Interdisciplinary Bioaerosol Complexity

Among insurance carriers, philosophies for tackling the problem range from complete denial of coverage to stunning overreaction. We need to be concerned with the presence of mycotoxins, the by-product of fungal metabolic processes and the basis of the health issues with regard to bioaerosols and the indoor environment. The amounts of toxin needed to elicit effects vary widely among toxins and there are no medical parameters with which to measure the ill health effects of a particular environment.

The American Conference of Governmental Industrial Hygienists has published a book, Bioaerosols, Assessment, and Control, which has been embraced by the IAQ industry. "The fact that fungi are growing indoors does not necessarily imply the presence of mycotoxins nor the exposure of occupants to any mycotoxins that may be present," state the authors. "Toxigenic species of fungi apparently do not always produce mycotoxins."

When we, as claim professionals, see claims with minor mold colonization's turning into $30,000 mold remediation fiascoes, are we justified in assuming that something went very wrong in the process of interdisciplinary communication? "Isolation of fungi known to produce toxins or identification of mycotoxin in source samples are reasons to suspect mycotoxin exposures," the passage continues. "However, only detection of specific mycotoxins or toxicity in air samples provides convincing environmental evidence of exposure."

Therefore, more often than not, we in claims are dealing with environments posing unspecified and undefined health concerns. This is why adjusters are needed. Is it reasonable and practical to assume that the presence of mold will result in health issues in every case? Are the environmental experts' reports discussing toxicity?

When adjusters hire environmentalists, are they communicating properly what their claim requirements are? The claim professional, not the expert just hired, should be in control of bioaerosol claims. Environmentalists understand the technical aspects of testing and investigating the quality of the indoor environment. Few, however, understand the process of adjusting and the potential for adverse litigation.

Adjusters do not have to be experts in indoor air quality to take control of mold claims. They should use expert testimony as a tool, and not forget to adjust the claims. This involves communicating to the environmentalist any coverage concerns and multiple occurrences that may have been discovered. All sources of bioaerosol contamination need to be documented, not only by the adjuster but by the expert. If litigation arises later, the defense will want to know how much of the bioaerosol problem was contributed to by other occurrences or other maintenance issues. Here again, one of the two main reasons an expert was hired in the first place was to provide for possible litigation. The other, of course, is health related.

Building a Philosophy

The first thing that has to happen within a claim department is deciding what stance to take, based upon upper management perceptions of liability exposure involving bioaerosol claims. Education is the second important factor, and will enlighten the dark corridor of misunderstanding. Education will bring with it possibilities of developing a framework and technology within which to adjust bioaerosol claims.

Once a philosophy is established and an educational program instituted, a prudent plan of action should be developed, based upon valid environmental information. Giving direction to the field examiner is as critical with mold as it with any other discipline.

Bioaerosol adjustment philosophy should be tempered with the understanding that the industry has been dealing with mold-related claims since the first structure was insured. The press and successful litigation have propelled mold-related health concerns into the consciousness of the public. The inability of the various departments of insurance to act quickly and decisively has bred lethargy and helped to open up an array of new strategies and gadgets with which to increase settlements and claim expenses.

Of course, the fundamental problem is that the lack of attention to IAQ can result in successful bad faith suits and excess verdicts. IAQ is important and, certainly, it should be investigated if it is determined that coverage exists or that coverage could exist. This is at the foundation of any bioaerosol philosophy.

Many environmental firms claim that they will be happy to schedule meetings with management and help with the understanding of their discipline. This is a great way to learn and communicate the insurance industry's needs, and will be helpful to anyone who is attempting to formulate a philosophy.

Take advantage of the many avenues of environmental understanding. The Indoor Air Quality Association (IAQA), in conjunction with environmental firms, approves several certifications, including the Certified Mold Remediator and Certified Indoor Environmentalist. Recently, the IAQA teamed up with the Foundation of the Wall and Ceiling Industry and Chelsea Group in an effort to provide a new certification, Mold Loss Prevention (MLP). The program is designed for safety personnel, field superintendents and project mangers. Numerous training publications and CDs also are available, as are PowerPoint and slide presentations. In addition, many environmental firms have developed their own educational programs. Although the motives of these firms vary, the programs can be informative and economical.

Outlining Strategy

After discussing bioaerosol philosophy with superiors and staff, and developing educational programs, it is time to address scenarios and logistics. Now, when faced with contractors' estimates or environmentalists' protocols, adjusters can begin to identify areas of concern.

Field adjusters are insurers' eyes and ears, informing, documenting, and conducting oversight on mold claims. They must identify immune-deficient occupants and document current health complaints immediately. As the adjuster on-site, it is important to identify the extent of the mold and the quality of the air, regardless of the visible mold present. A relatively small amount of mold, in full colonization, may produce significant mycotoxins.

It is important, therefore, when surveying potential mold sites that adjusters wear personal protective equipment as defined by OSHA. This should be as standard equipment in adjusters' autos as their cameras.

On the other hand, large areas of visual mold can have little effect on air quality. The potential toxic nature of the IAQ should be the main focus, not the scope or square footage of mold present. The New York Remedial Guidelines identify four levels of investigation that rely on square footage. Square footage, however, is not in any way related to the production of toxic IAQ, other than belaboring the point that a greater presence of mold increases the chances of health problems.

The vital question is whether the IAQ has been compromised, as compared to baseline and background outdoor levels, and whether colonization is progressing. It has been found that the presence of Microbial Volatile Organic Compounds is an excellent predictors of microbial contamination in buildings. Some studies show that MVOC presence in a building is a better indicator of microbial problems than culturable fungi.

Oftentimes, when mold has been identified visually, environmentalists will inspect the structures, give visual analyses of the mold present, and prepare remedial protocols, all with little or no sampling. The logic here is that the specific kinds of mold present are not an important factor, as the remediation process is the same for all.

This is a problem of scope and documentation. Without sufficient sampling, the scope of the mold contamination cannot be defined. Are there health hazards in other rooms? Is the remedial protocol going to assume that the entire structure needs to be remediated? Will mold/health litigation be defensible without supporting laboratory analyses? Both health and documentation would be better served by requiring the appropriate sampling techniques from environmentalists. The insurance industry must stress that it is interested in the verification of a healthy environment and the proper documentation with which it can defend itself.

Getting the Job Done

After the protocol is developed and presented, it is time to decide how to handle the estimation process. It is not logical to allow any firm both to remediate and provide the environmental services on a single claim. The IAQA has found that this relationship is not scientific, noting obvious and inherent conflicts of interest. It is best to use only environmentalists that are not associated or linked to any firm or group that offers construction remediation services.

The most effective way to clarify the remediation process is to communicate to environmentalists the need for specific protocols of fungal abatement. Vague protocols lead to a speculative interpretation of the process. The expert must understand that adjusters are charged with the preparation of estimates based upon their reports. For example, it is necessary to know the exact location and the amount of the drywall that has to be removed.

A recent trend that attempts to expedite and coordinate mold remediation is a joint walk-through by contractor and environmentalist. It is highly recommended that the adjuster be included in this as a means of fostering clearer communication and timelier remediation.

What is a fair estimation of mold remediation? This is the examiner and field adjuster's nightmare. Specific unit prices exist for every endeavor. It behooves adjusters to obtain these unit costs and enter them into their estimating software programs. Adjusters should not allow duplication or one-each scenarios to appear on contractors' estimates.

If, for example, we look at containment, we will find that there is limited and full containment. Containment is necessary in order to isolate contaminated areas from the rest of the unaffected structure or from previously remediated areas. Containment areas should be maintained under negative pressure relative to the surrounding areas.

If the charge is "one each $850.00″ for a containment area, a more detailed explanation of the line item is required. Does this price include three doors, and 8×12-foot, frame-constructed chamber with negative air and air locks? Containment needs vary based upon the layout of the structure and the scope of the mold. This is a case-by-case decision, which can be controlled provided that the examiner has been furnished the appropriate documentation. Containing an interior door, for instance, uses specific materials and demands a finite amount of labor. This can be determined and a fair price set.

The negative air and air scrubber charges on estimates may seem ubiquitous. Sometimes it is unclear which kinds and how much of this equipment should be on site. If work is progressing on one room at a time and it is contained, there probably will be a charge for both a negative air machine and an air scrubber. A large room would require more equipment, as air movement becomes an issue. In addition, these machines require high energy particulate air filters, which are expensive and must be changed regularly. A daily charge for this equipment may include these filters, or they may be a separate item.

The next decision to make is how many days this equipment should remain in the structure. This is a question for the remediators to decide, based upon the productivity of their work forces. If the costs begin to mount, however, it may be necessary to calculate what a reasonable time would have been in order to contain and tear out contaminated materials.

Personal protective equipment is another area of concern, as this equipment often is not itemized. Clothing and equipment costs can be obtained from a number of firms specializing in safety products for the hazardous environment. Aramsco, which publishes a magazine of mold abatement products, is one good source for pricing (www.aramsco.com).

Biocide treatments also can be problematic. They may be redundant after contaminated materials have been removed and all surfaces HEPA-vacuumed or sanded. The only way to clear the air is to remove all forms of mold, eliminate moisture, and provide for the proper RH. Killing mold spores with a biocide does not eliminate its potential for introducing mycotoxins into the air. If the removal of the mold is successful, the use of biocides would seem unnecessary. In fact, biocides may contribute to poor air quality, especially as affects immune deficient, allergic, or hypersensitive individuals.

The claim industry should be aware of the practical problems of contractors who engage in remediation in order to be able to adequately estimate losses. Using protective clothing, containment, and respirators greatly reduces the effectiveness of personnel. One cannot work as fast or as productively in this equipment, and numerous breaks must be scheduled for worker health reasons. This directly affects the cost of a job. Adjusters should ask their contractors for complete itemization in the remedial estimates.

It may be useful for field personnel to conduct oversight duties on mold claims. This would allow examiners to verify and document the quality and progression of work. Oversight also could eliminate unnecessary remediation, immediately identify supplemental work, and provide links to remediating contractors. In addition, oversight could verify the need and use of protective equipment and machinery.

A defined mold-handling philosophy, implementation of an educational program, and the mastery of environmental tools and techniques are the keys to controlling bioaerosol claims. As always, field property adjusters are the front-line defense. Using common sense and the accumulated data on losses will help them make informed decisions regarding scope, severity, and probability of health issues. Above all, they must never forget to adjust the claims.

Thomas E. Kosterman is president and CEO of Kosterman Multi-Line Services and Catram, an independent adjustment company, both of Florida. He can be reached at kmsclaim@sunline.net.