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VERTEX was retained by an insurance carrier as an expert to investigate the cause of mold issues and review a claim for business interruption loss at a long-term care facility in Lockhart, Texas. In our investigation, VERTEX identified co-mingled mold and water damage resulting from pipe-leaks during a February freeze event that affected the region. Additionally, VERTEX conducted oversight of remedial activities for a 1-month period at the site to determine what portions of material removal were related to mold damage versus water damage mitigation. From our observations, VERTEX produced a reference map depicting mold damage versus water damage for use in determining the appropriate cost allocation for remedial activities. We determined that approximately 56% of building material removal was prompted by mold damage and the remaining portion was associated with water damage mitigation.

Additionally, the Insured’s claim requested reimbursement for lost resident revenue. Business interruption insurance reimburses Insureds for net income that would have been earned or incurred by the Insured during the interruption period and continuing normal operating expenses, including payroll, incurred by the Insured during the interruption period. Therefore, VERTEX analyzed the Insured’s expenses to determine which normal operating expenses continued during the interruption period. VERTEX reduced the Insured’s claim from lost revenue to lost net income and continuing normal operating expenses. In addition, VERTEX also made two reductions to the interruption period. First, the Insured’s claim included the time period for both water damage mitigation activities and mold remediation activities. VERTEX reduced the interruption period to only include the period for mold remediation activities, since water damage mitigation was not covered under the policy. Second, VERTEX identified unrelated delays caused by the Insured that were included in the Insured’s claimed interruption period. Therefore, VERTEX reduced the interruption period by the time period due to unrelated delays caused by the Insured. Finally, VERTEX applied the deductible, which the Insured’s calculation had not considered.

Based on Vertex’s analysis, approximately $1M in invoiced costs were disputed and the recommended business interruption claim amount was reduced by $1.3M.

 

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