Master Insurance Claim- Big Frustration!

[BIG RED IS BACK]

The insured's policy will not pay anything at all if they have a copy of the bylaws/articles of incorporation that indicate that the floor and floor coverings are "common elements" within the unit boundaries.

For example, a recent claim occurred, in which are Articles of Incorporation and the condominium Bylaws said:



In layman's terms, and in this specific case (the OP's bylaws were likely different, as everyone has their own version), this means that the adjuster takes those bylaws into consideration and determines that the insured does not own the walls or ceiling in the condo, only the finish on whatever the material may be (paint or stain, fixtures, that kind of thing). Inasmuch as the section regarding flooring is questionable, it would be arguable either way. Most bylaws are more specific, this one was not.

The best thing I can recommend to the thread starter is to read the bylaws and articles of incorporation for your condominium. See if you actually own the floors or the floor coverings. If you do, pursue it with your insurance company. If the condo owns them, you have a range of options available to you to pursue the costs of damages sustained from the loss.


In the case I described, the insured lucked out and did not have to get into a battle regarding the floors, which sustained heavy damage, since the carrier had both the homeowners policy and the condominium policy, and it was just a matter of deciding whose policy they wished to include the damages on, since they were paying for them one way or the other.

Great, another dude who just like to argue.

I have numerous master policies in my agency and have seen dozens of claims pay out, the tenant pays his deduct, then their policy usually pays $4500 to cover the $5,000 master policy deduct and then the master policy takes over.

 

[Accelerated]

Great, another dude who just like to argue.

I have numerous master policies in my agency and have seen dozens of claims pay out, the tenant pays his deduct, then their policy usually pays $4500 to cover the $5,000 master policy deduct and then the master policy takes over.

Well, do keep in mind that I am the guy on the other side of the equation. You sell your polices and do your best to keep the insured happy with being your client, and I (or my adjusters) get contracted by the carriers to inspect the losses and determine what is and what is not covered.

Paying out on something that is listed in the bylaws as not the property of the insured would be known as "checkbook adjusting" (or "throwing money at the problem to make it go away) if the scenario I presented was even remotely accurate. If you are a staff adjuster, I guess you can get away with it (until your files get audited), but as an IA firm, if it is obviously not covered (as was the case in the scenario I presented), it is generally best to stay away from such practices, if you wish to keep the client, that is. It is the place of the insurance carrier to be benevolent, not the independent adjuster.

All that said, some carriers are more concerned with image and customer service that what is covered or excluded. I have had some carriers re-open files where the loss was specifically excluded in bold on the dec pages and told my company to write it up anyway, since the agent was a massive producer and had a personal interest in the insured, and they wanted the agent to continue to sell their policies.

 

[VolAgent]

Well, do keep in mind that I am the guy on the other side of the equation. You sell your polices and do your best to keep the insured happy with being your client, and I (or my adjusters) get contracted by the carriers to inspect the losses and determine what is and what is not covered.

Paying out on something that is listed in the bylaws as not the property of the insured would be known as "checkbook adjusting" (or "throwing money at the problem to make it go away) if the scenario I presented was even remotely accurate. If you are a staff adjuster, I guess you can get away with it (until your files get audited), but as an IA firm, if it is obviously not covered (as was the case in the scenario I presented), it is generally best to stay away from such practices, if you wish to keep the client, that is. It is the place of the insurance carrier to be benevolent, not the independent adjuster.

All that said, some carriers are more concerned with image and customer service that what is covered or excluded. I have had some carriers re-open files where the loss was specifically excluded in bold on the dec pages and told my company to write it up anyway, since the agent was a massive producer and had a personal interest in the insured, and they wanted the agent to continue to sell their policies.

While I like Big Red, I would have to agree with you.

Unless I had some interest in keeping the board happy, I'd have a cow if I had to pay the deductible and then have a claim against my policy because they didn't want to pay the deductible on the master policy.

 

[b61mack]

Well snoodle, was a 1 post wonder!

 

[AgentProvocateur]

I have numerous master policies in my agency and have seen dozens of claims pay out, the tenant pays his deduct, then their policy usually pays $4500 to cover the $5,000 master policy deduct and then the master policy takes over.

It makes sense for the carrier to process the claim this way when the unit owner policy and the master policy are from the same company, which I assume is your situation, Big Red?

If the unit owner policy is from a different company than the master policy, I think you would see the claim handled differently.
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All that said, some carriers are more concerned with image and customer service that what is covered or excluded. I have had some carriers re-open files where the loss was specifically excluded in bold on the dec pages and told my company to write it up anyway, since the agent was a massive producer and had a personal interest in the insured, and they wanted the agent to continue to sell their policies.

I'm disturbed to hear exclusions are not applied equally to all customers.

Do any agents have personal experience seeing this happen? Please share your stories.

 

[Accelerated]

I'm disturbed to hear exclusions are not applied equally to all customers.

Do any agents have personal experience seeing this happen? Please share your stories.

You named yourself very aptly.

 

[snoodle77]

Wow I didn't know so many people replied.

I am still waiting on insurance. The engineer told me that the technician who came out did not record the readings so he had to come out (2 weeks after) to take readings. Mind you he used a different meter that only goes a little more than half way through the floor. Then he said the floor is dry based on his readings.

From what I can gather based on talking to the insurance adjustor a few days after the engineer came out, they seem to want to say the floor is dry now and no visible damages (other than slight cupping) so they will not replace the floor. They seem not to care about how long the floor was "wet."

I also got the impression that they will only deal with visible mold, as they referred to me to the EPA standard on mold remediation and told me I have less than 10 sq.ft of visible mold. They didn't want to remove the dry wall or floor to see if there is mold when they came out to inspect. I read EPA guideline and it talked about items that are wet for more than 48 hours. Basically there is a potential for mold and steps should be taken to address it. I am wondering if it's OK for the insurance just pick part of the EPA guideline to follow. Also, is it my responsbility to prove that there is mold or is it the insurance's to prove that there is no mold growth resulted from the water damage?

I have a lawyer now. We are just waiting on the insurance then we will start the next phrase (appeal and file a complaint).

My insurance said it doesn't matter if the floor is damaged by the water break or moisure coming up from the slab, the master insurance is responsbile for it. My insurance doesn't understand why the master insurance is make it difficult for me.

My bylaw is vague on the common elements. It says common elements are those portions that's used by all units owners to include flooring, roof, slab, etc. Well, if you read it litereraly, only the hallway and stairs are common elements. That's another issue I might have to deal with if it comes to it.

Thanks for all your comments! I used to have good impression of Travelers but the adjustor ruined it for me.

 

[b61mack]

Hire your own private mold testing company. You can't rely on them!

 

[snoodle77]

Hire your own private mold testing company. You can't rely on them!

I thought about it. However, I heard only a protocol written by an industrial hygienist would hold up in court (and used by insurance). Is that true?

 

[b61mack]

I would be worried about my family, so get your own mold testing company.