馃攳
Week 2 The Art of Adjusting: Reservation of Rights letters and Covid 19 - YouTube
Channel: Chantal Roberts
[2]
hi i'm Chantal Roberts and i'm an
expert witness for claims handling
[6]
standards practices and procedures
i was an adjuster for 20 plus years the
[11]
art of adjusting is a vlog to help
professionals and lay people alike
[15]
understand a bit more
about the insurance claims industry
[18]
today we'll be talking about copic 19
claims and reservation of rights letters
[22]
which i'll refer to as ROR
what is an ROR? it's a letter letting the
[26]
insured know that the insurer has a
question
[30]
regarding if coverage is applicable for
the claim
[33]
there are 10 parts to an ROR and we'll
go over them in an example
[37]
our insured mike has closed his store
businesses r us
[41]
due to the governor's order regarding
the coronavirus
[44]
his store was closed from april 15th to
july
[48]
3. he has a cp policy with a business
interruption coverage
[51]
he filed a claim on july 15 and the
adjuster spoke with him on the same day
[56]
here's how i
handle these coverage issues first i
[59]
would send the letter
the day that i spoke with mike the
[63]
letter would be sent certified return
receipt requested
[66]
regular mail and email it would say
reservation of rights letter right there
[70]
on the top and i would write
your business or your store businesses r
[76]
us
was closed from april 15 to july 3rd due
[79]
to
governor smith's executive order
[81]
regarding the coronavirus there are
questions
[84]
whether coverage under policy number id
10-t
[88]
applies to the loss so right there the
letter must be timely i sent it as soon
[92]
as i knew that there was a coverage
question and it clearly identifies the
[96]
letter as being a reservation of
wright's letter which is why i like to
[99]
put it right there on the top
in this next paragraph we're going to
[102]
hit about five issues
so i would write the nature of the
[107]
coverage question is as follows
your policy id 10-t has a business
[112]
income and extra expense coverage form
CP 00 30 1012 which states that you must
[117]
suffer from a direct physical loss or
damage
[119]
from a specific cause of loss you stated
in our conversation
[123]
july 15 you did not know if you had the
virus at your location
[127]
but none of your employees are sick
there may not be coverage for your loss
[131]
because there
does not appear to be any damage at your
[134]
property
i draw your attention to the following
[136]
policy language listed on page 4
of 10 of the CP 10 30 10 12 which states
[142]
and then you would insert the policy
language right there
[144]
so we've hit five points in this little
bitty paragraph first you have to
[148]
identify the policy
use the policy number then the specific
[151]
form that you're quoting from
you refer to specific facts and the
[157]
relevant facts as they relate to the
claim you identify which
[160]
claim or the part of the claim which may
not be covered this also includes the
[164]
basis for the insurer's
coverage position you state how those
[168]
facts
apply to the policy and then you quote
[172]
the
relevant policy language and identify
[174]
any definitions conditions exclusions
which may bar coverage it's always a
[179]
good idea to include the policy language
as an enclosure so for our example we're
[183]
going to go ahead and have a second
reason for a ror a second coverage
[189]
question
and the second coverage question
[192]
paragraph would mirror the one above
i like to separate the two coverage
[196]
questions because if
you put all of the coverage questions in
[200]
one paragraph and then all of the
language in one paragraph
[204]
mike who is a layperson may not
understand which
[207]
policy language applies to which fact
of loss so it's good to break these
[213]
things out
so that the insured is very clear on
[218]
what is applicable to what policy
language for the sake of time i'm
[221]
skipping to other parts of the letter
so i tell mike that i've assigned an
[225]
appraiser i'm continuing my
investigation
[228]
and i've asked for mike's cooperation in
my investigation
[231]
i also write no act of a happy insurance
company's representative while
[236]
investigating the claim
shall be construed as waving any of the
[239]
insurers rights there may be other
reasons why
[242]
coverage does not apply and so in this
section
[246]
i hid the last three points of the
reservation of rights letters
[249]
i've included general reservation of
rights i've asked for continued
[253]
cooperation
and i've stated as the adjuster i'm
[257]
going to continue my investigation
as i do that if there's no coverage
[262]
after my investigation is finished
a denial letter should be sent if there
[266]
is coverage
the ror should be withdrawn so this week
[269]
i've discussed
what makes a good ror and a claim and
[273]
every claim is different and
every insurer has different protocols
[276]
for handling losses
but a good ror should have these 10
[280]
parts that we've discussed
few claims go to a jury trial and
[283]
picking an expert who has been deposed
the most or gone to trial the most
[287]
may not be the correct expert failing to
have a second set of eyes on the claim
[291]
in order to save expenses
isn't always the best way to resolve a
[294]
loss as an expert witness
and former claims adjuster i'm sharing
[298]
my experience on the art of adjusting
however being in the litigated world
[302]
we're in see below for some legalese
thank you for listening i appreciate
[307]
your time
Most Recent Videos:
You can go back to the homepage right here: Homepage