QBE AMERICAS THE IA GUIDELINES

Transcription

1 QBE AMERICAS THE IA GUIDELINES INDEPENDENT ADJUSTER SERVICE LEVEL, ESTIMATING, AND FIELD INSPECTION REQUIREMENTS for PROPERTY CLAIMS The purpose of this document is to establish guidelines to direct the actions of the Independent Adjusting firms and their Adjusting Staff with regard to the handling of QBE Americas, and all of it s affiliates field claim assignments, as related to the following: Service Level Expectations, Customer Interactions, Communication, File Activity, Authority, Professionalism, Technical estimating Mechanics, Estimating Platform Usage, Damage Documentation, Repair Scope Determination, Price Calculations, and Policy Driven Considerations. [January 2017 * Kevin Kelker

2 SERVICE LEVEL REQUIREMENTS/ASSIGNMENT ACKNOWLEDGEMENT:... 3 SETTING EXPECTATIONS WITH THE CUSTOMER:... 3 FIRST CONTACT:... 3/4 GENERAL COMMUNICATION:... 4 ESCALATION PROCESS:... 4 APPOINTMENT AND INSPECTION:... 4/5 INVESTIGATION:... 5 INSURANCE TO VALUE:... 6 REPORTING TO QBE:... 6 RECORDED STATEMENTS:... 6 OFFICIAL REPORTS:... 6 AUTHORITY:... 6/7 MISCELLANEOUS:... 7 APPROPRIATE ATTIRE:... 7/8 ESTIMATING REQUIREMENTS... 8 ESTIMATES:... 8/9 MEASUREMENTS: OPENINGS: PHOTOGRAPHS: DIAGRAMS:

3 ROOFING: EAGLEVIEW:...13 FLOORING AND ITEL: CABINETS: DRYWALL PAINTING AND DECORATING SHOWER PAN LOSSES FENCING DEBRIS REMOVAL DEPRECIATION OVERHEAD AND PROFIT FIELD INSPECTION REQUIREMENTS LADDER ASSISTS AND SECURITY REQUESTS: CONTENTS DEPRECIATION GUIDELINES NOTE: Exceptions or additions to these Guidelines may be communicated and required by QBE Americas or any of it s affiliates, based on specific policy, process, or system driven directives during integration projects. These directives may be temporary in duration and include third party business partners. 2

4 SERVICE LEVEL REQUIREMENTS ASSIGNMENT ACKNOWLEDGEMENT: Assignments are considered to be on a limited task basis unless clearly conveyed as a full adjustment. Acknowledge receipt of assignment by to QBE within 24 hours of receipt. Acknowledgment to include QBE s claim number, the name of the I/A firm s assigned adjuster and their telephone number and address. SETTING EXPECTATIONS WITH THE CUSTOMER: The most important aspect of achieving customer satisfaction is to establish expectations at every step of the claim experience; from first contact to claim settlement, the customer should be aware of each phase of the claim process. Once expectations are set, it is critical to deliver on those expectations. Reiterate each phase of the claim process to the customer: o Contact customer. o Set appointment. o Conduct loss inspection. o Scope damages. o Diagram structure. o Photo document loss and damages. o Collect documents and loss information from the customer. o Prepare damage estimate. o The IA should discuss the general scope of damages and repair methods with the customer to confirm understanding and process expectations o Report packages containing photos, estimate, scope report, diagrams, rough draft estimate, audit report, variance report, loss recap and other required attachments will be submitted to QBE for review. These will be based on divisional needs and requirements. o QBE will contact the customer to explain coverage analysis and or settlement details. FIRST CONTACT: First contact to be made with the customer within 24 hours of receiving the assignment. This must be a voice to voice contact. 3

5 If contact cannot be made within the 24-hour time frame, an explanation is required in the initial report, and a contact letter must be sent to the customer within 48 hours of assignment. If no contact within seven days, the IA should contact the QBE adjuster to close the claim. Upon voice contact with the customer, introduce yourself by first and last name, indicate that you are calling on behalf of the customer s insurance company (state company name), and explain the reason for calling. Confirm the customer s address and/or loss location address, phone number, and confirm the customer s QBE claim number; confirm pertinent information about the inspection (two story, roof tarped, or any other access concerns). Recount the facts of the loss and empathize with the customer s loss and situation. Provide the customer a contact phone number and address as well as an alternate contact number within the I/A firm. GENERAL COMMUNICATION: All telephone calls, faxes, letters, s, etc. are to be responded to within 24 hours. If QBE s policyholder contacts you directly and they have questions or issues other than the scope of the damage estimate or inspection, direct the policyholder to the QBE Claims Employee. Advise the policyholder or borrower, that you will follow up with QBE and QBE will respond to them within 24 hours. Be professional and empathetic in your communication and correspondence. Discussions concerning coverage issues are to be directed to and handled by QBE. If a policy or coverage question should arise from the customer, politely refer these to QBE for resolution; provide the QBE contact information to the customer. Do NOT discuss coverage issues or policy provision questions with the customer, Public Adjuster, contractor, etc. unless directed and approved by QBE. ESCALATION PROCESS: In the event a loss or customer issue requires the matter to be escalated, contact QBE immediately, and QBE will advise how to manage the situation or take over the matter. APPOINTMENT AND INSPECTION: Make every attempt to make appointments voice to voice. 4

6 Attempt to schedule the inspection for a specific time on a specific day; avoid generalized time frames, i.e. between 8 am and noon tomorrow. Work within the customer s schedule; avoid arriving at a loss location without an appointment. Do not set appointments or complete inspections with a minor or only a minor present. Inspection to occur within 72 hours of the first contact with the customer. If an inspection is not completed within this time frame, an explanation is required in the initial report. If running late or a reschedule is needed, an advisory call to the customer is required. Reschedule with an apology and work with the customer s schedule; update QBE of the rescheduled date and reason Leave the customer with your business card, contact information, and QBE contact information. Winter inspections present several issues, including snow, low temperatures, and access. If the roof cannot be inspected due to a heavy amount of snow or ice you will need to generate additional information. If the insured reports interior damage, then you will want to schedule an appointment to inspect the interior damage. You will notify the QBE adjuster and you may submit the estimate to the QBE adjuster for partial settlement. Advise the insured you will follow up with them when it appears the local weather conditions have improved and remind the insured they can call your office to schedule the exterior re-visit too. If permission is granted by the insured, you may complete the exterior only inspection at your discretion and as early as possible. INVESTIGATION: Investigation to be completed within 7 calendar days of assignment for residential losses and within 9 calendar days for commercial losses. Follow-up investigation activity accomplished at a minimum of 14 calendar days until the claim is resolved or as otherwise explained in reports. First status at 10 days and the follow up second status report at 21 days, from the time the assignment was accepted. Notification to QBE within 24 hours if the investigation uncovers potential coverage issues (NOTE the I/A is NOT to make any coverage determinations) Notification to QBE within 24 hours if the investigation determines loss exposure exceeding $10,000. Notification to QBE within 24 hours if the investigation determines adverse risk factors or suspected fraud. It is QBE s policy that there will be no referrals, recommendations, or implied use of any contractor to customers. Reserve recommendations should be sent to QBE within 72 hrs or upon inspection finalization. 5

7 INSURANCE TO VALUE: REPORTING TO QBE: Insurance to value calculations are to be completed on total structural losses or per assignment instructions. If an insurance to value calculation is not indicated on the assignment, the overall insurance to value of all involved risks is to be commented on in the initial report (examples: risks appear insured to value or risk may not be insured to value given materials used in construction and recent addition to the building). Notification to QBE within 24 hours of an investigation determining potential insurance to value issues (NOTE QBE will then determine any co-insurance issues). Use approved estimating platform reports. Reports are to be submitted electronically. The degree of detail in the reports is to be in proportion to the nature and circumstances of the loss. An initial report is due within 10 calendar days of assignment. Supplemental reports are due within 10 calendar days of the initial report or sooner if requested. Only affected captions need to be addressed in supplemental reports for additional damages or hidden damages. Closing reports are due within 5 calendar days of closing the assignment, submitting the estimate, and are to include the final billing invoice. RECORDED STATEMENTS: Statements are to be taken per assignment instructions only. Statements are to be in digital.wav file format and forwarded to QBE when directed to do so. Do not transcribe recorded statements unless requested by QBE. OFFICIAL REPORTS: AUTHORITY: Official reports (police report, fire reports, etc.) are to be obtained if outlined in the assignment instructions otherwise Police and Fire reports will be obtained by QBE. You DO have authority to reach an agreed scope of damages with the customer, Public Adjuster, or their contractor of choice, however, final approval for all such scope agreements must be approved by QBE. Such agreements must be noted in the report submitted to QBE. You have NO authority to reach an agreed repair price without QBE s approval and direction. 6

8 You have NO authority to authorize repairs or expenses without QBE s approval. You have NO authority to authorize emergency services or mitigation without QBE s approval. You have NO authority to authorize a contractor to assist in determining an agreed scope of damage and repair costs without QBE s approval. You have NO authority to authorize the use of any expert without QBE s approval. You have NO settlement or denial authority without QBE s approval. You have NO authority to obtain a release without QBE s approval. You have NO authority to accept service of a summons and complaint on behalf of an insured and/or any affiliate of QBE. All coverage decisions will be made by QBE. MISCELLANEOUS: Utilize the most current and approved QBE Daily or Catastrophe Fee Schedule for all losses. The presence of a CAT Code on the assignment will determine if the Catastrophe Fee Schedule is to be used. No additional charges for local phone calls. No additional charges for administrative, clerical, office, and/or file set up fees. No charge for the first seventy-five (75) miles (See Fee Schedule). Mileage exceeding the first seventy-five (75) miles will be paid at the approved QBE Fee Schedule Rate (See Fee Schedule). You agree to provide a centralized and consistent process for claim assignments and allow for claim specific instructions in addition to the service level requirements outlined in this document. QBE has the right to audit all claims, related files, and records, including but not limited to estimates and invoices; adjuster timesheets must be available for inspection on time and expense billed assignments. QBE has the right to re-inspect all claims handled by you. You agree to provide QBE with reports when requested. You agree to protect confidential information. Where a QBE guideline may conflict with a state fair claim handling requirement or mandate, the state guideline will supplant such guideline. Claims records to be retained for a minimum of three years after case closure or last report filed, whichever is later; records must be maintained longer if mandated by applicable laws. APPROPRIATE ATTIRE: Dress professionally. Be clean and neat; do not wear dirty or tattered clothing. 7

9 Do not wear shorts or T shirts of any kind as outerwear. Do not wear clothing with inappropriate slogans, graphics, or advertisements. Do not wear sandals, slippers, Crocs,' or open toed shoes. Dockers type slacks are preferred, but clean jeans are acceptable. Collared shirts are preferred; these can be button up or golf type shirts. ESTIMATES: ESTIMATING REQUIREMENTS Estimates are to be completed using The QBE approved estimating platform (Symbility) establishing RCV, depreciation, and ACV calculations as directed in this document. Estimates are to be component based. No lump Sum or single bottom line estimates are allowed. Large or total loss estimates can include sub-bids for Plumbing, Electrical, and HVAC trades only. Large or total loss estimates should be component based and stick built unless otherwise directed by QBE. Estimates are to be written using the most current Symbility price database for the loss location area. No custom or created databases are to be used. If the estimate is a supplement to the original loss damage estimate, please use the original price list for new or added components. Estimates are to reflect a proper scope of damage and include all needed operations. If a new or updated database is loaded during the creation of an estimate, all previously entered components must be recalculated to the new database pricing. This does not apply to Supplemental estimates. Include overhead and profit when the complexity of loss requires the need for a general contractor to oversee repairs (not always three distinct trades). Estimates are to be submitted to QBE for review and approval; do NOT release estimates or any other documents to policyholders or any third party without QBE s prior approval. See Setting Expectations above. Do NOT estimate damages not covered under any policy without QBE s prior approval. This would include damages with causes such as termites, wear, and tear, etc. QBE does not allow the IA to make or determine coverage or policy conditions. Item comments should be used whenever less than 100% of the item is being estimated. Item comments should be used to describe the estimate components when unusual damages or estimate circumstances are involved; it helps 8

10 the customer understand the estimate and avoids confusion for QBE during potential re-inspections. Price overrides from the estimating platform database should include an item comment explaining the change and provide supporting information on how the overridden price was derived; the text line should immediately follow the overridden price in the body of the estimate (NOTE: notations such as cannot find price in database or changing price to reflect or meet contractor price are not acceptable). Avoid manually grouping several component operations or line items under one component. Utilize the Symbility price database as it is intended to include listed operations and materials. Example: Do NOT select the line item for 3-tab shingles and then indicate it includes all flashing, vents, etc., if it does not. Write-in components should include a text line explaining the reason for the write in and provide the basis for pricing with supporting information; the text line should immediately follow the write-in component in the body of the estimate. A deduction for openings should be shown for each affected interior room and taken for applicable component operations (examples: painting, cleaning, etc.); measure all openings to the inside edge of interior trim if present. This also applies to exterior elevations. Repairs to adjoining areas should be considered in the absence of a natural break. A natural break could be a doorway or flooring transition strip, differences in surface material of floors, walls, or ceilings. Cabinets (wall and base), tub surrounds, showers, and mounted mirrors are considered openings with respect to painting, cleaning, wallpaper operations. This would not apply to framing, drywall, etc. operations. Estimates and diagrams should show multiple doors, windows, and missing wall measurements. Roof estimates should show the number and type of layers (example: two layers, composition over wood shake) in a line item note. If estimating material or components are missing from the structure and the quality of the item is not known, select a material grade that is equal to, or would be normal for the quality of the structure itself. All estimates must include the applicable state and/or local sales tax. Sales tax should not be included in each line item entry but should be a single total amount to properly reflect the material and/ or labor directed by state law. Each estimate must show the actual tax percentage being applied to the loss. Each estimate must include the peril and/ or cause of loss. Each estimate must include the date of loss and inspection date. Each estimate must include the QBE issued claim number. 9

11 MEASUREMENTS: Measurements should be to the nearest inch. Interior room measurements should be made wall to wall (not trim to trim). Floor measurements should have cabinets, bathtubs, etc. deducted where appropriate for the type of flooring; hard flooring such as tile or wood or vinyl tile should reflect appropriate deductions (NOTE: vinyl sheet or roll goods should not have deductions due to the way the material is purchased). Exterior repairs should be broken out by elevation with measurements; examples: front, right, rear, left (NOTE: estimates should reflect total overall measurements and dimensions for each elevation and include deductions for any applicable openings. Offsets must be included in the estimate and illustrated on the diagram. Rooms should not be squared off. Rooms should be identified by a name also reflected and consistent with the estimate. OPENINGS AND NATURAL BREAKS: See Estimates Section PHOTOGRAPHS: Photographs are to be sufficient to properly and clearly document damages; show all affected areas including the cause/origin (example: photos of pipe leak or fire origin). Photograph the risk address (unless a Rural Route, etc.) and each exterior elevation whether damaged or not. For hail damage claims, photographs should show the overall roof area, test squares showing damage or lack thereof, and close-ups of hail hits. Roof photographs should include the drip edges, multiple layers, and general condition of the roof surface as well as the pitch gauge (indicating the roof pitch).. Photograph quality should be such that QBE can easily identify damages; wide views and close-ups are useful to verify damages. Photographs should include damages potentially excluded from coverage (example: rotten wood). Photographs are to include a brief description of the damages depicted Photographs are to be in digital format and attached to reports. The number of photos must be reasonable to document the loss conditions properly but avoid needless duplication. Photograph any unacceptable risk at the loss location such as maintenance concerns, safety issues; bad dogs, chemical or hazardous material storage. 10

12 DIAGRAMS: Diagrams should be completed using Symbility diagram Diagrams are required on all claims. Diagrams should detail rooms and dimensions for all affected areas and/or adjoining rooms (example: open runs of flooring). Rooms should be identified by their name (example: master bedroom, kitchen, etc.); closets should be listed as separate rooms or subrooms per Symbility and NOT offsets. Offsets should be illustrated on the diagram; rooms should not be squared off. Diagram should indicate damages and note origin of loss. Interior room diagrams should include the number and position of doors and windows. Diagram should show polar direction (N, S, E, W) and the front of the risk Rooms not damaged are required to be included in the diagram as well but do not require measurements or openings. Roof diagrams and measurements are required on all claims where there is possible roof damage or is the cause of loss. Roof diagrams are to include the dimensions, roof pitch, number of stories, and the age and number of layers of the existing roofing; show measurements for all ridge, hips, eaves, and rake dimensions. Roof diagrams should indicate which slopes are recommended to be repaired or replaced. Roof diagrams should show the location of vents, jacks, and length and placement of ridge vents. Roof diagrams on hail claims are to include the location of multiple test squares and the number of hits per test square. For wind and hail claims, indicate the direction of the storm on the diagram. Aerial Photo generated roof diagrams are allowed if needed to determine. measurements, slope, etc on a multi story, high pitch, or complex roof. The cost should be paid directly by the IA. APPLIANCE & HVAC: Appliance and machinery losses should include good overview photographs as well as close up photos of identification plates. All appliances or HVAC equipment being addressed in the estimate should include Make, Model and Serial numbers, age and other pertinent information. If lightning report is needed, the IA will report to the QBE adjuster that a report may be needed and the QBE adjuster will handle accordingly. 11

13 ROOFING: Repair should always be the first option considered in the estimated scope. Roof tear off is a fixed amount. Do not add an additional waste factor for tear off roof claims are to be physically inspected with no exceptions. The investigation should occur from the surface of the roof (if additional help is needed to gain access to roofs on multiple stories or steep pitched [>7/12], ladder assists are acceptable see Ladder Assists and Security Requests below. If roof replacement is recommended, an explanation as to why repairs are not possible should be included. When estimating damages on roofs where the existing material is 20 yr., 3tab, comp shingles, 25 yr., 3tab, comp shingles are an acceptable LKQ replacement product in the following conditions; 1. The IA Adjuster must determine the 20yr shingles are not available in the loss area. 2. The IA Adjuster must indicate efforts to obtain 20 yr. shingles in the narrative report. 3. If the IA Adjuster cannot determine if there are 20 shingles available or if there are questions, estimate what is currently on the roof and the QBE Claims Employee will make any needed changes. All decisions to repair or to total a roof must be based on the conditions of the roof and normal reparability issues. Do not make the decision based on the Material-Example; the roof is a 20 yr., 3-tab comp shingle roof and can be repaired, but there are no 20-yr. shingles available in the area. The roof can be repaired using 25 yr., 3 tab, comp shingles. Select the appropriate waste factor for the type of roof being replaced or repaired. If we have a 3-tab roof replacement we will allow for replacement of ridge, and waste factor should be capped at 10% waste. Steep and two story charges are based on actual area. Do not add an additional waste factor for these items. Roof slopes should be estimated as separate entities unless the roof is totaled On roof claims involving hail damage, a slope in each direction should be tested; the test square (10 x 10 ) should be marked with chalk to be visible in photographs and hail impacts circled versus marked through with an X Replacement and/or repair recommendations are to be supported by the estimate, measurements, diagrams, photographs, and report; QBE will review and determine the degree of damage that qualifies for total roof replacement Granule loss in and of itself is typically not considered damage; some granule loss is inherent to composition type shingles. If spaced sheathing is observed, photographs from the attic should be taken for documentation. 12

14 In the absence of other covered damage, lifted/non-sealed tabs alone are not necessarily indications of wind or other damage. Additional items to consider are: ridge cap, metal valley, plumbing sleeves, chimney step flashing, skylights, vents, felt, drip edge, pipe jacks, removal and reset of A/C unit, or antenna/satellite attached to the roof, access charge, and debris removal, as appropriate. Need photos to confirm damage and replacement. 10% waste factor on gable roof replacements. 15% waste factor on hip roof replacements and may be appropriate on more intricately designed roofs with multiple roof lines, valley, or dormers. 10% waste factor when replacing one slope. 5% waste factor should be used for a flat roof & most metal roofs. Add linear feet when replacing the ridge shingle. ROOFING and EAGLEVIEW: During the inspection, the field adjuster will be required to follow the Roof Assessment Checklist and ensure each item is addressed. This checklist is for everything on the property to ensure a complete inspection of the exterior is completed. Once the roof has been assessed and photographs have been taken, the I/A will need to determine if an EagleView report should be ordered. Additionally, the I/A may be asked by the QBE handling adjuster to order the report. Information that needs to be considered when ordering a report include, but are not limited to the following; how complex is the roof? How many facets does the roof have? How many square feet is the dwelling? Are more than two levels involved? Is this a high pitch roof? Gable roofs are generally excluded from reports unless there are more than three dormers. You are not required to physically measure the roof when the EagleView report has provided this information. The I/A s report must include the type(s) of roofing, the age of roof, slope pitch, and the number of layers of roofing. When EagleView is not available, measurements must be taken or verified manually and sketched in Symbility. FLOORING and ITEL: Repair should always be the first option considered in the estimated scope. If flooring replacement is recommended, an explanation as to why repairs are not possible should be included. Typically, we only owe for one finished surface; this applies to all flooring surfaces (examples: wood, vinyl, tile, carpet, etc.). 13

15 We owe to replace hardwood with hardwood; the top surface (sand and finish) is considered the finished surface - if you have carpet over a hardwood floor, do not figure to sand and finish the hardwood floor and then replace the carpet. Field Adjusters must distinguish hardwood floors from laminate floors due to high variances in price, quality, and repair options depending on type and quality of the flooring. Generally, repairs to damaged hardwood floors can be isolated to the damaged planks. These planks can be removed and replaced, and the floor sanded, stained, and refinished to match. It is important to identify the cause of loss to wood floors since wood flooring can be damaged by non-covered causes such as warping from humidity, surface water, improper installation, etc. The Field Adjuster should evaluate the level of damage to the hard wood floors as hardwood floors can be sanded and refinished without replacing the actual wood. This is dependent on the extent of damage and the number of time(s) the wood floor has previously been sanded and refinished. When estimating to sand, stain, and finish hard wood flooring some items that need to be taken into consideration are: Refinishing the floor up to a natural break. The machinery used to sand, stain, and refinish wood floors may mar baseboards causing them to be damaged, appropriate repairs or replacement should be allowed. For engineered hardwood flooring, the type and manufacturer of engineered flooring often determines the reparability. Some manufacturers give a warranty of 1 to 3 sandings for the lifetime of the engineered wood. When replacing wood & tile floors, it should be replaced to a natural break (doorway, flooring material transition, etc.). It is generally difficult to stop at doorways unless there is a clear transition. If strip flooring runs under a door, proper estimating may require an estimate to extend into another room. Replace vinyl & carpet flooring to a break ; either a different floor covering, transition strip, or floor levels. Unlike the possibility for wood & tile floor, carpet does stop at a threshold and would not extend to an undamaged room. Area deductions for items such as base cabinets should only be taken when calculating laid to fit flooring products such as vinyl tile, hard tile, wood flooring, etc.; flooring products such as roll (carpet) or sheet (vinyl) goods are cut to fit installation and should not reflect deductions. Carpet and sheet vinyl measurements should be calculated by the square foot. Do not clean carpet that is going to be replaced. Identify all needed flooring construction components. If there is a sub-floor, the only replacement requirement is typically just the finished floor, however, if the sub-floor is damaged, we would owe to repair or replace as needed 14

16 Utilize the appropriate quantity and waste calculation method for the material being replaced. ITEL Flooring Process for all QBE loss assignments. Please take and submit flooring samples to ITEL on all losses involving flooring damage if the replace quantity is equal to or greater than 150 sf, or if premium grade flooring is being estimated. The Field Adjuster will attempt to secure ITEL sample as policy language does authorize to receive a sample to determine claim settlement. This includes carpet and wood flooring. Tile and vinyl flooring reports will be left to the Field Adjuster s discretion or at the request of the handling adjuster. The Field Adjuster should attempt to update the estimate with the Itel results. If Field Adjuster is unable to update the estimate with Itel results within a reasonable timeframe, they will enter all the available information in the estimate and list as an ITEL line item. Leave the cost to supply as an open item on estimate. The Field Adjuster will update the narrative and explain that an Itel report was submitted and the estimate will be updated as soon as the report is received by the Field Adjuster. When taking flooring samples for ITEL, remove them from a closet, against a wall or another out of the way location. Do not create a hazardous situation for occupants. If needed, arrange to secure a sample when the mitigation work is going on, or meet with the insured s contractor in order to secure a sample. CABINETS: Consider cabinet repair when possible depending on the scope of damage If cabinet replacement is recommended, an explanation as to why repairs are not possible should be included. If there is a matching issue regarding the replacement of the stain/veneer of the cabinets, consider using a reface of cabinets. Typically, we owe for equivalent quality of material; i.e. like kind and quality Non-site built cabinet units can be removed and replaced on an individual basis Site built cabinet runs may require more extensive repair or replacement options depending on trim, shelving, and tie-ins DRYWALL: Estimate the actual square footage that needs to be repaired or replaced and include the minimum charge adjustment if applicable. Be sure to estimate using the proper component for the repair (there are multiple components to choose from) 15

17 Popcorn or blown acoustic textured ceiling repairs should reflect a scope for remove and replace on the entire ceiling versus spot repairs within the ceiling area, unless the existing ceiling has been previously spot repaired PAINTING AND DECORATING: If only one wall in a room is damaged, go ahead and paint all walls in the same room. This would not include the ceiling, if there was no damage to the ceiling. You may consider using masking/tape for ceiling, if needed. When a wall or ceiling has been water stain damaged, the standard repair is to spot seal the stain and paint the wall or ceiling with one coat Consideration should be given when ceilings, walls, and trim are different colors or types of paint; for example, repairing ceiling damage does not necessarily require painting the walls when they sustain no damage and/or are a different color than the ceiling New drywall typically requires a prime coat prior to the finish coat, or a total of two coats Documentation is required if estimating three paint coats as it is rare that damages would require to seal/prime and then paint two finish coats Trim should not need to be painted unless it sustains damaged. SHOWER PAN LOSSES: If replacement is recommended, an explanation as to why repairs are not possible should be included. Consideration should be given to reparability (i.e. thin set versus mud set, etc.) before replacement is determined. Grout failure is an example of a normal maintenance issue which is typically excluded in most policies under the wear and tear provisions. The IA Adjuster should discuss with the QBE Claims Employee to determine if coverage exists. If grout failure is evident, a shower pan test may be necessary to determine causation and applicable coverage; any third-party testing required to determine causation is to be pre-approved by QBE. If grout failure is evident as the cause of loss, provide photos to the QBE Claims Employee and obtain direction in handling the loss inspection. Direction for coverage should be provided by QBE. Prior to the final scope, repair, access, and cosmetic impacts and options such as reroute,' tunneling,' foundation penetration,' location,' etc., should be fully discussed with QBE and based on policy coverage. FENCING: If fencing replacement is recommended, an explanation as to why repairs are not possible should be included. Repairs should not be depreciated. 16

18 Depreciation only applies if one entire fence run (corner post to corner post) has been damaged and needs replacement; replacing anything less than an entire fence run would be considered a repair and not subject to depreciation. This is a general rule as some exceptions may exist and need to be considered and noted If a fence is co-owned, payment should reflect 50% of the estimated cost for repair or replacement; documentation of co-ownership should be obtained - but if verification of co-ownership cannot be obtained, estimate the loss at 100%. Estimates for verified co-owned fence losses should show the full scope of the damage, and then reflect 50% of the unit cost. This should be noted as a line item note in the body of the estimate. Fence inspections should include measurements of damaged areas or runs; do not count fence sections. DEBRIS REMOVAL: Debris removal is an allowance for general clean-up and removal of debris out of the house or structure and to the truck or dumpster. Scope what is being hauled off and figure the appropriate number of hours; this should be listed as one entry for the entire estimate in a General category at the bottom of the estimate. Only estimate for one-line item for DMO charge. Do not estimate for separate DMO charges; interior and exterior. If a dumpster is involved, consider the proper size and the number of times it must be emptied. If a Truck Load component is being considered to haul debris, DO NOT use a fraction of a load. DEPRECIATION: Appropriate depreciation should be addressed on all claims. Line by line depreciation should be shown with the proper application of depreciation based on the age, usage, and condition of the item, regardless of the policy type. Refer to the Depreciation Schedule within Symbility for direction on material life span expectations. Labor only operations, such as cleaning, are not subject to depreciation Refer to specific state DOI law that would exempt any material from depreciation. Make a note of any laws that would apply. Do not depreciate using a single percentage factor estimate wide (i.e. 50% of the entire estimate). Do not exceed 75% depreciation on any single line item or component Address all depreciated components as recoverable in the estimate. The QBE Claims Employee will change appropriate items to non-recoverable as the policy conditions allow. Depreciate Law and Ordinance issues 100% until the cost is incurred. The same applies to Building Permits, etc. The depreciation for these items can be less if instructed by the QBE Claims Employee. 17

19 OVERHEAD AND PROFIT: The application of Overhead and Profit (O&P) should be calculated as Overhead (10%) AND Profit (10%) instead of Overhead AND THEN Profit (21%). Overhead and Profit should be included when the complexity of the loss or conditions of the loss require the need for a General Contractor; do not determine O&P based solely on the number of trades involved in the repairs. Overhead and Profit calculations should not include tax. Tax should not be applied to the O&P calculation amount unless required by the state where the loss occurred. FIELD INSPECTION REQUIREMENTS LADDER ASSISTS AND SECURITY REQUESTS: Roof must be multiple stories and/or a slope pitch greater than 7/12; provide documentation to support the need. Pre-approval from QBE is NOT required; provide documentation to support the need. Cost for ladder assist is paid directly to the contractor, etc. by the I/A; cost is to be included in the I/A bill to QBE as a pass-through cost with no markup and not a separate bill (no contractors, etc. will be paid directly by QBE). Security assists for protection are to be handled in the same manner as ladder assists. CONTENTS: Do not include the replacement and/or cleaning of damaged contents such as furniture, clothing, electronics, toys, etc. in the structure estimate Consider remove and reset components or contents manipulation to facilitate structure repairs. Inform the insured they will need to provide a list to the QBE Claims Employee of the damaged contents property. The insured will need to use Inventory sheets provided by QBE. Obtain overview photos of all rooms and all higher value contents that are damaged. Photograph the underside of furniture cushions and the inside of the drawers to document the brand of furniture. The primary task of the IA Adjuster on Contents claim assignments is to investigate the loss conditions, photos the loss conditions, and contact the insured. 18

20 The IA Adjuster is not to create contents lists, or price contents lists. QBE Claims Employees will use an approved contents vendor for this activity. SHEDS & OTHER STRUCTURES: Determine if the structure qualifies as an Other Structure (Coverage A) or Personal Property (Coverage B): The Structure qualifies as an Other Structure (Coverage A) when: It is a permanent part of the realty, has a foundation, or has tie downs or is in some other way affixed to the realty. If it was removed, it would deface the property. The structure qualifies as Personal Property (Coverage B) when: It is manufactured to be easily moved such as pre-fabricated plastic storage units, or the shed is placed on skids for easy transport. DEPRECIATION GUIDELINES The QBE Depreciation Guidelines should be used as a guide when applying depreciation to estimates and personal property inventory forms. 1. Depreciation should be applied by percent on each line item where applicable. 2. A maximum of 75% depreciation will be taken on structural components. 3. Structural components less than one-year-old will not be depreciated unless there are notes in the claim file to explain any deviation. Verbal discussions regarding the age of the items with the insured or borrower should be documented in the Independent Adjuster (IA) notes or adjuster log notes and Short Form narrative. 4. The Independent Adjuster must show applicable depreciation as outlined in this Guide from dollar one. 5. No depreciation will be taken on contents items that are less than six months old unless there are notes addressing why depreciation was warranted (i.e. excessive wear and tear or condition). 6. QBE Claims Employees will review all estimates and inventories to confirm the correct percentage of depreciation was applied to the loss in accordance with policy guidelines. 7. Any necessary revisions to estimates and inventories or deviations from the guidelines need to be addressed in the IA Short Form narrative report or in the adjuster log notes. A line-item- by-line-item discussion of each component is not required. 19

21 8. QBE Claims Employees should contact the IA for an explanation regarding the age and condition of the home, any major components related to the loss and an explanation as to IA deviations from the guideline if these were not included in the IA s narrative. In cases where the depreciation amount is not significant, it is acceptable for the adjuster to document the file and pay the claim. 9. The following structure trades are not subject to depreciation: asbestos, cleaning, contents manipulation, l, equipment, excavation, permits & fees, rough carpentry, labor, scaffolding, temporary repairs, wrecking & hauling, and water extraction services. 10.Depreciation taken should be spot checked on each estimate by focusing in on the five largest estimate items based on the items stated Replacement Cost. 20