Author Topic: Can an Insurance Adjuster Dictate Safety & Health Actions on Claims?  (Read 146 times)

JasonYost

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      For the past month or so I've been working a fire and smoke damaged property for the property owner in Bedford, Indiana.  The property owner's tenants had been smoking on the second-floor balcony.  When they left, the smoldering cigarette started a fire.  It burnt portions of the balcony, exterior construction, attic, roof, and impacted portions of the interior via the Heating, Ventilation and Air Conditioning (HVAC) system.  (There were gaps in the ductwork that allows the gases and particulate to enter the system and be distributed through the building.)

      When I had completed my analysis, I wrote a protocol.  Then, a month later, I get a call from the property owner and her restoration company, asking me to return to the structure and meet with the insurance adjuster.  So, I did.

      It took the adjuster one hour to begin to list a bunch of things "I won't pay for . . ."  such as but not limited to:
      Quote
      engineering controls
      Personal Protective Equipment, PPE
      roof

      This adjuster claimed that none of the engineering controls or PPE were necessary on the job; therefore, he "won't pay" for them.  He went so far as to say:
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      I know a lot of other restoration companies around here that will do the work without PPE.

      Do you think it is appropriate for an insurance adjuster to make decisions on occupational safety and health on insurance claims?
      If so, what qualifies them to do so?

      I went to college, and spent four years studying occupational safety and health (as well as industrial hygiene management and environmental management).  He has no training at all.  Is he - by his actions - stating that that education is not necessary to understand and comply with occupational safety and health laws?  Well, I can tell you that my education proved to me that one does need the training.

      So, let's cover a few things, now, to help readers understand what makes these things necessary:
      The Occupational Safety & Health Administration (OSHA) has specific laws and enforcement measures in place that outline behavior on construction sites, like a fire or smoke damaged structure.  And, these standards are not industry-specific only; in other words, they apply to residential as well as commercial structures.  Some of these laws, as they pertain to this conversation, include:

      1.) All workers on the job site have to be trained to work in such environments and in the capacity they are being applied on that work-site.  An example of this is 29 CFR 1926.21.

      2.) Respiratory protections (in a list of capacities) are to be applied on and off the work-site.  An example of this is 29 CFR 1926.103.

      3.)  Other protective equipment is to be employed in protecting workers on-site.  Examples of this include 29 CFR 1926.28, 1926.95, and 1926.96.

      4.)  Hazard communication laws are in place, also.  An example of this is 29 CFR 1926.59.

      5.)  And, then, there's the General Duty Clause that enforces industry-based knowledge in the workplace.

      And, none of the applicable laws are to be applied randomly.  There's a heiarchy of control measures that an employer is to apply to the workplace in order to assure compliance and workers' protection.  The following image summarizes it well:

      This is enforceable by law.  An employer of a business cannot say to the Court or Occupational Safety and Health Review Commission that he or she was unaware of the law, nor can they say they were exempt from the law because the insurance adjuster told them it wasn't necessary.

      Workers' health and safety require compliance...

      The integrity of the cleaning requires compliance (how else are you going to control the debris that gets in the air while cleaning?)...

      Environments may be negatively impacted by the cleaning process (how will one prevent the gases and particles associated with such a loss from spreading to other rooms or outdoors without engineering controls?)...

      So on and so forth.

      So, before you allow an insurance adjuster to dictate procedures, like engineering controls and PPE, make sure they are qualified to act as occupational safety and health consultants without a conflict of interest (which is impossible).  And, when in doubt, hire an occupational safety and health consultant to assure things are being done safely and effectively.

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      Jason Yost, BS Occupational Safety & Health
      Industrial Hygiene & Environmental Management
      http://www.solutionsiec.com/

      JasonYost

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      Re: Can an Insurance Adjuster Dictate Safety & Health Actions on Claims?
      « Reply #1 on: November 29, 2017, 03:57:38 PM »
          While on this property in Bedford, Indiana, the restoration technician asked me an important question that I think is applicable and important to this conversation:
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          Are indoor environmental professionals (IEPs) occupational safety and health consultants?

          The truth is that there are varying types of Indoor Environmental Professionals (IEPs).  The term, IEP, is, itself, generic, covering a list of disciplines related to environmental assessment indoors.  This means that under the broad term IEP one can find asbestos assessors, lead (paint, water, etc.) assessors, mold assessors, a combination of these, or someone who specializes in something else related (like gases, fumes and vapors).  To the degree applicable to their profession, they should be trained in safety and health laws, but not all are.

          In order to assure you're working with someone with an understanding of these laws, look for someone with a college education in occupational safety and health - someone without bias (e.g., someone who doesn't work with or for the insurance or restoration companies) - and/or maybe certified (e.g., some CIECs and CSPs).
          Jason Yost, BS Occupational Safety & Health
          Industrial Hygiene & Environmental Management
          http://www.solutionsiec.com/

          JasonYost

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          Re: Can an Insurance Adjuster Dictate Safety & Health Actions on Claims?
          « Reply #2 on: December 04, 2017, 03:53:05 PM »
              An Indianapolis, Indiana insurance adjuster writes:
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              Why should I want one of these occupational safety and health consultants on my claim?

              Besides all of the reasons I listed previously, if you're wanting to deny something along these lines without liability, you want to involve one of these professionals to investigate and consult - in a defensible manner.
              Jason Yost, BS Occupational Safety & Health
              Industrial Hygiene & Environmental Management
              http://www.solutionsiec.com/

              JasonYost

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              Re: Can an Insurance Adjuster Dictate Safety & Health Actions on Claims?
              « Reply #3 on: December 12, 2017, 03:35:16 PM »
                  An Indianapolis, Indiana insurance adjuster wrote to me:
                  Quote
                  I've been adjusting claims for twenty years and never heard any of this, except with people who are too nervous about things, go online and read too much hype.  And, I've not had any problems.  You'd think if anyone would it'd be me.

                  This is the wrong attitude to have.  First, you're choosing to act in ignorance, which doesn't serve you or your clients.  Second, not everyone response to environmental stressors the same.  I'd refer you to my article on toxicology and dose-response relationships:
                  http://restorationboard.com/medical-wellness-health/dose-response-relationships-between-people-the-built-environment/

                  I believe you'll find it helpful.
                  Jason Yost, BS Occupational Safety & Health
                  Industrial Hygiene & Environmental Management
                  http://www.solutionsiec.com/

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                  Re: Can an Insurance Adjuster Dictate Safety & Health Actions on Claims?
                  « Reply #3 on: December 12, 2017, 03:35:16 PM »