Proving an Insured Loss: Policyholders Need Experts Too

4 ADJUSTINGTODAY.COM architects, auditors, engineers, or other professionals and the cost of using the Insured’s employees, for producing and certifying any details contained in the Insured’s books or documents, or such other proofs, information or evidence required by the Company resulting from loss or damage payable under this Policy for which the Company has accepted liability, including consultant’s services to the extent they are for producing and certifying any details contained in the Insured’s books or documents, or such other proofs, information or evidence required by the Company resulting from loss or damage payable under this Policy for which the Company has accepted liability.” Comment: Sometimes the insurer may dispute costs for items that were not specifically requested by the insurer. Also, sometimes there is language that excludes certain types of professional help. 2. “Professional Fees. This Policy covers the actual costs incurred by the Insured, of reasonable fees payable to the Insured’s accountants, architects, auditors, engineers, or other professionals and the cost of using the Insured’s employees, for producing and certifying any particulars or details contained in the Insured’s books or documents, or such other proofs, information or evidence required by the Company resulting from insured loss payable under this Policy for which the Company has accepted liability.” Comment: Similar to #1 but does not specifically mention “consultants.” This provision clarifies that “auditors fees” are covered, subject to whatever limit is shown. It is not clear, however, whether the insurer intends “auditors” to be used in a descriptive sense—meaning anyone who “audits” or compiles figures, or in amore defining way, limiting the term to an actual professional “auditor.” 3. “Claim Preparation Expense. Expenses incurred by the Insured or by the Insured’s representatives including accountants, appraisers, architects, auditors, consultants, engineers or other such professionals in order to arrive at the loss payable under this policy in the event of a claim.“ Comment: Often the shorter the endorsement, the broader it ends up being. 4. “Loss Adjustment Expenses. This policy is extended to include expenses incurred by the Insured, or by the Insured’s representatives, for preparing and certifying details of a claim resulting from a loss which would be payable under this policy.” Comment: Check declarations for specific dollar limits on these coverages. 5. “$________ on reasonable fees payable for producing and certifying particulars or details of the insured’s business required by the insurer in order to arrive at the loss payable under this policy in the event of a claim.” Comment: This endorsement is obviously subject to a limit of insurance, which would be purchased at a level commensuratewith the risk involved. There is no reference to a premiumcharge, and it is open-ended as to the types of services that are covered. Obviously, the term“reasonable” may prove troublesome in the execution of any claim. 6. “In consideration of an additional premium included, coverage under this policy is extended to cover any cost of inventory, appraisement, adjustment and preparation of loss data, not to exceed $________, in connection with any claim covered under this policy. It is understood and agreed that the insurance granted under this endorsement is intended to cover any and all costs as mentioned above which the insured deems necessary in the event of a loss, and it is further understood and agreed that the insurance under this endorsement is not subject to the average (coinsurance) clause, if any, contained elsewhere in this policy.” Comment: Like Example 1, this endorsement also limits the amount of coverage for fees, but it calls for an additional premium to be paid. Ostensibly, it places no limits on who may supply the services. The actual cost of the additional coverage as well as the limit of insurance are important factors to consider. Several insurance companies use more complex endorsements to extend coverage for loss adjusting expenses. While the items in the formmay vary to some

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