Weather Related Damage

Now that spring is here, the possibility of severe weather is a constant threat.  Here in the south we have just gotten through three severe storm episodes in the last two weeks.  With the severe storms come the storm claims.  It should be noted that whenever a claim is submitted to a carrier, the damage has to be weather related.  In other words, the cause of the damage has to be connectable to the resulting damage.  Although this point might seem obvious, there are those people that don’t realize what this statement means.  Just because your a/c goes out after several days of rain doesn’t mean that it was struck by lightning.  Unless lightning is proven to have been present when the failure occurred (and it is possible), the failure was most likely caused by something else.  We recently investigated an instance where a homeowner claimed that his heat pump expired as a result of ice that formed during a winter storm in February.  Upon further investigation, it was determined that the breakers that controlled power to the heating side of the unit were old and worn to the point where nuisance tripping was occurring.  As a result, the unit would not operate for more than a few minutes before shutting down.  The condition of the breakers is shown in the photograph below.  It is also understood that not everyone can be their own technician but, remember, if your claim is submitted on the basis of weather damage, the damage has to be seen as sudden and accidental.  But, more importantly, the damage has to be “connectable” to the damage causing event.  It is further suggested that when a weather related incident is encountered, it is documented as thoroughly as possible. Examples of documentation include taking photographs of ice crushing pipes, burn marks left behind after a lightning strike, wind tearing off roofing shingles, flood water level marks left on walls.  Remember to make notes and document all conversations with people involved as well.        

Cracked and Worn Breakers

Getting Bad Gas?

We’ve been working on an assignment where two vehicles equipped with diesel engines were allegedly damaged by bad diesel fuel. We were asked to determine if the gas station where the fuel was purchased was acutally selling contaminated diesel fuel. Unfortunately, the vehicles were already repaired and any diesel fuel had already been discarded by the time we began our investigation. We have been able to determine that at the time the purchases were made, the water level in the diesel tank was above the state mandated maximum level of 2 inches. As a result, there was a possibility that a combination of diesel and water could have been pumped into each customer’s vehicle when the purchases were made. Once the purchases were completed, the water level could have dropped enough so that the next customers would not have purchased water contaminated fuel. It is also possible that while the diesel tank monitoring instrumentation measure water depth inside the tank, the diesel might be contaminated with something else. Something that would ignite in a diesel engine but at the same time, could cause damage to the engine – like gasoline. Diesel samples were obtained and sent to a lab for analysis. The result of that analysis revealed that the samples did not contain any water but instead contained traces of gasoline. Specifically, levels of toluene and xylene were higher than normal.

If you find yourself in a similar situation, regardless of having purchased diesel or gasoline, it is imperative that you don’t lose your purchase receipt. Your receipt will become invaluable regardless of whether you paid cash or used a credit card. Next, get your vehicle to a mechanic as soon as possible after you suspect engine trouble. Second, advise you mechanic that if the fuel tank or lines have to be drained, not to discard anything that comes out of the lines or tank. Third, collect all contents in a clean, dry, container and label the container with the cutomer’s name and date that the contents were taken. Also save all parts. If possible, photograph the contents and all parts that have to be replaced. If the engine has to be replaced, photograph the engine and record the engine identification number. The mechanic should be able to assist in obtaining the number if necessary. Fourth, if the fuel appears to be contaminated, advise your insurance carrier and then the station owner where the fuel was purchased. Once the initial notifications have begun, each party should begin it’s investigation. The more information is obtained when the discovery is made, the easier it will be to prove the claim or discredit the fraud.

I’m Not the Enemy!

Earlier this year, I was asked to investigate the cause of failure of a hot water line fitting in a commercial establishment.  As most of you know, I am an engineer who performs forensic analysis on failed products.  It so happens that the guy that installed the failed part was insured by the company that hired me.  As soon as I called him to find out what work he had done, he got very defensive saying that I was hired by the insurance company to deny the claim.  This isn’t the first time that this has happened to me.  In fact, this is more like “par for the course”.  I understand that when people submit a claim to their insurance company, they are worried about whether the claim will be covered.  And when a technical expert shows up, that scares them even more.  I have learned over the course of my forensic career to be patient with people.  Sometimes, all it takes is a little give-and-take for the insured to feel more at ease.  By that, I mean as the insured expresses their thoughts, I listen and then explain why I am involved and what I will be doing.  At other times, the insured isn’t willing to listen or just won’t cooperate.  It is in these instances that I am viewed as the “enemy” and I’m the one “out to get them”.  In reality, I am usually tasked to provide an explanation of what happened to cause the damage or injury that occurred.  Remember, insurance adjusters are not experts in everything and as a result, have to hire people with expertise in areas other than their own.  But, there are those that just don’t or refuse to understand.  I know that it can be scary to have a stranger come to your door and ask a lot of questions but, there really is a purpose to the method.  Unfortunately, there are those that will attempt to commit fraud and as a result, make it harder on everyone else who is trying to do things honestly.  As it turned out, the insured that I was dealing with appeared to have been doing work outside of the scope of his insurance policy.

Be Careful How You Treat Your Engineering Investigator!

Consider the following incident involving a vehicular impact and damage to the vehicle’s transmission. Assume that the driver hit an object in the road and claimed that the object caused damage to the transmission’s oil pan.  In short, fluid leaked out and the transmission was ruined.  On the surface, this seems like a plausible scenario and it would be reasonable to conclude that the failure of the transmission could occur after being hit by flying debris from the object that was struck.  However, what if evidence was found to indicate that things were not  as they appeared?  Needles to say, the final conclusions went against the owner’s claim.  Understandably, the owner would be upset and most likely not open to an alternative explanation.  If you are trying to get your insurance company to pay off on a claim, the last thing you want to do is insult the investigator.  The investigator has no interest in the outcome of the settlement between you and your insurer.  As a result, if you accuse the investigator of acting improperly with no evidence to support your accusation, neither the investigator or your insurer is going to feel inclined to help you in any way.  Not many people know this but, whenever a claim arises, the policyholder can hire their own engineer, appraiser, adjuster, attorney and anyone else they need to help prove their claim.  However, professional help does cost which is why insurers are seldom opposed in the claims process.  So, when you are faced with talking to an engineer, adjuster, appraiser or anyone else hired by and insurance company, be as polite and honest as you can be.  If you disagree with something, you can ask questions but, don’t insult or accuse the inverstigator of taking a “kickback”.  Instead, the time for an appeal ccomes after the initital decision is made by the insurer.  After that, appeals can be made directly to the insurer.  If there is  no satisfaction, then file a complaint with your state consumers affairs department or the office that regulates insurance companies.