 2026 PLRB Claims Conference, highlighting the value of in-person learning, networking, and shared industry enthusiasm in a conference setting.
[ 04:18 ] - The PACE Designation Program has been announced! This structured educational initiative is designed to help participants better understand insurance concepts through a guided and engaging learning experience.
[ 05:09 ] - The PACE Designation Program starts with a Core, building foundational claims and coverage understanding to empower learners to advance to more complex topics. The Personal Lines Track then dives deep into residential and Homeowners losses.
[ 07:46 ] - "Claims intensives" offer flexibility within the program, allowing learners to tailor their path based on interests and career goals.
[ 11:54 ] - The program was developed using member feedback, addressing a clear need for training both new entrants unfamiliar with insurance and experienced professionals seeking deeper expertise.
[ 12:47 ] - The PACE Designation Program covers both foundational claims concepts and material specific to each line of business (starting with Personal Lines).
[ 13:05 ] - Advanced content explores nuanced coverage issues, including policy interpretation and legal influences, reflecting the complexity and depth of real-world claims decision-making.
[ 13:50 ] - The program extends beyond technical skills to include ethics, fraud awareness, and people skills, reinforcing the well-rounded competencies needed in modern claims roles.
[ 14:58 ] - Future expansions aim to include additional lines like casualty and auto, along with commercial coverage, positioning the program as a comprehensive, multi-discipline education track.
Your PLRB Resources
Sign Up to Learn More! https://2it6qrau8fd.typeform.com/pacedesignation
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 scenario@plrb.org.
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).
For our 100th episode, we'd like to share these clips from three exemplary episodes: one each from a property, casualty, and auto example.
My Son Set Off Fireworks in My House
Is there an exclusion for stupid? Join Alissha, Mike, and Tim to discuss bad decisions, wedding rings stuck on fingers, dumpster fires, and whether the choice to set off a firework inside a house is considered "intentional" under the policy.
Game Show Time! What Kind of Vehicle Is It?
Anytime something with wheels leads to a claim, Parker's colleagues come to Parker to find out whether the claim should fall under the CGL policy or the auto policy… or a secret third option.
Your Insurance Policy Will Decide When You're Done Ridesharing
A "FastFeast" driver ends their shift but forgets to log out of the app. On the way home, they crash—and their insurance denies the claim. Why? They were still "on the job." In the gig economy, one tap can mean the difference between coverage and denial.
We're taking a break this week after another successful PLRB Claims Conference. As we gear up for this podcast's 100th episode next week, we'd like to re-share the very first episode.
Alissha, Tim, and Mike introduce a complete rebranding of PLRB's podcast as "What's the Scenario? with PLRB", starting with a mini-scenario on a bear attack.
Notable Timestamps
[ 00:16 ] - A family went camping, only for their personal property to be destroyed by a bear.
[ 01:41 ] - The team introduces themselves. Alissha Watley is Senior Meetings Manager at PLRB responsible for some of PLRB's annual conferences. Tim Havlir is Property Coverage Counsel at PLRB with years of experience answering coverage questions. Mike Brode is Vice President of Educational and Technical Services at PLRB managing PLRB's educational offerings, both live and online.
[ 02:36 ] - This podcast is intended for insurance industry professionals who need quick-hit trainings on coverage issues that answer interesting insurance questions relevant to their daily work. These 20-minute episodes will provide clear explanations of complex coverage problems, answers to burning questions from real adjusters, and analysis of the latest trends, all grounded in true-to-life scenarios that authentically capture the insurance professional's experience.
[ 03:10 ] - Topics to be covered include terrorism, pandemics, fireworks, NFTs, aggressive contractors, phone scams, matching, vacation rentals, and more.
[ 05:00 ] - Back to the bear attack, the property would be considered covered property; it doesn't matter that it's off-premises.
[ 06:13 ] - In this named policy, vandalism requires a mental state of intent which the bear did not have. The same issue applies to other perils such as theft and malicious mischief.
[ 08:30 ] - There is no named peril for damage by animals.
Your PLRB Resources
Homeowners Annotation on Theft - https://search.plrb.org/?dn=135&src=gsa
Homeowners Annotation on Vandalism - https://search.plrb.org/?dn=150&src=gsa
Coverage Question "Raccoon Cannot Cause Malicious Mischief or Vandalism" - https://search.plrb.org/?dn=26392&src=gsa
Coverage Question "Birds Cannot Commit Theft" - https://search.plrb.org/?dn=25272&src=gsa
Coverage Question "Vandalism and Malicious Mischief Involving Cows" - https://search.plrb.org/?dn=85933&src=gsa
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org with your story.
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).
https://thenounproject.com/icon/bear-4387678/
https://fontawesome.com/icons/tent?f=classic&s=solid
https://thenounproject.com/icon/steak-766620/
https://thenounproject.com/icon/grill-5779567/
Right now we're gearing up for next week's PLRB Claims Conference. So this week, we're sharing a recent episode discussing how to make the most of the PLRB Insurance Services Expo.
You're a new exhibitor, and you're excited and anxious about your first visit to the PLRB Claims Conference. How will you handle the rushes of attendees and the breaks between them? How will you build relationships that will last after you leave the Expo floor? What tone will you strike with members? Gemcor has been attending PLRB since 1984, just three years after our dad founded the company. It's the one conference we commit to every single year, and today we'll share our perspective. Notable Timestamps
[ 00:58 ] - In this scenario, a new exhibitor is hoping for success at the upcoming PLRB conference.
[ 03:27 ] - The team discusses their favorite conference locations.
[ 07:59 ] - Successful exhibitors emphasize consistency and face-to-face connection as the core driver of lasting client relationships.
[ 10:57 ] - Every conversation counts, even if someone isn't a potential client at that moment.
[ 12:07 ] - Conferences surface real-time industry trends and information, from informal hallway conversations.
[ 13:19 ] - Downtime isn't wasted time if it's used appropriately.
[ 14:55 ] - Follow-up is critical to keep the momentum going after a conference.
[ 16:40 ] - Booth presence matters: engaged, approachable exhibitors attract more meaningful interactions.
[ 17:49 ] - Dana summarizes the key points above.
Your PLRB Resources
PLRB Events: Upcoming Events - https://members.plrb.org/events/
Claims Conference: Event Site - http://www.plrbclaimsconference.org/
Affiliate Membership: Which PLRB Affiliate Membership Is Right for You? - https://www.plrb.org/affiliate/
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 scenario@plrb.org.
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).
An adjuster starts to close the file on a roofing claim. The adjuster had worked closely with the roofing contractor and saw the claim through to its resolution, with the contractor getting paid in full. Then the adjuster receives an invoice with a supplement, from a company in another state. Upon calling the insured, they had no awareness of this company. Today Steven Badger from Zelle LLP will address these and other topics as we continue our discussion on "hot topics" in hail claims.
Notable Timestamps
[00:01] - Some in the industry describe the "reclaim game" as when an insured gets paid on a prior roof claim, never fixes the roof, then years later submits a new claim for the same unresolved damage.
[02:52] - On every new claim, adjusters can ask if the insured has ever filed a prior claim for the same damage, as opposed to relying solely on industry claim-history reports.
[03:45] - Early investigation often includes reviewing historical aerial and street-view imagery plus a low-cost hail history report to understand the roof's actual damage timeline.
[05:32] - Establishing coverage for business or goodwill reasons can open the door for supplementation.
[06:29] - Permit records, especially for commercial roofs, can confirm whether a claimed roof replacement really occurred and reveal the value and scope of prior work.
[07:35] - Is a supplement being submitted by the contractor who actually did the work or by a third-party supplement firm?
[13:08] - When contractors waive or absorb deductibles, insurers can request proof the deductible was paid.
[14:48] - Contractors who take over the claim process without a public adjuster license may be committing the unauthorized practice of public adjusting in certain circumstances.
[17:19] - Even in contentious claims, both sides can resolve disputes fairly and professionally.
Your PLRB Resources
Steve Badger's LinkedIn https://www.linkedin.com/in/steven-badger-467b0322/
Recorded Webinar: Resolving High Estimates and Post Work Supplementals https://members.plrb.org/education/courses/resolving-high-estimates-and-post-work-supplementals
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 scenario@plrb.org.
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).
Steven Badger from Zelle LLP joins us to talk about all the "hot topics" in the always interesting world of hail and other weather-related claims. Steve will cover all the emerging trends in these claims, including current fraud and other abuse schemes, and provide his recommendations on how to address the common issues. He will also talk about what he is seeing with recent expanded use of the appraisal process. Finally, Steve will talk about how his clients are addressing these issues through underwriting and policy wording changes.
Notable Timestamps
[ 00:07 ] - The episode introduces a discussion on emerging trends in hail and weather-related insurance claims, including fraud schemes, disputes over damage assessments, and how insurers are exploring underwriting and policy wording changes to address recurring issues.
[ 01:22 ] - A key industry trend is shifting toward bigger-picture solutions that reduce disputes altogether, such as improving building resilience or changing claims processes so insurers and policyholders spend less time fighting over losses.
[ 02:12 ] - Roof resiliency is a major topic. If roofing materials could withstand moderate hail, many claims would never occur, raising debate about requiring more durable materials like Class 4 hail-resistant roofing in hail-prone states.
[ 03:28 ] - Some insurers already offer premium discounts for homes with Class 4 hail-rated roofs, but experts argue broader mandates may be necessary to significantly reduce hail claim frequency and stabilize insurance markets.
[ 05:39 ] - Insurers report a rise in fabricated hail and wind damage claims, particularly during slow storm years when contractors relying on storm work may be tempted to create damage to generate insurance-funded repairs.
[ 07:24 ] - Fabricated damage raises complex coverage questions. If a contractor intentionally damages property, insurers must consider whether the loss could fall under vandalism or malicious mischief provisions.
[ 09:40 ] - Disputes often shift from scope of damage to pricing. Estimating tools like Xactimate help set initial reserves, but they are still estimates and can be manipulated by adding or removing line items.
[ 11:27 ] - Many policies ultimately require payment based on the "amount actually incurred," meaning the real cost of repairs. This shifts focus from software estimates to contracts, invoices, and proof of actual payments.
[ 14:08 ] - Contractors and public adjusters may inflate estimates within software systems, even adding items like adjuster commissions that are often not covered, which can raise unrealistic expectations for policyholders.
[ 15:33 ] - One strategy to counter inflated estimates is obtaining real competitive contractor bids. Presenting an independent price for the same work can help challenge excessive claims and refocus negotiations on actual costs.
Your PLRB Resources
Invoking "Our Option" – Increased Use of Preferred Contractor Networks https://www.youtube.com/watch?v=kC_WAl0N7gI
The Appraisal Process – Is it Still Useful to Resolve Disputed Claims? https://www.youtube.com/watch?v=v5YgKpL5FlI&t=1s
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 scenario@plrb.org.
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).
The insured lives in a single-family home in Austin, Texas. While hanging a shelf on the wall in one of the bathrooms, the owner drilled right through the metal stud, directly into a plumbing pipe, causing water damage to the wall and to the carpeting on the floor. (Yes, you heard that correctly, carpeting…in the bathroom!) Should there have been some type of pipe protection near the stud? And, does code even allow carpeting in a bathroom? Notable Timestamps
[ 00:08 ] - The scenario involves a homeowner drilling into a metal stud and puncturing a plumbing pipe, causing water damage to the wall and bathroom carpet.
[ 01:15 ] - The hosts discuss home "deal breakers" and vintage advertisements.
[ 05:39 ] - PLRB's Building Code Address Report confirms Austin enforces the 2021 IRC and 2021 Uniform Plumbing Code (UPC).
[ 06:09 ] - Under the 2021 UPC, pipes within one inch of a metal stud must be protected by at least 18-gauge steel nail plates extending beyond the pipe's diameter to prevent drill punctures.
[ 09:28 ] - The IRC clarifies that permits are not required for finish work such as carpeting.
[ 09:56 ] - Code limits absorbent materials only at the actual tub or shower floor surface. In other words, carpet elsewhere in the bathroom is only prohibited by common sense and not by model building codes.
[ 11:25 ] - While model codes allow bathroom carpeting, local ordinances may impose stricter sanitary rules, so adjusters should always verify municipal amendments before reaching conclusions.
[ 13:52 ] - Ruth summarizes the key points of this episode.
Your PLRB Resources
Address Report https://members.plrb.org/building-codes
What's New on the Building Codes Address Report? https://members.plrb.org/documents/whats-new-on-the-building-codes-address-report?query=address%20report
Ask a Code Question https://members.plrb.org/building-codes/ask-building-code-questions
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 scenario@plrb.org.
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).
For this holiday week, we'd like to prepare you for the upcoming PLRB Claims Conference, so we're sharing a classic episode featuring some highlights on what to expect. You might notice some details specific to the original date of taping, but we've lightly edited it to keep it relevant. We're looking forward to seeing you at the conference!
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 sponsorship@plrb.org
Contact Tom O'Dowd at todowd@plrb.org
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 scenario@plrb.org.
Sponsorship
PLRB thanks Alacrity Solutions for its Diamond Sponsorship of the 2025 Claims Conference. "Insurance Claims Made Easy — Streamlined claims, repairs & recovery services built for speed. Trusted nationwide partner for insurance carriers & policyholders." Visit alacritysolutions.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
A supervisor leads a team of very needy CAT adjusters! Over the course of the year, the supervisor fields many questions as it comes up in their claims. Was there hail on X date? Was there lightning in the area? This hurricane is coming soon, where can I get news about it? Winter weather caused a slip and fall!! Where can I find information on wildfire perimeters and California evacuations? For help herding all these cats, we'll head to PLRB.org. Notable Timestamps
[ 00:00 ] - The episode introduces a scenario where a supervisor fields constant weather-related questions from cat adjusters, highlighting the need for a centralized, reliable source for hail, lightning, hurricanes, wildfires, and more.
[ 02:15 ] - The team previews multiple scenarios—winter storms, hail, lightning, power outages, tornadoes, hurricanes, and wildfires—showing the breadth of searchable weather data available to support claim investigations.
[ 03:16 ] - Using a winter slip-and-fall in Iowa City, Iowa, the report pulls verified storm data from the National Weather Service, including freezing rain reports and hourly observations to validate conditions on the date of loss.
[ 07:42 ] - For hail damage in Illinois, radar-derived data and verified hail reports allow adjusters to map proximity, estimated hail size, and associated severe thunderstorm warnings tied to a specific date and address.
[ 09:53 ] - Lightning reports provide daily probability percentages and satellite detection data, helping assess commercial equipment claims while noting limits in resolution and cloud-to-cloud versus cloud-to-ground distinctions.
[ 12:25 ] - Power outage searches archive data every ten minutes via PowerOutage.us, identifying outage timing, affected customers, and likely storm causes—critical for business interruption investigations.
[ 14:09 ] - A tornado case study of the Mayfield event demonstrates wind reports, damage points, and EF-scale path polygons, enabling precise analysis of storm track and intensity relative to a property.
[ 17:31 ] - Wildfire tools include historical perimeters like the Garnett Fire, evacuation zones, thermal hotspots, smoke analysis from National Oceanic and Atmospheric Administration data, and hurricane spaghetti models—underscoring a single portal for comprehensive weather intelligence.
[ 17:49 ] - Dylan summarized upcoming PLRB Weather/CATs developments.
Your PLRB Resources
Weather/CATS Hub - https://members.plrb.org/weather-cat/
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 scenario@plrb.org.
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).
A restaurant experienced a power outage lasting over an hour and a half. Because of the outage, they decided to close for the rest of the evening, claiming lost revenue from missed dinner service. PLRB weather tools will help us explore outage duration, date and time, location, and eventual cause. As we investigate, we'll encounter an efficient proximate cause issue, the electrical currents exclusion, and a fried squirrel. Notable Timestamps
[ 00:00 ] - The episode sets up a real-world insurance scenario: a restaurant closes after a 90-minute power outage and claims lost revenue, raising questions about cause, duration, and coverage.
[ 00:38 ] - Investigating a power outage starts with verifying the exact date, time, duration, location, and cause, all of which are critical inputs for determining whether a claim may be payable.
[ 02:29 ] - Using PLRB's power outage report, investigators can search by address and date range, view outages within a one-mile radius, and see results on an interactive map and data table.
[ 03:14 ] - Outage data comes from utilities nationwide, gets updated every ten minutes, and covers about 87% of U.S. electric customers. This report helps establish whether an insured location likely lost power.
[ 05:04 ] - The report shows outage IDs, UTC timestamps, customer counts, utility names, estimated restoration times, and potentially the confirmed cause, all exportable in a shareable PDF.
[ 06:53 ] - Determining the outage cause is essential because many policies distinguish between natural events and artificial causes, which can directly affect coverage decisions.
[ 08:19 ] - In this case, investigators found the outage was caused by a squirrel contacting electrical equipment, leading to arcing that damaged a transformer and knocked out power.
[ 13:04 ] - The court rejected "but for" causation and made a ruling that did not invalidate the policy exclusion.
[ 17:49 ] - Dylan summarized upcoming PLRB Weather/CATs developments.
Your PLRB Resources
Weather/CATS: Get a Power Outage Report - https://members.plrb.org/weather-cat/power-outage-report
Case Law Review: City of West Liberty v. Employers Mutual Cas. Co., 922 N.W.2d 876 (Iowa 2/01/19) - https://members.plrb.org/documents/city-of-west-liberty-v-employers-mutual-cas-co-2019
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 scenario@plrb.org.
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).
You're a new exhibitor, and you're excited and anxious about your first visit to the PLRB Claims Conference. How will you handle the rushes of attendees and the breaks between them? How will you build relationships that will last after you leave the Expo floor? What tone will you strike with members? Gemcor has been attending PLRB since 1984, just three years after our dad founded the company. It's the one conference we commit to every single year, and today we'll share our perspective. Notable Timestamps
[ 00:58 ] - In this scenario, a new exhibitor is hoping for success at the upcoming PLRB conference.
[ 03:27 ] - The team discusses their favorite conference locations.
[ 07:59 ] - Successful exhibitors emphasize consistency and face-to-face connection as the core driver of lasting client relationships.
[ 10:57 ] - Every conversation counts, even if someone isn't a potential client at that moment.
[ 12:07 ] - Conferences surface real-time industry trends and information, from informal hallway conversations.
[ 13:19 ] - Downtime isn't wasted time if it's used appropriately.
[ 14:55 ] - Follow-up is critical to keep the momentum going after a conference.
[ 16:40 ] - Booth presence matters: engaged, approachable exhibitors attract more meaningful interactions.
[ 17:49 ] - Dana summarizes the key points above.
Your PLRB Resources
PLRB Events: Upcoming Events - https://members.plrb.org/events/
Claims Conference: Event Site - http://www.plrbclaimsconference.org/
Affiliate Membership: Which PLRB Affiliate Membership Is Right for You? - https://www.plrb.org/affiliate/
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 scenario@plrb.org.
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).
For this holiday week, we'd like to prepare you for the upcoming PLRB Claims Conference, so we're sharing a classic episode featuring some highlights on what to expect. You might notice some details specific to the original date of taping, but we've lightly edited it to keep it relevant. We're looking forward to seeing you at the conference!
A supervisor is leading a small but mighty teams of adjusters, and they're taking their team to Indianapolis this spring for the 2025 PLRB Claims Conference. The only problem? They've never been before and have no idea where to 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 scenario@plrb.org.
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).
The insured felt like she did everything right. She insured the ring when she bought it, kept it scheduled on her policy, kept up with maintenance, and filed a claim right away when it was stolen. She even submitted the original appraisal for $22,000 so the insurance company would know how much to write on the check. So she was shocked when the insurance payout was only $14,000. Apparently diamonds are cheaper today, but she thinks: "shouldn't the appraisal lock in the cost?" Notable Timestamps
[ 00:45 ] - An insured may assume an appraisal amount guarantees payout, but jewelry claims often hinge on policy type and current replacement cost, not the dollar figure listed on the appraisal.
[ 02:00 ] - Jewelry appraisals lack a single governing standard; credentials vary widely, making it critical for carriers to evaluate who prepared the appraisal and whether it meets insurer expectations.
[ 04:20 ] - Premiums may be based on a scheduled value, yet replacement cost policies aim to restore the item itself, which can result in payouts lower or higher than the original appraisal.
[ 06:10 ] - Clear communication from agents and adjusters about agreed value versus replacement cost policies can prevent frustration and disputes when a jewelry claim is settled.
[ 08:10 ] - Replacement cost focuses on replicating the exact item—cut, color, clarity, and materials rather than paying the appraisal number, which can change with market conditions.
[ 09:30 ] - It is the insured's responsibility to keep appraisals updated; insurers do not automatically adjust jewelry values for inflation or market shifts in metals and gemstones.
[ 11:40 ] - Outdated or inflated appraisals can create claim friction, while modern update tools and reminders help carriers reduce underinsurance and improve customer satisfaction.
[ 14:45 ] - Early education about policy limits, valuation methods, and appraisal updates builds trust, supports smoother claims handling, and leads to a more positive claims experience.
[ 17:12 ] - Brennan summarizes the key points above.
Your PLRB Resources
CE Course: Jewelry Valuation & Adjustment - https://members.plrb.org/education/courses/jewelry-valuation-amp-adjustment
Coverage Question: Agreed Value Settlement For Repair Of Jewelry - https://www.plrb.org/documents/wedding-ring-diamond-replaced-w-o-notifying-insurer-acv-for-original-ring-pcq-2009-10-08/?search=diamond%20value https://members.plrb.org/education/courses/a-deep-dive-into-a-premises-liability-claim-part-1
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 scenario@plrb.org.
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).
Swine & Dine Farms underwent a devastating loss when a ventilation system shut off, resulting in the deaths of 2,400 hogs. Swine & Dine didn't own the hogs: they were contract growers raising the hogs for an "integrator," the contract owner of the animals who is not suing for the value of the lost hogs. What liability coverage is available for these folks? Notable Timestamps
[ 00:41 ] - A ventilation failure led to the suffocation of thousands of hogs raised by a Contract Grower.
[ 04:47 ] - This scenario centers on farm commercial liability policies, not property coverage.
[ 05:20 ] - Standard farm liability forms often exclude damage to property in the insured's care, custody, or control, with narrow exceptions that may not fit contract grower operations.
[ 07:45 ] - Adjusters should obtain and closely review the grower–integrator contract, as it may define ownership, responsibilities, and procedures that directly affect liability and coverage.
[ 08:46 ] - Force majeure clauses can limit or eliminate liability when losses arise from events beyond a party's reasonable control, but their applicability depends on precise contract language.
[ 11:08 ] - Coverage and defense issues may diverge, requiring careful coordination when contracts include provisions that could waive recovery even if coverage defenses exist.
[ 12:51 ] - Brennan summarizes the key points above.
Your PLRB Resources
Recorded Webinar: Farm Bureau Town Hall Meeting - https://members.plrb.org/education/courses/farm-bureau-town-hall-meeting
CE Course: Specialized Equipment Losses - https://members.plrb.org/education/courses/specialized-equipment-losses
Listeners can email education@plrb.org for help navigating resources, requesting new content, or getting tailored curriculum support.
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 scenario@plrb.org.
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).
As you prepare your new year's resolutions, take a moment to ask, "What's your elevator pitch?" This holiday week, we're sharing a classic episode featuring an inspirational and thought-provoking scenario that you can bring into your personal and professional life.
A claims adjuster is out at a party when they are asked: "So, what do you do for a living?" Our adjuster responds with just: "I'm in insurance claims." That's an "Oh no" moment. Turns out their cousin had a terrible experience on a claim and our adjuster is going to hear all about it, ending in: "You claims people are all cheaters!"
Notable Timestamps
[ 00:36 ] - Today's scenario begins as an interpersonal encounter about explaining your career in insurance, but the elevator pitch is applicable even on claims.
[ 02:05 ] - What our claims professional needed was an elevator pitch: a succinct, prepared, organized response. Whether at a party or at a claims site, our adjuster wants to know how to summarize their thoughts in a persuasive way. Ding Ding! Your elevator's here! Are you ready?
[ 02:30 ] - Mike was asked: "what's your elevator pitch?" That was an "oh no" moment...
[ 03:35 ] - An elevator pitch is a simple presentation that you give in the time it would take to ride an elevator: around 30 seconds.
[ 04:18 ] - 1. Grab 'em at the beginning. Get their attention with a great opening.
[ 04:25 ] - 2. Tell 'em what you're gonna tell 'em. Be organized in your thought process.
[ 04:32 ] - 3. Hit 'em with your bid conclusion/sell/ask. Be brief and practiced.
[ 05:11 ] - Alissha: "So, what do you do for a living?" Mike: 1. "I allow you to take the risks to make life worth living." 2. "Without insurance, you wouldn't be able to insure your home or car." 3. "We step in when bad things happen and we hope to get people back on their feet."
[ 09:15 ] - Be prepared, be organized, be succinct.
[ 10:00 ] - Let's say an insured has suffered a casualty loss. How can an elevator pitch help? 1. "I'm so sorry that this happened." Take a moment to express sincere empathy. 2. Review the medical records / facts. 3. "I know that this has impacted your life, so how about we take care of your damages?"
[ 11:50 ] - What's the pitch for a hurricane loss? Again, start off with an emotional connection. Second, spell out the steps to get them back into the place they were before the accident. Third, conclude with the ask and what you need for the next steps.
[ 13:35 ] - Mike applies the elevator pitch to auto claims handling.
[ 15:42 ] - Mike provides a recap of the scenario and the points above.
Your PLRB Resources
Mike's PLRB Presents presentation on this topic: https://www.plrb.org/courses/pitching-in-an-elevator-2/lessons/pitching-in-an-elevator/
Webinar: Designing & Delivering Effective Business Presentations - https://www.plrb.org/courses/designing-delivering-effective-business-presentations/lessons/designing-delivering-effective-business-presentations/
Claims Chat: Why Should You Consider Claims as a Career? - https://www.plrb.org/courses/why-should-you-consider-claims-as-a-career/lessons/why-should-you-consider-claims-as-a-career/
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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
During this time of year as many people are exchanging presents, I'm sure you're all wondering exactly how those various gadgets would be classified under the HO3 policy. So for this holiday week, we're sharing a classic episode featuring an excellent coverage scenario.
The insured, a father of 4, was out buying Christmas gifts for his children. This year he decided to splurge and buy each of them a drone and an Apple Watch. On his way back home, he stopped to get gas, and when he went into the minimart for coffee, a thief stole everything out of the back seat. The insured notified the police and submitted a claim under his ISO 1991-edition HO3. The adjuster considers this to be a covered Theft loss, but she knows there are specific provisions in the policy for watches and aircraft.
Notable Timestamps
[ 00:17 ] - A theft claim is submitted for four drones and four smartwatches under the 1991 HO3. The question arises whether special provisions for aircraft and watches applies.
[ 01:27 ] - The team debates the merits of drones and smartwatches, their capabilities for wall damage and dog-scaring, and the wisdom of being notified emails the instant they are received.
[ 03:09 ] - A $1,000 special limit of liability applies to theft of "watches." Is an Apple Watch a watch?
[ 03:42 ] - Alissha argues that smartwatches are too different from a basic time-telling watch, and is more like a phone. Smartwatches were likely not part of the original policy intent.
[ 04:55 ] - Mike argues that it's called an "Apple Watch" -- its makers and users consider it a watch, even if it's more complex.
[ 06:05 ] - The group quotes Shakespeare and Merriam-Webster; it tells the time and it's on your wrist, so…
[ 06:30 ] - Grassie v. Merrimack Mut. Fire Ins. Co., 291 A.2d 254 (N.H. 1972) (watches that were inoperable and kept in display case were still subject to special limit of liability for theft of watches).
[ 07:00 ] - Ambiguities are construed in favor of the insured. So both sides need to hire a good lawyer.
[ 07:52 ] - How would the policy treat an iPhone strapped to your arm? Coverage C would likely provide full coverage for a smartphone.
[ 09:51 ] - "Property Not Covered" includes "aircraft"… but "model or hobby aircraft not used or designed to carry people or cargo" are covered.
[ 10:20 ] - Toy drones likely fall under hobby aircraft.
[ 11:15 ] - This scenario looked at what's covered property, but a drone could also be a covered cause of loss, even if it destroys itself.
[ 12:40 ] - Unlike BP and CP forms, there's no concern about the loss happening off-premises; homeowners get worldwide coverage for Coverage C.
[ 14:19 ] - In the 2022 ISO form, a $2,000 special limit of liability applies to model or hobby aircraft.
[ 15:51 ] - Under the recovered property provision, if the thief is caught after the amount is paid, the insured can choose to return the payment or have the insurer salvage the goods.
[ 18:00 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
FAQ, Drones and First Party Property Coverage, http://search.plrb.org/?DN=60514
FAQ, Is a Drone an Aircraft Under the CGL Policy?, http://search.plrb.org/?DN=56440
Coverage Question on "Is An Apple Watch Considered A Watch Or A Computer?" - https://search.plrb.org/?dn=58826&src=gsa
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
Sod's Country Farms was raising 65,000 chickens when a fire burned down the poultry house. After a detailed investigation, the cause of the fire was undetermined. To further complicate matters, Sod's Country Farms didn't even own the chickens themselves, but raised them for a vendor. They want to know if the property loss of the animals is covered-- and what policy would be most appropriate. Notable Timestamps
[ 00:00 ] - A poultry house fire destroys 65,000 chickens, but the insured doesn't own the birds.
[ 03:30 ] - Contract Growing is common in agriculture, with farmers raising animals owned by vendors.
[ 05:20 ] - Under the ISO BOP, animals are generally excluded, but exceptions exist for animals owned by others and "boarded" by the insured.
[ 07:00 ] - Courts may rely on dictionary definitions when policy terms like "boarded" are undefined.
[ 09:00 ] - Adjusters should review the contract for risk transfer provisions, insurance requirements, and other-insurance clauses to understand responsibilities and potential overlap.
[ 11:30 ] - Standard BOP coverage can fall short for farming operations. Specialized farm policies are designed to address poultry risks more directly through scheduling and declaration-based coverage.
[ 13:30 ] - Declarations pages matter in agricultural losses. How buildings, poultry locations, and coverage types are defined can determine whether coverage applies or is excluded.
[ 15:30 ] - Valuing large-scale poultry losses is complex, involving age, weight, market timing, pricing data, and delay to market, often guided by specific policy language on cash market value.
[ 17:15 ] - Brennan summarizes the key points above.
Your PLRB Resources
Annotation: BP191 - Animals - https://members.plrb.org/documents/bp191-animals
Podcast Episode: Don't Count Your Chicken Coops Before They're Insured - https://members.plrb.org/education/courses/dont-count-your-chicken-coops-before-theyre-insured
Listeners can email education@plrb.org for help navigating resources, requesting new content, or getting tailored curriculum support.
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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
Alex is a team leader working with a mix of experienced adjusters and brand-new claims professionals, some assigned to the field and others working behind a desk. Alex has to make sure his team has the training they need to approach their work with confidence. Luckily PLRB.org's Education Hub has everything they need to succeed. Notable Timestamps
[ 00:10 ] - The PLRB Education Hub supports team leaders like Alex with training for both new and experienced adjusters to build confidence in handling claims.
[ 01:25 ] - Update #1: A new critical thinking course will help adjusters analyze information, decide when to bring in experts, and resolve claims fairly and in good faith.
[ 02:20 ] - Update #2: The annual "Claims Resolution" webinar series will address ethics of automation, bad faith in AI, and how emerging tech affects investigations.
[ 03:35 ] - Update #3: A new PLRB designation program aims to take adjusters from entry level through line-of-business-specific training with elective options.
[ 05:05 ] - The Education Hub offers 200+ recorded webinars, podcasts, modules, and downloadable slide decks as an on-demand claims knowledge library.
[ 06:35 ] - "Test Your Claims Knowledge" microlearning modules use flashcards, definitions, photos, and scenarios for quick, interactive training.
[ 08:45 ] - Member companies can integrate PLRB courses, webinars, microlearnings, and even this podcast directly into their own LMS platforms.
[ 12:55 ] - PLRB will help members curate custom courses by combining videos, quizzes, and interactives in any sequence to match specific training goals.
[ 14:10 ] - The library includes 100+ non-CE modules, about 200 podcasts, some 250 recorded webinars, plus many shorter video series for flexible learning.
[ 16:25 ] - Mike summarizes the key points above.
Your PLRB Resources
Upcoming Events: PLRB Conferences & More! https://www.plrb.org/events
PLRB Education HUB: https://members.plrb.org/education
Listeners can email education@plrb.org for help navigating resources, requesting new content, or getting tailored curriculum support.
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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
Jamie has been a property adjuster for some time now and is ready to graduate to larger and more complex losses involving hurricanes, construction defects, historic buildings, massive commercial structures, and more. Chris is a seasoned large loss adjuster looking to hone their practice in the casualty arena and network with others in their area. To address these questions, we'll take them to the PLRB Large Loss Conference. Notable Timestamps
[ 00:15 ] - The conference attracts adjusters ready to move into larger and more complex losses, giving them exposure to hurricanes, defects, historic buildings, and large commercial structures.
[ 01:40 ] - Attendees include seasoned adjusters, newcomers to large loss work, EGAs, casualty specialists, and experts like engineers and forensic accountants, creating a fully integrated learning environment.
[ 03:45 ] - Sessions use real or modeled claim scenarios to walk participants through years of handling, highlighting decision points, mistakes, successes, and insights from complex losses.
[ 06:20 ] - Topics span property, casualty, liability, business interruption, food contamination, smoke damage, and multi-claimant events, ensuring relevance to a broad range of adjusters.
[ 08:52 ] - Presenters use interactive tools—polling, role assignments, breakout groups, and scenario debates—to let attendees test coverage positions and compare investigative approaches.
[ 11:45 ] - Networking is built into the event with receptions, meals, and vendor interactions, giving adjusters chances to reconnect with long-time colleagues and meet new industry partners.
[ 13:15 ] - Intimate spaces and structured seating make it easy to meet people from across the country, fostering mentorship opportunities and cross-disciplinary conversations.
[ 15:20 ] - Mike summarizes the key points above.
Your PLRB Resources
Upcoming Events: PLRB Conferences & More! https://www.plrb.org/events
CE Course: A Deep Dive Into a Premises Liability Claim, Part 1 https://members.plrb.org/education/courses/a-deep-dive-into-a-premises-liability-claim-part-1
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
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Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
This holiday week, we're sharing a classic episode about the PLRB Building Codes department.
The adjuster on a hail claim receives a long list of line items that are "required by code." Once the old shingles are torn off, they find rot and gaps in the sheathing, and the contractor says a thicker sheathing is now required by code. Notable Timestamps
[ 00:10 ] - Ice barriers, drip edges, a double felt underlayment... Searching the internet only leads the adjuster spiralling down a rabbit hole.
[ 01:30 ] - What internet rabbit holes have you gone down?
[ 04:28 ] - With PLRB's updated Address Report, members can provide an address and specify details such as rafter spans.
[ 05:05 ] - PLRB's Building Codes Address Report provides the adopted building code for a specific address, ensuring it falls within the correct city boundaries (e.g., Parma, Ohio).
[ 06:39] - Hail reports from NOAA are also included, allowing adjusters to confirm if hail was present in the area on the claim date. They also provide state-specific matching information, such as Ohio's "reasonable comparable appearance" standard.
[ 08:27 ] - The report includes diagrams that visually differentiate between modern wood structural panels and older lumber sheathing (planks), explaining concepts like H-clips for edge support.
[ 11:31 ] - The reports clarify requirements for common contractor-claimed line items, such as ice barriers, confirming if they are required (e.g., statewide in Ohio) and providing links to the source of this information.
[ 14:14 ] - The "Ask a code question" button links to a form where building code experts will research the specific inquiry and provide citations and links back to the member.
[ 15:44 ] - Ruth provides a recap of the points above.
Your PLRB Resources
Building Codes Hub & Address Report - https://members.plrb.org/building-codes
FAQ: When is Double Underlayment Required? - https://www.plrb.org/documents/when-is-double-felt-underlayment-required/?search=When%20is%20Double%20Felt%20Underlayment%20Required?
Ask a Building 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 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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
Benny's Liquor, Fireworks & Gunpowder Emporium went up in flames last night. Motion-detector alarms caught the fire and automatically notified the police, who found the fire and called the local fire chief, but by the time they arrived it was too late. Now his insurer claims he violated his Protective Safeguards Endorsement by installing burglary alarms instead of actual fire alarms. Benny doesn't recall anything about this, but apparently it's some paper he signed when he bought the policy.
Key Takeaways
[ 00:37 ] - Benny's shop burned down, and his insurer denied the claim due to a protective safeguards endorsement violation.
[ 01:05 ] - Benny had a motion detector burglar alarm instead of the required fire alarm and does not recall agreeing to the protective safeguards endorsement.
[ 06:09 ] - Protective safeguards endorsements require the insured to maintain the specific safeguards named in the policy schedule as a condition of insurance.
[ 06:59 ] - If the insured knows of any suspension or impairment in the safeguards, they must notify the insurer or risk losing coverage.
[ 08:29 ] - If a safeguard is shut off due to breakage or leakage, repairs must be completed within 48 hours for notification to the insurer not to be necessary.
[ 10:47 ] - Courts often follow the strict policy language; simply having a different type of alarm, even if it detected the fire, is not considered compliant.
[ 12:04 ] - The protective safeguards endorsement is often found in commercial property or farm coverage, and courts tend to enforce strict compliance.
[ 15:15 ] - Coverage can be denied even if the breach of the safeguard duty did not affect the outcome of the loss because compliance is a condition of the insurance.
[ 18:11 ] - Beth provides a summary of the key takeaways.
Your PLRB Resources
Coverage Question: Fire Loss Involving Protective Safeguards Endorsement - https://www.plrb.org/documents/fire-loss-involving-protective-safeguards-endorsement/
Law Review: New Hamilton Liquor Store, Inc. v. Amguard Ins. Co. - https://www.plrb.org/documents/new-hamilton-liquor-store-inc-v-amguard-ins-co-2020/
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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
Sam is a huge Bears fan. He sets up his brand new smoker in the backyard and put a perfectly seasoned pork shoulder on to cook all day -- just in time for the Sunday Night Bears v. Packers game. The smoker was near the side of the house, but not directly next to it. After 8 hours, the shoulder was tender and ready to eat… but the insured's siding had melted. Sam seeks coverage for the replacement of the melted siding (and for the pork shoulder he dropped when he saw the damage). Notable Timestamps
[ 00:23 ] - Sonia sets out a tragic game day scenario.
[ 01:16 ] - Fire is often defined by courts using dictionary definitions, such as Merriam-Webster's: "the phenomenon of combustion manifested in light and heat".
[ 04:38 ] - Scorching analysis suggests black marks may indicate oxidation and a glow (which could be fire damage), while brown marks often indicate high heat damage only.
[ 06:58 ] - For insurance purposes, losses must be fortuitous; Sam was trying to smoke meat, not melt the siding, so the damage was fortuitous from his perspective.
[ 08:37 ] - Most states rely on "proximate cause", i.e. the dominant or efficient cause that initiates the events, when analyzing causation for claims.
[ 09:23 ] - Friendly fire is contained in its usual place (like a stove), while hostile fire is unexpected or uncontrolled and not in its intended location. However, this analysis is not typically used by modern courts.
[ 11:43 ] - Sonia provides a recap of the points above.
Your PLRB Resources
The Future of Insurance Podcast - https://future-of-insurance.com/podcast/
Coverage Question: Smoker Melts Nearby Siding - https://www.plrb.org/documents/named-peril-coverage-smoker-melts-nearby-siding-pcq-2025-02-24-slc-a/
Coverage Question: Christmas Lights Scorched Couch: Is Couch Covered? - https://www.plrb.org/documents/fire-peril-scorched-couch/
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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
Curd Appeal sells the best-looking cheeses on the block, but over the long weekend their refrigerator broke down, and now their limburger isn't the only thing that smells. The owner argues they are covered under the BP 00 03, but the adjuster spots some holes in their argument. The owner hits back with a supplemental endorsement they purchased, hoping to find coverage any way they can. Notable Timestamps
[ 03:00 ] - The five-point process for property coverage analysis includes: covered property, direct physical loss, covered cause of loss, conditions, and additional coverages/extensions.
[ 04:37 ] - Mechanical breakdown (like a refrigerator going out) is often an excluded cause of loss in a standard policy.
[ 07:18 ] - Supplemental endorsements for food spoilage are designed to work with the base policy and can specify limits and change base policy language.
[ 08:59 ] - This food spoilage coverage extension insures against direct physical loss or damage to food stock or food merchandise contained in a refrigeration unit.
[ 10:47 ] - The endorsement defines a covered cause of loss to include mechanical breakdown and power outage (change in temperature/humidity).
[ 12:31 ] - This food spoilage endorsement often explicitly deletes the mechanical breakdown exclusion from the base policy, but only for that specific coverage extension.
[ 13:41 ] - The food spoilage extension may only apply if the loss is not covered by Equipment Breakdown Insurance (an optional policy coverage).
[ 14:10 ] - The optional Equipment Breakdown Protection Coverage in the BP 00 03 policy covers direct loss or damage caused by mechanical breakdown or electrical failure of machinery.
[ 15:33 ] - The Equipment Breakdown Protection Coverage might exclude leakage at a valve or seal, which is a distinction that could make the supplemental endorsement the only source of coverage.
[ 18:31 ] - Brennan provides a recap of the points above.
Your PLRB Resources
Property Question of the Week: Food Spoilage under BP and CP Forms – No Off-Premises Power Outage - https://www.plrb.org/documents/food-spoilage-under-bp-and-cp-forms/
Property Question of the Week: Mechanical Breakdown of Freezer: Food Covered? - https://www.plrb.org/documents/mechanical-breakdown-of-freezer-food-covered/
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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
"Simply the Vest" is a dry cleaning service with a basement full of supplies, tools, clothing, and… water. After a heavy rain, the owners discovered that their sump pump had failed, causing water to back up into the basement, resulting in damage to their property. Under their BP 00 03 form, coverage for this cause is firmly excluded. However, they paid for a supplemental endorsement with some interesting technicalities…
Notable Timestamps
[ 02:43 ] - When assessing coverage, always start with the underlying policy form before reviewing any endorsements, ensuring clarity on the initial coverage.
[ 05:32 ] - Supplemental coverages given to an insured typically identify specific needs that they have in the transaction and provide clear limits for each supplemental coverage provided.
[ 08:11 ] - Endorsements can provide additional coverage for water-related claims like backup and overflow or mold, which are generally types of losses that would otherwise be excluded.
[ 11:18 ] - Determining coverage requires looking at the exact policy language, fitting it to the specific scenario, and matching facts to the policy language.
[ 13:45 ] - Sump pump issues often involve power outages (necessitating battery backup) or mechanical breakdown, but each claim has to be assessed based on its individual merits.
[ 15:23 ] - An endorsement providing additional water backup coverage may also modify or replace the existing water damage exclusion found in the underlying BP policy.
[ 17:49 ] - If a loss isn't excluded under the underlying policy, the supplemental coverage-- which could be subject to a lower limit-- would not be needed.
[ 16:18 ] - Brennan provides a brief conclusion.
Your PLRB Resources
Coverage Question: Sump Pump vs. Septic Pump - https://www.plrb.org/documents/sump-pump-vs-septic-pump-pcq-2024-09-24-dwf-b
Property Question of the Week: Sewer Backup Coverage vs. Flood Exclusion - https://www.plrb.org/documents/sewer-backup-coverage-vs-flood-exclusion/
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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
We are experiencing some technical difficulties with today's episode, so instead I thought I would share two clips that were previously cut for time. In these clips, Dana Grodin and Alison McLaney, both of Gemcor and Digipraise, answer our burning questions about diamonds, lab-grown and natural. I'll re-insert their introduction before we hop into the clips, but the rest of the material has never appeared on this feed before. You might have caught it if you subscribe to our YouTube channel, so if you like these quick hits head over there for more. Notable Timestamps
[ 00:50 ] - Introducing Dana Grodin & Ali McLaney of Gemcor & Digipraise.
[ 03:33 ] - Beginning of the clip "I Didn't Think a Diamond Could Chip!" Although diamond is the strongest material known to mankind, it has weak points and structural bonds, meaning hardness does not equate to avoidance of chips.
[ 05:00 ] - The myth of a "flawless" diamond is common, but most diamonds have clarity characteristics (crystals/clouds) that act as weak points visible under magnification.
[ 06:15 ] - Gemcor determines if an imperfection breaks the surface, constituting damage, and investigates if the damage is new or pre-existing, noting mounting condition.
[ 08:53 ] - Beginning of the clip "What is a Lab-Grown Diamond?" Lab grown diamonds are chemically and physically identical to natural diamonds. LGDs have exploded in popularity, now representing 50% of engagement ring sales.
[ 09:45 ] - Unlike natural diamonds created over millions of years, LGDs are grown in a lab in about 30 days, resulting in them being thousands of dollars less expensive.
[ 10:45 ] - Differentiation between natural and lab grown diamonds requires very high-quality, specialized equipment because standard diamond testers and visual inspection fail.
[ 12:00 ] - Ethically, all lab grown diamonds should have a laser inscription (e.g., LG) on the girdle, but vendors sometimes omit this marking, creating significant disclosure risk.
[ 16:18 ] - Brennan provides a brief conclusion.
Your PLRB Resources
Podcast Episode: "You Can't Salvage My Mother's Ring!" https://youtu.be/Ijph_AuQZq4
Podcast Episode: The Lab-Grown Mismatch: One Earring, One Surprise https://youtu.be/zp8UUIqQ9Q0
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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
This is a holiday week for the podcast, so we're replaying a classic episode. This episode has been lightly edited to remain accurate to the upcoming 2025 Large Loss Conference taking place at the Gaylord Texan Resort & Convention Center in Grapevine, TX on Wednesday November 12 through Friday November 14. We'll be back next week with our regularly scheduled episode.
Today our adjuster is leveling up in their career and handling their first large loss property claim. The adjuster quickly runs into trouble-- where can a claims professional go for help? This November 12 - 14 in Grapvine, TX, join PLRB for the 2025 Large Loss Conference. Notable Timestamps
[ 00:39 ] - Alissha asks HERSELF "what's the scenario?" This scenario features late notice, Category 3 water, and additional damage during a claim.
[ 03:24 ] - Late notice issues? Attend the educational session "It's Too Late, Baby, It's Too Late: Navigating a Late Reported Large Loss" with Andy Rock (Rock Law Group).
[ 04:34 ] - For water mitigation issues, check out "Interpreting the Microbiology of Storm Damage" with Jeremy Beagle (SDII Global).
[ 05:05 ] - For other large storm issues, see "A Coastal Catastrophe: Navigating a Large Hurricane Loss in the Northeast" with Anthony Antonellis and Brendan Labbe (both of Sloane and Walsh LLP).
[ 05:45 ] - The Large Loss Conference is intended for claims professionals involved in these losses or hoping to get experience with larger claims, as well as the experts, attorneys, and accountants who provide insights on these claims.
[ 06:43 ] - The Large Loss Conference is differently structured than PLRB's other conferences. The educational sessions are 90 minutes long, often more focused on case studies, and involve more interactivity.
[ 07:56 ] - Andrew features the educational session "Back to the Future: How Adjusters Can Use Forensic Meteorology in Hail and Wind Claims" with Howard Altschule (Forensic Weather Consultants).
[ 08:48 ] - The Large Loss Conference features many casualty and personal lines sessions as well, such as "We Didn't Start the Fire: Was it Smoking or Smokin'" with David Heemann (Mutual of Enumclaw), Pete Fowler (Fowler Construction Consultants), and Jennifer Kalvestran (Anderson, McPharlin & Conners LLP).
[ 11:08 ] - The conference's general session will feature "Whoever Said Insurance Was Boring? 30 Years of Fascinating Claims Stories" with Steve Badger (Zelle LLP).
[ 11:56 ] - Most educational sessions are approved in FL, TX, DE, NC, and OK Continuing Education credit, and even some courses approved for GA CE credit!
[ 12:56 ] - To register, visit PLRB.org and click on the banner on the main page OR the Events tab. Registration is free for members.
[ 13:50 ] - Maria McNally will be available to discuss membership or website questions.
[ 14:45 ] - Alissha provides a recap of the scenario and the points above.
Your PLRB Resources
PLRB's Events tab: https://www.plrb.org/plrb-events/
Direct Link to PLRB's Large Loss page: https://www.plrb.org/event/plrb-2025-large-loss-conference/
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 scenario@plrb.org.
Sponsorship
PLRB thanks SERVPRO Restoration for its Diamond Sponsorship of the 2025 Claims Conference. "The #1 Choice in Cleanup and Restoration We have more than 50 years of experience in the cleanup and restoration industry." Visit servpro.com!
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
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).
Today's insured looked out the window and saw that a windstorm with strong 50 MPH sustained winds had kicked up soil from their neighbor's farm fields. The soil accumulated in layers over their home, garage, pool, hot tub, and all their beautiful landscaping. The garage door was open, so their home carpentry workshop and storage was covered in dirt. Even their koi pond was buried in the soil. None of the buildings were structurally compromised, but the insured will need a professional cleaning. Notable Timestamps
[ 08:03 ] - Direct physical loss can include the cost of exceptional cleaning effort for a dwelling or other structure, even if no permanent damage occurred.
[ 10:20 ] - Water in a pool or pond is likely not covered property under a standard homeowners policy due to a "property not covered" provision for water.
[ 11:23 ] - The cost to drain and refill a pool may be covered if necessary to repair damage to the structure itself.
[ 13:46 ] - Personal property inside a building is only covered for windstorm damage if the wind first created an opening (like to the roof or siding) through which dirt or dust entered.
[ 15:02 ] - Personal property located outside a building, such as patio furniture, would be covered for damage from wind or a dust storm.
[ 16:35 ] - Animals, including koi fish, are generally excluded from personal property coverage in a standard policy, often requiring a special endorsement.
[ 19:14 ] - Damage to landscaping, trees, shrubs, and plants is an additional coverage, and windstorm is typically not one of the few named perils that apply.
[ 20:47 ] - Beth provides a recap of the points above.
Your PLRB Resources
TYCK: Wind Blew Dirt On My Koi Fish - https://members.plrb.org/education/courses/wind-blew-dirt-on-my-koi-fish
Coverage Question: Overflow from a Sump: Does It Apply to Water from a Drainage Line? (Another Koi Fish Hypothetical) - https://www.plrb.org/documents/overflow-from-a-sump-does-it-apply-to-water-from-a-drainage-line-pcq-2017-06-07-jch-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 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 scenario@plrb.org.
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).
Beatriz is a city dweller who never learned how to drive a car. However, recently she got tired of the train and decided to get an E-bike. She bought an old E-bike off a friend, purchased a battery from AftermarketBatteries.biz, and soon was zipping through the streets. Her friends even got her a "bumper sticker" that reads "Beatriz's Car" for the side. But one night, it caught fire while charging outside her apartment door. Is it a covered motor vehicle under the standard ISO HO-3 form? Notable Timestamps
[ 00:00 ] - E-bikes are becoming increasingly common in cities, raising new insurance questions, particularly around how coverage applies when losses occur.
[ 02:23 ] - E-bike Trivia: Rainy Days & Freezing Batteries
[ 04:12 ] - Coverage disputes often center on whether an e-bike qualifies as a motor vehicle under the HO3 form, with fire and theft being frequent causes of loss.
[ 06:34 ] - E-bikes are classified into three classes based on speed and power, which affect where they can be ridden and complicate insurance coverage determinations.
[ 08:24 ] - The 2022 HO3 form clarified that e-bikes with throttles are motor vehicles, unlike the 2011 edition, which did not define related terms.
[ 11:42 ] - Pedal-assist-only e-bikes are generally not considered self-propelled, but throttle-equipped bikes risk being excluded as motor vehicles under certain policies.
[ 13:22 ] - Policy language can lag behind technology, creating a gap where there is uncertainty in coverage.
[ 16:14 ] - Expensive e-bikes may require endorsements for coverage, since they can fall into property-not-covered provisions under homeowners insurance.
[ 17:05 ] - Urban fires linked to aftermarket batteries prompted new laws, such as requiring UL Certification in New York, to improve e-bike safety.
[ 19:17 ] - Sonia provides a recap of the points above.
Your PLRB Resources
Coverage Question: Is an E-Bike Considered a Motor Vehicle in Minnesota? https://www.plrb.org/documents/is-an-e-bike-a-motor-vehicle-in-minnesota-pcq-2024-11-11-jch-a
FAQ: E-Bikes and First Party Issues https://www.plrb.org/documents/e-bikes-and-first-party-issues/?search=ebike
Recorded Webinar: Transportation Network Companies: Driving into the Future Webinar https://members.plrb.org/education/courses/transportation-network-companies-driving-into-the-future-webinar
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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Send us your Scenario!
Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.
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).
A few months ago, today’s insured decided to jump into the latest trend for a lot of suburban dwellers, and he got some chickens! He built a chicken coop and a caged in area for the chickens to be safe from predators. The coop itself looks like a very large shed with a fenced-in area extending from the coop. The insured calls up their agent to ask if there’s coverage for the coop under their HO 00 03 03 22 policy covering their home and an attached garage. Notable Timestamps
[00:00] - A homeowner built a large chicken coop and asked their insurer whether it was covered under their 2022 homeowners policy.
[02:00] - The hosts dive into trivia, noting that chickens are genetically the closest living relatives to the T-Rex.
[05:00] - Coverage depends on construction: a coop attached to the house may fall under Coverage A, but detached coops lean toward Coverage B or C.
[07:30] - One key test is portability: if the coop can move with the owner, it likely counts as personal property under Coverage C.
[10:00] - Courts consider a variety of factors, e.g. how the coop is affixed, its adaptation for use, and the owner’s intent to keep or move it.
[12:30] - Some coops are deliberately not anchored to protect against flooding or predators, adding complexity to coverage classification.
[14:25] - Similar issues arise with swing sets, pools, and other backyard structures—each must be evaluated individually.
[15:15] - Selling eggs could cross the line into business use, potentially excluding coverage under standard homeowner policies.
[18:00] - Coverage type affects settlement: Coverage B buildings may qualify for replacement cost, while Coverage C property is typically ACV.
[20:00] - Beth provides a recap of the points above.
Your PLRB Resources
Coverage Question: Other Structures Used for Business – Raising Chickens https://www.plrb.org/documents/other-structures-used-for-business-raising-chickens/
Other Structures: Can Some Items Be Treated As Either Coverage A Or Coverage B Property? https://www.plrb.org/documents/other-structures-can-some-items-be-treated-as-either-coverage-a-or-coverage-b-property-pcq-2022-01-17-jem-a/?search=other%20structures
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
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Send us your Scenario!
Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.
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).
Mia is a mid-level claims specialist with about five years’ experience in the job. One afternoon, she gets a call from a customer named James. He’s frustrated—bordering on furious. He’s been waiting for an update about his property claim, and from his perspective, no one communicated anything. He feels ignored. He’s escalating. Mia can tell this is going to be a difficult conversation. But instead of reacting defensively—or shutting down—she mentally runs through the CLEAR model. Notable Timestamps
[ 00:30 ] - The "CLEAR Method" module, developed with Equis Consulting, helps insurance professionals handle difficult circumstances and challenging customers effectively.
[ 01:25 ] - The CLEAR Model is applied when an adjuster, Mia, handles a reassigned property claim from James, who is furious due to a lack of updates.
[ 04:40 ] - "C" is for Connect; acknowledge the customer's emotions and frustration early to build trust and prevent escalation into a confrontational "fight or flight" situation.
[ 07:05 ] - "L" is for Listen; allow frustrated customers to vent without interruption, actively hearing their concerns to gather clues and make them feel heard, without becoming defensive.
[ 09:55 ] - "E" stands for Engage; avoid industry jargon and maintain a calm tone. Ask angry customers to list their top three priorities to shift them from emotional to logical thinking.
[ 11:25 ] - "A" is for Acknowledge; recognize the customer's frustration without accepting blame or fault. This helps build trust and moves the conversation forward positively.
[ 13:20 ] - "R" means Resolve; define next steps and set priorities to move the claim towards resolution. Under-promise and over-deliver on commitments to build trust and ensure follow-through.
[ 16:35 ] - Mike provides a recap of the points above.
Your PLRB Resources
New Course: Handling Challenging People and Difficult Circumstances - https://members.plrb.org/education/courses/handling-challenging-people-difficult-circumstances-course
Guest Site: Equis Consulting & their podcast “Leadership is the Conversation” - https://equisconsulting.com/
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
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Send us your Scenario!
Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.
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).
Messy Masonry, Inc. was hired as a subcontractor on a new home construction. Their job was to install two giant bay windows overlooking a lake, but they ended up splashing mortar on one of them. When they attempted to scrub it off, the window was scratched. As for the other window... another subcontractor, Outside the Lines Painting, was hired to paint the window frames, but accidentally sanded part of the windows in that process. The homeowner found the scratches months later. Notable Timestamps
[ 00:00 ] - A construction scenario involves Messy Masonry splashing mortar and scratching a bay window, and Outside the Lines Painting sanding another window, damaging the glass.
[ 01:26 ] - The "damage to property" exclusion, particularly j(5) and j(6), is a complex and often confusing aspect of the CGL policy.
[ 03:43 ] - Courts have ruled that if damage results from work product done incorrectly, it's not an "occurrence" and therefore not covered by a CGL policy, even before exclusions are considered.
[ 05:28 ] - The j(5) exclusion applies to property damage on "that particular part of real property" where the insured or subcontractors are performing operations, if the damage arises from those operations.
[ 06:03 ] - The j(6) exclusion covers "that particular part of any property" requiring repair or replacement due to "your work" being incorrectly performed.
[ 11:32 ] - Courts have viewed incidental tasks, such as cleaning up mortar, as part of "performing operations," meaning damage occurring during such tasks can fall under the exclusion.
[ 17:13 ] - The specific scope of a subcontractor's contract, detailing what work they were hired to perform, is a crucial factor in determining the applicability of CGL policy exclusions.
[ 17:37 ] - Brennan provides a summary of the key takeaways.
Your PLRB Resources
Upcoming Course: All About the CGL Damage to Property Exclusion - Coming Soon!
Learning Path: What Part is "That Particular Part" in the CGL j.(5) and j.(6) Exclusions? - https://members.plrb.org/education/courses/what-part-is-that-particular-part-in-the-cgl-j5-and-j6-exclusions
Advantage Homebuilding LLC v. Maryland Cas. Co. 470, F3d 1003 (10th Cir. Kan. 2006). https://www.plrb.org/documents/advantage-homebuilding-llc-v-maryland-cas-co-2007/
Alverson v. Northwestern Nat. Cas. Co., 559 N.W.2d 234 (S.D. 1997) https://www.plrb.org/documents/alverson-v-northwestern-natl-cas-co-1997/
Employers Mut. Cas. Co. v. Pires, 723 A.2d 295 (R.I. 1999) https://www.plrb.org/documents/employers-mut-cas-co-v-pires-1999/
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
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Send us your Scenario!
Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.
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).
An insured filed a claim for a lost diamond earring. The stud and its match were scheduled as 1.00 Carat each, “I” color and SI clarity, for $8,000. Her insurer asked Gemcor create a match. When we received the mate, we ran our standard test and found something unexpected: the diamond wasn’t natural. It was lab-grown. In the years since its purchase, the replacement cost for lab-grown diamonds has plummeted. But the insured believed they were both natural, and wants a natural replacement. Notable Timestamps
[ 00:58 ] - A client filed a claim for a lost diamond earring, but the mate, initially thought to be natural and scheduled for $8,000, was unexpectedly discovered to be lab-grown, with its replacement cost having plummeted.
[ 01:28 ] - Lab-grown diamonds are chemically and physically identical to natural diamonds, grown from a seed crystal in a lab, and only very high-quality equipment can differentiate them.
[ 02:08 ] - The main difference for lab-grown diamonds is value, as they are not rare. Natural diamonds take millions of years, while lab-grown are created in 30 days, making them significantly less expensive.
[ 06:12 ] - An insured's original appraisal correctly stated "lab grown," but underwriting dropped this crucial detail from the policy, as the industry lacked awareness of its importance years ago.
[ 10:10 ] - If an insurance company pays for a pair and later discovers the remaining earring is lab-grown, salvage recovery is minimal, as there's no market to resell them when new ones can be easily manufactured.
[ 11:27 ] - A lab-grown diamond pair purchased for $8,000 in 2001 (or $2,000 two years ago) can now be replaced by the original jeweler for $1,000 or less due to plummeting market prices.
[ 14:04 ] - The purpose of insurance is to make the insured whole by replacing the item with like kind and quality, not necessarily the original dollar amount, which is impactful when lab-grown prices change quickly.
[ 16:45 ] - Ali & Dana provide a recap of the points above.
Your PLRB Resources
CE Course: Jewelry Valuation & Adjustment - https://members.plrb.org/education/courses/jewelry-valuation-amp-adjustment
Coverage Question: Wedding Ring Diamond Replaced W/O Notifying Insurer: ACV for Original Ring? - https://www.plrb.org/documents/tree-root-damage-fortuitous-or-non-fortuitous-pcq-2022-01-21-dwf-b/
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
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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 scenario@plrb.org.
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).
An insured brought her diamond ring to a local jeweler for a routine cleaning. The jeweler found damage and recommended filing a claim. Our team checked the original appraisal on file, which raised questions about the identified break. However, close analysis confirmed a different break in the girdle. The insured was entitled her to a like-kind replacement or cash if she surrendered the chipped stone. But, the insured does not want to surrender the diamond for sentimental reasons. Notable Timestamps
[ 00:52 ] - The insured's diamond had a girdle break, and while entitled to replacement, she didn't want to surrender it due to sentimental reasons.
[ 01:54 ] - Dana & Ali introduce themselves, Gemcor, and Digipraise.
[ 04:32 ] - When a claim involving a damaged stone is resolved, the stone belongs to the insurance company under the policy. However, the insured can often buy back the stone at its salvage value.
[ 05:01 ] - Jewelry claims require empathy because insureds often have deep emotional and sentimental attachments to their pieces. Approaching these conversations sensitively is crucial for a positive resolution.
[ 05:39 ] - For minor damage like a "small nick on the girdle," repairing the stone and compensating for loss in value is an option. This allows the insured to keep their original diamond and prevents further damage.
[ 09:50 ] - Before a claim can move forward, an expert on behalf of the insurance company must inspect the jewelry to verify damage. This prevents premature replacement recommendations.
[ 11:48 ] - Many clients are underinsured because they fail to update appraisals, leading to coverage being capped at outdated values and significant out-of-pocket costs.
[ 16:48 ] - Diamond certifications with a map of imperfections are vital tools. They help distinguish between pre-existing flaws and new damage, which directly impacts coverage decisions.
[ 15:44 ] - Ali & Dana provide a recap of the points above.
Your PLRB Resources
CE Course: Jewelry Valuation & Adjustment - https://members.plrb.org/education/courses/jewelry-valuation-amp-adjustment
Coverage Question: Agreed Value Settlement For Repair Of Jewelry - https://www.plrb.org/documents/wedding-ring-diamond-replaced-w-o-notifying-insurer-acv-for-original-ring-pcq-2009-10-08/?search=diamond%20value
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 scenario@plrb.org.
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).
Warning, this scenario mentions suicide. The insured's 21-year-old son lives with them and suffers from depression. While the insured parents are away, their son goes through a breakup and decides to kill himself. He gets very drunk and douses the entire first floor in the gasoline they use for their lawnmower. He turns over a candle and goes upstairs to pass out. A neighbor called the police in time, and the young man was saved-- but the resulting fire consumed the house. Notable Timestamps
[ 00:10 ] - John shares a serious scenario that raises pertinent coverage questions.
[ 01:22 ] - The intentional loss exclusion ensures insurance covers fortuitous/accidental events, not property purposely destroyed for the prupose of collecting insurance proceeds.
[ 02:00 ] - The intentional loss exclusion is clearly worded: if any insured commits an intentional act causing loss, no insured, even innocent ones, are entitled to coverage.
[ 03:16 ] - Two criteria for the exclusion: the act must be by an insured, and committed with intent to cause loss, which can be difficult to prove.
[ 04:53 ] - Courts consider if the perpetrator lacked the ability to form intent due to mental handicaps, mental health issues, or age, making the exclusion potentially inapplicable.
[ 05:40 ] - Courts are now less friendly to the intoxication defense. The inferred intent doctrine holds that if a loss (like fire from gasoline) is "substantially certain to occur," intent is inferred, regardless of primary motive (e.g., suicide).
[ 08:30 ] - Suicidal intent can be a defense, as individuals may not be in their right mind. However, the inferred intent doctrine makes recovery difficult if the actions were likely to cause property damage.
[ 13:36 ] - In states with a Standard Fire Policy (SFP), which uses "conduct of the insured," innocent co-insureds might still recover, overriding tighter policy language.
[ 17:20 ] - John provides a recap of the points above.
Your PLRB Resources
Annotation: Intentional Loss (HO90) https://www.plrb.org/documents/intentional-loss-ho90/#toc22
50-State Survey: Innocent Co-Insureds https://www.plrb.org/documents/table-of-contents-innocent-coinsured/
SEE ALSO: 988 Suicide & Crisis Lifeline - 988 offers 24/7 judgment-free support for mental health, substance use, and more. Text, call, or chat 988. samhsa.gov/mental-health/988
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 scenario@plrb.org.
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).
The adjuster on a hail claim receives a long list of line items that are "required by code." Once the old shingles are torn off, they find rot and gaps in the sheathing, and the contractor says a thicker sheathing is now required by code. Notable Timestamps
[ 00:10 ] - Ice barriers, drip edges, a double felt underlayment... Searching the internet only leads the adjuster spiralling down a rabbit hole.
[ 01:30 ] - What internet rabbit holes have you gone down?
[ 04:28 ] - With PLRB's updated Address Report, members can provide an address and specify details such as rafter spans.
[ 05:05 ] - PLRB's Building Codes Address Report provides the adopted building code for a specific address, ensuring it falls within the correct city boundaries (e.g., Parma, Ohio).
[ 06:39] - Hail reports from NOAA are also included, allowing adjusters to confirm if hail was present in the area on the claim date. They also provide state-specific matching information, such as Ohio's "reasonable comparable appearance" standard.
[ 08:27 ] - The report includes diagrams that visually differentiate between modern wood structural panels and older lumber sheathing (planks), explaining concepts like H-clips for edge support.
[ 11:31 ] - The reports clarify requirements for common contractor-claimed line items, such as ice barriers, confirming if they are required (e.g., statewide in Ohio) and providing links to the source of this information.
[ 14:14 ] - The "Ask a code question" button links to a form where building code experts will research the specific inquiry and provide citations and links back to the member.
[ 15:44 ] - Ruth provides a recap of the points above.
Your PLRB Resources
Building Codes Hub & Address Report - https://members.plrb.org/building-codes
FAQ: When is Double Underlayment Required? - https://www.plrb.org/documents/when-is-double-felt-underlayment-required/?search=When%20is%20Double%20Felt%20Underlayment%20Required?
Ask a Building 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 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 scenario@plrb.org.
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).
The 100-year-old named insured died of natural causes. His daughter, the executor, inherited and moved into the home, continuing to pay the same bills—including insurance premiums. Four years later, a fire occurred, but the policy still listed her late father. Can it pay out? Notable Timestamps
[ 00:10 ] - The daughter continued to pay the premiums, but did not contact the insurance company to advise them of her father's death.
[ 01:30 ] - Trivia Time! Who was the oldest living person?
[ 04:06 ] – Insurance policies generally follow the insureds, as defined by the policy, as opposed to the property itself.
[ 05:01 ] - A "death clause" provides a grace period to ensure coverage for the legal representative of the deceased (such as the executor of the estate) with respect to the premises and property covered at the time of death. This provision allows the family time to address affairs following a death.
[ 06:15 ] – The grace period is not indefinite. Coverage under this clause typically ceases once the probate proceeding is finalized and the assets are distributed, as there is no longer a legal representative for the deceased. Some modern policies also include a hard cap, such as 180 days (approximately six months), for this grace period.
[ 10:20 ] – Insurance companies are generally not obligated to actively seek out information regarding a policyholder's death. Courts have affirmed that the responsibility lies with the policyholder or the person seeking coverage to notify the insurer of any changes to the situation.
[ 13:56 ] – Arguments appealing to "fairness" or doctrines like "mutual mistake" (where both parties are mistaken about a fact) typically do not succeed in court when the insurance company was unaware of the policyholder's death.
[ 17:33 ] – To prevent coverage lapses and ensure proper protection, it is critical for individuals or their families to contact their insurance agent or company to update policies, especially after a major life event like the death of a named insured.
[ 14:00 ] - Tim provides a recap of the points above.
Your PLRB Resources
Coverage Question: If Named Insured Dies, Does Non-Resident Legal Representative Have Duty To Maintain Heat? https://www.plrb.org/documents/death-must-representative-maintain-heat/?search=duty%20to%20maintain%20heat%20representative
Ramsey v. Allstate Ins. Co. (6th Cir.) (2013) https://www.plrb.org/documents/ramsey-v-allstate-insurance-co-6th-cir-2013/
Davis v. Westfield Ins. Co. (2022) https://www.plrb.org/documents/davis-v-westfield-ins-co-2022/
Kantz v. Everett Cash Mut. Ins. Co. (2018) https://www.plrb.org/documents/kantz-v-everett-cash-mut-ins-co-2018/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
A concrete foundation is crumbling due to a truck's sugar-contaminated sand delivery. Now, a court case hinges on whether the CGL auto exclusion applies: Did the damage occur in the truck or on the job site?
Notable Timestamps
[ 00:30 ] - At the outset, it seems the question (of whether the CGL or the BAC policy applies) turns on whether the damage occurred on the job site, at the concrete plant, or on the sand delivery truck.
[ 05:01 ] - Sugar can be used in small, controlled amounts to delay concrete setting time, but higher concentrations can prevent proper curing. The contamination in this scenario was due to a "failure to clean" the truck from a previous job.
[ 08:57 ] - The CGL Auto Exclusion operates to ensure coverage falls under the proper policy. In this case, the property damage occurred on a truck, so it should not be handled by the CGL policy but by Business Auto Coverage.
[ 13:02 ] - The CGL form defines property damage to include "loss of use", meaning that even if the sand itself wasn't physically damaged, its inability to be used for its intended purpose (making proper concrete) qualifies as property damage.
[ 15:47 ] - The Business Auto policy "Care, Custody, and Control" exclusion applied because the concrete plant's employee made the error.
[ 16:24 ] - Brennan provides a recap of the scenario and the points above.
Your PLRB Resources
In Brief: Clear Blue Specialty Ins. Co. v. Landrieu Concrete and Cement Industries, LLC, 2025 U.S. App. LEXIS 10563 (5th Cir. La. 5/1/25). https://www.plrb.org/documents/clear-blue-specialty-ins-co-v-landrieu-concrete-and-cement-industries-llc-2025/
Annotation: CGL Policy Key GL39 – Automobile Exclusion. https://www.plrb.org/documents/gl39-automobile-exclusion
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
This is a replay of an episode that originally aired on March 19, 2024.
An insured’s detached garage burns down in a covered lightning strike, and somehow it’s not covered just because of a little side hustle? The PLRB crew hunt for coverage and find what the insurer can pay out on when an insured rents out their property without updating their insurance company.
Notable Timestamps
[ 00:17 ] - The insured remodeled their detached garage for use as an AirBNB rental, but never notified their insurer. The garage burned down, and the insured files a claim for the property damage, contents, and nearby oak tree that also burned down.
[ 02:40 ] - This scenario’s policy explicity does not cover structures “held for rental”, so this clause would apply even though no guests were present on the date of loss.
[ 05:50 ] - The contents would likely be covered as long as the detached garage is not considered an “apartment.”
[ 07:42 ] - However, the Special Limit of Liability would limit that contents recovery to $3,000 under this policy.
[ 08:04 ] - AirBNB provides a form of coverage which they state is not insurance, but it likely applies only when guests were, at minimum, present.
[ 09:52 ] - The oak tree is also covered, but likely limited to $500.
[ 11:13 ] - In a variation on the scenario, the group discusses that property of tenants would likely not be covered.
[ 13:26 ] - Fair rental value coverage only applies to covered losses.
[ 14:50 ] - Clauses on “homesharing activities” are more frequently appearing in newer forms.
[ 16:30 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Adjuster Resource Sheet on Home Sharing Issues for Property Adjusters - https://search.plrb.org/?dn=72175&src=gsa
Highlights of 2022 Revisions TO Section I ISO Homeowners Form - https://search.plrb.org/?dn=87749&src=gsa
Coverage Question on “Home Sharing Endorsement Would Not Apply Where Tenant Rented Garage For More Than 30 Days” - https://search.plrb.org/?dn=77494&src=gsa
Webinar on “Homeowners Liability Coverage: Current Trends” - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0086
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/container.cfm?conlink=sec/cq/default.cfm) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
https://thenounproject.com/icon/garage-6216862/
https://fontawesome.com/icons/bolt-lightning?f=classic&s=solid
Is a recycle bin a “vehicle”? Does a car antenna ripping a coat fall under the Vehicles peril? How about a poorly secured wedding dress in the backseat of a convertible? If you occasionally win a biking competition, does the loss of your bike trigger business property coverage? Join Mike, Tim, and Alissha for the lightning round and discuss bikes, eBikes, sleds, boats, and more.
Notable Timestamps
[ 00:15 ] - The insured is an avid cyclist who occasionally wins money from his hobby. Another cyclist cut him off and he crashed his bike into a tree while at a park, destroying the bike.
[ 01:13 ] - Mike & Alissha share personal stories, including a disastrous encounter with a parked car.
[ 03:47 ] - The bike itself is Coverage C Personal Property as there’s an exclusion for motor vehicles, but not for vehicles.
[ 07:04 ] - There is a Named Peril for losses caused by vehicles. Courts interpret this broadly to mean anything from boats to sleds; rollerblades and recycle bins might be pushing it.
[ 09:22 ] - The force / weight / momentum of the vehicle must cause the loss. The team goes through a lightning quiz round exploring a variety of mini-scenarios on the vehicles peril.
[ 13:53 ] - Depreciation can be subtracted when the bike is replaced if it was paid under ACV.
[ 14:29 ] - Although the insured occasionally won money, that likely doesn’t qualify it as a business.
[ 15:18 ] - eBikes present novel issues due to the motor vehicles exclusion, so PLRB has prepared detailed resources on this issue.
[ 17:12 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Detailed annotation on Vehicles Peril - https://search.plrb.org/?dn=151&src=gsa
Legacy podcast on “The Coverage Contrarian: E-Bike Coverage Under a Homeowners Policy” - https://www.plrb.org/distlearn/podcasts/index.cfm?id=a0066
Coverage Question on “E-Bike Excluded Under "All Other Motorized Land Conveyances" Language” - https://search.plrb.org/?dn=74811&src=gsa
Adjuster Resource Sheet on “Analysis of Coverage for an E-Bike Accident under a Homeowners Policy” (includes a link to a 50-state compendium) - https://search.plrb.org/?DN=77489
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/container.cfm?conlink=sec/cq/default.cfm) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
https://freesound.org/people/univ_lyon3/sounds/541432/
https://fontawesome.com/icons/bicycle?f=classic&s=solid
This is a replay of an episode originally aired on Apr 22, 2025.
An adjuster working on a complex property damage claim closes the file, having paid out on the claim. Then they receive a notice that the insured is demanding appraisal. They call up the insured, only to find out that the insured has no idea what’s going on.
About Our Guest
Steven J. Badger, Partner, Zelle LLP sbadger@zellelaw.com https://www.linkedin.com/in/steven-badger-467b0322/
Notable Timestamps
[ 00:20 ] - The insured signed a form on a tabet, presented to them by the contractor, without realizing it authorized a later appraisal demand.
[ 01:13 ] - Steve shares an anecdote about his appraisal training sessions & debates.
[ 02:39 ] - Steve's review of the trends shows that contractor-driven appraisal demands are more common now than they used to be.
[ 03:50 ] - Assignment of Benefits would raise other issues and would not be permitted in all states.
[ 05:15 ] - The adjuster can begin addressing an appraisal demand by contacting the insured to ask if they are aware of the demand, if the work is complete in their opinion, and the amount they paid.
[ 07:22 ] - In the states where Steve practices, the contractor performing the work (and the public adjuster on the claim) cannot also act as the appraiser.
[ 08:45 ] - Steve leverages his presence on LinkedIn to call out illegal behavior.
[ 10:11 ] - Zelle LLP has drafted an alternative appraisal clause addressing abuses in the appraisal process. Removing the appraisal clause entirely would simply increase litigation.
[ 12:37 ] - The goal of appraisal is prompt amicable resolution of disputed claims.
[ 13:15 ] - Steve provides a recap of the scenario and the points above.
Your PLRB Resources
Steve will be presenting at the Texas Hail Claims Conference on February 12-13, 2026 in Dallas.
Recorded Webinar: Combatting Common Abuses and Schemes in CAT Claims - https://www.plrb.org/courses/combatting-common-abuses-and-schemes-in-cat-claims/
CE Course: Property Insurance Appraisal - https://www.plrb.org/courses/property-insurance-appraisal/
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
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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 scenario@plrb.org.
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).
This is a replay of an episode originally aired on Apr 15, 2025.
A Texas adjuster gets an assignment for a simple hail damage claim. He anticipates having to argue with the roofing contractor, debate whether overhead and profit is owed, deal with the supplementing company, receive an appraisal demand, and finally face a lawsuit. About Our Guest
Steven J. Badger, Partner, Zelle LLP sbadger@zellelaw.com https://www.linkedin.com/in/steven-badger-467b0322/ Notable Timestamps
[ 00:20 ] - Because of his years of experience, he knows that the 30 square comp shingle roof should cost about $20,000 to replace. (Amount provided is for reference and example purposes only.)
[ 01:10 ] - For 34 years, Steve Badger has represented mostly the commercial property insurance industry, and for the past decade has focused on catastrophe, hail, and wind claims.
[ 02:00 ] - Many policies allow the insurance company to replace the roof themselves through preferred contractors.
[ 04:15 ] - Having an "preferred contract network" or "managed repair" endorsement can reduce ambiguity as compared to the base policy.
[ 05:50 ] - Such endorsements could be optional or mandatory.
[ 07:00 ] - Steve argues that these endorsements can be a win/win/win for the insurer, insured, and contractor.
[ 08:20 ] - Steve explores the potential benefits of the endorsement, such as reduced deductibles.
[ 09:15 ] - Invoking "our option" means that if-- for example-- the selected contractor floods the house, the insurer could be responsible. However, an endorsement in this style could allow the insured to choose to employ the network. Further, contractors in the network could assume the risk.
[ 11:15 ] - Steve discusses industry interest in preventative solutions.
[ 13:00 ] - Steve contrasts the contractor who put on the roof asking for a supplement to a separate company focused on supplementation, and shifts focus to the insured's needs.
[ 16:10 ] - Steve provides a recap of the scenario and the points above.
Your PLRB Resources
Steve will be presenting at the Texas Hail Claims Conference on February 12-13, 2026 in Dallas.
Recorded Webinar: Combatting Common Abuses and Schemes in CAT Claims - https://www.plrb.org/courses/combatting-common-abuses-and-schemes-in-cat-claims/
CE Course: Roofing Fraud: Don't Get Nailed - https://www.plrb.org/courses/roofing-fraud-dont-get-nailed/
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
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LinkedIN - Please follow at “Property and Liability Resource Bureau”
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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 scenario@plrb.org.
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).
The insured's kitchen sink wasn’t draining well. A plumber scoped the line and found tree roots blocking it. The only fix is to dig up and replace the pipe. The adjuster checked the HO3 (2011) exclusions but didn’t find one specifically for tree roots. Do others apply?
Notable Timestamps
[ 00:45 ] – The adjuster checks the ISO HO3 (2011) policy but finds no explicit exclusion for damage caused by tree roots.
[ 04:44 ] – Tree root damage exclusions can exist in some policies, but are rare. If clearly written, they’re usually enforceable.
[ 05:30 ] – Lacking that, adjusters must look at general exclusions. The team explores all possibilities, including wear and tear, inherent vice, and non-fortuitous loss.
[ 06:14 ] – Does wear and tear apply? Tree root intrusion may be interpreted as gradual, expected deterioration, not sudden damage.
[ 07:14 ] – "Insurance covers risks, not costs." Damage expected to happen over time (like root growth) may fall outside coverage.
[ 10:12 ] – Earth movement was suggested as an exclusion. It's debatable whether tree roots pushing soil could qualify as "earth movement."
[ 12:08 ] – Inherent vice is another possible exclusion, if pipe failure resulted from defective materials rather than external damage.
[ 13:03 ] – Faulty maintenance or neglect may apply if the homeowner ignored known tree root issues or failed to maintain the system.
[ 14:01 ] – If pipe damage is covered, costs to dig up the lawn may also be covered as part of the repair.
[ 15:00 ] – But if the loss is excluded, tear-out costs likely aren’t covered unless tied to investigation or specifically included.
[ 16:04 ] – The bottom line: coverage depends on facts, foreseeability, and exclusions. Without a tree root exclusion, outcomes are uncertain.
Your PLRB Resources
FAQ: Tree Root Losses - https://www.plrb.org/documents/tree-root-losses/
Coverage Question: Tree Root Damage: Fortuitous or Non-Fortuitous? - https://www.plrb.org/documents/tree-root-damage-fortuitous-or-non-fortuitous-pcq-2022-01-21-dwf-b/
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
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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 scenario@plrb.org.
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).
A wealthy couple is murdered after a glamorous party—jewelry stolen, town abuzz. Their estate files an HO3 claim for the stolen jewelry and loss in home value due to the stigma. But does the policy cover reputational "diminution in value"? Notable Timestamps
[ 00:37 ] - The scenario involves a wealthy couple poisoned in their mansion, with jewelry stolen and a claim submitted under their HO3 policy ISO 2011 edition.
[ 01:39 ] - Trivia Time! Who are the six main characters of the board game Clue?
[ 03:40 ] - Diminution in value refers to a property's market value being less than before a loss, even after full physical repair, due to stigma.
[ 04:35 ] - The common argument against covering diminution in value is that policies typically cover physical loss and physical repair, not consequential or economic losses.
[ 06:16 ] - First-party auto and property policies share similar loss settlement language.
[ 07:47 ] - In Royal Capital Dev., LLC v. Maryland Cas. Co., No. S12Q0209, 2012 WL 1909842, — S.E.2d — (Ga. 5/29/12) [reviewed at PLRB, Prop. Ins. L. Rev. 8462 (2012)], the court allowed for diminution in value in a first-party property claim, drawing an analogy to auto claims.
[ 08:50 ] - If there were physical traces like blood or bullet holes from the murders, it could potentially establish a physical loss, strengthening an argument for diminution in value, even if the cleanup cost itself is minimal.
[ 10:28 ] - Real estate experts or appraisers could testify by comparing the home's value without the incident to similar properties affected by negative events.
[ 13:04 ] - It's crucial to check your jurisdiction; while Georgia allows it, many states disallow it, and others have no specific case law on the matter.
[ 14:00 ] - Tim provides a recap of the points above.
Your PLRB Resources
FAQ: Diminution in Value in First Party Property Claims - https://www.plrb.org/documents/diminution-in-value-in-first-party-property-claims/
Coverage Question: Pet Dog Attacked Owner; Blood on Carpet - https://www.plrb.org/documents/pet-dog-attacked-owner-blood-on-carpet-pcq-2023-10-27-twh-b/
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 scenario@plrb.org.
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).
John, a self-employed trucker, injures himself fixing his rig “Betsy” (1st PIP claim). Later, he’s hurt again when a mechanic’s shuttle van crashes (2nd PIP claim). Two accidents, two PIP claims—one while working, one as a passenger—make for a rough day. Notable Timestamps
[ 00:17 ] - John has two injury claims in Michigan: a slip and fall while working on his truck (Injury 1) and being rearended while a passenger in a mechanic's shuttle van (Injury 2).
[ 01:02 ] - Michigan was once the most expensive state for car insurance but has fallen to the sixth most expensive according to insure.com as of May 25. Which was the cheapest?
[ 02:22 ] - Michigan's standard PIP statute under MCL § 500.3114 dictates that the named insured generally collects benefits under their own auto insurance policy, not the policy covering the vehicle involved in the accident.
[ 02:49 ] - There are exceptions to the Michigan PIP priority rule, including when an insured is injured as an occupant of a vehicle owned by or registered to their employer or while a passenger in a vehicle used in the business of transporting passengers.
[ 04:04 ] - For John's first injury (slip and fall), regarding the "owned by employer" exception, a Michigan appellate court in the reviewed case held the truck was owned by both John (the driver/title holder) and the leasing company (Shoulder Trucking).
[ 05:36 ] - The court in this scenario found that he was an employee of himself as an independent contractor, leading his commercial insurance carrier to take priority.
[ 07:09 ] - For John's second injury (shuttle van), the key statutory exception language relates to being a passenger in a vehicle "used in the business of transporting passengers".
[ 07:52 ] - The phrase "in the business of transporting passengers" is construed in Michigan using a two-prong test from a seminal case: 1) whether transporting passengers was the primary purpose for the vehicle's use, and 2) whether the transportation was incidental to the overall business or activity.
[ 08:55 ] - Applying the two-prong test to the mechanic's shuttle van involves considering factors like whether the service was free (suggesting incidental) or regularly offered (suggesting primary purpose or not incidental). The court in the case discussed did not decide this issue for the shuttle van, sending it back to the finder of fact.
[ 09:39 ] - Brennan provides a recap of the scenario and the points above.
Your PLRB Resources
Case Law Review: Smith v. Farm Bureau Mut. Ins. Co. of Mich. (2025) https://www.plrb.org/documents/smith-v-farm-bureau-mut-ins-co-of-mich-2025/ Case Law Review: Miclea v. Cherokee Ins. Co. https://www.plrb.org/documents/miclea-v-cherokee-ins-co/
PLRB State-By-State Survey on PIP, Michigan → “Priority” https://www.plrb.org/documents/michigan-pip-compendium/#priority
Case Law Review: Bender v. USAA Gen. Indem. Co. (2025) https://www.plrb.org/documents/bender-v-usaa-gen-indem-co-2025/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
A "FastFeast" driver ends their shift but forgets to log out of the app. On the way home, they crash—and their insurance denies the claim. Why? They were still “on the job.” In the gig economy, one tap can mean the difference between coverage and denial. Notable Timestamps
[ 00:01 ] - The core scenario involves a driver for the delivery app FastFeast who had an accident on the way home after their shift and whose insurance claim was denied because they were still logged into the app.
[ 02:07 ] - A ghost kitchen is a delivery-only establishment with no physical storefront that exists solely on delivery apps. Some ghost kitchens are linked to existing restaurants, like one possibly operating out of Chuck E. Cheese kitchens...
[ 05:14 ] - Many personal auto policies, including older ones still in use, contain a livery or public conveyance exclusion that can apply if the vehicle is being used for ridesharing.
[ 07:15 ] - Applying the livery exclusion may lead to coverage issues when a rideshare driver is actively transporting passengers during an accident.
[ 08:10 ] - Under older livery language, it becomes ambiguous if an accident occurs while a driver is merely logged into the app awaiting an assignment but not actively carrying passengers or property.
[ 11:11 ] - The definition of "livery" in these exclusions has been debated in courts; a majority interpret it to include both passengers and property (cargo), while a minority have limited it to passengers only.
[ 14:21 ] - Modern exclusionary language for transportation network companies (TNCs) is designed to be less ambiguous than older livery clauses, often excluding coverage simply if the driver is logged into the TNC's digital network, regardless of whether they have an active customer.
[ 17:09 ] - Brennan provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage Question: “Does The “Livery Or Public Conveyance” Exclusion Apply To An Insured Logged Onto Door Dash But Not Making A Delivery? 2024.06.19” https://www.plrb.org/documents/does-the-livery-or-public-conveyance-exclusion-apply-to-an-insured-logged-onto-door-dash-but-not-making-a-delivery/?search=ride%20sharing%20exclusion
Coverage Question: “Does A Rideshare Exclusion Apply To An Insured Who Is Only Logged On To The Uber App? – 2024.03.04” https://www.plrb.org/documents/does-a-rideshare-exclusion-apply-to-an-insured-who-is-only-logged-on-to-the-uber-app-2024-03-04/?search=ride%20sharing%20exclusion
Emerging Issues: “Does a PAP Provide Coverage for Delivery Drivers Using Personal Vehicles with the Emergence of Ride-sharing Services Like Uber/Lyft/Grubhub? “https://www.plrb.org/documents/does-a-pap-provide-coverage-for-delivery-drivers-using-personal-vehicles-with-the-emergence-of-ride-sharing-services-like-uber-lyft-grubhub/?search=ride%20sharing%20exclusion#passorprop
Case Law Review: Bender v. USAA Gen. Indem. Co. (2025) https://www.plrb.org/documents/bender-v-usaa-gen-indem-co-2025/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
Our insured, a widow with two adult kids, dies in a house fire. Her son, who planned to move out soon, escapes unharmed. Her daughter, who lives out of state but stores a drum set in the basement, is the executrix and returns home to handle next steps and insurance. Notable Timestamps
[ 01:00 ] - The son planned to move into his girlfriend’s apartment by the end of the month
[ 02:00 ] - The death clause in the HO3 form is explained as a critical provision ensuring the dwelling remains covered after the named insured's death until the estate can be settled.
[ 03:00 ] - The policy language of the death clause states that the legal representative of the deceased is insured for the premises and property.
[ 04:00 ] - A legal representative is typically the judicially appointed executor or administrator, not just an heir.
[ 05:00 ] - Courts have generally held that the death clause overrides the personal property of others clause, which would likely preclude coverage for the daughter's drum set as she was not a resident insured at the time of the fire.
[ 06:00 ] - The son, who was living in the house at the time of the fire, is covered for his personal property, though he cannot make a claim for the dwelling itself.
[ 08:00 ] - The son's ALE coverage would cease if he moves in with his girlfriend, and the daughter is not entitled to ALE because she was not a member of the household at the time of the named insured's death.
[ 09:00 ] - The difference in ALE coverage for the son and daughter reflects the insurance policy's goal to maintain the pre-loss situation, covering the resident son but not the non-resident daughter.
[ 10:00 ] - Coverage under the death clause is intended as a temporary measure providing peace of mind to the family while they settle affairs, and it ends once the estate is settled.
[ 11:00 ] - If the legal representative deeds the house to themselves after the named insured's death but before a loss, coverage under the original policy terminates because the insurance follows the named insured's personal interest, not just the property.
[ 12:00 ] - Once the property is deeded to new owners (even family members), they must obtain their own insurance for coverage.
[ 13:00 ] - John provides a recap of the scenario and the points above.
Your PLRB Resources
Annotation on the Death Clause - https://www.plrb.org/documents/death-ho120/?search=death Coverage Question: “Does the Death Clause Prevent the Insurer From Cancelling the Policy?” - https://www.plrb.org/documents/does-the-death-clause-prevent-the-insurer-from-cancelling-the-policy-pcq-2019-11-19-twh-a/?search=death%20clause
Case Law Review: “Insurable Interest Lost When Executor Transferred Property To Self” - https://www.plrb.org/documents/archer-v-cotton-states-mutual-ins-co-2010/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
A windstorm-caused power outage at the Cheesecake Manufactory led to the spoilage of hundreds of cheesecakes and a business income loss. The adjuster is questioning if the windstorm deductible applies to the claim, despite the power outage being the direct cause of the spoilage. Notable Timestamps
[ 00:00 ] - The scenario presented involves a windstorm that caused a power outage, leading to spoiled cheesecakes and a claim for spoilage and lost business income, raising the central question of whether the windstorm deductible applies given the chain of events.
[ 01:30 ] - Trivia: Where did the maximum natural wind gust ever recorded occur?
[ 03:00 ] - The windstorm deductible endorsement states it applies to losses "caused directly or indirectly by windstorm or hail", but this language, even with "indirectly," can still lead courts to perform a proximate cause analysis, often leaving the "dominant and efficient cause" determination to a jury, unlike clearer anti-concurrent causation language.
[ 04:30 ] - While "directly or indirectly" might address some indirect causation issues, the very definition of "windstorm" is not straightforward and is heavily subject to interpretation by courts based on specific case facts.
[ 06:00 ] - Case law interpretations of "windstorm" can be narrow, such as a Rhode Island case finding high winds didn't qualify due to excessive rain; or surprising, like a Texas court holding a tornado was not a windstorm for deductible purposes.
[ 07:30 ] - Is a tornado the epitome of a windstorm? Depends on who you ask...
[ 09:00 ] - When two different endorsement provisions contain irreconcilable conflicts, such as both stating that "no other deductible applies" to the coverage they provide, a court might determine that no deductible applies at all.
[ 12:00 ] - The business income claim follows a chain of events from the windstorm to the power outage and then the spoilage. The business income loss specifically results from the inability to operate due to the spoiled inventory, which might also involve potential Extra Expense.
[ 13:30 ] - Brennan provides a recap of the scenario and the points above.
Your PLRB Resources
PLRB Catastrophe Services Launches New Power Outage Reports - https://www.plrb.org/documents/plrb-catastrophe-services-launches-new-power-outage-reports/?search=power%20outage%202025
Turner Construction Co. v. ACE Prop. & Cas. Ins. Co., No. 04-4451-CV, 2005 WL 2837575, — F.3d — (2d Cir. 10/28/05) (applying Texas law) reviewed at PLRB, Prop. Ins. L. Rev. 6978 (2005)
Windstorm Deductible – Food Spoilage – BI – PCQ.2024.07.26.twh.a - https://www.plrb.org/documents/windstorm-deductible-food-spoilage-bi-pcq-2024-07-26-twh-a/?search=power%20outage%202024
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
A windstorm knocks over a power line, causing hundreds of cheesecakes at a local restaurant to spoil. The owners have to close for a few days as they manufacture more. Their adjuster wants to know how to investigate the storm and power outage. Notable Timestamps
[ 00:20 ] - The loss of desserts is always tragic, even lemon merengue.
[ 01:00 ] - Trivia: Which variety of cheesecake contains "quark"? Or should we say "Weißkäse"?
[ 01:50 ] - PLRB.org features a Weather and Catastrophe hub designed for insurance professionals and not for cat enthusiasts.
[ 02:17 ] - Users can get a full weather/cat report from the historical weather section of the Weather and Cat hub by entering an address and date range.
[ 03:11 ] - A full weather/cat report provides data including hail, wind, precipitation, lightning probability, storm reports, and watches/warnings.
[ 04:15 ] - For this scenario, the report showed evidence of strong winds, such as a 72 or 73 mile per hour gust reported near the scenario's location in Waco, Texas.
[ 06:08 ] - The PLRB hub also offers a power outage report tool which uses data from power outage US and covers 80% of the United States.
[ 07:18 ] - The power outage report can show the location of outages near the address, indicating that power was out in the general area.
[ 08:13 ] - Both the full weather/cat report and the power outage report can be combined to provide evidence, in this scenario for example, that a storm came through and knocked out power for the area.
[ 09:59 ] - Dylan provides a recap of the scenario and the points above.
Your PLRB Resources
Get a Full Weather/CAT Report (hail, wind, precipitation, more) - https://www.plrb.org/weather-cat/plrb-cat-data/
PLRB Catastrophe Services Launches New Power Outage Reports - https://www.plrb.org/documents/plrb-catastrophe-services-launches-new-power-outage-reports/?search=power%20outage%202025
Mankoff v. Privilege Underwriters Reciprocal Exch., No. 05-22-00963-CV, 2024 Tex. App. LEXIS 594 (Tex. App. 01/29/2024) (Court of Appeals of Texas, 5th District, applying TX law) [reviewed at PLRB, Prop. Ins. L. Rev. (2024)] - https://www.plrb.org/documents/mankoff-v-privilege-underwriters-reciprocal-exch-2024/?search=mankoff
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
A plumber drove the company truck the wrong way on a busy highway for some time before he realized, panicked, swerved, and flipped the truck. Police believe he was on illegal drugs, although he disputes it. His employer claims equipment damage under their BOP policy.
Notable Timestamps
[ 00:25 ] - The plumber (the business) is now making a claim under their businessowners policy, BP 00 03 07 13, for the $50,000 worth of plumbing equipment and parts damaged in the accident.
[ 01:45 ] - This episode was filmed at the 2025 PLRB Claims Conference in Indianapolis, right in the middle of the Expo hall at the PLRB booth!
[ 04:00 ] - The BOP: The hottest dance craze, or finally a policy too large for a pocket?
[ 04:40 ] - BOP policies are primarily on-premises forms, but a small amount of coverage exists for Off-Premises Coverage for property in the course of transit or at a premises the insured does not own, lease, or operate.
[ 06:24 ] - The highway is probably not a "premises." As for whether a van can be a premises, that might be a topic for a future episode.
[ 07:30 ] - The tools were not intended to be removed and left at the job site, so they would likely not be considered in transit.
[ 09:30 ] - Dishonest or criminal acts are excluded, and arguably it is not necessary to wait for a criminal conviction to qualify as a "criminal act."
[ 12:00 ] - If the driver was under the influence and another car swerved into its lane, one could argue that the accident would have happened anyway. In this case, if the influence of drugs is proven, it likely caused the loss.
[ 13:35 ] - The dishonest or criminal acts exclusion does not apply to "acts of destruction." There is no intent here so it's unlikely, but the case law is limited.
[ 16:00 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Annotation: BP34 - Personal Property Off Premises - https://www.plrb.org/documents/bp34-personal-property-off-premises/?search=%22In%20Transit%22%20coverage%20in%20the%20BP%2000%2003%2007%2013
Coverage Question: In Transit; Stop For Gas Does Not Mean That Money Was Not In Transit At Time Of Loss - https://www.plrb.org/documents/in-transit-stop-for-gas-does-not-mean-that-money-was-not-in-transit-at-time-of-loss-pcq-2022-08-18-jem-b/?search=%22In%20Transit%22%20coverage%20in%20the%20BP%2000%2003%2007%2013
Recorded Webinar: Product Liability Cases Involving Emerging Risks: Vaping/Marijuana/Toxic Torts - https://www.plrb.org/courses/marijuana-cannabis-hemp-drugs/lessons/product-liability-cases-involving-emerging-risks-vaping-marijuana-toxic-torts/
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
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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 scenario@plrb.org.
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).
An adjuster working on a complex property damage claim closes the file, having paid out on the claim. Then they receive a notice that the insured is demanding appraisal. They call up the insured, only to find out that the insured has no idea what’s going on.
About Our Guest
Steven J. Badger, Partner, Zelle LLP sbadger@zellelaw.com https://www.linkedin.com/in/steven-badger-467b0322/
Notable Timestamps
[ 00:20 ] - The insured signed a form on a tabet, presented to them by the contractor, without realizing it authorized a later appraisal demand.
[ 01:13 ] - Steve shares an anecdote about his appraisal training sessions & debates.
[ 02:39 ] - Steve's review of the trends shows that contractor-driven appraisal demands are more common now than they used to be.
[ 03:50 ] - Assignment of Benefits would raise other issues and would not be permitted in all states.
[ 05:15 ] - The adjuster can begin addressing an appraisal demand by contacting the insured to ask if they are aware of the demand, if the work is complete in their opinion, and the amount they paid.
[ 07:22 ] - In the states where Steve practices, the contractor performing the work (and the public adjuster on the claim) cannot also act as the appraiser.
[ 08:45 ] - Steve leverages his presence on LinkedIn to call out illegal behavior.
[ 10:11 ] - Zelle LLP has drafted an alternative appraisal clause addressing abuses in the appraisal process. Removing the appraisal clause entirely would simply increase litigation.
[ 12:37 ] - The goal of appraisal is prompt amicable resolution of disputed claims.
[ 13:15 ] - Steve provides a recap of the scenario and the points above.
Your PLRB Resources
Steve will be presenting at the Texas Hail Claims Conference on February 12-13, 2026 in Dallas.
Recorded Webinar: Combatting Common Abuses and Schemes in CAT Claims - https://www.plrb.org/courses/combatting-common-abuses-and-schemes-in-cat-claims/
CE Course: Property Insurance Appraisal - https://www.plrb.org/courses/property-insurance-appraisal/
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
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Send us your Scenario!
Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.
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).
A Texas adjuster gets an assignment for a simple hail damage claim. He anticipates having to argue with the roofing contractor, debate whether overhead and profit is owed, deal with the supplementing company, receive an appraisal demand, and finally face a lawsuit. About Our Guest
Steven J. Badger, Partner, Zelle LLP sbadger@zellelaw.com https://www.linkedin.com/in/steven-badger-467b0322/ Notable Timestamps
[ 00:20 ] - Because of his years of experience, he knows that the 30 square comp shingle roof should cost about $20,000 to replace. (Amount provided is for reference and example purposes only.)
[ 01:10 ] - For 34 years, Steve Badger has represented mostly the commercial property insurance industry, and for the past decade has focused on catastrophe, hail, and wind claims.
[ 02:00 ] - Many policies allow the insurance company to replace the roof themselves through preferred contractors.
[ 04:15 ] - Having an "preferred contract network" or "managed repair" endorsement can reduce ambiguity as compared to the base policy.
[ 05:50 ] - Such endorsements could be optional or mandatory.
[ 07:00 ] - Steve argues that these endorsements can be a win/win/win for the insurer, insured, and contractor.
[ 08:20 ] - Steve explores the potential benefits of the endorsement, such as reduced deductibles.
[ 09:15 ] - Invoking "our option" means that if-- for example-- the selected contractor floods the house, the insurer could be responsible. However, an endorsement in this style could allow the insured to choose to employ the network. Further, contractors in the network could assume the risk.
[ 11:15 ] - Steve discusses industry interest in preventative solutions.
[ 13:00 ] - Steve contrasts the contractor who put on the roof asking for a supplement to a separate company focused on supplementation, and shifts focus to the insured's needs.
[ 16:10 ] - Steve provides a recap of the scenario and the points above.
Your PLRB Resources
Steve will be presenting at the Texas Hail Claims Conference on February 12-13, 2026 in Dallas.
Recorded Webinar: Combatting Common Abuses and Schemes in CAT Claims - https://www.plrb.org/courses/combatting-common-abuses-and-schemes-in-cat-claims/
CE Course: Roofing Fraud: Don't Get Nailed - https://www.plrb.org/courses/roofing-fraud-dont-get-nailed/
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 scenario@plrb.org.
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).
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 sponsorship@plrb.org
Contact Tom O'Dowd at todowd@plrb.org
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
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Send us your Scenario!
Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.
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).
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
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Send us your Scenario!
Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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
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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 scenario@plrb.org.
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).
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
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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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
Today we’re going to feature an excellent podcast episode 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 how the expected or intended injury exclusion applies when a person punches another in the jaw without knowing their own strength. Let’s listen in. Key Takeaways
When considering whether this exclusion applies to a given claim, one must always know three things:
- the jurisdiction whose law would govern
- the version of the exclusion contained in the policy you're dealing with;
- and most importantly, one must know all of the relevant facts bearing on the application of the exclusion.
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 - https://www.plrb.org/documents/additional-living-expenses-ho37/#toc47
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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
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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 scenario@plrb.org.
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).
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
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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 scenario@plrb.org.
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).
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
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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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
Today our adjuster is leveling up in their career and handling their first large loss property claim. The adjuster quickly runs into trouble-- where can a claims professional go for help? This October 23 to 25 in Tampa, join PLRB for the 2024 Large Loss Conference. Notable Timestamps
[ 00:39 ] - Alissha asks HERSELF "what's the scenario?" This scenario features late notice, Category 3 water, and additional damage during a claim.
[ 01:57 ] - The team talks Tampa taco trucks & Cuban cuisine.
[ 03:24 ] - Late notice issues? Attend the educational session "It’s Too Late, Baby, It’s Too Late: Navigating a Late Reported Large Loss" with Andy Rock (Rock Law Group) & Gregg Golson (J.S. Held LLC).
[ 04:34 ] - For water mitigation issues, check out "Interpreting the Microbiology of Storm Damage" with Jeremy Beagle (SDII Global).
[ 05:05 ] - For other large storm issues, see "A Coastal Catastrophe: Navigating a Large Hurricane Loss in the Northeast" with Anthony Antonellis and Brendan Labbe (both of Sloane and Walsh LLP), and "Double Trouble: Multiple Storms at the Same Property" with David Frantz (Kubicki Draper, P.A.).
[ 05:45 ] - The Large Loss Conference is intended for claims professionals involved in these losses or hoping to get experience with larger claims, as well as the experts, attorneys, and accountants who provide insights on these claims.
[ 06:43 ] - The Large Loss Conference is differently structured than PLRB's other conferences. The educational sessions are 90 minutes long, often more focused on case studies, and involve more interactivity.
[ 07:56 ] - Andrew features the educational session "Back to the Future: How Adjusters Can Use Forensic Meteorology in Hail and Wind Claims" with Howard Altschule (Forensic Weather Consultants).
[ 08:48 ] - The Large Loss Conference features many casualty and personal lines sessions as well, such as "We Didn't Start the Fire: Was it Smoking or Smokin'" with David Heemann (Mutual of Enumclaw), Pete Fowler (Fowler Construction Consultants), and Jennifer Kalvestran (Anderson, McPharlin & Conners LLP).
[ 11:08 ] - The conference's general session will feature "Fraud and Other Abuses In CAT Claims, What The Hail Is Going On?" with Steve Badger (Zelle LLP).
[ 11:56 ] - Most educational sessions are approved in FL, TX, DE, NC, and OK Continuing Education credit, and even some courses approved for GA CE credit!
[ 12:56 ] - To register, visit PLRB.org and click on the banner on the main page OR the Events tab. Registration is free for members.
[ 13:50 ] - Jeff Kerensky & Maria McNally will be available to discuss membership or website questions.
[ 14:45 ] - Alissha provides a recap of the scenario and the points above.
Your PLRB Resources
PLRB's Events tab: https://www.plrb.org/plrb-events/
Direct Link to PLRB's Large Loss page: https://cvent.me/Ze4y1w
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
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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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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).
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 scenario@plrb.org.
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/
One day a hailstorm hits a bike manufacturer's warehouse, and the property owner is overwhelmed by the loud sounds of the hail hitting the metal roof. But when the adjuster gets up on the roof, the dents turn out to be minor, arguably cosmetic.
Notable Timestamps
[ 00:18 ] - Despite the dents appearing to be cosmetic, the insured requests a new roof.
[ 01:08 ] - Jeff and Mike compete for the best "dad joke."
[ 01:53 ] - The hail was "direct" and "physical", but was it a "loss"? If the roof is now leaking, that would qualify as damage because it is a loss of functionality. Without a leak, it's a harder question.
[ 04:05 ] - Another claim is that the dents lessened the life expectancy of the roof. That becomes a fact question.
[ 06:40 ] - The "ugly" factor? Another claim is that the dents lessened the eventual sale price of the building. Many loss in value claims fall under the deductible, but others can qualify as a direct physical loss.
[ 09:50 ] - If the dent is hard to see, that can impact the loss in value claim, but not necessarily defeat it.
[ 10:40 ] - A third argument for coverage would be that the dents invalidated the insured's warranty on the roof, and that loss should be considered a "loss" as in "direct physical loss".
[ 14:00 ] - Some insurers have argued that it's wasteful to replace a roof that is not functionally impacted, but this argument is unlikely to be successful.
[ 15:40 ] - Replacement Cost may be significantly higher than Actual Cash Value in a scenario like this.
[ 16:16 ] - Jeff provides a recap of the scenario and the points above.
[ 18:35 ] - We'd like to shout out "The Future of Insurance," PLRB CEO Bryan Falchuk's podcast.
Your PLRB Resources
Is Hail Splatter a Direct Physical Loss? – PCQ.2019.09.26.jch.a - https://www.plrb.org/documents/is-hail-splatter-a-direct-physical-loss-pcq-2019-09-26-jch-a/?search=cosmetic
Webinar: Coverage Challenges with Common Endorsements (Includes discussion of Cosmetic Damage) - https://www.plrb.org/courses/coverage-challenges-with-common-property-endorsements/
Annotation - Cosmetic Damage HO 06 43 & HO 06 44 (HO16E) - https://www.plrb.org/documents/cosmetic-damage-ho-06-43-ho-06-44-ho16e/
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 scenario@plrb.org.
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/
Anytime something with wheels leads to a claim, Parker's colleagues come to Parker to find out whether the claim should fall under the CGL policy or the auto policy… or a secret third option.
Notable Timestamps
[ 00:22 ] - Mike details the above scenario.
[ 01:15 ] - An "auto" would usually be covered under Business Auto policy, whereas "mobile equipment" would typically be covered under CGL.
[ 02:20 ] - "Auto" means: 1. A land motor vehicle, "trailer" or semitrailer designed for travel on public roads; . . . However, "auto" does not include "mobile equipment".
[ 03:15 ] - For the full definition of "mobile equipment", see: https://www.plrb.org/documents/gl14-mobile-equipment-defined/
[ 05:00 ] - The game begins! Is it an "auto" or a piece of "mobile equipment"? Cars are autos, while bulldozers are mobile equipment.
[ 07:10 ] - Dump trucks are considered autos.
[ 07:50 ] - What about a road grader that is used for snow removal? Recall that "self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos:" ... Equipment designed primarily for: Snow removal;" In this case, it was not designed "primarily" for snow removal.
[ 09:35 ] - Backhoes, skid steers, and combines are equipment, but a boat is neither!
[ 11:40 ] - An auto with a permanently attached tree removal device? "Mobile equipment" means... "Vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted ... Power cranes, shovels, loaders, diggers or drills;"
[ 13:29 ] - A cherry picker is dual purpose: can be considered an auto or a piece of mobile equipment, depending on if the stabilizers are down and the truck is in use.
[ 16:01 ] - Mike provides a recap of the scenario and the points above.
Your PLRB Resources
Policy Annotation - GL14 – “Mobile Equipment” Defined - https://www.plrb.org/documents/gl14-mobile-equipment-defined/
Will CGL Liability Coverage Apply When the Insured Loses Control of a Bobcat at a Work Site Damaging a Parked Vehicle? 2023.07.27jrm - https://www.plrb.org/documents/will-cgl-liability-coverage-apply-when-the-insured-loses-control-of-a-bobcat-at-a-work-site-damaging-a-parked-vehicle-2023-07-27jrm/
In South Carolina, Is A Golf Cart Mobile Equipment? 2023.01.12 - https://www.plrb.org/documents/in-south-carolina-is-a-golf-cart-mobile-equipment-2023-01-12/
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 scenario@plrb.org.
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). 1971 Plymouth Roadrunner. Greg Gjerdingen from Willmar, USA. Wikimedia Commons. CC-2.0. Other images: Pixabay, CC0, Public Domain, or Adobe Stock.
The named insured has retired and moved to his condo in Florida. His adult daughter accepted a new job in the city her father is leaving, so she and her two children have moved into the insured dwelling. A fire occurred destroying the entire home and all of its contents.
Notable Timestamps
[ 00:37 ] - John details the above scenario.
[ 02:30 ] - Who is "You"? "You" is the named insured or insureds indicated in the Declarations, and the spouse of that person if the spouse is a household resident.
[ 03:45 ] - How does the insurance policy define "y'all"? Or "youse"?
[ 04:11 ] - "Residence Premises" is the one-, two-, or three-family dwelling listed in the Declarations in which "you" reside.
[ 05:26 ] - The majority of courts would hold that the named insured could not recover for this loss because he relinquished residency: left for six months, initially planned to sell, got a new driver's license, never planned to move back, changed voter registration, forwarded mail, etc.
[ 06:10 ] - Snowbirds who move back and forth have an intention to return, so they would likely be covered in a similar situation.
[ 07:05 ] - A minority of courts allow coverage as long as the insured resided in the premises at the inception of the policy period.
[ 07:40 ] - The insured's contents would be covered because coverage for contents are not tied to residency.
[ 08:55 ] - The daughter is not a named insured, and is likely not an "insured" (members of your household who are also your relatives) because she is not a member of the insured's household.
[ 10:10 ] - To determine who is a member of the household, courts generally look to (1) whether they live under the same roof, (2) whether they live in a close intimate relation, and (3) whether the length of stay is substantial. (ISO has added language to include college students, who intend to return.)
[ 11:55 ] - The children of divorced parents may be considered members of multiple households.
[ 12:45 ] - What if the fire had been set intentionally by the grandchild? Since the child is not an insured, it wouldn't fall under the intentional loss exclusion.
[ 14:26 ] - If the insurance company knew or had cause to know that the insured had moved and kept accepting premiums, they could be estopped from making the argument against coverage.
[ 16:33 ] - John provides a recap of the scenario and the points above.
Your PLRB Resources
To learn more about this issue specifically, look up our 50 state survey: Must Insured Reside At Premises? – An Introduction https://www.plrb.org/documents/introduction-must-insured-reside-at-premises/
Also see the PLRB’s annotation on the definition of “insureds” in the policy at PLRB, Homeowners Annot., Key HO5 https://www.plrb.org/documents/insured-ho5/?search=HO5
...and the definition of “residence premises” at PLRB, Homeowners Annot., Key HO10. https://www.plrb.org/documents/residence-premises-ho10/
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 scenario@plrb.org.
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).
Tree-lined residential drive in Boston, MA. The neighborhood kids were playing baseball in the street, and the big kid hit a home run; ball landed on the roof. It was a flat roof with a drain in the middle of it. The ball somehow rolled right onto the drain and completely blocked the top of it. The poor homeowner had no idea, and heavy rains came through that night, causing several inches of water to build up on the roof, eventually finding its way inside the house. This caused $20,000 in water damage to the interior of the building, and the insured is looking for coverage.
Notable Timestamps
[ 00:25 ] - The adjuster is wondering about two exclusions: (1) surface water, and (2) backup of drains. The policy is an ISO 00 03 05 11.
[ 01:33 ] - Would you give a ball back if it rolled onto your property?
[ 02:30 ] - A July 23, 2024 MA Supreme Court decision will likely be impactful on surface water issues.
[ 03:10 ] - Surface water typically applies to rain or melted snow entering a home from the yard or driveway. What about a patio 6 inches high? A deck 3 feet up? A roof?
[ 05:00 ] - Historically water on a roof was not considered surface water, but in the last decade many courts held that the surface water exclusion might apply to water on roofs. See Martinez v. Am. Family Mut. Ins. Co. 413 P.3d 201 (Colo. App. 2/09/17): "the rooftop of his home [was] a mere continuation of 'the earth's surface.'"
[ 07:30 ] - The MA Supreme Court's decision that water on a roof is not excluded as surface water only applies to MA, but other states may find it persuasive given the infrequency of major decisions on these issues.
[ 09:30 ] - The backup and overflow exclusion likely does not apply because the water never even entered the drain, much less backed up out of it.
[ 11:20 ] - The majority view of "water which backs up" terms it as water that flows in reverse.
[ 13:10 ] - Let's say the kids put the ball down the drain intentionally. Coverage A is all-risk, open peril; the loss is covered unless it's excluded. The exclusion for vandalism wouldn't apply as the home was not vacant for 60 days. That loss would likely be covered.
[ 15:00 ] - Let's say it was leaves blocking up the drain. Could faulty maintenance apply? That would be dependent on the severity of the build-up and other circumstances. Ensuing loss concerns may impact this issue. https://www.plrb.org/documents/massachusetts-ensuing-resulting-loss/
[ 17:50 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Zurich American Insurance Company v. Medical Properties Trust, Inc. - https://www.plrb.org/documents/zurich-am-ins-co-v-med-properties-tr-inc-2024/
Flat Roof Drain Blockage on Commercial Building – PCQ.2024.07.26.twh.b - https://www.plrb.org/documents/flat-roof-drain-blockage-on-commercial-building-pcq-2024-07-26-twh-b/
Surface Water – “Act of Nature or Otherwise Caused” – PCQ.2021.10.31.twh.a - https://www.plrb.org/documents/surface-water-act-of-nature-or-otherwise-caused-pcq-2021-10-31-twh-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 scenario@plrb.org.
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).
A claims adjuster is out at a party when they are asked: “So, what do you do for a living?” Our adjuster responds with just: “I’m in insurance claims.” That’s an “Oh no” moment. Turns out their cousin had a terrible experience on a claim and our adjuster is going to hear all about it, ending in: “You claims people are all cheaters!”
Notable Timestamps
[ 00:36 ] - Today's scenario begins as an interpersonal encounter about explaining your career in insurance, but the elevator pitch is applicable even on claims.
[ 02:05 ] - What our claims professional needed was an elevator pitch: a succinct, prepared, organized response. Whether at a party or at a claims site, our adjuster wants to know how to summarize their thoughts in a persuasive way. Ding Ding! Your elevator’s here! Are you ready?
[ 02:30 ] - Mike was asked: "what's your elevator pitch?" That was an "oh no" moment...
[ 03:35 ] - An elevator pitch is a simple presentation that you give in the time it would take to ride an elevator: around 30 seconds.
[ 04:18 ] - 1. Grab 'em at the beginning. Get their attention with a great opening.
[ 04:25 ] - 2. Tell 'em what you're gonna tell 'em. Be organized in your thought process.
[ 04:32 ] - 3. Hit 'em with your bid conclusion/sell/ask. Be brief and practiced.
[ 05:11 ] - Alissha: "So, what do you do for a living?" Mike: 1. "I allow you to take the risks to make life worth living." 2. "Without insurance, you wouldn't be able to insure your home or car." 3. "We step in when bad things happen and we hope to get people back on their feet."
[ 09:15 ] - Be prepared, be organized, be succinct.
[ 10:00 ] - Let's say an insured has suffered a casualty loss. How can an elevator pitch help? 1. "I'm so sorry that this happened." Take a moment to express sincere empathy. 2. Review the medical records / facts. 3. "I know that this has impacted your life, so how about we take care of your damages?"
[ 11:50 ] - What's the pitch for a hurricane loss? Again, start off with an emotional connection. Second, spell out the steps to get them back into the place they were before the accident. Third, conclude with the ask and what you need for the next steps.
[ 13:35 ] - Mike applies the elevator pitch to auto claims handling.
[ 15:42 ] - Mike provides a recap of the scenario and the points above.
Your PLRB Resources
Mike’s PLRB Presents presentation on this topic: https://www.plrb.org/courses/pitching-in-an-elevator-2/lessons/pitching-in-an-elevator/
Webinar: Designing & Delivering Effective Business Presentations - https://www.plrb.org/courses/designing-delivering-effective-business-presentations/lessons/designing-delivering-effective-business-presentations/
Claims Chat: Why Should You Consider Claims as a Career? - https://www.plrb.org/courses/why-should-you-consider-claims-as-a-career/lessons/why-should-you-consider-claims-as-a-career/
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 scenario@plrb.org.
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).
Mungle’s Crackers manufactures crackers shaped like exotic land and sea animals, among other food products. Apparently there was a bad batch of their latest line of Platy-Pies, because reports of moldy bags of pastries covered their social media and they had to recall many bags of the high-fructose treats. One angry customer got ill after his snack and has already filed a lawsuit against the company.
Notable Timestamps
[ 00:15 ] - Today's scenario will be Mike's debut as a host!
[ 00:37 ] - This Notice of Loss landed on the desk of our adjuster Ralph, who is relatively new to insurance and totally new to commercial lines. Ralph would like to be walked through how to approach this claim and claims in general.
[ 01:39 ] - The team agrees that today's scenario, which was drafted by the producer who also edits these show notes, is GOOD and HAS CREATIVE NAMES.
[ 02:05 ] - The acronym "DECIDE" takes the adjuster through the Declarations page, Endorsements, Conditions, Insuring agreement, Definitions, and Exclusions.
[ 05:50 ] - The policy itself can act as a checklist, and this is a helpful mnemonic can be helpful for adjusters (and numismatists).
[ 06:30 ] - A Reservation of Rights letter can mention that investigation is underway, but advise the insured of potential coverage issues.
[ 08:00 ] - Declarations page: Checking that the company insures the involved entity, that the loss fell within the effective dates, what the insured's limits are, etc.
[ 08:55 ] - Endorsements: Any food product recall coverage? Are any other parties insured? Do special limits of liability apply?
[ 09:28 ] - Conditions: Let's say the insured sent out $50 coupons to each affected customer, then sought reimbursement. The Voluntary Payments section would likely create an issue for the insured in that case.
[ 10:20 ] - Insuring agreement: It is not disputed that an accident led to bodily injury in this claim.
[ 11:05 ] - Definitions: "Occurrence", "bodily injury", "property damage" (moldy products?) are likely all defined. Endorsements can modify those definitions. Members can reach out to PLRB attorneys for guidance.
[ 12:05 ] - Exclusions: Exclusions like Recall / Sistership may apply.
[ 13:15 ] - Supervisors or even a roundtable of colleagues can be a great resource.
[ 14:00 ] - The next step is likely to examine the allegations. The duty to defend can be broader than the duty to provide coverage.
[ 15:00 ] - Mike provides a recap of the scenario and the points above.
Your PLRB Resources
Claims Chat - https://www.plrb.org/courses/can-you-help-me-walk-through-a-claim-part-1/lessons/can-you-help-me-walk-through-a-claim-part-1/
Part 2 - https://www.plrb.org/courses/can-you-help-me-walk-through-a-claim-part-2/lessons/can-you-help-me-walk-through-a-claim-part-2/
Simple Approach to Coverage Decisions (eLearning that’s a good start for anyone looking to understand a policy) - https://www.plrb.org/courses/a-simple-approach-to-coverage-decisions/
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 scenario@plrb.org.
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).
An adjuster is assigned a property loss claim. The insured’s house is in South Zanesville, Ohio on Cinema Drive, and they experienced hail damage to a portion of their roof on June 16. Their homeowners policy was only recently purchased on June 1 of this year. This claim brings up a number of questions, and luckily the adjuster is an employee of a PLRB member company, so they log on to PLRB.org. When they log in using their company email, they realize that PLRB.org has recently been upgraded with a new look and a member-structured approach. How can the member use the new PLRB.org to answer their question?
Notable Timestamps
[ 00:16 ] - Employees of PLRB member companies can create an account at PLRB.org, via their work emails, at no charge to them or their companies.
[ 01:23 ] - Jeff Kerensky has worn many hats at PLRB, but surely his appearance on this podcast is the pinnacle of his career... at least until his next pod.
[ 03:04 ] - Members can confirm hail damage at a specific date and address via PLRB's weather hub, specifically the Hail Search. It will show weather reports including hail size and their proximity to your selected location.
[ 07:16 ] - "OH..." (You say the rest.)
[ 09:40 ] - Only part of the roof was damaged, and matching is a state-specific issue. Thanks to PLRB's State-By-State on Matching, we know that a reasonableness standard will apply in Ohio.
[ 14:00 ] - Typing in an address on the PLRB.org Building Codes hub will show the local/state/relevant rules on topics like drip edges, ice barriers, etc.
[ 16:55 ] - Jeff provides a recap of the scenario and the points above.
[ 18:30 ] - This podcast is available in video format on PLRB.org or on YouTube! This episode includes visuals from Jeff's walkthrough.
Your PLRB Resources
Weather Hub: https://www.plrb.org/weather-cat/
Hail Search: https://cats.plrb.org/imaps/Hail_Research/
Property Hub (Including 50-State Surveys): https://www.plrb.org/property-lines/
Matching in Ohio: https://www.plrb.org/documents/ohio-matching/
Building Code Hub (Including Address Search): https://www.plrb.org/building-codes/
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 scenario@plrb.org.
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).
Homeowner is relaxing one night, and all of the sudden there was a huge clap of thunder. It was so loud she thought it might have hit the house or somewhere in the yard … but everything looked ok. Six weeks later she got her normal water bill in the mail (billed quarterly), and to her surprise, it was outrageously high – $4,500. She knew she wasn’t taking that many showers and thought there must be a leak, so she called a plumber who came over, scoped a camera, and found a big leak underground next to the house. It looked like the underground pipe had burst open, not just deteriorated. The homeowner immediately knew what happened: lightning damaged the pipe 6 weeks ago.
Notable Timestamps
[ 00:15 ] - The insured wants coverage for 3 things: (1) the water bill, (2) the plumber’s invoice for the camera inspection, and (3) repairing the underground pipe, including the cost to dig out the land and replace it with sod to access the pipe. Policy = ISO HO 00 03 05 11
[ 01:45 ] - Trivia Time! Where is the lightning capital of the United States? What is the study of lightning called?
[ 03:35 ] - Now for a multiple choice: Is it Coverage A, Coverage B, or Coverage C? The answer is likely C! The water lost is personal property.
[ 04:18 ] - Newer policies state that water is Property Not Covered, but older ones don't. This only applies to homeowners losses; commercial properties have an exclusion that likely applies.
[ 06:00 ] - Whether Lightning or Accidental Discharge from a Plumbing System (or Zeus?), this is likely a covered cause of loss.
[ 07:00 ] - Once the insured demonstrates a direct physical loss, the burden shifts to the insurance company. So, if the insurer wants to investigate further, the insurer would pay for that.
[ 08:45 ] - As long as the insured's investigation (the plumber's investigative camera-scoping) was reasonable, it is likely covered even if it occurred prior to the claim being filed.
[ 10:00 ] - The pipe replacement is covered, and replacement costs generally include anything required to get to the repair. Land is typically Property Not Covered, but it's not the land that suffered the loss. The cost of digging to the pipe to repair it is likely covered.
[ 11:05 ] - But what if camera-scoping didn't work, and digging to the pipe was part of the investigative process? And, what if the damage to the pipe turned out to be wear and tear? In that scenario, tear-out costs would likely not be covered.
[ 12:15 ] - No case law advises on what is needed regarding replacing the land.
[ 13:00 ] - In the wear-and-tear scenario, a specific provision may apply to lead to coverage for tear-out costs, e.g. if water damage was caused by the leak.
[ 14:30 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Constant Or Repeated Seepage Or Leakage Of Water — Burden Of Proof – PCQ.2022.06.27.jem.a - https://www.plrb.org/documents/constant-or-repeated-seepage-or-leakage-of-water-burden-of-proof-pcq-2022-06-27-jem-a/
Structure Settled After Water Escaped From Pipe – Earth Movement, Water Exclusion – PCQ.2022.04.13.twh.b - https://www.plrb.org/documents/structure-settled-after-water-escaped-from-pipe-earth-movement-water-exclusion-pcq-2022-04-13-twh-b/
Water Exclusion Might Not Include Metered Water – PCQ.2018.02.26.dwf.a - https://www.plrb.org/documents/water-exclusion-might-not-include-metered-water-pcq-2018-02-26-dwf-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.
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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 scenario@plrb.org.
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).
So the insured, being the diligent car owner and maintenance-oriented person that he is, appears at his auto shop for a routine oil change. However, the insured auto shop failed to adequately tighten the oil drain plug, causing all of the installed oil to leak out. According to the insured, this was a routine oil change, performed every six months, and there must have been a mistake in the drain plug tightening process. As a result, the engine completely seized, causing the entire engine to need to be replaced.
Notable Timestamps
[ 00:15 ] - The customer files a lawsuit against the insured auto shop. The insured auto shop has a CGL policy is seeking coverage for the engine repair under that policy.
[ 01:30 ] - Are the days of changing your own oil over?
[ 02:33 ] - The insured must establish that this event was an occurrence-- an accident or unexpected event. Courts are split on whether faulty work constitutes an occurrence.
[ 05:00 ] - The "Your Work" exclusion bars coverage for property damage to the insured's work, or any part arising out of it. On the one hand, lack of oil caused the engine to seize. On the other hand, the shop didn't work on the engine itself. Courts would be split.
[ 08:40 ] - The majority position (on engine repair specifically) follows Travelers Ins. Co. v. Volentine, 578 S.W.2d 501 (Tex. App. 1978): the whole engine is considered "other property" in cases such as this.
[ 10:33 ] - The minority position is represented by Barbee v. Hartford Mut. Ins. Co. 408 S.E.2d 840 (N.C. 10/3/91) and State Auto. Mutual Ins. v. Glover, 253 Miss. 477 (1965).
[ 13:04 ] - The intent of the "Your Work" exclusion is to limit coverage to the scope of the work the insured was hired to perform.
[ 15:13 ] - Michele provides a recap of the scenario and the points above.
Your PLRB Resources
IIs There CGL Coverage for Damage to an Engine Caused by Insured’s Faulty Repair of Timing Chain? 2021.09.10 - https://www.plrb.org/documents/is-there-cgl-coverage-for-damage-to-an-engine-caused-by-insureds-faulty-repair-of-timing-chain-2021-09-10/?search=faulty%20work%20engine%20repair
Commercial General Liability Policy Annotation Key GL52, Your Work Exclusion - https://www.plrb.org/documents/gl52-your-work-exclusion/
Coverage Contrarian Podcast: Engine Servicing and Workmanship - https://www.plrb.org/courses/the-coverage-contrarian-engine-servicing-workmanship/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
A man lived in his house with his girlfriend at the time. Things were going so well, he bought an engagement ring, took her to Mexico for vacation, proposed in Cancun, and she said yes. He gave her the ring. She wore it the rest of the vacation, then packed it in her suitcase … but when she got home and opened up the suitcase, it was gone! The girlfriend had no HO or renters insurance because she lived with her boyfriend. The man had his own HO policy, but he hadn’t gotten around to scheduling the ring.
Notable Timestamps
[ 00:15 ] - He still thinks it should be covered anyway under Coverage C for personal property. The adjuster is reviewing the policy, ISO HO3 2011 edition, to see if any coverage can be granted.
[ 01:24 ] - The team discusses whether the ring met the deductible and if not, what that means for the relationship.
[ 03:10 ] - Ownership transfers from the donor to the donee once the fiancee accepts.
[ 04:55 ] - The boyfriend probably didn't "use" the ring.
[ 05:40 ] - Coverage for personal property of others applies only when the property is on the residence premises.
[ 07:22 ] - The theft peril likely wouldn't apply in this scenario where the ring was simply missing from the luggage, without more facts.
[ 09:40 ] - A $1,500 or so special limit would apply to theft of jewelry.
[ 11:14 ] - If the ring had been scheduled, the above obstacles wouldn't apply, but the boyfriend would still need "insurable interest" in the ring. Courts would likely hold in the boyfriend's favor in such a scenario.
[ 14:37 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Property FAQ: Engagement Ring Coverage - https://www.plrb.org/documents/engagement-ring-coverage/
Property Q&A: Engagement Ring Coverage – Prop. Q&A 166 - https://www.plrb.org/documents/engagement-ring-coverage-prop-qa-166/
Coverage Question: Scheduled Engagement Ring that Fiance Refuses to Return Post-Split – PCQ.2015.08.24.slc.a - https://www.plrb.org/documents/scheduled-engagement-ring-that-fiance-refuses-to-return-post-split-pcq-2015-08-24-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/container.cfm?conlink=sec/cq/default.cfm) 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
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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 scenario@plrb.org.
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).
A 90 year old red maple hangs over the insured’s house. One of the branches looks like it might fall, and if it does, it’s going to cause some major damage to the sun room. The insured knows this and is a diligent homeowner. One day the weather forecaster says major storms are coming through later in the week – wind and flooding are likely – so the insured hires a tree company to remove the limb safely in advance and also pays to get sandbags down on the low side of his property facing the river. The weather forecaster was right, a big storm came through, but the insured’s preventative actions worked – no damage.
Notable Timestamps
[ 00:15 ] - Now the insured wants his insurance company to reimburse him for the tree expenses and the sandbag expenses. He tells the adjuster, “I saved you from having to pay way more on repairs; I had wind coverage and I even had flood coverage. All I’m asking for is reimbursement of my costs.”
[ 01:40 ] - Of the three, only Tim is extra diligent.
[ 03:50 ] - Policies don't cover pre-storm expenses. Insurance policies typically cover fortuitous losses. The lack of coverage for preventative measures came up a lot during coverage.
[ 05:20 ] - Insurers have a duty to mitigate a loss, but there has to be a loss. It's a duty to prevent "further" damage.
[ 07:06 ] - So should insureds just let losses occur? It's a moral hazard...
[ 08:30 ] - Let's say a different tree branch fell on the house the day before & caused a covered loss. The removal of other branches would mitigate the loss, which would be reimburseable.
[ 10:37 ] - Could it be considered faulty maintenance if the insured DIDN'T prevent the foreseen loss?
[ 13:25 ] - Consider the insured asking the insurer if they would pay for a portable generator to prevent a pipe freeze. Insurance companies are allowed to pay for such a thing, if they wanted to.
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Pre-Storm Expenses To Protect Property - https://www.plrb.org/documents/pre-storm-expenses-to-protect-property/
Preventative Measures: Sandbagging - https://www.plrb.org/documents/preventative-measures-sandbagging/
PLRB, Duty to Protect Did Not Cover Removal of Fire Damaged Tree Where Dwelling Wasn't Damaged – PCQ.2018.08.01.jak.a – https://www.plrb.org/legacy-documents?DN=67261
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/container.cfm?conlink=sec/cq/default.cfm) 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
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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 scenario@plrb.org.
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).
Old brick mansion in New Jersey with a fireplace that the insured uses in the winter. During a routine cleaning, the chimney sweep noticed some cracking in the chimney bricks. He says (1) it’s probably due to age and normal use because over time the heat from the fires takes a toll; he says (2) in his estimation the cracking has existed for 3+ years. Notable Timestamps
[ 00:15 ] - He encourages the insured to submit an insurance claim anyway. Policy = ISO HO 00 03 05 11. The adjuster knows there is an exclusion for “cracking” but also knows that fire is a covered peril. Is there coverage for the chimney?
[ 01:18 ] - Trivia Time! How many fireplace-related deaths happened in the United States?
[ 04:18 ] - The "cracking" exclusion appears alongside other long-term normal-usage exclusions and would normally be considered in that context.
[ 06:18 ] - But, could we say that FIRE was the proximate cause in order to find coverage? Not necessarily. Courts created a distinction between "friendly" fires like stoves or fireplaces vs. "hostile" fires that "escape" their enclosures.
[ 08:55 ] - See Karadontes v. Continental Ins. Co., 354 A.2d 696 (N.J. App. 1976).
[ 09:40 ] - The fact that the "date of loss" when the cracking began was three years ago likely does not mean the insureds provided late notice. Courts created the discovery rule for cases such as this, starting the clock at the time the loss was discovered.
[ 12:50 ] - Who would notice a crack in their fireplace?
[ 13:50 ] - In civil law, the preponderance of the evidence standard applies, so in this case the chimney sweep's claims would likely be accepted.
[ 15:00 ] - Only sudden or accidental soot or smoke is typically covered.
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Chimney Damage-Faulty Maintenance or Covered Fire Loss? – Claims Magazine - https://www.plrb.org/documents/chimney-damage-faulty-maintenance-or-covered-fire-loss-claims-magazine/
Thermal Cracking Inside Chimney – Fire or Wear and Tear? – PCQ.2023.08.19.twh.a - https://www.plrb.org/documents/thermal-cracking-inside-chimney-fire-or-wear-and-tear-pcq-2023-08-19-twh-a/
Windstorm: Downdraft Into Chimney Disperses Soot – PCQ.2018.04.30.rcw.b - https://www.plrb.org/documents/windstorm-downdraft-into-chimney-disperses-soot-pcq-2018-04-30-rcw-b/
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/container.cfm?conlink=sec/cq/default.cfm) 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
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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 scenario@plrb.org.
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). Wall Cracking 3: https://vfx.productioncrate.com/video-effects/footagecrate-wall-cracking-3
The insured is a charitable organization. Times were tough; fundraising was stagnant. The insured was looking to save money, so they asked if they could lower their premiums by canceling their hurricane coverage. The underwriters agreed, and drafted a 1-page endorsement with an exclusion for named storms. Sure enough, the insured got hit with a hurricane the very next month. They submitted a claim anyways, now stating they don’t see any named storm exclusion in the policy. The adjuster looks but can’t find it either.
Notable Timestamps
[ 00:15 ] - It turns out the insurer forgot to include the endorsement in the policy bundle. But still, there are documented conversations that the insured wanted to cancel their hurricane coverage, and they got lower premiums, and the insured doesn’t even deny that. Who wins?
[ 01:56 ] - Ambiguities are construed against the insurer, because they drafted the policy. But in this case, there's no ambiguities within the four corners of the policy.
[ 03:30 ] - The contract says what the contract says, period. The Parole Evidence rule says evidence can't be presented that something else was meant to be different compared to what was in the written contract.
[ 06:08 ] - ...But this situation is so unfair! Courts "sit in both law and equity", meaning that if there was a mutual mistake, many courts will reform the contract.
[ 07:46 ] - See Shiloh Christian v. Aspen, a Florida case with similar facts which held in favor of the insured.
[ 11:30 ] - The adjuster's mistake can't create coverage, but if the insured relied on the insurer's mistake, the doctrine of detrimental reliance would protect the insured.
[ 13:55 ] - When does a hurricane get its name? What happens when your name gets co-opted as the name of a bad hurricane?
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Shiloh Christian Ctr. v. Aspen Specialty Ins. Co. (2023), No. 22-11776, 2023 WL 2920573, — F4th — (11th Cir. (Fla.) 4/13/2023) - https://www.plrb.org/documents/shiloh-christian-ctr-v-aspen-specialty-ins-co-2023/
Estoppel: Detrimental Reliance By Insured – PCQ.1993.04.16b - https://www.plrb.org/documents/estoppel-detrimental-reliance-by-insured-pcq-1993-04-16b/
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/container.cfm?conlink=sec/cq/default.cfm) 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
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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 scenario@plrb.org.
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). Ink Bleed 4: https://vfx.productioncrate.com/video-effects/footagecrate-inkbleed-4
Homeowner was an elderly widow in Texas who was not keen on moving into a retirement home, so she continued to live in her house by herself. As she got older, a lot of normal maintenance started to get ignored, including the roof – The shingles were old and looked like they were about to fall off any day. One day a windstorm came through the area, and sure enough, 20-30 shingles blew off. She called her insurance company. The adjuster reviewing the file thinks, wind is a covered cause of loss, but wear and tear and deterioration are not. He is wondering what to do when there are multiple contributing factors.
Notable Timestamps
[ 00:15 ] - The homeowner failed to maintain the roof, and then it was damaged in a windstorm. Both factors contributed to the loss, but only one (wind) is covered, and the other (wear and tear) is not.
[ 01:04 ] - The PLRB podcasters discuss how long their roofs have left before they'll need to be replaced...
[ 02:50 ] - There can be coverage for a roof even though it's past its useful life. It still performs a valuable function. ACV would be low, but replacement cost would replace old with new.
[ 03:44 ] - The question is whether it's functioning as a roof. If there are gaping holes, or damage to the point where it's value-less, it may not be covered.
[ 04:06 ] - Some carriers have endorsements clarifying when a roof's useful life (and coverage) ends.
[ 04:35 ] - The Anti-Concurrent Causation Preface: "Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss." When this is present and applicable, one exclusion's application means no coverage for the entire claim.
[ 05:45 ] - Ususally, the Anti-Concurrent Causation Preface does not precede the wear & tear exclusion. Without that clause, the exclusion would only apply if wear & tear were the proximate cause.
[ 08:00 ] - Tim makes the bold claim that Texas is the #2 state, after Ohio of course. Outside of Texas, under the majority rule, proximate cause means the dominant and sufficient cost. If the shingles were hanging on by a thread, wear & tear would be the proximate cause even if wind knocked them off. On the other hand, if the shingles weren't that bad and a 70-mph gust tore them off, the proximate cause would likely be wind.
[ 09:25 ] - The crew selects Houston as their favorite Texas destination. In Texas, when covered and non-covered perils combine to create a loss, the insured is entitled to recover that portion of the damage caused SOLELY by the COVERED peril. Failure to do so results in NO coverage. This sounds a lot like the Anti-Concurrent Causation Preface, even though it's not coming from the policy but from Texas case law.
[ 10:30 ] - It's the insured's burden to establish what damage is caused SOLELY by the covered peril. If there's a non-covered peril contributing to the loss in any way, it won't be covered, at least in this unique jurisdition.
[ 11:50 ] - A creative public adjuster brings up the Ensuing Loss clause. Losses that ensue from wear & tear can be covered... but Tim's not buying this argument. If the wear & tear causes a leak which leads to damage, that's one thing, but to consider the shingle damage as an ensuing loss of the wear & tear of the shingles themselves... it's a little close.
[ 13:08 ] - If spot repair can be effective, it's an option. But issues like matching, difficulty accomplishing the repair, and local ordinances or laws can mean a full replacement.
[ 14:07 ] - What if the only issue with spot repair is the rotted decking under the shingles? Mike had relevant personal experience to share.
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage Question - Roof Damage Caused By Combination of Wear and Tear Plus Freezing/Thawing - https://search.plrb.org/?dn=74356&src=gsa
Coverage Question - Windstorm Damage v Wear/Tear Shingles - https://search.plrb.org/?dn=20790&src=gsa Annotation - Texas Ensuing - Resulting Loss - https://search.plrb.org/?dn=45283&src=gsa
PLRB’s state-by-state on proximate cause laws - 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/container.cfm?conlink=sec/cq/default.cfm) 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
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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 scenario@plrb.org.
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).
At a store, a female patron wanting to try on clothing secured the dressing area with a curtain. Another patron, the insured, engaged in allegedly assaultive conduct by rummaging, feeling, and grabbing the curtain in an attempt to make physical contact with the female patron. The insured also knelt down and used his phone to take videos or photos of the patron under the curtain.
Notable Timestamps
[ 00:19 ] - At a store, a female patron wanting to try on clothing secured the dressing area with a curtain. However, another patron, (who happens to be our insured) entered the store with various family members, selected a shirt and approached the occupied dressing area. Although the insured was made aware by the patron not to come in, he then engaged in allegedly assaultive conduct by rummaging, feeling, and grabbing the curtain in an attempt to make physical contact with the patron.
[ 01:00 ] - At this point, a store associate provided the insured an alternate location to try on the shirt, which the insured did. But afterwards, the insured knelt down and used his phone to take videos or photos of the patron under the curtain.
[ 01:24 ] - The patron sued the insured for allegedly assaultive conduct in a store. Prior to trial, in her discovery deposition, the patron explained that she tried to laugh it off and make a joke out of an uncomfortable situation by saying "you don't want to spoil your breakfast." According to the patron, the insured's family told the insured not to act that way, and "we kind of giggled and I just tried to shut it down very quickly and said, guys, enjoy your day."
[ 02:00 ] - The insured sought coverage under his HO policy, and the insurer sought a declaratory judgment that it owed no duty to defend or indemnify the insured.
[ 02:40 ] - Special guest Michele Hunter, coverage counsel at PLRB, joins us today to discuss this podcast’s first Casualty topic.
[ 03:37 ] - See AIG Property Casualty Co. v. Anenberg, 2020 WL 4607839 (D. Haw. 8/11/20). This behavior does not seem accidental, but this particular policy defines an occurrence not just as an accident, but as an offense as well.
[ 05:50 ] - Among other charges, the patron claimed Negligent Infliction of Emotional Distress. If one claim triggers coverage, there is a duty to defend for the entire claim.
[ 06:46 ] - The insurer relied on the Intentional Acts exclusion to deny coverage. Courts are split on whether to apply a subjective or objective test in applying this exclusion. For the objective test, the court asks if a reasonable person would consider it an intentional act. The subjective test asks what the insured believed, and Hawaii applies this test.
[ 08:24 ] - However, the insured chose to argue that objectively speaking, his behavior was not intentional. The insured claimed that the patron’s joking response proved he had no intent to harm.
[ 09:20 ] - The court agreed that the insured objectively did not intend harm.
[ 11:30 ] - The majority of relevant case law does not allow the “creative pleading” addition of Negligent Infliction of Emotional Distress to establish coverage, in intentional sexual assault cases.
[ 12:40 ] - The court found that the Sexual Molestation exclusion did not apply because the complaint did not allege the pertinent actions.
[ 13:50 ] - The laughter occurred after the behavior, but this court used it to interpret the insured’s intent anyway.
[ 15:30 ] - Under the typical ISO definition of an occurrence, this would likely not be considered an occurrence.
[ 15:33 ] - Michele provides a recap of the scenario and the points above. This case demonstrates the impact that specific policy language, creative pleading, and individual judges can have on a seemingly clear-cut argument.
Your PLRB Resources
Homeowners Policy Annotation Key 611 Expected or Intended Injury Exclusion - https://www.plrb.org/documents/ho611-expected-or-intended-injury-exclusion/
AIG Property Casualty Co. v. Anenberg (Hawaii 2020 federal district case) - https://www.plrb.org/documents/aig-property-casualty-co-v-anenberg/
Coverage Question: Would a Michigan Court Apply a Subjective or Objective Standard When Interpreting the HO Policy’s Intentional Acts Exclusion? - https://www.plrb.org/documents/would-a-michigan-court-apply-a-subjective-or-objective-standard-when-interpreting-the-ho-policys-intentional-acts-exclusion-1997-09-10/
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/container.cfm?conlink=sec/cq/default.cfm) at no additional charge to you or your company.
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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 scenario@plrb.org.
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).
Ink Bleed 4: https://vfx.productioncrate.com/video-effects/footagecrate-inkbleed-4
Your friend clicked on a link in a questionable email. Now her computer is locked with a message saying it will unlock if she makes a bitcoin ransom payment. This is causing two problems for her: (1) Her computer doesn’t work now, and (2) She had 10 years worth of family photo albums stored on the hard drive, with no cloud backup.
Notable Timestamps
[ 00:15 ] - Today’s scenario involves ransomware. The computer wasn’t cheap, and those photos were priceless, so she wants her insurance company to make the ransom payment for her. The adjuster handling the claim is looking to see whether this is covered, and if so, what actually can be done.
[ 01:06 ] - The team discusses what happens when you click on a suspicious link, and what’s supposed to happen when someone says “O-H…”
[ 03:45 ] - The computer falls under Coverage C as personal property, and so do the digital photos.
[ 04:41 ] - Theft is a named peril under Covegage C that likely applies. Vandalism might also apply.
[ 05:35 ] - Being unable to access something qualifies as a loss in this scenario.
[ 07:08 ] - There is a split in courts, but in EMOI Services, LLC v. Owners Ins. Co., 2022-Ohio-4649, 2022 WL 17905839. —- N.E.3d — (Ohio 12/27/2022) (Supreme Court of Ohio, applying Ohio law) [reviewed at PLRB, Prop. Ins. L. Rev. 11510 (2023)], encryption of files, caused by a ransomware attack on the policyholder’s computer system, was not direct physical loss or damage to "media" covered under an Electronic Equipment endorsement to a businessowners policy.
[ 08:30 ] - If data isn’t physical in “O-H…I-O,” the Electronic Data coverage in commercial forms could apply, if it would otherwise have no application.
[ 09:30 ] - Assuming the matter is covered, the insurer could pay ACV… but could they pay the ransom? It’s an open question.
[ 11:04 ] - Calculating ACV for the photos is subjective, but market value would likely be low.
[ 13:00 ] - One of the Special Limits of Liability caps “personal records” at $1,500.00.
[ 13:48 ] - Ransomware is becoming an new insurable niche, with potential new endorsements coming down the road: “cyber-extortion” coverage, etc.
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage Question - Loss of Use: Hacked Cell Phone, Ransom Demanded - https://search.plrb.org/?dn=73714
Coverage Question - Cyber Losses FAQs - https://search.plrb.org/?DN=67890
Webinar - Cyber Loss Case Scenarios - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0091
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
Ink Bleed 4: https://vfx.productioncrate.com/video-effects/footagecrate-inkbleed-4
A young couple lives together in St. Pete, Florida. Their friend was vacationing in Italy for a month and asked them to dog sit for her 3 year old pit bull rescue, who had a checkered past but was doing well lately. The couple took in the dog, and one night they threw a dinner party. Out of nowhere, the dog attacked one of the guests, biting him in the leg. In the resulting chaos, blood got all over the expensive white wool carpet. The man got his leg treated at the hospital, he was fine– not suing! – the dog was returned to the shelter and now the couple is making an insurance claim to replace their blood-stained carpet under Section I of their HO3.
Notable Timestamps
[ 00:16 ] - Today’s scenario involves an insured with a dog that was not theirs, with some history of aggression but not recently, injuring a guest to their home, where the injury is not at issue but the carpet is. It’s a complex situation!
[ 01:12 ] - Mike shares a harrowing tale and Alissha argues on behalf of the dog.
[ 03:40 ] - There’s an exclusion for losses caused by “animals owned or kept by an insured.” The dog could be considered “kept” by the insureds because they hosted it for months.
[ 04:40 ] - There is a case to be made that this exclusion is only for “normal” pet damage like chewing, drooling, vomit, pooping, etc. It is grouped in wear & tear, and a dog bite could be described as fortuitous. However, some courts have disagreed. See resources below for citations.
[ 07:19 ] - Losses “caused by” pets are excluded, but losses that “ensue from” or “result from” pets are covered. If a dog knocks over a candle, that could be an ensuing loss, whereas a dog drooling on something could be a cause. It’s a hairline distinction.
[ 10:03 ] - You can look at state case law for your particular state for prior rulings on ensuing loss.
[ 11:00 ] - Blood is arguably a liquid & contaminant under the pollution exclusion. Such claims often involve emotional considerations.
[ 12:50 ] - According to a recent Florida case, blood is not a pollutant. See resources below for citations.
[ 13:30 ] - If there’s a Coverage C Peril, the exclusion would not apply.
[ 15:33 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Related Case: Bjugan v. State Farm Fire and Casualty Co., No. 13-35927, 2016 WL 1072207 (9th Cir. (Or.) 3/18/16) (unpublished) (U.S. Court of Appeals for the Ninth Circuit, applying Oregon law) [reviewed at PLRB, Prop. Ins. L. Rev. 9398 (2016)]. https://www.plrb.org/documents/bjugan-v-state-farm-fire-and-casualty-ins-co-2016/
Related Case: Nolan v. Auto-Owners Ins. Co., No. 301106, 2011 WL 5865522 (Mich. App. 11/22/11) [reviewed at PLRB, Prop. Ins. L. Rev. 8351 (2011)] (unpublished). https://www.plrb.org/documents/nolan-v-auto-owners-ins-co-2011/
Related Case: Fla. Farm Bureau Gen. Ins. Co. v. Worrell, No. 5D21-3196, 2023 WL 3130872, — So.3d —- (Fla. App. 5th DCA 4/28/2023) (Florida District Court of Appeal, 5th Dist., applying FL law) [reviewed at PLRB, Prop. Ins. L. Rev. (2023)]. https://www.plrb.org/documents/fla-farm-bureau-gen-ins-co-v-worrell-2023/
Coverage Question - Pet Dog Attacked Owner; Blood on Carpet - https://www.plrb.org/documents/pet-dog-attacked-owner-blood-on-carpet-pcq-2023-10-27-twh-b/
Coverage Question - Pollutant Exclusion: Deer Crashes Through Window and Blood Destroys Carpet - https://www.plrb.org/documents/pollutant-exclusion-deer-crashes-through-window-and-blood-destroys-carpet-pcq-2017-03-21-slc-b/
Coverage Question - Are Blood and Bodily Fluids Pollutants under Coverage A Dwelling? - https://www.plrb.org/documents/are-blood-and-bodily-fluids-pollutants-under-coverage-a-dwelling-pcq-2024-02-09-mrh-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/container.cfm?conlink=sec/cq/default.cfm) at no additional charge to you or your company.
Subscribe to this Podcast
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YouTube - Please like and subscribe at @plrb
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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 scenario@plrb.org.
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).
Ink Bleed 4: https://vfx.productioncrate.com/video-effects/footagecrate-inkbleed-4
A derecho swept through Iowa damaging the insured’s siding, and it’s going to require a complete removal and replacement of the siding. The contractor informed the adjuster that the siding contains asbestos. It wasn’t disturbed by the windstorm and is safe now, but it will be disturbed when it’s removed, so that’s going to have to be done by specially-licensed professionals with hazmat suits according to procedure. The adjuster handling the claim is willing to pay for the siding replacement. However, she is not sure about all of those extra costs to handle and contain the asbestos.
Notable Timestamps
[ 00:16 ] - Today’s scenario begins with a derecho which swept through-- wait, what is a derecho? An outlaw or a windy, violent, and quick thunderstorm?
[ 00:43 ] - After reading down the policy exclusions in the 2011 ISO HO3, the adjuster saw (1) the pollutants exclusion and (2) the Ordinance or Law exclusion, and she is seeking information about whether either of those applies to the extra asbestos abatement costs.
[ 01:53 ] - Over the years, asbestos changed in the cultural imagination from a miracle substance to a frequent mention on the law firm commercial circuit. The material is still being found anywhere heat needed to be regulated.
[ 04:26 ] - What laws should apply, and what about coverage? Generally, when you have a covered loss, the insurance company should include everything necessary to make that repair.
[ 06:40 ] - Asbestos is a pollutant, but (1) the pollutants exclusion doesn’t apply to a Coverage C peril, and (2) the pollutants exclusion doesn’t apply where the pollutant hasn’t been released.
[ 07:46 ] - Laws do require the insured to respond to pollutants as described in the Ordinance or Law Exclusion, but it was intended for building code issues and applying it to asbestos would likely be too broad of an application. Common sense safety measures are part of replacement cost.
[ 09:35 ] - The Ordinance or Law Exclusion has the anti-concurrent causation preface, which avoids any proximate cause analysis.
[ 10:31 ] - Asbestos claims often come up in third party scenarios. Could this be a hint for a future podcast episode?
[ 11:30 ] - What if an insurer decided not to cover anything related to asbestos? Courts tend to enforce plainly worded exclusions or special limits.
[ 13:00 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage Question - Asbestos When There Is a Covered Loss - https://search.plrb.org/?dn=79659
Coverage Question - Asbestos Remediation - Pollutant? Ordinance or Law? - https://search.plrb.org/?dn=79806
Coverage Question - Asbestos Removal After Water Loss - https://search.plrb.org/?dn=74381
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
The insured bought a house in Oregon and took out insurance under a 2011 ISO HO3. He lived there for a month, but then moved back to California and started renting out the Oregon house to a local couple. Six months later, the couple disappeared with no trace and the house had been trashed. Walls were dirty; carpet was dirty; graffiti in the bathroom, hole in the bedroom wall; bottles and cans everywhere; dog urine. The insured wanted his homeowners insurer to pay for a full Coverage A cleanup and restoration.
Notable Timestamps
[ 00:16 ] - The homeowner rented out his house, then returned to significant damages from absentee renters and is seeking coverage for cleanup and restoration.
[ 01:15 ] - The real question is, what happened to the tenants? Could it be… aliens? No.
[ 02:57 ] - If the homeowner wasn’t renting at the time of the insurance application, there was no misrepresentation.
[ 04:05 ] - If the insured didn’t reside there, is the house the “residence premises?” It’s disputed among the courts, but not an issue in Oregon.
[ 05:20 ] - Landlords should expect normal wear and tear which is not covered, but vandalism is covered.
[ 08:32 ] - Dog urine may be considered a pollutant which is excluded, but if it’s vandalism, that’s a Coverage C Peril and likely covered regardless.
[ 09:39 ] - What about questionable fashion choices, a tenant painting a wall red, or rainbow-colored? If it affects market value and ability to rent it, that could be a direct physical loss.
[ 11:30 ] - Vandalism is a Coverage C Peril, but excluded under Coverage A if the home has been vacant more than 60 days.
[ 12:15 ] - Which state law applies? In this case, the home was in Oregon, so even if the insured was living in California, it’s likely Oregon law will apply.
[ 13:24 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage Question - Tenant Damage Can Rise to the Level of Vandalism/Malicious Mischief - https://search.plrb.org/?dn=87158
Q&A - Damage By Tenants - https://search.plrb.org/?dn=38442
Coverage Question - Tenant Hoarders: Vandalism or Wear and Tear? - https://search.plrb.org/?dn=87102&src=gsa
For more on the vandalism exclusion, see: https://www.plrb.org/documents/vandalism-vacancy-ho126/
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
The insured’s house in Rhode Island was destroyed in hurricane winds. The insured is a natural handyman (although his day job is an accountant), and he decided to rebuild the house himself from scratch, working diligently nights and weekends. Since he has a talent for this, materials & labor only ended up costing him less than the replacement cost estimate but more than ACV. Is he owed ACV, RC, actual cost, or policy limits?
Notable Timestamps
[ 00:15 ] - The insured’s home undergoes a total loss covered under the standard ISO HO3 with standard replacement cost and Coverage A limits of $450K. ACV was determined to be $200K, and the replacement cost estimate was $400K.
[ 01:00 ] - The insured, a handyman, rebuilt the house from scratch for $300K, including materials and his own labor.
[ 02:15 ] - Tim and Alissha prefer to hire help, but Mike shares a story about how he once attempted a sump pump repair with limited success…
[ 05:43 ] - Twenty states are “valued policy states” where the insurer must pay the policy limits on a total loss to discourage policy limits consistently higher than replacement cost and the resulting higher premiums. This doesn’t apply here.
[ 07:03 ] - Mike suggests paying $200K until the work is confirmed, then the remaining $100K for the balance of the actual work done, even though the replacement cost estimate was higher.
[ 09:10 ] - Tim confirms that according to the policy, the insured is to receive the lowest of: the replacement cost estimate, actual cash value, or actual cost incurred. The philosophy to make the insured whole.
[ 10:26 ] - The insured’s own labor could be paid. It’s hard to figure out what “overhead & profit” would be in this scenario.
[ 12:00 ] - If the insured didn’t keep good records to substantiate the self-repair, some courts would rule against them.
[ 14:00 ] - If the actual cost to repair falls under ACV, however, the insured can always simply make the ACV claim.
[ 15:30 ] - If the insured rebuilds somewhere else, he is still only entitled to the replacement cost estimate for the original location.
[ 17:30 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage Question - Are DIYers entitled to the cost of their labor? - https://search.plrb.org/?dn=54422&src=gsa
Q&A: “The Do-It-Yourselfer: ACV (Defined as Replacement Cost Less Depreciation) and RC” - https://search.plrb.org/?DN=39042
PLRB Homeowners Policy Annotations - Replacement Cost Loss Settlement - 80% Insured (HO96) - https://search.plrb.org/?DN=26
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
The insured is a homeowner in Oregon. There were wildfires in the forests around his neighborhood, but the fire never got closer than 3 miles from his house, so he never had to evacuate. Nevertheless, the smoke was thick in his area, and enough of it penetrated into the inside of the house to leave a faint but noticeable smoky odor that does not seem to be going away. The insured is requesting smoke remediation to be performed in his house and on some of his contents.
Notable Timestamps
[ 00:18 ] - The interior and exterior of the insured’s home was left with a smoky odor after a local wildfire, and the insured is seeking remediation under the standard ISO form.
[ 01:10 ] - The team discusses the prevalence of wildfires in recent years.
[ 03:25 ] - In most jurisdictions, odor is considered a physical loss because it is caused by particulate matter, and it’s a named peril.
[ 04:27 ] - COVID particles die off quickly, whereas smoke particles tend to adhere for much longer.
[ 05:50 ] - Is the insured being “overly sensitive”? How to decide whose nose knows? Objective criteria like smoke particles can be objectively measured, and a medical opinion is another form of evidence.
[ 07:57 ] - In the pollution exclusion, “smoke” is specifically listed… but the pollutant was released by a coverage C named peril… namely smoke!
[ 10:50 ] - ALE could even apply if the odor made the home not fit to live in. Furniture could need repair or replacement.
[ 13:37 ] - The fire’s Canadian origin likely doesn’t affect coverage.
[ 15:00 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
HO Policy on Smoke Peril (HO55) - https://search.plrb.org/?dn=148&src=gsa
TYCK on Smoke Damage to Homes from Neighboring Wildfires - https://search.plrb.org/?dn=57796&src=gsa
Coverage Question “Home Suffers Odor From Wildfire Smoke” - https://search.plrb.org/?dn=26481&src=gsa
CE Course on “Investigating and Resolving Different Types of Wildfire Losses“ - https://www.plrb.org/public2/dislearn/description.cfm?mod=p0093
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/container.cfm?conlink=sec/cq/default.cfm) at no additional charge to you or your company.
Subscribe to this Podcast
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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 scenario@plrb.org.
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).
The insured, a father of 4, was out buying Christmas gifts for his children. This year he decided to splurge and buy each of them a drone and an Apple Watch. On his way back home, he stopped to get gas, and when he went into the minimart for coffee, a thief stole everything out of the back seat. The insured notified the police and submitted a claim under his ISO 1991-edition HO3. The adjuster considers this to be a covered Theft loss, but she knows there are specific provisions in the policy for watches and aircraft.
Notable Timestamps
[ 00:17 ] - A theft claim is submitted for four drones and four smartwatches under the 1991 HO3. The question arises whether special provisions for aircraft and watches applies.
[ 01:27 ] - The team debates the merits of drones and smartwatches, their capabilities for wall damage and dog-scaring, and the wisdom of being notified emails the instant they are received.
[ 03:09 ] - A $1,000 special limit of liability applies to theft of “watches.” Is an Apple Watch a watch?
[ 03:42 ] - Alissha argues that smartwatches are too different from a basic time-telling watch, and is more like a phone. Smartwatches were likely not part of the original policy intent.
[ 04:55 ] - Mike argues that it’s called an “Apple Watch” -- its makers and users consider it a watch, even if it’s more complex.
[ 06:05 ] - The group quotes Shakespeare and Merriam-Webster; it tells the time and it’s on your wrist, so…
[ 06:30 ] - Grassie v. Merrimack Mut. Fire Ins. Co., 291 A.2d 254 (N.H. 1972) (watches that were inoperable and kept in display case were still subject to special limit of liability for theft of watches).
[ 07:00 ] - Ambiguities are construed in favor of the insured. So both sides need to hire a good lawyer.
[ 07:52 ] - How would the policy treat an iPhone strapped to your arm? Coverage C would likely provide full coverage for a smartphone.
[ 09:51 ] - “Property Not Covered” includes “aircraft”… but “model or hobby aircraft not used or designed to carry people or cargo” are covered.
[ 10:20 ] - Toy drones likely fall under hobby aircraft.
[ 11:15 ] - This scenario looked at what’s covered property, but a drone could also be a covered cause of loss, even if it destroys itself.
[ 12:40 ] - Unlike BP and CP forms, there’s no concern about the loss happening off-premises; homeowners get worldwide coverage for Coverage C.
[ 14:19 ] - In the 2022 ISO form, a $2,000 special limit of liability applies to model or hobby aircraft.
[ 15:51 ] - Under the recovered property provision, if the thief is caught after the amount is paid, the insured can choose to return the payment or have the insurer salvage the goods.
[ 18:00 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
FAQ, Drones and First Party Property Coverage, http://search.plrb.org/?DN=60514
FAQ, Is a Drone an Aircraft Under the CGL Policy?, http://search.plrb.org/?DN=56440
Coverage Question on “Is An Apple Watch Considered A Watch Or A Computer?” - https://search.plrb.org/?dn=58826&src=gsa
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
Your friend Joan was growing 3 cannabis plants in her home in Hawaii, intended as medical marijuana. Just as the mature plants were almost ready for harvest, the heat lamp malfunctioned and caused the crop to burn in a small fire. Joan submitted a claim under her HO policy, and wants to know if coverage is available.
Notable Timestamps
[ 00:16 ] - Joan’s plants were valued at $2,000 each, and she wants to know if there is any coverage under 2011 ISO HO3.
[ 01:19 ] - Tim, Mike, and Alissha banter about Superbowl squares, “medical” marijuana, and the Ohio legislature.
[ 03:03 ] - The plant may seem permanent, but you would probably take it with you, so it likely wouldn’t be considered part of the “dwelling.”
[ 04:20 ] - The policy may have Additional Coverage for trees, shrubs, and plants limited to $500 per plant, but that would only be triggered under Coverage A and B after the plants were considered to fall under the “Land” exclusion. This claim falls under Coverage C, which would not apply the $500 per plant cap.
[ 05:20 ] - But isn’t marijuana illegal? Section II excludes controlled substances, but Section I does not, and there’s no “illegal property” exclusion there. CP and BP forms also exclude contraband.
[ 06:12 ] - There are a couple of hidden exclusions, namely a social implication that what you’re insuring is lawful property.
[ 07:45 ] - The group discusses the uncertain legality of marijuana.
[ 09:46 ] - Another “hidden exclusion” is fortuity - insurance doesn’t cover “costs.”
[ 10:40 ] - Joan’s cultivation of these plants is legal under Hawaii law.
[ 12:30 ] - Tim discusses the split among courts, including Tracy v. USAA Casualty Insurance Co., Civil No. 11-00487 LEK-KSC., 2012 WL 928186 (D. Hawaii 3/16/12) [reviewed at PLRB, Prop. Ins. L. Rev. 8428 (2012)] and Green Earth Wellness Center, LLC v. Atain Specialty Ins. Co., 163 F.Supp.3d 821 (D. Colo. 2/17/16).
[ 14:15 ] - The 2022 ISO form specifically excludes cannabis under most situations.
[ 16:30 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Homeowners Policy Annotations - Trees, Shrubs and Other Plants (HO43) - https://search.plrb.org/?dn=76
Webinar on Product Liability Cases Involving Emerging Risks: Vaping/Marijuana/Toxic Torts - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0172
Coverage Question on “Theft of Marijuana - Covered Under a Homeowners Policy?” - http://search.plrb.org/?DN=47330
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
[Recorded LIVE at the 2024 Claims Conference in Boston, MA!] The two head pastors of a megachurch had a falling out. One pastor left to start his own ministry, but just before he did, he changed the megachurch's Facebook password. He now has exclusive control of the account and sole access to the 100k+ followers, so the church filed a theft claim with its first-party insurer. Is this a direct physical loss to the church's property? Are Facebook followers even "property" with any means of valuation?
Notable Timestamps
[ 00:23 ] - Two pastors had a falling out, and one left to start his own ministry. The exiting pastor changed the Facebook passwork and took over the account, which has over 100,000 likes. The church filed a theft claim.
[ 01:17 ] - Tim, Mike, and Alissha discuss the fact that this episode was recorded live at the 2023 Claims Conference in Boston, MA.
[ 02:09 ] - The group banters about the continued relevance of Facebook groups like the one at issue in this scenario.
[ 03:00 ] - A gut feeling is not a basis for a denial. We have to go through the policy and articulate the basis for the decision.
[ 03:45 ] - A “facebook follower” doesn’t sound like property, but “my account” or “my password” or “my client list” sounds like it could be.
[ 05:19 ] - It took centuries for courts to develop and refine the meaning of land and property ownership, and “ownership” of digital assets is still a new field.
[ 05:43 ] - Is this a direct physical loss? The data is stored somewhere on a physical medium…
[ 06:30 ] - There is a special exclusion in Electronic Data for Manipulation By Employees. As for Employee Theft, Tim’s pocket policy comes in handy: “tangible property does not include electronic data.”
[ 07:40 ] - Practically speaking, can an insurer encourage an insured to “just work it out” with the thief?
[ 09:40 ] - Mike proposes “the Solomon approach.”
[ 10:50 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage Question on “Theft of Customer List Not Covered Under Employee Dishonesty” - http://search.plrb.org/?DN=26465
Businessowners Annotation on Electronic Data - http://search.plrb.org/?DN=45721
Businessowners Annotation on Employee Dishonesty - http://search.plrb.org/?DN=46222
[External] Moss & Barnett newsletter article “Whose Followers Are They? Establishing Ownership of Company Social Media Accounts by Aylix K. Jensen” - https://www.lawmoss.com/media/publication/1817_0437-00-Moss-and-Barnett%20Fall-2019-Newsletter_v8B-Final.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/container.cfm?conlink=sec/cq/default.cfm) 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
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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 scenario@plrb.org.
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).
An insured’s detached garage burns down in a covered lightning strike, and somehow it’s not covered just because of a little side hustle? The PLRB crew hunt for coverage and find what the insurer can pay out on when an insured rents out their property without updating their insurance company.
Notable Timestamps
[ 00:17 ] - The insured remodeled their detached garage for use as an AirBNB rental, but never notified their insurer. The garage burned down, and the insured files a claim for the property damage, contents, and nearby oak tree that also burned down.
[ 02:40 ] - This scenario’s policy explicity does not cover structures “held for rental”, so this clause would apply even though no guests were present on the date of loss.
[ 05:50 ] - The contents would likely be covered as long as the detached garage is not considered an “apartment.”
[ 07:42 ] - However, the Special Limit of Liability would limit that contents recovery to $3,000 under this policy.
[ 08:04 ] - AirBNB provides a form of coverage which they state is not insurance, but it likely applies only when guests were, at minimum, present.
[ 09:52 ] - The oak tree is also covered, but likely limited to $500.
[ 11:13 ] - In a variation on the scenario, the group discusses that property of tenants would likely not be covered.
[ 13:26 ] - Fair rental value coverage only applies to covered losses.
[ 14:50 ] - Clauses on “homesharing activities” are more frequently appearing in newer forms.
[ 16:30 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Adjuster Resource Sheet on Home Sharing Issues for Property Adjusters - https://search.plrb.org/?dn=72175&src=gsa
Highlights of 2022 Revisions TO Section I ISO Homeowners Form - https://search.plrb.org/?dn=87749&src=gsa
Coverage Question on “Home Sharing Endorsement Would Not Apply Where Tenant Rented Garage For More Than 30 Days” - https://search.plrb.org/?dn=77494&src=gsa
Webinar on “Homeowners Liability Coverage: Current Trends” - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0086
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://thenounproject.com/icon/garage-6216862/
https://fontawesome.com/icons/bolt-lightning?f=classic&s=solid
Is a recycle bin a “vehicle”? Does a car antenna ripping a coat fall under the Vehicles peril? How about a poorly secured wedding dress in the backseat of a convertible? If you occasionally win a biking competition, does the loss of your bike trigger business property coverage? Join Mike, Tim, and Alissha for the lightning round and discuss bikes, eBikes, sleds, boats, and more.
Notable Timestamps
[ 00:15 ] - The insured is an avid cyclist who occasionally wins money from his hobby. Another cyclist cut him off and he crashed his bike into a tree while at a park, destroying the bike.
[ 01:13 ] - Mike & Alissha share personal stories, including a disastrous encounter with a parked car.
[ 03:47 ] - The bike itself is Coverage C Personal Property as there’s an exclusion for motor vehicles, but not for vehicles.
[ 07:04 ] - There is a Named Peril for losses caused by vehicles. Courts interpret this broadly to mean anything from boats to sleds; rollerblades and recycle bins might be pushing it.
[ 09:22 ] - The force / weight / momentum of the vehicle must cause the loss. The team goes through a lightning quiz round exploring a variety of mini-scenarios on the vehicles peril.
[ 13:53 ] - Depreciation can be subtracted when the bike is replaced if it was paid under ACV.
[ 14:29 ] - Although the insured occasionally won money, that likely doesn’t qualify it as a business.
[ 15:18 ] - eBikes present novel issues due to the motor vehicles exclusion, so PLRB has prepared detailed resources on this issue.
[ 17:12 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Detailed annotation on Vehicles Peril - https://search.plrb.org/?dn=151&src=gsa
Legacy podcast on “The Coverage Contrarian: E-Bike Coverage Under a Homeowners Policy” - https://www.plrb.org/distlearn/podcasts/index.cfm?id=a0066
Coverage Question on “E-Bike Excluded Under "All Other Motorized Land Conveyances" Language” - https://search.plrb.org/?dn=74811&src=gsa
Adjuster Resource Sheet on “Analysis of Coverage for an E-Bike Accident under a Homeowners Policy” (includes a link to a 50-state compendium) - https://search.plrb.org/?DN=77489
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://freesound.org/people/univ_lyon3/sounds/541432/
https://fontawesome.com/icons/bicycle?f=classic&s=solid
It’s a very common coverage question: does the insurance company really need to pay to replaced undamaged materials just because the replacement for the damaged materials doesn’t quite match? Alissha, Mike and Tim bring this highly visual subject to an audio-only medium with concrete tips on bringing objectivity and expertise to a subjective issue.
Notable Timestamps
[ 00:19 ] - Just one of the insured’s kitchen cabinet doors was damaged in a covered loss. The damaged cabinet was discontinued by the manufacturer, so the adjuster suggested an alternative. The insured would like all of the cabinets in the kitchen, and the nearby dining room, to be replaced so that they all match.
[ 02:05 ] - Would it drive you crazy to have one cabinet that didn’t match?
[ 03:45 ] - There is a great deal of variation in the court system when it comes to matching issues, but usually the insurer must provide a “reasonable match.” Ultimately, it’s a highly subjective issue.
[ 07:04 ] - One objective factor is the effect on the market value of the real estate.
[ 07:36 ] - Even though the undamaged cabinets did not sustain a direct physical loss, they may need to be replaced to address the covered loss.
[ 09:25 ] - Big box stores, specialty cabinet makers, restoration contractors, and industry experts can help guide adjusters to the matching cabinets.
[ 10:55 ] - Cabinets out of the line of sight likely would not require replacements, but these issues require a subjective approach on each claim.
[ 13:33 ] - Newly replaced siding may not match pre-existing siding to the extent that the new siding hasn’t been weathered. This typically would not result in the replacement of all pre-existing siding.
[ 16:34 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
State-By-State annotations on matching - https://search.plrb.org/?dn=45375
Adjuster Resource Sheet quick reference guide on matching - https://search.plrb.org/?dn=87258&src=gsa
Coverage Question on “Pair Or Set Clause, Matching Case Law May Apply To Kitchen Cabinets” - https://search.plrb.org/?dn=72009&src=gsa
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://pixabay.com/sound-effects/medicine-cabinet-88899/
https://pixabay.com/sound-effects/wood-crash-103157/
In this episode, Mike, Alissha, and Tim answer everything you’ve ever wanted to know about bees, as long as you wanted to know if damage by bees was covered under homeowners insurance, if honey seeping through the walls is considered an ensuing loss, whether honey can be considered a “secretion,” and if bees should be considered “birds.”
Notable Timestamps
[ 00:27 ] - Honeybees have infested the insured’s walls. The insured will have to get the bees removed, and repair any damage leaking honey may have caused.
[ 01:58 ] - Mike shares his own close encounter with a woodpecker infestation.
[ 03:00 ] - Most homeowners policies exclude damages caused by animals because insurance covers “risks” and not “costs” like the typical expenses of homeownership.
[ 04:18 ] - Many policies list excluded categories of animals such as “birds, rodents, and insects.” Scientifically and in layman’s terms, bees are considered “insects.”
[ 07:08 ] - Some courts have held that even if a creature is not scientifically considered an “insect,” it may still be considered an “insect” under the policy under layman’s terms.
[ 07:47 ] - Damage created by burrowing insects is likely not covered because it would be considered “caused by” insects, regardless of whether the bees and the woodpeckers work together.
[ 08:56 ] - Under the ensuing loss clause, losses that “ensue from” insects are typically not excluded. In Arizona, damage by honey was considered covered-- or at least not excluded-- under the ensuing loss clause.
[ 11:56 ] - Secretions from animals are excluded under many homeowners forms, but the honey production process is more complicated than a simple secretion.
[ 14:47 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Annotation on Animal Exclusion - https://search.plrb.org/?dn=46314&src=gsa
Webinar on “Just Because It Ensues Does Not Necessarily Make It an Ensuing Loss” - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0128
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://pixabay.com/sound-effects/many-bees-flying-around-27383/
https://thenounproject.com/icon/honey-4899109/
https://thenounproject.com/icon/honey-1294409/
https://thenounproject.com/icon/bee-1248045/
NFTs may not be fungible, but they are transferable, and they are sometimes stolen with no traditional recourse. The PLRB crew discuss Bored Apes, acronyms, whether pixels are physical, and whether the internet is just a fad. Coverage topics include direct physical loss, special limits of liability, Property Not Covered, and more.
Notable Timestamps
[ 00:38 ] - An erstwhile member of the Bored Ape Yacht Club clicked a malicious link and his NFTs were transferred to an unknown source. The police were unable to assist.
[ 01:06 ] - An NFT or “Non-Fungible Token” is a digital certificate of ownership residing on a blockchain. In the art world, someone may be the true owner of a piece of art while the actual piece of art is stored elsewhere, and even if someone makes a copy. NFTs apply that same logic to digital art and other media.
[ 06:03 ] - Several courts have held that the loss of NFTs is not considered a “direct physical loss.” The microchip is physical, but the information on it is not.
[ 09:00 ] - Special Limits of Liability likely do not apply. However, an argument could be made that NFTs fall under the policy language for “securities, accounts, deeds, evidences of debt, letters of credit, notes other than bank notes, manuscripts, personal records, passports, tickets and stamps.”
[ 11:17 ] - Newer “Property Not Covered” provisions often discuss digital currency, but NFTs are not considered currency. The defining characteristic of currency is that it is fungible: any dollar is exchangeable with any other dollar. On the other hand, NFTs are by definition non-fungible.
[ 13:12 ] - Just like traditional art, experts may be needed to evaluate the worth of NFTs.
[ 16:01 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage Questions on “Is the missing digital art covered property?” - https://search.plrb.org/?dn=80503&src=gsa and https://search.plrb.org/?dn=79717&src=gsa
Homeowners annotation on digital currency - https://search.plrb.org/?dn=80104&src=gsa
Webinar on “The Great Bitcoin Robbery Caper” - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0130
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://pixabay.com/sound-effects/data-reveal-sound-6460/
https://thenounproject.com/icon/hacker-1942859/
https://thenounproject.com/icon/ape-1240957/
https://thenounproject.com/icon/binary-code-4635048/
Is there an exclusion for stupid? Join Alissha, Mike, and Tim to discuss bad decisions, wedding rings stuck on fingers, dumpster fires, and whether the choice to set off a firework inside a house is considered “intentional” under the policy.
Notable Timestamps
[ 00:17 ] - The insured’s son set off a firework in the house for the excitement, causing fire damage. The homeowners file a property claim.
[ 01:26 ] - Alissha, Mike, and Tim discuss their opinions on fireworks, sneaking over the state line, exploding toys, dog ownership, and dumpster fires.
[ 04:12 ] - There’s no exclusion for “stupid” (i.e. negligence), at least not prior to the loss.
[ 07:34 ] - There is an exclusion for intentional loss. “Intent” usually applies both when the actor intends the consequence, and when they know the consequences are substantially certain to result.
[ 08:46 ] - The fact that the son was intoxicated would not establish an insanity defense.
[ 10:36 ] - The son was living in the house, even though he spent much of the year at college, and would be considered an insured so no subrogation is possible.
[ 11:50 ] - For very young children, their young age can imply that they are not appreciating the consequences of their actions and that can speak to intent.
[ 13:04 ] - The team discusses scenarios where an adult intentionally set a fire so that her husband could heroically put it out, where someone breaks a ring to get it off their swelling finger, and where someone smashes a window to break into their own house.
[ 17:24 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Homeowners annotation on the intentional loss exclusion - https://search.plrb.org/?dn=37&src=gsa
Does a Farm Policy Cover Injury to a Semi Driver Caused by Water Balloons Tossed from Insured's Vehicle? - https://search.plrb.org/?dn=17362&src=gsa
Cutting Off Ring That is Stuck On Swollen Finger… Intentional Loss? - https://search.plrb.org/?dn=67944&src=gsa
Is Damage to Property of Others Coverage Available Under a Homeowners Policy for a Window Broken by the Insured Tenant's Son at a Rental Property? - https://search.plrb.org/?dn=73010&src=gsa
CE course on Intentional Versus Negligent Conduct For Casualty Adjusters - https://www.plrb.org/public2/dislearn/description.cfm?mod=p0056
CE course on Subrogation Claims - https://www.plrb.org/public2/dislearn/description.cfm?mod=p0050
Webinar on Fire Loss Investigation Strategies - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0024
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://thenounproject.com/icon/firework-152487/
https://thenounproject.com/icon/firework-1758560/
What do AI voice clones, $3,000 in wired cash, a lost wedding ring, and a Toledo prison have in common? This episode on the coverage issues presented when a family member-- or a business-- falls for a scam. The team discusses the various types of scams out there and what may and may not be covered under most insurance policies.
Notable Timestamps
[ 00:18 ] - Grandma got a call from someone claiming to represent a charity. She wired $3,000 to an overseas account. Her family researched and found the company did not exist, and helped her file a claim with her insurance company.
[ 01:15 ] - Mike & Alissha discuss their personal experiences with scams of this nature, and Tim warns of the dangers of A.I. voice clones.
[ 05:21 ] - Banks don’t always refund money in situations like this, drawing a distinction between “scams” and “fraud.”
[ 08:38 ] - Money is considered personal property under Coverage C, but it is typically subject to a special limit, recently in the range of $200 - $300. This likely still applies even if the money is not physical cash, but electronically held or wired funds. Cryptocurrency, commonly used in these types of scams, may not be considered money.
[ 11:36 ] - Insurers do not distinguish between “scams” and “frauds” when it comes to “theft.” The intent to deprive the insured of their possession qualifies it as a theft.
[ 14:36 ] - Tim discusses a tangential scenario where a wedding ring is lost in the insured’s luggage.
[ 15:35 ] - Commercial policies do have an exclusion for “voluntary parting,” holding businesses to a higher standard than homeowners.
[ 17:15 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Homeowners annotation on theft - https://search.plrb.org/?dn=135&src=gsa
CE course on Special Limits of Liability - https://www.plrb.org/public2/dislearn/description.cfm?mod=p0008
Voluntary Parting of Money by a Wire Transfer Scam - https://search.plrb.org/?dn=58693&src=gsa
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://pixabay.com/sound-effects/telephone-dial-and-call-ring-21151/
https://thenounproject.com/icon/thief-1400746/
Most contractors are honest actors, but how can an adjuster handle a situation in which a contractor takes an aggressive approach, or insists on cutting the insured out of communications? The PLRB crew discusses the difficulties posed by these situations and what some legislatures and doing to address them.
Notable Timestamps
[ 00:35 ] - Hypothetical contractors say that they are paying the insured’s deductible, so the insurance company should only deal with them directly, not the insured.
[ 03:25 ] - Some contractors apply high-pressure urgent sales tactics, and require down payments up front to lock in homeowners before they can research further.
[ 05:54 ] - Fraud, deposit-snatching, and poor workmanship are other issues present in the industry, though uncommon.
[ 08:15 ] - PLRB’s weather tools allow adjusters to confirm weather conditions like wind and hail were present on the date of the loss. On-site, adjusters may face difficult conversations if homeowners have already been promised a new roof.
[ 09:56 ] - Legislatures in nearly half of states have instituted some form of protection such as a customer’s right to cancel a contractor’s contract, prohibitions against contractors paying deductibles, and requirements that contractors have a license to act as a public adjuster.
[ 12:50 ] - Most homeowners policies forbid assignment of benefits without consent, but post-loss assignments are typically permitted.
[ 14:51 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
50-state survey on aggressive contractors - https://search.plrb.org/?dn=57778
One-stop weather research - https://cats.plrb.org/imaps/weather-cat/plrb-cat-data.html
Recorded webinar on investigating fraudulent roofing claims - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0111
Recorded webinar on assignment of benefits - https://www.plrb.org/distlearn/webinars/vplayer.cfm?vid=w0150
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://pixabay.com/sound-effects/writingpensignaturepaper-102967/
The next pandemic strikes a local hospital, resulting in a business income loss as the facility is closed for cleaning. Does the presence of the virus on the surfaces to be cleaned represent a “direct physical loss” sufficient for coverage? Tim, Alissha, and Mike will explore a scenario nobody wants to think about, applying case law from the post-COVID era.
Notable Timestamps
[ 00:34 ] - A hypothetical outbreak of Ebola means that a hospital needs to shut down significant portions of its premises for two weeks to have the area cleaned. Are they covered for the business income loss?
[ 04:06 ] - The team discusses how the Claims Conference closed in the early days of the COVID pandemic.
[ 08:30 ] - COVID presented novel challenges to businesses, and to adjusters handling business income loss claims. Many claims were denied based on virus exclusions or the lack of direct physical loss.
[ 10:38 ] - Many businesses argued that their properties experienced a loss of use, but a majority of courts (NY, IL, IN, FL, OH, WI, MA) so far has held that viruses do not cause direct physical loss.
[ 12:20 ] - Courts in Vermont and California have held that viruses could be a direct physical loss, pending expert testimony.
[ 16:30 ] - Going forward, adjusters can check for virus exclusions, which have become more common since the COVID pandemic.
[ 17:56 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Coverage question on the “Virus Exclusion, As Defense To COVID-19 Business Interruption Claims” - https://search.plrb.org/?dn=76345&src=gsa
Tim’s on-demand CE Course on Property Coverage Fundamentals - https://www.plrb.org/public2/dislearn/description.cfm?mod=p0092
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org.
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).
https://freesound.org/people/MATRIXXX_/sounds/506545/
A terrorist attack causes massive property damage, including to an insured business. The adjuster assigned to the claim is sure they’ve seen something in the policy about terrorism disclosure or terrorism caps, but isn’t sure what. In this episode, Tim, Alissha, and Mike will explore the TRIA act which enables coverage for minor terrorism losses, and why it likely does not apply to this scenario.
Notable Timestamps
[ 01: 40 ] - This episode concerns a real-life event, the 2020 Christmas Nashville bombing, in which the individual who set off the bomb died, several others were injured, and many businesses were damaged.
[ 03:15 ] - The “War” exclusion would not apply, as many insurers found out after the attacks on September 11, 2001.
[ 06:17 ] - What is TRIA? The Terrorism Risk Insurance Act made terrorism insurance available to businesses on a voluntary basis, for terrorist attacks certified by the Department of the Treasury.
[ 08:52 ] - Under TRIA, a terrorist attack is dangerous to life, property, or infrastructure; has resulted in damage within the U.S.; was committed as part of an effort to coerce U.S. civilians; results in at least $5M in aggregate damage.
[ 09:45 ] - In the Nashville bombing, the elements of a terrorist attack under TRIA were not met due to the lack of the coercion, amount, and certification elements. Because the TRIA elements are echoed in the policy’s terrorism exclusion, this likely means the claim is covered.
[ 13:12 ] - After the Boston Marathon Bombing, many insurers faced the same issues. The event was never certified by the Department of Treasury as a terrorist attack.
[ 14:45 ] - No event has ever been certified in this manner, but terrorism insurance exists and is affordable, so in that sense TRIA has been a success.
[ 15:44 ] - Tim provides a quick recap of the points above.
Your PLRB Resources
Article on Nashville Bombing - https://search.plrb.org/?dn=73725&src=gsa
On-Demand CE Course on Criminal Acts, Terrorism and Liability Claims - https://www.plrb.org/public2/dislearn/description.cfm?mod=p0033)
Overview of TRIA - https://search.plrb.org/?DN=39046
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org with your story.
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).
https://freesound.org/people/tony_bear/sounds/274007/
https://thenounproject.com/icon/trailer-699858/
https://thenounproject.com/icon/fear-4847137/
Alissha, Tim, and Mike introduce a complete rebranding of PLRB’s podcast as “What’s the Scenario? with PLRB”, starting with a mini-scenario on a bear attack.
Notable Timestamps
[ 00:16 ] - A family went camping, only for their personal property to be destroyed by a bear.
[ 01:41 ] - The team introduces themselves. Alissha Watley is Senior Meetings Manager at PLRB responsible for some of PLRB’s annual conferences. Tim Havlir is Property Coverage Counsel at PLRB with years of experience answering coverage questions. Mike Brode is Vice President of Educational and Technical Services at PLRB managing PLRB’s educational offerings, both live and online.
[ 02:36 ] - This podcast is intended for insurance industry professionals who need quick-hit trainings on coverage issues that answer interesting insurance questions relevant to their daily work. These 20-minute episodes will provide clear explanations of complex coverage problems, answers to burning questions from real adjusters, and analysis of the latest trends, all grounded in true-to-life scenarios that authentically capture the insurance professional’s experience.
[ 03:10 ] - Topics to be covered include terrorism, pandemics, fireworks, NFTs, aggressive contractors, phone scams, matching, vacation rentals, and more.
[ 04:27 ] - For those who were already subscribed to the podcast feed for PLRB on Demand, just stay subscribed to the same feed and the title and icon will change. New subscribers should hit “subscribe” to get alerts when we post a new episode.
[ 05:00 ] - Back to the bear attack, the property would be considered covered property; it doesn’t matter that it’s off-premises.
[ 06:13 ] - In this named policy, vandalism requires a mental state of intent which the bear did not have. The same issue applies to other perils such as theft and malicious mischief.
[ 08:30 ] - There is no named peril for damage by animals.
Your PLRB Resources
Homeowners Annotation on Theft - https://search.plrb.org/?dn=135&src=gsa
Homeowners Annotation on Vandalism - https://search.plrb.org/?dn=150&src=gsa
Coverage Question “Raccoon Cannot Cause Malicious Mischief or Vandalism” - https://search.plrb.org/?dn=26392&src=gsa
Coverage Question “Birds Cannot Commit Theft” - https://search.plrb.org/?dn=25272&src=gsa
Coverage Question “Vandalism and Malicious Mischief Involving Cows” - https://search.plrb.org/?dn=85933&src=gsa
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/container.cfm?conlink=sec/cq/default.cfm) 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 scenario@plrb.org with your story.
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).
https://thenounproject.com/icon/bear-4387678/
https://fontawesome.com/icons/tent?f=classic&s=solid
https://thenounproject.com/icon/steak-766620/
https://thenounproject.com/icon/grill-5779567/
Coming January 9, 2024, this podcast feed will be 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 scenario@plrb.org. 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.
- 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).
- Woosh: https://freesound.org/people/qubodup/sounds/60013/
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
While diversity is a buzz phrase in many sectors of the business world these days, it is a vital part of the insurance industry, and can make a difference in the resolution of claims. This podcast will discuss diversity and the importance of different viewpoints when assessing a claims decision.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
https://www.propertycasualty360.com/2019/10/15/understanding-the-value-of-diversity/
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
This episode of PLRB on Demand will feature guest host Trent Stoker, Director of Next Gen Strategy & Implementation at PEMCO Mutual Insurance Company. Trent will interview an expert on the subject of Growth Mindset in the context of leadership, learning, humility, and curiosity: Stan McNaughton, President & CEO of PEMCO Mutual.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
This episode of PLRB on Demand will feature Sherri Gallant and Dave Robinson on the topic of “Burning Through a Cannabis Business Interruption Claim.” Today’s podcast will explore a cannabis property loss with a focus on the business income loss aspect. These claims present special challenges, considerations, and decisions, as we will explore today.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
In today’s podcast episode, Becky will distinguish between industrial hemp and marijuana, and trace hemp’s complex history in the United States legal system. We’ll explore the legal status of industrial hemp and the emerging issues surrounding hemp and CBD oil. Becky will also go into basic farming principles and how to underwrite for grain, fiber, or CBD hemp exposures.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
In today’s conversation, Dr. Allison Stock, Vice President of Environmental Health and Safety at J.S. Held, will challenge some common misconceptions about food safety, and educate us on the science behind food-borne illnesses. She will provide us with some practical tips for avoiding these illnesses, and discuss how training can help food be prepared safely.
Check out this white paper of the same title from J.S. Held.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
In today’s conversation, we will learn more about Laura Spaulding’s experiences founding Spaulding Decon, working with insurance companies, and dealing with the types of messes most people wouldn’t want to handle. We’ll discuss how adjusters can prepare for biohazardous environments and how COVID has impacted claims.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
Beth Sterne of PLRB will give an overview of the Businessowners policy, including what type of business is usually covered by this policy and an overview of the coverages. We will also discuss the features that make this policy different from other commercial policies.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
Losses that involve business income can pose a particular challenge for adjusters. Picking through contents losses and picking through spreadsheets require very different sets of skills. Today, we will speak with Katharyn about her experiences working with business income losses.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
Is subrogation recovery possible after a hurricane, wildfire, or other mass destruction loss? Paul and Katy will review the types of claims from catastrophes or weather-driven losses that can result in successful subrogation, separate "Acts of God" from "Negligence by man" claims when considering subrogation opportunities, and evaluate subrogation opportunities from constitutional claims, Federal Tort Claims Act, and breach of contract/negligence losses.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
This episode of PLRB on Demand will feature Timothy Molony, Claims Concierge and Director of Business Development at BSC Forensics. Tim Molony’s reputation in the industry comes from working within a large national and international property insurance network. In addition to his business development role, he facilitates appraisals as both appraiser and umpire, where he is seen as impartial and balanced. He also assists carriers as an operations/regulatory consultant. Today’s podcast will explore Tim’s experience with hurricane claims and managing large teams of adjusters. We will look at how modeling, preparation, and appraisals have changed over the years, and examine how best to prepare for the unknown heading into a hurricane season.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
This is the third of a series called “The Coverage Contrarian,” where your experts at PLRB discuss and debate interesting coverage issues & nuances. What coverage issues can arise under a Homeowners policy in the event of an E-Bike accident? Check out this week's biggest debate on PLRB on Demand.
Illinois – Definition of Low-speed Electric Bicycle (625 Ill. Comp. Stat. Ann. 5/1-140.10)
Illinois – Definition of Motor Vehicle (625 Ill. Comp. Stat. Ann. 5/1-146)
Illinois – Self-Propelled (https://www2.illinois.gov/rev/research/legalinformation/regs/Documents/part195/Part%20195.105%20AD.pdf)
New York – Definition of Bicycle with Electric Assist (N.Y. Veh. & Traf. Law § 102-c (McKinney))
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
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During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
This is the second of a series called “The Coverage Contrarian,” where your experts at PLRB discuss and debate interesting coverage issues & nuances. What happens when the injury that's caused is worse than the injury the insured expected? Check out this week's biggest debate on PLRB on Demand.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
During this hiatus, PLRB on Demand! will re-run a series of its favorite previous episodes.
This is the first of a series called “The Coverage Contrarian,” where your experts at PLRB discuss and debate interesting coverage issues & nuances. When a mechanic is hired to work on one part of the engine, and another part of the engine breaks down, is there coverage? Check out this week's biggest debate on PLRB on Demand.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
This episode of PLRB on Demand marks our 100th episode! Over the course of this podcast, we have heard from attorneys, claims professionals, engineers, InsureTech experts, and our own PLRB staff. It has been a privilege to pick the brains of so many talented industry professionals.
From now through November, this podcast is going on a hiatus as we install a new recording studio and retool the format of the pod. In the coming months, I’d like to share with you some of my favorite episodes from over the last few years to keep this feed active and useful for our listeners.
This episode of PLRB on Demand will feature Angie Prinsen and Laura Pascoe, both Property and Casualty Claims Managers at Acuity Insurance, on the topic of “Skyrocket Your Leadership Potential by Unlocking a Growth Mindset.”
Angie Prinsen started her career at Acuity Insurance in 2004 and earned her bachelor’s degree in Business as well as her MBA at Lakeland University. Laura Pascoe has over 22 years of experience in the insurance industry and over the past few years, Laura and Angie have teamed up to share their Growth Mindset passion by presenting a TedX talk, a NAMIC webinar, and several internal training sessions at Acuity.
Today’s podcast will explore the concept of “growth mindset”: what it means, how it can be developed, and why it is important for leaders to have a growth mindset. Laura and Angie will help you support and guide your team towards a healthier and more effective mindset.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2023.
This episode of PLRB on Demand will feature Jeanie Ismay, trial attorney at Frank Daily Law. Jeanie’s presentation, “Why Face Time Matters: Maintaining Long-Distance Professional Relationships in the Digital Age,” has been adapted for this podcast. When was the last time you saw your most valuable contact in person? Join Jeanie Ismay as she enthusiastically shares her own professional journey and illustrates the many benefits of one-on-one, face-to-face connections. Jeanie's cautionary tales and tips will help you better understand how to maintain long-distant professional relationships in the digital age.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Jim Chaney, a Training Specialist at E. A. Renfroe & Company on the topic of “Hail Dents to Metal Roofs: Covered Damage or Not?”
Jim Chaney is an insurance trainer who develops and presents trainings for independent adjusters on topics including coverage, claims handling best practices, damage assessment, and more. Before coming to Renfroe, Jim spent nine years with Haag as their Director of Curriculum, including teaching the roof damage certification courses. Jim’s 28 years of industry experience includes work as a CAT adjuster and a field trainer.
Today’s podcast will explore the effects of hail impacts on metal roofing products and whether or not those affects are covered by typical insurance policies, a frequent and critical issue in many insurance claims. Jim will walk us through the myths and realities of damage caused by hail, and examine the key coverage issues raised by hail claims. Court cases will be cited to support information regarding coverage issues.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2023.
This episode of PLRB on Demand will feature Matt Paxton, television host and top hoarding expert. Matt’s presentation, “Understanding a Hoarder to Better Serve Your Clients and Lower Your Costs,” has been adapted for this podcast. Hoarder insureds exist, and they are not as uncommon as you might think. Join TV personality Matt Paxton as he shines light on the private lives of hoarders, dispels hoarding myths, and carefully unravels the psychology behind hoarding. Matt's key strategies for handling losses at hoarded homes will help you better service your clients, and maybe even save some time and avoid inefficiencies in the process.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Ashley Manning, a Senior Tech Claims Specialist in Property Litigation at State Auto. Ashley joined State Auto Insurance in 2007. Prior to this she worked in public relations at 360 Media in Atlanta, Georgia and Carolyn Grisko & Associates in Chicago, Illinois following her graduation from Indiana University with a Bachelor of Arts. Ashley is a Property Claims Examiner with State Auto Insurance with over 14 years of experience handling residential, commercial, farm and specialty claims including complex and litigated files.
We received a request for trainings on freeze claims including investigation of coverage, damage assessment and handling for 1st party homeowners losses. Last time, we spoke with PLRB’s own Tim Havlir about coverage issues related to freeze claims and other winter storm losses. Today, we’ll turn to damage assessment and claims handling of these common losses.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2023.
This episode of PLRB on Demand will feature Jeff Taxier, retired insurance and property restoration expert. Jeff’s presentation, “Too Much Technology, Too Soon,” has been adapted for this podcast. In an era where technology is quickly replacing many human processes, could we be suffering from too much technology, too soon? Join Jeff Taxier as he describes the benefits and downfalls of incorporating the latest technology trends into the world of claims adjusting. Jeff's delightful anecdotes will show you how technology can be fruitful and fun with the right adjuster expertise.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Tim Havlir, Property Coverage Counsel at PLRB. In his work in the property legal department at PLRB, Tim analyzes, researches and writes about a variety of first party coverage issues. He also responds to members' property insurance coverage inquiries on a daily basis, and today we have one such question we received from a member, who requested a training on coverage issues involving freeze claims for 1st party homeowners losses.
Winter storm losses claims open up a variety of issues for adjusters. Because winter storms often trigger other perils, such as power failure and collapse, causation issues may arise. In addition, the loss may trigger loss of use coverage. In this brief conversation, we will quickly highlight some of the more common issues that can arise in claims for winter storms.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2023.
This episode of PLRB on Demand will feature Peter J. Crosa, founder and CEO of independent adjuster firm Peter J. Crosa & Co. Peter’s presentation, “Loss of Balance, Balance of Loss,” has been adapted for this podcast. Losses are all around us, in claims and in everyday life scenarios. Join Peter Crosa as he expertly strums through tales and tips for finding balance in loss. Peter’s melodic approach to work-life balance will help you focus on what really matters and achieve harmony in your life.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Timothy Molony, Claims Concierge and Director of Business Development at BSC Forensics. Tim Molony’s reputation in the industry comes from working within a large national and international property insurance network. In addition to his business development role, he facilitates appraisals as both appraiser and umpire, where he is seen as impartial and balanced. He also assists carriers as an operations/regulatory consultant. Today’s podcast will explore Tim’s experience with hurricane claims and managing large teams of adjusters. We will look at how modeling, preparation, and appraisals have changed over the years, and examine how best to prepare for the unknown heading into a hurricane season.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Curtis VanNess, technical director at HVAC Investigators. Curtis’s presentation, “Death of an Air Conditioner: Compressor Failures Uncovered,” has been adapted for this podcast. When an air conditioner dies in the heat of summer, it can be a difficult time for any insured or any homeowner. Join Curtis VanNess as he takes a posthumous look at the electrical and mechanical failures that can befall an HVAC system. Curtis's review of the causes of HVAC failure will empower you to ask the right questions when determining what caused a system's demise or if it can be saved.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
Today’s podcast will explore cryptocurrency and its origins and new terminology, before we dive into the potential concerns with malware, ransomware, and theft. We’ll discuss the avenues for coverage for cryptocurrency as well as relevant case law.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Dustin T. Smoot, forensic specialist at Pie Forensic Consultants. Dustin’s presentation, “Work Hard, Play Hard,” has been adapted for this podcast. You’ve heard the phrase “work hard, play hard,” but how does it apply to your life? Join Dustin Smoot as he explores the highs and lows of achieving life goals. Whether climbing Mount Kilimanjaro or scaling through a mountain of paperwork, Dustin’s tips for success will have you working and playing at your best.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Dustin T. Smoot, forensic specialist at Pie Forensic Consultants. Dustin’s presentation, “Work Hard, Play Hard,” has been adapted for this podcast. You’ve heard the phrase “work hard, play hard,” but how does it apply to your life? Join Dustin Smoot as he explores the highs and lows of achieving life goals. Whether climbing Mount Kilimanjaro or scaling through a mountain of paperwork, Dustin’s tips for success will have you working and playing at your best.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature an interview with PLRB’s own Mike Brode, Vice President of Educational & Technical Services. Mike’s review of the structure of PLRB at the top of this episode is a great primer on what PLRB members can access, from the “Ask a Coverage Question” feature to our historical weather data and building codes database.
Our guest host for today is Ron D. Cripe, Program Designer at Equis Consulting. This interview premiered as an episode of Equis Consulting’s podcast “Leadership is the Conversation: a discussion with today’s top business leaders on topics to keep busy professionals informed.” Jim Dickson and Tom Meier, two Executive & Management Coaches from Equis Consulting, also joined in the conversation to discuss how you can prepare for changes in the industry; what’s changed and what hasn’t changed about connection in a work-from-home era; and accidental vs. intentional mentoring.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Garret Gray, President and CEO at Next Gear Solutions. Garret’s presentation, “The Real Time Paperless Contractor,” has been adapted for this podcast. When it comes to going paperless, the benefits extend beyond the trees. Join Garret Gray as he revisits life before the dawn of real time claims handling apps and other modern technologies. Garret's inventive insights will help you better understand the value of transitioning technologies, and will have you taking the leap from sorting through stacks of papers to soaring through 'the cloud.'
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
Today’s podcast will serve as a retrospective of Tom’s forty-four years at PLRB. We’ll hear about his early work as Research Counsel answering member questions, his role in the creation of PLRB’s heavily used Search reference database, and the service enhancements that have improved PLRB’s offerings during Tom’s years as President. We’ll learn how Tom guided PLRB through a radical transformation.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Bob Whelan, Principal Consultant at Donan. Bob’s presentation, “The Age-Old Question: When Did That Hail Damage Occur?,” has been adapted for this podcast. It's not uncommon for parties investigating a hail damage claim to asphalt shingle roofs to ask the question: how old is the damage? The answer to this question is particularly useful if an insured recently changed insurance carriers. Join Bob Whelan as he describes testing conducted by Donan to investigate the visual characteristics of degradation to asphalt shingles from a hailstone strike and shares what they learned. Using the information gleaned from this testing, insurers can become better at determining when hail damage to asphalt shingles occurred.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Bob Whelan, Principal Consultant at Donan. Bob’s presentation, “The Age-Old Question: When Did That Hail Damage Occur?,” has been adapted for this podcast. It's not uncommon for parties investigating a hail damage claim to asphalt shingle roofs to ask the question: how old is the damage? The answer to this question is particularly useful if an insured recently changed insurance carriers. Join Bob Whelan as he describes testing conducted by Donan to investigate the visual characteristics of degradation to asphalt shingles from a hailstone strike and shares what they learned. Using the information gleaned from this testing, insurers can become better at determining when hail damage to asphalt shingles occurred.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature guest host Trent Stoker, Director of Next Gen Strategy & Implementation at PEMCO Mutual Insurance Company. Trent will interview an expert on the subject of Growth Mindset in the context of leadership, learning, humility, and curiosity: Marilyn Gist, Ph.D., author of "The Extraordinary Power of Leader Humility."
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature guest host Trent Stoker, Director of Next Gen Strategy & Implementation at PEMCO Mutual Insurance Company. Trent will interview an expert on the subject of Growth Mindset in the context of leadership, learning, humility, and curiosity: Marilyn Gist, Ph.D., author of "The Extraordinary Power of Leader Humility."
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Louis Collisson, owner of LTJ Consulting, Inc. Louis’s presentation, “Safety Considerations at a Claim Site,” has been adapted for this podcast. Traversing a claim site can be hazardous, especially if you're not prepared with the gear and knowledge to ensure your safety. Join Louis Collisson, who has survived unsecured ladders, steep roofs, and even wildlife, as he shares his tips for staying vigilant for safety risks on claim sites. Louis' review of safety guidelines will help prepare you to insist on a high level of safety at your next claim site.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature guest host Trent Stoker, Director of Next Gen Strategy & Implementation at PEMCO Mutual Insurance Company. Trent will interview an expert on the subject of Growth Mindset in the context of leadership, learning, humility, and curiosity: Stan McNaughton, President & CEO of PEMCO Mutual.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Lisa Bergeron, Co-Creator and Chief Visionary at Advancing Workplace Excellence. Lisa’s presentation, “Power of Networking: Connect With Meaning and Purpose,” has been adapted for this podcast. Networking - you're probably doing it all the time without even thinking about it, but are you doing it effectively? Join Lisa Bergeron as she explores the dos and don'ts, along with the many benefits, of this powerful tool. Lisa's witty insights will help empower you to connect with meaning and purpose in your everyday life.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Robert A. Stern of Derrevere Stevens Black & Cozad and Kimberly Stafford of USAA. Today’s podcast will explore how to handle the adjustment of a weather-related claim, with a focus on subrogation. Through the examination of two fact patterns, Robert and Kimberly will discuss how to implement an investigation strategy which supports potential subrogation, and provide strategies for dealing with obstructive defense counsel and failed mediation. 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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Michael J. Miller, CFO at CitiSculpt. Michael’s presentation, “Net Promoter Score: The Storm on the Horizon for the Claims Community,” has been adapted for this podcast. Most businesses now track customer satisfaction via surveys, but how effective is this practice when it comes to the insurance industry? Join Michael J. Miller as he challenges the notion that adding more technology and online features is a solution to all problems. Michael's insights will encourage you to take a second look at what you think you know about your internet strategy.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Jenny Pye, CPCU, AIC, API, a recognized inspirational insurance presenter and leader, and Director of Commercial Claims Operations at Pilot Catastrophe Service. One of Jenny’s greatest passions is to provide mentorship to those seeking continuing education in insurance, including those pursuing their CPCU or other insurance designations. Continuing education can be valuable for anyone at any point in their insurance careers – it can provide needed education and insight for those early in their insurance careers and validate experience for those who are later in their careers. Today, we will speak with Jenny and spread the message of insurance education and designations.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Adrian Frank, Senior Executive Vice President at J.S. Held LLC; and Brett Goldberg, Entrepreneur, Executive, and Media CEO. Adrian and Brett’s presentation, “Incorporating Technology to Inspect, Document, & Instantly Report on a Site,” has been adapted for this podcast. Artificial intelligence, virtual inspections, and instant onsite reporting may seem like things of the future, but they are closer to claims handling than ever. Join Adrian Frank and Brett Goldberg as they navigate through the latest tech features streamlining the industry. Adrian and Brett’s insights will inspire you to integrate, enhance, and simplify your claims processes for a better customer experience overall.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature a “Webinar Follow Up” after July Twenty-Third’s “Commercial Roofing Investigation, Damages & Repairs” webinar. This webinar outlined claim investigation procedures and complexities regarding damages to roofing systems, described effective inspection procedures for various types of commercial roofs, and separated storm-related damages (wind, hail, weight of ice and snow) from wear and tear and other possible causes. 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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand features Daniel Thall, Property Operations Manager at Preferred Mutual. Daniel’s presentation, “Ice Dams: Loss Leader or Opportunity?,” has been adapted for this podcast. Ice dams can transform a few inches of ice into a sprawling, high-cost claim. Join Daniel Thall as he explores what causes ice dams and potential solutions. Daniel Thall's proactive ideas will propel the industry forward and cut off ice dam claims before they start.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Sherri Gallant and Dave Robinson on the topic of “Burning Through a Cannabis Business Interruption Claim.” Today’s podcast will explore a cannabis property loss with a focus on the business income loss aspect. These claims present special challenges, considerations, and decisions, as we will explore today.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand features Steve Powell, Executive Vice President at Sedgwick. Steve’s presentation, “Forensic Investigations: Trends & Trapdoors for Claims,” has been adapted for this podcast. Having a court bar your origin and cause investigator's opinions can effectively end your case, whether an insurer is providing a defense to its insured, prosecuting a subrogation action or defending itself against allegations of bad faith in a first-party case. Join Steve Powell as he highlights the trends and trapdoors facing forensic investigators. Steve's practical tips will help you and your expert avoid those trapdoors and keep your case on solid ground.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature a “Webinar Follow Up” for our “High Exposure Commercial Liability Claims” webinar. The webinar highlighted practical and effective methods of adjusting and investigating claims to expose and mitigate claims involving questionable and controversial strategies being employed by claimants and their representatives.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand features Steve Rosenthal, forensic accountant at Baker Tilly. Steve’s presentation, “Business Interruption From a Cyber Attack,” has been adapted for this podcast. You see it in the news every day- cyber attacks targeting businesses large and small and wreaking havoc to the economy. Join Steve Rosenthal as he examines the vulnerabilities, coverage options, and issues surrounding cyber attacks and their impact on business insureds and third parties. Steve's careful analysis of this critical topic will help you better service your business insureds.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This is an industry where claims professionals deal with a high volume of claims, time demands, and customers who are distressed due to the loss they just sustained. As a result, some claims professionals can become complacent or even jaded, but the best ones continue to grow, to challenge themselves, and to look at each claim as an opportunity to help their insureds at a time when they need it most. This year, we were pleasantly overwhelmed by the number of submissions we received from claims supervisors from all around the country who nominated their best and brightest for the PLRB Outstanding Claims Professional Award. Javier was one of only three claims professionals selected for this award. Today we’ll learn about Javier’s work in the insurance industry. 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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This episode of PLRB on Demand will feature Jessica Gaudio, Senior Director of Membership at The Institutes CPCU Society. Jessica’s presentation, “Preparing Today for Tomorrow's Workforce”, has been adapted for this podcast. As more and more insurance professionals approach retirement age, the industry is on the lookout for sharp new minds to fill in the gaps. Join Jessica Gaudio as she explores how to correct misconceptions about the insurance industry, what buzzwords to use in your job posting, and what Millennials value in a job. 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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This presentation by Diane Barnes-Reynolds, Managing Partner at Simon Reed & Salazar, P.A., has been adapted for this podcast. Electronic discovery is a vital process that can make or break your claims case, and can be as complex as a 1,000 piece puzzle. Join Diane Barnes-Reynolds as she carefully constructs the importance of organization and detailed claim file notes. Diane's insights will inspire you to discover the missing pieces to your claims puzzle.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2022.
This is the third of a series called “The Coverage Contrarian,” where your experts at PLRB discuss and debate interesting coverage issues & nuances. What coverage issues can arise under a Homeowners policy in the event of an E-Bike accident? Check out this week's biggest debate on PLRB on Demand.
Illinois – Definition of Low-speed Electric Bicycle (625 Ill. Comp. Stat. Ann. 5/1-140.10)
Illinois – Definition of Motor Vehicle (625 Ill. Comp. Stat. Ann. 5/1-146)
Illinois – Self-Propelled (https://www2.illinois.gov/rev/research/legalinformation/regs/Documents/part195/Part%20195.105%20AD.pdf)
New York – Definition of Bicycle with Electric Assist (N.Y. Veh. & Traf. Law § 102-c (McKinney))
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
Marty Frappolli's (Insurance & Risk Management Thought Leader) PLRB Presents! Industry Insights presentation, “Three Things Pizza Taught Me About Claims Leadership,” has been adapted for this podcast. Who knew that pizza and claims were so alike? Join Marty Frappolli as he explores the flavorful insights he has acquired from the world of pizza to the world of claims. Marty's tips for passion, persistence, and performance in your professional career will help you find the right ingredients for successful claims handling.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
Rhonda J. Thompson's (partner at Thompson Coe) PLRB Presents! Industry Insights presentation, “Managing Millennials: Get Woke & Be Chill,” has been adapted for this podcast. This pragmatic, humorous talk is targeted to managers and leaders who want a meaningful framework through which to approach Millennial professional employees in a service industry like insurance. The spotlight is on the leaders and managers and not the Millennial for a change. Critical to this talk are suggestions and tools for retaining and managing Millennials, and the benefits to an organization who commits to staying the course in thinking outside the box and navigating the Millennial gauntlet.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
Today’s podcast episode will feature excerpts Heather Becker of the Conservation Center’s new course on art & heirloom claims, which will discuss the information an adjuster may need to collect for art conservation, how damage to art & heirlooms can be preemptively minimized, and how conservators distinguish between pre-loss damage and related damage. In this episode, you will learn about how different mediums can present special considerations in a loss scenario.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This episode is a follow-up from a webinar that was presented by William Krekstein and Sherri King. Bill is a founding partner at Horst Krekstein & Runyon, and Sherri is a Claims & Risk Engineering Manager at State Auto. This webinar identified the current landscape for property insurance coverage disputes, including arguments on policy ambiguity, impact of public adjusters and perceptions on COVID-19 pandemic. The webinar also described recent judicial decisions affecting property insurers and their impact on claims handling.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
The PLRB Presents! Industry Insights presentation, “Identify, Develop and Inspire Your Future Claims Supervisors,” has been adapted for this podcast. Are you being the best leader you can be? Join Jackie Jones, Property, Commercial & SIU Claims Manager at Indiana Farm Bureau Insurance, as she provides you with the elements to seek out talent, channel personal development, and inspire others within the claims industry. Jackie's inspiring stories will motivate you to great leadership, whether you lead from the office or the field.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This episode of PLRB on Demand will feature Richard I. Woolf, attorney at Baker Sterchi Cowden & Rice LLC. Richard’s presentation, “How Claim Litigation Management Is a Lot Like Youth Basketball,” has been adapted for this podcast. How is coaching a youth basketball team similar to managing claim litigation? Join attorney Richard Woolf as he draws upon his experience on the court as a youth basketball coach to assist claims professionals and attorneys with obtaining better outcomes in the court. By mastering the basics, embracing your role and practicing sportsmanship, you too can take your claim litigation management skills to the next level.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This episode of PLRB on Demand will feature Steve Badger, Partner at Zelle LLP. Steve’s presentation, “The Hail Lawsuit Frenzy: Update From the Trenches,” has been adapted for this podcast. Hail damage claims are pervasive and complex, not to mention growing in number. Join Steve Badger as he depicts the hail claim crisis that is sweeping the nation. Steve's tales and triumphs from the trenches will help raise awareness to the growing concerns over frivolous hail claim lawsuits, and will empower you to take effective action.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This episode features Judge Nelson E. Canter, partner at McLaughlin & Stern, LLP. Judge Canter’s presentation, “The Essential Non-Party Witness,” has been adapted for this podcast. A credible witness is worth his or her weight in gold. Join Honorable Nelson Canter as he explores riveting case scenarios where non-party witnesses proved to be essential to untangling complex claims. Nelson’s experienced insights will help you find your next essential non-party witness.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This episode features Judge Nelson E. Canter, partner at McLaughlin & Stern, LLP. Judge Canter’s presentation, “Eliminating Subrogation Waivers,” has been adapted for this podcast. Are you interested in the proliferation of subrogation waivers in contracts and its impact on risk-sharing after a loss? Join Nelson Canter as he explains how subrogation waivers work and why contractual waivers of subrogation should be eliminated. Nelson's passion for holding culpable parties responsible for their actions will prompt you to take another look at these waivers.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
Over the past year, Payroll Protection Program loans, or PPP loans for short, have helped businesses keep their workforce employed during the COVID-19 crisis, backed by the U.S. Small Business Administration. Today Randall Wilson of Pario Forensic Accounting Services and Glenn Ricciardelli of MDD Forensic Accountants will discuss how PPP loans intersect with business income issues and projections.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This episode of PLRB on Demand will feature Todd Asher, CEO at Sygnali. Todd’s presentation, “Embracing a Digital Transformation,” has been adapted for this podcast. Are you embracing the future? It's coming whether you are ready or not, so get ready with this fascinating talk.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
On July 2, 2021, U.S. Court of Appeals for the Eighth Circuit, applying Iowa law, handed down the decision Oral Surgeons, P.C. v. Cincinnati Ins. Co., finding that business income claims arising from government orders, issued in response to the COVID-19 pandemic, were not covered. Today PLRB's Maria Pellegrino will discuss with us the facts and holding of this case as well as its implications.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This episode of PLRB on Demand will feature Stuart A. Mintz, AVP and Sr. International EGA in the Large Loss Unit at Custard Insurance Adjusters, Inc. Stuart’s presentation, “Condominium Claims: Issues and Possible Solutions,” has been adapted for this podcast. Overwhelmed by condominium claims? Stuart Mintz will provide you with seven key things you need to know.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This episode of PLRB on Demand will feature David Jarrett, counsel at Western Reserve Group. Dave’s presentation, “Examinations Under Oath: The Forgotten Tool,” has been adapted for this podcast. Are you ready for your next Examination Under Oath? Learn just how useful these can be in this interesting talk.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This episode of PLRB on Demand will feature Judge Nelson E. Canter, partner at McLaughlin & Stern, LLP. Judge Canter’s presentation, “Enforcement of Tenders of Defense and Indemnification,” has been adapted for this podcast. Want to brush up on tenders of defense and indemnification? Check out this engaging discussion of the topic.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
You may contact this guest at jstoner@redapd.com.
This webinar that this podcast follows up on focused on an internal roof drain pipe break within the walls of a very expensive and prominent historic home near New York's Central Park that was complicated by interpersonal elements on the side of both the insureds and the company. The emphasis of the webinar was upon the relational and trust issues created by those human issues.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
In today’s conversation, we will learn more about Laura Spaulding’s experiences founding Spaulding Decon, working with insurance companies, and dealing with the types of messes most people wouldn’t want to handle. We’ll discuss how adjusters can prepare for biohazardous environments and how COVID has impacted claims.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
Beth Sterne of PLRB will give an overview of the Businessowners policy, including what type of business is usually covered by this policy and an overview of the coverages. We will also discuss the features that make this policy different from other commercial policies.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
In today’s conversation, Dr. Allison Stock, Vice President of Environmental Health and Safety at J.S. Held, will challenge some common misconceptions about food safety, and educate us on the science behind food-borne illnesses. She will provide us with some practical tips for avoiding these illnesses, and discuss how training can help food be prepared safely.
Check out this white paper of the same title from J.S. Held.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
Throughout this podcast, we have touched on the issue of InsurTech and the changes coming for the insurance industry, as well as the issue of the working relationship between contractors and carriers and how that can be improved. As someone with experience on both the carrier side and the contractor side, and as someone with firsthand knowledge of the technology that will change the industry, Steve is specially situated to help us bring these topics together.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
This is the second of a series called “The Coverage Contrarian,” where your experts at PLRB discuss and debate interesting coverage issues & nuances. What happens when the injury that's caused is worse than the injury the insured expected? Check out this week's biggest debate on PLRB on Demand.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
Accidents are all around us, disrupting businesses and lives. Join Dr. Mary as she dissects the symbiotic relationship that technology and biology can have in our decision-making process. Dr. Mary's eloquent insights on automated cars, human brains, and even emotions will help you connect the dots and drive home dependability during disruption.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
In today’s conversation, Tim will help insurance professionals think through the current claims process and identify areas of opportunity for technology-assisted solutions, as well as to better understand the challenges for insurers. We will discuss examples of various tools and how they impact the claims process, and identify the areas where claims professionals add value to the claims process to help the listeners become hyper-focused on how they can improve their knowledge and skill sets to thrive as a claims professional in the next 10 years.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
What is your reputation? Ed Jones will help you understand how to build and maintain a reputation.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2021.
There are new phones and gadgets every year, so why shouldn’t the way insurers take inventory of those contents evolve as well? Today we’ll discuss with Tyler a modern digital way to conduct a detailed inventory of any type of contents loss using a simplified, efficient process. Tyler will examine true-to-life case scenarios exploring the interplay of consistency, accurate inventory quality, depreciation, and customer transparency.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
Losses that involve business income can pose a particular challenge for adjusters. Picking through contents losses and picking through spreadsheets require very different sets of skills. Today, we will speak with Katharyn about her experiences working with business income losses.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
Driverless cars are coming to a road near you whether or not the insurance industry is ready for it. Join Julia Molander as she reviews the features of driverless cars and their likely impact on the insurance industry. Julia's analysis of the likely effects of this new technology will shift your perspective into a new gear.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
Do you have a fixed mindset? Learn the difference mindset can make in your life and career.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
When was the last time that an employee told you they loved their job? Join Jason Coleman as he carefully crafts a foundation of interpersonal skills that helps build strong employee relationships and solid organizational success. Jason's insights and inspirations from his own personal journey as a leader will motivate you to better engage, retain, and celebrate your employees.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
In this conversation, Andrew and I will discuss an experienced front-line adjuster's takeaways on the industry, including how to work with leadership, how to prepare the skills you will need in the future as technology changes, how to retain talent, and how to know when to switch tracks.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
This is the first of a series called “The Coverage Contrarian,” where your experts at PLRB discuss and debate interesting coverage issues & nuances. When a mechanic is hired to work on one part of the engine, and another part of the engine breaks down, is there coverage? Check out this week's biggest debate on PLRB on Demand.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
As technology continues to improve, adjusters are finding themselves getting more and more done from behind a desk. Jarod will provide some key tips and resources on the apps that will help you adjust claims more effectively and learn more about your claim from afar, whether you are in the property, casualty, or auto arena.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
In this podcast, Jonathan Barger will help adjusters develop a framework for tackling innocent co-insured issues, from identifying if an issue exists in a claim to determining if the innocent co-insured is entitled to recover.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
How we feel about ourselves and our environment plays a huge role in our health, how we respond to stress and challenges, and how we perform in our personal and professional lives. Sometimes we experience internal conflict and find it hard to override our inner voice when faced with new challenges in life. Lydia will demonstrate how to take control of your life and challenge your thinking using the most powerful tool we have: our minds.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
How is the insurance industry implementing Artificial Intelligence, and how could it evolve in the future? Lars will review the possible applications of AI utilization across the claims workflow, and evaluate the ways insurers can measure their effective use of AI as well as the implications moving forward.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
The views and opinions expressed in the following presentation 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. (C) PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
When it comes to handling insurance claims, the State of Florida can present some unique challenges and opportunities. In today’s podcast, Andy Rock will help you navigate natural catastrophes, widespread Assignment of Benefits, and unusual quirks in the law so that you can head to the Sunshine State with confidence.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
While diversity is a buzz phrase in many sectors of the business world these days, it is a vital part of the insurance industry, and can make a difference in the resolution of claims. This podcast will discuss diversity and the importance of different viewpoints when assessing a claims decision.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
https://www.propertycasualty360.com/2019/10/15/understanding-the-value-of-diversity/
In today’s podcast episode, Becky will distinguish between industrial hemp and marijuana, and trace hemp’s complex history in the United States legal system. We’ll explore the legal status of industrial hemp and the emerging issues surrounding hemp and CBD oil. Becky will also go into basic farming principles and how to underwrite for grain, fiber, or CBD hemp exposures.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
Many of us have been ordered by our state and local governments to “shelter in place” due to the spread of the novel coronavirus. For many, this means getting used to a new workplace: your own home. Remote work has been a growing trend, but now it’s expanding faster than ever. Peggy Saldana will help us understand how to get the most out of our remote teams.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
Today, the customer experience on most apps is instantaneous. You can get food, furniture, rides, and places to stay with just a few taps on your phone. Filing an insurance claim can be a different experience because of the amount of work that goes into investigating and managing a claim. How can we manage those changing customer expectations, and improve their experiences? John Bachmann will help us dive into this key issue.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
We find ourselves in a time of unprecedented stress, anxiety, and uncertainty in the presence of the coronavirus crisis. Even before the outbreak of COVID-19, insurance professionals dealt with stress and anxiety in the workplace, and now they may be faced with pressing personal matters, changing work environments, new challenges in working remotely with teams, insureds dealing with even more stressors, and unyielding deadlines. Dr. Shelton will provide some valuable advice for claims professionals in this trying time.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
This episode of PLRB on Demand explores the insurance implications of the novel coronavirus. First we’ll speak with Tim Havlir, Property Coverage Counsel at PLRB. Tim will walk us through his comprehensive article on the property coverage impacts of this recent outbreak. Then we’ll reach out to Glenn Ricciardelli, a CPA, forensic accountant, and partner at Matson, Driscoll, and Damico with extensive experience in time element losses. Glenn will give us some insight into the business income implications of the novel coronavirus. Finally, we’ll speak with Paul Dispensa, Vice President of Liability Services & Membership, about his article on the potential for third-party liability. 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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
Is subrogation recovery possible after a hurricane, wildfire, or other mass destruction loss? Paul and Katy will review the types of claims from catastrophes or weather-driven losses that can result in successful subrogation, separate "Acts of God" from "Negligence by man" claims when considering subrogation opportunities, and evaluate subrogation opportunities from constitutional claims, Federal Tort Claims Act, and breach of contract/negligence losses.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2020.
Today’s episode is a joint venture with Timely Notice and will be posted on both podcasts. In the first half, Jonathan will interview John Hurley of PLRB about his selected 2019 case, McFarland v. Liberty Insurance. Then in the second half, PLRB will interview Jonathan Schwartz about his selected 2019 case, Owners Insurance Co. v. Dakota Station.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
What impact will changing technology have on the insurance industry? In this joint feature with Fourseventy Claim Management's FNO: InsureTech podcast, PLRB spoke with Rob Beller and Lee Boyd about the future of InsureTech and how to identify which new technologies will make a difference in your claims. In the second half, Lee and Rob interviewed PLRB about how to get the most out of the upcoming Claims Conference.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
Fail. LittleRainySeasons. Freesound.org. Creative Commons 0.
Success Fanfare Trumpets. FunWithSound. Freesound.org. Creative Commons 0.
Tension Build. BenjaminHarveyDesign. Freesound.org. Creative Commons 0.
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019.
Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
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. Listeners should rely on guidance from their companies and counsel as appropriate. (C) PLRB 2019. Music: On Target. Daniel Deweese. Prolific Two Publishing - Ascap. Biz Underscores. Purchase included all licensing types. Purchased from royaltyfreemusicrevolution.com. Now available on Atomica Music Library.
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. Listeners should rely on guidance from their companies and counsel as appropriate. (C) PLRB 2019.
The views and opinions expressed in the following presentation 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. (C) PLRB 2019.
This podcast has been adapted from Dan Dyce's 2017 PLRB Presents! Industry Insights presentation.
The views and opinions expressed in the following presentation 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. (C) PLRB 2019.
The views and opinions expressed in the following presentation 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. (C) PLRB 2019.
The views and opinions expressed in the following presentation 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. (C) PLRB 2019.
Referenced report: "Expanding Child Victim Compensation Laws Could Adversely Affect Insurers." A.M. Best. Best's Commentary. July 22, 2019. http://www3.ambest.com/bestweekpdfs/sr745111719481full.pdf
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. Listeners should rely on guidance from their companies and counsel as appropriate. © PLRB 2019. Music: Nimbus. Eveningland. Sound Effect: Woosh 2. XxChr0nosxX. Freesound.org. Creative Commons 0.