By PLRB
5
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The podcast currently has 161 episodes available.
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.
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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 [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
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.
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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 [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
It's not easy work standing over a hot fryer making french fry rings all day, so today's fry cook isn't in the best mood when the cashier starts complaining. After the lunch rush, the employees sneak out and step over to the neighboring gas station parking lot for a fistfight. Notable Timestamps
[ 00:26 ] - At DonutBurgers, two employees are still on the clock and in their uniforms when they leave the premises for a fight.
[ 01:39 ] - Cold or hot? Curly or shoestring? Salt or no salt? The team discusses the best fast food fries.
[ 03:25 ] - Insurance generally covers defense against claims seeking damages for bodily injury, if caused by an occurrence.
[ 04:35 ] - The concept of an occurrence is related to fortuity, as in, insurance is generally intended to cover accidents, not purposeful actions.
[ 05:20 ] - The definition of occurrence and the Expected or Intended Injury Exclusion usually operate to preclude defense of an employee for their assaults...
[ 06:00 ] - ...but the employer is often sued for negligent hiring, negligent background investigation, negligent training, negligent supervision, etc.
[ 07:15 ] - The policy in this scenario only covered employees for acts within the scope of their employment.
[ 08:15 ] - In the case upon which this scenario was based, the court held in favor of the insurer even though negligence was alleged, because the crux of the complaint centered on intentional conduct unrelated to business operations.
[ 10:30 ] - Nevada law supports the interpretation that there is no occurrence under these facts, so the action taking place off-premises likely did not impact the result.
[ 12:22 ] - Brennan provides a recap of the scenario and the points above.
Your PLRB Resources
Safety Nat’l. Cas. Corp. v. Bender (2024) 2024 U.S. Dist. LEXIS 159524 (D. Nev. 9/4/24) - https://www.plrb.org/documents/safety-natl-cas-corp-v-bender-2024/
GL17 – Occurrence/Accident Defined - https://www.plrb.org/documents/gl17-occurrence-accident-defined/
Can There Be an “Occurrence” When the Insured’s Employee Deliberately Strikes a Customer With a Baseball Bat? 2022.01.18 - https://www.plrb.org/documents/can-there-be-an-occurrence-when-the-insureds-employee-deliberately-strikes-a-customer-with-a-baseball-bat-2022-01-18/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
Subscribe to this Podcast
Your Podcast App - Please subscribe and rate us on your favorite podcast app
YouTube - Please like and subscribe at @plrb
LinkedIN - Please follow at “Property and Liability Resource Bureau”
Send us your Scenario!
Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
A restaurant hired a plowing service. One night, before the service plowed the lot, a grandmother exits her car, slips and falls, and breaks her hip. The woman sues, but the restaurant did not report the injured woman’s claim to their insurer for six months. Notable Timestamps
[ 00:26 ] - By the time the insurer learned of the loss, the injured person had already obtained a judgment against the insured.
[ 01:35 ] - How do you walk on ice?
[ 03:28 ] - A CGL's notice provision likely requires "immediate notice", "notice as soon as practicable", or "prompt notice". Courts interpret these provisions in line with a reasonableness standard.
[ 04:00 ] - Breach of this policy provision can give the insurer the right to deny coverage, so claims are often reported even prior to suit being filed.
[ 05:11 ] - In Illinois, courts examine factors including the wording of the notice provision, the sophistication of the insured, the diligence of the insured, and prejudice.
[ 07:33 ] - Some states (but not IL) require the insured to show prejudice-- in layman's terms, some impact beyond a technality.
[ 10:50 ] - Even if the insured feels that the snow plow company should be at fault, the insured must still comply with the insurance contract.
[ 12:27 ] - There's no universal bright-line rule on the amount of time: cases range from finding breach at three months, to finding no breach at two years.
[ 13:37 ] - Courts would also consider factual situations like difficulties with mail.
[ 14:10 ] - Typically in lawsuits lack of knowledge of a contract is not a defense, but in this case the sophistication of an insured is a factor.
[ 16:14 ] - Michele provides a recap of the scenario and the points above.
Your PLRB Resources
50 State Survey – Late Notice - https://www.plrb.org/documents/table-of-contents-late-notice/?search=late%20notice
Commercial General Liability Policy Annotation Key GL25, Late Notice - https://www.plrb.org/documents/gl25-notice-to-insurer/
Commercial General Liability Policy Annotation Key GL26, Notice Prompt And As Soon As Practicable - https://www.plrb.org/documents/gl26-notice-prompt-as-soon-as-practicable/
PLRB Coverage Reply, Is Prejudice Required to Deny a Claim for Late Notice? - https://www.plrb.org/documents/is-prejudice-required-to-deny-a-claim-for-late-notice-2022-09-30/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
Subscribe to this Podcast
Your Podcast App - Please subscribe and rate us on your favorite podcast app
YouTube - Please like and subscribe at @plrb
LinkedIN - Please follow at “Property and Liability Resource Bureau”
Send us your Scenario!
Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
A small grocery store specializes in farm-to-table meat and fish, locally sourced and priced at the high end of the market. After accepting their week’s shipment on a Wednesday evening, thunderstorms led to a power outage that spoiled the fish. Notable Timestamps
[ 00:36 ] - Another insured claims their back shed was hit by lightning, damaging expensive equipment.
[ 01:32 ] - The team discusses tips for what to do during a power outage.
[ 02:47 ] - On PLRB.org, on the Weather Hub, you can click Power Outage Report and enter in an address and date to see historical power outage reports in a grid with 1km x 1km squares.
[ 05:55 ] - The data can only demonstrate a probability that an outage occurred at the selected address.
[ 06:50 ] - The data does not include the cause of the power outage.
[ 07:00 ] - The lightning report data includes satellite data during a given 1-hour period for both in-cloud and cloud-to-ground lightning.
[ 09:40 ] - These reports can be used to confirm causality in a claim.
[ 10:24 ] - Tim & Mike chime in! Food spoilage claims can lead to confusion because the clauses frequently change. In these situations, it's best to read the policy carefully. Is there a distinction between on-premises and off-premises? Does it mention power failures as well as power surges? Is there an ensuing loss clause? The policy may also have an endorsement for food spoilage.
[ 12:43 ] - CP and BP form have an exclusion for artificially-generated electrical current, which would not apply in a lightning claim.
[ 03:24 ] - Andrew provides a recap of the scenario and the points above.
Your PLRB Resources
Get a Power Outage Report - https://www.plrb.org/weather-cat/power-outage-reports/
Get a Lightning Report - https://www.plrb.org/weather-cat/researching-lightning-data/
Adjuster Resource Sheet: Food Spoilage Claims Under Commercial Forms for Property Adjusters - https://www.plrb.org/documents/adjuster-resource-sheet-food-spoilage-claims-commercial/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
Subscribe to this Podcast
Your Podcast App - Please subscribe and rate us on your favorite podcast app
YouTube - Please like and subscribe at @plrb
LinkedIN - Please follow at “Property and Liability Resource Bureau”
Send us your Scenario!
Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
A CAT Manager is making preparations for her CAT team in advance of Hurricane Francine, which approached the Louisiana coast in the second week of September, 2024. She reads something about spaghetti models, and something about Fast Track cyclones? Notable Timestamps
[ 00:36 ] - The building owner submits the claim to their property insurer, looking for coverage for a new bollard. They have a standard CP 00 10 10 12, which does not include coverage for fences if the cause of loss was an accidental vehicle crash.
[ 01:21 ] - The PLRB team discuss pasta recipes.
[ 02:47 ] - Hurricane Francine caused a great deal of damage to homeowners and businessowners by the Louisiana coast.
[ 04:35 ] - Andrew shares some screenshots, available on the YouTube version of this podcast.
[ 05:02 ] - An error cone is shown, demonstrating the suspected path of the hurricane.
[ 05:28 ] - Spaghetti models show the various paths Francine might have taken.
[ 05:46 ] - Peak storm surge forecasts color code area by feet of storm surge.
[ 06:44 ] - The "Best Track" includes line, point data, and cumulative wind history.
[ 07:20 ] - Spaghetti models are a forecasting tool that provides multiple expectant paths. Tracks closer together indicate certainty. These are available on PLRB.org or via API.
[ 08:33 ] - Andrew demonstrates how spaghetti models can change over time. Error cones may be superimposed on the spaghetti models.
[ 10:17 ] - Storm surge is the rise in seawater caused solely by the storm's winds pushing the water onto shore. Soup gets involved now.
[ 11:15 ] - Best Track is a representation of the tropical cyclone's direction and intensity. The Best Track wind swath shows how the storm changed.
[ 12:10 ] - Catastrophe Managers can use these forecasting tools in resource allocation. Best Track data can assist in estimating claim ratios. Claims Adjusters can use Best Track data to assist in claims decisions. Underwriters can use this historical data in risk assessment.
[ 13:19 ] - Andrew provides a recap of the scenario and the points above.
Your PLRB Resources
Tropical Storm Francine: https://www.plrb.org/weather-cat/2024-francine/
Spaghetti Models: https://www.plrb.org/documents/view-tropical-cyclone-track-spaghetti-models/
Best Track Data: https://www.plrb.org/documents/view-national-hurricane-center-tropical-cyclone-best-track-maps/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
Subscribe to this Podcast
Your Podcast App - Please subscribe and rate us on your favorite podcast app
YouTube - Please like and subscribe at @plrb
LinkedIN - Please follow at “Property and Liability Resource Bureau”
Send us your Scenario!
Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
A brewery owner had bollards installed outside the building for safety purposes. One day a teenager veered off the road into one of the bollards, damaging it and the car. The adjuster is wondering if there should be no coverage on the basis that a bollard is a fence. Notable Timestamps
[ 00:26 ] - The building owner submits the claim to their property insurer, looking for coverage for a new bollard. They have a standard CP 00 10 10 12, which does not include coverage for fences if the cause of loss was an accidental vehicle crash.
[ 01:34 ] - Trivia time! What is a "pub" short for? How many Clydesdales are hitched to the Budweiser wagon? Lite beer was introduced into the U.S. in what decade?
[ 04:15 ] - A bollard is a short pole or stump placed to prevent vehicle access without preventing pedestrian access. These may be seen at the entrances to bike paths, or out in front of buildings or arenas.
[ 05:40 ] - Under the CP form, a bollard would initially fit under building coverage as an external fixture. Fences are excluded except for certain types of losses (not including this kind of loss).
[ 07:30 ] - A line of bollards, like a fence, is something like a barrier that marks a boundary. But, there is no continuity between posts, and it does not prevent pedestrian access.
[ 09:11 ] - A historic moment: the team agrees on something!
[ 09:37 ] - Courts typically do not construe ambiguous exclusions broadly. "If it's gray, you must pay."
[ 10:40 ] - Declarations Pages are typically more detailed in CP forms, and often include small structures. However, at least one court chose not to penalize an insured for failing to list a series of (light) posts.
[ 12:26 ] - If a Declarations Page lists most structures specifically but omits some, that may create an issue for the insured.
[ 13:25 ] - Strong subrogration potential exists here against the driver.
[ 14:30 ] - A cement block wall was considered a fence... at least according to a 1959 case, and under a grant of coverage which is typically construed more broadly.
[ 16:40 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Bollards: Do They Qualify As Fences? – PCQ.2017.05.09.twh.a - https://www.plrb.org/documents/bollards-do-they-qualify-as-fences-pcq-2017-05-09-twh-a/
Annotation: Property Outside Buildings (CP622) - https://www.plrb.org/documents/property-outside-buildings-cp622/
Chippewa Country Valley Festival v. Little Black Mut Ins Co (2002) - https://www.plrb.org/documents/chippewa-country-valley-festival-v-little-black-mut-ins-co-2002/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
Subscribe to this Podcast
Your Podcast App - Please subscribe and rate us on your favorite podcast app
YouTube - Please like and subscribe at @plrb
LinkedIN - Please follow at “Property and Liability Resource Bureau”
Send us your Scenario!
Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
Surveillance video shows a woman wearing a salon cape exiting through the front door of a hair salon. She spends a few moments in front of the salon examining her hair in a large handheld mirror. On reentry, she stumbles on the second and falls. Notable Timestamps
[ 00:32 ] - This is not her first time at the salon, and not her first time through the door that day.
[ 01:16 ] - Tripping and falling is a common experience.
[ 02:45 ] - The team watch & react to the video (only available for staff).
[ 04:08 ] - Ruth details the layout of the step.
[ 05:03 ] - The riser heights are within an acceptable range.
[ 05:40 ] - The tread depth is likely compliant, even if they are longer than usual.
[ 06:07 ] - The riser heights are not uniform, which may present a code issue.
[ 06:45 ] - In this case the 2018 IBC applied, and handrails are required on both sides. No handrails were present here.
[ 07:17 ] - The term "Legacy Code Exceptions" is typically preferred to describe when a code does not apply because the structure was built prior to the code's establishment.
[ 08:30 ] - A "triggering event" such as remodeling or occupancy change can mean that a legacy code exception would not apply. It also may not apply if something else, e.g. deterioration, made the area unsafe.
[ 09:18 ] - In some cases, an exception to a building code may be made if the structure of the building does not permit the code requirement, e.g. handrails.
[ 10:22 ] - In some states, if the steps were not up to code, the salon is negligent automatically or "negligent per se." In other states, evidence of code violation means there is a presumption of neglience; finally, other states merely find a code violation to be evidence of negligence.
[ 11:30 ] - Even in "negligence per se" states, establishing that the negligence existed is not the same as demonstrating that the negligence caused the injury as opposed to an intervening factor, e.g. the insured's behavior.
[ 12:33 ] - Ruth provides a recap of the scenario and the points above.
Your PLRB Resources
Address Report: Find a code adoption for insured's address with link to code book - https://www.plrb.org/building-codes/building-component/
Commercial Stairs Diagram: Interactive diagram with excerpts from code for each of the main components of stairs - https://www.plrb.org/building-codes/building-component/
Legal Duty Created by Building Codes: State-by-state analysis of case law and defenses - was the insured negligent based on failure to comply with building codes? - https://www.plrb.org/documents/overview-of-duty-created-by-building-codes/
Ask a Code Question - https://www.plrb.org/building-codes/ask-plrb-building-code-question/
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
Subscribe to this Podcast
Your Podcast App - Please subscribe and rate us on your favorite podcast app
YouTube - Please like and subscribe at @plrb
LinkedIN - Please follow at “Property and Liability Resource Bureau”
Send us your Scenario!
Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
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.
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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 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
The insured was making fried green tomatoes when they had to help a neighbor with an emergency. The tomatoes caught fire, and damaged the kitchen. The city building inspector came to sign off on the kitchen repairs, and noticed the rear deck was improperly constructed. Notable Timestamps
[ 00:27 ] - The policyholder is asking her insurance company to include fixing the deck as part of her fire claim. Since the deck wasn’t touched by the fire, the adjuster denied it. Now the public adjuster is coming back seeking coverage for the deck under the Ordinance or Law Additional Coverage.
[ 01:47 ] - Tim talks traditional Tennessee recipes.
[ 03:07 ] - The fire is likely covered, even if the homeowner left the skillet unattended.
[ 03:50 ] - To paraphrase, Ordinance or Law Additional Coverage covers increased costs due to enforcement of ordinance or law for the portion of "the undamaged part" of a covered building "necessary to complete" the repair of the damaged part.
[ 06:00 ] - If the inspector had insisted on fire alarms, the argument that the "necessary" language applies would be stronger.
[ 06:30 ] - In Chattanooga Bank Associates v. Fidelity & Deposit Co. of Maryland, 2004 WL 187409 (E.D. Tenn. 2004) [reviewed at PLRB, Prop. Ins. L. Rev. 6657 (2004)], Ordinance or Law coverage did not extend to code violations discovered in areas that were not affected by fire damage.
[ 07:10 ] - It seems city inspectors do sometimes withhold permits for seemingly unrelated code violations.
[ 08:10 ] - An inspector's order is likely considered an "ordinance or law" though it is not, strictly speaking, either one. Compare to the demand of a private HOA, which would not be an ordinance or law.
[ 09:11 ] - If something is built prior to a code change, it typically only needs to be updated when it is remodeled. The correct term for this is "Legacy Code Exceptions."
[ 10:30 ] - Commercial "ordinance or law" Additional Coverage forms specifically do not include violations that existed prior to the loss, but personal forms are often silent on that point.
[ 11:30 ] - The contractor who built the deck could be considered negligent, but the policy's faulty work exclusion may or may operate to override Ordinance or Law coverage.
[ 13:43 ] - It can be difficult to determine that a deck is out of code!
[ 14:30 ] - Tim provides a recap of the scenario and the points above.
Your PLRB Resources
Chattanooga v. Fidelity - https://www.plrb.org/documents/ordinance-or-law-ho149/
Webinar: Cracking the Code: Navigating the Complexities of Ordinance or Law Coverage - https://www.plrb.org/courses/cracking-the-code-navigating-the-complexities-of-ordinance-or-law-coverage/lessons/cracking-the-code-navigating-the-complexities-of-ordinance-or-law-coverage/
Adjuster Resource Sheet: Ordinance Or Law Issues - https://www.plrb.org/documents/adjuster-resource-sheet-ordinance-or-law-issues/
State-By-State: Tennessee: Faulty Workmanship - https://www.plrb.org/documents/tennessee-faulty-workmanship/
Tennessee Mountains Stack Cake Recipe - https://www.food.com/recipe/tennessee-mountains-stack-cake-46814
Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company.
Subscribe to this Podcast
Your Podcast App - Please subscribe and rate us on your favorite podcast app
YouTube - Please like and subscribe at @plrb
LinkedIN - Please follow at “Property and Liability Resource Bureau”
Send us your Scenario!
Please reach out to us with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to [email protected].
Legal Information
The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate.
Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).
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