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: Tue Jul 01, 2008 02:41 pm Post Subject:
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.
I touched on constructive notice before.Also how could a lawyer prove these things?
Lacking a time machine with a seat for two, he could not. But absolute proof is not needed. In court he would only need to be able to convince a jury that it happened as stated. He's put your GF on the stand and she's swear, under oath, that it happened as she stated. It's obvious that something happened to cause her injury. It's reasonable to say that she fell in some way, somewhere. The attorney would then show huge blown up photos of the defect in the railing and how it would be hard for anyone not to notice it. Its then a roll of the dice if the jury believes it. But here is the kicker... if they do, how much are they going to say the property owner owes? Perhaps a _whole lot_ more then the attorney was asking for from the insurance company. That is why insurance companies like to settle many claims without going to court. But on the other hand, perhaps the jury decides that there really was not enough information to show the accident happened as your GF decides so they award nothing. Now your GF's attorney just spend days and days and is not going to see a dime. This is why many attorneys never file suit or go to court.So you ask how an attorney can prove that the accident happened as stated? Well, it's not always about absolute proof. It's about what each party thinks a jury will decided.
Posted: Tue Jul 01, 2008 03:21 pm Post Subject:
Tscope what you stated i know they(insurance) know of constructive notice. You stated there is a defect and injury and where people are required to be. They know this so why deny the claim all together? Maybe the adjuster dont like my gf? Also what do you mean by adjuster drop the ball? You stated its not about absolute proof so what do the insurance want from her? Also lori im very sorry for getting you confused im confused too. I dont know how adjusters look at claims all day. adjuster are good i wouldnt be able to take it i would lose my mind.:-D:-)
Posted: Tue Jul 01, 2008 03:37 pm Post Subject:
Also could she get the adjuster to reevaluate the claim? Because alot of the pictures that showed deterioration and the rails leaning the adjuster dont have she didnt think the adjuster needed them. very hard for a owner taking care not notice it. Along with the photos could she point out to the adjuster the points you made on here tscope? Also is there any other things to point out? And the photos with the leaning rails and deterioration what can those prove to adjuster?
Posted: Tue Jul 01, 2008 05:10 pm Post Subject:
There are two different perspectives on most losses. But there is only one perspective that matters... what a jury things. Do you know what a jury will decide? Does the adjuster? Nope, to both questions. The adjuster needs to consider how much information there is that shows their insured is liable. It appears the adjuster thinks there is not enough. Your GF should be thinking there is enough information (otherwise she'd not be pursuing the claim).
You stated there is a defect and injury and where people are required to be. They know this so why deny the claim all together?
I only need to address the information in your post. You told me it happen so I'm accepting that. Of course, the adjuster does not need to simply accept this as fact. As you've stated yourself, how can your GF prove it happened as she stated.[/quote]Also could she get the adjuster to reevaluate the claim? Because alot of the pictures that showed deterioration and the rails leaning the adjuster dont have she didnt think the adjuster needed them. very hard for a owner taking care not notice it. Along with the photos could she point out to the adjuster the points you made on here tscope? Also is there any other things to point out? And the photos with the leaning rails and deterioration what can those prove to adjuster?[/quote]Yes, the adjuster can change her mind. Granted, it's human nature to avoid changing ones mind once a decision is made but people do it. Also, if the adjuster changes her mind then she needs to deal with the claim all over. I'm not saying she won't do it... just that it's a little more difficult to do.
Yes, supply all the photos. Your GF needs to prove her side to the adjuster. Photos are a _great_ way of doing this. It leaves little room for guessing. I'd also mention all the other items that you posted. They were good points. It's also good to let the adjuster know your willing to work with them if they are willing to discuss the matter further. Attorneys and adjusters are always at odds... but it's seldom that they don't treat each other with respect. Attorneys may know they are right but they also know the adjuster has the money and the process of getting the money can be made hard or easy. It's much easier to get money being nice to someone rather then making their life difficult.
I also think this thought all the time... "crap in, crap out". If someone gives me nothing to work with, they are probably not going to get much from me. If they lay out everything on a silver platter, they are probably going to get better results. To be honest, if your GF were to make up some nice documents with the photos laid out on them and write a nice clear letter... I'd imagine that it would go a long way.
Posted: Tue Jul 01, 2008 06:38 pm Post Subject:
Tscope what kind of documents to go along with the photos? How should this letter go? Its pretty obvious the owner is at fault maybe they can add some negligence on her part. She will accept within reason. These type of cases both are at fault to some degree and she knows this. But she would have to prove her side. Hopefully this letter can make the adjuster reevaluate. But probably not because it is difficult. Thanks a ton tscope, lori & other members your the best!:-D
Posted: Tue Jul 01, 2008 08:30 pm Post Subject:
How should this letter go?
I can't write the letter for you. There are 3 pages of good information here.Its pretty obvious the owner is at fault maybe they can add some negligence on her part.
Obvious to one person, yes.Also, if your GF has medical bills I'd _certainly_ ask if the policy contained Medical Payment coverage. If it does, this should have been offered.
Posted: Wed Jul 02, 2008 12:39 am Post Subject:
William no negligence has to be necessary for med pay so get to that NOW...when she composes her letter send pics of the danger, and her injury if you have them along with medical bills, doc notes etc...but get on the medpay right now..
Posted: Wed Jul 02, 2008 12:46 am Post Subject:
When is she suppose to ask for the med pay? I was not clear on this? Was it later, after everything else is settled? :)
Oh, "NOW". okay.
Yeah, my manager hates me as well...
Posted: Wed Jul 02, 2008 12:51 am Post Subject:
When is she suppose to ask for the med pay? I was not clear on this? Was it later, after everything else is settled? Oh, "NOW". okay. Yeah, my manager hates me as well...
Ok Touchy Todd...I had a long day too :roll: :wink: ( No offense, William ) but I think he some times wants REALLY direct answers....so thought I would just make that point very clear... :wink:Posted: Wed Jul 02, 2008 04:54 am Post Subject:
The original post states the three reasons that the adjuster denied the claim. To me the most important would be proof that it happened on their insured's property. I know its after the fact, but she should have told the landlord or management the day it happened or the following day at the latest. I would also agree with tscope, and is the reason that I don't see this going anywhere without an attorney. Due to the delay in reporting with no witnesses there is no proof or at worst case a chain of events…..fall-go to doctor same day sort of thing, they are going to hang their hat on that the accident didn't happen on the property - this could also be the reason that they have not offered medpay. Their not going to offer medpay when they dispute that the accident happened on their insured's property - it would put them on the hook if liability does exist. This is where I agree with tscope, the carrier will attempt to settle with an attorney due to legal costs or possible jury award depending on the area the suit would be brought but they will continue to blow your girlfriend off without an attorney unless she would file suit herself.
Also don't take the above post as me disbelieving the facts of the accident as you stated, it is just showing the carrier's side of the claim. If insurance companies gave money to anyone who claimed they fell on someone's property without proof……
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