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hey insurance people and lawyers got a situation! claim denied! help!

Hipsterave

TRIBE Promoter
Some of you may have read about my incident with a drunk driver a few weeks ago. The story continues.

I joined Coseco insurance in may of last year.

DO NOT USE COSECO THEY ARE TRYING TO SCREW ME AS YOU WILL READ BELOW.

Previously I had been with my old insurance company for my car for 17 years. I was recently in a 3 car accident where I was the front car. My foot was hard on the brakes stopped at a stoplight. A drunk driver plowed into a cab which then hit me and moved my car between 5 and 7 feet (the other two cars were written off my car had damage to the back end).

I was told that I had 0% fault which was expected and I took the car to my own body shop to have fixed. I noticed there was a clunking sound from the back of the car and informed the agent prior to taking it to the body shop. She said they will need to determine it was related to the accident to which I said no problem it wasn't there before so I was confident that it would be found to be related.

The claim for the body repair was paid and then I took the car to my mechanic to see what the problem was. He found a problem in the shocks on the back end. I had just had brand new shocks put in the car less than 1 year ago so I knew it was related to the accident.

The adjuster showed up on a day when my mechanic was not in the shop and the guy there didn't know what was wrong. He told the adjuster to look at the front of the car which he did and determined there was nothing wrong (which is true). My mechanic got back and realized that this happened and called the insurance company to let them know the error and gave them a technical report of how the damage was related. He is a licensed mechanic of over 40 years and I trust his opinion.

My car is older but has been immaculately maintained. Without returning the adjuster refused to come back and denied the claim was related to the accident. My mechanic demanded to speak to his manager who then made an appointment to come by on Thursday. Thursday afternoon he called to say he could not make it and would be there Friday. Friday he did not show up. Finally on Tuesday morning he arrived at the mechanic who was now pissed at me as the car was tying up his lift for 5 days waiting for these adjusters.

I had now been without a car for two weeks as it sat at the shop waiting for the insurance company to respond. Today (Tuesday) i get an email that the adjuster does not believe the mechanic and denied the claim. I asked for the technical explanation from the adjuster and how he knows more than my mechanic. The agent responded that she would have the original adjuster (who didn't see the back of the car) get in touch with me to tell me how the damage did not relate to the accident.

I requested that the manager contact me as he was the one that saw the car. Its only $300-400 in damage but I am really frustrated as I'm confident the problem was not there prior to being hit by the drunk driver in which i had 0% fault. I don't know what recourse I have now as I asked to speak with the agents manager to escalate the issue and she did not deny but ignored my request.
 

NemIsis

TRIBE Member
Omg dude. Paragraphs.... please. Trust me I know. I see this and I hand it back. I won't mark it. It's just too painful. Also, I'm sick and very crabby right now.
 

glych t.anomaly

TRIBE Member
Omg dude. Paragraphs.... please. Trust me I know. I see this and I hand it back. I won't mark it. It's just too painful. Also, I'm sick and very crabby right now.
hahaha awesome.

i tried to read it and stopped after one sentence it hurt my brain.

edit - just forced my way through, that sucks man.
 
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MoFo

TRIBE Member
So I actually read the thing and I'm gonna pipe in.

So much of your story has little to do with the actual situation: you wanting the second round of repairs to be covered by the new insurance company. You're kvetching about the delays, the miscommunication, your mechanic's errors (yes, someone else made the error but they do represent their shop) and then the delay it took for them to get back to you about the results. That has zero to do with the actual claim and more to do with customer service. That is a definite sign to change insurance companies. Call them, explain concisely to a customer service manager what had happened and tell them you're changing companies. They might throw you a bone but if not, then leave. It doesn't seem like this company respects your time or your business so why bother paying them? Again, it has nothing to do with your claim and what you want out of it: $$$.

Okay, so now that that's out of the way, your claim was denied because the new repair had nothing to do with the accident. And now they are having the guy who saw it with your original mechanic call you about it to verify it again. So what are you complaining about exactly? If I were the insurance company, I would assume you were trying to mil more repairs out of an accident claim. Shocks were put in last year by THIS mechanic? If so, how do you know he's not trying to cover his back so he doesn't have to put new ones in again for you at no extra cost? You can't prove that a new problem is because of the accident when those repairs were already resolved with the first claim unfortunately. It might be but there seems to be no proof. What did your mechanic say exactly was the cause of the new rattling?

The only way you can prove it in small claims is if your mechanic can testify for you or have a written mechanical report in an affidavit form (or both) I would think.

But this is all from watching endless hours of People's Court and Judge Judy.
 
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Bass-Invader

TRIBE Member
That's a great story but I'm not sure what your question is. Without the insurer's reasons for taking a position on that I'm not sure what you can do. Your best bet is to involve a lawyer if the amount in question is worthwhile. He'll at least be able to get the reasoning out of the insurer. It may well end up that the reasoning is sound though. I have no idea what general obligations insurers have to provide such reasoning in the absence of proceedings though (I would *hope* it would be mandatory!).
 

kyfe

TRIBE Member
Being that I used to work in the industry and this is my former employer and well at one point this was my job feel free to PM me. As for the accident damage being related, TBH I really highly doubt it, a rear and impact should have not caused your shocks to fail. Having said that I can help you win your dispute since I can help you speak their language.
 
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Hipsterave

TRIBE Promoter
So I actually read the thing and I'm gonna pipe in.

So much of your story has little to do with the actual situation: you wanting the second round of repairs to be covered by the new insurance company. You're kvetching about the delays, the miscommunication, your mechanic's errors (yes, someone else made the error but they do represent their shop) and then the delay it took for them to get back to you about the results. That has zero to do with the actual claim and more to do with customer service. That is a definite sign to change insurance companies. Call them, explain concisely to a customer service manager what had happened and tell them you're changing companies. They might throw you a bone but if not, then leave. It doesn't seem like this company respects your time or your business so why bother paying them? Again, it has nothing to do with your claim and what you want out of it: $$$.

Okay, so now that that's out of the way, your claim was denied because the new repair had nothing to do with the accident. And now they are having the guy who saw it with your original mechanic call you about it to verify it again. So what are you complaining about exactly? If I were the insurance company, I would assume you were trying to mil more repairs out of an accident claim. Shocks were put in last year by THIS mechanic? If so, how do you know he's not trying to cover his back so he doesn't have to put new ones in again for you at no extra cost? You can't prove that a new problem is because of the accident when those repairs were already resolved with the first claim unfortunately. It might be but there seems to be no proof. What did your mechanic say exactly was the cause of the new rattling?

The only way you can prove it in small claims is if your mechanic can testify for you or have a written mechanical report in an affidavit form (or both) I would think.

But this is all from watching endless hours of People's Court and Judge Judy.
My shocks were replaced not more than 8 months ago. there was no issue before the accident and a loud clunk after the accident. The mechanic said it is unusual but could have happened on the bounce when the car was struck from a stopped position hard on the break moving 5-8 feet forward.

I trust my mechanic hes honest (hard to find) and knows his stuff.
 

JEMZ

TRIBE Member
Dude insurance companies are the most corrupt organizations in the world. Period.

You see they have to deny a certain percentage of claims regardless of whether you are right or wrong just so that they can maintain their mega profits.

This is not true in any way, I'm all for reasonable discourse but try not to sound like an idiot.

Farbs this is too bad man. I work as a Case Manager for disability insurance so unfortunately I cannot help you, but I do wish I could. Good luck buddy.... be persistent. There are appeals avenues for a reason, just stay on it and get everything documented that you possibly can.
 
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MoFo

TRIBE Member
That's a great story but I'm not sure what your question is. Without the insurer's reasons for taking a position on that I'm not sure what you can do. Your best bet is to involve a lawyer if the amount in question is worthwhile. He'll at least be able to get the reasoning out of the insurer. It may well end up that the reasoning is sound though. I have no idea what general obligations insurers have to provide such reasoning in the absence of proceedings though (I would *hope* it would be mandatory!).
It's like $300.
 

MoFo

TRIBE Member
I trust my mechanic hes honest (hard to find) and knows his stuff.
So if this went civil, are you going to ask him to go to court? I thought you said he was already annoyed that it sat there for a while and that two separate adjusters (including a manager) came out to meet with him?

I'm sorry but I don't think you're going to get money for a repair AFTER the fact. You already got it repaired and then something happened and there was more damage. You can't prove that it was the accident beyond a reasonable doubt. what if it was a speed bump or whatever? There is no way they're giving you money and to be honest, it really does sound like you're making speculations, your mechanic is taking a guess and you're trying to validate not having to pay $300 for your mechanics' potentially shoddy workmanship.

You can noodge (whatever the Yiddish term is for pestering for something) by taking a retention strategy though and just weasel some money out of it. But yeah, you're not the one being screwed here technically in their eyes. Good luck proving that the shocks were damaged by a rear ending.
 
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