Mungle's Crackers manufactures crackers shaped like exotic land and sea animals, among other food products. Apparently there was a bad batch of their latest line of Platy-Pies, because reports of moldy bags of pastries covered their social media and they had to recall many bags of the high-fructose treats. One angry customer got ill after his snack and has already filed a lawsuit against the company.
Notable Timestamps
[ 00:15 ] - Today's scenario will be Mike's debut as a host!
[ 00:37 ] - This Notice of Loss landed on the desk of our adjuster Ralph, who is relatively new to insurance and totally new to commercial lines. Ralph would like to be walked through how to approach this claim and claims in general.
[ 01:39 ] - The team agrees that today's scenario, which was drafted by the producer who also edits these show notes, is GOOD and HAS CREATIVE NAMES.
[ 02:05 ] - The acronym "DECIDE" takes the adjuster through the Declarations page, Endorsements, Conditions, Insuring agreement, Definitions, and Exclusions.
[ 05:50 ] - The policy itself can act as a checklist, and this is a helpful mnemonic can be helpful for adjusters (and numismatists).
[ 06:30 ] - A Reservation of Rights letter can mention that investigation is underway, but advise the insured of potential coverage issues.
[ 08:00 ] - Declarations page: Checking that the company insures the involved entity, that the loss fell within the effective dates, what the insured's limits are, etc.
[ 08:55 ] - Endorsements: Any food product recall coverage? Are any other parties insured? Do special limits of liability apply?
[ 09:28 ] - Conditions: Let's say the insured sent out $50 coupons to each affected customer, then sought reimbursement. The Voluntary Payments section would likely create an issue for the insured in that case.
[ 10:20 ] - Insuring agreement: It is not disputed that an accident led to bodily injury in this claim.
[ 11:05 ] - Definitions: "Occurrence", "bodily injury", "property damage" (moldy products?) are likely all defined. Endorsements can modify those definitions. Members can reach out to PLRB attorneys for guidance.
[ 12:05 ] - Exclusions: Exclusions like Recall / Sistership may apply.
[ 13:15 ] - Supervisors or even a roundtable of colleagues can be a great resource.
[ 14:00 ] - The next step is likely to examine the allegations. The duty to defend can be broader than the duty to provide coverage.
[ 15:00 ] - Mike provides a recap of the scenario and the points above.
Your PLRB Resources
Claims Chat - https://www.plrb.org/courses/can-you-help-me-walk-through-a-claim-part-1/lessons/can-you-help-me-walk-through-a-claim-part-1/
Part 2 - https://www.plrb.org/courses/can-you-help-me-walk-through-a-claim-part-2/lessons/can-you-help-me-walk-through-a-claim-part-2/
Simple Approach to Coverage Decisions (eLearning that's a good start for anyone looking to understand a policy) - https://www.plrb.org/courses/a-simple-approach-to-coverage-decisions/
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.
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Please reach out to us 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).
