Diane's Diner is a favorite local place in the small North Carolina town in the mountains....

 

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Diane's Diner is a favorite local place in the small North Carolina town in the mountains. Diane's Diner is one of several ground-level retail operations in this larger building, with offices and other businesses on the upper floors. This is an old building and because of the slòpe of the street, Diane's Diner has 7 steps from sidewalk to her restaurant, one-day black ice formed among the steps, she sends one of her staff members to chip away the ice yet there isn't much success. One day a Dickson was leaving and slips among the steps. No sight of blood, he immediately gets back up. He then goes home and has had pain on most of his body, in particular his neck and lower back, but he took ibuprofen for it. Three days later, Dickson was at home with his wife, sitting in his chair, when his wife noticed his eyes were staring without awareness. The medical bills totaled $30,000. His medical insurance covered $7,000. The physical therapy bill was $5,000. His lost income for those 3 weeks was $4,200. His wife also lost income during that time, of $3,000. Dickson and his wife hire a lawyer who makes a claim against Diane's for $150,000 in damages. The lawyer provides copies of the medical bills and evidence of the loss of income. Diana's Diner is insured on a Businessowners' Policy (which includes general liability, so think of this as a CGL), at the location where the restaurant is and was in force at the time of the loss. The liability limit was $500,000 per occurrence, $1,000,000 aggregate, and includes products/completed operations coverage also at $500,000/ $1,000,000. There is an additional insured endorsement naming the owner of the building that the restaurant is in; the endorsement provides coverage for "losses, claims, and demands caused by the insured during the time this policy is in effect." Explain the process an adjuster should follow upon receiving notice of loss, as to steps to take upon receiving this, claims log entries, contacts with the insured, so as to abide by the Unfair Claims Settlement Act. Diane's Diner is a favorite local place in the small North Carolina town in the mountains. Diane's Diner is one of several ground-level retail operations in this larger building, with offices and other businesses on the upper floors. This is an old building and because of the slòpe of the street, Diane's Diner has 7 steps from sidewalk to her restaurant, one-day black ice formed among the steps, she sends one of her staff members to chip away the ice yet there isn't much success. One day a Dickson was leaving and slips among the steps. No sight of blood, he immediately gets back up. He then goes home and has had pain on most of his body, in particular his neck and lower back, but he took ibuprofen for it. Three days later, Dickson was at home with his wife, sitting in his chair, when his wife noticed his eyes were staring without awareness. The medical bills totaled $30,000. His medical insurance covered $7,000. The physical therapy bill was $5,000. His lost income for those 3 weeks was $4,200. His wife also lost income during that time, of $3,000. Dickson and his wife hire a lawyer who makes a claim against Diane's for $150,000 in damages. The lawyer provides copies of the medical bills and evidence of the loss of income. Diana's Diner is insured on a Businessowners' Policy (which includes general liability, so think of this as a CGL), at the location where the restaurant is and was in force at the time of the loss. The liability limit was $500,000 per occurrence, $1,000,000 aggregate, and includes products/completed operations coverage also at $500,000/ $1,000,000. There is an additional insured endorsement naming the owner of the building that the restaurant is in; the endorsement provides coverage for "losses, claims, and demands caused by the insured during the time this policy is in effect." Explain the process an adjuster should follow upon receiving notice of loss, as to steps to take upon receiving this, claims log entries, contacts with the insured, so as to abide by the Unfair Claims Settlement Act.

Answer rating: 100% (QA)

Upon receiving notice of the loss the first step the adjust er should take is to determine if there ... View the full answer