Investigations: Determining the Cause of Loss

The course, “Investigations: Determining the Cause of Loss,” covers a range of frequently encountered loss scenarios, focusing on the investigative challenges most commonly faced by adjusters. Topics include roof losses from wind and hail; investigation of residential fire losses involving high resistance heating and corrugated stainless steel tubing; water losses from ice damming and freeze breaks; and sump pump overflow and infiltration through basement walls. The module is presented by Lyle Donan, President and CEO of Donan Engineering, and Tom Counts, Senior General Adjuster for CNA Insurance Company.

The goal of the course is to help build the adjuster’s foundation for determining the cause of loss through better loss analysis and investigation. There are four main components of claim handling — fact gathering/ investigation, application of coverage, assessment of the covered damages, and claim resolution. This course focuses on fact gathering/investigation.

The course begins with a brief overview of causation, including concurrent causation and proximate cause. Next, the instructors discuss how wind affects buildings. Intentional hail damage and restoration fraud are discussed in great detail. The instructors explain residential fire losses, and how corrugated stainless steel tubing (CSST) has been found to cause fire losses in certain situations. Mold and cold weather residential water damage losses such as ice damming and frozen plumbing are detailed in section 5. Finally, appliance leaks and damage caused by water heaters, PVC plumbing, toilets, and sump pumps are discussed.

After completing the course, the attendee will be able to define concurrent causation; explain proximate cause; describe the effect of wind damage on buildings and identify where you should look for wind damage; recognize at what point a shingle is considered wind damaged; discuss various aspects of restoration fraud; identify different forms of intentional hail damage; enumerate the four classifications of fire losses under NFPA 921; list the potential risks associated with corrugated stainless steel tubing; define ice damming and explain how damage from ice damming can be identified; identify mold; outline common freezing failures; identify the various parts of a water heater; explain the potential areas of failure in a toilet; and describe the best way to investigate losses involving sump pumps.

The course is designed for practitioners and insurance professionals working in the area of insurance coverage analysis and litigation. Professionals in the property coverage arena will find this course beneficial.