As soon as the questioning began, the avalanche of “Give it up, you can't do anything about it” ensued. From a military standpoint, England had the greatest army and navy in the world, and had triumphed over large and powerful nations in several previous wars. As for resources, its trade routes and merchant marine were the envy of all and its wealth immense. The system was clearly firing on all cylinders, so either you are simply wrong to question or too weak to object to the imposition of the greater will.

That sounds very similar to how an insured or individual agent might feel when confronting an insurance carrier over a claims disagreement. Oh, I hear some of you already suggesting that company folks are hardly tyrants to be overthrown. But if you go back and read your history, you'll find the vast majority of the citizens of both England and the colonies felt the same about the mother country. Judging by the recent media frenzy over the royal wedding, some things haven't changed.

And while carriers, like England in those days, may get the vast majority of their decisions right, that doesn't change the fact that when something is wrong, someone needs to stand up and make the challenge, knowing the avalanche of “Let it go, you can't do anything about it” is sure to come.

While I certainly am not suggesting a war with the carriers, neither were the original patriots. They were British citizens, and most assumed those in power were simply unaware of the affect of their dictates. Once apprised of reality, our forefathers were certain, the proper officials would withdraw the obviously erroneous decisions and life would go on as before. We know somewhere along the line, that assumption became victim to hubris and arrogance on the English side, and the rest, as they say, is history.

Believing the vast majority of carrier folks are in reality as honest and true as the colonists believed those British officials, I suggest the original approach was the right choice: When in doubt, ask the question and trust the responders to see the error of their ways. Only when all reasonable approaches fail should the options turn to open war.

For example, take this actual claim that came my way via a student in one of my classes. Here are the basic facts, edited for brevity and to preserve the privacy of the parties involved:

The strip mall in which the insured was a tenant had a fire, with no implication the insured was involved. Due to the fire, containers of chemical the insured had in his business leaked, mixing with the fire fighting water. His insurance company had issued a BOP, using the standard CG0001 12/04 Commercial General Liability Coverage Form.

Roughly a month after the fire, the agent received a copy of a declination letter from the carrier, stating they had received a request for pollutant cleanup by the landlord. The letter stated three reasons for denial:

1. The claim brought is for costs to respond to cleanup of a “pollutant” and such costs are not covered under the policy
2. If there were an “occurrence,” there are no damages that meet the definition of bodily injury or property damage
3. The pollution exclusion applies in this matter.

I always suggest when facing multiple reasons for a claims denial, the best approach is to treat it as a game of Battleship: Consider each shot one at a time, and see if it is a hit or miss. Under no circumstance allow the other party to bury you under an avalanche of reasoning, when the intent is clearly to let the mere weight of the argument crush your feeble attempts. Sounds like that English army/navy/economy bit, right?

Related: Read the Amrhein's previous column “Keep It Simple”.

So let's take the above three reasons one at a time, not arguing detail but simply asking the simple question that will put the burden back on the carrier to offer those good and decent folks the opportunity to either defend their decision or realize the error of their ways.

1. Yes, the expenses were for cleanup of a pollutant, but only for damages arising from a hostile fire. Where is that excluded, as opposed to the clearly excluded simple cleanup due to spillage or container leaks?
2. What do you mean “if there were an occurrence”? The fire definitely happened, and isn't the landlord's demand for cleanup an allegation that property damage as defined took place as a result?
3. Why does the pollution exclusion apply when the form clearly states as an exception to the exclusion (f.(1)(a)(iii)): “However, this subparagraph does not apply to: “Bodily injury” or “property damage” arising out of heat, smoke or fumes from a “hostile fire”?

Note two key points.

First, as readers of my previous columns know, read the forms. You can't just argue right and wrong and fair when dealing with specific contract language.

Second, it isn't your job to be a skilled forms interpreter/expert/attorney, so don't let anyone tell you otherwise. Just like those folks who insisted a bunch of amateur hunters were no match for trained British soldiers, people often assume only “experts” are qualified to question another “expert.” And for those who are considered “experts” either by themselves or others, it's a great way to attempt to intimidate the opposition. But you aren't trying to win, just get to the right answer. And anyone is entitled to ask a reasonable question. I like reading the forms first partly to give myself some confidence that my question is reasonable.

So in the above claim, our agent friend did not spend weeks doing legal research or wait until he finished adjuster or law school. He simply sent an email to the adjuster who wrote the denial letter asking, in his own words, the three questions above. Now he waited. Would his query find a reasonable, honest and true practitioner of the arts or was he about to start a war?

Perhaps the best answer is simply to quote the response from the adjuster which, by the way, came back the very same day as the agent's questioning message (again, edited for privacy):

Related the article “And Another Agent Is Cringing” by Diana Reitz.

Thank you for your oversight and feedback on this matter. I apologize for any confusion or concern that I may have brought in this matter.

Upon review, I agree with your position. I will be in contact with your insured to discuss this matter further, as well as advising him in letter form that we will rescind the prior denial and adjust this matter for him under the terms and conditions of the policy issued.

Again, I apologize for any inconvenience.

Don't you just love a happy ending?

But let us be clear: This is exactly the sort of response I see time and again from reasonable, astute folks in our industry. Mistakes and misunderstanding may occur, particularly in an industry often buried amidst the detail of thousands of claims daily. Yet when reasonable folks defer argument and open warfare for simple questions, providing good folks on the other side room to thoughtfully review instead of backing them into a corner where their only real option is to crumble or fight back, wonderful things happen.

So along with our other celebrations this month, let us add the quiet satisfaction and joys found in working with folks who are more interested in partnering to get it right for our insureds than proving who is the biggest, baddest dude on the playground.

Cue the fireworks!