ADDENDUM: RECOVERY CASES OF INTEREST CLAIMS COMMITTEE MEETING MARCH 5, 2015 BOARD OF GOVERNORS MEETING MARCH 18, 2015

Transcription

1 QA Recovery Cases of Interest Fire Loss: This loss involved fire damage to an owner occupied dwelling. The loss occurred as a result of improper use of a torch by the plumber working in the home. We were able to recover $277, from the other insurance carrier for the plumber. Our GCA was $301, and we recovered 92%. Vehicle Loss: This loss involved vehicle damage to an owner occupied dwelling. The driver drove into the home causing damage. The automobile insurance carrier paid $2, We recovered 100% of GCA. Vehicle Loss: This loss involved a vehicle striking a second vehicle that ran into the owner occupied home. Through mediation we recovered $10,000 collectively from both drivers. We received 37% of the GCA. Fire Loss: This loss involved a fire loss to an owner occupied dwelling. The roofing contractor improperly used a torch on the roof and set roof system on fire. The roofer s insurance carrier paid $150,000. Our GCA was $160, and we recovered 94%. Fire Loss: This loss involved a fire loss to an owner occupied dwelling. The roofing contractor improperly used a torch on the neighboring roof and set roof system on fire. The fire spread causing damage to our insured s home. The roofer s insurance carrier paid $10,000. Our GCA was $13, and we recovered 76%. Vehicle Damage: This loss involved vehicle damage to a building owned by a condominium owner association. The auto insurance carrier paid $2, or 100% of GCA. Fire Loss: This loss involved fire damage to an owner occupied dwelling. The fire was caused by improper installation by the utility company. The utility company paid $6, Our GCA was $15, and we recovered 39%. Vehicle Damage: This loss involved vehicle damage to an owner occupied dwelling. The vehicle stuck our insured s vehicle and pushed it into the garage door. The auto insurance carrier paid $10, or 100% of GCA. Fire Loss: This loss involved fire damage to an owner occupied dwelling. The neighbor was using a burn barrel and the fire got out of control spreading to our insured's back yard and home. The other insurance carrier paid $13, Our GCA was $23, and we recovered 60%. Water Loss: This loss involved water damage to an owner occupied home. The water heater to unit upstairs failed causing water to seep through the floor damaging our insured s unit. The other insurance carrier paid $6, or 100% of GCA. Page 1 of 11

2 Fire Loss: This loss involved fire damage to an owner occupied dwelling. Our cause and origin expert found that a void was created in the chimney when repairs were made. The carrier for the company paid policy limits of $100,000. Our GCA was $168, and we recovered 59%. Water Loss: This loss involved water damage to an owner occupied home. The refrigerator water supply line was installed incorrectly causing water damage to the home. The installer paid $21, or 100% of GCA. Fire Loss: This loss involved fire damage to an owner occupied dwelling. The fire was caused by improper installation by the utility company. We recovered $48, or 100% of GCA. Vehicle Damage: This loss involves a moving truck containing personal property belonging to our policyholder. The truck crashed causing damage to the personal property. Based on the contract our policy holder has signed with the company we were able to recover $2, or 11% of GCA. Other: This loss involved structural damage to the laundry room of an owner occupied dwelling. The neighbor was having a swimming pool constructed, and the backhoe operator working next door, struck and damaged the laundry room with the bucket of the backhoe. The operator of the backhoe worked for the subcontractor for the pool GC. The subcontractor was working outside the coverage of his liability insurance and the GC s liability policy did not cover the negligence of subcontractors. We retained counsel for subrogation and settled with a 12% Recovery of $20,000, collected from both the subcontractor and the general contractor. Fire Loss: This loss involved fire and smoke damage to an owner occupied dwelling when a HVAC technician caught the wood truss on fire when using a torch to install an air handler in the attic. We settled with the carrier for the HVAC Company for $4,000, 16% of the GCA of $24, Fire Loss: This loss involved fire damage to property of owner occupied dwellings. The damage was the result of an issue with the utility company s overhead electrical service that hangs over the three sheds in the back yard corner where four property lines intersect. Citizens insured two of the properties. One was settled for $5,130.17, 24% of the $21, GCA. The second was settled for $4,516.23, 27% of the $16, GCA. Both settlements were with the utility company. Water Loss: This loss involves water damage to a seasonal owner occupied condominium. It was determined that the plumbing company had failed to properly terminate the old water supply lines inside the wall, which were being abandoned in favor of new supply lines. We settled with the plumbing company for $16,604.07, 99.9% of the $16, GCA. Water Loss: This loss involves water damage to a tenant occupied townhouse. The damage resulted when a screw head broke off between inner and outer tub of a less than Page 2 of 11

3 1-year old washing machine. The screw rubbed a hole in the outer tub allowing it to leak. We recovered $2,981.05, 50% of the $5, GCA from the appliance manufacturer. Vehicle Loss: This loss involves damage to an owner occupied dwelling from a cable TV overhead line dragging across the roof. A large delivery truck was driving down the street and it hooked the overhead line. We recovered $5,084.83, 91% of the $5, GCA from the carrier for the cable TV company. Water Loss: This loss involves water damage to an owner occupied dwelling, when the water supply line to a new refrigerator disconnected internally. We recovered $2,500, 16% of the $15, GCA from the appliance manufacturer. Water Loss: This loss involves water damage to an owner occupied condominium from a failed water heater in the unit above. We recovered 83% of the $1, GCA ($1,202.50) from the carrier insuring the unit above. Water Loss: This loss involves water damage to an owner occupied condominium from a failed toilet water supply line in the unit above. We recovered $24,163.77, 100% of the claim from the above unit owner s carrier. Fire Loss: This loss involves fire damage to an owner occupied dwelling when the hot tar kettle being used for roof repairs malfunctioned. The roofing company was unlicensed and uninsured. A salesman working as a subcontractor for a legitimate roofing company had borrowed some equipment and had presented the job as being done by the legitimate roofing company. The responsible person would not respond and was deemed uncollectable. However, the legitimate roofing company did settle for 50% of the $15, GCA ($7,700). Water Loss: This loss involved water damage to a tenant occupied condominium from the fire suppression sprinkler system in the unit above. The children of the tenant in the unit above started a fire which engaged the sprinklers. We recovered $2, or 9% of the GCA $23, Water Loss: This loss involved water damage to an owner occupied condominium from the failure of a faucet in the unit above. We recovered $11, or 87% of the GCA $13, Water Loss: This loss involved water damage to a tenant occupied condominium. The owners of the unit above left a portable washing machine connected and the faucet on. The hose popped off causing water damage to our insured s unit. Liability was accepted and we recovered 100% of the $17, GCA. Sink Hole: This collateral damage loss involves stabilization costs associated with a sinkhole claim. There was $1, of additional damage caused by the stabilization contractor. We recovered 100% from the contractor. Water Loss: This loss involves water damage to a tenant occupied condominium. The damage is the result of a leaky roof. We recovered $9, or 100% of the GCA. Page 3 of 11

4 Fire Loss: This loss involves fire damage to a tenant occupied dwelling. The tenants were in the process of moving in and had placed some items on the range, bumping the knob and turning on the right front burner. This was not noticed and a fire ensued. Liability was accepted and we recovered $25,000 or 61.4% of the GCA $40, Water Loss: This loss involves water damage to a seasonal, owner unoccupied condominium, from a failed toilet supply line in the unit above. We successfully recovered $10, or 48% of the GCA $22, Water Loss: This loss involves water damage to an owner occupied condominium when the unit above was repairing the sink. Unit above is also insured by Citizens and we recovered $2, or 100%. Water Loss: This loss involves water damage to an owner occupied condominium from the fire sprinklers of the unit above, which were activated by a kitchen fire. We recovered $3, or 89% of the GCA $4, Water Loss: This loss involves water damage to an owner occupied condominium from a toilet overflow from the unit above. We recovered $3,000 or 35% of the GCA $8, Vehicle Loss: This loss involved a vehicle striking our owner occupied home. We recovered $9, from the other insurance company which was 45% of the GCA. Water Loss: This loss involved water damage to an owner occupied dwelling. The insured s contractor failed to complete the installation correctly and the copper piping failed allowing water to escape and cause damage. The contractor s insurance carrier accepted liability and we recovered $21, which was 48% of the GCA. Vehicle Loss: This loss involved vehicle damage to a tenant occupied dwelling caused by a drunk driver losing control of their vehicle. We recovered $10, which was 36% of the GCA. Water Loss: This loss involved water damage to an owner occupied dwelling. The water filter was installed incorrectly by the insured s contractor allowing water to escape and cause damage. The contractor s insurance carrier accepted liability and we recovered $14, which was 100% of the GCA. Liability Loss: This loss involved bodily injury to guest staying in our insured s investment property. The property is managed by a property management company. The guest sustained a significant cut on his leg from the bed frame. The property management company s employee had cut the bed frame so it would be the same length as the new mattress. We pursued the property management company for their intentional tort and gross negligence. They accepted liability and we recovered $1, which was 100% of the funds that Citizens had paid under the Coverage E portion our insured s policy. Vehicle Loss: This loss involved vehicle damage to an owner occupied dwelling. The neighbor lost control of the rental car that he was driving. The rental car was self-insured Page 4 of 11

5 through a rental car company whose carrier accepted liability. We recovered $5, which was 66% of the GCA. Vehicle Loss: This loss involved vehicle damage to an owner occupied dwelling. Two vehicles were involved in an accident causing damage to our insured s property. The atfault driver did have insurance who accepted liability. We recovered $3, which was 63% of the GCA. Vehicle Loss: This loss involved vehicle damage to a commercial building. A road ranger truck was stolen and involved in a high speed police chase causing the stolen vehicle to crash into our insured s property causing damage. The driver was arrested and restitution was awarded by the courts. We recovered $16, which was 100% our GCA. Vehicle Loss: This loss involved vehicle damage to a tenant occupied dwelling. The tenant's elderly visitor accidentally pushed on the gas pedal instead of the brake which caused the vehicle to hit our insured s property. The at-fault driver s carrier accepted liability. We recovered $19, which was 93% of the GCA. Water Loss: This loss involved water damage to an owner occupied dwelling. The cause of loss was the failure of the kitchen faucet. It was determined that the faucet was defective and the manufacturer accepted liability. We recovered $24, which was 100% of the GCA. Water Loss: This loss involved water damage to an owner occupied dwelling. The damage was caused by an internal leak within the refrigerator. It was determined that the refrigerator water supply line was defective and the manufacturer accepted partial liability. We recovered $4, or 55% of the GCA $8, Vehicle Loss: This loss involved vehicle damage to an owner occupied dwelling. A driver lost control of their vehicle and caused damage to our insured's property. The at-fault driver s carrier accepted liability. This is a pro rata recovery as the other insurance carrier had $25,000 policy limits and there were 5 total claimants. We recovered our pro rata share of $4, which was 67% of the GCA $9, Water Loss: This loss involved water damage to an owner occupied dwelling. The upstairs unit owner was having a contractor replace the A/C within their unit when the contractor struck and broke off a sprinkler head allowing water to escape and leak down into our insured s unit below. The at-fault contractor s carrier accepted liability. We recovered $8, which was 88% of the GCA. Vehicle Loss: This loss involved vehicle damage to an owner occupied dwelling. A cement truck driving down the street snagged the power cables that run from the municipal power pole leading to the insured s electric service pole located in the yard of the risk. The power lines pulled the insured s electric service pole and snapped it at the base and damaged the meter, service panel and conduit. The at-fault driver s carrier accepted liability. We recovered $2, or 82% of the GCA $2, The insured was reimbursed her deductible by the other insurance carrier. Page 5 of 11

6 Water Loss: This loss involved water damage to an owner occupied dwelling. This loss occurred as a result of the failure of the master bath shower door due to a product defect. The manufacturer accepted liability. We recovered $3, which was 96% of the GCA. Vehicle Loss: This loss involved a vehicle striking our owner occupied manufactured home. We recovered $9, from the other insurance company who had a policy limit which was 55% of the GCA. Water Loss: This loss involved damages from contaminated water from backup in attached unit of two family dwelling to our insured s residence. We recovered $ through the other insurance company which is 0.03% of the GCA $16, There was a lack of negligence supports. Water Loss: This loss involved damages to owner occupied home originating from a water purifier that was installed incorrectly. We recovered $7, from the responsible party which was 44.4% of the GCA $16, Power Surge: This loss resulted from the utility company s power lines that blew causing power surge damage to the rental home. We recovered $4, which was 100% of the ACV and 97.4% of the GCA $5, Water Loss: This loss involved water damages from split PVC pipe to an owner occupied residence. We recovered $8, from the manufacturer of the pipe which is 49.9% of the GCA $16, Fire/Smoke Loss: This loss occurred as a result of a fire that originated in the unit below our insured s unit. The fire was intentionally initiated by other unit s teenage son. We recovered $1, which is 27.5% of the GCA $6, Fire/Smoke Loss: This loss occurred as a result of an intentionally set fire in another condominium unit that damaged our insured s unit. We recovered $1, or 29.7% of the GCA $6, Water Loss: This loss occurred as a result of contractor negligence when improperly connecting the new refrigerator. We recovered $14, or 86.8% of the GCA $16, Vehicle Loss: This loss occurred as a result of a negligent driver who struck our risk. We recovered $26, or 97.8% of the GCA $26, Fire/Smoke Loss: This loss resulted from the tenant s teenage daughter negligent cooking. We recovered $26, which is 81% of the GCA $32, Page 6 of 11

7 Vehicle Loss: This loss resulted from a negligent driver to our owner occupied risk. We recovered from the other carrier $3, or 97% of the GCA $3, Water Loss: This loss resulted from a water heater leak from another unit in the condominium building damaging our insured s unit. We recovered $ or % of the GCA $2, Water Loss: This loss resulted from a leak from a toilet tank in another unit in the condominium building that damaged our insured s unit. We recovered $ or 0.13% of the GCA $3, Contractor Negligence: Contractor using heavy equipment working next door to insured s home caused cracks to the exterior of the home. Contractor s insurance carrier denied liability. We filed Arbitration. Arbitrator determined a portion of the damage was caused by the contractor and awarded Citizens a partial recovery of $4, or 11% of the GCA $45, Vehicle Loss: Vehicle struck fascia of clubhouse lobby entrance. Settlement reached for $2, or 90% of GCA $2, Water Loss: Above unit owner had a clogged AC line which caused a backup and allowed water to run into our insured s unit below. Unit owner agreed to accept liability. Settlement reached for $2, or 100% of GCA. Water Loss: Above unit owner had water leak that entered insured s unit causing water damage. Settled claim for $6, or 90% of GCA $6, Water Loss: Water supply line connected to toilet failed. Expert inspection of evidence concluded failure was due to normal wear and tear from normal water pressure and chloride stress. Evidence sent to manufacturer for testing and liability was accepted. We recovered $ , 44% of GCA. Water Loss: Kitchen faucet failed causing water damage to insured s residence. Evidence collected and sent to expert for testing. The cause of the failure was confirmed to be manufacturer defect due materials used in construction allowing chloride corrosion. Manufacturer accepted full liability. Settlement reached at $11, or 95% of GCA $11, Water Loss: Insured s condo unit received water damage after hot water heater in above unit failed causing water to leak into insured s unit. Claim submitted to carrier for unit owner. We recovered $2, or 50% of GCA $5, Vehicle Loss: Excluded driver of vehicle had seizure while driving. Lost control and struck insured s rental property causing damage. Tenant living in property also had damage to personal property. Carrier for the vehicle owner offered $10, limits because of Page 7 of 11

8 excluded driver. Agreed accept pro-rata share and allow carrier to pay insured full deductible and full out of pocket.. Recovered of $2, or 20% of GCA $25, Water Loss: Water damage to insured s condo unit after water intrusion from a broken AC line from the above unit. Investigation determined AC line was damaged by AC Repair Company. Carrier accepted liability. Settled claim for $ , 81% of GCA $ Water Loss: Water damage to insured s condo unit due to water intrusion after building. Sprinkler system was accidently turned on by AC Company doing repairs in building. Carrier for AC Company accepted liability. Settlement reached for $ , 95% of GCA $4, Water Loss: Drain hose connected to dishwasher failed causing water damage to insured residence. It was initially determined that the failure was due to improper installation. The evidence was collected and sent to the installer for inspection. The installer claimed the failure was due to manufacture defect and not install issue. After denial, evidence was then sent to expert who concluded failure to be a combination of manufacturer defect and improper installation, but the majority of the failure was due to manufacturer defect. Subrogation was pursued against the installer only for 50% of the claim. Settled claim for $ , 31% of GCA $6, Water Loss: Dishwasher malfunctioned causing water to leak out and damage insured s property. The cause of the malfunction was determined to be from a defective control valve. Manufacturer accepted liability. Claim settled for $8, or 85% of GCA $10, Water Loss: Water line to upstairs toilet failed causing water damage. Water line tested for defect and expert concluded design and construction of supply line led to failure. Supply line manufacturer is based in China. Pursuit of subrogation would not be cost effective. Settled claim for $ , 39% of GCA of $19, Vehicle Loss: Driver lost control of vehicle and drove into insured s yard striking gate and front porch. Carrier for driver accepted full liability. Settlement reached for $7,269.90, 97% of GCA of $7, Water Loss: Water intrusion into insured s unit from adjacent unit that was vacant and experienced a water leak. The insurance carrier for the unit owner agreed to accept full liability. Settlement reached for $ , 99% of GCA of $ Vehicle Damage: This loss involves damage to the tenant occupied risk due to an accident involving two vehicles; one or both vehicles hit the risk as a result of the accident. We recovered $4, or 51.30% of GCA $9, Water Loss: This loss involves water damage to owner occupied dwelling. The apartment on the 5th floor had water damage which caused damage to the fourth floor which in turn Page 8 of 11

9 caused damage to our insured s apartment. We recovered $6, or 59.75% of GCA $11, reported to be water filter leak under kitchen sink in above unit that caused water damage to six floors below. We recovered $8, or 84% of ACV of GCA $9, reported to be overflow of the toilet tank through the flush handle hole in the unit above the Insured. We recovered $2, or 100% of GCA $2, Other Damage: This loss involves other damage to owner occupied dwelling. The reported COL is an employee operating a backhoe for The City of Clearwater, lost control and damaged the garage and caused damage to the wall. We recovered $5, or 100% ACV of GCA $7, ($2, deductible which was sent directly to PH by City of Clearwater). Water Loss: This loss involves water damage to rental dwelling. The COL is reported to be water leak from the unit above our insured. We recovered $4, or 100% of ACV GCA. Water Loss: This loss involves water damage to owner occupied dwelling. Water damaged was incurred from the above unit. We recovered $5, or 100% of GCA $6, Insured was reimbursed $1, deductible from other carrier. Vehicle Damage: This loss involves vehicle damage to owner occupied dwelling. A vehicle crashed through the rear of the risk damaging the exterior wall and bedroom. We recovered $10, or 93.05% of GCA $10, reported to be Plumbing / Condensate Line / Water Leak second floor HVAC closet. The HVAC service company technician was performing maintenance on the HVAC system and didn t connect the condensation drain line back to the unit properly. We recovered $11, or 71% of GCA $16, reported to be water damage from failure of plastic elbow on 5 month old refrigerator. We recovered $3, or 63.6% of ACV GCA. reported to be water leak from above condo unit which is vacant and caused water damage to insured s kitchen ceiling. We recovered $1, or 100% of GCA. Vehicle Loss: Drunk driver drove through stop sign hit another car, they went through the 6ft chain link fence, one car landed in front of the porch damaging a column and the other car landed on the side of the house and put a small hole in the exterior wall. We recovered $2, or 100% of GCA. Page 9 of 11

10 reported to be water damage from the washer machine hose in the unit above the risk. We recovered $12,424.75, 100% of ACV GCA $13, Water Loss: This loss involved water damage to dwelling. The COL is reported to be a failed water heater connector. We recovered $1,000 or 25% of GCA $3, Theft Loss: This loss involved theft of property from the insured s risk. Police captured the responsible party. The court ordered restitution in the amount of $3,900 or 100% of the GCA. Insurance Fraud: These losses involved fraud committed by the same Public Adjuster with multiple insured parties. The Public Adjuster and the insured were convicted. We received $ this quarter. Total Restitution awarded from the courts is $51, Vehicle Loss: This loss involved damage to a building caused by a driver losing control of their vehicle and causing damage to our insured s property. The driver s carrier accepted the liability and reimbursed each insured a pro-rated amount. We recovered $1, or 65% of the GCA. Legal Expense Cost Recoveries costs in the amount of $ We recovered the full amount. costs in the amount of $118, Through bankruptcy proceedings for the responsible party we were able to recover $6,000. We recovered 5% of judgment amount. costs in the amount of $5,250. We recovered the full amount. costs in the amount of $210. We recovered the full amount. costs in the amount of $5,500. We recovered the full amount. costs in the amount of $ We recovered the full amount. Legal Expense Recovery: This loss involved 2 installments for a judgment awarded to Citizens for fees and costs in the amount of $50,000. $4, was received this month. Additional payments due. Page 10 of 11

11 Legal Expense Recovery: This loss involves the first installment for a judgment awarded to Citizens for fees and costs in the amount of $135,000. First installment received was for $2, Page 11 of 11