The Independent Insurance Claim Adjuster Resource

Hey all you independent adjusters, claim reps, public adjusters and insurance attorneys!  Here’s a serious situation for you to ponder and comment on.  We would be delighted to receive your input on this situation:

A mess of tree limbs located within the lines of an insured-rental property falls and lands almost exclusively onto a parked vehicle in the public right of way.  The roof of the vehicle has been crushed in and the windows are broken with damages estimated at $13,000, therefore the vehicle is non-operable.  You are assigned the claim and learn the following:

The property is one of many rental units owned by an insured with a large policy covering several million dollars worth of property in the city.  It is a residence that was converted into two units and the tree which caused the damages is the only tree on the property.  It’s also the only tree that could have caused the damages.

The weather report indicates an average 25 mph wind with 35 mph gusts around the time of the incident, but this is not an adverse weather condition for the area.  The weather pattern, when compared throughout years is common and happens several dozen times per year.  Also, there is no damage in other areas throughout the neighborhood.

The local forester reveals there were no other reported incidents in the days following this one, and that they also forced removal of the tree immediately upon notice of the incident.  The tree type is common throughout the region for poor sustainability.

You briefly interview the property owner and he claims to know nothing of the tree’s poor condition.  He states that since he did not know the condition of the tree before it happened and was given no notice, he is not negligent and therefore not responsible.  There are some green leaves toward the bottom of the tree but the top is obviously dead or deteriorating and it’s evident that if anyone had looked up, the condition would have been obvious.  Your field surveyor decided to photograph only the green leaf portion of the tree.

The vehicle owner is livid and feels that the property owner knew about the condition of the tree prior to the incident.  A lawsuit is imminent if the claim is not resolved.  So far, the vehicle owner just wants his vehicle replaced, not repaired.  The odds are good that if you offer him diminshed value plus repairs, he would consider accepting the offer.

The vehicle owner then provides you with two affidavits.  The first affidavit is from the neighbor directly across the street and in plain view of the tree.  This neighbor is a property owner and his affidavit clearly states the tree was in poor condition prior to the incident.  The other affidavit states that there is a black plastic liner beneath mulch surrounding the entire postage stamp sized front yard, and the liner is preventing the tree from receiving proper moisture.  You learn that your insured isn’t too fond of mowing grass or maintaining any other landscaping on the property and that he most likely put the liner there to prevent any grass from growing.

The vehicle owner has no insurance and therefore he makes his only claim against your insured.  You learn that his business is suffering from the loss of use on his vehicle and that he likely has no money to repair the vehicle.

Do you pay the claim?  Do you deny it?  If so, why or why not?  We would love to hear your comments on this!

December 28th, 2010

It was widely report that a Maine ski lift failed causing injury to three or more riders this morning, at the SugerLoaf Mountain resort near Carrabassett Valley, Maine.  According to eye witness reports, the chairs were approximately 20 to 40 feet above the ground.  The extent of injuries is not known at this time but is suspected broken bones are involved.  Over 80 other riders were stranded on the lift awaiting rescue.  Rumors have circulated the that only method for rescuing the stranded riders is to provide a rope for them to escape with.  It is highly unlikely that any type of ladder equipped vehicle would be able to navigate the steep snowy mountain side.

SugarLoaf Ski Lift Incident

From an insurance claim perspective there is little doubt that the resort will be able to object to Read more…

Monday, December 27th, 2010

There aren’t too many other things that go hand in hand so well as blizzards and insurance claims, except for maybe holiday food and weight gain. Today marked the pinnacle for one of the worst winter storms in the Eastern United States.  The storm has left tens of thousands stranded in vehicles and subways alike from the Carolinas up to Maine, causing the bulk of problems in New York City where there isn’t much of a place to put the 16 some odd inches of heavy white frozen precipitation.  It was recently reported that the Big Apple’s 5 boroughs are entrenched in a backlog of over 1,200 emergency calls caused by the immobility of police, fire and emergency worker personnel.  We could ramble on for pages about the length of the storm and the problems it has caused, but we’re here to ramble about insurance claims related to these storms.

A quick listen and look at the NYC police and fire radio frequency scanners hosted by the great folks at Radio Reference, will find that NYC fire and police are undoubtedly a busy group – of course, we had a feeling that was already the case.  The radio transmissions haven’t slowed down for weather.

When people think about blizzards it should be no surprise the most common type of insurance claim is automobile related.  Taking a moment to realize the extended depths of personal injuries and civil liability though brings us to produce this list of common insurance claims related to blizzards:

• Delay & Canceled Travel Insurance Claims – caused by canceled flights due to weather
• Vehicle Immobility (Towing) Insurance Claims – caused by vehicles stuck in roadside snow drifts and slick areas
• Health Insurance Claims – related to persons injured by their own fault
• Premises Liability Claims – although they aren’t too common Read more…

Between late nights in the office, missing cargo, and property appraisals, I can occasionally be found mudding through the piles of resumes that end up on my desk.  It’s not that my office is looking to expand, but rather I feel compelled to send a quick email to the folks who submit them letting them know it was received and that we’ll keep in on file.  It never hurts to give someone hope who’s entering somewhat of a closed door type business; it’s not like we have applications laying around to be filled out.  Conversely, there might be a really well qualified candidate in one of our sub-markets who’s interesting in freelancing.

I once heard that the best weapon an attorney has are writing skills.   This rings true for more than one profession though and independent claim professionals are no exception.  I’ve personally seen insurers loose scores of cases because an adjuster or claim representative worded something poorly. All to often we forget the subtle differences and nuances of the English language; which is amplified to the Nth degree in litigation. Read more…

Independent Adjuster: An independent person and/or company working to provide loss assessment and claim handling to an insurance carrier, attorney or self-employed entity; not working in a payroll but on an as needed basis.

There really is no easy definition that can be made because an Independent Adjuster is many things; but not always at the same time.  Looking at the phrase within we see “independent” and “adjuster”,  (I/A for short) meaning the latter half of the title only becomes active when making an adjustment to something.  What if there is no adjustment to be made?

We believe it is incorrect to reference a party as an “adjuster” when that person or entity is merely investigating a claim or surveying damages.  Those folks would respectively be called independent investigators or surveyors.  This theory is well evidenced as marine surveyors do not refer to themselves, or within their job community as “marine adjusters”. Read more…