The Art of Adjusting® Podcast

Episode #84: Holiday Claims Without The Headaches

• William Auten & Chantal Roberts • Season 3 • Episode 84

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Holiday cheer meets claim chaos, and we’re here to make sense of it. From overloaded outlets and dry Christmas trees to frozen pipes and black ice, we walk through the winter risks that drive property, auto, and liability claims—and how smart adjusting turns messy losses into clean resolutions. We share practical tools adjusters can use right now: when to call a cause-and-origin expert, how to preserve cords, sockets, and devices for subrogation, and what chain-of-custody documentation should look like to avoid spoliation fights.

The conversation digs into policy nuance around freeze losses and ensuing water damage, plus the real-world factors that determine negligence: missed fuel deliveries, drafty penetrations on windward walls, and “reasonable time” standards for clearing snow and ice. We also talk friendly fire versus hostile fire, linear burn patterns that suggest accelerants, and why early manufacturer notification can make or break a recovery. If you work with renters, you’ll get talking points for contents coverage and loss-of-use, and if you manage a team, we offer ways to bridge training gaps without overwhelming new adjusters.

We don’t skip the human side either: holiday burnout is real, and clear choices—simpler gatherings, fewer decorations, better checklists—help keep stress down and claims up to standard. Whether you’re in property, auto, liability, or workers’ comp, this seasonal playbook will sharpen your field questions, improve your evidence handling, and guide insureds and third parties toward the path that serves them best. Subscribe, share with a colleague, and leave a review to help more adjusters find the show—then tell us your toughest winter claim and what you’d do differently next time.

For more insights, you might consider a career in liability adjusting or if you're searching for reliable adjusting services, visit Auten Claims Management.

To explore more about Chantal Roberts and her contributions to the industry, visit CMR Consulting.

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William Auten:

Hello, I'm Bill Auten of Auten Claims Management.

Chantal Roberts:

I'm Chantelle Roberts of CMR Consulting, and welcome to the Art of Adjusting podcast.

William Auten:

Today we're going to talk about life as an insurance adjuster from the perspective of property, auto, liability, or workers' compensation adjusters. Our goal is to bring interesting topics in the world of claims adjusting to people who are working as an adjuster now and to people who are considering a career as a claims adjuster.

Chantal Roberts:

Hi, Bill.

William Auten:

Hey Chantel, how are you?

Chantal Roberts:

Doing well, thanks. How are you?

William Auten:

Good, good. I don't know if you noticed, but the holiday season has kicked in in full force around here.

Chantal Roberts:

Yeah. You know, I love the sweater. I do not own an ugly sweater. I have never owned an ugly sweater, actually. An ugly sweater. Me neither.

William Auten:

This is actually an ugly sweatshirt. It's got a hood and everything.

Chantal Roberts:

So that's nice. Very nice. I'm bringing the bling with the the um sequins.

William Auten:

Nice.

Chantal Roberts:

Yeah.

unknown:

Yeah.

William Auten:

Nice and doing traditional Santa hat for me.

Chantal Roberts:

Yeah. Yeah. Just about as good as it can get for me. So we are actually going to be talking about the holidays today. And I'm I'm um excited about it. Uh yeah.

William Auten:

So um our our caption and our notes here say holiday check-in, decorations, weather, you're in burnout. Uh, first of all, uh, is all your Christmas shopping done?

Chantal Roberts:

No. Because I have holiday burnout.

William Auten:

Oh, yeah. And how about your decorations?

Chantal Roberts:

No, we don't. In fact, we are going to be having just uh we we usually have a small, well, not a small, we have a big holiday cocktail party. And we've decided to cancel it this year because we're just both stressed and things have got to get off the plate. So what we've decided to do is have a holiday pizza party with three very close couple friends, and so it would just be a total of eight people, and that is it. Um, so we haven't even decorated really. So uh just again, get because you got to give yourself that grace. I mean, we've talked about this.

William Auten:

Take the stress out of it, you know? Yeah, we've talked about this.

Chantal Roberts:

Yeah, yeah, we've talked about it lots of times. So you just gotta give yourself some grace and and do that. What about you? I mean, you had that huge Thanksgiving.

William Auten:

Um Yeah, yeah. We so we had um so we had kind of a big thing that we had to get the decorating done before that. We were able to get that done um when was it? Oh man, it was like the first week, weekend of December. Oh, okay. Um which or was I think it was in November?

Chantal Roberts:

Or do you wait?

William Auten:

Um I lost you. I'm not sure what happened.

Chantal Roberts:

Oh, do you put your Christmas or your holiday stuff up beforehand, like b during Thanksgiving or before or after?

William Auten:

We put uh so we we put it up after Thanksgiving. Um we did it only a little bit earlier than normal this year uh because we had to get it done. So it um it's been up now and we we like it. You know, we have had the Christmas tree lights on and and the fireplace is decorated nice and yeah, yeah.

Chantal Roberts:

So I do want to remind everybody, we are are gearing up to get a total of of what 10 listeners? Woo-hoo! Yeah, yeah, yeah. Uh so uh please like, follow, subscribe, share, comment on on these on these podcasts so that we know that you're interested. If you've got an idea that you want us to talk about, or you've got a concept or a question that you want us to talk about, we are happy to do that. In fact, we did that earlier this year, and we had uh a couple of questions coming in from uh Dave Ayadanza, who is one of our old OG listeners, and he had asked us a couple of questions, and so we've answered those. So be sure you ask us questions.

William Auten:

Yeah, LinkedIn is a great place to connect with us so um and communicate uh any questions that you have. So um on the topic of holiday seasons, there's so many things that could potentially go wrong in terms of claims, both on the property side and the liability side. A lot of it is weather driven because this is where the snow starts to come and the weather starts to turn nasty, and that contributes to um issues all over the board. Um so property adjusters are gonna see spikes in claims, liability people are gonna see spikes, auto adjusters are definitely gonna see some fender benders, uh, not just on the roads, but in the parking lots where frantic shoppers are frantically shopping.

Chantal Roberts:

Exactly. Yeah, yeah. It's not just going to be people running into one another, but I actually had uh I think I had gotten those very last uh parking spot one time. And when I came back out of the mall, this is when I was in college, I was driving my mom's car. Someone had keyed the, and I guess I cut them off from that one spot. I had no idea that I had done it, but I mean, people, that's my mom's car, dude. That's not that's not um, but uh it's not just accidents, it could be something as rude as someone keying your car.

William Auten:

Vandalism, yeah. I have claims. Uh people break in when all the gifts are out, and uh there's a story about this guy who dressed in all green. You ever hear of him?

Chantal Roberts:

No, who's he?

William Auten:

Grinch.

Chantal Roberts:

Grinch. See, I've been thinking of the porch pirates. Have you been here? I mean, you we hear about the porch pirates every year.

William Auten:

There's this series of videos that keep showing on my on my social media feed, and I think they're AI generated, but they're people stealing packages, and then the package blows up with uh sparkly purple dye and uh um covers them. But it actually looks really dangerous, so I don't really think they're real videos. I think I hope they're AI because um the the explosions look like they could actually injure somebody, especially around the face and eyes.

Chantal Roberts:

So or or they're doing that, or people are actually doing it on purpose to get viral or whatever.

William Auten:

Yeah.

Chantal Roberts:

And again, I would not recommend doing that.

William Auten:

But we talk about liability claims. Holy cow.

Chantal Roberts:

Oh, yeah, yeah, yeah.

William Auten:

Yeah, we we don't want that.

Chantal Roberts:

No, but you know, December, and of course, and we're gonna move into this in January because we we do have a predictable pattern, and I don't mind that, quite frankly, that we we always talk about these winter claims, and I am always of the mind that sometimes we forget things and hearing things over and over again is is what's gonna help us get better. But you know, December and winter, we have these predictable claims patterns every year, and most of them do revolve around uh weather.

William Auten:

Yeah. You know, it'd be fun to talk about um what's the movie with uh uh Christmas Vacation.

Chantal Roberts:

Yes. I just posted that. I just posted a a LinkedIn post of uh Clark Griswold plugging in the the excuse me the lights, but but also the old man in the Christmas story, you know how he always had uh the huge uh big extension cords of lights.

William Auten:

Okay, well, right, right, right. He had a fire hazard thing that he plugged into the wall and it did burst on him, it uh every year it burst on him, yeah, yeah.

Chantal Roberts:

And and if that is not a uh fire hazard that we need to be talking about, so I think that's a great way to get into it. So let's talk about property losses. And and so, okay, so our first ones, of course, as adjusters, one of the things that we're gonna be looking for when we have our fire losses, there's a couple of different kinds of fire losses we can have, right? We can have the ones where our insureds have uh, or they're kind of like the old man where they put in too many plugs and they over. Oh, one of them's gotta go. Yep. One of them, you know, and and we're gonna have that fire. And when you're looking at a fire, you're looking for the origin and cause. And of course, if it's a big loss, I do recommend you always get an origin and cause expert involved, even if it is kind of obvious. But what you're gonna be looking for is making sure that the fire didn't begin in the middle of the room, you know, or something like that, because then you might be suspecting some kind of arson. Uh, as opposed to it being an electrical thing, that's gonna, of course, happen near the electrical outlets. And you're going to want either your field adjuster or your expert or whomever to hold on to those electrical cords, the wires, uh, maybe even cut out that particular socket in case it has to go to court or you do subrogation or something like that.

William Auten:

So I would say if you're an adjuster and you come across a fire that looks to have been um related to an electrical component or to any uh if if you seem to be able to identify where it happened and you have a suspicion as to why it happened, uh if it's a big enough loss, get a cause and origin uh uh professional in there. Don't touch anything, don't take anything out, because what may happen is um if there's a defect with one of the items that failed, if it's a uh, you know, maybe it's a GFI outlet, or maybe it's a power strip, or maybe it's Christmas tree lights, whatever it is, um they're gonna they're gonna want to uh arrange for uh the manufacturer to be on notice so that they can send their people as well. And everybody can be there when the evidence is examined and taken, so there's no spoliation issues. And that just spoliation is just that you've ruined the value of any evidence and it can no longer be used to support one side or the other uh in terms of uh liability claim. So um yeah, evidence is gonna be key, important in just about any fire claim, unless it's very minor and it was, you know, a cooking accident on the stove, and the the insured admits that's what it was. You know, that if it's a very, very obvious situation, then um it's not as important.

Chantal Roberts:

And you mentioned a very good thing where we're talking about getting our experts in and spoliation. Don't wait to notify the manufacturer or everybody else who's involved, the electrician, uh the construction people, the whomever. Uh it get those people involved early. And if if you think that you're gonna be subrogating, uh get those people involved early because they are gonna want that. And if you can't, uh then you absolutely need to be taking a lot of photographs because they will say that you've spoliated, meaning you've destroyed the evidence.

William Auten:

Yeah, if you've got a situation where one of the uh potential uh at fault parties does not want to participate, um, your job then becomes uh documenting everything as best you can with video, photographs, you know, and it again it depends on the severity of the of the damage um or god forbid injuries. But in those cases, you want to um really preserve everything you can about the scene. Um uh chain of custody should be used. Um we use forms where you know whoever's giving the item to us has to sign off on it. Uh we record the date, where we got it from, who we got it from, and then um and then it goes into uh either our evidence storage or to one of our engineers. So that's gonna be real important. Um and you know, as an adjuster, most times if you're assigned a claim like this, you will receive directives um for all this ahead of time, but not all. Hopefully.

Chantal Roberts:

Hopefully.

William Auten:

Sometimes uh a claim is reported and it doesn't seem as serious as it actually is until you get there.

Chantal Roberts:

Yeah, yeah. And and and and we're all saying hopefully, fingers crossed, because I just read, of course, Sandy Vina, who uh helped us out during while you were out, and she had just written a blog, and she had said, why are Gen Z not becoming claims adjusters? And of course, it's something that all claims adjusters know, and for some unknown reason there is a disconnect in the C-suites. It's because they gave this intern, uh, it was a workers' comp carrier, gave an intern a full load of 150 claims. You cannot do that.

William Auten:

What could go wrong?

Chantal Roberts:

What could go wrong? You he left within a day, and and that's what the blog was about. Because this is why everybody's running around uh running from claims, and so you had mentioned you might get instructions, but the first thing I thought of was this poor little intern who wasn't even a full-time adjuster. I bet you dollars to donuts. They didn't give him instructions. So this is again another reason why you should like, subscribe, and share this podcast with everybody else is because we do give you instructions. But that advertisement aside, you are absolutely right. You should hopefully be getting instructions on on how to do that.

William Auten:

Yeah, and for for managers and uh you know, the uh claims directors who are kind of leading the teams out there, um you know, make sure that everybody is aware of uh, you know, it's tough because you in any claims department, you're gonna have the new folks and the seasoned folks. And uh if you're doing uh a seminar every quarter about, you know, assigning cause and origin, the old folks have all heard it all before a thousand times. The new folks, for them it's brand new information. But you still gotta you still gotta have those conversations in those meetings. And um, you know, I've been I've been the experienced guy in those meetings, and and you you wanna um you wanna just get up and leave because you've already been through it so many times.

Chantal Roberts:

Yeah.

William Auten:

But you can you can offer valuable advice too as the as the senior folks and management should recognize those folks and allow them to have the floor um so that the younger people can uh can learn from them.

Chantal Roberts:

Exactly. You know, speaking of fire, the other one that we we often will see is when a friendly fire becomes a hostile fire, and these are quote unquote insurance terms. The friendly fire is the fire that stays in its area, whether that be in the little fire pit that we have outside, or the turkey fryer, or the fireplace, yep, versus the hostile called.

William Auten:

It's a place for fire.

Chantal Roberts:

Exactly. That's the name. Oh my god, they're so smart. Or it becomes a hostile fire, which then it's it doesn't mean that it's all starting things like, what do you mean? What are you looking at? I'm afraid. No, that's not what we're talking about. We're talking about how the fire has gotten outside of its place. Um, for example, a spark from the fireplace lands on the carpet and starts a fire.

William Auten:

That is now a hostile fire.

Chantal Roberts:

That is now a hostile fire. So these are things that you would need to be taking a look at. And again, having a fire start in the middle of a living room, in the middle of a bed, unless they're smokers, gonna be suspicious.

William Auten:

Fires that start around the perimeter of a room in a in a linear fashion.

Chantal Roberts:

Yeah, in a linear fashion. Yeah, also suspicious.

William Auten:

Yeah.

Chantal Roberts:

Fires that kind of like walk outside of the door in a very linear way. You know, start maybe start in the middle, just means that they've poured gas or some kind of accelerant all the way down. Because by the way, fire goes up. I don't know if anybody knew this, but fire goes up. And so it's really weird for a fire to start on the second floor and then go down to the first floor unless it's an all-consuming fire and everything capes in.

William Auten:

We had a an arson claim many, many years ago, and um it was winter, and the house was all closed up, and the arsonist poured gasoline, like I said, around the perimeter of two rooms in the house and lit it on fire. Well, it it started on fire, but then quickly went out because it had no air because of the house was closed up. And nobody noticed the damage until a couple weeks later. And they went in and there were these burns burn marks. Of course, it smelled like smoke, burned carpet in the place.

Chantal Roberts:

Right.

William Auten:

Um, but there was just these burn tracks around the perimeter of each room. Who did it, do you know? Yeah, yeah. We've eventually well we the um we had a cause and origin guy who uh was also involved in the local fire department. So um he was kind of a law enforcement background, and yeah, they got him. They got him.

Chantal Roberts:

Oh, good, good, good, good, good.

William Auten:

He wasn't very smart though. I mean, I well, I'm not gonna give any advice as to how he could have succeeded here, but just uh it was winter and the house was closed up, and we'll leave it at that.

Chantal Roberts:

Yeah, you know, and there's a lot of times we're talking about property damage, but there's also a lot of times when the property itself can create a liability claim. And and we've kind of uh talked about that. Uh we shouldn't jump ahead yet, because I'm thinking space heaters, I have space heaters uh in in a couple of places like my bathroom, because I hate waking up in the morning and having to take a shower and it's like freezing cold and everything. So I have a space heater in my bathroom. And I also have a space heater in my office. So if you've got an old one or whatever, those can of course create a fire. But going back to I guess to the to the liability one, you could have like what m uh carbon monoxide too.

William Auten:

But Yeah. Yep. Um when it comes to fires, the the Liability tie tie-in is usually uh the manufacturer of the item that started the fire.

Chantal Roberts:

Yeah.

William Auten:

Um another liability claim that happens in fires is when one property starts on fire and the fire extends over the neighboring property and causes damage over there. And um so for that neighbor in their insurance company, their insurance company will pay for their damage and then try and subrogate against the building owner where the uh the fire started. However, they're gonna have to prove that the homeowner of the first fire um actually was negligent in causing the fire, and that's not always the case. Um, if you have if you have uh uh an older electrical system, for example, that is working fine and has there's no signs that it's uh about to fail in any way, but a lightning strike or power surge happens and it does fail, um that's not necessarily liability. You could make arguments that, well, maybe they should have put a new system in and maybe they had the opportunity and sh, but they didn't. I don't know. The the a lot of gray areas there, but the bottom line is that they have to prove liability on that other uh property or owner in order to collect. Just because the fire started on their property doesn't automatically make them responsible for damage to other properties around there.

Chantal Roberts:

Right. And I do want to point out because this I've been talking a lot in my expert reports about the regulations that the that the departments of insurance and the states make, and then the difference between the Unfair Claims Settlement Practices Act, because I don't think that there is a lot of people who know the difference, which might be a great podcast topic to do one time. Because we go over the Unfair Trade Practices or the Unfair Claims Settlement Act, like 1st of January every year without fail, because it's important. But one of the things that these regulations, these administrative regulations talk about is the fact that just because the accident happened by someone else, like you, it's a liability claim, you as the carrier cannot tell your insured, no, I'm not gonna handle it. You need to go over to X because you know it's a liability claim. And if you think about it, that makes just a ton of sense because what has the insured done? They have paid you a premium. And so you are gonna work their claim, take the deductible, and then you've got the right to go after the other person for subrogation. And whether you get repaid or not, that's fine. I I would rather go through my insurance company so that way I don't have to deal with another adjuster. Because gosh knows, the way my luck is I'd probably get an adjuster like me and I'm mean. I don't want to deal with a mean adjuster. So yeah, well, that's something to think about.

William Auten:

Um if uh if if a third party is making a claim for liability against your policy holder, um the adjuster handling that claim should not be sitting there saying, Well, you should go through your own insurance company and they'll subrogate. Yep. Now you could make arguments that it's probably that they may be better off because they might have replacement cost coverage. Um they they might not have to wait for a liability decision or a dispute or a reduction based on contributory negligence or something like that. Uh so you can uh intelligently talk to them with some nuance and let them know that going through their own carrier might be the best bet. You'll entertain their claim, you'll you'll view it, you'll assess it, evaluate it, and whatever, uh, but they'll probably get faster service and actually uh better results if they were to go through their own insurance company if they have replacement cost coverage, for example.

Chantal Roberts:

Great, yes, great, great suggestion because it it it is kind of a dual thing. Like not only as a first-party carrier, can you not say you need to go to the to the other party, but as the third-party carrier, you owe a duty to protect your insured. So you can't sit there and go, no, you I'm not gonna take your claim. Now, listen, I know that there are a lot of carriers out there that will say, unless the insured calls it in, then we're not gonna take a third-party claim. That's a whole different kettle of fish, and I'm gonna tell you, I don't agree with it, but that again, whole different podcast. There are some problems with that theory, whole different podcast, but we're continuing on. Uh, but you're right. You've got uh going back to our fire thing, there's a lot of things, manufacturing defect, who's gonna be at fault? Is it the tenant versus the landlord? You know, if we're renting or something to that effect. I am always talking to my students about getting renter's insurance, and and they think, oh, I don't need anything for for my stuff. Yeah, I don't have anything. Uh and then I think, well, what happens if someone else starts the fire or whatever? And so yeah.

William Auten:

Well, uh, part of our job is to educate um uh both your policy holder and any third-party claimants um within reason. I mean, you don't want to educate your way out of a defense, um, but you do need to let that person know what their uh options could be, um and explaining how their own policy might react versus a third-party claim. I think it's an important conversation to have. And we actually do that quite a bit here.

Chantal Roberts:

Yeah, yeah, we do. And and it's part of the thing as to why I'm really, really passionate about some things, you know, and and make sure, and again, this isn't you as an adjuster. Of course, you would do this to your house since we're telling you, but if you only use your fireplace once a year uh back in Arkansas, didn't need a fireplace that often, right? And so we were kind of bad about getting it cleaned because we didn't need it that often. But you could have a fire that way. I think that in the northeast you all have uh what blowbacks or puffbacks or something like that. And usually those are excluded, but it's like the oil heating uh yeah.

William Auten:

For an oil furnace, um you can have a situation where uh uh when the wind blows, it forces air down the chimney and um and pushes it out. And today there's a the uh better devices to prevent that. Um but uh if you do see them, um not not very often anymore. Uh of course I don't handle property as much anymore either. Um but first party isn't just fires. You've got uh freeze damage when the weather cools down. Um you know, we've got a lot of folks, especially in older homes, might have basement openings that are fine during the summer. Um, but in the winter it uh it's a recipe for disaster and the wind blows, and uh and it just it only takes a small opening sometimes for uh for bad things to happen, especially if the if it's on the windy side of the property. Absolutely. That wind will come in and uh it'll just freeze a little section of the pipe, and that's all it needs to do.

Chantal Roberts:

It is all yeah, yeah. I it's really interesting being up here in in Kansas. I have and I and and I'm going to go to a home improvement store later on today and get a foam board because I've got one particular part in my kitchen sink. It ironically it faces the east, but at night I can open the the cabinet door when I'm getting ready to let the faucet drip, and I can feel the cold air coming in uh just from the the wall there. So I want to put a foam board in, even though I let the the faucet drip, but you're absolutely right. It can just be a little bit that causes that that thing, that pipe to burst. And remember, we don't, or I should say, I shouldn't say we, the policy, nine times out of ten, you gotta read your policy, all of it, every single time, but the policy generally does not pay for the pipe that burst, it pays for ensuing loss. So while the pipe burst, that absolutely 100% needs to get fixed, and you need to tell the insured, hey, this part isn't gonna be repaired. By the way, I would send out a reservation of rights letter to that effect, in addition to making that phone call. But the ensuing loss, meaning cutting it open, drying everything out, repairing, replacing, repainting, whatever, that would be I'm glad you brought this up.

William Auten:

Normally I would ask, um I would ask you a question.

Chantal Roberts:

Yes.

William Auten:

Where does it exclude uh freeze damage to pipes, to the pipes?

Chantal Roberts:

To the pipes? The f uh it's usually in the uh homeowners section and uh in the exclusions, where it will say we do not pay for freezing to pipes, appliances, HVAC systems, blah, blah, blah. And and what do you why are you shaking your head no?

William Auten:

So you're using some of the language from the freeze damage exclusion if you fail to maintain heat in the home.

Chantal Roberts:

Right.

William Auten:

Then there is also a section that will not pay for uh it will pay for water damage from accidental discharge, but it won't pay for the repair to the pipe. Right. Now that's in a situation where the pipe fails for some unknown reason. But freezing to pipes, that's not excluded. That's an accidental, that's an accidental loss to the pipe. So a burst pipe will pay for that.

Chantal Roberts:

Okay. This is this is where we're going to have to get up on to our policies. Okay, Bill, keep talking. Okay, okay, ice ice dams. You can do ice dams. I'm gonna pull up the HO policy here.

William Auten:

All right, you do some research and I'll talk about ice dams. Ice dams have uh uh ice dams are covered if you have an HO3 or or better. Um you have to have a uh uh if you have a named peril policy, an ice dam, uh water from an ice dam is not covered unless there's an opening caused by the weight of ice and snow. So what happens in an ice dam is you get ice built up at the edge of the roof, and then behind that ice, the water starts to pond there and pool, and shingles aren't designed to sit in standing water. So that ponding and pooling causes the water to back up and get under the shingles and then um and then come into the home through the eave and through the ceiling, and it causes water damage. And once the ice melts, the water goes away and the leak stops. Um that is covered under an HO3, but interestingly, most HO3s are not endorsed to have um uh to change or modify the coverage to the personal property. Personal property is insured on a named apparel only basis. So if that leakage uh comes down and damages your furniture and whatever uh things that are not the building, those items technically wouldn't be covered uh by an ice dam. So that's my ice dam talk.

Chantal Roberts:

Okay. So uh I just want to point out, by the way, that Bill did say last podcast that Google said I was right. I just want to I just want to point that out to everybody that Google said I was right. All right, so you are, I mean, you are correct in that you're talking about our exclusion, section one exclusions. And by the way, guys, I am just using our standard ISO homeowners policy 03 broad or special forms. Uh, the addition date I'm using is 511. There is a more recent one, but nine times out of 10, most people are using either their own company's policy form or they're still using the 511. Okay, so it says we do not ensure, however, for loss caused by uh 2C caused by one freezing of a plumbing, heating, air conditioning automatic, blah, blah, blah, appliance caused by freezing. This provision does not apply if you have used reasonable care to maintain the heat in the building, um, which is that exception to the exclusion. And for purposes of this provision, a plumbing system or household appliance does not include a sump, sump pump related, blah, blah, blah, or a roof drain, freezing, thawing, pressure, or weight of water ice, uh, whether driven by wind or yeah, uh wind to a fence, footing, retaining wall, pure door um pier or dock, which we totally don't have. But I am quite certain that we don't cover for that damage to the pipe that is that has that is burst.

William Auten:

So we do a search for accidental discharge.

Chantal Roberts:

Okay. We do have accidental discharge. Uh again, same section. Section one, peril assured against, and then there's exclusions uh caused by, which is C, same section that we see are fro are freezing. This is mold, fungus, or rot, which uh which talks about uh doesn't cover from mold, fungus, or rot if there's accidental discharge from plumbing, heating, blah, blah, blah, and same thing. And see, here it is. It's this is kind of what I'm thinking of. Any, I guess, any of the following wear-tear, mechanical breakdown, latent effect, um, discharge, dispersal, seepage, migration, that's of pollutants, though, really. Um, settling, shrinking, bulging, expansion. Uh and the exception to C, which is our exception to the exclusion, meaning that there is coverage, is unless otherwise excluded, resulting from an accidental discharge or overflow of water or steam storm within a storm drain, plumbing or heating, we do not cover loss to the system appliance from which this water or steam is escaped, which means that we don't cover the pipe. Um, section one A3 water paragraphs A and C apply to surface waters under 2BC ensuing losses described in coverages A and B, not precl not precluded. That's where I'm getting that we don't cover for those frozen pipes.

William Auten:

Because we do not cover loss to the system or plants from which this water or steam escaped for purposes of this provision of uh so you know what we need?

Chantal Roberts:

We need a coverage attorney, and that brings us to a great point.

William Auten:

This is this is never this is never going to be an issue that's litigated because to repair a frozen pipe is a very inexpensive repair. True. Um and and in most cases, when you've got a leaking pipe, even if the even if it falls under um this segment of the policy and it's you know the pipe fails because it corrodes and rusts out, um the the pipe isn't covered, but the resulting water damage is, even then, the cost to repair the pipe is minimal, and nobody's ever gonna sue for that. I don't think I mean somebody could someday. Um but in most cases, uh this is a pretty clear provision. Um but in a situation where you have um, let's say the entire home free, let's say family goes away on vacation, the heating system fails for unknown reasons, they made uh every effort to maintain heat in the property, but something went wrong that was out of their control, and the entire house froze from top to bottom. Every pipe in the place burst. You're gonna pay for that repair.

Chantal Roberts:

Let's see. Um okay. Again, Google, coverage council Google for whatever it's worth, right? I mean, and we all know if it's on Google, it's gotta be correct. Most homeowner insurance policies cover the resulting water damage from a burst frozen pipe, but typically do not cover the cost of repairing the frozen pipe. I agree. It it hinges on the damage being sudden and accidental. Um, you know, and of course it talks about the the failing to maintain heat and often it's 55 degrees, you know, yada yada yada, blah, blah, blah. And we've talked about this before. Um, but you're right. I mean, nine times out of ten, none of us, including the the field adjusters, take that pipe out. So we just pay it because it's gonna be so minor. I just am pointing that stuff off out or whatever.

William Auten:

So for what it's worth, for what it's worth, folks, make sure you make keep your house warm enough where the pipes don't freeze anyway.

Chantal Roberts:

And uh it's more for the adjusters, how you adjust the claim, yeah. You know, so maybe ask questions of the insured. Your thermometer, your thermostat was set to 55 and above, right? Hent, hint.

William Auten:

So let's take a look at how um how a liability claim could ensue in a in a frozen pipe situation. And um, I've had these claims where uh we might insure the company that delivers fuel to the house, maybe it's propane or heating oil or whatever, and they're in a schedule and uh they miss. A delivery unbeknownst to everybody. And uh the family goes on vacation, doesn't realize that delivery was missed, and uh insured had a contract. Uh they promised to deliver on a regular basis, and somebody fell asleep at the office there and didn't send the guy out to fill. And then the pipes freeze. Um, so that that uh supplier would have a potential liability claim against them.

Chantal Roberts:

Yes.

William Auten:

And uh more than potential. Uh they they would actually have a claim, and I've been involved in the adjustment of those claims.

Chantal Roberts:

And see, that that's interesting because immediately I go to one of our favorites, is I can see a pipe bursting. And when I did have a pipe burst, even in Arkansas, I had it happen. It was in the garage, an unheated garage, and it actually was leaking outside of the house. And so the water was freezing out there, and that created a slip and fall hazard.

William Auten:

Oh, yeah. Yeah. So um, yeah, we've we've had we've had claims where um contractors caused a leak and it uh it got outside into a public area and somebody slipped and fell on ice. So that can happen too.

Chantal Roberts:

And I and I do want to talk about as well, because I have this argument with with a a colleague or a friend of mine who believes, for whatever reason, that our property owners should be out in the middle of a of a uh blizzard shoveling the sidewalk. And I actually have a neighbor who does this, and I don't know why, other than maybe he wants to get out of the house. And this is his his exercise or whatever. But yeah, you you don't actually have to have that egress, ingress, meaning going to and coming from the the building property until the the storm ends. And and and so and and even then you don't have to be if the storm ends at 12 01 a.m. the insurance does not have to be out there at 12 02 shoveling.

William Auten:

They they have a quote reasonable time end quote to shovel or we had a unique unique circumstances last year, and the weather's setting up to do the same thing this year, where we have um a little bit of snow, a little bit of rain, a little more snow, a huge dive in temperatures, and then maybe a little more snow. It's almost impossible to avoid the buildup of ice when you've got those kind of of conditions, yeah. Varying conditions. Um and right now we're not getting enough snow. Like most plow contracts are set uh based on how many inches need to fall before they'll come because they can't be there every second of every day. So they'll say two inches, every two inches, or when it reaches three inches, we'll come out and plow. What that what that results in is you get a dusting of snow multiple times throughout the day. So there's never more than in uh a little layer of snow, uh, but it gets compacted by cars driving over it and people walking on it and just kind of sunlight hitting it, but not melting it all the way. And then all of a sudden you get this crusty situation that's almost over time that builds up. I was at a uh a parking lot last winter uh where there was a liability claim. The ice was eight inches thick. Oh my, it was unbelievable. I've never seen anything quite like it.

Chantal Roberts:

I don't think that ice or the salt ice melt would would get rid of that.

William Auten:

That and that's the problem. That that was the problem with an entire segment of the state last year is that everybody had the same problem. And the the places that had it an even bigger problem were were the ones where it was a very tight quarters and snow plow trucks really couldn't maneuver. Like if it was a bigger parking lot, they could they could get a head start and push and and clear it a little better. But these other ones where there's a lot of traffic and the snow gets compacted throughout the day. Uh this happened to be a like a convenience store parking lot. It was very small and it was open 24-7. So there was constantly cars coming in and out over three, four weeks, and it just built up and built up, and the plow couldn't do anything. The salt wouldn't do anything. And um, yeah, so uh unfortunately it's starting to do the same thing this year, and it's starting earlier. Last year it started January, February. This year we're already in December. We had single digits last Friday. It was six degrees when we left the house.

Chantal Roberts:

And and you know, again, I ask, why would anyone want to live out there? That's just crazy talk. It's it's cold here today.

William Auten:

We we have to stay here. We love the taxes so much. We just we have the best taxes, they're so high, and they make all of our politicians really happy. So that's what I care about.

Chantal Roberts:

It's kind of like California, it's so expensive. Uh but yeah, these guests slipping on unshuffled walks. I live in fear of this because I'm a claims adjuster. So, of course, my uh entrance, even if I'm not expecting a package, I never know when someone's gonna come walking up to my house, you know, and delivery person, who knows exactly. And I live in fear of them slipping and falling. So I am out there with some salt and my shovel and getting it at least somewhat clear. So that you don't want the milkman getting hurt, exactly, you know.

William Auten:

You don't have a milkman, do you?

Chantal Roberts:

We actually do. One of my neighbors, uh, and and it's so cute, too, because the company is named Chateau. So you think of it being like French, and of course, the French were the ones who settled this area and blah, blah, blah. But it's S-H-A-T-T-O. And it's the person's last name. It's like Chateau Farms, Chateau Dairy. And so I thought that was really, really cute.

William Auten:

Anyway, I gotta look at that, look at that up now. Yeah.

Chantal Roberts:

So the the other thing that you can you can think about, and we've talked about this before, which I thought was absolutely interesting, is the icicles and how they can become basically daggers to your head and kill you, um, which was crazy. Uh you don't remember talking about that? I do.

William Auten:

Yeah.

Chantal Roberts:

Because I just remember I I I turned your description was uh was uh it was apt.

William Auten:

Um yeah, we we do get those. It's not just icicles that can't I I don't think I've ever had one that uh an icicle actually, you know, impaled somebody. Um, but those chunks of ice do cause concussions and knock people to the ground and cause some you know serious injuries because especially if they're high, like we were in New York City one winter, and um the sun was hitting this uh tall building next to us, and all of a sudden these segments of ice were just crashing to the ground around us, and we had to run for cover. So yeah, it could be bad.

Chantal Roberts:

Yeah, yeah. Um, and there are so many more. I mean, I don't even think that we can we can get to all of them having Santa up on your on your roof, and and I mean he probably has those claws that you put on your your you know shoes that the roofers and the the field adjusters sometimes use when they're climbing their roofs and stuff like that. So he doesn't fall.

William Auten:

I can't think of the name of them.

Chantal Roberts:

I thought they were called claws, but like I thought that's what their legal name was. But and then of course, reindeer. That's a whole different thing because our their farm animals, they're not really farm animals, but they're specialized animals. So they're gonna Cougar paw. Cougar paws, that's what it is. Um, and the reindeer that that's going to be a special if they get injured or hurt or whatever, they're going to have a reindeer uh uh attacks somebody. Is it grandma because grandma was walking, she was a little drunk, and she was walking out in the middle of the road ran over by a reindeer.

William Auten:

Yeah.

Chantal Roberts:

I mean, you know, if it's it could happen.

William Auten:

I've heard I've heard a song about it.

Chantal Roberts:

I did too, and it could happen, but maybe it's grandma's time to go. I don't know.

William Auten:

I'm not saying it's operator error.

Chantal Roberts:

It could be operator error, maybe you know, it's like a little gonk glon gonk. Um from Santa's.

William Auten:

Santa's drinking a little more than milk.

Chantal Roberts:

You see, that's what I'm saying. Listen, I was watching Jamie Oliver yesterday with the husband, and Jamie Oliver was putting out cherry instead of milk that would be. So I'm just saying maybe that is the reason why grandma got hit. Not necessarily because she had also been drinking, but explains those rosy cheeks. Exactly. And you so there are a lot of auto-related act vehicular accidents that could happen in the in the winter.

William Auten:

Santa damaged your roof.

Chantal Roberts:

See, that's what I'm saying. Look, and again, this is what I'm gonna say. You gotta go through probably your own homeowners and then let them subrogate against the North Pole, because that's just gonna be really hard for you to get in touch with the North Pole, because I think they probably take the whole month of January off after that big old push. I would I mean I would too.

William Auten:

They have repairs to make on the sleigh, exactly.

Chantal Roberts:

You know, because because in and the reindeer, they gotta rest, especially if they hit grandma. Because low speed doesn't necessarily mean low exposure.

William Auten:

That's true.

Chantal Roberts:

Sometimes it does because we've talked about the missed claims, yeah. The minor impact soft tissue claims, but I mean maybe presents falling out of the sky on somebody's head.

William Auten:

It could be a disaster. Let's talk again. Let's talk again about um the Griswold family and the exploding Christmas tree and the cat.

Chantal Roberts:

Okay.

William Auten:

Um so do you do you guys do real tree or or uh we we usually do real tree, yeah. Have you ever seen a video of a tree uh getting lit on fire?

unknown:

No.

William Auten:

No, no. So um, because we live out in the country and we have you know, we have a lot of wood that falls every year. So we we we burn wood um and we would burn the Christmas tree. We'd put it out and you know, and then in the spring we would clean do cleanup and stuff. And when we when we were allowed to have open fires, which you can't always hear, right? Um the uh Christmas tree was always spectacular because the pine needles have all that sap in there and all that sugar makes uh really hot fuel and it's dry really dry wood and they go up so fast that if it were to happen in your house, there'd be no chance to put it out. It would be as sudden, almost as sudden as it is in the movie, um, where the cat chews on the uh the light cords. Yeah.

Chantal Roberts:

I gotta tell you, the uh the spousal unit is the one that's used to having the spousal unit. Yeah, the spousal unit. He's the one who's used to having the live tree. And so ever since we moved up here, we've had the live tree because I grew up with the fake tree because we live in fear of the tree catching on fire. And and so for that reason, too, I can't have him keep the lights on at night with the live tree, even though I water it every day. I mean, it's dead, but I still am like I'm watering it every other day.

William Auten:

But well, they say that helps, you know, because it does the capillary action will still pull that water up through the through the tree. Right. And um but even so, I mean that they they go up so quickly. Um, now when I was a kid, my mom had these little uh antique clips that would hold a candle, and you put those all over the tree. Could you imagine okay?

Chantal Roberts:

So let's talk about the Dickinson stuff because I wonder about that, but then I sit there and think they must just when you think about Ebenezer Scrooge, they were just putting the Christmas tree up on Christmas Eve.

William Auten:

Right.

Chantal Roberts:

So it was really only one night.

William Auten:

And so temporary.

Chantal Roberts:

Yeah, so it probably was still pretty fresh and not dry. And while it could be set on fire, I mean you're all sitting there looking at it.

William Auten:

Right. Whatever. Enjoy it for a few minutes and then put everybody put it out. Yeah. There was a uh do you watch Wheel of Fortune?

Chantal Roberts:

No, how old are you, dude?

William Auten:

I don't watch it. My spousal unit watches it.

Chantal Roberts:

Oh, your spousal unit watches it. No, I don't watch it. No.

William Auten:

She uh, so we were watching it, I think yesterday, and there was a woman from Buffalo, New York um who left her tree up all year long this year.

unknown:

Oh no.

William Auten:

She said she never got to it, and then it was like June. And she's like, I'm not gonna take it down now. I'm just gonna have to put it back up again in six months. So she just left it up.

Chantal Roberts:

So Well, there you go. The one thing that we have at Overland Park that I I do kind of like with our live trees is you can drop the tree off at a couple of the parks, and Overland Park then takes them and then puts them in our lakes and uses it for the fish habitats. Nice. Yeah. So don't they float? No, I think they weigh them down. Okay. I'm assuming they weigh them down. I don't know, but yeah, but it's it's nice. I just I would just think that after so many years you would start building up an island, but what do I know? I'm I'm a claims adjuster and an expert witness, not not a other kind of person. I we're probably getting way off topic, and we're gonna be talking the new year where we're gonna be talking about uh, of course, our claims handling standards, practices, and procedures with the Unfair Claims Practice Act. And so our next episode will actually come out on New Year's Day. So that'll be nice.

William Auten:

Where oh yeah, that makes sense. Welcome.

Chantal Roberts:

So won't that be very lovely? You can start working on that, and yeah, so there you go. I think we've pretty much covered everything. We haven't really talked about auto, but except for Sandy.

William Auten:

We have yeah, we have lots of stuff here. Auto, there's um using ladders to put Christmas tree lights up and the hazards associated with that, and uh so many hazards. So so many hazards. We'll save those for Christmas 2026. How's that sound?

Chantal Roberts:

Yeah, that sounds good. Let's do that.

William Auten:

Right on.

Chantal Roberts:

Okay. Well, we will see you later.

William Auten:

All right, take care.

Chantal Roberts:

Bye.

William Auten:

Thanks for joining us on the Art of Adjusting Podcast, where we talk about life as an insurance adjuster. Hit that subscribe button real quick and tell all of your adjuster friends to check this out as well. For independent adjusting services, go to www.autin.claims. And for anyone interested in working as an independent liability adjuster, go to the contact us tab to join our roster.

Chantal Roberts:

So this wraps up another Art of Adjusting podcast. If you enjoyed this podcast or this episode, please give us five stars and a review. It does help the algorithm pick us up. In the meantime, you can contact me at theartofadjusting.com for consulting and training purposes.

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Chantal M. Roberts, CPCU

Co-host
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Heather Blevins, CPCU

Co-host
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Sandy Avina, MBA

Co-host
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William Auten

Co-host
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Nicholas Kearns

Editor