State doi - What do they actually do?

Submitted by gb298888 on Thu, 03/27/2008 - 22:47

The insurance company is giving me a hard time. This is a ho claim third party. They have all medical records and bills and photos. Liability is pretty much clear. I even gave them prior medical records going 6years back just so they can see a prior injury never occurred. i spoke with the adjuster and supervisor and they both stated they cant process or evaluate my claim. The supervisor even started laughing during parts of the conversation. Its not the first time they said this its around the 5th time. Good thing i record the last time. I file a complaint with ny state doi. What do you think will happen? Do the state doi contact them?

Posted: 27 Mar 2008 11:03 Post Subject:

Is this still about the pipe or something your landlord left out? I thought you'd already settled this one? No? What do you mean they are laughing and not evaluating your claim...didn't you send them all the paper work a month or so ago? Is this a different claim?

Posted: 27 Mar 2008 11:53 Post Subject:

no this is the same one im trying to settle with them. They do have everything , even prior records i didnt have to send but still did.and they are just being mean. He laughed at me because i told him they dont handle claims fair and he said we handle all claims like this. I just wanna give up now. I dont see how adjuster like that sleep at nights. They rip off ppl and feel good. Not all.... But the bad ones make good one look bad too.

Posted: 28 Mar 2008 12:05 Post Subject:

What will happen after they find out i filed a complaint with the ny state doi? They will probably treat me worse? Arent they are suppose to settle a claim promptly when they have all the info they need and more and liability is clear? What is the use of fair claim practice law if they still treat claimants like this? What are some the fair practice act for ny? I cant find them. Thank you

Posted: 28 Mar 2008 12:45 Post Subject:

Let's calm down and try and take this a step at a time...

He laughed at me because i told him they dont handle claims fair and he said we handle all claims like this. I just wanna give up now

.don't give up...I don't blame you though for being upset this is just terrible!

I dont see how adjuster like that sleep at nights. They rip off ppl and feel good. Not all.... But the bad ones make good one look bad too.

I don't know how they sleep either....thanks for making clearly ''all'' adjusters aren't that way... :wink:

What will happen after they find out i filed a complaint with the ny state doi?


nothing with you, they will have a certain time limit in which to respond to the complaint...most state dois take these very seriously.

Arent they are suppose to settle a claim promptly when they have all the info they need and more and liability is clear?

yep they are supposed to...

Tell me exactly what you said and what they said...when you called this time....(it might be tomorrow before I get back with you 11 month old grandson is needing my attention! :shock: )....discribe the conversation, what you ask what they said, have they made an offer? have they said when they will be making an offer? What is the hold up? etc....I'll also try and look up the fair claims practices for NY and atleast get you a link for them..if i have time before work I'll check thru them...remind me as well, when this injury happen, and when you turned it into the insurance company, when you began talking to the adjuster, how long ago did they get all of your records? didn't they tell you last time that they needed to requests them their selves? did you send the med.auth. into them so they could? if so have they got them?

Posted: 28 Mar 2008 01:44 Post Subject:

I called to see if she got anything new from adjuster. She said no. I asked about the claim. She said she cant process or evaluate it so it just sitting there. I said let me speak with your super. He came on and said the same thing i said that not fair. He laughed and said that is the way we handle claims.

Posted: 28 Mar 2008 01:55 Post Subject:

Injury happened april 26, 07. And first contact with insurance co was jan. 15,08. Bc landlord was trying to hide it bc he was at fault. I dont think i should of file a complaint they may treat me worse now.

Posted: 28 Mar 2008 02:02 Post Subject:

No offer on the table yet. What will the state doi do? Will they look at my claim file? How do they investigate the complaint? i hope they don't lie i got them on tape to prove it. I heard the state doi go to the office and check things. And fine them for things that isn't right?! True?

Posted: 28 Mar 2008 11:04 Post Subject:

Ok, GB first off you don't have to make mulitple posts dear, you can just put all the information in one if you'd like... :wink:

I think I've figured this out (*maybe)

I called to see if she got anything new from adjuster.

Is the ''she'' you are talking about the independent adjuster? Is that who you talked to and her supervisor? Have you talked to the actual company adjuster at all?

Let's leave the state doi questions aside until we get this figured out ok?

Posted: 28 Mar 2008 11:45 Post Subject:

They hired a independent adjuster. I dont really talk with him much. He is very nice. But i just go directly to the insurance co when i need answers. The lady adjuster and her supervisor work for the insurance co . They are the ones giving me a hard time. Sorry for the post

Posted: 28 Mar 2008 11:49 Post Subject:

They hired a independent adjuster. I dont really talk with him much. He is very nice. But i just go directly to the insurance co when i need answers. The lady adjuster and her supervisor work for the insurance co . They are the ones giving me a hard time.

Ok, so it's the actual company....George did they tell you what they are waiting on...please explain a little more what the actual trouble is...have they got everything they need to evalutate your injury? If so and they are in the midst of this evaluation did they tell you how long this would take? when they would be ready to make you an offer?

Sorry for the post

:) no sweat don't worry about it...just wanted to be sure you knew would be easier to have it all in one post...each time ....not add to the same one, but a new one each conversation...ok? :wink:

Posted: 28 Mar 2008 12:21 Post Subject:

No they havent told me why. They have everything rigit in front of them. I shovldnt have waste my time sending prior records. All they said it is just sitting there and they cant evaluate it or process it. Im just sick of this whole thing.

Posted: 28 Mar 2008 12:46 Post Subject:

All they said it is just sitting there and they cant evaluate it or process it.

call them back, (record it)...do not lose your cool write out everything first if you need too...ask them...
do you have everything you need to evaluate my injury and make an offer of settlement to me for my injury? If they answer yes, then ask when can i expect an offer from your company..if they say no ask why? what do they need to move forward in the settlement of your claim...ask them if you have understood correctly and they have accepted liablity for this injury? If not ask why....what do they need to complete their investigation....then let us know....

Im just sick of this whole thing.

i know you are hang in there .... :wink:

Posted: 29 Mar 2008 10:30 Post Subject:

The adjuster lady is being very unethical. All she keep saying is she cant evaluate my claim. She gave me no reason of why. Im getting sick of this. Hopefully the state doi do something soon. I filed a complaint with them 3days ago. The lady at the doi told me it could take up to tuesday for an examiner to be assign.

Posted: 29 Mar 2008 10:56 Post Subject:

All she keep saying is she cant evaluate my claim. She gave me no reason of why

You need to ask her point blank (while you are recording it) WHY can't she evaluate your claim, and the other questions I suggested you ask...

Posted: 30 Mar 2008 03:28 Post Subject:

I wont be able to talk to again until tuesday. She is out of her office on monday. Meanwhile Could you give me a range of what my claim is worth? Soon after they get the complaint from doi, i know they will make an offer. What is a good range?

Posted: 31 Mar 2008 05:23 Post Subject:

Gb,

I went back and re-read all of your posts from the past few months. One thing I never read was that they accepted liability. Have they ever told you they except liability? Have you had this conversation with them? Thinking about a settlement may be putting the cart in front of the horse. Looking back, this claim was not submitted until 7 months after the claimed accident (according to you it was due to the landlord). Were there any witnesses? Claims reported 7 months after the fact (depending on what your landlord told them) can be difficult. Did the landlord admit that the pipe was there to his insurance company? When was the porch damaged to expose the pipe - the day before or a week before? How long have you lived there? How many times do you pass by this pipe/porch per day/week. Is this the main entrance to your residence? Was the pipe out in the open where someone should have seen it? Has someone else tripped on the pipe? Has anyone complained about the pipe prior to your accident? Complained to who? You? Landlord?.....

There are a lot of questions that need to be answered prior to them accepting liability. Maybe they have asked them to you already and you just didn't post that part. Maybe your landlord said you were making things up and that the porch was okay. Maybe the landlord told them that you reported it to him 7 months after the fact. Like I said, late reported claims can be difficult if the landlord was not honest or if something does not add up. The adjuster has to put all the pieces together to see if the claim adds up.

If they have not accepted liability at this time, the DOI may just get them to speed up a denial, or at least send you a form letter letting you know they are still investigating. The DOI can not and will not determine liability.

Posted: 31 Mar 2008 10:33 Post Subject:

Meanwhile Could you give me a range of what my claim is worth?

No we can't really do that here, a person would need to review all the medical records, and the claim....do you know how much you have in actual expenses? All medical, loss of wage etc?

Posted: 31 Mar 2008 02:38 Post Subject:

Hi. Dasfux. They havent said anything about liability as of yet. My landlord maybe admit the pipe was there who knows. Thats my it good to have pictures. They dont lie they just snaps what in front of them. And the insurance co have these pics. I lived here for years. That is the main entrance but the pipe isnt noticable. I noticed it after the fall. The landlord is responible to do periodically checks to the apartment and do proper steps to make the place safe. The whold porch is unstable do he care and fix it..... no. It s a violation as well. He keeps the whole apartment in very harzardous ways. If he could fix the pipe/porch he should of flagged it. He had 2 duties by law on by ny tenant and landlord law and the porch violation of how he must keep it. And he breach both of them. That is negligence. Ex. If im driving down the road speed limit is 35 by law and im doing 45 and cause an accident im negligence because i didnt do what was required by law and in result of that i caused an accident.

Posted: 31 Mar 2008 02:51 Post Subject:

Sorry for second post. Once again the landlord can say im making things up but pics dont lie. And he can say i just reported the accident 7months later but he respond to my lawyers letter that was sent to him a few days after the accident. i dont have them anymore not bc i didnt have a good case or the case merits. So he can lie if he wants that his problem he will just look dumb when he get proved wrong. Everything adds up on my end. i think liability is clear and he was negligence. And i dont think they are dealing with the claim right. So i will doi investigate to make sure they are. They want to deny im ready for court. I can wait a year or 2.

Posted: 31 Mar 2008 05:07 Post Subject:

I forgot to mention. Landlords owe their highest duty to keep things safe to/for the tenants.

Posted: 31 Mar 2008 09:19 Post Subject:

Wait a minute here GB,

but he respond to my lawyers

YOU shouldn't be talking to ANYONE at the Ins company AT ALL!!! If you have retained an attorney...never ever ever! that is what you are paying the attorney for, and your attorney is going to have a fit if they find out you've been talking to anyone there! Please if you are represented stop it! You are compromising your claim! Call your attorney with these questions but never the carrier...

Also I thought liability had been determined....if not then they are not in any position to talk to you or your attorney yet anyway..

Posted: 31 Mar 2008 09:42 Post Subject:

Gb,

Lori's right, determining what your claim is worth is impossible without looking at all of the information. All I can say is that it is worth what you feel its worth. Say they come back to you and accept liability and offer you 20K. If you feel that is fair you accept it, if not then you have to decide what you think is fair. Since you are handling this yourself, you have to look at what your out of pocket has been since the accident (anything above and beyond your normal costs), you also have to look at what the injury may cost you in the future. Only you can supply this information and only you can decide what your claim is worth.

I meant no offense by my prior post and sure it is good that you have pictures. Does that mean that there is clear liability.... No. I'm just trying to show you what they could be looking at. Who is to say this pipe wasn't exposed just the day before your accident. What is a reasonable time to have it repaired? They are also going to question how you did not see this pipe if you tripped on it, being that this is the main entrance to your building that you have lived at for years.

Posted: 31 Mar 2008 09:44 Post Subject:

Lori-

They no longer have an attorney. I read it somewhere in one of their posts.

Posted: 01 Apr 2008 10:28 Post Subject:

Lori-
They no longer have an attorney. I read it somewhere in one of their posts.

thanks dasfuk, this claim is spread all over the place, i must've missed that one...perhaps they should get that attorney back....on this one...

Posted: 01 Apr 2008 06:45 Post Subject:

Hi. Lori. Why do you think i should get back that atty? I couldnt reach that lady adjuster. But they have recieved the complaint i filed. I dont think they will try to play anymore games. Let see what she or her supervisor have to say now. I really didnt want to file a complaint. I dont like doing that. But if that is the only way i can get some cooperation i will.

Posted: 01 Apr 2008 08:18 Post Subject:

Gb,

At this point you might as well wait and see how they respond to your claim. Since it has been a couple months, you might want to have the first 6 digits of an attorney dialed so you can hit the last one if you get a denial. I really see this one going that route since it has been a couple months. As an independent adjuster, I normally found the longer the wait the more times it came back as a denial. I assume they are getting their ducks in a row to make a denial. Who knows I could be wrong and they are just evaluating your claim.

Posted: 01 Apr 2008 09:17 Post Subject:

But they need a reason to deny the claim. Right? Im not giving them a fraudulent claim. I have permanent nerve damage to my hand and wrist. This is not me saying it. Its proved by an emg. Im just want to be compensated fairly. They have everything. Should they have accept liability by now if they were? I even gave them prior records. I see working with insurance co doesnt work.:-):-x

Posted: 02 Apr 2008 03:27 Post Subject:

Sure they need a reason to deny liability and no, I doubt they are questioning that you are injured. But just because you are injured on someone's property does not automatically make them negligent and responsible for your injuries. Just because the apartment complex or building is not well kept or has other hazardous conditions does not make them negligent for this particular incident. They can't dispute that there is an injury, but they can dispute that their insured was negligent.

They can dispute when you took the photos or even if they are photos of the actual scene of the accident. They can claim you should have seen the pipe since you lived at the property and most likely passed by this area numerous times a day. They can dispute that you never tripped on the pipe and got injured somewhere else. Their insured may have stated that the porch broke the day before you were injured and they were only aware of it the day you were injured when they came to inspect the property. (This would be a question of what is reasonable for notice of the problem.) These are questions (plus others) that could be raised and are more difficult to determine 7 months after the fact.

The questions that they most likely have above coupled with the almost 3 month delay in response since the claim was submitted would lead me to believe that they could deny liability on behalf of their insured.

Posted: 02 Apr 2008 10:18 Post Subject:

I agree with Dasfuk, also a reason they 'cannot' evaluate your injury, is either that their investigation isn't complete or they are on the brink of denial...They will not even look at your injury if they haven't or won't accept liablity for your injury...Could be many reasons they haven't completed the investigation, one being lack of cooperation on their insured's part...

Have you received any letters at all saying that they need additional time to investigate, or when they think their investigation will be completed and liablity determined? See there is no sense or reason to even discuss your injury until that has occured (acceptance or denial)..

The reason I think you may need to contact your attorney again, is that apparently you cannot get any information from this adjuster or her supervisor...Personally if it's been three months since the claim was reported (is that right?)....I'd give them one more call then I'd see an attorney...three months is more than enough time to accept or deny your claim.

Posted: 02 Apr 2008 11:52 Post Subject:

Dasfuk and Lori, you two make very excellent points. Dasfuk, dates are on all the photos. No is expecting a pipe to be there near the steps. It just shouldnt have been their. Ok the insured can say that the porch broke a day before i was injured or that he was aware after the injury and when he came to inspect. Now the incident happened in april. I have picture of it still like that in may. In order to fix it he need a few screws. This is a very reasonable time to fix and still didnt. Not like he had to rebuild the whole house. So that would be negligent. Dont you think? Lori, yes 3months is enough time to accept or deny. They sent me a letter saying the reviewed all the documents and they need any names of witnesses in order to complete the investigation. I told them from the start there was none expect me. I also got a letter from their independent adjuster saying they have everything.

Posted: 02 Apr 2008 11:57 Post Subject:

Also i want to thank you two(lori & dasfuk) for your time and help. Your help have really helped me a ton. once again thanks.

Posted: 02 Apr 2008 12:41 Post Subject:

Ok, when was it you got the letter from who? that said, (basically) "we have everything we need now to complete our investigation?" Or is that what it said?

Posted: 02 Apr 2008 01:29 Post Subject:

The last letter i recieved was on march 13. This was from the insurance co. It stated they reviewed all the documents. And in addiction they need the names of anyone who was there. I told them from the start. It was only me. And that what the letter stating. No addition info other than names

Posted: 02 Apr 2008 02:07 Post Subject:

And in addiction they need the names of anyone who was there. I told them from the start. It was only me. And that what the letter stating. No addition info other than names

I know you already told them this, but did you respond to this request? Either call them or write and tell them (again) no witnesses?

Posted: 02 Apr 2008 02:23 Post Subject:

No i havent i told them from the start. Should i tell them again?

Posted: 03 Apr 2008 03:01 Post Subject:

Yes, it would appear that they are waiting on a response from you as to any witnesses and you should respond by phone or in writing.

Short Story sorry:

I had a similar claim where a tenant claimed that she fell on some uneven concrete stairs at an insured's building. The claim was submitted about 3 months after the fact. After conducting my investigation I turned it into the insurance company. The insurance company requested that I ask for any witness names in writing to the claimant. I received a response of no witnesses from the claimant and the claim was denied the following day. With this claim, I really felt the claimant was making it up due to information uncovered about the claimant in the course of my investigation, but my point is they may be setting up their denial.

As far as when the porch was fixed after your accident does really come into play. The important thing for you to show is when the porch was damaged and the pipe exposed. You need to show that their insured had notice or should have had notice of the hazard. If the pipe was exposed only the day before the accident then their insured may not have had notice or implied notice of the problem, and thus did not have time to fix it or at least flag it for his tenants/their guests. (This is when what is reasonable for the insured to know that their is a problem).

Once again, it appears that they are setting up their denial. I would call them and let them know that there were no witnesses and see what they say. Then get the attorney.

One other thing - is this a multi-tenant building or are you the only tenant. If it is multi-tenant, check with other tenants to see if they can tell you when the pipe was exposed. If you are the only one that lives there (family members/friends would not be good witnesses) check with maintenance people, meter readers, phone company, whomever you can think of that is at the property on a normal basis that could confirm your story as to when the pipe was exposed. Also, with this type of injury did you go to the hospital the same day. Was an ambulance called? Any type of report filed?

Posted: 03 Apr 2008 07:46 Post Subject:

Hi. Dasfux, what do you mean by what information you uncovered about the claimamt? Also i have pictures almost 2weeks after the incident. So that wouldnt be a reasonable amount of time to fix something that only need a few screws? That seems reasonable. When he fixed it should matter. Because how much time is driving a few screw could take. He should of notice it if he didnt already know. I already showed that the porch was damage. It has other tenants but they moved out and new moved in.

Posted: 03 Apr 2008 07:59 Post Subject:

also what should i say after i give them that information should i ask for a updated or when the investigation is going to be finished. I dont think the adjuster will want to play any more run around games. She have recieved that complaint. Could you tell me what questions to ask her. The investigation should be complete after i tell them that info.

Posted: 03 Apr 2008 09:49 Post Subject:

No i havent i told them from the start. Should i tell them again?

Yes, if they specifically requested this information in a letter, then you need to respond to that question...they ''could'' hang their hat, on that alone...(re: can't complete investigation because claimant has not supplied requested information....) I know it shouldn't matter, but some adjuster would do just that... So call them tell them referencing their letter of blah blah date, 'no witnesses'...

If you are the only one that lives there (family members/friends would not be good witnesses) check with maintenance people, meter readers, phone company

mailman always a good one, and likely passes it daily...in my prior life when I handled a lot of HO claims, I got tons of great information from mailmen/women, they could probably even attest to how long it was that way, when they noticed it repaired etc (assuming the mailman goes by it of course)...

It has other tenants but they moved out and new moved in.

Get their forwarding addresses at the post office or find their phone numbers and call them!

I dont think the adjuster will want to play any more run around games. She have recieved that complaint.

How do you know that? And was the complaint, re: time it has taken to investigate?

should i ask for a updated or when the investigation is going to be finished

Absolutely...you also need to get on the witness thing...when you talk with the adjuster be sure and tell them there are no witnesses to your fall/injury, but there should be plenty re: the pipe..(this is correct right?)...then you need to get to finding those witnesses....yesterday......

Posted: 03 Apr 2008 09:11 Post Subject:

Gb:

You are missing my point. I does not matter how long he took to fix the porch after the incident. Should he have fixed it soon after….. sure, but it does not come into play as far as him being negligent as you had already fallen (or this is at least the way I understand how it happened). What comes into play is if the porch was damaged for an unreasonable amount of time prior to your incident. If he knew or should have known the porch was damaged prior to your incident and did not highlight or fix the problem within a reasonable time… that is where he is negligent. The fact that he is a scumbag landlord that does not take care of his property does not by itself make him negligent for your incident.

Mail men/women - They were always good for letting me know how long a property had been vacant. Wonderful people. Find witnesses.

As far as my claimant. It was found that she had a pending insurance fraud case against her and a history of questionable accident claims of a similar nature.

Posted: 03 Apr 2008 09:12 Post Subject:

Me above. Stupid log on.

Posted: 04 Apr 2008 12:06 Post Subject:

Well if he didnt know he should of. He should of took reasonable steps and also do periodically checks to ensure the safety of tenants. It was also a code violation. A few duties he had and breach all.

Posted: 04 Apr 2008 12:29 Post Subject:

All Dasfuk is trying to get across to you GB is that how quickly AFTER your fall doesn't affect your claim...now if another person would've fallen....then well, another claim..or if it had been brought to his attention PRIOR to your fall, and he still didn't fix it then you fell after he KNEW there was a hazard...then 'maybe' you'd have some 'gross' negligence to boost your claim..Dasfuk isn't disagreeing the guy is a lazy landlord...just trying to get across to you that it really is of no (or little) affect on your claims value...and he 'should've' known...well maybe, but maybe not as well...clearly you didn't see it or your wouldn't have fallen and you walk by it a few times a day right?

Posted: 04 Apr 2008 07:39 Post Subject:

Gb:

That's the question, should he have known. Personally I believe and have seen a lot of landlords and property management companies that let things go and really don't care about their property or their tenants (except when rent is due). So yes I believe that your landlord does not take care of property. Does he owe his tenants a safe place to live... sure, but you are getting hung up on code violations. A code violation by itself (even for the porch) does not make him negligent. If the porch broke the night before your incident then no, I don't think he should have known or would have known about the damage unless someone told him. On the same hand, he should have flagged it or fix it in my opinion if he had known any more then a day before your fall.

By not fixing it or at least flagging it after your fall was just stupid on his part and he was begging for another claim.

Posted: 04 Apr 2008 07:51 Post Subject:

Gb:

That's the question, should he have known. Personally I believe and have seen a lot of landlords and property management companies that let things go and really don't care about their property or their tenants (except when rent is due). So yes I believe that your landlord does not take care of property. Does he owe his tenants a safe place to live... sure, but you are getting hung up on code violations. A code violation by itself (even for the porch) does not make him negligent. If the porch broke the night before your incident then no, I don't think he should have known or would have known about the damage unless someone told him. On the same hand, he should have flagged it or fix it in my opinion if he had known any more then a day before your fall.

By not fixing it or at least flagging it after your fall was just stupid on his part and he was begging for another claim.

Posted: 05 Apr 2008 09:03 Post Subject:

Also why did they want all these bills and medical records if they havent even accept liability. Medical records cant help you accept liability.

Posted: 06 Apr 2008 11:04 Post Subject:

No but they can lock down the date of loss, prior conditions etc...Many times adjusters will ask for these to get a 'jump' on it, in case liability is assumed.

Posted: 09 Apr 2008 08:12 Post Subject:

How long should it take the adjuster to make an offer if they accept liability?

Posted: 10 Apr 2008 09:38 Post Subject:

After they accept liability, and have received all the medical info they need then shouldn't be more than 30 days, generally within a week to ten days.

Posted: 12 Apr 2008 01:26 Post Subject:

Is it alright for me to have my medical provider fax over all my medical records to the adjuster? The adjuster said the statement i gave to the independent adjuster needed to be signed. I dont see why a statement is good enough. She said that if i dont give a signed statement and sign a hipaa authorization by may she will closed the file.

Add new comment

Restricted HTML

  • Allowed HTML tags: <a href hreflang> <em> <strong> <cite> <blockquote cite> <code> <ul type> <ol start type> <li> <dl> <dt> <dd> <h2 id> <h3 id> <h4 id> <h5 id> <h6 id>
  • Lines and paragraphs break automatically.
  • Web page addresses and email addresses turn into links automatically.