by Guest » Thu Jul 03, 2008 10:40 am
Guys..its truly interesting to see so many people have expressed their grievances at this fraud forum.
It needs a lot of guts to stand against frauds & I'm amazed to see a couple of you have really done that. I still remember the day (Dec, 2003) that my fiance went on to see the American Family Insurance representative & got a car insurance policy for us.
It was quite a shock for me when our car got stolen after that. American Family seemed quite proactive to meet the claim initials as we were to shift from that place the next day.
A couple of days later we were being consulted by their rep about the residue of our claim which according to them could not be met due my fiance's felony conviction since 2 decades. What they had to say was that American Family would not have covered him at all in case they had this information beforehand. They had given us an ultimatum that if he withdraws the claim he would be free or else they would seek legal help & see that he gets a sentence.
In mid-2004, my fiance got convicted of insurance scam. It was evident that the applications submitted by American Family Insurance to the attorney general were fraudulent. Once he recalled the signing procedure, he never remembered the agent asking him about his felony conviction. The agent must have submitted the paper works for which he had obtained my fiance's signature. The applications with us were left blank for those questions. My fiance was up with 1-6 for 2 folds of insurance fraud..I haven't read much about the american family insurance complaints but any advice would be of great help to people under such circumstances!
Thanx.. Amy_LV
It needs a lot of guts to stand against frauds & I'm amazed to see a couple of you have really done that. I still remember the day (Dec, 2003) that my fiance went on to see the American Family Insurance representative & got a car insurance policy for us.
It was quite a shock for me when our car got stolen after that. American Family seemed quite proactive to meet the claim initials as we were to shift from that place the next day.
A couple of days later we were being consulted by their rep about the residue of our claim which according to them could not be met due my fiance's felony conviction since 2 decades. What they had to say was that American Family would not have covered him at all in case they had this information beforehand. They had given us an ultimatum that if he withdraws the claim he would be free or else they would seek legal help & see that he gets a sentence.
In mid-2004, my fiance got convicted of insurance scam. It was evident that the applications submitted by American Family Insurance to the attorney general were fraudulent. Once he recalled the signing procedure, he never remembered the agent asking him about his felony conviction. The agent must have submitted the paper works for which he had obtained my fiance's signature. The applications with us were left blank for those questions. My fiance was up with 1-6 for 2 folds of insurance fraud..I haven't read much about the american family insurance complaints but any advice would be of great help to people under such circumstances!
Thanx.. Amy_LV
Posted: Wed Apr 13, 2011 09:10 pm Post Subject:
To Mark Clemens:
Regarding your post... AmFam was legally required to inform you as to why they are not going to pay the claim. They cannot simply deny to pay without giving a specific reason within the denial correspondence.
Can you find the paperwork and see specifically why they denied to pay the claim? That will give us the information necessary to help you out.
InsTeacher 8)
Posted: Thu Apr 14, 2011 07:28 pm Post Subject: My mothers claim with American Family
The company said and I quote: " Your policy does not provide payment for laboratory tests, diagnostic x-rays, office calls, chemotherapy or diagnostic procedures such as bronchoscopy, cystoscopy, or a biopsy." I,m sure my parents assumed that these items would be covered under the policy, but even if they were not, the surgery to remove the tumors and treatment of the tumors should have been covered. What would be the point of having the policy if less than 10% of the costs would be paid.
Posted: Thu Apr 14, 2011 08:35 pm Post Subject:
To Mark Clemens
Thanks for responding. The next question is this- specifically, what type of policy did she have? Your comment of
Your policy does not provide payment for laboratory tests, diagnostic x-rays, office calls, chemotherapy or diagnostic procedures such as bronchoscopy, cystoscopy, or a biopsy."
indicates to me that this was probably not true medical expense insurance, but some off-shoot type of policy. I need to know, as specifically as possible, exactly WHAT her policy was. There are a lot of policies out there that pay for only certain medical expense situations and this is why I need the details!
As well, if the policy isn't going to pay for the costs, Medicare should absolutely come into play here...assuming that she was on Medicare. Medicare provides excess coverage in the event the Medicare beneficiary also has an individual private medical plan.
InsTeacher 8)
Posted: Fri Apr 15, 2011 12:27 pm Post Subject:
If Medicaid paid any portion of the claims, the state may have the right of asset recovery against the estate. Medicare either pays or it doesn't, and unless covered by other insurance that would make Medicare the secondary insurer, subrogation is usually a non-issue with Medicare.
The insurance you describe, as InsTeacher has said, is probably some form of supplemental benefits. It would not be in conflict with Medicare at all, but could be considered "income" under Medicaid, and affect benefits payable under that program.
This is what happens to people when we let the government interfere in too many aspects of our lives.
Posted: Sat Apr 23, 2011 04:19 am Post Subject: car accident
AZ: how long does insurance company have to make an offer for settlement on an auto accident underinsured claim? My husband needs surgery on his spine and the insurance policy for the person that hit him was inadequate so we had to make a claim on our underinsured. First thing out of their mouth was "we take on the roll of the other persons insurance". so does that mean American Family treats me like they're not MY insurance company? The doctors confirm that he needs the surgery and American Family delays even more. It's not like we have a million dollar policy!
How long does this take?!
Posted: Sat Apr 23, 2011 04:26 am Post Subject: car accident
AZ: how long does insurance company have to make an offer for settlement on an auto accident underinsured claim? My husband needs surgery on his spine and the insurance policy for the person that hit him was inadequate so we had to make a claim on our underinsured. First thing out of their mouth was "we take on the roll of the other persons insurance". so does that mean American Family treats me like they're not MY insurance company? The doctors confirm that he needs the surgery and American Family delays even more. It's not like we have a million dollar policy!
How long does this take?! how much time LEGALLY does the insurance company have to complete their investigation?
What law requires an insured to see the insurance companies doctor for an IME?
Does the insured have the right to ask for documentation on what the insurance company has paid to "its doctors" over a certain time frame?
~Please Help~ thank you!
Posted: Sat Apr 23, 2011 05:57 am Post Subject:
does that mean American Family treats me like they're not MY insurance company?
Yes. Their offer is a settlement. Which means whatever amount is agreed to would require your husband to sign a release and once the release is signed, that is it. No more money. Do you know _exactly_ what all of his medical bills will be, past, present and future?What law requires an insured to see the insurance companies doctor for an IME?
Prior to suit? None, not in this case... unless your carrier is providing Medical Payment or PIP coverage. Then they can have an IME done.Does the insured have the right to ask for documentation on what the insurance company has paid to "its doctors" over a certain time frame?
You have the right to ask for anything. This does not mean you will get it. Who paid any bills? Do you have PIP or Medical Payment coverage in your state? I see no reason why your carrier would not tell you what bills have been paid. Of course, your medical providers can tell you as well. It's not secret information.Has the other carrier offered their limits? If so, as long as your carrier agrees to this, then you should have collected from the other person's carrier.
Prior to settling with your carrier you need to go back to your medical providers and negotiate your bills down. Your carrier will then pay you the settlement amount based on the original bills.
Posted: Sat Apr 23, 2011 01:53 pm Post Subject:
tcope has provided a very good explanation above.
You're husband's decision to have any necessary treatment is not conditioned on whether the auto insurance company(ies) are paying anything or not. If you have health insurance to cover the treatment, you use that insurance to cover the bills . . . with the understanding that your health insurance is intended to pay for "first party" losses (your own) not "third party" losses (those you suffer caused by the negligence of another person), and your health insurance company will be entitled to collect up to 100% of its actual expenditures on your behalf from whatever settlement you eventually obtain.
The auto insurance company (yours or the at fault party) has no legal right to prevent your husband from receiving the treatment his physician deems necessary, and they cannot require any SECOND OPINIONS to determine whether there is a need or an alternative.
This is a civil tort. Your husband was injured through the negligence of another. He is entitled to obtain whatever is reasonable to "restore him to whole" -- as close physically to his pre-injury condition as possible (knowing that this is really an impossibility). Even if the at fault party's insurer pays the limit of liability, and your insurance company pays its limit of liability, if your losses exceed that combined amount, you still have a legal claim for the excess against the party that caused your husband's injuries (but whatever you might recover would be payable to your health insurer and/or your own auto insurer, for the amounts they paid over and above what the at fault party's insurer paid to either of them). For that, you will need an attorney of your own choosing.
If your husband needs surgery, schedule the surgery and have it done. Disregard whatever any auto insurance company is telling you about that. You don't need their opinion or approval, and they have no right to prevent it. That's entirely unnecessary at this point. Determining continuing disability later is a different matter entirely.
Negotiating the value of medical expenses with those providers? Sure, you can always do that, before or after the fact. Before is better.
Posted: Wed May 11, 2011 09:39 am Post Subject: secondary home insurance
looking for a reputable insurance for my secondary home.
any sugestion?.
Posted: Wed May 11, 2011 03:15 pm Post Subject:
Find a reputable local agent or broker, and you'll probably find the answer you are seeking. What's wrong with the company that insures your primary residence?
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