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.
March 15th, 2010 at 6:32 pm #Herb Andler
My sons home recently burned to the ground and and was determined by the inspectors to have been caused by an electrical short .
It has now been nearly three months waiting for a settlement. Last week he got a call from Sterling Bank whoholds the contract that they would be puttng the home into foreclosure. (at the time the home burned his home payments were current.
In addition, while trying to get a payoff from the bank he was advised he has been chged interest since the fire
when does the insurance company assume responsability for costs incurred after the fire loss ?
March 16th, 2010 at 11:15 am #Lee Albert
If a car is stolen with the keys in the ignition, will the insurance company not pay out on TPFT?
March 16th, 2010 at 11:03 pm #admin
Herb,
1. The bank is still entitled to get their mortgage payments even if the house burned down and the insurance claim is not settled. Your insurance ALE or Rental Value payments should offset the mortgage payments.
2. If the fire was accidental as you say, the insurer should have issued a payment for the repairs or the value between two and four weeks after the fire. If they suspect arson or your son, then it can drag on for months and possibly be denied. Get a written status.
If you are going to do this yourself without a public adjuster or attorney, look at the table of contents of the eBook at UClaim.com entitled Homeowners Loss Advice Deluxe. Its guaranteed and includes free consultations with the author.
March 16th, 2010 at 11:07 pm #admin
Lee,
I don’t know what “TPFT” is. But if you have comprehensive coverage, then it should be covered, unless your policy has an exclusion for that. Most don’t have such an exclusion, and if yours does, get another insurer.
March 19th, 2010 at 11:35 pm #jen
Hi,
We have a slab leak in our kitchen (hot water). The adjuster came out on Tuesday, he sent out a leak detection company come out and says he is going to send a furniture repair guy out to look at cabinets. Sink cabinet completely rotted, sink looks like it is going to cave in. Hot water was pouring out through back wall of house. No mention of Serv Pro or water damage specialist or mold specialist. What are our rights? He has us turning water off and on at curb all day since Tues. No hot water. Can you tell me the process?
Thanks
March 20th, 2010 at 2:04 pm #admin
Jen,
Well you said the magic word “rot”. They may deny your claim based on that. So be careful what you authorize their people like ServPro to do, because they may come after you for their bill. Tell them they must get their payment from the adjuster, not you.
April 7th, 2010 at 11:39 am #andy
My home has a pitched roof and a flat roof. We had a bad hail storm last week and the flat roof now has holes. In addition, the beams holding up the flat roof are rotted. To get up on the flat roof to fix, the beams will need to be replaced. Would this be covered or am I hosed because the beams are rotted?
April 7th, 2010 at 6:54 pm #admin
Andy,
Well, a “quality insurer” might replace the rotted beams with new ones as a way to complete the repairs, but a cheap insurer might say they will just pay to install scaffolding or temporary support and let you decide if you want to replace the rotted wood. That cute little Geico green Gecko ain’t so cute anymore, is he.
April 23rd, 2010 at 2:56 pm #R Fowler
I am curious. Today someone was parked in our driveway. My husband, in attempting to pull into the garage, hit the side of the garage doorway. It has done significant damage to the garage door frame and the wall it is attached to. He also has some paint that hopefully can be buffed out of the car’s bumper.
My question is this: Can I claim the damage to his car and the garage door on his car insurance, or do I have to claim the damage on the car to the car insurance and the damage to the garage to the homeowners insurance. We have a $1000 deductable on our homeowners and do not want to make a claim against it.
Can the car insurance cover both the car and the garage? If he had hit someone else’s house, it would cover it, wouldn’t it?
Thanks in advance for your help!
April 26th, 2010 at 3:27 pm #admin
Fowler,
For your own property, you have to make the claim on the separate policies. Yes, if it was someone else’s house, the car insurance would cover both, the house under liability and the car under collision.
May 14th, 2010 at 7:08 pm #cooper
we received a check from insurance co for claim of pump failure due to power outage during flooding rain storms. our rental in-law apartment was completly damaged and has so much damage that the 5000. dollars we received will not cover the amount of damage. The check came with both our names on it and the mortgage co. and the second mortgage co names on it. Are we allowed to put this in the bank or do we have to send it to the mortgage companies? we will use the money to fix as much as we can but will be doing it ourself to save money.
May 18th, 2010 at 10:35 am #admin
Cooper,
Usually you give the check to the mortgagee, they have to pay it back to you as you do the repairs up to the 5000.00. But in your case it might be easier to send them copies of your repair receipts along with the 5k check, without your signature, and let them endorse it and return it to you, and make an inspection if they like.
May 24th, 2010 at 11:17 am #Anita
We had severe storm damage to our home May 8, 2009. We had to have a whole new roof, etc. The insurance company was American Family and the insurance actually expired midnight that same day. We had to switch to vacant house insurance with another company- so it was covered. The storm damage claim was made to American Family and the work has been completed. The problem is, right before the year deadline we discovered inside water damage. We called American Family who sent out an adjuster. I just found out they are denying the water damage claim and said it’s a new claim. What do I do. I do not feel it should be a new claim, because we did not have water damage prior to the storm. Since the house is vacant, no one noticed the water stains until March 2010. What do I do?
May 24th, 2010 at 3:16 pm #admin
Anita,
I would say the prior insurer should cover it if not an excluded loss.
May 25th, 2010 at 5:42 am #Anita
How should I approach the American Family Insurance company about feeling it should be part of the initial storm damage? They are saying since it wasn’t reported in the first adjuster’s estimate, that it wasn’t part of the original claim.
May 25th, 2010 at 2:48 pm #admin
Anita,
If I understand, you want the prior insurer to cover the claim. Now if they say the damage was “before” the storm, then they can still cover it, as long as it is not excluded (rot, etc.) and apply a new deductible. Their denial letter is supposed to state “specific” reasons for denial. You can scan and email a copy of the denial letter to info@insuranceclaimhelp.org if you like, for us to review.
May 26th, 2010 at 5:52 am #Anita
No – they are saying the water damage happened after the storm and want us to file a new claim. However, we no longer have them as our insurance company, thus they would not be responsible for the claim. We are saying the water damage happened during the storm and should be included in our original claim. The storm came, pulled up our roof, the roofer’s tarped the damage and we waited in line for 9 months for the roofers to put on the roof. The water damage happened during the storm, but did not come to anyone’ attention until the roofers were hammering on the roof and part of the ceiling sheet rock fell. The ceilings are 12 – 20 feet high throughout the house, so no one looked up apparently as time went on. So, we believe the water damage was caused by the storm – we had no damage prior to the storm.
Thanks for any help you can give us.
May 27th, 2010 at 11:19 pm #admin
Anita,
Well, if the damage allegedly happened during that storm and you have an all risk policy with named exclusions (as do 99% of policy holders), then the burden to disprove your claim is on the insurer. If they can’t disprove it, and persist in the denial, then you sue them, or give up, or continue to pester them.
June 5th, 2010 at 2:13 pm #Bradley
We purchased about 1 year ago with a spot of water damage in one of the rooms. Closing conditions were for the seller to repair. Through the course of the past year, it has become apparent that seller only repaired the symptoms of the leak, not the cause. In addition, the roof in general is in pretty bad shape, with some rotten shakes, missing shakes, old hail damage, moss, etc. We had a home inspection prior to purchase but the roof had snow on it during the inspection so condition of the roof was not inspected. Seller disclosed that roof was in good shape, other than the one isolated leak.
It is apparent i cannot delay on this roof any longer, but I am wondering if I have any options for claims with either the prior insurance company or current insurance company. I do not know if the previous owners got insurance money for the roof previously, but I doubt that I myself would be able to get any money from them without getting the courts involved which I would prefer not to do.
Any help appreciated
Thanks
June 8th, 2010 at 11:28 pm #admin
Bradley,
Insurance won’t cover wear and tear. You will have to sue the seller for making false representation.
June 14th, 2010 at 7:41 am #Dina
We had lighting hit our home a year ago and had to replace the AC and Electrical box in our house. Now my car has been giving us one serious problem after another and the mechanic feels that it was from an eletrical surge. The damage to the car is the brain of the transmission and the brain of the car amoung some other things. Would an electrical surge be covered under car insurance? The mechanic is saying there is nothing else he can do to fix the car.
June 16th, 2010 at 10:27 am #Sally Edwards
Hi I had a accident at the beginning of the month. A car drove into my drivers side wing dented and scratted and scratted bumper. He admitted liability. My insurance company called today and as the damage is nearly as much as the car value they said it was a write off. I was at work and couldn’t talk properly so they are calling me back on Friday. Can I insist on getting 3 off my own quotes to have the vehicle repaired? I am fully comprehensive and am claiming against the other parties insurance. My vehicle is a ford fiesta S reg.
Please any advise. Many thanks.
June 21st, 2010 at 3:39 pm #admin
Sally,
They may pay you based as a total loss, but you can still keep the car and repair it. For extensive details on how to do this without getting burned get one of the eBooks at UClaim.com on Total loss Auto.
June 21st, 2010 at 3:44 pm #admin
Dina,
Should be covered under comprehensive. But you will need the mechanic to put his opinion in writing. This is unusual. Was the car plugged into the house electrical system? Exactly how could lightning get the car? I thought cars being on rubber tires should be immune from lightening?
July 5th, 2010 at 1:31 am #Matthew
Dear All.
I was recently at a BBQ party where i was helping to erect a tent with the other party goers. I accidentally hit someone in the forehead with a tentpole resulting in a small cut and a scratch on his glasses. I was very apologetic and offerd to pay for the damages but the person insisted that there was no need, it was an accident and he was wealthy enough to pay for it and said this in front of witnesses. Two days later he has changed his mind and now wants my insurance details. Can i now refuse to compensate him?
July 5th, 2010 at 10:21 pm #admin
Matthew,
IMO, he can sue in small claims court for negligence for as long as your state allows. I myself would not turn in such a small claim to insurance.
July 14th, 2010 at 5:42 am #tony
my daudater was in a motorcycle acciendent she was not at fault. she had comp only so the other insurance company is paying . her bike was a complete lost. she broke her leg cant work , or drive her truck , it is a stick shift. the drivers insurance copmany has totaled her bike , provided her with a car, they contacted her a week ago , informed her the bike was a complete lost but did not give her amount for settlelment, wanted promission to pick up the bike , she said no , not with out a amount for the bike . told her that she had three days to return the car , and told her that she had to pay storage from that point on to the shop where the bike is . it was over a week from that point that the insurance company gave her a amount, is this legal. please help
thanks tony