Five Slips at the Same Strip Mall
A commercial lines agency places 62% of its small-retail book through one broker. Over 18 months, five slip-and-fall claims arise at the same 12-unit strip mall, all against different tenants insured by the same carrier. Four claimants are represented by the same law firm; three share an address with a claimant from a prior claim; two reported treatment at the same clinic within 48 hours; none has a police or incident report and each property has a working camera system. Combined incurred is $310,000 on $44,000 of premium. The broker warns that pushing back 'will cost us the account' and that the state bars nonrenewal solely because an insured filed claims. The regulator has an open market-conduct exam covering this book.
1. Distinguish legitimate frequency from coordinated activity by naming three measurable indicators and the data that would test each.
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- Claimant-network overlap. Test: map claimant addresses, phone numbers, and attorneys against the prior five years of the book. Three shared addresses is a measurable, testable link; two claimants at the same clinic within 48 hours is a treatment-sourcing pattern. Data: ISO claim index, the carrier's own claim system, and public records.
- Incident-reporting gap. Test: compare each alleged fall to camera coverage, tenant logs, and whether an incident report exists. A working camera and no report is a documentary gap, not proof - but five of five is a rate that random negligence does not produce. Data: site inspection and preservation letters.
- Timing and severity clustering. Test: days from incident to attorney representation, and the ratio of general damages to documented specials. Uniformly fast representation and round-numbered demands suggest a referral pipeline rather than five independent accidents.
For each, state what result would clear the claim. A deterrence program that cannot be falsified is just suspicion with a budget.
2. The state bars nonrenewal based solely on claims history. What can you lawfully do, and what must you avoid?
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Can do: underwrite the property, not the claimant - require the landlord to document lighting, handrails, snow-and-ice contracts, and camera retention, and surcharge or exclude where those controls are absent; refer the cluster to SIU; share the pattern with the fraud bureau as permitted; and, at renewal, offer the account on modified terms tied to objective site conditions.
Must avoid: nonrenewing or cancelling an individual insured because a claimant sued them (the prohibited act); blacklisting the broker without documentation; and letting the broker's commission threat affect the analysis - that is a conflict of interest for the producer and, if it reaches the file, an ethics problem for the adjuster.
Why the distinction holds: the statute restricts action based on claim filing, not action based on documented physical conditions or underwriting criteria applied uniformly. Build the file around the site inspection, not the claim count. Because a market-conduct exam is open, every action in this file will be read by an examiner who will ask whether the treatment was objective and consistently applied across similar risks.
3. Draft the three-sentence message to the broker and identify what you will not say.
Read the worked answer
Message: 'We are reviewing five claims at the same property and have referred the pattern to our SIU team; the review is standard for clustered losses and does not mean any tenant or claimant has done anything wrong. At renewal we will be asking each tenant for documented site controls - lighting, handrails, camera retention, and snow removal contracts - and terms will be based on those conditions. We would like your help getting those documents, because a property with documented controls is easier to place and defend.'
Will not say: that any claimant, tenant, clinic, or attorney is suspected of fraud (defamation and bad-faith exposure, and it poisons the relationship with the broker); that this is retaliation for claim filing (it isn't, and saying so frames it as one); or anything implying the broker's account is at risk if he cooperates. Keep the deterrence rationale explicit: objective conditions, uniform criteria, documented referral. Put nothing in writing that you would not want read aloud at the market-conduct exit interview.