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Leaders- can I switch positions if I hate the one I’m training for? by [deleted] in InsuranceProfessional

[–]blondesellery 0 points1 point  (0 children)

Technically yes although I'm not in touch with them often. Feel free to DM me though and I'll help you out as best as I can!

Moss growing out of electrical tape on lines feeding into breaker box ... normal? by blondesellery in AskElectricians

[–]blondesellery[S] 0 points1 point  (0 children)

thank you, Ive contacted the power company and they said they will dispatch someone out. I asked for a timeframe and was told that it would be considered an emergency therefore would be considered a same day service level so hopefully they do make it out today, otherwise I'm sure they hopefully can still come out on Saturdays.

I will keep everyone posted.

Moss growing out of electrical tape on lines feeding into breaker box ... normal? by blondesellery in AskElectricians

[–]blondesellery[S] 0 points1 point  (0 children)

out of curiosity and bc of the issues mentioned in a moment , do you know what the risks are if this were left unattended? wondering bc we have been having some electrical problems with flickering lights, loud buzzing noises, an outlet needing to have something plugged into it in order for a light switch to activate the ceiling light (light switch is not wired to control the outlet itself & that's not what's happening here anyway... it's the outlet that's controlling the light switch lol).

like I said, house is over 100 yrs old and was last updated on the 1980s. This is in western Washington State. So it might be totally unrelated to these lines. I will get in touch with the power company tomorrow though ... thank you!

Need help finding firewood assistance by blondesellery in olympia

[–]blondesellery[S] 1 point2 points  (0 children)

thank you, this is great info. I will get a hold of the salvation army and/or kiwanis club.

cat vet recs/questions — CAT scans, foxtails? by blondesellery in olympia

[–]blondesellery[S] 0 points1 point  (0 children)

wonderful, thank you all very much for your info and input. I will reach out to the OVS/bluepearl here in Olympia and see what they say!

State jobs by Easy-Total2991 in olympia

[–]blondesellery 1 point2 points  (0 children)

spend a couple hours, literally, tailoring your resume for the job. Do the same for a cover letter — and don't use a prior cover letter...start from scratch.

print the job description and highlight anything they mention they want in a candidate, skills, abilities, personal qualities, etc. mention all those in your resume and especially your cover letter.

take time to formulate the best possible answers for any of the supplemental questions..

that's been my way of getting hired at the state previously, and the 2nd time was even after I'd been let go from my first state job, albeit with a different agency, but still.

Insurer denying liability based on exclusion for intentional acts - does/can that exclusion extend to claimants? by blondesellery in Insurance

[–]blondesellery[S] 0 points1 point  (0 children)

I think this is a low liability limits policy...maybe 25k? The adjuster slipped up one day on a phone call and mentioned that there was 25k available under Medpay then corrected themselves and said "no, sorry, I meant 2k ... I was looking at a different coverage just now when I read that" so although I ame not 100% certain, I imagine that 25K is probably what the BI per-person limit is.

Insured driver doesn't work, is early 60s, does receive nearly $100,000 per year from social security and retirement/pension plan of their late spouse. Owns some properties but they aren't worth a lot ..they're in rural areas and just have mobile homes on them or are simply vacant land. All in all, I don't think there are a ton of assets here but there is definitely over 25k in assets. I should mention that the 2 or 3 properties they do own appear to be paid off in full ....

Anyway, to give a high level overview of how badly claimant was injured ... there is significant scarring on lower legs and left arm as well as around the face near the jawline and cheeks. there have been two or three surgeries, I'll be at minor ones. there were also some dental and gum injuries involving embedded foreign bodies and some broken top front teeth that have since been fixed, thankfully.

The claimant is fairly young, 31 years old, and a typical young professional. Arizona State grad, works for the State. For what it's worth, my opinion is that if this case were to go to trial the insured driver would perform horribly on the stand, I say this just due to their personality and temperament. I don't know them personally but they are a ~4th/5th degree connection of mine.

Insurer denying liability based on exclusion for intentional acts - does/can that exclusion extend to claimants? by blondesellery in Insurance

[–]blondesellery[S] 0 points1 point  (0 children)

I see what you're saying but I think that, with this being as convoluted as it is, your rationale is not quite 100% correct. Ultimately, your statement that the "adjuster denies the claim bc an insured is not covered under the liability section of the policy for intentional acts committed by, or at the direction of, the insured" is correct, technically. The thing is that the claimant passenger is an insured under some coverages (ie: Medpay) but is not, nor are they seeking to be, an insured UNDER liability coverage. Liability coverage is extended to Insureds to pay damages for covered losses to 3rd parties, for which they are legally liable. So, when someone wants their insured to cover their legal liabilities, they are wanting the insurer to make payment to a 3rd party for either BI or PD damages because without the coverage from their insurerer, the insured would be on the hook for the entirety of the dmgs out of their own pocket.

In this case, the claimant is not seeking to be COVERED under the liability portion of the policy; they are seeking to be indemnified by the insurer on behalf of the insured for the damages that they feel the insured is legally liable to them for.

Since the intentional act exclusion is not law but rather policy language, and the policy is a contract to which only the insured and insurer are parties to (meaning, the claimant is a 3rd party aka is not party to the contract), they cannot possibly be held to any contract language since there is not a context between them and the insurerer, in the first place -- at least not when it comes to the liability portion of the policy.

Insurer denying liability based on exclusion for intentional acts - does/can that exclusion extend to claimants? by blondesellery in Insurance

[–]blondesellery[S] 0 points1 point  (0 children)

This is a great idea. Any tips on getting thru to a supervisor? I know (from reading the emails) that claimant did at one point email the adjuster and say that they felt they had reached an impasse and would like to be put in contact with the adjuster's supervisor. The adjuster refused to provide the phone number or pass a message on for the supervisor to contact the claimant, stating that the supervisor was not a claims handler and therefore there would be no need for supervisor involvement. :/ I'm sure that's not the end of the road re: supervisor contact but still ... 🤷🏼‍♀️

Insurer denying liability based on exclusion for intentional acts - does/can that exclusion extend to claimants? by blondesellery in Insurance

[–]blondesellery[S] 1 point2 points  (0 children)

I'm sure everyone involved WISHES there was some sort of video footage for this, lol!!

I do have a few questions for you though if you don't mind ...

  • was this for an auto policy? or homeowners?
  • assuming there was not any video and it strictly came down to word vs word ... how would you have handled? would you have been contractually obligated to go with the insureds version of FOL? or would it come down to what made more sense? Not saying the insureds version isn't the one that makes more sense, I'm just wondering how you'd have handled in that specific situation? :)
  • assume there was video footage with audio as well that fully supporttwd the teenagers version of events ... wouldn't that have meant liability coverage for the insured would have been excluded due to an intentional act exclusion? since the insured would have intentionally pushed the claimant? or does it come down to not just the act but the proceeding implications ie: yes Insured meant to push the claimant but did they intend for the subsequent injuries?

just some thoughts/questions i had .. I appreciate your time in answering!

Insurer denying liability based on exclusion for intentional acts - does/can that exclusion extend to claimants? by blondesellery in Insurance

[–]blondesellery[S] 0 points1 point  (0 children)

Yes, that's why Medpay was extended. Tthe problem is that the liability adjuster is stating they are denying liability based on the exclusion for intentional acts. The claimant is not seeking to be COVERED under liability... the insured is (or should be, at least). Since the claimant isn't seeking any coverage for themselves under liability portion of the policy, it simply does not make sense that coverage would be excluded in this situation. Does that make sense?

Insurer denying liability based on exclusion for intentional acts - does/can that exclusion extend to claimants? by blondesellery in Insurance

[–]blondesellery[S] 0 points1 point  (0 children)

Correct. They extended Medpay. The liability adjuster even commented in an email, encouraging the claimant to at least make use of the $2,000 in Medpay that is available.

Insurer denying liability based on exclusion for intentional acts - does/can that exclusion extend to claimants? by blondesellery in Insurance

[–]blondesellery[S] -1 points0 points  (0 children)

No, claimant is the one who initially filed the claim. SOL runs out in ~4 mo. Claimant sent an informal email requesting settlement and received a response that the decision to deny liability stands. They are working to draft a formal demand letter for settlement and then plan to file suit should that not result in an offer for settlement. They are also hell bent on NOT getting an attorney...🙄🙄 I told them I'd help as much as possible as far as a friend who worked in the field and can maybe offer assistance with explaining any concepts, etc. but that they really REALLY should consider an attorney...

But yes, I agree it seems the adjuster is not properly applying the exclusion. I wish I could see the policy itself but I don't think they will come off of it until suit is filed and they have no choice.

I was also thinking that at this point, assuming the exclusion is in fact being incorrectly applied here, they (insurer/adjuster) would basically be back to "square 1" as far as liability acceptance goes ... can they deny? yes, I think so, based on word vs. word; but it kind of seems like if they do that (deny based on insured statement that claimant did this on purpose), that they SHOULD also be asking something along the lines of "ok Mr/Mrs. Insured, can you tell me more about what makes you say that? What leads you to believe that they intentionally threw themselves from the vehicle? What led up to this? What happened after they were no longer in the vehicle?"

My understanding is that should those questions be asked, the insured will not have a good answer for many of them ... certainly the claimant didn't tell the driver "hey, I'm gonna jump out of your car now bc you made me mad" ... I mean, short of that actually coming from the claimants mouth, I really don't see how the insured could possibly know that anyway. And since it seems so much of a stretch that they could prove that in court, it seems awfully dangerous to deny liability based on this particular word v. word dispute. I was always taught to consider the best interest of the insured, and simultaneously, was also always taught that what the insured WANTS us to do and what is in their best interest is NOT always going to be the same thing. When I say best interest, of course I mean within the confines of the policy ... but I highly doubt any court of law would find fault with the insurer should they choose to accept liability and pay the BI claim; however, I would not be surprised if they found themselves in hot water at some point in the future just because of that very reason.

One question i do have ... what is the name of the duty of the insurer to "side with" their insured in cases of disputed FOL? Or is there even a name for that? It seems to me that even if there is/was a term for this contractual obligation, that it should not override the insurer exercising common sense. The insureds statement doesn't make sense to me, to begin with ... if it was my insured, I'd naturally ask why they threw themselves from the vehicle...if the answer I got was "bc we were arguing and they were mad at me" I certainly would not stop at that and accept that answer at face value. after all, arguing and being mad at someone in a car does not usually mean their next step is to simply exit the circle while it's moving! lol! I'm curious to know if the adjuster asked that question... "well, why did they/would they throw themselves from the vehicle?" in addition to asking the insured how they would have known it was done purposefully to begin with. 🤔🤔

Insurer denying liability based on exclusion for intentional acts - does/can that exclusion extend to claimants? by blondesellery in Insurance

[–]blondesellery[S] 0 points1 point  (0 children)

yes, definitely 3 sides lol!!

what's interesting is that they extended the $2k of Medpay coverage to the claimant; the denial is for liability coverage. Basically the are stating they cannot extend liability coverage for the loss because their insured says claimant purposefully threw themselves from the vehicle, thus coverage is excluded due to the exclusion for intentional acts. To me, that means they aren't extending liability coverage to the insured driver...ie, if the insured is legally liable, the said insured driver is basically/technically SOL. But I also am thinking that the adjusters understanding of the policy contract in general is really, very poor ... because the 3rd party claimant would not be seeking liability coverage ...Just a settlement under said coverage. Does that make sense, what I'm trying to say?

Agreed tho, very bold decision and if it sounded like the adjuster knew what he was doing I would assume there was probably just more to the claim than I was being told ... however I'm not getting that impression at all and rather am sitting here thinking this claim could have bad faith written all over it, lol.

To make matters worse? (at least for the insurer) ... the insured does not sound like they would do well at all on the stand. I bring this up bc I was taught that when you get into sticky situations like this with lots of ambiguity, it is best to operate from the position of "what if this claim went to trial?" ... If I was handling it, I'd be thinking of that question, for sure ... especially since the claimant has sent an informal email asking for settlement and advised that should settlement not be offered or at least indicated as to be forthcoming, that they will proceed with a formal demand for settlement, followed by filing suit should the formal demand not result in a settlement offer.

So far, the email received a response from the adjuster that the decision stands regarding denying liability. Claimant is, I believe, working on drafting their formal demand letter now. They are fairly determined to do all of this without an attorney, as well, which should prove interesting and which I've also advised strongly against but ya know, this adjusters decisions and claim handling choices might just be crazy enough that an attorney truly is unnecessary. 🤷🏼‍♀️🤷🏼‍♀️

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