Week 14 The Art of Adjusting Contracts of Adhesion - YouTube

i'm Chantal Roberts and i'm an expert witness  for claims handling standards practices and  

procedures i was an adjuster for 20 plus  years the art of adjusting is a vlog to help  

professionals and lay people alike understand  a bit more about the insurance claims industry  

today is election day a day where we can vote for  changes in an average insurance policy an insured  

cannot make changes to the policy however this  is known as a contract of adhesion while there  

are endorsements and endorsements are a way  for and ensured to make changes to the policy  

an endorsement is still written by the  insurer since the insurer writes the  

policy and the insurer does not have a  say in how it's worded in the event that  

there is confusion or an ambiguity over a word  courts will generally rule against the insurer  

or drafter of the contract if the wording question  is not defined in the policy courts will use the  

everyday meaning of that word the everyday meaning  of a word is usually the one found in a dictionary  

so the logic is that an insurer had the  opportunity to word the policy in a manner  

it wanted to and if it didn't or its language  was not clear that's the fault of the carrier  

coverage would then be awarded to the insured  this is an important concept for adjusters to  

understand because it comes up often while  handling claims often the insured the agent or the  

policy holder attorney will believe that a policy  says one thing and the adjuster and carrier will  

think that the policy says another ambiguities  can either be semantic involving a choice of words  

their meanings or their contextual uses in  a contract or syntactic ambiguities meaning  

the in the arrangement of a word  involving sentence structure punctuation  

nouns connectives verbs and their tenses it should  be noted that just because there's a definition  

of a word in a policy that doesn't mean that  the word is or used to be ambiguous just like a  

lack of a definition doesn't mean that  a word isn't ambiguous or is ambiguous  

it's very confusing bill wilson who is an  insurance thought leader and author of when words  

collide also points to the latin phrase no saitor  aso sai sis meaning it's known by its associates  

this means that if there is a list of policy items  and one item is thought to be ambiguous then the  

entire list should be taken into consideration  together so for example fruit farm is our insured  

and its products are insured with fruity insurance  company a tomato blight has killed all of fruit  

farms tomatoes they turn in a claim to fruity  insurance after an investigation the adjuster  

bradford mcpair denies the claim stating tomatoes  are not a covered property because they're not  

fruit mcpear quoted the following policy language  we cover the fruit you grow including apples pears  

peaches grapes or plants which develop from  a flower and contains seeds tomatoes aren't  

specifically listed in the definition but  the definition is not ambiguous based on  

its associates therefore fruity insurance would be  incorrect in its coverage decision so this week i  

discussed contracts of adhesion and contracts can  be confusing if there is a question in regards to  

wording on a contract it's a good thing to  always talk with your adjuster or an attorney  

every claim is different and every insurer has  different protocols for handling losses however  

this being the litigated world that we're in see  below for some legalese few claims go to a trial  

and picking an expert who has been opposed the  most or has gone to trial the most may not be  

the correct expert failing to have a second  set of eyes on the claim to save expenses  

isn't always the best way to resolve a loss as  an expert witness and former claims adjuster  

i'm sharing my experience in the art of adjusting  thank you for listening i appreciate your time you