What's the Scenario? with PLRB

This is a replay of an episode that originally aired on March 19, 2024.     An insured's detached garage burns down in a covered lightning strike, and somehow it's not covered just because of a little side hustle? The PLRB crew hunt for coverage and find what the insurer can pay out on when an insured rents out their property without updating their insurance company.   Notable Timestamps   [ 00:17...

Is a recycle bin a "vehicle"? Does a car antenna ripping a coat fall under the Vehicles peril? How about a poorly secured wedding dress in the backseat of a convertible? If you occasionally win a biking competition, does the loss of your bike trigger business property coverage? Join Mike, Tim, and Alissha for the lightning round and discuss bikes, eBikes, sleds, boats, and more.   Notable Timestam...

This is a replay of an episode originally aired on Apr 22, 2025. An adjuster working on a complex property damage claim closes the file, having paid out on the claim. Then they receive a notice that the insured is demanding appraisal. They call up the insured, only to find out that the insured has no idea what's going on. About Our Guest Steven J. Badger, Partner, Zelle LLP sbadger@zellelaw.com ht...

This is a replay of an episode originally aired on Apr 15, 2025. A Texas adjuster gets an assignment for a simple hail damage claim. He anticipates having to argue with the roofing contractor, debate whether overhead and profit is owed, deal with the supplementing company, receive an appraisal demand, and finally face a lawsuit.   About Our Guest Steven J. Badger, Partner, Zelle LLP sbadger@zellel...

The insured's kitchen sink wasn't draining well. A plumber scoped the line and found tree roots blocking it. The only fix is to dig up and replace the pipe. The adjuster checked the HO3 (2011) exclusions but didn't find one specifically for tree roots. Do others apply? Notable Timestamps [ 00:45 ] – The adjuster checks the ISO HO3 (2011) policy but finds no explicit exclusion for damage caused by...

A wealthy couple is murdered after a glamorous party—jewelry stolen, town abuzz. Their estate files an HO3 claim for the stolen jewelry and loss in home value due to the stigma. But does the policy cover reputational "diminution in value"?   Notable Timestamps [ 00:37 ] - The scenario involves a wealthy couple poisoned in their mansion, with jewelry stolen and a claim submitted under their HO3 pol...

John, a self-employed trucker, injures himself fixing his rig "Betsy" (1st PIP claim). Later, he's hurt again when a mechanic's shuttle van crashes (2nd PIP claim). Two accidents, two PIP claims—one while working, one as a passenger—make for a rough day.   Notable Timestamps [ 00:17 ] - John has two injury claims in Michigan: a slip and fall while working on his truck (Injury 1) and being rearende...

A "FastFeast" driver ends their shift but forgets to log out of the app. On the way home, they crash—and their insurance denies the claim. Why? They were still "on the job." In the gig economy, one tap can mean the difference between coverage and denial.   Notable Timestamps [ 00:01 ] - The core scenario involves a driver for the delivery app FastFeast who had an accident on the way home after the...

Our insured, a widow with two adult kids, dies in a house fire. Her son, who planned to move out soon, escapes unharmed. Her daughter, who lives out of state but stores a drum set in the basement, is the executrix and returns home to handle next steps and insurance.   Notable Timestamps [ 01:00 ] - The son planned to move into his girlfriend's apartment by the end of the month [ 02:00 ] - The deat...

A windstorm-caused power outage at the Cheesecake Manufactory led to the spoilage of hundreds of cheesecakes and a business income loss. The adjuster is questioning if the windstorm deductible applies to the claim, despite the power outage being the direct cause of the spoilage.   Notable Timestamps [ 00:00 ] - The scenario presented involves a windstorm that caused a power outage, leading to spoi...

A windstorm knocks over a power line, causing hundreds of cheesecakes at a local restaurant to spoil. The owners have to close for a few days as they manufacture more. Their adjuster wants to know how to investigate the storm and power outage.   Notable Timestamps [ 00:20 ] - The loss of desserts is always tragic, even lemon merengue. [ 01:00 ] - Trivia: Which variety of cheesecake contains "quark...

A plumber drove the company truck the wrong way on a busy highway for some time before he realized, panicked, swerved, and flipped the truck. Police believe he was on illegal drugs, although he disputes it. His employer claims equipment damage under their BOP policy. Notable Timestamps [ 00:25 ] - The plumber (the business) is now making a claim under their businessowners policy, BP 00 03 07 13, f...

An adjuster working on a complex property damage claim closes the file, having paid out on the claim. Then they receive a notice that the insured is demanding appraisal. They call up the insured, only to find out that the insured has no idea what's going on. About Our Guest Steven J. Badger, Partner, Zelle LLP sbadger@zellelaw.com https://www.linkedin.com/in/steven-badger-467b0322/ Notable Timesta...

A Texas adjuster gets an assignment for a simple hail damage claim. He anticipates having to argue with the roofing contractor, debate whether overhead and profit is owed, deal with the supplementing company, receive an appraisal demand, and finally face a lawsuit.   About Our Guest Steven J. Badger, Partner, Zelle LLP sbadger@zellelaw.com https://www.linkedin.com/in/steven-badger-467b0322/   Nota...

Let's say you're a service provider in the insurance industry. You've been attending PLRB Conferences for a few years, and you're thinking about taking the next step to increase exposure and build relationships with the right people in the industry.    Notable Timestamps [ 01:20 ] - Exhibiting and sponsoring at the PLRB Claims Conference can be an impactful option, and PLRB has a variety of offeri...

In the middle of the night, a burglar broke into the policyholder's house. Nearby police arrived, and the suspect was apprehended. Debbie filed a claim for the police's bullet holes in her house and cleanup of heating oil spilled when a bullet hit the tank.   Notable Timestamps [ 00:15 ] - The bullet holes were all from police guns. 150 gallons of heating oil spilled in the basement. [ 01:40 ] - H...

Joining us next week? Enjoy this replay of our recent episode on the Claims Conference.   A supervisor is leading a small but mighty teams of adjusters, and they're taking their team to Indianapolis this spring for the 2025 PLRB Claims Conference. The only problem? They've never been before and have no idea where to start.   Notable Timestamps [ 00:15 ] - One more salute to our once and future hos...

Homeowner Lisa claims she was asleep when she woke up to smoke alarms blaring. She safely evacuated her home, but the fire destroyed her garage and spread to part of her home. The adjuster requests that Alex determine the fire's cause.   Notable Timestamps [ 00:15 ] - The scenario outlines a garage fire claim and a need to investigate the cause of the fire. [ 01:00 ] - When investigating a fire cl...

Homeowner Jane Thompson lived 20 miles from the large Badone wildfire. One week after the fire department fully contained the wildfire, Jane called Evergreen Mutual and reported a strong smoke odor throughout her home.    Notable Timestamps [ 00:20 ] - Jane also noticed discoloration on her walls and soot on her furniture. Jane was understandably concerned about her family's health and potential l...

Just before purchasing a policy, the insured subcontractor says "I need to provide something called a 'Certificate of Insurance' to my general contractor," and add them as an additional insured. What issues does this create from an underwriting or claims perspective?   Notable Timestamps [ 00:15 ] - The adjuster is giving him the Coverage A limits to rebuild the house. But he is also making a clai...

The insured signed up for a "retrospective rating plan." Under this plan, the insured promised to reimburse Unforgettable for its paid losses. The insurance company discovered invoices left unsent due to a computer programming error.   Notable Timestamps [ 00:15 ] - Total Surprise Transportation promised to reimburse Unforgettable Insurance for its paid losses, including "Allocated Loss Adjustment...

A concert attendee filed suit against a band's lead singer based on the singer's alleged "onslaught" of blows to the attendee's face, head, and body over a dispute. However, the singer's claimed that the confrontation only became violent when the attendee threw the first punch.  Notable Timestamps [ 00:25 ] - The singer tendered the suit to his insurer, who agreed to defend under a reservation of...

A restaurant was hosting a funeral lunch. During the lunch, a gunman entered and shot an individual who was not related to the funeral reception, but who was in eyeshot of lots of the patrons and children. The victim survived & the gunman fled.   Notable Timestamps [ 00:24 ] - The insured restaurant has a CGL policy and sought coverage after a group of the patrons filed a lawsuit against the resta...

The insured owns a house in Louisville, KY, near Churchill Downs. Every year, prior to the first Saturday in May, he rents his house out for two weeks. He secured a renter for $3,000. However, a week before the Derby, his home was destroyed in a fire.   Notable Timestamps [ 00:15 ] - The adjuster is giving him the Coverage A limits to rebuild the house. But he is also making a claim for Fair Renta...

A bank robber in a high speed chase from the police and smashed into a tree on the insured's premises. A large limb fell on power lines, and the insured's home sustained a power surge. The insured claims  electrical damage to his refrigerator, toaster, and TV.   Notable Timestamps [ 00:20 ] - The adjuster sees the insured had a standard ISO HO 00 03 05 11. Is there coverage for these household ite...