PCOC - Summer 2019 - 17

INSURANCE

Believe It or Not!

I Can't Believe this Really Happened!

By Paul Lindsay, SVP
PCOC Insurance Program
EPIC Insurance Brokers

I

I am sure you can imagine insurance
claims adjusters see and hear some
strange things. Look at the diverse nature
of your clients, the questions and complaints you must field. Then mix in imagination, insanity, lies, greed, and (here's the
big one!) plaintiff attorneys. Shake it all up
and you get...CHAOS! Compound this
with the reality of each adjuster handling
some 110 to 130 open claims at any given
time, you can see the opportunity to see
strange things. Thus when things get this
strange my team and I move in to help.
In my last article "1, 2, 3, Blast Off"
(I should have written "3, 2, 1, Blast-off!")
I promised to entice you with examples of
unusual claims that have come our way
over the past 30 years. These examples
are told at times with some humor and
the obligatory change of names and exact
events to protect reputation and the innocent, etc. etc. However, there are valuable
lessons contained within each story.

I CAN'T BELIEVE THIS REALLY
HAPPENED!
It's Time for Dinner - The homeowner was very proud of her recently

purchased $2.5 million dollar villa
overlooking the ocean. The only dark
spot was the delay in closing due
to the discovery of drywoods in the
attic. However, the fume company
came out quickly, tented and fumed
the home without causing one iota of
property damage. A housewarming
party ensued.
As I recall, 20 guests were on their
third bottle of wine when something
plunked into a wine glass. Then, another.
Then one further down the table. Soon
there was the melodic pattering sound
of objects hitting the table and people surrounding it. Yes, you guessed
it, a weakened beam had chosen the
celebratory moment to partially break
through the ceiling and cascade its
parasitic friends on the party below.
Just think of the mayhem this caused!
The irate homeowner rang every
number she could find: 911, the HOA,
regulatory agencies, her attorney and
then, eventually, the PCO. The claims
adjusters learned about it from a
multi-million demand.
Result: The PCO and adjuster immediately calmed things down and alleviated the homeowner's stress by housing
her elsewhere and covering reasonable
expenses. Working with the homeowner
and PCO, the adjuster whittled the settlement down to the actual property
damage, time for loss of use, reasonable
incidentals, and three bottles of wine.
(Just kidding about the wine!)
I Thought You Should Know -
The father stumbled into the emergency room manifesting dizziness,
flu-like systems and pallid skin color.
He stammered that his home had just
been treated for cockroaches and fleas.
Several hours later, his anxious family
picked him up with doctor's instructions

to gather overnight needs and VACATE
THE HOME IMMEDIATELY.
Once again a cacophony of alarms
were sounded and a claim for bodily
injury due to multiple chemical sensitivity
(MCS) arrived. The demand? Hundreds of
thousands of dollars due to trauma, pain
and suffering, and living expenses. Oh,
plus a new house with all the furnishings.
Now, the more irrational and exaggerated the claimant becomes, the more
suspicious the claims adjuster becomes.
So, while taking care of the immediate
issues to lessen the impact of the alleged
exposure and make sure immediate
needs were taken care of, we began
investigating the merits of the case.
The blood test of the claimant showed
pesticide contamination. Residence
air and swab sampling showed pesticides beyond what was disclosed on
the SPCB statute 8538, rule 1970.4,
Pesticide Disclosure form. It was damning evidence. However, based upon
some conflicting data (e.g. only one
section of the home showed multiple
pesticides) and the ugly harassment
of the adjuster by the claimant, we got
approval to take it to trial.
There on the proverbial courthouse
steps, just before the court convened,
one of the claimant's teenage children
sheepishly approached our defense
counsel and stated "I thought you should
know that my father bought a bunch of
pesticides and sprayed himself all over."
Result: The lawsuit was immediately
dropped and the claimant was prosecuted for felony insurance fraud. I
admit gloating about the outcome for
a long time!
How Many People Does it Take
to Drive a Ford Fiesta? - The route
tech swore he looked down for just a
second when the car in front slammed
SUMMER 2019 | THE VOICE

17



PCOC - Summer 2019

Table of Contents for the Digital Edition of PCOC - Summer 2019

EVP Message
Presidential Profile Incoming PCOC President Mike McKenzie Says the New Role Isn’t About Him, but About the Industry.
NPMA Federal Update The Latest in Legislation Affecting PCOs Around the Nation
Two Prerequisites to Managing Small Business Growth If You’re Planning to Grow Your Small Business, Here are Some Key Considerations to Help You Succeed.
State Capitol Report Change is Here A New Governor and Majority Democratic Legislature Has Altered the Foundation Upon Which PCOC Built its Success Over the Past Years.
Insurance Believe It or Not! I Can’t Believe this Really Happened!
Firm Profile Thrasher Termite & Pest Control: A Family Affair
Index to Advertisers
PCOC - Summer 2019 - Intro
PCOC - Summer 2019 - cover1
PCOC - Summer 2019 - cover2
PCOC - Summer 2019 - 3
PCOC - Summer 2019 - 4
PCOC - Summer 2019 - 5
PCOC - Summer 2019 - 6
PCOC - Summer 2019 - EVP Message
PCOC - Summer 2019 - Presidential Profile Incoming PCOC President Mike McKenzie Says the New Role Isn’t About Him, but About the Industry.
PCOC - Summer 2019 - 9
PCOC - Summer 2019 - NPMA Federal Update The Latest in Legislation Affecting PCOs Around the Nation
PCOC - Summer 2019 - 11
PCOC - Summer 2019 - Two Prerequisites to Managing Small Business Growth If You’re Planning to Grow Your Small Business, Here are Some Key Considerations to Help You Succeed.
PCOC - Summer 2019 - 13
PCOC - Summer 2019 - State Capitol Report Change is Here A New Governor and Majority Democratic Legislature Has Altered the Foundation Upon Which PCOC Built its Success Over the Past Years.
PCOC - Summer 2019 - 15
PCOC - Summer 2019 - 16
PCOC - Summer 2019 - Insurance Believe It or Not! I Can’t Believe this Really Happened!
PCOC - Summer 2019 - 18
PCOC - Summer 2019 - 19
PCOC - Summer 2019 - 20
PCOC - Summer 2019 - Firm Profile Thrasher Termite & Pest Control: A Family Affair
PCOC - Summer 2019 - Index to Advertisers
PCOC - Summer 2019 - cover3
PCOC - Summer 2019 - cover4
PCOC - Summer 2019 - outsert1
PCOC - Summer 2019 - outsert2
PCOC - Summer 2019 - outsert3
PCOC - Summer 2019 - outsert4
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