Recommended Webinar: The Complexity of Subrogation: Condominium Projects, The Anti-Subrogation Rule, and Landlord/Tenant Issues

PLRB educational services

PLRB/NASP Subro Investigation for Adjusters Webinar Series

“The Complexity of Subrogation: Condominium Projects, The Anti-Subrogation Rule, and Landlord/Tenant Issues”

May 17, 2016 — 12:00:00 PM CST

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Provencher Establishes Documented Roof Inspection Requirement Protocol

ProvpursuitOfExcellenceencher & Company is pleased to announce the establishment and implementation of a documented Roof Inspection Requirements Protocol.

In-depth investigation and analysis during the inspection and reporting process is key to managing roof damage claims. At Provencher & Company we are consistently striving to ensure our field adjusters are providing our clients and their insureds with the highest level of service and investigation available.

If you would like more information on the Roof Inspection Requirements Protocol, please contact Jim Abbott, Vice President Business Development & Client Relations, at 866-722-5246 (ext 1222) or complete the Contact Us form located on our website: www.provencherclaims.com.


 

Let Me Make This Clear…

Correspondence
By
R.M.Bissell
Business Correspondence, from Fire Insurance Lectures delivered before the 
Insurance Institute of Hartford, Inc. season of 1916
 
Formerly a large and well-known book-store in Chicago had painted on its window shades, which were always decorously pulled down on Sundays, the following text: ”Words are the only things that live forever.” Sometimes it seems as though this text had especial reference to those occasional letters which tactlessly written or stupidly expressed steal quietly out from the home office of an insurance company and lead indefinitely thereafter harmful and malevolent lives in the minds of their receivers. 
Now, let us consider some of the more obvious qualifications of good business correspondence. In their order of merit and importance it seems to me these most essential characteristics could be listed as follows:

 

 
1. Clarity
2. Discretion
3. Courtesy
4. Form, i.e., proper use of the English Language
Of these the first is naturally of by far the greatest importance, even though it is true that a letter may be very clear and at the same time very objectionable. But clearness we must have at any cost. A good many things are involved in this matter of clearness. In the first place, clear thinking is necessary for clarity in writing. If you do not have a definite understanding of a proposition in your own mind you can hardly hope to give a correct idea of it to another. Indeed, I am inclined to believe that lack of clearness proceeds more often from a correspondent’s muddiness of thought than from any other one cause, although another factor, namely: ignorance of and lack of training in the meaning and use of words, prevents many intelligent men from writing good letters.

 

******

Report Writing the Provencher Way: Part 4 – Report Captions Continued

In our ongoing effort to maintain and continuously improve our business, we have taken the time to document proper report writing specifics to Provencher & Company.  The intent of this post is to describe a standardized content look for a Provencher & Company captioned report.  Below, you will see that we have defined the purpose/meaning of each caption and provided an example of the report writing style and expected technical writing level of the content.

As this is such an important topic; one that requires great attention and detail, the Report Captions section of this series has been divided into three parts.

Report Captions Continued:

Adjustment:
In this caption, you need to state in a clear concise manner, the facts associated with the loss adjustment. While this caption needs to contain the story of the loss, do not, under any circumstances, write in such a fashion that it appears to be folksy, conversational, repetitive, or opinionated.  Additionally, do not, under any circumstances, attempt to restate anything prepared by an expert you or the client has employed.  Refer the client to the expert’s report, along with a comment regarding the summary finding.
 
Example of Adjustment Caption Verbiage:
We are enclosing sample photographs of the damage.  We are also attaching our estimate on the remaining repairs.  Our estimate will detail the scope of damage found during our inspection.  Sixteen offices, two baths, a kitchen and a long hallway were damaged by water.
 
Our damage estimate totals $25,188.14 and is based on normal and reasonable unit prices for this area.  We believe that the cost for repairs and painting will probably not exceed this amount.  Our contact, Mr. McClay, advised that he has an estimate in process for the repairs but has not as yet forwarded it to us.  You should note that our estimate is conservative for painting all surfaces and does not include any allowances for moving and/or protecting furnishings.  We believe that the insured will get the painting done on only the effected walls and may not expend the entire amount in our estimate.
 
We Clean Systems, Inc. was used for water extraction and drying.  We have a copy of the work authorization but no estimate or invoice has been received to date.  We have requested the information from your insured and hope to get it shortly.
 
Kittleburger Plumbing made repairs to the plumbing and we have their invoice for the repairs.  The cost for the repairs was $102.50. Lock Technology was contacted to replace a broken lock cylinder on the front door and rekey another cylinder to match the one on the front door that was broken to gain emergency entry in off hours.   The cost was $417.19.
 
Barclay Electric was used to replace a phone jack and blocked off some floor boxes to prevent additional damage.  No invoice has been provided.
 
Business Interruption:
At Provencher & Company, we have a separate Business Interruption division, which includes a Forensic Accounting expert that is responsible for managing and reporting on all losses with a BI exposure.  That office will work in concert with you, the field adjuster.   While the BI staff will conduct a comprehensive interview with the insured and request all financial documentation, we need you in the field to determine the Covered Cause(s) of Loss, establish the Period of Restoration (POR), and initial control of Extra Expense (EE).  If there is no suspension of the insured’s business, that should be documented in your report and why.  That can be accomplished all in one caption entitled Business Interruption.
 
Example of Business Interruption Caption Verbiage (no loss of income claimed): 
While the insured risk did sustain wind damage to the roof, allowing water to enter into the premises damaging walls and floors, the insured is not filing claim for loss of income. They were able to open immediately and resumed operations working around the affected areas.
 
If you are assigned a claim that has a BI exposure, please insert the following captions into your report template:
 
(Refer to the Business Interruption – Interface with the Property Adjuster document for details on workflow)
 
Cause of loss – Business Income:
For all commercial losses that have BI coverage and either a partial or complete suspension of their business operation has occurred, you must identify and document what cause(s) actuates the coverage.   Be brief, clear and factual. Note that most policies require direct physical damage to the insured’s business space, even if not covered property, caused by a Covered Cause of Loss. Even if only the BPP is covered property under the policy, the physical damage to the building will guide both the actuation of the coverage and the period of restoration as long as it was from a covered cause.  Note that even if BI/EE coverage may not be apparent, a claim by the insured may be submitted.  Therefore, we prefer to be proactive in identifying if a covered cause of loss exists should coverage be found.
 
Examples of Cause of Loss for BI Caption Verbiage:
The roof of the building, occupied by the insured business, was severely damaged by wind.  As a result, the insured’s business suffered extensive water damage to the interior of their space resulting in a complete suspension of their business operations.
 
Another Example
While the insured did sustain direct physical damage to their space from wind damage to the roof, the physical damage to the insured’s space is not sufficient to shut down operations.   The reason the insured could not operate was due to off-premises power outage which is not covered by this policy.
 
Another Example
The insured’s operations were suspended due to wind driven rain, a non-covered cause of loss, which entered the building through an open window.
Period of Restoration – Business Income:
The ‘period of restoration’ is the reasonable length of time necessary to restore full business operations due to the covered cause of loss that actuates the BI coverage.  This is very important as you may have an area damaged by a covered cause of loss and other areas damaged by non- covered causes of loss – this needs to be clearly identified as the POR is only established for covered cause(s) of loss.
 
If the insured is a tenant in the building, we still need to know the extent of damage to the building and length of time anticipated to affect repairs due to the covered cause of loss.  This is critical as that will be the governing factor in determining in the length of time for which a business income claim will be considered for payment – not just the time required to affect repairs to the insured’s covered property. The POR is not simply established based on the amount of time the insured is out of operation.
 
Examples of Period of Restoration for BI Caption Verbiage:
The period of restoration for repairs is three months.   However, the insured should be able to utilize the undamaged portion of the building to continue operations, in full or in part, while the repairs are being undertaken.
 
Another Example
The period of restoration is six months.  Due to the nature of the insured’s business, temporary relocation is not feasible.
 
Another Example
The period of restoration is six months, but the insured may be able to relocate the operation to temporary facilities.
 
Another Example
While it is anticipated the insured’s operations will be completely suspended for a total of six months, we are only establishing a period of restoration of three months as this is the anticipated length of time necessary to complete repairs resulting from the covered cause of loss.  The flood damage to the building is a non-covered cause of loss which is the contributing factor to the extended period of time the insured’s operations have been suspended.
 
Extra Expense – Business Income:
With the exception of the CP 0050 (specific to EE coverage), most policies that include this coverage limit the use of Extra Expenses to the amount by which it reduces the BI loss.  As such, your narrative in this caption must clearly demonstrate the need or prudence for using this coverage.
Example of Extra Expense for BI Caption Verbiage:
The insured will be able to expedite the clean-up process through the use of their employees which will require payroll in excess of normal.
Another Example
Since the period of restoration is six months, the insured will likely opt to move into temporary quarters in order to preserve their customer base.
Another Example
Because of the refitting necessary to accommodate their equipment, it is not feasible for the insured to move to temporary quarters.  However, the use of expediting expenses for the damaged equipment and replacement of inventory should reduce the period of restoration of six months to a period of suspension of four months.
To Be Done:
In this caption, you need to clearly and concisely tell the client what tasks remain outstanding in order to bring the file to a timely and successful conclusion.  If there are multiple items that still remain to be done, this may be best demonstrated in a bulleted format.
Again, you must demonstrate to the client you are in control of the adjustment and have clear direction on how and what needs to be done to bring the case to a timely and successful close. We point this out because this is often where adjusters make a huge leap of faith which can be fatal.
You feel that because you know what you’re doing and what needs to be done, the client feels the same way.  Generally speaking, that’s not true or more importantly their boss who may be reading your report may not know you at all.  Do not simply state (as we often see) “Please diary your file ahead 30 days for our next report” as that adds no value and more than likely will force the person reviewing the file to write or call you to find out your action plan or even worse, ask for the case be reassigned to expedite closure.
 
Example of the To Be Done Captioned List Verbiage:
1.   Obtain all outstanding invoices.
2.   Once all invoices are received, compare against amount allowed.
3.   Secure copy of the engineering report.
4.   Secure agreed price with insured.
Recommendations:
In this caption you will make any necessary recommendations for action on the part of the client. If you are requesting an advance payment, correspondence on their part that needs to be issued, etc. would all go under this caption.
 
Example of Recommendation Caption Verbiage:
After application of the policy deductible, final payment is recommended in the amount of $1,465.83 as follows (see attached Statement of Loss for details):
           Net claim         (Advanced)      Final Payment
           $41,465.83  $40,000.00      $1,465.83
 
Due  to  the  small  amount  of  existent  claim  payment  due,  I  would  not recommend including mortgagee or the loss payee on final check.  Loss was adjusted with Operations Manager, Mr. McClay.  Check should be issued in the name of your insured, Stevens & Sons, LLC and sent directly to:
 
          Stevens & Sons, LLC Mr. John Jasper
          Owner & General Manager
          2010 Blue St. Westlake, OH 44145
 
If your report is a final report, you want to conclude your recommendations with a professional conclusion.  Remember, this is a report, not a letter. Reports are directed to a file, not addressed like a letter, nor signed like a letter.  The pre-filled captions at the top of the report identify the file to which this report is directed.  Your name and title go at the end of the report attesting to this being your work product.
 
Example of the File Conclusion Caption Verbiage: Recommendations:
This concludes the adjustment of this loss.  We are closing our file. Thank you for the assignment.
_____________________
(Your Name) 
(Your Title)
 
(Your Provencher Email)
(Your Cell Phone)


Report Writing Tips
Now that you have the report structure guidelines ala Provencher & Company, we would like to close with a mini flashback to your grade school and middle school grammar and writing classes with a few bad habits we adults have picked up in our business writing.  Please don’t let this happen to you!
 
Basic Rules of Grammar and Structure
 
•Maximum length of a paragraph is eight lines.  If it is more than eight lines, break into two paragraphs, or re-read it and eliminate extraneous words.
 
•A paragraph should focus on one subject. A paragraph that is too long is unreadable.
 
•A paragraph consisting of only one sentence is usually improper and needs to be edited by expanding the thought, eliminating it or adding it somewhere else in the document.
 
•Use consistent spacing throughout report. Block alignment provides best overall appearance.  Make sure the selected font size is not too big or small; 11 or 12 point font works best for business writing.
 
•Try not to use the word “and” more than once in the same sentence.
 
•If you find you have a lot of commas in one sentence, consider breaking it into more than one sentence.
 
•Sentences that meander endlessly are impossible to follow.
 
•Single digit numbers are to be spelled out, “two” instead of “2”, while double digit numbers are to be displayed in numeric form, “37” rather than “thirty seven”.   Write “first” instead of 1st.  If you are beginning a sentence with a number, always spell it as a word.
 
•Don’t type over old reports because you are too lazy to start a new one.   This is how incorrect information gets transferred!
 
•Read your report aloud to see how it sounds.
 
•Use Spell Check and the on-line dictionary! Howe embarrassing 2 git to cart wit misspelled words on yur repert!  Also keep in mind Spell Check cannot pick up on misspelled words if the misspelled word is a real word, i.e., two versus too – proofing your work is critical!
 


Contributed by:
Julie Rock-Chatellier

 
 

Report Writing the Provencher Way: Part 3 – Report Captions

In our ongoing effort to maintain and continuously improve our business, we have taken the time to document proper report writing specifics to Provencher & Company.  The intent of this post is to describe a standardized content look for a Provencher & Company captioned report.  Below, you will see that we have defined the purpose/meaning of each caption and provided an example of the report writing style and expected technical writing level of the content.

As this is such an important topic; one that requires great attention and detail, the Report Captions section of this series will be divided into three parts.

Let’s begin the report:

Begin each First Report with this sentence:

We received this loss on (fill in the date) and contact was made with the insured on (fill in the date). An inspection and meeting with the insured was held on (fill in the date).
 
Note, this should always come after the report header and before the first caption and not repeated for subsequent reports.
Enclosures:
List all enclosures you are sending with this report.  Photographs, engineering report, letter from an attorney, etc.  Do not list your report as an enclosure!
 
Example of Itemized List of Enclosures:
1.   Photographs
2.   Conquest Engineering Inc. report
3.   Letter of representation from Public Adjuster, Joe Smith
 
Reserve Recommendations:
Special Note: Current reserves should be documented on EVERY report.
As you know, insurance company reserves are those estimated sums of money that are set aside by an insurance company to cover known and unknown projected and open claim payouts and expenses. There are few functions more important to an insurance company than maintaining a proper balance between reserves and actual payments made on claims. A key measure of the solvency of an insurance company is their posted calendar and accident year loss ratios, which are calculated from earned premiums compared to claims paid in the current calendar year and those still outstanding to be paid through the reserves. Over and under estimating reserves are both problems. We must strive to get the estimated reserve as close and as accurate the first time and adjust it when needed. 
 
List each coverage and be as accurate as possible. If there is coverage for Business Interruption and the insured’s business has suffered a loss of income, list that coverage in the reserve but do not list a value as that is the responsibility of the Business Interruption department. In lieu of a dollar value, insert the verbiage “TBD – separate report to follow”.
 
If you determine there could be a possible higher exposure at a future date, mention it in your narrative under this caption. If for some reason you need to recommend a change to the reserve inform the company immediately via interim report. Don’t wait until the next report! The reserves you submit are probably the only numbers that will be reviewed by upper management of a client. Every time you review a file, you should always ask yourself, are the reserves still adequate?  Has anything materially changed since my last report that may impact my reserves? Is so, this information needs to be communicated to the client.  Remember, recommending to raise or lower the reserves are each important to the client along with why the change is being recommended.
If  there  is  a  huge  swing  in  reserves,  contact  the  Provencher  & Company  claim  manager immediately! At our end of the business, surprises are rarely a good thing!
An improperly reserved loss reflects incompetence in the eyes of the client and that is all that matters.
 
Example of Reserve Caption Verbiage:
Building: Loc 1, Bldg 2 $100,000
BPP:         Loc 1, Bldg 2 $  25,000
BI:         Loc 1, Bldg 2 TBD – separate report to follow
Our reserves are based on our initial inspection. The building reserve may increase due to possible structural damage to several steel beams. This loss is being inspected by an engineer to determine the condition of the structure. Once the engineer inspects the damage we will adjust the reserves accordingly.
You have now informed the client there may be a large increase in reserves to cover the structural beams that may need replacing. Since you have set the foundation for a potential large reserve increase, the client is not likely to question your adjusting ability.
Abstract of Coverage:
The adjuster is responsible for verifying coverage in place at the time of loss for every claim. All claims will generally require a copy of the Policy Declarations unless otherwise specified. Claim files must demonstrate the adjuster understood the full importance of coverage, including all forms and endorsements, and how the coverage applied to the claim.
Example of Abstract of Coverage Caption Verbiage:
Coverage was verified through the Declarations Page provided by your office. Coverage is afforded under Building and Property coverage form CP 0010 (04/02) insuring Item A, and B Building and Business Personal Property under a blanket building and business personal property at location 001 in the amount of $4,340,750. Coverage subject to Cause of Loss form CP 1030(04/02). Coverage is subject to a coinsurance clause of 90%; Replacement Cost Valuation. The policy is subject to a $10,000 deductible.
 
Coverage Issues:
This is an example of an optional caption you should insert when there are coverage issues that need to be brought to the attention of the client.

Example of Coverage Issues Caption Verbiage:
At time of our inspection, it was noted the property had been vacant for a period in excess of 60 days.   Your policy specifically excludes loss resulting from vandalism when the property has been vacant for more than 60 days.
 
Risk:
In this caption, tell the client what they insure. If they insure five buildings on the property, make a sub-caption and briefly describe each.  Loss Location One, and the address. Describe business at Loss Location One – furniture store, multi-family dwelling etc. Type of construction – pier and beam construction with composition shingle roof.  Building use – warehouse, restaurant, age and condition prior to loss.

Example of Risk Description Caption Verbiage:
At risk is a family owned corporation, engaged in the masonry business. Your insured has been in business at this location for more than 30 years and appears to operate a very efficient and well maintained property. Approximately two years ago, the insured engaged the services of a contractor to replace the composition roof.   The building consists of one story masonry block building, in excess of 25 years of age with brick veneer, approved composition roof and has been maintained and was in good condition prior to this loss.
 
Cause of loss:
What caused the damage? Date, time (if applicable), sequence of events.   Be brief, clear and factual.

Example of Cause of Loss Caption Verbiage:
On the reported date of loss, 4/10/2010, the area was impacted by back to back severe snow storms causing approximately five feet of snow to accumulate on the roof of the insured building. As a result of the weight of ice and snow, the roof system failed, causing the roof to collapse.
 
Subrogation:
Subrogation refers to the potential of recovery under the subrogation provision of the policy; in this example, a contribution from joint-tort feasors, fidelity bond recovery, and refund of overpayments could be sited as subrogation possibilities.
When claims involve potential subrogation recovery, the adjuster is responsible for: recognizing subrogation opportunities, investigating matters related to subrogation, and advising the carrier/client accordingly.
Example of Subrogation Caption Verbiage:
The damaged insured building is less than two years old.  It is believed the design of the roof did not conform with local building codes, which could have contributed to the collapse of the roof.  It is the recommendation of this adjuster that a structural engineer be hired to determine the actual cause of the roof failure.
Salvage:
Any property covered by an insurance policy that is damaged but escapes total destruction by a covered peril is defined as salvage.  As a verb, salvage refers to the process of recovering all or part of a claim payment through selling the remaining damaged property.
Example of Salvage Caption Verbiage:
The business personal property contained in the building sustained minimal damage to the packaging.  As a result, the undersigned adjuster contacted the file handler at your office and secured the approval to bring in The Salvage Guys, a professional salvor. The salvor is working with the insured to separate damaged from undamaged goods and will submit a complete inventory within the next two weeks. You will be updated on the status of the salvage through our next report.
Report Captions is to be continued next week….
 
Did you miss the beginning of this series? Find them here:
 
 

Report Writing the Provencher Way: Part 2 – Report Handling

Report Handling
 
Asyou are reading this, if you have not yet been fully trained in our claim system, W5, and don’t have access  to  our  report  template, you should reach out to our staff in the National Claims Center to gain access to those templates. You must have Microsoft Word loaded on your computer in order to use this template.
First and foremost in the reporting process at Provencher & Company, is documenting the claim file with the date of contact and date of inspection date. Both should be done within twenty-four (24) hours of receiving the assignment, even if the inspection date is in the future. If you are unable to establish contact with the insured, the file should be noted in the way of T&E to record the attempt (daily claims) or a note of the file (CAT claims). The only time the first contact & date of inspection area of the claim file should be left blank, is if contact has not been established and then the file should reflect the attempts. The management team cannot address any potential issues or defend you handling to the client, if the file is not documented.
With regard to written reports:
Please email your reports to reports@provencherclaims.com in Word format. This allows us to make any necessary cosmetic changes without having to send the report back to you to make the changes.   If, however, your report is deficient in content, or we see technical gaps or inconsistencies upon review – it will be returned for revision.
Additionally, all enclosures listed in the report should be attached to the same email if possible. Attachments should be in PDF format and labeled in sucha fashion to be easily identified as the enclosures listed in your report.
Never send a reportdirectly to a client without our priorapproval.  Ourinternal audit system is designed to catch any errors before the reportgoes to our clients.  If the need arises wherein you have to communicate directly with a client via email, always use your Provencher email account.  Help us to help you look good; we are in this together!
 
 
Technical Content Cautions
 
Provencher & Company, LLC adjusters are the best of the best in our industry. There are, however, times we can fall into certain report writingtraps due to the fact that we are busy and moving on to the next claim. We must take the time to look back at the prior reports we have written on the same claim to avoid repetition, conflicting messages, etc.  Hereare some of the most common traps that our file audits have uncovered:
 
  • Captions identify a topic. Rambling verbiage that changes topics within a caption is confusing and throws doubt on your thought process. Information relative to subrogation should be covered in the Subrogation caption, not buried under the Adjustment caption or discussed in the Cause of Loss Caption.
  • Do not repeat, reproduceor duplicate captions and information from prior reports, except by reference (see First Report). For example, as coverage is always addressed in the first report, do not include a caption for Coverage in reports two, three and four unless there is new information – omit the caption! The exception to this is the Reserve Caption.
  • Current reserves should be documented on every report. 
  • Large losses oftenrequire loss management by the adjuster. Youmay be managing a team of experts and adjustersrather than doing all the work yourself.  If you hire experts forcause & origin or damages, let them do the work they were hired for. Lettheir report(s) stand ontheir ownDo not reiterateor interpretexpert reports! It is unnecessary and creates fodder for plaintiff’s attorneys.
 
 

Coming next week….

Part 3: The Report Content


Did you miss the beginning of this series? Find them here:
     Report Writing the Provencher Way: Part 1 – Introduction


 Contributed by: