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Homeowners Insurance – Understanding Water Damage

The key to understanding if water damage to your home is covered is based on knowing WHERE the water ORIGINATED. A homeowners policy covers water damage, but with significant exclusions and limitations. Typically a policy will pay for sudden and accidental water damage from inside water sources but will not pay for losses caused by […]



The key to understanding if water damage to your home is covered is based on knowing WHERE the water ORIGINATED.

A homeowners policy covers water damage, but with significant exclusions and limitations. Typically a policy will pay for sudden and accidental water damage from inside water sources but will not pay for losses caused by water that finds its way into your home from the outside.

Examples  of inside water sources that cause water damage and that are typically covered are inside water pipe leaks or breaks (like behind a wall or under a sink); or leaks from appliances (like hot water tanks, washing machines, or dishwashers).  Your property deductible is deducted from the covered loss.

It is important to note that it is the “damage” to your home from the water loss that is covered; NOT the repair to the actual item that failed.  Your policy pays for the necessary costs to access (i.e. cut open an undamaged wall to access a broken pipe and then pay to repair the wall) and repair the damage caused by the water.  But, the broken pipe itself, which failed because of wear and tear, decay, defective materials or methods of construction, is not part of the covered loss.  The cost to repair the pipe or appliance is your responsibility.

Let’s take a closer look at FOUR types of water damage:

  1. Roof Leaks
  2. Water Leaks Through a Foundation
  3. Water Backup Through Sewer or Drain
  4. Flood (Excessive Surface Water, Overflow of a Body of Water, Etc.)

Roof Leaks

A typical homeowners policy covers water damage caused by an accidental external cause (for example a tree branch falls on it, windstorm blows shingles off, etc.) and coverage is provided for both the roof and any water damage to your walls, ceilings, carpet, personal property, etc., subject to your deductible.

However, if the water damage is not caused by an accidental external cause and simply because the roof is old and worn out, only the damage to the walls, ceilings, carpet, personal property, etc. is covered…..the roof itself isn’t covered.

The reason that the resulting water damage to the inside of your home is a covered loss, even when a roof isn’t damaged but simply old and worn out and allows water to leak in, is because the “wear and tear” exclusion in a homeowners policy says damage first must be from “accidental direct physical loss”…BUT it also goes on to say “however, we do insure for any resulting loss.”

This makes sense when you consider that most other covered water losses result from something that failed because of wear and tear and leaked water causing damage – like a water pipe that rusts and leaks, or a hot water heater that wears out and leaks, or a water connection that gets old, splits and leaks. So, this is why insurance companies monitor and care about the condition of your roof.

Because of this exception to the “wear and tear” exclusion, an insurance company may periodically inspect the roof on a home they insure to make sure it has not worn out.  If a roof becomes deteriorated or neglected, the insurance company may insist that the roof be replaced or they will cancel the insurance policy.

For a home owner seeking insurance for the first time from an insurance company on a home they purchase or already own, the insurance company or agent will want to know the age of a roof before a policy can be written…if the roof is too old for it’s type (i.e. comp or tar and gravel roofs have a shorter life span than tile roofs), then the insurance company will refuse to write a policy. A more expensive “non preferred” policy will need to be purchased that likely will include a roof exclusion. Once a new roof is put on, then the exclusion will be removed or a new cheaper preferred policy written.

Water Leaks Through a Foundation

A typical homeowners policy excludes water damage caused by:

Water below the surface of the ground, including that which exerts pressure on, or seeps or leaks through a building, wall, bulkhead, sidewalk, driveway, foundation, swimming pool, hot tub or spa, including their filtration and circulation systems, or other structures.

To keep homeowners policy premiums affordable for everyone, coverage is not provided for losses that can be prevented by sound building practices or as a result of normal wear and tear, rather than sudden and accidental events.  So, the main reasons it is necessary to exclude “water below the surface” from a policy are:

  1. Current construction methods require the foundation to allow water to drain away from the home. Older homes may not have followed these methods or due to improper grading, the shifting of the soil or past severe water events, water may find a path to begin collecting underground next to the home.    If the intrusion of water through foundations were covered by insurance, then a home owner would have no incentive to correct the problem.  Covering these events would give rise to repeated claims after every periodic severe weather season.
  1. Over time, every foundation settles, cracks, and eventually deteriorates.  This “wear and tear” may require a home owner to excavate around the foundation (and basement) to place drain tiles and patch/re-seal the foundation and basement concrete walls.  Again, if this type of water loss was covered then a home owner would have no financial incentive to repair or improve their home.

 

Water Backup Through Sewer or Drain

Most homeowners’ policies exclude or restrict water damage caused by the backup of sewers or drains.  The provisions vary from company to company, but usually states that water damage is excluded if caused by:

Water or water-borne material which backs up through sewers or drains or which overflows or is discharged from a sump, sump pump or related equipment.

This exclusion is talking about “overflows” of water from sewers (like out of toilet bowls) and “backups” from drains (like floor drains and sinks).   The source of the water or sewage may be “off premises” from a plugged public sewer system or caused by water inside the home that is left on or stuck on which overwhelms a drain system that is plugged or restricted.

It is important to mention that almost ALL policies sold by Farallone Pacific Insurance include coverage for sewer or drain water backup. The companies we represent tend to offer policies that are more comprehensive than those sold by our competitors and automatically include coverage. If the company doesn’t include the coverage automatically, we offer our clients the opportunity to purchase coverage via an endorsement.

Water back up from sewers or drains damage can be costly, both the cleanup and repair, so

why does a homeowners policy exclude coverage for sewer or drain water backup?

  1.  Water backup losses are extremely common but preventable with maintenance and preventative measures by the home owner.  Water losses from plugged up toilets and clogged up drains can be prevented or minimized when home owners are observant and promptly repair sticking toilet bowls and clogged, slow running drains.
  2.   Water systems require periodic maintenance or reinvestment by the home owner. Over time, every water drainage system becomes restricted with rust, deposits and accumulated debris. Drain fields become saturated and tree roots interfere with drainage.  Without preventative maintenance, slow running drains won’t handle normal water flow or plug up completely.
  3. Off premises sewage backups can be prevented with the installation of drain backflow preventers that are installed on your drain line.  Unfortunately, many older homes did not have these preventers installed.
  4. During flooding the water table rises and first causes water backup through sewers and drains.  Since “flood” is an excluded coverage, the unendorsed homeowner’s policy has this exclusion.

Flood (Excessive Surface Water, Overflow of a Body of Water, Etc.)

A homeowners policy excludes water damage caused by flooding, more specifically:

 a)  Flood, surface water, waves, tidal water, tsunami, seiche, overflow of a body of water, storm surge or spray from any of these, whether or not driven by wind, including hurricane or similar storm.

 b) Release of water held by a dam, levee, dike or by a water or flood control device or structure.

There are two primary reasons it is necessary to exclude “flood” from a homeowners policy:

  1. Flood losses are often devastating natural disasters that cause more property losses than any individual insurance company can financially withstand.
  1. Most surface water losses can be prevented with proper landscaping of a property that drains water away from structures.   If these losses were covered, property owners would not go to the expense of preventative landscaping for the extreme weather events that occur in long cycles – like every ten, twenty or thirty years.

If your home is located in a floodplain and your community participates in the National Flood Insurance Program (NFIP), you can purchase flood insurance coverage. Your lender may require flood insurance as a condition of your loan.  The NFIP is administered by the Federal Emergency Management Agency (FEMA), which works closely with nearly 90 private insurance companies to offer flood insurance to home owners through authorized property and casualty insurance agents

If you are interested in learning more about water damage coverage, exclusions and limitations or have other insurance related questions, please contact Ramona Johanneson at rjohanneson@fp-ins.com or 415-493-2502.

 

HOA Master Policy Blues – What Happens When Coverage Runs Out

Live in a condo or home in a HOA? Find out in this article what happens when the master HOA policy runs out of coverage after a loss. If you live in a condo or a home and belong to a HOA – what will you do when the master HOA policy doesn’t pay because […]



Live in a condo or home in a HOA? Find out in this article what happens when the master HOA policy runs out of coverage after a loss.

If you live in a condo or a home and belong to a HOA – what will you do when the master HOA policy doesn’t pay because there isn’t enough coverage after a loss? Hopefully you’ll simply submit a claim to your condo owners (HO6) or homeowners (HO3) individual policy and let your own insurance company pay for the special assessment levied against you, using the “loss assessment” coverage in your policy. You’ll pay nothing other than your policy deductible, typically $1,000 or $2,500 and walk away.

But wait, did you know that most – the majority of condo and home policies sold in the industry – include just $1,000 of loss assessment coverage? Sure, if there is a fire and the master HOA policy runs short of coverage because the repair estimates from the contractor were 40% higher than the master policy limits….maybe an assessment might be $10,000 to each owner and you’re on the hook for just $9,000. The reality is that there are many worse losses than this every year involving condos, homes and the common areas surrounding them. The most common serious losses involve injuries/fatalities at the pool, spa, gym, walking/riding trails and tennis courts. A recent settlement from a slip and fall within the association’s common exercise area resulted in a jury awarding $2 million MORE than the limit on the HOA master association liability policy.

The old axiom is true: there’s safety in numbers. For example, if you live in a 100-unit condominium association or master planned home community and your association is forced to levy a special assessment against unit owners because of a $2 million shortfall in the master policy due to the slip and fall loss just mentioned, this $2 million is split 100 ways for a special assessment of $20,000 per owner. Oh, but what if the same thing happened in a 20-unit condominium or master planned home association? The special assessment would be $100,000 per owner.

If you are wondering what you can do to protect yourself against being on the hook for a large special assessment by a condo or home HOA association, the answer is simple. Purchase a condo owners or homeowners policy that includes an “automatic” loss assessment limit of $50,000 (the maximum typically available). The policies sold by or endorsed by Farallone Pacific Insurance Services include this $50,000 limit for condos or homes belonging to a HOA. Once the special assessment is levied, you’ll contact Farallone Pacific and ask that a claim be submitted to your own condo or home policy and $50,000 is going to go a lot further than the standard $1,000 included in most policies.

I encourage you to take a look at your condo or home policy right away if you belong to a HOA, see exactly what the loss assessment coverage limit is. If the policy states $1,000, you should contact me immediately and I will help you to purchase a better policy, likely for the same or less premium than you are paying now. Our agency represents a number of preferred insurance companies and I’m confident that one of our policies will meet or exceed your expectations.

To learn more about loss assessment coverage, please contact Ramona Johanneson at rjohanneson@fp-ins.com or by calling 415-493-2502.

 

Benefit Insights Understand the ACA Reporting Requirements

We thought it helpful to provide an outline of the Affordable Care ACT (ACA) reporting requirements under IRS Sections 6055 & 6056. While some mandates continue to be delayed, we fully expect 2016 to be the year of full compliance with reporting requirements. There is a great deal of confusion regarding the use of the […]


Posted in Healthcare

We thought it helpful to provide an outline of the Affordable Care ACT (ACA) reporting requirements under IRS Sections 6055 & 6056. While some mandates continue to be delayed, we fully expect 2016 to be the year of full compliance with reporting requirements. There is a great deal of confusion regarding the use of the newly required 1095 and 1094 forms. This primer hopes to shed light on the subject and hopefully clear up questions on your responsibility.

This should not be construed as tax advice. We are sharing our understanding of the ACA requirements and how they apply to each market segment, but we are not operating as a tax advisor. As always, we strongly suggest that anyone should consult with a licensed tax professional or CPA before filing any IRS documents.

SUMMARY

  • Most Small Group Employers (under 50 full-time and full-time equivalent employees) are exempt from filing any documents under Sections 6055 and 6056
  • Large Employers are required to file 1095-C and 1094-C forms
  • 1095-B forms are filed directly by the Insurance Carriers unless you are an employer that offers a self-insured group plan
  • 1095-A forms impact individuals that purchase their insurance directly from a State or Federal Exchange and have no impact on group plans

FORM REQUIREMENT & RESPONSIBILITY MATRIX

 

Insurance Type Required Form 6055 Reporting
Insurer Responsibility
Required Form 6056 Reporting
Employer Responsibility
Individual (On-Exchange) N/A
Form 1095-A sent by Marketplace
N/A
Individual (Off-Exchange) Form 1095-B
Form sent by Insurance Carrier
N/A
Small Group Fully-Insured
Including SHOP Marketplace
Form 1095-B
Form sent by Insurance Carrier
N/A
Small Group Self-Insured Form 1095-B
Form sent by Employer not Carrier
N/A
Applicable Large Employer (ALE)   Fully Insured Form 1095-B
Form sent by Insurance Carrier
Form 1095-C
Sections I, II
Applicable Large Employer (ALE)   Self-Insured N/A Form 1095-C
All Sections 6055 + 6056

DEFINITIONS & EXPLANATIONS

FORM 1095-A

If you bought health insurance through one of the Health Care Exchanges, also known as Marketplaces, you will receive a Form 1095-A which provides information about your insurance policy, your premiums (the cost you pay for insurance) and the people in your household covered by the policy. The 1095-A form, only applies to those individuals that purchased their own plans directly from a State sponsored or Federal (www.healthcare.gov)

The Affordable Care Act, also known as Obamacare, requires most U.S. residents to have health insurance, but it also offers a tax break, the Premium Tax Credit, to help offset the costs of health coverage. If you bought coverage through one of the health insurance marketplaces, you should receive a copy of Form 1095-A, which provides information needed to claim the tax credit.

The 1095-A does not apply to any Small or Large Group plans and does not impact an company, medical plans.

FORM 1095-B

A Company is responsible for filing IRS Form 1095-B only if two conditions apply: It offers health coverage to its employees, and it is “self-insured.” This means that the company itself pays its employees’ medical bills, rather than an insurance company. A company that doesn’t meet both conditions won’t have to deal with Form 1095-B. Its employees might still receive a 1095-B, but this comes direct from their insurer carrier, not the employer. The 1095-B reports information showing that an employee or individual had the required minimum essential coverage required under the law. This is proof that an individual meets the ACA Insurance Mandate to have coverage. If an employee or individual cannot provide this proof, they may be subject to the ACA fines for not having insurance coverage.

FORM 1095-C

The Affordable Care Act requires certain employers to offer health insurance coverage to full-time employees and their dependents. Those employers must also send an annual statement to all employees eligible for coverage describing the insurance available to them. The Internal Revenue Service (IRS) created Form 1095-C to serve as that statement.

The health care law defines which employers must offer health insurance to their workers. The law refers to them as “applicable large employers,” or ALEs. A company or organization is an ALE if it has at least 50 full-time workers or full-time equivalents. A full-time worker, according to the law, is someone who works at least 30 hours a week.

Small Group employers with less than 50 full-time workers and full-time equivalents are not responsible for sending or reporting 1095-C information to the Federal Government or their employees. They are exempt as a small employer.

FORM 1094-B

Form 1094-B is the cover sheet used by insurance providers when they send the IRS information about who has health coverage that meets the standards of the Affordable Care Act. The 1094-B is brief and only takes up less than a page. This form is also used by any employer that offers health care coverage to its employees and is “self-insured”.

If an employer falls short of 50 full-time and full-time equivalents and is not “self-insured”, they are not required to send out 1095-C’s, 1095-B’s and do not need to report their health plan information to the IRS. Your insurer will report directly to the Federal Government using the 1095-B. Most employees on group coverage should receive a 1095-B directly from the insurance carrier.

FSAs, HSAs and HRAs are not subject to the Form 1095-B filing requirement (because they do not provide Minimum Essential Benefits and therefore by themselves do not relieve the employee from the individual mandate penalty tax).

FORM 1094-C

IRS Forms 1094-C and 1095-C are filed by employers that are required to offer health insurance coverage to their employees under the Affordable Care Act. The main difference between them is that the 1095-C provides information about health insurance (see above) and is sent to both employees and the IRS, while the 1094-C is a cover sheet about the 1095-C and is sent only to the IRS. If an employer is exempt from filing a 1095-C, the 1094-C is not required.

Contact Denis Squeri for more information – dsqueri@fp-ins.com

15 Warning Signs of Workers’ Compensation Fraud

The workers’ compensation insurance system is a no-fault method of paying workers for medical expenses and wage losses due to on-the-job injuries. While the majority of WC claims are truthful, the National Insurance Crime Bureau reports that billions of dollars of false claims are submitted each year. To help you detect possible WC fraud, experience […]



The workers’ compensation insurance system is a no-fault method of paying workers for medical expenses and wage losses due to on-the-job injuries. While the majority of WC claims are truthful, the National Insurance Crime Bureau reports that billions of dollars of false claims are submitted each year. To help you detect possible WC fraud, experience shows a claim may be fraudulent if two or more of the following factors are present:

 

  1. Monday Morning: The alleged injury  occurs either “first thing Monday morning,” or late on a Friday afternoon but not reported until Monday.
  2. Employment Change: The reported accident occurs immediately before or after a strike, a layoff, the end of a big project or at the conclusion of seasonal work.
  3. Job Termination: If an employee files a post-termination claim
    1. Was the alleged injury reported by the employee prior to termination?
    2. Did the employee exhaust his/her unemployment benefits prior to claiming workers’ compensation benefits?
  1. History of Changes: The claimant has a history of frequently changing physicians, addresses and places of employment.
  2. Medical History: The employee has a pre-existing medical condition that is similar to the alleged work injury.
  3. No Witnesses: The accident has no witnesses, and the employee’s own description does not logically support the cause of injury.
  4. Conflicting Descriptions: The employee’s description of the accident conflicts with the medical history or First Report of Injury.
  5. History of Claims: The claimant has a history of numerous suspicious or litigated claims.
  6. Treatment is Refused: The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
  7. Late Reporting: The employee delays reporting the claim without a reasonable explanation.
  8. Hard to Reach: You have difficulty contacting a claimant at home, when he/she is allegedly disabled.
  9. Moonlighting: Does the employee have another paying job or do volunteer work?
  10. Unusual Coincidence: There is an unusual coincidence between the employee’s alleged date of injury and his/her need for personal time off.
  11. Financial Problems: The employee has tried to borrow money from co-workers or the company, or requested pay advances.
  12. Hobbies: The employee has a hobby that could cause an injury similar to the alleged work injury.

Knob and Tube Wiring = No Homeowners Insurance

Knob and Tube wiring was installed in homes up until about 1950. There are a few instances of homes built in the 1960’s and 1970’s with this wiring, but these are the exception. It is now nearly impossible to obtain homeowners insurance if a home has knob and tube wiring. The insurance companies understand the […]



Knob and Tube wiring was installed in homes up until about 1950. There are a few instances of homes built in the 1960’s and 1970’s with this wiring, but these are the exception.

It is now nearly impossible to obtain homeowners insurance if a home has knob and tube wiring. The insurance companies understand the increased risk of fire and the potential for injury or death, based on the limitations of knob and tube wiring.

These limitations are:

  • It is not a grounded system, making it more hazardous than modern wiring. A person may come in contact with water, such as in a kitchen, bathroom, basement, crawlspace or outdoors and electricity and water don’t mix.
  • Two-prong receptacles as opposed to three-pronged. This eliminates the use of many appliances, even small kitchen appliances.
  • Usually restricted to a maximum of 60 amp service. Over the years, homeowners put in higher-rated fuses to increase amps. Given the wire was not intended to carry this additional current, the insulation becomes brittle exposing more wiring or overheating to the point of causing a fire.

Insurers have been updating their guidelines over the years in regards to the type and age of electricity in a home. It used to be that “if” a home was on circuit breakers and not fuses that a preferred insurer would accept knob and tube wiring. More recently, preferred insurers changed their guidelines to say “we don’t care if you have circuit breakers, we don’t want a home with knob and tube wiring”.

This meant that homeowners (those obtaining a new policy either because they were non renewed by their insurance company, had let a policy cancel, were buying insurance for the first time for a house purchase or whatever) were forced to buy insurance from a non preferred company (these are called surplus lines) who charge a significantly higher premium (often 3x’s as much). Lenders accept these policies.

Initially almost all of the non preferred companies (there are really only about four in California…so keep this in mind) were offering a HO3 form homeowners policy for homes with knob and tube wiring. Then, the non preferred companies changed their guidelines to say the same thing as preferred companies, “we don’t care if you have circuit breakers, we don’t want a home with knob and tube wiring”.

Fortunately, one non preferred company of the surplus lines companies, a company called Scottsdale, is still agreeing to insure a home with knob and tube wiring if the amps are 100, if a licensed electrician inspects the wiring and writes a report stating it is safe and if the client (and lender if applicable) will accept a DP1 dwelling fire policy form (this policy form provides a lot less coverage than a homeowners policy form HO3).

What has been a challenge lately is finding an electrician to inspect the wiring and write the favorable report to submit to Scottsdale Insurance Company. Without the 100 amps and the written report, even Scottsdale offering the minimal DP1 dwelling fire policy is not an option.

Knowing that you likely cannot insure a home with knob and tube wiring (well…unless you meet the requirements of Scottsdale, want to pay a great deal for insurance and are fine with the added risk you incur….like self-insuring some of the perils by purchasing a bare bones DP1 policy), then you should consider hiring a licensed electrician to update the electricity in your home. The cost can be considerable, between $8,000 and $20,000 depending upon the square footage and design of the home.

If you are purchasing a home with knob and tube wiring, it will be important that the update to the electricity in the home be completed PRIOR to close of escrow. An insurance company will not agree to insure the home and give you time, say 30 days, to do the updates.  The seller’s lack of maintenance on the house of updating the wiring at some point in time over the years makes their problem (old home wiring is very dangerous problem) your problem. You should not attempt to buy a home that is unsafe to live in and, not being able to buy insurance on it, tells you this really clearly. The insurance companies, even the ones that take almost every other big problem of really old roofs that will likely leak, old heating systems that will likely catch the home on fire or leak toxic fumes into the home and such, are saying no to knob and tube…so big red flag. Too many claims and too severe is a good assumption.

It is unfortunate that some insurance agents are not knowledgeable about knob and tube wiring and believe they can insure a home at close of escrow or otherwise. These agents don’t intentionally mean to mislead homeowners and homebuyers and honestly don’t know the guidelines of the company he or she represents, but the outcome is the same. A policy is written and as soon as the knob and tube wiring is discovered, based on an older home questionnaire, an inspection by the insurance company or in some other way, a notice is sent stating the policy is being cancelled. Suddenly finding out a home is likely uninsurable and $8k or more needs to be spent to have the home’s wiring updated is not a surprise anyone wants.

To learn more about insuring a home with knob and tube wiring, please contact Ramona Johanneson at rjohanneson@fp-ins.com or by calling 415-493-2502.

Benefit Insights – Educating Employees on Health Benefits

Employers are responsible for educating their employees about the health coverage options they offer. Employees have the right to receive clearly presented health and benefit information and assistance reading health materials, if needed. More specifically, employers are responsible for informing employees of: What benefits are covered in the offered health plan(s) Cost-sharing requirements and arrangements […]


Posted in Healthcare

Employers are responsible for educating their employees about the health coverage options they offer. Employees have the right to receive clearly presented health and benefit information and assistance reading health materials, if needed.

More specifically, employers are responsible for informing employees of:

  • What benefits are covered in the offered health plan(s)
  • Cost-sharing requirements and arrangements
  • Procedures for resolving complaints and appealing decisions
  • Licensure, certification and accreditation status
  • Methods for measuring consumer quality and satisfaction
  • Composition of the provider network
  • Obtaining referrals to specialists
  • Cost of emergency care services
  • Price, quality and safety of health benefits provided by the offered plans

Required Documents

The Employee Retirement and Income Security Act (ERISA) requires health plan administrators to give plan participants specific information about the benefits to which they are entitled, including covered benefits, plan rules, financial information and documents about the plan’s operation and management. This information must be provided in writing on a regular basis or upon request.

There are certain materials that a plan sponsor must provide to each participant and beneficiary in a plan, even if not requested:

  • Summary plan description
  • Summary of material modifications (whenever the plan is amended)
  • Summary annual report (contains information on the financial condition of the plan)
  • Summary of Benefits and Coverage

These materials can be provided electronically, as long as certain requirements are met, including the requirement that the plan member gave consent to receive the documents electronically.

 

BACK TO THE BASICS: 7 Simple Ways to Reduce Your Workers’ Compensation Costs

Are you looking for ways to reduce your WC costs? Going back to the basics in establishing and managing your safety programs allows you to control your premiums through minimizing your losses. Here’s how. 1) Get Management Behind it First and most importantly, the only way companies really control their workers’ compensation costs is to […]



Are you looking for ways to reduce your WC costs? Going back to the basics in establishing and managing your safety programs allows you to control your premiums through minimizing your losses. Here’s how.

1) Get Management Behind it

First and most importantly, the only way companies really control their workers’ compensation costs is to convince all involved that controlling cost is worth the effort. Companies who have made the greatest strides do so because everyone is focused on the importance of safety.

2) Use Modified Duty/Return to Work Programs

If you don’t have a company policy on modified duty, you’re at a distinct disadvantage. It is an important practice that needs a comprehensive approach. The most successful Return-to-Work program can accommodate almost any restriction.

3) Understand the Elements that Contribute to your WC CostsYour classification codes, experience modification, sudden company growth or company acquisitions can all affect your premiums. It’s important that you know the impact that each brings to your overall workers’ compensation pricing.

4) Orientate and Train Your Employees

Orienting and training your employees is a crucial step in promoting a safe work environment. How you train and encourage your new employees in safe working practices will determine your insurance costs in the near future. During orientation, you’ll find that many employees resist asking questions. To counter this reluctance, you, the employer, should use checklists and fill any gaps by explaining, in detail, what you expect of new employees.

At the end of the training course, ask new employees to sign the checklist to confirm that they understand and have been instructed in the company’s safety procedures. This signed checklist should become part of the employee’s permanent record.

5) Put Policies into Practice

If you don’t have safety policies, then develop and use them. Most companies have written disciplinary procedures but fall short when it comes to using them.

Review your claim information—do the same people and injuries show up from year to year? If so, are your employees properly trained and do they understand disciplinary procedures?
Insist that claims are reported immediately. Statistics reveal that for every week a claims goes unreported the cost increases

6) Report Claims Promptly

Insist that claims are reported immediately. Statistics reveal that for every week a claims goes unreported the cost increases dramatically—as much as 50 percent. When employees delay reporting an injury, find out why. Then turn to your policy statements and use the necessary disciplinary procedures on record. Your goal is to get employees to report injuries, not to judge whether an injury is important enough to report.

7) Investigate Causes (the “why” behind the “what”)

Even after a claim is paid, the incident is not over until you discover its root cause. While one injury is behind you, others will take its place unless you do something to reduce the chance of the incident reoccurring. Go beyond “what” happened and find out “why” it happened. Round table “claims without names” at your safety committee meeting, so employees can compare notes and learn from the past.

JustGive offers charity gifts that make this holiday mean more

One of our nonprofit clients, San Francisco-based JustGive, is an online charitable giving site. The organization uses technology to fulfill its mission to increase charitable giving. Founded 15 years ago, JustGive has changed the face of philanthropy, and sent more than $400 million to over 80,000 charities working throughout the world. As you scramble with […]



One of our nonprofit clients, San Francisco-based JustGive, is an online charitable giving site. The organization uses technology to fulfill its mission to increase charitable giving. Founded 15 years ago, JustGive has changed the face of philanthropy, and sent more than $400 million to over 80,000 charities working throughout the world.

As you scramble with last minute holiday preparations, JustGive has three great charity gift options that would work for anyone left on your list. It’s so easy to get caught up in the holiday sales, deals and newest tech gadgets—but, what if, in the words of Dr. Seuss, “Christmas … perhaps … means a little bit more” this year? These charity gifts give back and help others, accomplishing just that.

Grant their wishes

Make a charitable donation, in a friend or loved one’s name, as your gift. It’s a thoughtful way to support a cause they care about most or benefit the local community where they live. It’s pretty simple to find the charity to donate to:

  • Search by charity name or keyword using a database of nearly 2 million charities
  • Browse recommended charities organized by cause in the JustGive Guide
  • Select a local charity using your recipient’s city or zip code

Specific charity gifts

Is a specific cause near and dear to your friend’s or parent’s heart? You can choose a gift from JustGive’s Holiday Gift Guide for that cause, knowing exactly what it accomplishes. The guide contains 16 gifts for causes ranging from hunger to homelessness, children to animals, the environment and health, and more. For example:

·         $52 delivers 8 local language books to a school through UNICEF

·         $75 sends a care package to a child through Present Now

·        $80 to Feeding America provides 800 meals for hungry families

 

Let them choose the charity

Instead of defaulting to a Starbucks or retail card this year, surprise friends, clients or vendors with a charity gift card. This card puts the power of giving in their hands, and they decide what cause they’d like to support. It works like a typical gift card, except your recipients redeem it online (at justgive.org) to give to their favorite charity.

Charity gift cards can be for any amount you’d like, and you can personalize them a special photo (or your business logo), and add a special holiday message.  They’re easy to deliver: send them by email instantly or print them just in time to give in person. (Perfect as a stocking stuffer or for that little something extra too.)

This holiday, we hope these ideas help you with last-minute gifts that matter . . . just a little more. Sharing kindness and joy—and to all a great gift!

– Candy Culver, Marketing Consultant

All Homeowners Policies Are NOT Created Equal

All homeowners policies include Additional Living Expense coverage, also known as ALE or Loss of Use. This coverage is meant to cover the cost of “living elsewhere” if a claim is filed because the home sustains damage and can no longer be lived in. It might only take a few months for the repairs to […]



All homeowners policies include Additional Living Expense coverage, also known as ALE or Loss of Use.

This coverage is meant to cover the cost of “living elsewhere” if a claim is filed because the home sustains damage and can no longer be lived in. It might only take a few months for the repairs to a home to be made, but if the home has significant damage or is a complete loss, it could take a year or two – depending on where the home is located and what repairs are needed.

The typical payments most homeowners receive when they are forced to live elsewhere are for:

  • Rent (and associated costs of deposits & cleaning) for temporary housing (initially a hotel – then an apartment, condo or home). The mortgage payment is still being made on the damaged or destroyed home, so this rent and associated costs are “additional” costs to live.
  • Moving costs incurred to move (to and from); including moving company/van, boxes, packing materials, etc.
  • Meals eaten and mileage reimbursement when out shopping for: temporary housing, replacement of personal property items damaged/destroyed, new flooring, fixtures and appliances for home being rebuilt, etc.
  • Pet boarding costs
  • Costs associated with pictures, printing, photocopying and mailing (to insurance company and otherwise)
  • Parking (hotel, meter and permit)

As the title of this article states, ALL homeowners insurance polices are NOT created equal in terms of ALE coverage. There are two parts to ALE coverage and these are:

Limitation of Dollar Amount: Many insurance companies “cap” how much they will pay a homeowner to live elsewhere; typically it is 20% of the dwelling limit of a policy. For instance, if the policy insures a home for $500,000, the most an insurance company will pay is $100,000 for all costs associated with living elsewhere (again initially a hotel and then a more permanent residence while the home is being rebuilt).

Limitation of Time: Many insurance companies “cap” how long they will pay for a homeowner to live elsewhere; typically it is 12 or 24 months from the date of loss. The face of the policy may state ALS (Actual Loss Sustained) but the fine print of the policy places a time limit.

Having a “cap” on the dollar amount or the time might not seem like too big of deal, unless you live in CERTAIN cities. Because many parts of California have a higher than average cost of living, especially in terms of rents in places such as San Francisco and surrounding Bay Area cities, buying a policy with a “cap” can be a real problem. In addition, the limitation of time the insurance company will pay for a homeowner to live elsewhere isn’t realistic in many cities; there may be delays in construction beyond the control of the homeowner or insurance company.

Fortunately, there is an alternative. As stated, many insurance companies limit the dollar amount and time that they will pay for ALE. There are a few insurance companies who sell homeowners insurance policies with NO dollar limit/NO time limit coverage for ALE.

Two of the most reputable of these are Encompass Insurance (ELITE policy) and ACE Insurance (Platinum policy). While it’s true that some insurance companies state they are “luxury home specialist”, they fall short by limiting ALE to 50%. This likely won’t be enough coverage in many instances due to the time it takes to rebuild a home being lengthy, such as the case of homes in San Francisco.

A recent conversation with Malcolm Kaufman of Alain Pinel, one of San Francisco’s most knowledgeable and seasoned Realtors with a solid background in economics and finance, confirmed what many people already suspected: the time to rebuild a home in San Francisco often exceeds 24 months.

Malcolm shared that the reason for the delay in San Francisco is the fact that it can take several phone calls and weeks to schedule an appointment with a contractor, engineer, architect and such. These are busy professionals and their expertise in “building in the city” is crucial. Pulling in contractors and other experts from areas outside San Francisco can be a poor decision. San Francisco is unique and being familiar with the rebuilding process, permits, environmental, neighborhood guidelines and more is very important.

If you live in the Bay Area or any city with a higher than average cost of living, purchasing a homeowners policy from Encompass or ACE is recommended. Without an Encompass or ACE policy, you may find yourself paying out-of-pocket expenses to live, possibly for a year or more, while your home is being rebuilt.

Again, ALL homeowners policies are NOT created equal. Knowing ahead of time what your ALE coverage is and possibly changing insurance companies to a company who will better meet your needs, should the unthinkable happen, can give you peace-of-mind and potentially save you tens of thousands of dollars.

For more information about Homeowners Insurance, please contact Ramona Johanneson at rjohanneson@fp-ins.com or by calling415-493-2502.

What You NEVER Expected: The Most Common Causes of Residential Fires Locally

You’ve likely read a lot of articles about what the most common reasons are for fires at a residence. We’ve also read a lot of these articles and it seems most give the same top few reasons: Unattended cooking, outdated or improperly used heating unit/device, careless smoking, forgotten candles, improperly stored hot ashes and so on. Many of […]



You’ve likely read a lot of articles about what the most common reasons are for fires at a residence. We’ve also read a lot of these articles and it seems most give the same top few reasons: Unattended cooking, outdated or improperly used heating unit/device, careless smoking, forgotten candles, improperly stored hot ashes and so on. Many of these articles are
found in national publications.

We have often wondered, and maybe you have too, what are the common causes of fire locally. When a fire investigation is done after fires in Marin, Sonoma and surrounding areas….what caused them?

We are fortunate to have spoken recently to Steve Walton, Fire Investigator of the Larkspur Fire Dept. Steve is extremely knowledgeable and kindly spent hours answering questions about the origin of fires and providing information we feel you might find helpful.

Like boat and barbecues, lawn-mowing season is back. Just remember that under the right conditions, a lawnmower is a fire waiting to happen. Steve states that lawn-mowing fires are
one of the most common local causes of loss. Often the metal blade of the mower will hit a rock, causing sparks that ignite dried grass.

Ideally grass will have been mowed before it turned from green to tall, dry and brown, but the reality is not everyone has a chance to take care of their grass cutting before they should have and this is a problem.

So what do you do if it’s the middle of summer and you find yourself needing to mow? Steve’s best advice makes perfect sense: only cut grass in the morning when temperatures are lower, humidity is higher and on a day with little to no wind. This might mean spreading your mowing project out over a week’s time; it’s possible you’ll only be able to mow from 7am-
8 am each morning and not on consecutive days.

Another common cause of loss is cooking related fires. Common sense is to never leave cooking food unattended…not even for a second. However, distractions can and do happen – especially when there are kids, pets and elderly in the home. The best rule to follow is, never step out of the kitchen away from the stove without turning off the stove. Seconds away from a stove quickly turn into minutes and this is all it takes for a fire to get started.

Fire Investigator Steve stated also that a number of local fires are a result of improper storage of combustible materials. Often fires occur due to residents of apartments using the water heater or furnace area of the apartment as an overflow storage area. When space is limited, it’s tempting to open the small door and place some items next to the water heater or furnace…thinking nothing will happen. These items are typically brooms, mops, plastic bags with items of clothes, shoes, etc.

Unfortunately malfunctions of water heaters and furnaces occur and a spark leads to a fire starting. This fire quickly spreads and the outcome can be a significant loss of property and even life. The same can occur when homeowners place these same items or other combustible items near the water heater or furnace in a home or garage. Steve advises to keep at least 30 inches of clearance – should a malfunction occur, the chances of a fire starting will be minimal.

Lastly, a common cause of fire that Steve mentioned is one that surprised us the most. Steve states that he is beginning to see surge protector and power strips, purchased by consumers in local retail and home improvement stores, which are inferior. They were manufactured in such a way that the poor quality and reliability result in their failure and a fire ignites.

What we took away from the conversation about fires being started, as a result of the malfunction of surge protectors and power strips, is that consumers should be cautious when
making a purchase of these items. The message is that all surge protections and power strips are not created equal. If you are deciding between buying one made in China that feels light
and less sturdy than a more expensive, heavier power surge or power strip…spend the extra money.

We hope you find this article helpful and wish to thank Steve Walton of the Larkspur Fire Department for his time in providing valuable information. Please feel free to contact our office if you have any questions.

For more information about Homeowner’s Insurance, please contact Ramona Johanneson at rjohanneson@fp-ins.com or by calling415-493-2502.

http://fp-ins.com/individuals-families/