General Insurance Claim Questions
Have a general insurance claim question? Post it here for our contributors to answer. Questions under 100 words are more likely to receive an answer.
Have a general insurance claim question? Post it here for our contributors to answer. Questions under 100 words are more likely to receive an answer.
September 23rd, 2008 at 9:57 am #marian hamilton
I would like to know if your car is in a flood and water get into your car and starter andother place . Should your car be total
September 24th, 2008 at 2:07 pm #admin
Hello Marian,
Yes, it should be a total, in my opinion. There are two arguments: mold concern and mechanical and electrical concern. The insurers “restoration company” cannot get inside the inner sheet metal panels of your car to clean them since they are spot welded together. And they will not guarantee in writing that electrical components will not fail prematurely. If the engine had water in it for over 24 hours, most mechanics will tell you that the crankshaft main bearings will fail prematurely.
You should take five minutes and give the adjuster, insurer and their body shop or cleaning company ratings on our “Rate Your Adjuster” page.
February 23rd, 2009 at 6:16 pm #susan
My husband and 6 of his band members were injured in an automobile accident when a cow was standing in the middle of the road at night. The cow owner had insurance and his landowners insurance has accepted responsibility for it. They say that there is a $500,000.00 cap on the policy to be split between the 6 men. But my husband has numerous injuries and still has 3 surgeries that we know of to go. They are asking us to submit a “demand” for the amount that we would like to receive from them on an individual basis. Even though they say that they only have 500,000. to work with we need to know if they can go above that if they need to in order to cover everyone costs. They have missed time at work and still have many outstanding medical bills to cover. We just need some advice before we give them an answer. Thank you
February 24th, 2009 at 10:23 pm #admin
Hello Susan,
First of all, I’m no expert on liability insurance claims. And I suggest you check with an attorney. If you can’t get 10 minutes of free advice on this question from an attorney after calling around, give them $75.00 for a few minutes of their time. Be careful about hiring an attorney on contingency who will get 1/3 as soon as you sign the contract. He can sit back and do nothing other than collect his money. It sounds like the damages are well over the $500,000.00 and the insurer is willing to pay. If the insurer agrees to pay the full 500,000, look for an attorney who is willing to take his fee from the amount “over” the insurance offer. 50% of the amount over is fair, in my opinion.
Now here is my advice, go ahead and make a demand for an amount for each of the 6 members. List each members claim on a separate sheet of paper. Medical bills, lost work, etc. and describe why the injury will affect future earnings or appearance. A damaged throat on lead singer may be worth more than a similar injury on a drummer who does not sing.
Now, DON’T sign any release from the insurer if it releases the policy holder (the landowner) also. Only release the insurer. And ask to see a certified copy of the policy. Don’t just take their word for it. Adjusters can lie. Also, you don’t want to give up your right to sue the landowner, since he may have assets over and above the insurance limit of $500,000.00 and or an “umbrella” policy.
And find out what the statute of limitations (time to file a lawsuit) is. Its usually 1 or 2 years from the date of the accident. Some insurers will delay the negotiations just so you accidentally forget, and then they won’t pay one dime. Pay a lawyer for an hour of his time to fill out a pre-printed complaint form to file at your local court, to “protect the statute”.
Again, get a lawyers advice for 1/2 hour.
June 30th, 2009 at 11:41 am #Scott Reich
I have home owners insurance with two questions.
1-I have a patio door that had leaked about a year ago, fixed the leak with minimal damage to the carpet and subflooring, recently began leaking again ad carpet has started to mold and leak still countinuing. Is this a valid claim.
2-Believe televison was hit by lighting during a storm was a pop and burning smell. Would this be covered and how would Iprove that was the case?
July 2nd, 2009 at 12:42 am #admin
Scott,
1. If the water is from a broken pipe or plumbing fixture, then it should be covered. But if it is from rain or flood or sprinkler water, that’s called “surface water” and excluded in most policies.
2. Most policies cover electrical surge, but not to appliances (so what good is it right?). And lightening damage is covered, but I suspect the adjuster will say it must be a “direct hit”.
Ask an electrician to read that part of your policy to see if he can come up with a creative explanation for the lightening damage that is not electrical surge.
August 31st, 2009 at 6:13 pm #Larry
I have a 2nd story outside deck (attached to the house) which has two drains at deck level. One of the drains drained into the supporting column and developed wood rot. This also spread to the entire deck under the concrete and tiles so that it was not noticed. It also spread to the other column and horizontal wood beam. The entire deck needs to be replaced. There was no way to know there was a leak. The way I found out was the one supporting column suddenly one day showed a sign of compression in the stucco. Should State Farm cover this and to what extent if so?
Thank you.
September 1st, 2009 at 4:02 pm #admin
Most insurers don’t cover rot, even if it was hidden from view. First try the sympathy route. If that fails, try to find a “concurrent cause”, another covered cause of loss that could have contributed to the loss. Be creative if you have to. Most home policies say they cover “everything except”, so this puts the burden and cost to disprove your claim on the insurer. If it cost more to hire an engineer to disprove your claim, it may be cheaper for your insurer to just pay you for your damages if you sign a release. Its called a “compromise settlement”.
September 10th, 2009 at 2:58 pm #Laurie
I am getting a new roof from a Hail Storm. I don’t really need a full new roof, but they don’t make the same roof so I get a full new one. What If I want to use the money for other home improvements instead? Can I do that or would I get in trouble?
September 10th, 2009 at 9:26 pm #admin
Hello Laurie,
You can use the money they gave you to go to Hawaii if you like. But keep in mind, that if they deducted depreciation from your settlement, and if you have replacement cost coverage, you can’t later recover that depreciated amount if you don’t do the repairs, and there is usually a time limit like 180 days to do the repairs.
Now for you other readers, sometimes you can “shift” money around if there are several trades in the repairs, and you get the adjuster to agree in writing before doing that. But in the case of a single item, like a roof, most adjusters won’t agree to it. Of course it won’t hurt to ask the adjuster, but make sure you have the money in hand before asking, because the adjuster could “change his mind” on the depreciation if he thinks you will “cash out.”
September 17th, 2009 at 6:33 pm #Larry
See previous question dated Aug 31st.
The wood rot on the decks was caused be a breakage in the “hot-mop” which was per code in 1989 when the house was built. With the tile flooring over the hot-mop, one cannot see the damage. I would therefore think that the insurer would be responsible for all wood rot and water damage since it was caused by this breakage. What do you think?
September 17th, 2009 at 7:46 pm #admin
Larry, go ahead and make the argument and hope for the best. If they deny the rotted wood, ask them to cover what it would have cost to access the repairs (which could include replacing the tile floor, etc.) and what would have been “non rot” damage at the time of the break. What could have caused the hot mop to break, something other than “wear and tear”, like a 400 pound guy walking on the deck?
And make sure the hop mop break occurred within your State Farm policy period. If not, go to the prior insurer.
November 17th, 2009 at 3:39 pm #toyia
i receive a insurance claim check for storm damage it had my name mortgage company, and the contractor. I sent it to the mortgage company to see if they would endorse it first can they hold the check if they refuse to endorse the check if so for how long.
November 17th, 2009 at 11:30 pm #admin
Toyia,
I don’t think they are allowed to hold onto the check, but its worthless to them if you have not signed it. Once the repairs are done, tell the mortgagee the job is done. After they send their own inspector out to confirm the repairs were done, THEN, legally they have to sign the check and return it to you.
December 12th, 2009 at 11:38 am #Jerry Gahan
In 2005 I received a notice from the IRS that Prudential Insurance had filed a1099-R in the amount of $32,329.27 for a loan against my life insurance policy that Prudential was “writing off/paying off”. Prudential never sent me a copy of the 1099 (the IES did), so I also had to pay penalties.
I ended up paying the IRS approximately $3,500 for this, $ 3,051 plus interest, and the California Franchise Tax Board about $1,500. I also had liens placed on my house, and my bank account.
I tried, for quite some time to get a statement of my account from Prudential
with little results. My last 2 (yearly) statements were completely blank.
I started getting suspicious and I called Prudential several times to get a statement, and kept getting all sorts of OTHER forms instead. After insisting, I finally got a statement from Prudential.
Prudential states that I STILL OWE THEM THE MONEY (plus 5 years of interest added to it, about $2,000 per year).
In a letter from Prudential (Dec. 2009), they state that they are required to report any taxable gain. Yet as of December 31, 2004 there was NO gain (the end of tax year 2004). In their letter dated 2009 they verify that the policy was reinstated and the loan “pay off” was reversed on March 4, 2004, 9 months before the end of that tax year (just barely over one month after payments were missed), and Prudentials account statement dated March 2005 (for the previous year) also verifies that the loan “pay off” was reversed. March 4, 2004 is 9 months before the end of that tax year, yet Prudential filed a 1099 anyway. Why did Prudential file a 1099 when they ADMIT there were NO gains for 2004?
Prudential explains that the reportable tax gain is the loan repay amount minus the cost basis, then in the next paragraph they again verify that the “pay off” was REVERSED.
Prudential says that they have no responsibility in the fact that I had to (wrongfully) pay
$5,000 in State and Federal taxes on the gains that they (falsely) reported. Even they have verified (in writing) that this was falsely reported, and that there was NO gain. Prudential gave an explanation of their actions by explaining the “letter” of the law that justifies their action. Of course the objective of that law, and their ethics were never mentioned, nor was there any apology for costing me $5,000.
I had liens placed on my house, my bank account, and the IRS threatened to attach my Social
Security checks, all because of a fraudulent 1099 from Prudential.
I would like to see a copy of the letter informing the IRS and me that the “pay off” was reversed. Let me guess, they are not required by law to inform anyone that they screwed up. The IRS says that my only recourse with them is to obtain a tax attorney, at my expense of course.
This policy has been in effect for 46 years, yet payments 5 minutes late, and the policy goes into default, in the hopes that they can find cause to cancel the policy and pocket the money.
My mother had a life insurance policy with Prudential for over 40 years, when she died I called Prudential (I’m the beneficiary), they said that the policy had lapsed just before she died, how convenient, they pocketed about $75,000.
How many people have they screwed using these practices?
Prudential was obviously not acting in “good faith”, on in my interest.
There is this new thing out, it is called Ethics, look it up.
Prudentials actions are illegal, unethical, and despicable. You are defrauding the IRS and me, and on top of that you are stealing from me.
The people of this country are sick of business practices like yours, if you have not noticed.
December 12th, 2009 at 4:43 pm #admin
Hello Jerry,
The volunteers at this website are more likely to answer short questions if you want to condense it, but I’m posting your question anyway.
Does anyone want to take a crack at TRB’s post?
January 7th, 2010 at 1:19 am #paras nath chaturvedi
if the vehicle parked in open ground without safty arregment did insurer repudiated the claim in the ground of neclgency
January 8th, 2010 at 1:52 am #admin
Paras,
I don’t think your insurer can deny your claim because of your negligence, unless they can prove you intended for your car to get damaged by doing something like parking it in the middle of a road, or on a railroad track or a ghetto.
January 9th, 2010 at 12:17 pm #Joseph Del Medico
I have hail damage to my roof (Ohio). My policy provides for cash value of repairs. Cash value is defined as the cost of repairs minus depreciation. the problem is that the Building Code will not allow the repairs therefore I will need a new roof. The insurance company has denied my claim for a new roof. What should I do.
January 10th, 2010 at 11:59 am #c Lauerman
I was getting out of my parked car in a parking lot when a strong gust of wind came up and my car door flew out of my hand and into the car door of the car parked next to me. The damage was minimal, but enough that I waited in the car for the owner. I requested that I try to pay for the damage out of my own pocket since it was minimal, but we both still went through our insurance policies. He decided he wanted to have the insurance cover the claim in case there were issues with the body work and went ahead and submitted the claim and body shop he was working with. The next day he called me to say he changed his mind…he was willing to let me pay for it. The damage was $75 — I paid him, he called the body shop and told them not to cash the insurance check when they received it. They did not cash it, but I now have an incident on my record with a zero payout, and have lost my good driver’s discount.
Is there any way to dispute this claim that wasn’t even paid by insurance to clean my record?
January 12th, 2010 at 2:30 am #admin
Lauerman,
I don’t know. Ask your agent.
Anyone else know?
January 12th, 2010 at 2:39 am #admin
Joseph,
Check to see if you have code improvements coverage or endorsement in your policy. Are you sure you don’t have RCV coverage on structure?
January 19th, 2010 at 4:38 pm #admin
Dear Visitors who regularly monitor this website via RSS feeds or other methods. Because of the burden of increasing visitors with questions, your answers are needed. Questions will be posted, but Admin responses may now either be delayed, or not given at all. Here is your chance to give back. Your involvement in the Discussion Forum of this website is also desired. Thanks.
February 1st, 2010 at 11:08 am #Ryder
Hello,
I have a home that I am buying currently in escrow. Recently, there was some water damage from heavy rains…leaking roof…bedroom damage. The sellers made an insurance claim and they seem to be dragging their feet getting things fixed. My escrow runs out in 4 days. Is it possible to close escrow and continue with the repairs with new ownership even though its not my claim? Thanks.
Ryder
February 1st, 2010 at 7:35 pm #admin
Ryder,
Insert a clause or provision in the escrow agreement that the seller assigns his interest in “the claim” to you, and that seller agrees to cooperate to fulfill his duties in the claim, eg. give statement, etc. In most states this does not require approval by the insurer. Only assignment of “the policy” requires prior approval from the insurer. Check it with an attorney in your area. And don’t forget to put your own insurance on the house. I had one client whose house burned down 3 days after escrow close.
February 19th, 2010 at 8:25 am #rob
i had bad ice dams on my roof this year and water was coming inside my house through my windows. the water was bad enough to cause plaster in a front closet to actually cave in exposing the wall behind it which lead me to see rotten wall boards. i just bought the house three years ago and havent had this problem until we got this amount of snow. will they cover this being that it was already happening over a period of time. i had no way of knowing?!!
February 21st, 2010 at 3:16 am #admin
Rob,
It depends on your state and your policy. Some policies actually make an exception to the rot exclusion, if it was out of sight. So first read your policy.
I have heard that some northern states have special ice dam endorsements. Check with your agent if you don’t have that endorsement.