Inside Adjuster Essentials

IAE 04.1 Coverage Analysis Workshop – Javier Sanchez

Javier Sanchez has submitted  a claim for water damage to his home following a storm. The loss assignment including coverage information is attached below as well as the adjuster’s report with photos. Based on the available information, complete a review of the loss for coverage.

  1. Write a captioned coverage note confirming your review.
  2. Write a paragraph recapping your analysis of coverage and your position.
  3. If you find the loss is covered, write instructions to the adjuster to complete an estimate for the covered portions.
  4. If you find the loss is partially covered or not covered, draft a letter to the insured to explain your position.

Complete your response and upload as a Word doc or PDF.

 

SANCHE~1

 

SANCHE~2

IAE 03.5 Smoke Gets in Your Eyes

Dawn has an HO-2 policy. She recently reported a claim for smoke damage to her home following a fire at her neighbor’s home. The fire was contained at the neighbor’s residence and did not damage Dawn’s home otherwise. Her dwelling is a covered location and the loss occurred during the policy period.

Is the smoke damage to Dawn’s home covered on her policy?

If the home was habitable despite the smoke damage but local law enforcement demanded Dawn vacate her home because of dangerous conditions created by the neighbor’s loss, would her policy pay for ALE while she had to be out of the house?

Would your coverage position change if Dawn had an HO-3 policy?

Write your answer and upload below as a Word doc or PDF.

IAE 03.4 Something is Rotten in Oak Cliff

Jessica recently reported a claim for loss to her refrigerator contents after a storm took out the main transformer two blocks from her home. The loss occurred at a covered location during the policy period.

Is Jessica’s food spoilage claim covered under her HO-3 policy?

Which, if any, policy provisions apply?

Write your answer and upload below as a Word doc or PDF.

IAE 03.3 It’s Shocking! Shocking, I tell you!

Ethel just bought a beautiful  new MacBook Pro. Recently, the computer stopped working. The morning she discovered this, she also remembered a severe storm a few nights earlier. Ethel believes the damage occurred due to a power surge during the storm, because she had forgotten to unplug it from the wall before she went to bed.

Is the damage to Ethel’s MacBook due to a covered peril?

What additional information might you need in order to confirm the cause of loss?

Which, if any, policy provisions apply?

Write your answer and upload below as a Word doc or PDF.

IAE 03.2 It’s Always Sunny in Philadelphia

Edgar has a two-story walk-up in Philadelphia. He recently reported a claim for water damage in his living room following a severe hailstorm. The adjuster inspected and found the flashing around a skylight was not properly installed and this was the most likely cause of the water intrusion. The adjuster noted in her report that there was no evidence of wind or hail damage to the roof or skylight. This loss occurred during the policy period at the insured location.

Would this damage be due to a covered peril on Edgar’s HO-2 policy? If so, which peril?

Which, if any, coverage provisions apply?

What if Edgar had an HO-3? Would this change your position on coverage?

Which, if any, coverage provisions apply?

Write your answer and upload below as a Word doc or PDF.

IAE 03.1 Ethel in Iowa

Ethel’s primary residence is in Iowa. Each winter, she travels to Texas. She has an HO-3 policy on her home in Iowa. She leaves the water turned on when she goes to Texas because her plumber to her it is hard on her pipes to be turning the water on and off all the time. She doesn’t want to pay for heat when she’s not there to enjoy it, so she keeps the thermostat at 40 degrees and because she is a very responsible woman, asks her neighbor who is a little sweet on her to stop in every few days to make sure everything is fine. On a cold day last February, Ethel’s pipes froze anyway, and she sustained damage to her home. The loss occurred at a covered location during the policy period.

Is this damage due to a covered peril under the policy? If so, which one?

Which, if any, policy provisions apply?

Complete your answer and upload below as a Word doc or PDF.