Today is the second day of 2019. If you have friends in the property department of your claims division, be sure to do something nice for them today. Our region had a bit of a windstorm yesterday and they are probably going to be terribly busy.
If you handle general liability claims, you may find some new activity this week as well. History would suggest that wind events generate several property damage liability claims as well. The usual scenario involves a tree that is situated on a policyholder’s property and falls during a windstorm and damages the neighbor’s property.
When an incident occurs like the one described above, the focus of the adjuster’s job will be to get all the facts so that a rational decision can be made regarding liability and damages. The other part of the adjuster’s job will be to educate the policyholder and the claimant with respect to the duties owed to others under tort law, and whether there was any breach of that duty. In the example noted above, a windstorm caused a tree to fall on to someone else’s property. The word “caused” is particularly important, because if it was solely the wind that caused the damage, there cannot be liability. With no liability, no claim should be paid. This is the basis of the Act of God Doctrine.
Liability claims are often pursued when someone’s property is damaged in an event that involves weather or some other natural occurrence. Often, the claimant will rely on the idea that something owned by your policyholder caused damage to their stuff, and so the claimant should not have to pay for their own damage. The basic flaw to this line of thinking is that if a natural occurrence (aka Act of God) was the cause, there is no legal liability to the claimant. Your policyholder must have done something negligent, and that “something” must be the cause of the damage for the general liability coverage to pay a claim.
Sometimes when the wind blows, we find that an insured ignored some type of maintenance issue or failed to do something that could have prevented the incident. In the tree example, if an insured knows of any trees that pose a hazard to people or property, they have a duty to correct any known issues to prevent damage or injury.
Dealing With Policyholders
When a claim involves a natural occurrence and no liability applies, we often find that policyholders will sympathize with the claimant and feel some sort of responsibility as a “good neighbor” to make things right. Adjusters are people too and we get this line of thinking. However, we also understand the concepts involved in tort liability.
Educating people is an important skill for any adjuster. An insurance policy is a complicated document, and the concepts involving legal responsibility for damages can be difficult to explain. However, that is part of the job for a professional adjuster.
We must remember that a policyholder is the customer, but we also must remember that the product they purchased (the policy) provides defense and indemnity. That “defense” part is very important and is worth explaining to a “good neighbor” policyholder.
Dealing With Claimants
Someone who has just sustained an injury or property damage, and who feels that someone else was the cause deserves to be heard for at least two especially important reasons. First, they deserve the professional courtesy of having their side of the story considered. Second, they deserve to be heard because they may have factual information that does not align with your policyholder’s version of events.
If a case involves a natural occurrence as a cause with no negligence on the part of the policyholder, we find that the best approach with a contentious claimant will involve empathy, facts, and real-life examples.
Always lead with empathy. If you can show that you understand a claimant’s position, they are likely to be more receptive to any factual information you will be supplying to them.
When it comes to the facts, be sure you know all of them, and make sure you are receptive to new facts that may become known. Facts are important, and should be distinguished from opinions, speculation, and hearsay, which makes the investigation portion of our job so much more important.
An adjuster’s ability to provide examples will get easier with experience, but with some skill an adjuster should be able to use common examples to demonstrate how a policyholder cannot be held liable for an Act of God. One example might be a house fire caused by lightning versus one caused by careless smoking. Another might be damage from an auto accident involving a drunk driver versus damage to an auto caused by a tornado.
Professional adjusters need to find the facts before making liability or coverage determinations. The finding of facts cannot rely on biased opinions or preconceived notions about what happened, but when the facts show that mother nature was the sole cause of an incident, there should be no legal liability.
If you have a claim involving damage caused by an Act of God, contact us today and we’ll help you get the facts.