by William23 » Sat Jun 21, 2008 10:57 am
Hi. Everyone on ampminsure. My girlfriend is in this situation. She lives in this big apartment complex. She trip and fell on this defect near the step. After the fall she didnt go to the doctors until a few days later. My girlfriend isnt the type to run to the doctors for a little pain. She knows that is just took a fall and of course she is going to feel pain. But after a few days the pain got worse. She went to the doctor and they put her on pain meds and a splint. Doctor said her body may heal and resolve the injury or it may require surgery. After that she hired an atty. Later on she and her atty discontinue the services for a reason. She was trying to handle it on her own. Finally after the investigation was done the adjuster deny the claim. The adjuster states the reasons for the deny is 1. The hazard was not report to the owner, 2. Residents of the didnt see hazard and 3. There was no witness or proof it happen there. Owner was notified by atty and picture of defect.
Posted: Mon Jun 30, 2008 08:58 pm Post Subject:
When I said that a code violation is an indication of negligence, I meant that once the violation has been documented then it's been confirmed that a defect was not just something small and that it's been documented that it exists. But yes, if a defect is against code then this is something to consider as well. Building codes cover the obvious things so if something that is against code causing an injury, then it's easy to show that it should not have been allowed to have exist.
I can't say why the claim was denied (did your GF actually receive a written denial? It's not a denial until it's in writing) it could be that the adjuster made a bad call or that the adjuster was correct and there is some information that I/we don't know about. I can say that once an adjuster has made a determination it can be difficult to get them to reconsider.
Question... did your GF have any medical expenses? If so, did the adjuster offer to pay those bills under Medical Payments? If the policy has this coverage (most do) and the adjuster failed to offer it, I'd say there is a good chance that the adjuster dropped the ball on this claim.
Posted: Tue Jul 01, 2008 12:04 am Post Subject:
T-I did not go back and read the thread, but I think the OP mentioned that part of the denial was GF's inability to PROVE that it even happened on the property and that she could not prove the date that it happened...
RE: Medpay, (been a long time now since I handled these and could be a 'Missouri' thing)...but I seem to remember medpay excluding 'residents or tenants' no?
Posted: Tue Jul 01, 2008 01:49 am Post Subject:
I think that's an exclusion under a personal policy but not a commercial GL policy. GL policy still has the same type of exclusion but it's as an "insured". That is, neither policy provides coverage to an insured under the policy.
Posted: Tue Jul 01, 2008 02:01 am Post Subject:
Got it, and an insured (clearly) isn't defined as a tenant, or resident of the insured premises....right?
Posted: Tue Jul 01, 2008 03:57 am Post Subject:
I hope not... always the policy would cover them for liability and such. :)
Posted: Tue Jul 01, 2008 05:10 am Post Subject:
That's what I took from it Lori. The OP's girlfriend waited a couple of days to go to the doctor and then didn't report it to the landlord for….x period of time. I've seen these denied all of the time, when there are no witnesses and late reporting of an accident. Who is to say it happened on the property or down the road. I don't see this going anywhere without an attorney, unless I am missing something.
Posted: Tue Jul 01, 2008 06:44 am Post Subject:
What about proximate cause? And yes it was in writing. He stated that the hazard was not reported to the insured and regular tenants didnt note the hazard and no proof the fall took place there. But deterioration doesnt happen over night. Also how could a lawyer prove these things?
Posted: Tue Jul 01, 2008 10:07 am Post Subject:
Dasfuk, I agree if those are the facts, I'd have denied it too more than likely.
William I agree with you on
deterioration doesnt happen over night.
What about her ability to prove when and where it happened? Don't think that I saying it didn't happen EXACTLY as you say...I'm sure it did, the problem (apparently) is that she needs to prove this...(you always must prove your loss)....Posted: Tue Jul 01, 2008 11:38 am Post Subject:
But how must she prove it? I dont think the apartment complex have cameras and she was by herself. So how must she prove it? It is pretty foreseeable. Its not like she is claiming the fall cause her to get into a car accident. Now that isnt foreseeable and have no connection.
Posted: Tue Jul 01, 2008 11:52 am Post Subject:
Its not like she is claiming the fall cause her to get into a car accident. Now that isnt foreseeable and have no connection.
William I don't understand this comment at all or your point...I dont think the apartment complex have cameras and she was by herself
You don't 'think' so? Man, that's the first thing you need to check on!It is pretty foreseeable.
Again, (maybe I haven't had enough coffee yet) I don't get what you mean, what is pretty foreseeable?Add your comment