by jhd » Thu Jan 22, 2009 08:27 pm
My insurance company made a decision on my claim that I disagreed with, so I asked for a reinvestigation. They came up with the same result (big surprise).
When I called and asked for them to send me the basis for the decision, they said they could only send the police report, not the information provided by the other driver or their insurance company, or the notes from the claims agent.
Are they required to disclose all of this information, or am I wrong in assuming this?
When I called and asked for them to send me the basis for the decision, they said they could only send the police report, not the information provided by the other driver or their insurance company, or the notes from the claims agent.
Are they required to disclose all of this information, or am I wrong in assuming this?
Posted: Thu Jan 22, 2009 11:42 pm Post Subject:
Most of that is considered work product and only a court order would require them to release it. Some other items (information from 3rd parties) is still their work product but also there are privacy concerns when releasing information from other parties that is not available to the public.
They have no obligation to furnish this information, only to inform you of their decision.
Posted: Fri Jan 23, 2009 12:13 am Post Subject:
Thank you. That's what I needed to know. My girlfriend is an attorney and works for a firm that handles maritime claims. They said basically the same thing.
There isn't a law that says they CAN'T provide that information, but neither is there one that says they have to.
Posted: Fri Jan 23, 2009 12:17 am Post Subject:
Privacy laws could be cited for reason's for not releasing some information. So in a way, there is law that may apply to some of the information.
Posted: Fri Jan 23, 2009 03:43 am Post Subject:
Most states have laws that, in the event of a denied or contested claim, the information that is furnished to the policyholder need only contain the reasons for the denial as allowed by law. They are under no obligation to disclose any internal information obtained during their investigation either during or after the claim.
In fact, most states have laws that specifically state the the information obtained in the investigation of a claim is "confidential and not subject to public inspection."
They do have to provide you with the reason for the denial, and you always have the right to an arbitration hearing or a lawsuit, depending on the verbiage in your contract and the laws in your state. Your policy should contain language that addresses your rights in the event of a contested claim, and your rights do go beyond just having the claim reinvestigated.
Let us know what state you're in, and some additional details on the claim, and we can help more.
InsTeacher 8)
Posted: Fri Jan 23, 2009 06:54 am Post Subject:
Most states have laws that, in the event of a denied or contested claim, the information that is furnished to the policyholder need only contain the reasons for the denial as allowed by law.
So, there is no way you can know whether the investigation was fair or not. What if the other driver has lied to both his and my insurer? How can I contest the decision?
Posted: Fri Jan 23, 2009 07:14 am Post Subject:
Your policy should contain language that addresses your rights in the event of a contested claim, and your rights do go beyond just having the claim reinvestigated.
So, that answers your question!
Go through your paperwork and you'll be in a much better position to deal with this one or at least provide us with information in a greater detail..
Posted: Fri Jan 23, 2009 02:22 pm Post Subject:
they said they could only send the police report
J, the police report will have the other partys name, maybe even their carrier and policy number, (in my city this is ALL on the police report)certainly drivers license number, and maybe date of birth, also all the vehicle information (ie VIN etc.)...You can always file a complaint with your states dept of ins. who will investigate the claim and the liabilty determination, they HAVE to provide all information to them..
Please do let us know your state, the facts of loss, and the reason given for the denial perhaps we can help you a little there...also this is the other guys carrier correct? Have you filed a claim with your carrier?
Posted: Fri Jan 23, 2009 04:59 pm Post Subject:
So, there is no way you can know whether the investigation was fair or not. What if the other driver has lied to both his and my insurer? How can I contest the decision?
Not sure if your jhd as well. The insurance company is required to act in good faith. But this does not really address your question. What I can also say is that there is no big motivation for the carrier to do otherwise, certainly not on smaller claims. I've worked for a _lot_ of insurance companies. Every single one judged adjusters on their speed and customer service. While carriers may have procedures to pay as little as possible (aftermarket parts, limiting rental to actual repair time, etc) an adjuster is _not_ judged on making liability decisions that favor the carrier. If anything, management might tell an adjuster that they need to accept liability rather then not.But does this mean that the right decision was made? Not always. You also ask what if a driver lies. Well, an adjuster should decide for themselves how a drivers statement would be view by a jury. If they think a jury would believe the driver then they are going to give the statement weight. When I do this and the other person tells me that the driver is lying, I point out that I was not there and how can I know _who_ is lying. That is, why can't that driver be telling the truth and they are the ones lying (I don't mention that last part... I only mention here to make the point).
You can always file a complaint with your states dept of ins. who will investigate the claim and the liabilty determination, they HAVE to provide all information to them..
I find that most DOI's don't make liability decisions (most... if not none). This is a more of a civil matter (for a judge and jury, not the DOI).Posted: Sat Jan 24, 2009 01:11 am Post Subject:
I find that most DOI's don't make liability decisions (most... if not none). This is a more of a civil matter (for a judge and jury, not the DOI).
The OP didn't supply the state the accident occured so I couldn't look it up...I will say in MO we get DOI complaints re: liability decisions and have to answer in detail how these decisions were reached, then the DOI agrees or doesn't (I've never had one they didn't agree with so I don't know what happens if they don't)..but you are of course correct and all they would really be investigating is to make sure the carrier did a complete and full investigation....(i thought he felt they did not properly investigate it? maybe i 'read' that into the post and that's not the problem :? )Again it would help us help you if we knew where the differences lie...your own carrier (with all things being equal meaning no independent witnesses etc.) should always give the benefit of the doubt to their own insured.
Posted: Thu Feb 12, 2009 02:04 am Post Subject: my insurance adjuster is a jerk
can insurace companies take a claim and make it two and double charge me for the deductable
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