What's the Scenario? with PLRB

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 https://www.linkedin.com/in/steven-badger-467b0322/ Notable Timestamps [ 00:20 ] - The insured signed a form on a tabet, presented to them by the contractor, without realizing it authorized a later appraisal demand. [ 01:13 ] - Steve shares an anecdote about his appraisal training sessions & debates. [ 02:39 ] - Steve's review of the trends shows that contractor-driven appraisal demands are more common now than they used to be. [ 03:50 ] - Assignment of Benefits would raise other issues and would not be permitted in all states. [ 05:15 ] - The adjuster can begin addressing an appraisal demand by contacting the insured to ask if they are aware of the demand, if the work is complete in their opinion, and the amount they paid. [ 07:22 ] - In the states where Steve practices, the contractor performing the work (and the public adjuster on the claim) cannot also act as the appraiser. [ 08:45 ] - Steve leverages his presence on LinkedIn to call out illegal behavior. [ 10:11 ] - Zelle LLP has drafted an alternative appraisal clause addressing abuses in the appraisal process. Removing the appraisal clause entirely would simply increase litigation. [ 12:37 ] - The goal of appraisal is prompt amicable resolution of disputed claims. [ 13:15 ] - Steve provides a recap of the scenario and the points above. Your PLRB Resources Steve will be presenting at the Texas Hail Claims Conference on February 12-13, 2026 in Dallas. Recorded Webinar: Combatting Common Abuses and Schemes in CAT Claims - https://www.plrb.org/courses/combatting-common-abuses-and-schemes-in-cat-claims/ CE Course: Property Insurance Appraisal - https://www.plrb.org/courses/property-insurance-appraisal/ Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.  Legal Information The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate. Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

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@zellelaw.com https://www.linkedin.com/in/steven-badger-467b0322/   Notable Timestamps [ 00:20 ] - Because of his years of experience, he knows that the 30 square comp shingle roof should cost about $20,000 to replace. (Amount provided is for reference and example purposes only.) [ 01:10 ] - For 34 years, Steve Badger has represented mostly the commercial property insurance industry, and for the past decade has focused on catastrophe, hail, and wind claims. [ 02:00 ] - Many policies allow the insurance company to replace the roof themselves through preferred contractors. [ 04:15 ] - Having an "preferred contract network" or "managed repair" endorsement can reduce ambiguity as compared to the base policy. [ 05:50 ] - Such endorsements could be optional or mandatory.  [ 07:00 ] - Steve argues that these endorsements can be a win/win/win for the insurer, insured, and contractor. [ 08:20 ] - Steve explores the potential benefits of the endorsement, such as reduced deductibles. [ 09:15 ] - Invoking "our option" means that if-- for example-- the selected contractor floods the house, the insurer could be responsible. However, an endorsement in this style could allow the insured to choose to employ the network. Further, contractors in the network could assume the risk. [ 11:15 ] - Steve discusses industry interest in preventative solutions. [ 13:00 ] - Steve contrasts the contractor who put on the roof asking for a supplement to a separate company focused on supplementation, and shifts focus to the insured's needs. [ 16:10 ] - Steve provides a recap of the scenario and the points above. Your PLRB Resources Steve will be presenting at the Texas Hail Claims Conference on February 12-13, 2026 in Dallas. Recorded Webinar: Combatting Common Abuses and Schemes in CAT Claims - https://www.plrb.org/courses/combatting-common-abuses-and-schemes-in-cat-claims/ CE Course: Roofing Fraud: Don't Get Nailed - https://www.plrb.org/courses/roofing-fraud-dont-get-nailed/ Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.  Legal Information The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate. Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

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 tree roots. [ 04:44 ] – Tree root damage exclusions can exist in some policies, but are rare. If clearly written, they’re usually enforceable. [ 05:30 ] – Lacking that, adjusters must look at general exclusions. The team explores all possibilities, including wear and tear, inherent vice, and non-fortuitous loss. [ 06:14 ] – Does wear and tear apply? Tree root intrusion may be interpreted as gradual, expected deterioration, not sudden damage. [ 07:14 ] – "Insurance covers risks, not costs." Damage expected to happen over time (like root growth) may fall outside coverage. [ 10:12 ] – Earth movement was suggested as an exclusion. It's debatable whether tree roots pushing soil could qualify as "earth movement." [ 12:08 ] – Inherent vice is another possible exclusion, if pipe failure resulted from defective materials rather than external damage. [ 13:03 ] – Faulty maintenance or neglect may apply if the homeowner ignored known tree root issues or failed to maintain the system. [ 14:01 ] – If pipe damage is covered, costs to dig up the lawn may also be covered as part of the repair. [ 15:00 ] – But if the loss is excluded, tear-out costs likely aren’t covered unless tied to investigation or specifically included. [ 16:04 ] – The bottom line: coverage depends on facts, foreseeability, and exclusions. Without a tree root exclusion, outcomes are uncertain. Your PLRB Resources FAQ: Tree Root Losses - https://www.plrb.org/documents/tree-root-losses/ Coverage Question: Tree Root Damage: Fortuitous or Non-Fortuitous? - https://www.plrb.org/documents/tree-root-damage-fortuitous-or-non-fortuitous-pcq-2022-01-21-dwf-b/ Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.  Legal Information The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate. Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

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 policy ISO 2011 edition. [ 01:39 ] - Trivia Time! Who are the six main characters of the board game Clue? [ 03:40 ] - Diminution in value refers to a property's market value being less than before a loss, even after full physical repair, due to stigma. [ 04:35 ] - The common argument against covering diminution in value is that policies typically cover physical loss and physical repair, not consequential or economic losses. [ 06:16 ] - First-party auto and property policies share similar loss settlement language. [ 07:47 ] - In Royal Capital Dev., LLC v. Maryland Cas. Co., No. S12Q0209, 2012 WL 1909842, — S.E.2d — (Ga. 5/29/12) [reviewed at PLRB, Prop. Ins. L. Rev. 8462 (2012)], the court allowed for diminution in value in a first-party property claim, drawing an analogy to auto claims. [ 08:50 ] - If there were physical traces like blood or bullet holes from the murders, it could potentially establish a physical loss, strengthening an argument for diminution in value, even if the cleanup cost itself is minimal. [ 10:28 ] - Real estate experts or appraisers could testify by comparing the home's value without the incident to similar properties affected by negative events. [ 13:04 ] - It's crucial to check your jurisdiction; while Georgia allows it, many states disallow it, and others have no specific case law on the matter. [ 14:00 ] - Tim provides a recap of the points above. Your PLRB Resources FAQ: Diminution in Value in First Party Property Claims - https://www.plrb.org/documents/diminution-in-value-in-first-party-property-claims/ Coverage Question: Pet Dog Attacked Owner; Blood on Carpet - https://www.plrb.org/documents/pet-dog-attacked-owner-blood-on-carpet-pcq-2023-10-27-twh-b/ Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.  Legal Information The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate. Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).

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 rearended while a passenger in a mechanic's shuttle van (Injury 2). [ 01:02 ] - Michigan was once the most expensive state for car insurance but has fallen to the sixth most expensive according to insure.com as of May 25. Which was the cheapest? [ 02:22 ] - Michigan's standard PIP statute under MCL § 500.3114 dictates that the named insured generally collects benefits under their own auto insurance policy, not the policy covering the vehicle involved in the accident. [ 02:49 ] - There are exceptions to the Michigan PIP priority rule, including when an insured is injured as an occupant of a vehicle owned by or registered to their employer or while a passenger in a vehicle used in the business of transporting passengers. [ 04:04 ] - For John's first injury (slip and fall), regarding the "owned by employer" exception, a Michigan appellate court in the reviewed case held the truck was owned by both John (the driver/title holder) and the leasing company (Shoulder Trucking). [ 05:36 ] - The court in this scenario found that he was an employee of himself as an independent contractor, leading his commercial insurance carrier to take priority. [ 07:09 ] - For John's second injury (shuttle van), the key statutory exception language relates to being a passenger in a vehicle "used in the business of transporting passengers". [ 07:52 ] - The phrase "in the business of transporting passengers" is construed in Michigan using a two-prong test from a seminal case: 1) whether transporting passengers was the primary purpose for the vehicle's use, and 2) whether the transportation was incidental to the overall business or activity. [ 08:55 ] - Applying the two-prong test to the mechanic's shuttle van involves considering factors like whether the service was free (suggesting incidental) or regularly offered (suggesting primary purpose or not incidental). The court in the case discussed did not decide this issue for the shuttle van, sending it back to the finder of fact. [ 09:39 ] - Brennan provides a recap of the scenario and the points above. Your PLRB Resources Case Law Review: Smith v. Farm Bureau Mut. Ins. Co. of Mich. (2025) https://www.plrb.org/documents/smith-v-farm-bureau-mut-ins-co-of-mich-2025/ Case Law Review: Miclea v. Cherokee Ins. Co. https://www.plrb.org/documents/miclea-v-cherokee-ins-co/ PLRB State-By-State Survey on PIP, Michigan → “Priority” https://www.plrb.org/documents/michigan-pip-compendium/#priority Case Law Review: Bender v. USAA Gen. Indem. Co. (2025) https://www.plrb.org/documents/bender-v-usaa-gen-indem-co-2025/ Employees of member companies also have access to a searchable legal database, hundreds of hours of video trainings, building code materials, weather data, and even the ability to have your coverage questions answered by our team of attorneys (https://www.plrb.org/ask-plrb/) at no additional charge to you or your company. Subscribe to this Podcast Your Podcast App - Please subscribe and rate us on your favorite podcast app YouTube - Please like and subscribe at @plrb LinkedIN - Please follow at “Property and Liability Resource Bureau” Send us your Scenario! Please reach out to us at 630-509-8704 with your scenario! This could be your “adjuster story” sharing a situation from your claims experience, or a burning question you would like the team to answer. In any case, please omit any personal information as we will anonymize your story before we share. Just reach out to scenario@plrb.org.  Legal Information The views and opinions expressed in this resource are those of the individual speaker and not necessarily those of the Property & Liability Resource Bureau (PLRB), its membership, or any organization with which the presenter is employed or affiliated. The information, ideas, and opinions are presented as information only and not as legal advice or offers of representation. Individual policy language and state laws vary, and listeners should rely on guidance from their companies and counsel as appropriate. Music: “Piece of Future” by Keyframe_Audio. Pixabay. Pixabay License. Font: Metropolis by Chris Simpson. SIL OFL 1.1. Icons: FontAwesome (SIL OFL 1.1) and Noun Project (royalty-free licenses purchased via subscription). Sound Effects: Pixabay (Pixabay License) and Freesound.org (CC0).