Problems viewing this email? Click Here October 29, 2015      Q&A of the Week Determining Cause of Loss A Washington subscriber recently asked the following question: A hole was discovered in a client's pool super structure. They have an all risk policy. The insured believed ice fell off the roof and damaged the pool wall. The insurance company had an engineer review, and they advised that the trajectory was such that ice from the roof could not have damaged the pool. The pool is a saltwater pool, and the damage was not from the freezing of the water within the pool. We advised the adjuster that if it was not the ice, we are not aware of what caused the damage, only that it clearly occurred during the winter months. The adjuster advised that we must advise him of what caused the damage prior to them providing coverage. We feel that we should only have to report that there is a loss on the property and that unless the carrier can exclude it from the exclusions within the policy, they should pay for the damage. Who is correct? Must the insured have knowledge of what caused the damage? ANSWER: You are correct. The homeowner just has to report the loss and cooperate with the carrier. If the carrier's engineer cannot determine the cause of loss, and the carrier cannot identify an exclusion, then the loss should be paid. There is no exclusion for mysterious damage to pool linings. The insured gets the benefit of the doubt, and the loss should be paid. Read More    What's New This Week in FC&S Commercial Crime Coverage Form The current commercial crime discovery form, CR 00 20 11 15, and loss sustained form CR 00 21 11 15, are revisions of earlier discovery and loss sustained forms. Read More    Litigation Watch Legal Duty of Claims Adjuster The insurer brought an action seeking a declaratory judgment that it had no duty to indemnify the insured in an underlying lawsuit. The insured's assignee later filed a complaint against the insurer and against the claims adjuster retained by the insurer for negligence. This case is Lodholtz v. York Risk Services Group, 778 F.3d 635 (2015). Lodholtz sustained injuries in the factory of Pulliam Enterprises. He filed a lawsuit seeking compensation. Pulliam filed an insurance claim with its insurer, Granite State Insurance and the insurer retained York Risk Services as a claims adjuster. However, neither Granite State nor York ever communicated to Pulliam whether they believed Granite had a duty to defend Pulliam under the terms of the policy. Read More    Fraud of the Week Policy Inception Fraud—Pennsylvania AMOUNT: Unknown A Pennsylvania man was sentenced to probation for submitting multiple claims to different insurers for the same damage to the same vehicle. Read More        FC&S Ask the Experts Did you realize that the Q&A section of FC&S is made up of questions submitted by subscribers like you? Paid subscribers to FC&S Online or print FC&S Bulletins are invited to submit insurance coverage questions to the editors. We'll provide a personalized opinion within five business days. (We'll let you know if it will be longer than that. Sometimes we have to gather research or other supporting materials). Who knows? Your question may be featured (anonymously) in the online Q&A of the Week or as an FC&S update. Submit your coverage interpretation question right to the editors of FC&S for quick and reliable information. Ask our expert staff a question by clicking here.    Maximize Your FC&S  Online Subscription! FC&S editors regularly conduct web-based demos of the service. Feel free to contact Christine Barlow, cbarlow@alm.com, to set one up! They only take 30 minutes, a small investment of time that will help you learn all that FC&S Online has to offer.    Contact Us As always, your comments and questions are welcome. Contact us at: FC&S Department Phone: 800-543-0874 Fax: 859-692-2293 Email: eAlerts@nuco.com The Zalma Insurance Claims Library   Insurance Claims: A Comprehensive Guide The only source you'll need to successfully handle insurance claims from start to finish. More Info Construction Defects Coverage Guide Your single-source for identifying, insuring, investigating, prosecuting, and defending cases that result from construction defect claims. More Info Mold Claims Coverage Guide This guide will allow you to handle mold insurance claims and litigation resulting from mold or fungi related disputes with confidence. More Info For more information about these titles Click Here

FC&S Team Kelly Maheu, J.D. Publisher   Diane W. Richardson, CPCU Consulting Editor Christine G. Barlow, CPCU Managing Editor, FC&S   Diana B. Reitz, CPCU, AAI Consulting Editor David D. Thamann, J.D., CPCU, ARM Managing Editor, FC&S Bulletins   Emily Brunner Online/Print/Production Editor Susan L. Massmann, CPCU Managing Editor, Electronic Publications   Tosha Brinkman Marketing Manager Barry Zalma, Esq., CFE Contributing Editor   Donna Cozatchy Creative Director

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional service. If legal advice is required, the services of a competent professional person should be sought. To ensure future delivery of email, please add admin@list.nationalunderwriter.com to your address book, contacts or safe sender list. You have received this email at %%merge members_.emailaddr_%%. Click here to unsubscribe from %%merge list.descshort%% Copyright ©2015 The National Underwriter Company, A Division of ALM Media LLC. All rights reserved.   4157 Olympic Blvd., Suite 225 Erlanger, KY 41018 1-800-543-0874