by gb298888 » Thu Mar 27, 2008 10:47 pm
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: Mon Mar 31, 2008 09:19 pm 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: Mon Mar 31, 2008 09:42 pm 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: Mon Mar 31, 2008 09:44 pm Post Subject:
Lori-
They no longer have an attorney. I read it somewhere in one of their posts.
Posted: Tue Apr 01, 2008 10:28 am Post Subject:
Lori-
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...They no longer have an attorney. I read it somewhere in one of their posts.
Posted: Tue Apr 01, 2008 06:45 pm 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: Tue Apr 01, 2008 08:18 pm 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: Tue Apr 01, 2008 09:17 pm 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: Wed Apr 02, 2008 03:27 am 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: Wed Apr 02, 2008 10:18 am 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: Wed Apr 02, 2008 11:52 am 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.
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