“The Independent Adjuster and the Oil Spill; Opportunity or a Trap” Guest Blog by CPLIC Risk Management- Errors and Ommissions Coverage for Adjusting Firms and Adjusters

June 22, 2010

Each year since founding ClaimSmentor, I have turned to CPLIC  for advice to share with our members on Errors and Omissions coverage for independent adjusters. We consider ourselves very fortunate to have members of this firm participate on our site. This year is especially important due to the added complications we may be facing this hurricane season with the oil in the gulf coast. I cannot thank them enough for their support providing this information for our members and all of you in the independent adjusting community. Their specialty is dealing only with Errors and Omissions (known as E & O ) coverage for the claims industry.

The following statement to their members is reprinted with permission from the Claim Professionals Liability Insurance Co., a Risk Retention Group created by independent adjusters for the risk management of independent adjusting companies.  See WWW.CPLIC.NET for more details:

Urgent Message from

CPLIC Risk Managment Concerning Oil Spill in Gulf Coast.

The Independent Adjuster and the Oil Spill;

Opportunity or a Trap?

The June 14 edition of the Wall Street Journal ran a full page ad on page A18, the back page of the first section. It outlined how BP wants claimants to file a claim, and their claims philosophy.

This is prior to the meeting at the White House, in which BP put $20 billion into the hands of an independent commission. How that will affect the present operation BP is now running we do not know.

All of us want more work, and we all, probably, would be willing to be involved in this claim settling process. But there are some pitfalls.

At CPLIC, we have analyzed the situation, and would like to offer some insights, suggestions, and comments. Remember, this is all prior to the White House meeting.

The Present Situation

Our understanding is that Worley has been engaged to handle claims on behalf of BP. Crawford & Co. represents Transocean. We are not aware of how the work is being spread between the two, or if it is only BP/Worley that is processing claims at this time.

How the $20 billion fund, now in play, will be handled is anybody’s guess. However, this could mean some opportunity for independents.

Geographical Areas

Obviously, the area covered is the Gulf Coast from Louisiana around to Florida. Considering the number of claims that are going to come out of this spill, you probably do not need to be in that area to be involved.

If you are in that area, here?s a word of caution. Forecasters predict this to be the most active hurricane season since 2005, and the Gulf Coast could very well be affected. If you get a chance to be involved in the BP claims, please be judicious in resources you commit to BP. Remember that a hurricane will also stretch you, and that you have regular clients who depend on you. These situations always stretch and challenge us, but do not get so overloaded that things get out of control. When this happens, the chance of E&O claims goes up. Using resources wisely protects your deductible.

Type of Claims

At first blush, you would think these claims would be third party claims, and so they are. However, determining liability will not be the issue. Damages will be the issue.

Many of these third party claims will handle just like business interruption claims. Make sure you use adjusters knowledgeable in this area. You may also encounter some hull claims, as well as other kinds of property damage claims.

There may not be many first party claims. The pollution exclusion may see to that. There also may be trigger problems. One of our members thinks that fire or explosion may be the trigger. In the end, this may be a decision for a court.

If the claims are first party, you will be working for a carrier, not BP. If there are questions of coverage, do not forget to take a non-waiver, or a reservation of rights. Those cases where you should have reserved rights, and did not, are hard cases to defend. If you are not sure, talk to your principal. If you are still not sure, or cannot get an answer from your principal, reserve your rights anyway. It is better to be safe than sorry.

If there is coverage in your claim, subrogation will be in order. This leads to a potential trap.

The Trap

If you find your regular client base sending you work that leaves you subrogating against BP, and you are taking BP cases in addition, you may find yourself in a conflict of interest situation. Be very judicious in the work you accept.

For those of you doing work for governmental entities in the Gulf area, be especially careful, particularly if your client has a shoreline. They may have cleanup costs, and ask you to handle their subrogation. Certainly, BP will be the target. You may run afoul of Public Adjuster laws.

CPLIC can offer no hard and fast rule here. Be judicious, use good judgment, and err on the side of caution.

What To Do At The Beginning

Even if you take every precaution, you will be sued. We are dealing with a highly politically charged situation. The plaintiff’s bar will be running ads soliciting clients. We will draw some suits. How do we protect ourselves?

This is the situation our insureds and CPLIC faced after Ike/Rita. First remember this is an agency situation. We all understand the principle of agency. In any contracts you sign with clients in association with this (or, if possible, any) work, make sure there is a clause under which the principal agrees to defend and indemnify you, absent a specific count of negligence against you.

This is a partnership here. Make sure your client understands this. Your client wants you on his side when the yelling starts. Do not give the plaintiff?s lawyer the opportunity to separate you. Even if there is a specific count against you, your principal may still defend you, depending upon the allegation.

Make sure you have your lawyer look at the hold harmless agreement in this light. If you need help in this area, contact us.

Closing Comments

What is written above may sound scary. It is not intended to scare. It is intended to make us wise about the opportunities out there, and to prepare us to meet them. It comes out of CPLIC’s six years of experience defending you. And there are opportunities, hopefully for many of us.

As you go forward, let us know of problems you encounter in following our suggestions. If you think we are off base, or missed something, let us know. It will help us serve you better.

K. M. Johns III CPCU, ARM AIM

Risk Management Committee Chair

Major contributors to this article were:

Alan Mayfield & Bruce Mountjoy

All Rights Reserved

© CPLIC 2010

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Please view their Q & A they did for us in 2009 here. Most importantly note the recommendation that independent adjusters have their own E & O policy for their own protection:

CPLIC 2nd E & O Info

Here is also a link to our first guest in August 2008  blog post by Dale Moore and Michael Hale of CPLIC with additional FAQ:

https://dimechimes.wordpress.com/2008/02/08/errors-and-omissions-coverage-guest-bloggers-dale-moore-client-relations-director-for-cplic/

During my 50 Hour Fundamentals of Claims class, we cover Error and Omission Coverage with new adjusters. I am constantly amazed at their answers to questions on adjusters E & O coverage. Most state that they would rely on the coverage of an adjusting firm to protect them. When I question them further, it is interesting to see that I have never had one adjuster be able to tell me who the adjusting firm’s E & O policy is with, what the policy number is, how to contact the E & O carrier, what the E & O policy covers them for, if the E & O policy provides for defense costs for them if they are named individually in a lawsuit. In other words,  they are working without even knowing about their coverage.

In recent years, many carriers, especially state run insurers like Texas Windpool and Citizens Property of Insurance in their RFP 08-0016 had terms stating they did not protect adjusting firms or independent adjusters so they were basically out on their own as far as providing an Answer to a Complaint (lawsuit) which is a costly proposition. I especially disagree with this position as the majority of claims litigation issues post hurricanes Katrina and Ike involved disputes insurance consumers had due to insurance company coverage decisions on wind/ water issues, wind debris to shingle issues, and other coverage or carrier guidelines an independent adjuster is required to follow.  It is long past due that  insurers,  the government,  and now BP and the Ken Feinburg group administering the BP Escrow fund  grant independent adjusting firms  and independent adjusters a  fair and meaningful defense and indemnity agreement.

This guest blog is a great example of what ClaimSmentor is all about. It is not about what I think as a former staff adjuster and claims manager nor about my experience as a participant in the independent claims industry. It is all about bringing together a professional group of reputable resources to provide proper advice and information to the independent claims adjusting community who have a most difficult time gathering current industry information applicable to claims assignments and catastrophe operations except when they are out on assignment.

I urge anyone who does not have their own E & O policy to run not walk to CPLIC to address your questions and check on your own E & O coverage.

Thanks again from ClaimSmentor to CPLIC for allowing us permission to share their 2010 Urgent message with our members.

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Errors and Omissions Coverage- Guest Bloggers- Dale Moore and Michael Hale for CPLIC

February 8, 2008

We’d like to thank Dale Moore, Client Relations Director and Michael Hale, President of CPLIC at www.cplic.net for providing answers to initial E & O questions posed by members at ClaimSmentor which we share with our blog readers as well today. Please feel free to pose additional questions in reply to this blog posting and we’ll get Dale to answer them in reply to this guest blog entry!

1)    Question:  Is Errors and Omissions (E & O) occurrence based?  Does it only cover what happens during the policy period?

Answer:  A few companies do offer E & O on an occurrence form but most professional liability insurance, of which E & O is a part, is written on a claims made basis and has been since around 1985.  On a claims made policy you can purchase retrospective coverage back for as long as you have been continuously insured.  Since this cost money you should look at the statue of limitations where you do your work and buy what you need.  Then as long as the inspection that you made or the event occurs that brings about a claim is within the retrospective period and you report to your carrier as soon as the claim is made against you, coverage at the time of your report would apply.

 2)    Question:  How long should the policy be kept in effect to cover one?

Answer:  The coverage should be in effect when you first start handling claims and should remain in effect by annual renewals until you retire or leave the business.  Most companies will offer you a one, two or three year extended reporting period after you cease handling claims for any reason which will apply to any claims brought against you during that time as long as the error occurred before you elected to start that extension. 

3)    Question:  What are the normal limits of Liability?

Answer:  Most companies offer limits from $500,000 to $5,000,000.  Most adjusters buy limits that are required by their clients as they do not have those size assets to protect. 

4)    Question:  What are minimum and maximum limits?

Answer:  A few companies will insure you for limits lower than $500,000, say $100,000 or $250,000 but not many above $5,000,000.  To obtain limits above you would buy an excess policy. 

5)    Question:  Do the different states regulate E & O?

Answer:  If you insure with a traditional insurance company that is admitted in the state that you do business then your state would regulate that insurance company.  Increasingly, adjusters are choosing to belong to and be insured by the only Risk Retention Group specifically created for adjusters. As a Risk Retention Group it is regulated by the state of domicile and registered in all other states. 

6)    Question:  What are the policies for Florida?

Answer:  Many of the traditional insurance companies would use the ISO forms to support their policies.  Some of the surplus lines companies may use some type of manuscript.  Claim Professionals Liability Insurance Company, RRG uses a manuscript policy written specifically for independent claim professionals and it may be viewed at www.cplic.net by clicking on the bar for policy.

 7)    Question:  If I already have E & O and work a storm for a company that offers E & O, what happens then?

Answer:  Your E & O is to protect you.  The company you are working for may also have a program that will protect you but you will have to see and read their actual policy to be sure.  However, their policy would not normally protect you from claims brought by them against you.  You are always better protected to have coverage specifically in your name.

 8)    Question:  Are attorney fees and court costs covered by E & O?

Answer:  A primary policy would cover defense costs if the claim against you is covered.  Defense costs would include both.

 9)    Question:  Are costs to travel to a different jurisdiction for depositions or court appearances covered?

Answer:  When your insurance company instructs you to travel that cost is generally covered; however, your lost income is not generally covered.  You will have to look at the specific language to be sure.  

10)    Question:  Is E & O higher when you are new and does it go down with experience?     

Answer:  The basis for charging for the coverage is generally the revenue you produce.  Therefore, your premium will generally increase as you become more productive.

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Note that we also think this article  from Sept 2007 which includes quotes by another CPLIC representative to be excellent info on E and O as well over at the Roughnotes.com site:

http://www.roughnotes.com/imp_cybercast/Archives/v004_September2007/index.htm

Direct contact information for Dale if you are more comfortable directly contacting them is: 

 

Dale Moore, CIC
Director Client Services
CPLIC, RRG & Carter Claims
17742 Irvine Blvd., Ste 102
Tustin, CA 92780
Tel: 877-572-7542
Fax: 714-731-4605
www.cplic.net
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CPLIC is endorsed by both the National Assn of Independent Insurance Adjusters (NAIIA) and the National Assn of Catastrophe Adjusters (NACA) based on information on both of their websites.
There is also informative information found on the Claim Professional Liability Insurance Company (CPLIC) website.
Here is also a link to their E & O survey application form found on their website.
http://www.cplic.net/Short_App.pdf
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Again, feel free to post your additional questions on E & O by replying below or in the ongoing topic at ClaimSmentor for replies by CPLIC. We’ll be sure to get the links to your additional questions to them for a response.
I’ll start off the first additional questions I’ve recently received below:
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1) What should an adjuster ask the adjusting firm for IF they are going to use their E & O carrier for coverage? At minimum, I would think they should get the carrier appropriate information such as policy number and limits and contact information. How about the coverage forms? Do you know if this is normally supplied by the Adjusting firms?
2) You mentioned the limits available. What do you recommend as a minimum for adjusters?
3) Is it hard for a new adjuster to be approved with no experience for E & O coverage?
4) What are some of the common reasons for claims…i.e..mistakes of adjusters/adjusting firms that bring forth claims under their policies?
5) Do attorney fees/ court costs mentioned in your Q & A reduce the E & O limits to pay a claim?
6) What are common exclusions on an E & O policy and typical reasons besides non payment for cancellation of an E & O policy?
7) Do needs differ for catastrophe adjusters who travel nationwide vs a daily adjuster working claims in a fixed territory?
8) Given the large number of adjusters named in lawsuits after Katrina, have you seen a large increase in E & O claims since 05 creating a need for higher limits and a definite higher priority that adjusters carry their own individual E & O policy?
9) If an adjuster does carry their own E & O policy and they are covered on an adjusting firms E &O, what is a typical “other” insurance clause as to which policy would be primary?
10) Should an adjuster work claims for multiple adjusting firms, would that change their coverage needs?
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Stayed tuned for E & O Part II when we get responses to the 10 new questions we’ve received!