E&O Claims

I have been an agent for 50 years and have learned a lot from experience. One valuable lesson I learned is be careful with companies that write their own policy. I always look to see if a company uses the ISO form or write their own. I learned 4 years ago that even if aa company uses the ISO form doesn't mean that they can't still put a restrictive coverage endorsement on the policy. Years ago someone told me that if you were a lawyer and CPA you could make a good insurance agent. Four years ago a company domiciled in Florida and came to Georgia. They used the ISO form so I felt confident with their policy. I sold a lot of homeowner policies with them and even placed my home with this company. In October 2018 a hurricane came this far inland and I had a lot of claims. Most were for damage to other outside buildings. Heritage's policy had an endorsement buried in their policy that stated outside buildings had to be attached to the main dwelling to be covered. None of the claims I had were attached. I called the territory manager in Atlanta and talked with him about this and he was shocked. He said he had a privacy fence that cost $15,000 that wasn't attached. He went to a company meeting and the president, VP of claims and VP of marketing were there. He brought this to the attention of the executives and found that the policy the company filed in Georgia was the Florida policy, they just replaced Florida with Georgia and got the policy approved. In Florida it is common for outside buildings to have to be attached to the main dwelling. The president of the company asked the claims VP if they should pay the claims anyway and asked the marketing VP how much business would it cost if they didn't pay the claims. The VP of claims said no, we aren't going to pay. I held my breath because I just knew I was going to have several E&O claims. No one filed an E&O claim but I lost some good insureds. Unless you read each policy from cover to cover you can't really know what is covered. One more thing. After this I started making sure I explained all coverages and options but I found people don't really care. All they want is the lowest rate, until they have a claim. I have had people across from my desk and I would be explaining the coverages and notice their eyes had glazed over. So, after 50 years as an agent and I still could have had E&O claims. Learn from your experience and go forward.
 
They used the ISO form so I felt confident with their policy. Heritage's policy had an endorsement buried in their policy that stated outside buildings had to be attached to the main dwelling to be covered. I called the territory manager in Atlanta and talked with him about this and he was shocked. He said he had a privacy fence that cost $15,000 that wasn't attached.

The VP of claims said no, we aren't going to pay.

Unless you read each policy from cover to cover you can't really know what is covered. One more thing. After this I started making sure I explained all coverages and options but I found people don't really care. All they want is the lowest rate, until they have a claim. I have had people across from my desk and I would be explaining the coverages and notice their eyes had glazed over.

Insightful post ehall,

Knock on wood, but as part of my standard practice to review every quote that comes across my desk, I look at the list of endorsement forms. If there's a form I don't recognize and it looks questionable, I request and read the form. That doesn't mean you have to read the policy cover to cover if you're familiar with the ISO forms.

If a form like the one you described is in there, I mention it to the customer in my quote email. (and usually attach the form) You're right, 99% of the time, they don't care, but I still try to get it in writing that I pointed it out. That doesn't mean I have to deliver a long dialogue on their policy.

We need to be reading our own insurance policies as insurance professionals. If we can't do that at a bare minimum, why should our customers be placing any faith in us? We want them to sit there and listen to us drone on about their coverage, but apparently, it's too difficult for most of us to have the attention span to read our own policies.

So gentlemen, go read your policies & understand what's in them if you haven't already.
 
Hi! I work for Farmers Insurance. I have been working in insurance for over a year. I am an insurance producer. Recently there have been a lot of changes in our company & I have made a huge mistake. So prior to these changes, I could close a home policy & offer replacement cost sometimes I would ask about the year of the roof sometimes not. I was still able to issue a replacement cost home insurance. But, in October of 2022, they rolled out with a new flex program. This program no longer offered Replacement cost, apparently it’s to roofs older than 9 years. Well at the beginning the error message I would get was “not available per zip.” So I would always quote replacement cost but it would say not available. Okay, so I sold ACV to many people!! I would sometimes update the roof sometimes not, because it was just not a routine I had. Since before I didn’t ask, but was still able to sel RCV. Whatever, now with the recent storms we have been having customers have been complaining & my agent had 3 E&Os now!! Because the roof year wasn’t updated nor was the ACV explained. So they are reforming my policies, adding RCV for roofs or adding endorsements that were never talked about before. I am in huge trouble it’s embarrassing. Now, we are going back to all of our policies recently sold & trying to update the roof, but I just feel so ugly so embarrassed. I am looking for another job just because I feel like I have failed everyone. How do I deal with this. I have customers who are still going through claims, some who haven’t filed so I have to call to update roof & 3 E&Os filed already. I feel such an urge to quit because I feel like I have messed up sooo much

While I know very little about P/C, I don't want this to appear as if I am kicking you when you are down; however, from what I read, yes, you did make a mistake -- numerous times. I can't advise you to quit, find a new job, etc. What I can offer is this -- stand up and go back and fix what you can. You've taken ownership of the mistake(s), and now do whatever you can to fix them.

Yes, I get that you are already doing that -- in that you are going back to all of respective policy holders, and trying to correct the mistake -- and you have let go of your embarrassment, ego, etc., and focus on the task at hand. Client first. Focus on the client and protecting their best interests. That is also how you handle your embarrassment, ego, and so on. Good luck!
 
Back
Top