Claims agents and adjusters are bombarded with information every day regarding new tools and techniques promoted as improvements to the industry. But knowing which ones are going to improve the process compared to those that will just add cost is critical for the adjuster trying to manage claims in a fair and cost-effective manner. The difficulty in making appropriate decisions is heightened when the claim involves unsettled areas of damage restoration.
Some of the Challenges
The introduction of a new piece of equipment to repair dents in a car can lead to a fairly straightforward calculation; is it significantly more cost-effective to repair the damaged piece than it is to replace it? In contrast, it is often quite difficult to determine either the starting point or the comparative yardstick to evaluate a new process for projects that are controlled by a somewhat vague standard of care.
Compare the car damage illustration to a contractor who proposes a new process to clean sewage contaminated soft contents. With the car, a visual inspection of the auto can be used to ensure proper fit and finish. However, a visual inspection of the washed items may indicate that they look clean, but sampling may show that there is some bacterial residue; particularly in dense items like quilts, stuffed animals or sleeping bags. At that point the question arises: What level of bacterial residue, if any, is acceptable in such a situation?
Although claims professionals do not have to be experts in every detail of restoration work, they have to be generally knowledgeable and use common sense when evaluating requests for new or innovative services from either their clients or the contractors.
The term "generally knowledgeable" means having a basic understanding of the types of losses being addressed and the restoration methods available. In the case of fungal contamination, it is critical that claims adjusters and case managers understand the basic standard of care that defines what is acceptable for mold remediation. Adjusters should not believe marketing claims that promise huge cost savings by the simple application of an "advanced formula" chemical that eliminates the need for removal of mold contaminated sheet rock. The standard of care clearly emphasizes that porous materials with visible fungal growth should be physically removed.
Understanding the Standard of Care
With very few federal or state regulations that actually control the mold remediation process (Texas being the notable exception), claims professionals often become familiar with aspects of one key document and make decisions as if that document, by itself, is authoritative. Unfortunately, fungal contamination is much more complicated than that and an individual should not base decisions on a single source, regardless of the quality of that information.
The New York City Guidelines (Guidelines on Assessment and Remediation of Fungi in Indoor Environments (nyc.gov/html/doh/downloads/pdf/epi/epi-mold-guidelines.pdf) provide a wealth of information for evaluating mold claims but do not constitute a standard of care. The guidelines have to be looked at in relation to the Texas regulations and other industry guidance documents to identify those areas of substantive agreement across the board.
An adjuster who falls for the sales pitch from a contractor who "treats mold in place" with high levels of ozone instead of removing the contaminated material in a controlled and careful way could face real problems. That is because the New York City Guidelines have some pretty clear language:
The use of gaseous, vapor-phase, or aerosolized (e.g., fogging) biocides for remedial purposes is not recommended. Using biocides in this manner can pose health concerns for people in occupied spaces of the building and for people returning to the treated space. Furthermore, the effectiveness of these treatments is unproven and does not address the possible health concerns from the presence of the remaining non-viable mold.
Other documents from the American Conference of Governmental Industrial Hygienists (ACGIH), the Restoration Industry Association (RIA), and the Institute of Inspection Cleaning and Restoration Certification (IICRC) say the same thing; with several of them specifically mentioning ozone as inappropriate for mold remediation when it is used as a stand-alone technique to deal with the contamination.
This straightforward understanding of the standard of care can also be useful when assessing new technology. The growing popularity of hydroxyl radical generators as a tool for restoration contractors to address odors and hazardous contaminants in building can be better understood by going back to the language from the New York City Guidelines. Since the advertisements for the hydroxyl radical generators claim that they are killing bacteria, mold, and other microorganisms, the output from the machines would be considered a biocide. The italicized language from the standard makes it abundantly clear that such biocides should not be used for mold control; although hydroxyl radical equipment can play a valuable role in other types of restoration such as fire or black water losses as long as they are run in unoccupied spaces.
Constantly Evolving Technology
Advances in the mold remediation industry are being seen in all areas: investigative techniques, remediation tools and procedures, and evaluation of control efforts. The use of DNA-type testing for mold investigations is one that has been gaining steam over the past seven years. The science has a pretty daunting title: mold-specific quantitative polymerase chain reaction (MSQPCR). Nevertheless, the data provided through this analytical process is being used in a variety of ways that can impact the claims professional.
One of the biggest issues in a potential mold claim is whether the mold growth is a result of a covered loss or was a pre-existing condition related to maintenance or other building owner responsibilities. With a little bit of targeted research, the MSQPCR analytical process could be used to help address this common concern. The EPA has already used the new sampling technology to develop an overall measure of mold contamination issues in homes that they call Environmental Relative Moldiness Index (ERMI). The government research notes that an ERMI sample provides an evaluation of the home over the long-term and cautions against using the Relative Moldiness Index as a measure of short-term activities such as remediation. It seems logical that the sampling could be adapted to help determine if a house was contaminated prior to the water loss in question. Having a definitive answer from a relatively inexpensive and simple to collect sample could make decision-making on the legitimacy of different aspects of claims much simpler and easier to defend should a dispute arise.
Science Connects Mold Exposures to Health Problems
On the flipside, ERMI style samples are already being used extensively by some farsighted experts in the environmental health field. There is a growing body of evidence, from carefully controlled medical studies, that dust samples can be used to predict health concerns in specific subsets of occupants who are susceptible to mold exposure. One physician has even identified core components of an ERMI sample that he compares to a scoresheet in order to provide his patients with information about whether a particular space is suitable for their occupation.
Such sampling is becoming more critical every day as science continues to explain some of the past mysteries of mold contamination; such as the common situation where multiple people are in the same environment and yet only a small portion develop significant symptoms and problems. DNA-style sampling was instrumental in validating the hypothesis that nearly a quarter of the population has a genetic susceptibility to develop a Chronic Inflammatory Response Syndrome (CIRS) after exposure to mold and other contaminants in water-damaged buildings. This research proved that the illness does not conform to a standard dose/response curve where higher levels of fungal spores equates to more people with symptoms. As a result, some people never get sick and others, who are genetically susceptible, get sick with seemingly trivial exposures.
Seeing the Big Picture Helps in Making Better Decisions
The old adage that the only constant in today's world is change, has never been more true. Claims professionals who deal with mold related situations cannot afford to take a narrow or antiquated view of the industry. Fortunately, change can be properly understood and managed by using core principles as a measuring stick to evaluate new tools and procedures that are advocated for dealing with fungal contamination. Insurance representatives need to invest a little time and effort in understanding the standard of care which is the foundation for all successful and defensible remediation projects.
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