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Subrogation Packet Claims Adjustment Specialists

Subrogation Packet Claims Adjustment Specialists. Introduction. Erin C. Callahan Washington University in St. Louis SMU Law School Worked in the private equity industry for 8 years I have been with CAS for a year and a half . Back Ground of Subrogation .

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Subrogation Packet Claims Adjustment Specialists

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  1. Subrogation Packet Claims Adjustment Specialists

  2. Introduction • Erin C. Callahan • Washington University in St. Louis • SMU Law School • Worked in the private equity industry for 8 years • I have been with CAS for a year and a half Back Ground of Subrogation • The concept dates back to Roman Law • The origin of the word means substitution – meaning the substitution of the insurer for the insured. • Subrogation as a doctrine was transferred from England over to this county. It has always been accepted here. • Cases in the late 1800’s contain descriptions of subrogation • It’s not a new concept

  3. What is Subrogation ? • Subrogation from an Insurance Perspective – Recouping expenses for a claim the insurance company paid, when another party should have been responsible for paying at least a portion of the claim. • Subrogation from a Legal Perspective– The substitution of one person in the place of another with reference to a lawful claim, demand, or right, so that he or she who is substituted succeeds to the rights of the other in relation to the debt or claim, and their rights or remedies. • Why is this important to know? • If we are stepping into the shoes of another, we need to know as much information as possible about the claim and claimant in order to succeed.

  4. The Big Picture • Step 1. The claims adjuster documents the subrogation potential, identifying all parties that may be involved, and makes sure all the investigations and documentation are obtained. • Step 2. CAS subrogation department reviews all incoming files for subrogation potential • Step 3. CAS subrogation department works with the adjuster to identify additional investigatory needs -collaboration is essential. • Step 4. The CAS subrogation department then notifies all potentially responsible parties in writing. • Step 5. Then CAS subrogation department might have to refer cases to experts for issues relating to the cause and origin of the incident, engineering, construction practices and codes or other specialized areas of investigation.

  5. Step 6 & Step 7 • Step 6. Claims with large potential for recovery may also be referred to an attorney. • Step 7. While the claims adjuster is responsible for handling and reserving all active files, CAS subrogation department manages any collection and recovery matters. • The adjuster turns the case over to the subrogation department after all claims activities, are concluded. CAS subrogation department will keep the case active until recovery is made or all avenues, including litigation, are exhausted.

  6. Identification of Subrogation • What is the cause of loss? • This does not mean "roof leak" or "plumbing leak" - we need more information • We need information on WHAT caused the roof leak or plumbing leak how did it occur. • Be specific - this is when you need to address Who? What? When? Where? and Why? • Identify possible responsible parties - think outside of the box! • Ex: owner/driver of vehicle, contractor, product manufacturer, tenant, builder, service providers (utility company, etc.), recent repairmen, winterization company • In identifying possible responsible parties, consider these possible theories of liability: • Product failure, Improper installation, Construction defect, Negligence, Government involvement

  7. Documentation of Subrogation • If the loss was caused by a product or appliance, try to obtain any documentation possible. • If the borrower may has any user manuals, warranties, or receipts of purchase • If the loss involves any product or part that had to be installed, try to obtain the product. • Receipts for the installation, or at the very least, the name and contact info for the person, or company that completed the installation • If the loss involves a risk that is less than 10 years old, try to obtain contractor information. • If the loss involves a tenant, try to obtain a copy of any lease agreements and find out whether the tenant has any insurance coverage of his or her own such as renter’s insurance. • If there has been any recent repair work, try to obtain a copy of any receipts or invoices. • WHEN IN DOUBT PRESERVE IT!

  8. Evidence • Identify what product caused the loss this includes collecting information regarding the brand, make, model, serial number, manufacturer, and/or installer of the product or part. • Photograph the product and surrounding area extensively • Always include a photo of the data plate that can be clearly read • Take an ample amount of photos from every angle • For claims involving wind/hail damage to roofs or roof leaks - clearly photograph the roofing materials and how they are installed or nailed so that the subrogation department can review the claim for subrogation potential due to improper installation • Gather and secure any evidence that needs to be examined further or any product that is the cause of the loss • If the product or part can be easily removed, gather and send via DPI kit • If the product or part is too large to be easily moved, contact the subrogation department and we can schedule for that part to be picked up by DPI. • In this case, always make sure that the borrower securely stores the evidence until pickup can be arranged.

  9. Subrogation Worksheet- Product Claim #: __________ Insured: ____________ Field Adjuster: ____________ Date: __/__/___ Make: _________________ Model #: ___________________ Serial # ________________ Was the product purchased: New ( ) Used ( ). Is original receipt available: Yes ( ) No ( ) Where was product purchased: _________________________________Age: ________________ Is the product under warranty: Yes ( ) No ( ). Warranty/Manual available: Yes ( ) No ( ) Any prior issues with product: Yes ( ) No ( ). If yes, describe: _______________________________ Has the product ever been serviced: Yes ( ) No ( ). If yes, by whom: __________________________ Location of evidence: ________________________________________________________ If evidence is a larger item, please inform insured to securely store item. Then, notify Hope Zimlich immediately to arrange for pick-up and delivery to DPI. If mailing in evidence, notify Hope Zimlich, then complete the DPI Claim Form and mail both the form and the evidence combined to:  To: DPI, LLC 1059 East Tri County Blvd. Oliver Springs, TN 37840 865-482-8480

  10. Date: __/__/___ Claim #: _______________ Insured: _________________ Field Adjuster: ______________ Contractor/Installer/Builder name: _________________________ Phone #: ________________ Address: ________________________ City: _______________ State: _______ Zip: ________ Description of workmanship defect: ________________________________________________ ____________________________________________________________________________ When was work completed: ________________ Homeowner warranty: Yes ( ) No ( ) Is insured the original owner: Yes ( ) No ( ). If not, how long has insured owned: ___________ Copy of original contract/work order available: Yes ( ) No ( ). If yes, submit copy with claim file. Who hired contractor/builder/installer: ______________________________________________ What were they hired to do: __________________________________________________ Date contractor completed work: ____/ _____/ _____ Expert recommendation: Yes ( ) No ( ). If expert recommended, please notify the claim handler with Proctor or Great American immediately. SUBROGATION WORKSHEET – WORKMANSHIP

  11. C&O Recommendations 1. For fire losses, if the home was occupied at the time of loss, see O and C questionnaire. 2. If the risk was vacant at the time of loss, C&O recommendations will be applicable on a claim-by-claim basis based on the suspected cause and circumstances surrounding the fire 3. If unsure about whether to recommend a C&O or not--recommend it!! It is much more difficult to seek approval for a C&O later if it was not recommended in your report.

  12. Applications and Examples

  13. Roofing

  14. Plumbing • The rise in water-related losses is due to multiple causes. • New homes have more bathrooms • Icemakers, water filter systems, soft water systems, fire sprinklers, and wet bars ect. • Some pipes are made of plastic vs. metal. The plastics used are often cheap, lightweight, and readily manufactured. The red arrow points to pin holes in the pipe wall. Notice the crushed pipe wall which is much thinner than normal (blue arrow). 

  15. Water Heater Supply Failures • Stainless steel braided water heater supply lines contain an inherent design defect. Over time, during ordinary use the rubber tubing is exposed to metallic ions. The metallic ions may be coming from the brass coupling assemblies. Low concentrations of chlorinated typically found in treated drinking water, combine with the elevated temperatures produced by the hot water unit, cause metal ions to be released from the brass stem insert as water travels through the tubing. These foreseeable environmental conditions are hazardous to the tubing material because EPDN rubber degrades in the presence of metallic ions in a mild chlorinated aqueous solution i.e tap water

  16. What to do with a Toilette Leak • Please determine whether the toilet overflowed from the bowl or the tank. • An overflow from the bowl indicates a clogged toilet. • A tank overflow signifies a malfunctioning valve, the tank itself or the improper sizing of the tank overflow drain. • Next, photographic documentation is crucial. • Please take photos!!! Take several of the toilet in place including several of the condition of the guts in the tank. • If it’s a large enough of a loss we may need to ship the toilette to be inspected. Please don’t take anything apart!

  17. Fire and Vehicle Losses

  18. Data Plates

  19. What not to say • Blank • “NO” • “Act of God”/ “Mother Nature” • Weather related loss without a qualification. • Instead say “Damage caused by wind. Roof is 22 years old. No subrogation.” • Give a theft answer for a plumbing claim. “There is no subrogation potential involved as the persons involved in the theft and vandalism have not yet been apprehended by local authorities.” • “No third party liability” • Don’t cut and paste

  20. Resources General Resources • http://www.efiglobal.com/ • http://www.subrogationrecoverylawblog.com/ • http://www.dpi-inc.com/ • http://www.fastwaterheater.com/waterheatermodels.asp

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