MS Plans

MSPR10 Interior Estimating Guidelines

This section will identify and highlight the primary guidelines with respect to interior estimating.






Flooring

 






Personal Property

Field adjusters will handle documentation of contents claims. Examiners may refer the contents claim to U.S. Adjusting’s Contents Division for valuation, inventory creation or boots on the ground depending on the need.

The field adjuster should provide inventory forms to the insured and instruct the insured not to dispose of any damaged personal property prior to a planned inspection.

Loss of personal property should be documented with adequate, annotated, and clear photos. Photos should include model or serial numbers if available. If it is not possible to take photos, the explanation should be documented in the claim log.

For electronics, determine if a certified repair technician should be utilized to determine cause of loss and reparability of an item.

Restoration, cleaning, or repairs for clothing, rugs, jewelry, furniture, collectibles, tools or paintings should be considered prior to making payment on any of these items.

Submission of a completed estimate should not be delayed pending personal property completion. If a partial settlement is made, the claim log shall be documented with any outstanding personal property issues or information relating to the personal property portion of the loss that is forthcoming.

MSPR09 Roof & Exterior Estimating Guidelines

This section will identify the primary scoping and estimating guidelines for roof and exterior claims. Refer to the Estimating Tip Sheet and the Claim Handling Guidelines for additional information.


Roof Estimating

“Per square” price should be used if the damage is in concentrated areas. Round to nearest bundle.

A double layer of felt is appropriate when the pitch of the roof is 4/12 or less. 

30# felt should be used on roofs with slope pitch greater than 7/12.

Steep charges should be used on roofs with a slope of 7/12 pitch or greater (per Xactimate line item description). Multiple story charges should only be used on roofs with an eave height of equal to 18’ or greater (per Xactimate line item description).  Steep and/or multiple story charges are calculated on the actual squares of the affected slopes.

Actual measurements on roofs are to be used for tear-off. For multiple layers, add first layer as roof tear-off allowance and the second layer tear-off on a separate line of the estimate as removal of an additional layer. When most or all of an entire slope of roofing material is blown off, the tear-off allowance should be proportionally reduced or eliminated, depending on the circumstances.

Except for metal roofs, Xactimate line item pricing includes haul off, so no separate allowance for dumpsters should be allotted unless there are unusual circumstances.

When paying to replace roofing, use separate line items for the “Remove” and “Replace” operations. The “Remove” line item should allow for the actual square footage with no waste and no rounding to the nearest bundle.

Additional items to consider are: ridge cap, valley metal, plumbing sleeves, chimney step flashing, skylights, vents, felt, drip edge, pipe jacks, cap sheet (tile), removal and reset of A/C unit, cooler, or antenna attached to the roof, access charge, as appropriate.

Drip edge, vents, and any other components that will be removed with the shingle removal should be allowed as replace-only.

The cost for the ridge cap & starter row are included in the waste factor for 3-tab shingles on full slope replacements. Laminate shingles, high profile, wood, tile and metal roofs may have additional charges for ridge cap, when necessary.






MSPR08 General Field Guidelines

In this section we will review the general field guidelines for MS Plans claims including the handling of temporary repairs, tree debris removal, inspection and reporting guidelines, overhead and profit, depreciation and sales tax.


Overhead & Profit

O&P may be applied to an estimate based on complexity of the repairs. Factors to consider in making this determination include:

  • the nature and extent of the damage
  • the number of trades needed to make repairs
  • the degree of coordination or supervision of trades required to make repairs

On claims that warrant general overhead and profit, Field Claims Adjusters should include O&P in the Parameters (10 & 10, non-cumulative). O&P should not be applied to roofing. 

When applicable, general overhead and profit is considered part of the repair/replacement cost and is NOT depreciable.

O&P is not taxable and should not be applied to sales tax.


Depreciation

Depreciation applies to tangible items. Consider all factors, including the quality of the roofing material, its life expectancy, age and overall condition.

Depreciation does apply to labor for betterment items. For example, labor for installation of the entire roof would be a betterment and depreciation for labor would apply along with materials. Depreciation should not be applied to labor for removal, repairs, etc.

Depreciation should be calculated and applied on an item-by-item basis using appropriate guidelines and methods. Apply depreciation using the Age and Condition Setting

Repairs of covered damage should not be depreciated.

Xactimate profiles should be set to a maximum of 75% depreciation.

Do not apply depreciation to sales tax, or overhead and profit.

The correct parameters settings for depreciation and O&P are shown below:

If set properly, the parameters appearing on the report should be appear as below:


Sales Tax

Sales tax should be added and separately identified on all estimates, as appropriate.

Sales tax of 7% applies to tangible items (labor and materials).

Sales tax is not applied to O&P. Be sure to set Xactimate sales tax profile to “Neither” as shown below, ensuring that all sales tax items are selected and updated.

 

When reviewing the summary page on the estimate report, the O&P and sales tax lines should all appear above the subtotal if the sales tax parameters are set correctly.

 

MSPR07 MWUA Deductibles & Endorsements

This section will review the various deductible provisions of the MWUA policies and other pertinent endorsements.

Deductible Endorsements

The field adjuster and the examiner should take special care to review the applicable deductible clauses identified in the Declarations and applied based on the facts of the loss.

Dwelling Special Windstorm & Hail Deductible Clause (6001, 6003, 6004)

  • Deductible of specified amount ($500, $1000, $2500) applies to loss to dwelling and contents due to peril of windstorm or hail

Trailer or Mobile Home Special Windstorm & Hail Deductible Clause (6008)

  • Deductible of $500 applies to loss to dwelling and contents due to peril of windstorm or hail
  • Applicable only to trailer or mobile home risks

Special Wind and Hail Deductible Clause (6013)

  • Deductible of $1000 applies for loss due to windstorm or hail
  • Applies separately to each dwelling if more than one dwelling covered on the policy

Named Storm % Deductible Clause (6012, 6012-5, 6012-10, 6012-15. 6012-20)

The Named Storm Deductible Clause replaces the Deductible Clause attached to the policy applicable to Windstorm and Hail in cases of a Named Storm. Read the language of the deductible endorsements closely when confirming coverage. Note that the deductible amount reflects a percentage of the applicable limit of liability.

  • 6012: 2% deductible applies
  • 6012-5: 5% deductible applies
  • 6012-10: 10% deductible applies
  • 6012-15: 15% deductible applies
  • 6012-20: 20% deductible applies

In the case of 2% deductible:

  • Minimum of $500 for policy limit of $500,000 or less
  • Minimum of $1000 for policy limit above $500,000

The Named Storm deductible applies separately to structure and contents. Additionally, separate deductibles apply for each Named Storm unless more than one Named Storm present when a single loss occurs.

“Named Storm” means a storm system that has been named by the National Hurricane Center of the National Weather Service. A Named Storm is “Present” and the Named Storm deductible applies to loss due to wind or hail:

  • When Named Storm reaches the Gulf of Mexico
  • Until termination of storm watch or warning by National Hurricane Center for such Named Storm for any part of Mississippi
  • Including loss from wind or hail from tornadoes or other storms spawned by or occurring while the Named Storm is Present

Additional MWUA Endorsements

Endorsement for Complete Exclusion of Damage or Loss Resulting from Fungi (Including Mold), Wet or Dry Rot, or Bacteria (6011)

No coverage for any loss, damage, or cost directly or indirectly caused by, resulting from, contributed to, or aggravated by fungi, wet or dry rot, or bacteria, even if such fungi, wet or dry rot, or bacteria were caused by a covered windstorm or hail event.

“Fungi” means any type or form of fungus or fungi, including but not limited to mold, mildew, mycotoxins, spores, and includes scents and byproducts produced or released by such fungi.


Mandatory Evacuation Expense clause (ME 15-01)

This endorsement applies only when policy covers perils of Windstorm and hail and covers expenses incurred due to mandatory evacuation from a Named Storm (as named by NWS) ordered by civil authority. This clause is added to part E. Other Coverages.

Coverage applies when the primary residence is located in mandatory evacuation area (occupied by the insured for more than 270 days in most recent calendar year or is the insured’s legal residence).

Limit of liability is $500 for a single Named Storm even if multiple evacuations are ordered.

Policy deductible does not apply to this coverage.


Notice of Flood & Earthquake Exclusions (MWFL/EQ)

Policy excludes coverage for damage due to flooding of all types, including storm surge from a hurricane, surface water, flash floods, waves, tidal water, tidal waves, wind-driven rain or water, or any other overflow of water and spray from these events.

Policy excludes coverage for any damage caused or precipitated by an earthquake or earth movement including damages due to earthquake, earth movements, tremors, aftershocks, and also earth movement land shock waves, aftershocks and tremors before, during or after a volcanic eruption.


MSPR06 MWUA Coverage (Part 2)

In this section we will review coverage provisions for the MWUA policy forms, including the Perils Insured Against, Exclusions and Conditions sections of the policy.

Note that a complete copy of the policy forms is available below under the Resources section. This lesson will address the highlights of the policy, particularly focusing on those provisions which differ from typical ISO policy forms, and those provision that set it apart from the MPRIUA policy form. Additionally, this lesson will identify and highlight distinctions in policy language and provisions between the MWUA Basic Policy in effect on policies issued prior to 3/1/2020 and the MWUA RCV and MWUA ACV policies issued beginning 3/1/2020. In any case of a conflict between the descriptions in these lessons and the policy forms, the policy forms will prevail.


The MWUA policy covers the perils of windstorm and hailstorm in the lower six coastal counties: Jackson, Harrison, Hancock, George, Pearl River and Stone.


Exclusions

Water Damage

The policy does not provide coverage for direct physical loss(es) to property covered under the policy if the loss is caused directly or indirectly by water damage that is caused or results from human or animal forces or any act of nature.

water damage exclusion


Neglect

Neglect means the insured’s neglect to use all reasonable means to save and preserve property at and after the time of loss.


Power Failure

Power failure means the failure of power or other utility service unless the loss is caused by covered damage to the power equipment at the Described Location.



Ordinance or Law

Any ordinance or law:

  • Requiring or regulating construction, demolition, remodeling, renovation, or repair of property including by not limited to changes in applicable building codes and/or removal of any debris
  • Requirements of which result in loss in value to your property or
  • Requiring you or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize or in any way respond to or assess the effects of pollutants

Mold, Fungi, Wet or Dry Rot, or Bacteria

Any language of the policy and endorsements notwithstanding, the policy does not provide coverage for any loss, damage, or cost directly or indirectly caused by, resulting from, contributed to or aggravated by fungi, wet or dry rot, or bacteria even if they were caused or contributed to directly or indirectly by a covered windstorm or hail event.


Conditions

Policy Period

The policy applies only to loss that occurs during the policy period provided the policy was in force.


Insurable Interest and Limit of Liability

MS Plans will not be liable in any one loss for:

  • An amount greater than the interest of a person insured under the policy at the time of the loss
  • More than the applicable limit of liability


Loss Settlement

The loss settlement provisions vary significantly between the MWUA Basic form (pre-March 2020) and the MWUA RCV and MWUA ACV (March 2020 and later). The provisions for the three policies are outlined separately below.

Covered losses on the MWUA Basic form are settled as follows:

Actual Cash Value (ACV) at the time of loss (not more than cost to repair or replace) for the following:

  • Personal property
  • Carpeting, household appliances, outdoor equipment whether attached to the building or not
  • Structures that are not buildings

Dwelling & Other Structures are settled at replacement cost without deduction for depreciation subject to the following:

If, at the time of loss, the Limit of Liability for the damaged building is 80% or more of the full replacement cost immediately before the loss, the policy will pay the cost to repair or replace, after deductible, not more than the least of the following:

  • Limit of liability shown in the Declarations applicable to the affected building
  • Replacement cost of that part of the damaged building for like construction and use on the same premises
  • Necessary amount actually spent to repair or replace the damaged building

If, at the time of loss, the Limit of Liability for the damaged building is less than 80% of the full replacement cost immediately before the loss, the policy will pay the greater of the following amounts but not more than the Limit of Liability applicable to the affected building:

  • Actual cash value of that part of the building that is damaged
  • The proportion of the cost to repair or replace, after deductible and without deduction for depreciation, that part of the building that is damaged which the total amount of insurance on the damaged building bears to 80% of the replacement cost of the building (the amount of the loss subject to a coinsurance penalty)

To calculate the amount of any penalty due, it can be helpful to use the calculation model below:

The 80% coinsurance requirement is only applicable on the MWUA Basic form. The post-March 2020 policies will not include this provision.

Field Adjusters are expected to submit a building valuation (ITV produced in Xactimate) with their reports. To determine the amount of insurance required to meet the 80% of full replacement cost, do not include the value of the following:

  • Excavations, foundations, piers or any supports below the surface of the lowest basement floor
  • Those supports above below the surface of the ground inside foundation walls if there is no basement
  • Underground flues, pipes, wiring and drains

Note that the recoverable depreciation will be held back pending completion of repairs and/or replacement. No more than the actual cash value of damage will be paid unless:

  • The actual repair or replacement is complete
  • The cost to repair or replace is both
    • Less than 5% of the Limit of Liability on the damaged building; and
    • Less than $5000

Replacement cost settlement provisions can be disregarded and the insured may make a claim for damage to a building at on ACV basis and make an additional claim within 180 days  from the date of loss on a replacement cost basis.


Covered losses on the MWUA RCV form are settled as follows:

Actual Cash Value at the time of loss but not more than the amount required to repair or replace and not more than the limit of liability shown in the Declarations that applies to:

  • Personal Property
  • Freestanding carpet and rugs
  • Household appliances whether attached to the building or not
  • Outdoor equipment whether attached to the building or not
  • Structures that are not buildings

If the insured does not notify MS Plans of the intent to repair or replace the damaged structure within 180 days of the date of loss, the lesser of the following amounts will be paid:

  • The limit of liability shown in the Declarations for the damaged structure
  • The actual cash value of the covered loss to the the damaged structure

No more than the actual cash value will be paid unless:

  • Actual repair or replacement is completed within 180 days of the date or loss or
  • The cost to repair or replace is less than $5000

Covered losses on the MWUA ACV form are settled as follows:

Covered losses are settled at actual cash value at the time of the loss but not more than the limit of liability shown in the declarations that applies to the damaged property.


Loss to Pair or Set


Appraisal

If the insured and MS Plans agree on the cause of property damage but fail to agree on the amount of loss, either party may demand appraisal.


Other Insurance and/or Service Agreement

1.Where there is other property insurance providing coverage for the same or similar perils, MS Plans pays only the proportion of the loss covered under this policy that is this policy’s limit of liability applying to the loss bears to the total amount of insurance covering the property.

2.Where there is a Service Agreement, MS Plans insurance is excess over any amounts payable under the plan.


Windstorm or Hail Period

One or more windstorm or hail events that occur within a 72 hour period will be considered one windstorm or hail event.

Loss Payable Clause

If the Declarations show a loss payee for certain listed insured personal property, that person is considered an additional insured under this policy with respect to only that property.

If MS Plans cancels or nonrenews the policy, the loss payee will be notified in writing pursuant to the policy provisions.


 

MSPR05 MWUA Coverage (Part 1)

In this section we will review coverage provisions for the MWUA policy forms, including the Definitions, Deductible, Property Covered and Other Coverages sections of the policy.

Note that a complete copy of the policy forms is available below under the Resources section. This lesson will address the highlights of the policy, particularly focusing on those provisions which differ from typical ISO policy forms, and those provision that set it apart from the MPRIUA policy form. Additionally, this lesson will identify and highlight distinctions in policy language and provisions between the MWUA Basic Policy in effect on policies issued prior to 3/1/2020 and the MWUA RCV and MWUA ACV policies. In any case of a conflict between the descriptions in these lessons and the policy forms, the policy forms will prevail.

MWUA Forms

In the material that follows, the colors above will be used to assist in distinguishing between the available forms. Unless so specified, the terms apply to all of the policy forms.



Definitions



Described Location

The premises described in the Declarations.


Named Storm

A storm system that has been named by the National Hurricane Center of the National Weather Service.


Primary Residence

A dwelling occupied by the insured for more than a total of 270 days in the most recent calendar year or dwelling that is the insured’s legal residence.


Deductible

The following provisions apply:

  • MS Plans pays only that part of the total of all loss payable in excess of the deductible shown in the Declarations.
  • In the case of a Named Storm, the Deductible Clause is replaced by the applicable Named Storm Deductible Clause.

Specific application of the deductible forms will be discussed in more depth further on in the course.


Property Covered

Just like with the MRPIUA policy, Other Structures coverage is a sublimit of Coverage A.


Vacancy

Subject to the exclusions and all other policy provisions, coverage applies even if the Described Location is unoccupied or vacant at the time of the loss.


Consequential Loss – Change in Temperature

 Physical Damage to Dwelling

Up to 5% of Coverage C limit may be used to cover damage to property contained in the dwelling or other covered structure due to change in temperature as direct result of damage to dwelling or equipment caused by windstorm or hail.

Physical Damage to Power, Heating or Cooling Equipment

Up to 5% of Coverage C limit may be used to cover damage to property contained in the dwelling or other covered structure due to change in temperature as direct result of damage to power, heating or cooling equipment caused by windstorm or hail.

Payment reduces Coverage  C limit by the amount paid.


Other Coverages

Additional Living Expense

If a covered loss makes the Described Location which is used as the Primary Residence uninhabitable, the policy covers the reasonable, necessary increase in living expenses incurred by the insured in order for the household to maintain its normal standard of living.

  • Total limit of liability for ALE is 10% of Coverage A – Dwelling and payment under this coverage reduces the limit of liability accordingly (not additional coverage).
  • ALE coverage applies without application of the deductible.
  • Payment will be for the shortest time required to repair or replace the damage or if the insured permanently relocates, the shortest time required to settle elsewhere.
  • Periods of time for ALE are not limited by the policy expiration dates.
  • ALE coverage in the event of civil authority prohibiting use of the Described Location due to direct damage to neighboring premises by windstorm or hail is limited to 2 weeks.

  • Policy does not cover loss or expense due to cancellation of lease or agreement.
  • Additional coverage for ALE applies only to the Primary Residence.
  • Coverage does not apply to an insured’s business, whether conducted on or off any insured location.


Debris Removal

The policy will pay the insured’s reasonable expense for removal of:

  • Debris of covered property if windstorm or hail caused the loss.
  • Removal of contents is limited to contents covered under Coverage C – Personal Property.

This coverage is not additional insurance and payment reduces the limit of liability applicable to Coverage A – Dwelling accordingly.


Reasonable Repairs

In the event that covered property is damaged by windstorm or hail, the policy will pay the reasonable cost incurred by the insured for necessary measures taken solely to protect against further damage from windstorm or hail.

  • This is not additional insurance any payment will reduce the limit of liability for Coverage A – Dwelling accordingly.
  • This coverage does not relieve the insured of duties under the policy with respect to covered property.


 

MSPR04 MRPIUA Coverage (Part 2)

In this section we will continue our review coverage provisions for the MRPIUA policy, including the Perils Insured Against, Exclusions and Conditions sections of the policy as well as pertinent endorsements.

Note that a complete copy of the policy form is available below under the Resources section. This lesson will address the highlights of the policy, particularly focusing on those provisions which differ from typical ISO policy forms, and those provision that set it apart from the MWUA policy form(s). In any case of a conflict between the descriptions in these lessons and the policy forms, the policy forms will prevail.

 

Perils Insured Against

The policy insures for property damage to covered property at the Described Location due to a named peril unless otherwise excluded.

Policy insures against 8 named perils:

1. Fire or Lightning


2. Windstorm or Hail

Remember that the peril of Windstorm or Hail  is excluded from Perils Insured Against for property located in Hancock, Harrison or Jackson Counties. For property located in these counties, the policy does not insure against any property damage of any kind caused by, resulting from, contributed to, or aggravated by the peril of windstorm or hail.

For those counties where coverage does apply, the peril of Windstorm or Hail does not provide coverage for property damage:

  • To the inside of a covered building or the covered property contained in a building caused by rain, water, snow, sleet, sand, or dust even if the rain, water, snow, sleet, sand, or dust is driven by wind unless the direct force of wind or hail first damages the building, causing an opening in the roof or wall and then the rain, water, snow, sleet, sand, or dust enters through this opening;
  • Related to or in any way caused by water from sprinkler equipment or other piping unless the equipment or piping was damaged as a direct result of wind or hail;
  • Related to or in any way caused by:
    • Frost or cold weather or ice (other than hail), snow, or sleet, whether driven by wind or not;
    • To watercraft of all types
    • To gravemarkers, including mausoleums
  • To the following property when it is located outside of the building unless liability is assumed in this policy by a separate and specific schedule, list, or endorsement for which a premium is paid by you for such assumed liability:
    • Awnings;
    • Signs, radio or television antennas, aerials, or satellite dishes, including lead-in wiring, masts or towers;
    • Greenhouses, chicken houses, hothouses, slathouses, trellises, or pergolas;
    • Fences or walls, including but not limited to seawalls, property line walls, and similar walls; or
    • Wharves, docks, piers, boathouses, or other structures located over water. If any part of the wharf, dock, pier, boathouse, or other structure is located over water, it is not covered property under the peril of Windstorm or Hail. (Note that if a portion of the structure is over water and a portion is on land, the portion on land will be covered while the portion over water will be excluded.)

3. Explosion

The Peril of Explosion does not include property damage related to or in any way caused by explosion of steam boilers or steam pipes, if owned or leased by you or operated under the named insured’s control, nor does it include property damage related to or caused by:

  • Discharge of firearms by the named insured or resident of Described Location
  • Electric arcing;
  • Broken water pipes;
  • Breakage or operation of pressure relief devices.

4. Riot or Civil Commotion


5. Aircraft


6. Vehicles

The Peril of Vehicles does not include property damage related to or caused by:

  • Vehicle or motorized conveyance owned or operated by the named insured or any resident of the Described Location or such vehicle that is within the care, custody or control of the named insured or resident
  • Any vehicle to fences, driveways and walks.

7. Smoke

The Peril of smoke includes the sudden and accidental damage from smoke, including emission or puffback of smoke, soot, fumes or vapors from a boiler, furnace or related equipment.

The Peril does not include property damage related to or in any way caused by smoke from illegal activities by the named insured or a resident of the Described Location nor Property Damage related to or in any way caused by smoke from fireplaces, agricultural smudging or industrial operations.


8. Volcanic Eruption

The Peril of Volcanic Eruption does not include property damage caused by earthquake, land shock waves, or tremors.


Exclusions

Exclusions include the following:

Earth Movement


Governmental Action


Illegal Acts


Intentional Property Damage


Mold, Fungi, Wet or Dry Rot, or Bacteria

  • No coverage for property damage or cost directly or indirectly caused by, resulting from, contributed to, or aggravated by any type or form of mold, fungi, fungus, mycotoxin, spores, wet or dry rot, or bacteria even if due to a Peril Insured Against.
  • The exclusion includes scents, byproducts produced or released, stains, health hazards and deterioration or weakening of property.
  • Considering this exclusion is in effect, estimates should not include line items for antibacterial or antimicrobial cleaning.

Neglect

Nuclear Hazard

Ordinance or Law

  • Means any ordinance or law:
  • Requiring or regulating the construction, demolition, remodeling, renovation, or repair of property including removal of resulting debris;
  • The requirements of which result in any reduction in value to property; or
  • Requiring you or others to test for, monitor, clean up, remove, contain, treat, detoxify, neutralize, or in any way respond to or assess effects of pollutants.

Thus, coverage does not apply for either code upgrade or for cleanup, testing, monitoring, etc. for pollution-related losses or damage.


Pollution

Policy does not cover any property damage or cost directly or indirectly caused by, resulting from, contributed to, or aggravated by the discharge, dispersal, release or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals, liquids or gases, waste materials or other irritants, contaminants, or pollutants into or upon the insured property and/or land, the atmosphere, or any water course or body of water.

Exception: This exclusion does not apply if such discharge, dispersal, release or escape is sudden and accidental.


Power or Other Utility Service Failure

Power Failure means the failure of power or other utility service if the failure takes place away from the Described Location.

Exception: If the failure results in property damage caused by a Peril Insured Against on the Described Location, the policy will pay for property damage caused by that Peril Insured Against.


Theft

The policy provides no coverage for theft.

  • Even if theft occurs at the same time as, after, or as a result of a Peril Insured Against, there is no coverage for the theft of covered property.
  • If as a direct result of theft, property damage to covered property is caused by a Peril Insured Against, coverage for the resulting property damage is available subject to the policy terms.

Vacant or Unoccupied Structure

Unless otherwise endorsed, MS Plans does not pay for property damage occurring while the insured structure is vacant or unoccupied for 90 consecutive days.

Exceptions:

  • Exclusion does not apply to additional structures located on the insured premises that are not intended to be inhabited such as sheds, outbuildings or storage buildings, if the principal insured structure is neither vacant nor unoccupied
  • Exclusion does not apply to seasonal or vacation homes that have not been rented to anyone or held out or offered as a rental property at any point in the preceding 12 month period

MRPIUA Vacancy Permit (Form V)

Note that the insured can obtain the Vacancy Permit Endorsement which replaces the language in the Vacant or Unoccupied Exclusion. The endorsement creates an additional exception to the exclusion in such cases where the insured structure is vacant or occupied due to an active construction project that lasts or is expected last longer than 90 consecutive days. To be effective, Form V must be completed and approved by MRPIUA prior to the expiration of the 90 consecutive days.


Water Damage

The policy does not pay for property damage to covered property that results from water damage.

This exclusion applies whether the water damage was related to or in any way caused by human or animal forces or any act of nature.

Exception: Property damage caused by fire or explosion resulting from water damage is covered subject to the policy terms.

water damage exclusion


Conditions

Duties

MS Plans has no duty to provide coverage under the policy if the insured fails to comply with the listed duties.

  • Prompt notice
  • Protect property (reasonable & necessary repairs to protect property and keep accurate records of same)
  • Cooperate with MS Plans in the investigation of the claim
  • Prepare inventory of damaged personal property
  • Provide as often as reasonably required: inspection of damaged property, copies of requested records and documents, examination under oath
  • Sworn Proof of Loss

Loss Settlement

Covered losses are settled at actual cash value calculated as of the date of the loss. If the actual cash value exceeds the amount required to repair or replace the damaged property, we will pay the amount to repair or replace the damaged property.


Appraisal

If the insured and MS Plans agree on the cause of property damage but fail to agree on the amount of loss, either party may demand appraisal.


Other Insurance and/or Service Agreement

1. Where there is other property insurance providing coverage for the same or similar perils, MS Plans pays only the proportion of the loss covered under this policy that is this policy’s limit of liability applying to the loss bears to the total amount of insurance covering the property for property damage caused by the same or similar peril (see example on next slide)

2. Where there is a Service Agreement, MS Plans insurance is excess over any amounts payable under the plan.


Subrogation

The insured may waive a right of recovery against another person or entity

  • in writing
  • before a loss

If not waived, MS Plans may require an assignment of rights of recovery to the extent of any payment made by MS Plans. In such cases, the insured must sign and deliver all related papers and cooperate with MS Plans in these efforts.


Loss Payment

MS Plans will settle all losses with the named insured(s) and payment will be made to the named insured(s) and any other party identified as an additional insured under the policy. Loss will be payable 60 days after receipt of the signed, sworn proof of loss from the insured and:

  • Agreement is reached as to the cause of loss;
  • Agreement is reached as to the amount of the loss;
  • There is an entry of final judgment; or
  • There is a filing of an appraisal award.

Mortgage Clause

Loss payable under Coverage A or B will be paid to mortgagee and the insured, as interests appear.

  • Mortgagee interest is limited to whole principal plus any accrued interest as of the loss date.
  • If more than one mortgagee, order of payment is the same as order of precedence of the mortgages.

If a claim is denied, a mortgagee may still have a valid claim assuming certain requirements are met.

Mortgagees are included on claim payments from first dollar.


Loss Payable Clause

If the Declarations show a loss payee for certain listed insured personal property, that person is considered an additional insured under this policy with respect to only that property.

If MS Plans cancels or nonrenews the policy, the loss payee will be notified in writing pursuant to the policy provisions.


MRPIUA Coverage Summary

MSPR03 MRPIUA Coverage (Part 1)

In this section we will review coverage provisions for the MRPIUA policy, including the Definitions, Deductible, Property Covered and Other Coverages sections of the policy.

Note that a complete copy of the policy form is available below under the Resources section. This lesson will address the highlights of the policy, particularly focusing on those provisions which differ from typical ISO policy forms, and those provision that set it apart from the MWUA policy form(s). In any case of a conflict between the descriptions in these lessons and the policy forms, the policy forms will prevail.

03.1 MRPIUA Intro


Insuring Agreement

The insuring agreement states the following:

We will provide insurance for property damage you prove was caused during the effective period of this policy by a Peril Insured Against in this policy in exchange for payment of the premium and full compliance with all applicable provisions of this policy.


Definitions

Described Location: 

The premises identified in the Declaration.


Insured Structure: 

The insured building(s) located at the Described Location.


Loss:

Property damage covered by this policy.


Property Damage: 

Sudden and accidental direct physical damage to or the destruction of tangible property.


Service Agreement:

A service plan, property restoration plan, home warranty, or other similar service warranty agreement, even if it is characterized as insurance.


Unoccupied:

The insured structure is a building where, even if the personal property necessary to sustain normal occupancy is maintained in the structure, there is no one using it. The insured structure will be considered unoccupied even if you, the owner, or current/former tenant considered the lack of occupation temporary.


Vacant: 

The insured structure is substantially empty of the personal property necessary to sustain normal occupancy. The insured structure will be considered vacant even if you, the owner, or current/former tenant considered the vacancy temporary or may have intended to return.


Deductible

The policy will pay only that part of the total of all covered property damage that exceeds the deductible amount shown in the declaration.

Effective 12/1/2014 forward, the applicable deductible for the MRPIUA policy is:

$1000 flat deductible per policy, per occurrence


Property Covered


Other Coverages

Debris Removal

The policy will pay for reasonable expense for removal of:

  • Debris of covered property provided a Peril Insured Against caused the debris; or
  • Ash, dust or particles from a volcanic eruption that has caused property damage to an insured structure or personal property covered under this policy when that personal property is contained in a building.

This expense is included in the Limit of Liability for the coverage that applies to the damaged property.


Reasonable Repairs

  • Reasonable cost for necessary measures to protect damaged covered property from further damage
  • Only applies if property is covered by the policy and damage is caused by a Peril Insured Against.

Coverage does not:

  • Increase the applicable limit of liability
  • Relieve the insured of duties outlined in the policy Conditions

Preservation of Property

Insures covered property against property damage from a covered peril when removed from the Described Location in order to protect it from an imminent covered peril.

Coverage does not:

  • Increase the applicable limit of liability
  • Apply for more than 5 days from the date of removal

Note that this coverage must be “bookended” by covered perils. That is, the insured must move the property to protect it from an imminent covered peril, and any damage claimed must be caused by a covered peril.


Fire Department Service Charge

Pays up to $500 for liability assumed by contract or agreement for fire department service charges incurred when fire department is called upon to save or protect covered property from a Peril Insured Against.

Coverage does not apply if the property is located within the limits of the city, municipality or protection district responding.

Coverage:

  • Is additional insurance apart from the limit of liability in the Declaration
  • Applies without application of a deductible

MSPR02 Adjuster & Examiner Expectations & SLAs

 

This section will review the adjuster and examiner roles, conduct and performance expectations and our Service Level Agreements (SLAs) with MS Plans.

 

Adjuster Requirements

The following areas of compliance are required for all adjusters and examiners intending to work claims for MS Plans.

02.2 Adjuster Requirements

Adjuster Certification

Adjuster certification must be completed in-person the first time, and renewed annually thereafter. Renewal must be completed by the last day of the anniversary month of the initial certification. For example, if certification was completed on February 18, 2019, online renewal must be completed by February 29, 2020.

Licensing

An adjuster license is required by the state of Mississippi to handle claims. Emergency licenses are not readily issued and obtaining the license prior to a CAT event is recommended.

HR

Adjusters on the U.S. Adjusting Services roster should ensure their HR file is up to date with all required documentation including but no limited to I-9 documents.

Tools and Equipment

Examiners will be based in the U.S. Adjusting Services office in the DFW area and will be provided with necessary equipment. Field adjusters should ensure access to the following.

02.3 Equipment

Additionally, at a minimum, the following tools will be necessary for a successful field deployment.  Each adjuster should maintain their equipment in good working order to ensure safety while deployed.

  • One-story and two-story ladder
  • Tape measures (retractable 25-35ft, long tape 100ft and measuring wheel)
  • Pitch gauge
  • Metal roofing gauge
  • Composition shingle gauge (adjusters should have both the 1/12 and 4/09 models on hand)
  • Chalk and/or soap stone
  • Shears or razor knife (used for siding and carpet samples)
  • Flashlight/ headlamp
  • Footwear appropriate to access roofs.  Cougar Paws are highly recommended due to the added safety that they provide the adjuster when accessing high slope roof surfaces.

 

Conduct Expectations

02.5 Dress code

02.6 conduct standards

Conflicts of Interest

Adjusters must avoid any situation where a conflict could exist or appear to exist between their personal interests and US Adjusting Services or our clients including any outside financial interests that might influence decisions or actions on behalf of the US Adjusting Services or MS Plans.

Adjusters should also avoid outside activities that encroach on working time, interfere with regular duties, adversely affect the quality of work performed, or negatively affect US Adjusting Services or its client reputations.

Adjusters should never recommend a specific contractor.  If asked to recommend a contractor by a client (not a policyholder), provide at least three contractors names with a disclaimer that you are not endorsing any one specific contractor. There may be times that the client provides a list of recommended contractors.   The client and/or US Adjusting Services management will provide any such information in written form.

Riding with a contractor, or having a contractor ride with you, is strictly prohibited. Any adjuster suspected of having an improper agreement with a contractor will be dismissed from duty immediately pending investigation into the matter.

Perceived Conflict of Interest

The appearance of impropriety can be as damaging as an actual impropriety.  Once you are viewed as not having the best interest of the insured in mind, it will be very difficult, if not impossible, to undo that perception.

 

Adjusters should consult their manager immediately regarding any conflict of interest or potential perceived conflict.

02.7 zero tolerance harassment

Adjusters and examiners should ensure their behavior on any deployment is professional and avoids any potential harassment of others they may have working relationships with. U.S. Adjusting Services has a zero-tolerance policy for harassment and reserves its right and responsibility to take appropriate action in such cases where harassment is alleged to have taken place.

 

Roles, Responsibilities, Service Level Agreements and Quality Assurance

02.9 Adjuster and Examiner roles

Coverage decisions are the responsibility of the assigned claim examiner. Field adjusters should refrain from making coverage determinations or discussing specifics of coverage with the insured.

02.9 Adjuster and Examiner roles

 

02.9 Adjuster and Examiner roles

 

02.9 Documentation

overview of MS Plans cover photo

MSPR01 Overview of MS Plans

overview of MS Plans cover photo

 

This section will provide an overview of the Mississippi Wind Underwriters Association and Mississippi Residential Property Underwriters Association property insurance plans.

01.2 MS Plans Overview Summary

Mississippi Windstorm Underwriting Association (MWUA)

The Mississippi Windstorm Underwriting Association (MWUA) was established by House Bill 274 of the 1987 session of the Mississippi Legislature to provide an adequate market for Windstorm and Hail Insurance in the Coastal Area of Mississippi. MWUA provides coverage for Windstorm and Hail perils only.

The MWUA is administered by a Board of Directors. Along with the board, all rules and regulations are subject to oversight by the Commissioner of Insurance.

The Plan also administers Coastal Services, which assists coastal agents with a better understanding of the rules, operations and functions of the MWUA and also meets with local building officials, contractors, and engineers to help promote and educate on how to improve construction in the coastal areas to help mitigate against possible wind losses. Additionally, the Plan administers individual Catastrophe Savings Accounts, a tax advantaged regular savings account or money market account established after January 1, 2015 by a Mississippi income taxpayer, to assist with post catastrophe losses, or to self insure all or a portion of one’s home.

The Mississippi Windstorm Underwriting Association (MWUA) was established by House Bill 274 of the 1987 session of the Mississippi Legislature to provide an adequate market for Windstorm and Hail Insurance in the Coastal Area of Mississippi. MWUA provides coverage for Windstorm and Hail perils only. The MWUA is administered by a Board of Directors. Along with the board, all rules and regulations are subject to oversight by the Commissioner of Insurance. The Plan also administers Coastal Services, which assists coastal agents with a better understanding of the rules, operations and functions of the MWUA and also meets with local building officials, contractors, and engineers to help promote and educate on how to improve construction in the coastal areas to help mitigate against possible wind losses. Additionally, the Plan administers individual Catastrophe Savings Accounts, a tax advantaged regular savings account or money market account established after January 1, 2015 by a Mississippi income taxpayer, to assist with post catastrophe losses, or to self insure all or a portion of one’s home.

Mississippi Residential Property Insurance Underwriting Association (MRPIUA)

The Mississippi Residential Property Insurance Underwriting Association (MRPIUA) was established by House Bill 1113 in the 2003 Regular Session of the Mississippi Legislature.

The purpose of the MRPIUA is as follows:

  • To provide an adequate market for residential coverage insurance throughout Mississippi
  • To provide adequate insurance upon property in all areas to enable home owners to obtain financing for the purchase and improvement of their property
  • To provide an equitable method to whereby insurers writing fire and extended coverage in Mississippi are required to meet their public responsibility
  • To provide a mandatory Plan to assure an adequate market for fire and extended coverage throughout Mississippi

The MRPIUA is a separate and independent entity that operates as a private enterprise governed by a Board of Directors. All rules and regulations are subject to the review of the Commissioner of Insurance. The MRPIUA is operated and managed by the Mississippi State Rating Bureau.

The MRPIUA policy provides property coverage on a named peril basis.

01.6 MRPIUA Coverage Area


As with each of the lessons that follows, you will now be asked to complete a short quiz (4 questions) over the material in this lesson. Click the quiz below to begin. 70% is required to proceed to the next lesson. You may review the questions and responses by clicking “View Questions” at the end of the quiz. If you do not correctly complete 70%, you may review the information and retake the quiz in order to proceed.