Mapletree Down

This is a good one.

Back in April, a few months after we went self-managed, I decided to look through our General Liability insurance policy for items our former PM might have missed.

First thing I found was that our fountain had no insurance for damage or loss, so we added a rider for $5K.

Next up was tree loss, damage and removal. Appeared we had $5K for loss, $500 for removal. We decided we wanted more for loss, up to, instead of 5, $10K for wind and flood. Dropped agent an e-mail.

Agent wrote back that we could up to $10K, but that the coverage was only for fire, lightning, riot, etc., but not wind or flood.

I wrote back that we were not interested in riot, etc., only flood and wind, and if that was not included, we had no need for extra coverage. But if they were included, please advise.

Agent wrote back, and I quote: “wind is covered. flood is not. I will have it issued with the endorsement. If you decide against it, we can remove it.”

I wrote back, and I quote: “We’ll take the wind. Thanks.”

No further e-mails. The rider was issued and we paid the extra premium.

Can you see what’s coming?

27 July, big storm rolls through and takes out a 48 foot maple, 24 inch trunk diameter.

I e-mailed Agent with the details and asked how to begin the claim process.

Agent writes back saying oh-so-sorry, wind damage/loss is not covered, then repeats the fire, lightning, riot, etc. language, and that seeing wind isn’t covered, neither is removal.

Should be interesting bringing this to conclusion, eh? Esp. as I have those e-mails tucked safely away in my AOL filing cabinet, copies of which I’ll forward to Agent next week.

Your thoughts would be appreciated. Thank you in advance.

That's pretty standard. If the tree would have landed on a garage, insurance would cover. But a tree being just blown down is not.

No endorsement was sent to us. Just a bill with the notation OPTION TP ADDED.

Option TP in the body of the policy reads:

"The Limit of insurance for Trees, Plants, Lawns and Shrubs under Extensions of Coverage is changed to the amount shown in the Declarations for this Option TP."

The riot, etc. language appears elsewhere in the policy.

Our position? We relied on what Agent wrote:

"wind is covered. flood is not. I will have it issued with the endorsement. If you decide against it, we can remove it.”

because as we wrote, we were not interested in a change unless wind was covered.

Wind is covered sounds pretty unambiguous.

I will have it issued with the endorsement sounds pretty unambiguous.

But this could make for a great bar exam essay question. We've got contract law, agency law, insurance law...plus a pair of arguable positions.

Susan,

No. TP is a specific, optional coverage as I noted above. It covers loss of trees, etc., not related to damage to anything else, such as a building.

BTW, the $10K is cumulative and limited, as in, if 50 trees were destroyed, the max coverage is $10K.

Earlier this year, we replaced a dead (no trauma, just up and died) 4" trunk, 12 footer. Cost? $400! That's why we decided to add tree loss coverage in the event we lost a few dozen in one event from wind.

Mary,

How would we know what was included in the endorsement (including variances, additions) if we were not provided one?

Yes, the language in the policy is what the language is.

So are representations made by the insurer's Agent. He's the expert, we're not. We didn't draft the policy, they did.

In this instance, we have a written statement from Agent that "wind is covered" and "I will have it issued with the endorsment."

C'mon, guys. Somebody out there needs to take our side of this, lest I retire to my bed in a slough of despond.

Anytime a change is made to an ins policy an endorsement outlining that change and showing the increased amount of the policy should be recieved. If you didn't receive this endorsement, you should have called the ins. co.

Considering the fact that you have a written statement from the agent, IMO, you should be able to use that as justification that the damage should be covered. I would be talking to the ins. company from now on and perhaps looking for a different agent. He either told you something is covered that the ins. co does NOT cover. Or he told you it was covered but failed to inform the ins. co. which may be why you didn't recieve an endorsement adding this coverage.

I want to take your side on this, John. I just think you should have called the ins co. especially when the agent seemed to be giving you the run around about whether or not wind was covered. If I think a co. rep. is acting like he doesn't know what he's talking about, I'm not afraid to go to the higher ups and find out what's going on. Frankly, I don't bother with ins. agents, I go straight to the co. with my questions.

John,
I applaud you with enthusiasim. Right, wrong, I don't know, but that never stopped Don Quixote (however you spell it) and trusty Sancho. You may be tilting at trees and he faced windmills, but give em hell. Remember ol Sir Don did not acknowledge defeat. There was no such word.

Brad,

First of all, I think I'm a very prudent person. What would I have done? I would have called the ins co when I received the bill. Reason stated below.

Secondly, an endorsement was never received, only a bill. But this is what the bill said:

"Just a bill with the notation OPTION TP ADDED. Option TP in the body of the policy reads: "The Limit of insurance for Trees, Plants, Lawns and Shrubs under Extensions of Coverage is changed to the amount shown in the Declarations for this Option TP.""

This means only the limit of insurance coverage was increased. Nothing is mentioned about adding wind damage to the coverage. This is why I would have called the ins. co. directly.

But I do agree with the rest of your response. The ins. co. should honor the claims made by their agent. The proof is in the emails!

John,

Good point! Which reinforces my belief that it's always best to go right to the source; in this case, the ins. co.

Well, I am gong to get every one of my trees - and maybe even the grass - covered by insurance! Then hope they all die!!

Update

So I sent my detailed letter to our Agent.

Agent suggested he have an Adjuster come out to see if lightning was the cause of the loss, in which case the loss would be covered.

Adjuster paid a visit, then called me a few weeks ago to say the claim would be denied as the obvious cause was wind. Letter to follow.

I suggested to Adjuster she review the letter I sent to Agent. Adjuster replied her part in the process was over, and if I had additional issues, I should contact Agent.

I didn't; not because I didn't have additional issues, but because I wanted to discuss the matter with my fellow Board members later this month at our meeting.
No letter from Adjuster was received.

Yesterday, Adjuster called and informed me Claims Mgmt., after reviewing my letter, had reversed her denial and that BOTH removal & replacement would be covered...and asked I get some estimates so we could put this puppy to bed.

Oh, and by the way, Adjuster added, no future wind loss would be covered.

My take away? I'll post again after the check(s) clear!

Let me get this straight:

You thought you had wind damage insurance for trees.
A tree came down from the wind.
They told you coverage would be for lightening, but not wind.
The adjustor came out and determined it was wind, so claim was denied.
You raised a little heck.
Second thoughts from company - tree is covered.
Company tells you that in the future, wind damage would not be covered.

Susan,

Essentially, you're correct. Though I didn't raise a big (or small) fuss. I simply asked my letter (our HOA's position) be considered.

I was guessing that a lawyer saw the letter and decided that if the payment would be the same or less then if this turned legal and/or a complaint was sent to the state insurance board.

The thing is that if a person had reasonable reason to believe wind would be covered then things could get very ugly. While most of the time insurance boards don't do a lot for individuals, they do keep an eye out for a chance to make an example. The cost of either one could easily exceed the cost of the claim.

Epilogue:

We gatherd 3 estimates for removal, 4 for replacement.

Here's something interesting I learned in the process, which I provided to Adjuster during negotiations:

>>>NOTE: Replacement of a 48 foot tree, with a trunk circumference of 75 inches (24 inch diameter), has not been found to be available due to the size of the product and equipment needed for installation. Therefore, the vendors below have employed the accepted concept of CALIBRATION, that being: Based on the trunk size (diameter, one foot above ground) of the lost tree, a mathematical process indicates how many smaller trees would add up to the value of the lost tree. The quotes varied by using 4 inch trunk/10-14 feet tall through 6 inch trunk/20-22 feet tall in the calculations. Fewer, larger trees are more expensive compared to smaller ones. Installation included.<<<

Of course, and acceptably, InsCo picked the lowest bids for both the removal and the replacement values.

We (dammit) had a $1K deductible. However, minus that pesky detail, yesterday we received a check in excess of $4K with no conditions attached, approx. 20% of our 2009 projected dues income. $600 will go for removal. Cool.

My takeaway? Persistence + arguing one's position unemotionally and intelligently + being respectful to the other side's personnel & views = contentment in (our) HOA Land and more proof to Membership that we're lookin' after them.

May you, too, hopefully, have champagne dreams and caviar settlements!

Not to rain on the parade but wait till you get next years insurance premium bill to see if they jack it up. Might need that 4k to pay you new insurance bill.