Jim Pearl

Burglary Insurance to be an "outside" not an "inside" job Burglary insurance claim can be complex as there are many cases where the break-in is not easy to prove. One such case was the Iowa Supreme Court case C & J Fertilizer, Inc. v. Allied Mutual Insurance Co., 227 N.W.2d 169 (1975). In this case, all the exterior doors to the building were locked when plaintiff's employees left the premises at the end of the business day, and on the next working day it was seen that the exterior doors were still locked, but the front office door was unlocked. There were truck tire tread marks visible in the mud in the driveway leading to and from the plexiglas door entrance to the warehouse. It was demonstrated this door could be forced open without leaving visible marks or physical damage. There were no visible marks on the exterior of the building made by tools, explosives, electricity or chemicals, and there was no physical damage to the exterior of the building to evidence felonious entry into the building by force and violence. Chemicals were stored in an interior room of the warehouse and the door to this room, which had been locked, was physically damaged and carried visible marks made by tools. Chemicals were stolen as also some office and shop equipment. The policy made it clear that the “place of business was entered feloniously, by actual force and violence". The SC found that was nothing relating to the negotiations with insurer’s agent which would have led plaintiff to reasonably anticipate that the insurer would bury within the definition of "burglary" another exclusion denying coverage when, no matter how extensive the proof of a third-party burglary, no marks were left on the exterior of the premises. The court felt that the insured was ignorant of the technical issues and would have thought that a burglary would be proven where it was an "outside" not an "inside" job. The SC felt that “The exclusion in issue, masking as a definition, makes insurer's obligation to pay turn on the skill of the burglar, not on the event the parties bargained for: a bonafide third party burglary resulting in loss of plaintiff's chemicals and equipment.” The SC stated that there is mass advertising to sell "protection”. A person who has been incessantly assured that a given company's policies will afford him complete protection is unlikely to be wary enough to search his policy to find a provision nullifying his burglary protection if the burglar breaks open an inside, but not an outside, door. There has to be an implied warranty of fitness for intended purpose. The SC felt that “Effective imposition of an implied warranty would encourage insurers to make known to insurance buyers those provisions which would limit the implied warranty inherent in the situation. These exclusions would then become part of the initial bargaining.” The court also applied the unconscionability doctrine. The burglary claim was allowed based on the above points.

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Pay attention, your business auto insurer might be changing its terms, and not in your business's favor.... Two changes I have noted on a few commercial auto insurance policies I reviewed that you should be aware of: First, an "approved driver only" clause in the liability coverage. Under normal circumstances, you submit your list of company drivers to a prospective business auto insurer and they'll run MVRs to determine whether there are any drivers they feel are unsafe and unfit for coverage. Once coverage is bound, they provide you with a list of guidelines for drivers who should and should not be on the road - - - but they're not making HR decisions for you, and your business should automatically be covered for any new driver hires. With this clause in place, the insurer is pretty much telling you who you can hire and who you can't by saying if you don't submit the driver to them for approval before hiring them and putting them behind the wheel, your business has no coverage for that driver. It's somewhat understandable an insurer would do this, and also really dumb. Insurers want premium. A business needs to make money in order to pay premium. This insurer is hampering the business's ability to make the money to pay the premium. At some point, this insurer's strategy is self-destructive and frankly untenable for its policyholders anyway. The other item to watch out for is coinsurance. Some auto insurers have started requiring your business to insure the physical value of a given vehicle to a certain amount they believe it to actually be worth, and if you don't they will pay only a portion of the cost to repair or replace the damaged vehicle. Say you insure a dump truck for $145k, and when it gets damaged your insurer shows up and says, "eh, shoulda been insured for at least $200k. The repairs are $60k, we'll give you $43k." Don't worry about my lousy math, just know that's how it'll go down for you at claim time if you have coinsurance on your commercial auto policy. Coinsurance was a property insurance clause that used to be a good thing because it prevented people from defrauding insurers and avoiding paying the proper premiums for their property. Now it is weaponized against policy holders to allow insurers to underpay claims. If you want to know whether your commercial property insurer will give you a fit at claim time, ask them to confirm your property is currently insured to value. Tell them you want to be sure it is, and will raise the values within reason if the insurer feels the current values are too low. If they say yes or tell you to raise the values to "x" to get your business's property fully insured to value, you're good to go. If they refuse to answer, pray you never have a property loss and get ready if you do because you're almost certainly in for a fight. The more you know....... #strategy #unbiasedadvice

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The Workers Compensation Paradox : Workplace injuries are going down. Workers' comp costs are going up. That paradox should stop every claims professional in their tracks. If frequency is falling, why is severity rising faster than ever? The answer isn't in the claim file. It never was. For decades, our industry has built smarter and smarter tools to analyze what's already recorded — injury codes, billing data, prior claim history. We've gotten very good at recognizing which claims look like expensive ones based on what past expensive claims looked like. But the real drivers of delayed recovery? Fear of re-injury. Catastrophizing. Workplace dissatisfaction. Mental health overlays. Social stressors that never get documented anywhere. WCRI and NCCI have confirmed this for years: biopsychosocial factors — not injury severity — are the primary predictors of delayed return-to-work. And yet most claims organizations have no repeatable, reliable way to surface them. That's the blind spot. At The Claim Lab, we built our entire platform around closing it. We go directly to the injured worker — at day one — with validated psychosocial questionnaires that capture what no claims system records. We turn that data into AI-driven risk profiles that tell your team not just which claims are at risk, but why — and what to do about it. Not a flag. A playbook. The result: 10–15% reductions in disability duration that have outsized impact on indemnity spend, litigation rates, and most importantly — the experience of the injured worker trying to find their way back. Severity isn't going away. But with the right intelligence, it is manageable, measurable, and increasingly — preventable. If your team is doing everything right and still losing ground on claim costs, it may be time to look at the one data source no one else is collecting. The person behind the claim. Learn more at www.claimlab.org \#WorkersCompensation \#DisabilityManagement \#ClaimsManagement \#Insurtech \#ReturnToWork#claimlab

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My claims advocate opened the file and started naming people, not policy provisions. That taught me everything about how claims actually work. It was my first big claim. SEC suit against an investment management client. We bring in Ed, our senior claims advocate and attorney, to help manage the response. I'm expecting him to dive into the policy. Start reading provisions. Analyze coverage grants. Review exclusions. Instead, he opens the file and says: "Ah, good. We got Greg." (Greg was the underwriter.) Then he says: "And my buddy Sarah handles claims for Greg and their team." He knew them by name. Knew their track records. Knew how they operated. I thought we were there to review coverage. To design response. He taught me we were there to work with people. Policies don't respond to claims. People do. The policy language matters. But the people interpreting that language matter more. Ed spent the first 30 minutes teaching me about how Greg and Sarah work. Not about their company—about them specifically. How Greg approached gray coverage situations. How Sarah worked with brokers during claims. What their track record looked like on similar situations. He said: "These are good people to have on a claim. They won't be easy. They'll be tough. But we always seem to get to a reasonable place with them." That was the tell. "A reasonable place." Here's what I learned: most claims aren't black and white. They're not "this is clearly covered" or "this is clearly excluded." They live in gray areas where the policy language could go either way. And in those gray areas, the people on the other side of the table often determine the outcome. Some carriers approach gray coverage asking: "How can we deny this?" Others ask: "How can we cover this?" That difference is everything. Twenty years later, the people are still how we select carriers. My teams don't just evaluate policy forms. We evaluate who will be in the room when our client's business is on the line. Because coverage is only as good as the people who honor it. Let's connect if you want a broker who's been through this before.

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Health Insurance Costs Are Out of Control These are real plan options from Blue Cross Blue Shield of Illinois, and the numbers are staggering. Monthly premiums over $3,600–$3,800 for Silver PPO plans. Deductibles ranging from $3,000 to $12,000. Out-of-pocket maximums as high as $21,200. Even the Bronze PPO plan is nearly $2,800/month with a $17,200 deductible. For many families, that’s more than a mortgage payment just for health coverage, before receiving care. Something in our healthcare system clearly needs to change. #Healthcare #Insurance #Costs #BlueCrossBlueShield #HealthcareReform #HealthInsurance

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