Study 10 - Residential Property Claims Flashcards
What are the three types of residential policies?
Homeowners (A, B, C & D)
Tenants (C & D)
Condo (C & D)
What is in coverage A of Section I?
Dwelling
- Main building, attached structures, permanently installed outdoor equipment, outdoor swimming pool
What is in coverage B of Section I?
Detached Private Structures
- Structures seperated from the main building by a clear space (garden shed, greenhouse, gazebo, barn/stable, boathouse)
What is in coverage C of Section I?
Personal Property
- Contents usual to a home (located at the property/temp removed)
What is in coverage D of Section I?
Additional Living Expenses
- Extra costs incurred when an insured person incurs additional cost while property is unfit to occupy as result of insured peril
Under what are swimming pools covered in Quebec?
Endorsement
What are the three other coverages specific to a Condo?
Unit improvements and betterments
Loss assessment
Unit additional protection
What is the name for the condo corporation in Quebec and BC?
Quebec - Syndicate
BC - Strata corporation
What questions must an adjuster ask when comparing heat and fire?
Has heat been applied?
What resulting products of fire are in evidence?
What are the permitted exclusions of the fire peril in Ontario?
Riot, civil commotion, war, invasion, act of foreign enemy, hostilities, civil war, rebellion, revolution, insurrection or military power
What are the permitted exclusions of the fire peril in Quebec?
Civil war, riot or civil disturbance, nuclear explosion, volcanic eruption, earthquake, or other cataclysm
What are some typical things an adjuster can recommend to help minimize damage?
- There may be some urgency to board up exposed areas
- There may be a need to air and deodorize the premises
- Washing walls should be attempted as soon as possible to determine what painting would be required
- Protective barriers or fencing may be required to limit any trespassing or further damage
- Complex or large losses still under investigation, property may require on-site security
Define water hammer
Pressure shock wave induced in plumbing supply systems when a sudden change occurs to the stability of the water, causing a banging noise in pipes
Explain the water hammer exclusion
Exclusion under explosion
Is not excluded in an all-risk form or Quebec policy forms
What is the common exclusion of smoke?
Agricultural smudging or industrial operations
What are some common examples of falling objects that may cause damage?
Falling trees, meteorites, aircraft parts and debris from blasting operations
What are the four main occurrences covered under the water peril?
- Sudden and accidental escape of water from a watermain
- Sudden and accidental escape of water or steam from within a plumbing, heating, sprinkler or ac system or domestic water container located inside the dwelling
- Sudden and accidental escape of water from a domestic water container located outside the building (not insured if caused by freezing)
- Water that enters dwelling from an opening created suddenly and accidentally by another insured peril
What must an insured do to obtain coverage for frozen pipes rupturing if they are away for more than four consecutive days?
- Insured arranged for someone to enter the house each day to ensure that heating was being maintained
- Insured shut off the water supply and drained all the pipes and domestic water containers
What are the common water exclusions?
- Continuous or repeated seepage or leakage
- Backup from a sewer, sump or septic tank
- Ground water or rising water table
- Surface water
- Shoreline ice building
- Damage by waterborne ice or other objects, whether by rain or otherwise
What precedent was set in Easton v. Lanark Mutual Co?
An insured is not required to accept a method of payment that diminishes the value of his home
What are the common roofing problems that have nothing to do with hail?
- Moisture trapped in the roofing material may cause bubbling
- Sheathing that expands and contracts may cause wrinkling
- Oils evaporating from the roofing materials may cause an alligator-type pattern on the roofing surface
What are the perils within transportation?
- Collision
- Derailment
- Upset
- Stranding
- Overturn
- Sinking
What are the restrictions of the theft peril?
- Caused by a tenant in a part that is rented out, the tenants family or tenants employees
- Dwelling under construction
- Animals, birds, or fish
- When by fraud or trickery; a change of ownership in property takes place with the insured’s agreement
What are the typical extensions of property?
- Debris removal
- Cost of removing property from premises to protect it from loss for up to 30 days or until the policy term ends (whichever is first)
- Property removed from insured’s property to protect it from damage
- Personal property in transit to another home
- Fire department assessments
- Property coverage from change in temperature due to insured peril
- Loss of freezer food due to interruption of electrical power or mechanical breakdown up to $2000
- Replacement or re-keying of locks if keys are stolen
- Tearing out for repair due to water damage (swimming pool & watermain not covered)
- Arson conviction rewards
- Coverage for credit card, debit card, forgery and counterfeit money up to $1000
What is the difference between vacant and unoccupied?
Vacant - no contents & no occupants
Unoccupied - contents & no occupants
What facts would an adjuster want to determine regarding a claim?
- When the loss occurred
- Specific location from which the loss occurred
- Who discovered the loss and what time of day it was
- How the loss was discovered
- Whether police were notified
- Name of the landlord, if applicable
- Brief description of the residence, to include its age and the type of construction
- Names of household occupants
- Nature of any repairs already completed
- Insured’s story of what they believe happened
- Description of item or items damaged that includes the following: ownership of the item, location of the item, make/model/size/serial number, identifying marks on item, details of purchase, storage/repair
- Whether a financing contract exists for damaged items: amount owed, to whom
What are the additional requirements of theft and burglary claims?
- How entry was gained to the premises
- Whether visible signs of the entry exist
- Confirmation whether doors and windows are kept locked
- Whether an alarm is in place
- Whether an alarm is kept activated
What background info can be confirmed from the application?
- Name of prior carrier and policy number
- Whether insured had prior losses
- Details of prior claims
- Whether insured ever had insurance cancelled
- Details related to why a cancellation occurred
What does the adjuster need to do to get the info required for the estimate?
- Note cause and severity of damage
- Measure dimensions of floors, walls & ceilings
- Documents the number of doors, windows & other openings
- Details each restoration activity with a description of the material (identifies whether floor coverings need cleaning, repair or replacement)
- Details damage and what must be done to restore the property, starting w/ floor & moving to walls then ceilings
- Identify all damaged areas, including framing, windows, doors, vapour barrier, sheathing and exterior finish, insulation, interior finish, walls, ceilings, floor finishes, trim, moulding, finish carpentry, wall & ceiling finishes, staircases, shelving and cabinetry
- Identifies what kinds of subcontractor will be needed, such as those specializing in broadloom, wood flooring, plumbing, electrical, heating, ventilation & ac
- Consider other damage way ensue because of repairs
- Identify how much demolition, debris removal & final cleanup required
What are the four items that repair activities are categorized in?
Function
Unit amount (area, volume, length)
Cost per unit
Total cost
What is P & O?
Profit and overhead
What are the two most common roofs?
Gable and hip
What is the line at the top of the roof called?
Ridge
What are the lower edges of a roof called?
Eaves
What makes up a gable roof?
Two rectangles
How much more do hip roofs cost than gable roofs?
10 to 15 percent to cover the waste factor
What are the conditions of replacement of a home at replacement cost?
- Repairs or replacement must take place at the same location
- Same occupancy must be maintained
- Materials of the same quality must be used
- Repairs or replacement must take place within a reasonable time after the loss
What is guaranteed replacement cost called in Quebec?
Enhanced replacement cost
How can lightning damage be assessed?
- A direct strike can cause physical damage to property by vaporizing material.
- Lightning damage is sometimes evidenced by a hole in the roof or wall.
- Lightning damage can be tracked through the property.
- Lightning generally follows a defined path through electrical equipment.
- A loss adjuster may appoint a qualified expert to differentiate between lightning damage and other causes of electrical failure in appliances.
How does the loss of freezer food extension work?
- Most residential policies provide this extension of coverage; it is essential that the actual wording in force, at the time of the loss, be examined to determine whether an extension applies.
- Typically these extensions do not increase the limit of insurance available under the policy.
- Where the extensions are in addition to other loss or damage, the deductible applies to the entire loss and not specifically to the extension.
- Loss of food in a freezer caused by an interruption of electrical power or mechanical breakdown is covered for up to $2,000 without a deductible.
- This extension contains some exclusions, and the amounts insured may vary by policy.
