Insurance Claims

Hit-and-run and now a EUO

lookiehere — Sun, 22 Nov 2009 04:50:18 GMT

i was in a hit-and-run: no damage to the car, filed a police report, and took myself to the hospital. i sought treatment about a month after the accident when the pain (in my back) wouldnt go away. i went thru about 5 weeks chiro/physical thereapy, and it wasn't helping, so i stopped going.

at that point my insurance asked for an independent medical exam, which i complied with and resulted in a confirmed back muscular injury.

i went to 2 more sessions of physical therapy, and now do home excersises. i'm getting better.

my insurance has been calling me to close the claim, and said that if i dont close it they will subject me to an examination under oath (EUO). they did say that i could close the claim on my PIP ($3200) and close out the UIM payout at this time, but i still wonder if i do that will they try to come after me for something. they kept saying that the bills were excessive for my injury, and that it's been far too long since my injury to keep seeking medical attention. the only reason i wanted to keep it open is if i have a flare up again and need to see a doctor. then the letter for the EUO showed up. i'm ready to close this claim and move on with my life.

here are my questions: can they deny me what they have already paid out? should i call the insurance company and ask if i can close my claim without having to go through the EUO? if i close my claim can they still try to come after me for something? at what point should i hire an attorney?

i know it seems like i am being paranoid, but i have done nothing wrong. having read up on EUO's, i know i will need an attorney, i'd just like to avoid the whole situation by closing the claim, like they said i could last week. i am starting to understand why so many insurance attorneys exist out there. thanks for any advice you can give.

I don't want to get in trouble, please advise!

KarimG — Tue, 17 Nov 2009 16:14:10 GMT

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When my mother left to Chicago, I was driving her car in Brooklyn, New York. One night I got drunk and let a friend borrow the car to drive his girlfriend home. He hit a parked car with no one inside. The damage was pretty bad; he tried to drive away and got arrested for DWI, but not for the accident. I tried to get a police report to find out what happened, but there was no police report that mentions my car, just arrest report for the friend. I decided to fix my car without insurance. Now, two weeks later, I get a call from my insurance from Property Damage Team, and first they wanted to speak to my friend, then to my mother. They did not disclose any information to me since I’m not on the insurance. Since my mother is in Chicago, they asked to tell her to urgently call them. What are the consequences for me or for my mother for not reporting this accident? I didn’t call the insurance because I did not know what exactly happened. What are the best steps to take right now?

THIRD PARTY ADMINISTRATORS

DAWNALINA1974 — Sun, 15 Nov 2009 20:47:14 GMT

I also posted this in the bankruptsy forum as well, thought it might help in two places.

I had a fire on December 8, 2008, the house and contents were a total loss, we got an amount from insurance company it was too low in our opinion so we hired a PA to help us. They did there job and filed a new claim amount and we all agreed to the amounts.

We went ahead on our claim for the contents and settled with the PA, the house portion is a totally different problem.

Before the fire I was in a Chp 13 to save home from foreclosure, in May 2008 the lender told me that they could do a loan mod but I had to be out of the Chp 13, so I got it dismissed, in the next several months we agreed on a loan mod, they were gonna take all the fees, late payments, etc and just toss them out, drop our interest rate from 10.55 to 5.7, and start our loan out new with the original balance we first signed with. Two days after the mod was approved when the fire happened, so [the lender] said since we couldnt live in the home we cant keep the loan mod, I contacted Citi and let thiem know of the fire, then in February 09, our loan got sold. I have tried working with these people on a mod to no evail..You cant get anywhere with this company and there are several class action law suits agaisngt them as well as the state of Ohio as one. The check for the home was kinda just held and not cashed as the mortgage company said they would not distribute the proceeds to either me nor a contrator until the home is out of foreclosure, the checks ended up expiring and new ones were just issued after 6 months of them just sitting there, they were cut Nov 5 but were issued in my name my husband name, another company called dimont (which is a third party admistrator for mortgage). Checks were issued without my or husbands endoresment.

My question is how and is this legal. Who is this company and why do they thingk they can just cash it, they said they have forwarded the proceed to american home mort, I dont understand how they can file a claim and get the check when they no longer own my loan, I have contacted all three company with [one] not talking to me, not even telling me what they do, [another] says they no longer have an apen account with me so they cant help and [the third] saying that they dont know who this company is.

I need help, no one will speak to me, [one company] says I need to contact my PA, [another] says they dont have a contract with me so they cant talk to me, and my mortgage comp dont know who they are, I need some serious advice, I have tried calling my PA three times with no reponse, which I dont even want to be involved with them anymore, they did there job why are they still involved, I even had stuff taken out of my home (stolen) from the PA when they did their invetory list.

PLEASE HELP ME.. I dont know where or who to go too.

Health Insurance Claims - Delayed Filing

GAEMTP — Thu, 12 Nov 2009 18:41:55 GMT

Hi ALL,

Just wanted to ask a question abot Health Insurance. My wife had surgery in Feb of 2008. I recieved a bill from the Hospital and the surgeon. On March of this year I recieved a notice from a collection agency that I had a bill from the Anesthesia MD for $650. I check with my insurance and the claim was never filed. I talked with the agency about the filing of insurance and gave them the phone number, fax and contact information for my insurance company.

Last month my wife recieved a call from the collection company about the bill. They wanted to know why we have not started payment and when would we. I talked with my insurance company again, then the insurance did a 3 way call with the collection agency. Different tune from the collection agency. They stated that they would file with insurance.

Today I called the insurance company, Not filed..... Talk with the collection agency they stated that I would have to file due to the time difference. I talked with the supervisor she stated that she would file the bill. Today I was notified that it was file with the insurance company.

My question is What if the insurance company denies the claim due to the untimely filing of the claim. What are my options? What are my obligations? I do not want to seem if I do not want to pay the bill. I have insurance to help pay bills. Am I liable for the whole bill?

Please help,
Jeremy

Vacant House

suggie — Tue, 10 Nov 2009 23:39:00 GMT

My uncle has been living with me since he became ill 3 years ago.

His house has been vacant for 3 years his furnishings are still there

In the event of a fire will the property be covered since it has been vacant?

I had investment property several years ago and it was vacant and I had to get special insurance

Is that the case with this situation?

Insurance asking for financial records

astuartgirl — Tue, 10 Nov 2009 15:40:33 GMT

I live in FL.

I had a 32 day lapse in insurance due to my own stupidity and not knowing when my renewal date was.

I decided to find some cheaper insurance and went with a new company and about a week after the policy took effect, I hit a deer.

I have answered all their questions even on a recorded call; however, they don't believe me because they said they don't understand why I decided to take the long way home after shopping one evening (scenic route) and now want my cell phone records and they want me to sign a release for my financial records.

I don't believe I should have to give them this.

Do I?

Meanwhile, they have towed my car to an auto shop and declared it totalled and they are not paying for my rental car.

Thanks for any advise.

question on auto ins/claims re: parking lot accident in PA

mineme887 — Wed, 16 Sep 2009 17:45:42 GMT

My question is about an incident that occurred in PA around 3 months ago.

I was in a parking lot in my apartment complex parked in a parking space running perpendicular to the apartment buildings (i.e. not an angled space). When walking to my car, I noted a neighbor that was parked in front of a mailbox about 30 feet from my front door. The neighbor driving the truck was out of the vehicle talking to another neighbor about 10 feet from my apt. door. The truck appeared to be off.

I noted that the truck was still parked when I began backing out of my space. I had completed backing out turning so now my car was nearly parallel with the curb. My car was then struck by the truck, who was in reverse, with enough force that the rear of my car slid a few feet in the direction the truck was traveling.

The neighbor and I assessed the damages-he wanted to handle everything without insurance since the truck he was driving belonged to a friend. There was no damage to the truck sustained to the impact. The neighbor offered to replace my bumper, but did not think that the other damage to my vehicle was a concern ('the paint scratches will just buff out'...along those lines).
The neighbor was also having money issues and since my car was still drivable, I agreed to wait until it was more financially viable for the neighbor to be able to pay for the damages.

Fast forward to a few weeks ago, and the neighbor is displaying signs of financial recovery (buying a new motorcycle). I then proceed with obtaining an estimate as he originally requested and contacted him indicating the amount of the estimate. He is now denying any fault/liability/respon... for the incident, citing rather dubious web research to justify it (citing Ontario Canada laws). He is also disputing he was backing up and states that his truck was parked.

I do have the other neighbor preparing a written statement as she was outside of both vehicles. The police and my insurance company both are indicating that I should have contacted them immediately regarding the accident. The neighbor is refusing to provide his insurance info so I can claim my car's damage in an insurance claim and then have my company research and subrogate against the neighbor's insurance.

Do I have any options left beyond filing a plea with my local magistrate? Is there any other evidence beyond the written statement and pictures of the damage I can use for presenting my case if it comes to that?

Any info you can provide will be greatly appreciated. Thanks in advance...

(I apologize for cross posting this from the Small Claims forum, but I wasn't sure which area would provide the most information)

Auto Accident Claims question

marmalope — Mon, 09 Nov 2009 16:48:34 GMT

I was involved in an auto accident on Sept 5th, 2009. I was uninjured but my friend riding in the passenger seat cracked her Ankle in 3 places. The accident was the fault of the driver of the other car involved so now we are dealing with their insurance. They have Progressive insurance and they have been holding the claim for my friend while she recovers. She has not had to have surgery but has been in a Boot and on Crutches for going on 2 months and her doctor expects her to have to continue to wear the boot and use the crutches for another 3 weeks to a month with possible physical therapy after this. I understand that Progressive insurance should cover all of her doctor bills and also reimburse her for "Pain and Suffering" and any other expenses she has incurred due to the injury.

Here is my question. What should a typical "Pain and Suffering" settlement be in a case such as this. We do not want to go to court but I was just wanting to get as many facts as I could before they made her an offer. This injury has not only inconvenienced her everyday activities but has also prevented a preplanned Vacation.

Any insight that could help would be very much appreciated....

Thank you for all your help

Condo insurance denying claim for damage by a wild squirrel

kkm.9 — Tue, 03 Nov 2009 21:07:17 GMT

A wild squirrel got into my condo and did a significant amount of damage. It chewed up carpet, broke window blinds and chewed up wood on doors and windows. The insurance agency is denying my claim stating that it is not a "covered peril" in my policy. I do not see any exclusions in the policy so do not understand why it would not be covered. Do I have any recourse in the case?

auto insurance

jerryjr1977 — Thu, 29 Oct 2009 16:52:11 GMT

i have a problem with my auto insurance. i own a van that was recently wrecked. the insurance company charges my premium based on the vehicle i drive. they do not consider the condition it is in . when it was wrecked it had prior damage so it was not worth what i was being charged on my premium for it. i do not think that an insurance should be allowed to do this they should have to pay the amount they are charging me on my premium for the vehicle

LIFE INSURANCE AFTER DIVORCE

MOOSE53 — Mon, 26 Oct 2009 15:39:32 GMT

My husband and I divorced 9/11/08. He had taken out a life insurance policy for $10,000 with Mutual of Omaha and named me beneficiary before we were divorced but still wanted to me have it after the divorce to pay me back for buying him a handicapped van. He died 8/10/09. There is no contingent benficiary. I got a letter friday stating that since he died after the divorce that I was not entitled to the insurance money. Question? If he DIDN'T want me to have the money when he died, why didn't he change the beneficiary or cancel the policy? He continued to pay for nearly a year after the divorce. What can I do? I live in Texas. His surviving 2 sons do not speak to me after the divorce even though my ex and I were still very good friends, so they will not be of any help-especially since they refused to let me attend the funeral. VERY FRUSTRATED!

Asbestos and homeowner's insurance

Lake City 05 — Tue, 14 Oct 2008 07:48:11 GMT

I own a rental house that was built in the 1950s. Like many houses built in this area during this time period, the attic has vermiculite in it, which we now know has more than likely asbestos mixed in. On top of the vermiculite are seveal layers of fiber glass insulation. In other words, the vermiculate isn't disturbed, hasn't been in decades. I have done quite a bit of research on vermiculite, and it is my understanding that it is very common in houses built during this time period. I also understand that if left undisturbed, its impact on the residents is minimal.

I have been having a lot of problems with the tenant living on the premises. I am trying to sell the house, and the tenant has been out and out trying to sabotage it. He is threatening to call the building inspector and cause trouble for me owning an "unsafe house". He is threatening to call my insurance company and tell them all about it, in an effort to have them cancel my policy. He is threatening to call local real estate agents and appraisers and notify them that I have asbesos in the attic in an effot to ensure I can't sell the house. I'm afraid if I end up evicting the tenant, he'll actually spread asbestos all of the house to "teach me a lesson".

I have regular homeowner's insurance on the property. Does your regular, run-of-the mill homeowner's policy cover asbesos abatement? What if the tenant spreads if all over the carpets, thus effectively destroying the house? What if it is condemned over asbestos?

If it did come to my insurance company's attention that there's asbestos in my attic, do I have to worry about them cancelling my policy over it?

insurance company had my arrested and tried to deny it

tracey4039 — Fri, 16 Oct 2009 15:56:17 GMT

I had a house fire may22,2009 the insurance company paid for the repaires to my home and replaced my furnishings but is reluctent to pay for my family personal clothing. due to the fact that most if not all were desinger clothing. i held on to everything until i was given promission to throw them away now they saying that they could have been knock offs and i should not have been able to afford them. they called my husband and i in to take an exam under oath. and i brought all them they requested 2006,2007,2008 tax returns and some of the things that the cleaning company had returned all of the also desinger items. i and my husband made around 95,000 for the year. the lawyers asking the question stated that they weren't diong this because i was black or anything . she then ask me about my criminal record and i was more then honest i'd had a misderminor and was gining 2 years probation and it ended in may of 2009. she then questioned me about the type and number if cars i owned. and what car was i driving today. i answered all questioned even the one as to wither i was on welfare. im a nurse and my husband is a supervisor over maintance at a nursing home. i also showed them two fur coats that were lossed due to the fire that belong to my children both minks. all of a sudden the police walked in and arrested me saying i had two felony warrants for my arrest. i went to jail and was released once my fingerprints came back no charages were mine. know the insurance company and the lawyer refuse it appears to what to speck to me or my husband. they refused to exam my husband after they had denied they called the pollice and had me arrested. i then sent all the proff and paperwork to the insurance commissinor and the lawyer is there anything i can do to aaa for having me arrested just to prevent me from collecting on a valid claim

Totaling Property Damage Losses

SErnest — Thu, 15 Oct 2009 21:13:18 GMT

After a year of trying to resolve an insurance claim I made against the insurance company (one of their policy holders hit me from behind the interstate in Florida), I have finally moved up the pecking order and reached an agreement to total out my property damage of my vehicle using MY insurance company. On the day before the wreck occurred in 2008, my vehicle was worth $12, 500 based on market value suggested retail price from Kelly Blue Book research. The insurance company of the party who hit me failed to negotiate with me, not returning any phone calls, etc. so I filed a claim with my insurance company and they are going to subjugate (sp?) losses with the insurance company of the driver who hit me.

My problem is this, my insurance company is totaling my vehicle based upon a research teams "average" value of the vehicle and is about $3,000 lower than the Kelly Blue Book value. I have been without use of a car for over a year now and I feel the total should be equal or approximate to the value my car was worth a year ago. If I accept this lesser amount from my insurance company, can I take the other party and his insurance company to small claims court and recover some of my losses (i.e. difference of my insurance totaled amount vs value of my car a year ago, loss of use, etc) ??? Please help, I am frustrated and feel I have been abused by both insurance companies. Thanks!

Lost Life Insurance

KatrinaTX — Mon, 12 Oct 2009 11:22:20 GMT

I'm in the midst of searching for a lost life insurance policy taken out in the early 90's (before 1996). However, I'm not having very much luck at all. It was a term life insurance and it is supposedly set to expire sometime in 2010 because my papa passed away so abrubtly he was unable to tell us about anything and we can't find anything either. So I am here, searching for help.

Can someone please, please help direct me the right way for this matter?

Tired of insurance company mistakes

Insurance Overload — Wed, 07 Oct 2009 17:06:52 GMT

I work for a company that is self-funded insurance but contracts with a large insurance company to administer the plan. I have a daughter with special needs and many doctor bills. My daughter is also covered under NC medicaid. I find that I am spending an enormous amount of time fighting with the insurance company because they messed up the claim...let me give some examples.

Our SPD specifically covers enteral feeding supplies, yet month after month, these claims get denied which forces me to appeal - by the way, I have a 100% overturn success with the appeals.

The same goes for therapy. She receives speech, physical and occupational therapy 1 time per week. This has bee going on for 2 years. One week the claim goes thru no problem...the next week it is denied.

My daughter receives in-home nursing care that is covered by my insurance up to 40 visits per year where each visit is 4 hours. Do you think they keep track of the hours as I do...no, they deny claims and say I have exceed the 40 visit limit only to find out they entered in the wrong unit of time.

These examples only scratch the surface - I have proof (and they admit) they violated ERISA laws during an appeal process. I have a good relationship with my company and the liason to the insurance company, but I wouldn't mind stinging them a bit with a lawsuit for making me follow up on the insurance company's mistakes. Do I have a case?

car damaged going through puddle-comp or collision?

ynb006 — Mon, 21 Sep 2009 01:33:33 GMT

I drove through a huge puddle of water in a dark parking lot in the rain and a sheet of metal from underneath the care came loose. I don't think I hit anything. Is this comprehensive claim or a collision claim?

My insurance company first called it collision, saying it was because I was moving and collided with water. They have since changed it to comprehensive saying it was flooded. But yet they define flooding as meaning water inside the car. No water came into the car, maybe just some underneath because of that part that came loose.

All opinions encouraged?

Can I cancel life insurance taken out on me by someone else?

amelita — Sun, 20 Sep 2009 13:22:27 GMT

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When I was in my early 20s, I allowed my step-father to take out a life insurance policy on me (my mother, his wife, had passed away shortly before). Although I felt uncomfortable about it even then, for a variety of reasons I felt I was not in a position to argue and signed the papers. I am now 34, fully independent and living across the country, and he wants to raise the amount $5,000. Of course, he needs my signature. I have never had much of a relationship with him, and he has not paid one cent to me for any expenses since I was 18. I'm not sure why he ever needed life insurance on me, and I want the policy to stop. My questions: (a) can I stop the policy, even if he has been making payments for over a decade; and (b) is there a possibility that I may be legally responsible to reimburse him for the premiums he paid? The policy was taken out in OK. I live in NJ.

Insurance Commission

smallworld — Fri, 18 Sep 2009 03:36:36 GMT

Adjuster jack,

In your time as a adjuster have you ever had any dealings with the insurance commission?? I ask this because my renters insurance claim was denied and closed when it should of been paid, but I went to the insurance commission on the first of september and now all of sudden I getting calls from my claims rep that she need to talk to me about a settlement offen on my reopen claim after it was first denied.. Do I have to talk to the claims rep or can I just wait on the outcome of the insurance commission? What do you think the reason would be for the insurance company calling me now??

boat insurance claim, adjuster giving confusing information.

SandyBg1125 — Thu, 10 Sep 2009 20:38:09 GMT

My boat was stolen and only the hull was recovered. my insurance policy limit was $66,000. I read the policy which is difficult to understand fully. Under the loss settlement provision it states: "we will pay the cost of repair or replacement at the time of loss, without deduction for depreciation" not exceeding the smallest of the following amts:

1) reaplcement cost at time of loss

2)full cost of repair

3)applicable special limit of liability (not about boats)

4)any applicable limit of liability

I got a repair quote for $64,000 from the manufacturer. When I spoke to the adjuster he confused me stating my policy is "just like a car" and that my boat is a total loss. The reason for his 'total loss' is he says my boat is worth 40K-60K and they consider it a total loss if damage is greater than 75% of the value. He said he will pay off the loan and sell me the hull for 20% of the liability limit 66K (which would be $12,000). I read the policy and I don't see anything in specific that mentions 75% damage- total loss. I don't know if it need to specify that in the policy. Does anyone have any advise?

Requirement to pay overhead and profit?

bluethumb — Thu, 23 Apr 2009 00:07:44 GMT

As a contractor for 25 years in Texas, I customarily received overhead and profit on claims I work involving 3 or more trades. I currently have one insurance company declining to pay these items even after I provided them with copies of the subcontractors' invoices. Since these items total about $3,000.00 I questioned their decision and asked for the criteria they used to deny my claim to this compensation. I was informed that there was no written criteria and they were unwilling to write any or supply me with a written explanation for their position. When I asked what my next step of appeal was regarding this matter, they said they could not help me with that. I thought this to be most unprofessional and possibly unethical. Are there rules, laws, or regulations stating requirements that these items be paid if earned?

Insurance company and rental reimbursement

Mrs. V — Fri, 11 Sep 2009 05:49:53 GMT

I was rear-ended two month ago and this claim is slow moving!

The at fault drivers insurance said they would pay for my car, rental car, medical and pain suffering etc

Only problem is they didnt want to replace frame on vehicle 1st estimate 6,000.

I called my Insurance to have a second opinion on the frame as body shop said it needed to be replaced

My Insurance estimate was 15,000 and almost final 17,000 as its still at shop with my insurance NOW

Initially After finally finding a rental car two days later, the at faults insure was paying the bill but then said they would stop paying for it after I didnt have work started because I wanted to get another estimate. I was told by at fault that I didnt need another estimate as the frame didnt need to be replaced and another estimate wont change it. According to my insurance the frame was badly bent and needed replacement so I had my insurance take the claim.

I do not have rental insurance but was told that the at fault insurance would pay for rental car. I had rental car for one month the car and its now two months. Do I have to pay the difference of this because both insurance companies took their sweet time going out to estimate or did a substandard estimate?

I have now paid $385 and $400 plus loss of value when I trade my vehicle in after its fixed and the accidnt isnt my faullt! This stinks!

Canadian Insurence and suing homeowners insurence

Rayy — Fri, 11 Sep 2009 13:45:34 GMT

I was at a friends home the other day helping him prune some of his trees.

The ladder fell out from under me, and as a result I fell and broke my ankle.

Is it possible to sue his homeowners insurence for this type of accident?

Flood Insurance Claim

jbabbit — Thu, 05 Feb 2009 03:04:17 GMT

I live in Southeast Texas and my house was destroyed by flood during Hurricane Ike.

We have had so much trouble with our insurance claim. First of all the adjuster lowballed the claim. Adjuster said sign and notorize the proof of loss and we will start a supplement claim and all will be well. We did that. Started the supplement and in the mean time we hired a contractor. Contractor tried to get adjuster back out here to go over the scope of the job. Adjuster refused 3 different times. Went back and forth and Adjuster said sign the supplement then work with insurance carrier for the difference. Insurance company said we will not reopen the claim as the adjuster did a good job and you received all you are getting from us.

When the Adjuster first came here a week after the flood, he was here only 25 minutes. We had touched nothing as we arrived the same day as we were under mandatory evacuation. I think the adjuster made some mistakes and now we are having to pay to rebuild the rest of our house which we cannot afford. If they don't give us more money soon the reconstruction will stop.

The Insurance is also denying the exterior siding which is steel but it was damaged by the salt water and starting to rust and we had it taken off. We also have to replace this

We are not trying to make any money off of this. The insurance company says we are. We just want our house back. I am so tired of this. We did all the right things, bought the flood insurance in case something like this happens and now we can't get our money? What do we do?

I know we can hire a lawyer but I don't want to have to wait years to get in my house. Why won't they just build my house back the way it was?

I know this is long but any info would be appreciated.

Thanks

contractor´s overhead and profit

Alex Contractor — Sat, 05 Sep 2009 19:26:40 GMT

We are custom to get O&P if there are 3 or more trades involved. But lately we have been getting same response about O&P from different insurance companies. I sat on the phone with a desk adjuster and argued my point for over forty minutes. I’m being told that we are not qualified for O&P because job is not complex enough and some of the trades could be done by same subs and there is no need for additional sub’s to be involved. For an example on roofing we are being told to use our roofers to replace HVAC cap, when I said that’s illegal because roofer subs generally are not licensed to do such work and the answer was that nobody else from GC brings out this issue and they (insurance co.) have some other company who is willing to do this job for what the original estimate was written for. Also according to company’s policies there is no need to pay O&P on roofing, because it already has O&P built-in in material and labor pricing and therefore this trade is not qualified for O&P. At this point I had enough, I asked for a written copy of this policy, and they don’t have it. Then I asked to speak with supervisor and I found out that his name and number is a matter of national security and he is no were to be found. When I said that we have files where (same insurance company) we have been paid O&P for less compound jobs and I’m ready to fax them copy’s of this documents. After this adjuster said that they don’t even have to talk to me because I’m not a policyholder and tried to end this conversation, but I was ready to fax him a written statement from the policyholder authorizing us to deal and negotiate all aspect of this claim with there’s insurance company.

Unless I got something wrong insurance Co. owes us O&P