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    Wednesday, January 5, 2022

    Life Insurance Claim Denied Insurance

    Life Insurance Claim Denied Insurance


    Life Insurance Claim Denied

    Posted: 04 Jan 2022 06:36 PM PST

    Sorry to ask this group, especially the insurance gurus on here. ​But I'm seriously in a bind and wasn't sure what to do. Before anyone says to lawyer up, I am in the process of getting legal advice ASAP and to see what my recourse is. The life insurance in question is Accidental Death and Dismemberment.

    I live in a foreign country but have US life insurance due to my company and life circumstances. My wife died due to doctor negligence during her childbirth. She died from blood loss brought on by a condition of her childbirth. I filed a claim with the insurance company after an autopsy was performed and a lawsuit was brought against the doctor. The autopsy revealed her death was a complication of childbirth scenarios. And the lawsuit is almost finalized with the doctor accepting responsibility for my wife's death.

    My initial response from the insurance company was that her death was listed as Natural on her death certificate (not true) instead of Accidental and by defacto denied the claim. The death certificate, as translated only listed blood loss and multiple organ failure as cause of death. And it appears the other supporting documentation I sent in wasn't even reviewed.

    My 2 part question is, if the policy does not cover any loss "to which sickness, disease, or myocardial infarction, including medical or surgical treatment, is a contributing factor...." Am I wasting my time given that my wife's death was in a medical setting? Or does a doctor admitting fault constitute an accident and supercede the medical language of the statute?

    And if a doctor admitting fault does constitute an accident is there a way I can word my appeal to best reflect this? At the end of the day I'll still seek legal advice, but this would help temper my expectations.

    Thanks all.

    submitted by /u/Yourejokingrighttttt
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    My home just burned down and I have replacement cost coverage. How similar just the purchased item be to be paid out using replacement coverage?

    Posted: 04 Jan 2022 09:55 PM PST

    I have an expensive mountain bike that is a total loss and I'm wondering what the process to replace it will be like. The bike was $3500 new and I've put about $1000 into it. The bike is no longer being manufactured. Can I assume insurance will pay the replacement cost for a similar bike that costs around $4500?

    I assume the process will be something like: -claim bike valued at $4500 -insurance gives me "depreciated value" ex. $2000 or something -I buy a new bike for $4500 and insurance pays out for the depreciation difference.

    Is this accurate? Thanks for any insight you can provide.

    submitted by /u/nuggs0808
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    State Farm Insurance Policy Review - request by Agent

    Posted: 04 Jan 2022 08:40 AM PST

    Hello. Looking for some advice here. I have State Farm for my home and 5 autos. I have had state farm for 10+ years. The current agent took over my policy from another agent about 6 years ago. I have never had the need to talk to new agent in person and prior to him I had very little contact with prior agent. I have had a few claims and or questions that have been dealt with over the phone. My current agent recently emailed me the following:

    "I received a notice from our underwrites about some potential upcoming changes to your homeowner's policy that we need to review with you. I also see that my office manager was reaching out previously to set a time to do a complete policy review since it has been a number of years since that has been done so we will be able to kill two birds with one stone. Do you have a day in the next week or two what will work to meet?"

    Is this something that may be beneficial to me? Or is the agent just trying to get me to come in and then he will ask me all kinds of personal finance information and try to get me to put more of my business with State Farm - such as my investment accounts, bank accounts, etc and try to sell me or upgrade me on my insurance policies?

    submitted by /u/1rightwinger
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    Am I at fault in this car accident?

    Posted: 04 Jan 2022 06:48 PM PST

    So tonight I was doordashing with my boyfriend. We were at an intersection leading to a main highway that has no signs to clarify who yields when turning from the back roads. I was coming from one of these back roads turning right to get into the left lane, another car from the opposite side turned at the same time and assumed I was getting into the right lane and did not yield to me, and got in the left lane behind me, scraping the back left side of my car. I have no serious damage to my car except a some paint missing and scratches on my bumper. Its the same with the other car. It's just a very unclear situation to me and I haven't been in an accident before, I'll add an attachment of the damage for more insight.

    submitted by /u/Grclds
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    Escrow paid wrong insurance company, company won't refund my money

    Posted: 04 Jan 2022 06:00 PM PST

    For the past several years, I have used Progressive for my homeowners insurance. However, this year their renewal rate went through the roof so I shopped around and switched companies.

    Unfortunately, my homeowners insurance is paid out of my mortgage escrow account and my mortgage company paid the renewal premium to Progressive about a month before my policy actually expired (while I was still shopping). I bound coverage with the new insurer and notified Progressive that I would not be renewing my policy all prior to the Progressive policy's expiration date.

    My agent has told me that this is all fine and normal and Progressive will refund the payment, either to me or directly back to my mortgage company.

    The rub is, I've been waiting for that refund from Progressive for nearly 3 months. For the 1st month or so, it was like pulling teeth to even get Progressive to admit that they had received the payment. Finally they did, and they said they would issue a refund directly to my mortgage company. The last info I got from them indicated that they'd mailed a refund check on 12/6, but neither I nor my mortgage company have received it and we haven't been able to get any further updates. Every time my agent calls, they have to jump through hoops to get Progressive to realize that they received a check from me, need to refund it, etc. but nobody at Progressive can actually give them any useful information as to when/how that refund was/will be issued.

    I feel bad for my agent because I know they're caught in the middle of all this and are having to waste a bunch of their time chasing down Progressive. I've tried calling Progressive directly but they flatly refuse to talk to me because all of the customer service is supposed to be handled by the agent.

    Is there some kind of regulatory agency for insurance companies that I can lodge a complaint with to try to get Progressive to take this a bit more seriously?

    EDIT: located in FL

    submitted by /u/vrtigo1
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    Help! My insurance estimate is way lower than the body shop’s estimate

    Posted: 04 Jan 2022 11:58 PM PST

    I had an accident in Dec 2021, I called my insurance State Farm and filed a claim.

    They said I have two options -

    1. Go with the in network body shops and they will negotiate the price with the body shop , however I called 6 body shops that are in network in my area and their first available date is May 2022, correct it would be 6 months later. Of course I am not gonna wait that long

    2. Find out of network body shop. I found a body shop can fix my car in two weeks but their estimate is way higher than State Farm's estimate.

    State Farm said they are an outlier but I consulted several body shops and they are all similar prices.

    Now State Farm sent me a check of the price they estimated and refused to pay the price my body shop estimate

    What should I do? Do I have to cover the difference? It's hella expensive

    submitted by /u/crazykarma888
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    I want to be an agent but I refuse to commit fraud.

    Posted: 04 Jan 2022 05:19 PM PST

    I have been licensed in PL for a year and I left my first agency due to lack of upwards opportunity and the fact that the "assistant manager" (a rabid anti-vax, misogynistic stuck in 1960) made me really uncomfortable in the office. This agency refused to accept modern tech and changes in the industry and randomly pulled illegal favors for their friends and big clients like forging signatures and conveniently leaving newly licensed kids off polices…

    I quickly got headhunted by another agency and offered a 10K a year raise. This one is even worse. The going rule is if the insured argues, just leave the kid off the policy. Even if they're deferred and the law requires them to be listed. Don't mention the 3 pit bulls the prospect told you they have.

    What??? That's literal fraud. Why are these places allowed to get away with this? Was my studying and license a waste of time and money? I refuse to break my ethics and lie and potentially put insureds at risk just because they're mad about it.

    Is this how it is everywhere? Should I voluntarily surrender my license and change paths now?

    submitted by /u/ExpressionFormer9647
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    Underwriting

    Posted: 04 Jan 2022 11:00 PM PST

    Hello all. I've been interviewing/ talking internally at my company about moving into reinsurance underwriting. A few questions before going into an interview.

    What does the average day of an underwriter look like?

    Is underwriting more of a "sales" role? Do certain personalities thrive in this role?

    How are the salaries dollars wise and how are they calculated for underwriters? I assume there's a base + commission like a usual sales type of role.

    Any other tips or questions to talk to in my interview would be super helpful. Thanks!

    submitted by /u/Spartans1414
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    Replacement coverage for personal property - Do I have to replace it with the exact same item?

    Posted: 04 Jan 2022 10:43 PM PST

    What if the item is no longer manufactured? Would an item of similar value be covered?

    submitted by /u/nuggs0808
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    Covid Insurance for Tassie Trip

    Posted: 04 Jan 2022 10:09 PM PST

    Hi Everyone

    Daughter and two girlfriends booked to travel to Tassie in the next few weeks for 5 days. Am having trouble negotiating the minefield of insurance. Can anyone please advise if there is an insurance company out there that will cover the girls for all things specific to the Covid Pandemic ie cover cost of cancellation of return airfares if the girls are required to quarantine in Tassie; cover for cost of quarantine; cover for cost of medical/hospital (if they need to access); and anything else I have not mentioned but necessary.

    Thanks in advance

    M.U.M

    submitted by /u/HiBiscus22
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    Erie insurance adjuster trying to vastly undervalue a totaled truck. Any advice on how to fight it?

    Posted: 04 Jan 2022 10:47 AM PST

    Our work truck was wrecked recently, 2019 Chevy Silverado 2500HD with around 15k miles. Bought new for 45k. Kbb value is between 42 and 46k and every auto site I've looked at shows people selling them for around 47 - 50k now since the market is so jacked up.

    Anyhow, the adjuster called today and tried to say the value of the totaled truck is 15k. We told him that his valuation was low. I also emailed him several links on cars.com, autotrader, and another website that showed those trucks are selling for 47k+.

    What is the best way to deal with such an absurdly low valuation? His claimed value is nuts, 15k for a truck that is currently selling for around 47k.

    Edit: after disputing the vehicle value and sending an email with similar spec trucks and their prices we decided on bringing the truck to a different repair shop, sounds like the truck may get repaired instead of being totalled. The adjuster changed his attitude about the truck after my email. I don't know why he changed his mind, but if it gets repaired that works for me.

    submitted by /u/CrankyPhoneMan
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    I am unsure

    Posted: 04 Jan 2022 05:46 PM PST

    I was driving stopped at a red light. This truck rear ended me. Its not bad only light scratches. The truck drove away they didn't follow me or stop and get out. He ended up making a left turn from behind me.

    I just bought this car 3 days ago and now its got 5 white little thin scratches where the paint used to be. I emailed in a citizens crash report but what else should I do? Do I start a claim on the insurance(GEICO) over this?

    submitted by /u/RewardFabulous8590
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    What happened after recovered stolen vehicle?

    Posted: 04 Jan 2022 03:23 PM PST

    My car was stolen but now it was found, I have comprehensive coverage the body is good but it showing a lot of mechanical problems would comprehensive cover the damage?

    Also, I had to pay for the towing company as well for new plate number (the old plate was stolen) would that be covered?

    Thank you in advanced!

    submitted by /u/Upper_Ad1837
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    How to Add Interested Party to Renter’s Insurance

    Posted: 04 Jan 2022 08:45 PM PST

    I recently signed a lease with an apartment in Atlanta, GA. My landlord is requesting that I add the apartment complex as an interested party, but I have no idea how to go about this. Nothing online is helpful, and neither is the website I am insured from (Bundle with GEICO, Liberty Mutual does the renters insurance). Does anyone have experience adding interested parties using Liberty Mutual renters insurance? Thanks in advance!

    submitted by /u/Obi_Wan_Bissaka_29
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    Loss Assessment Coverage

    Posted: 04 Jan 2022 02:43 PM PST

    I own a Townhome in Colorado. My HOA recently informed me that their insurance carrier changed their policy and the HOA's deductible for Wind and Hail damage is $4M, which means that each homeowner would be on the hook for $23,000 should the damage occur. My HOA Board recommended increasing my Loss Assessment coverage on my home owner's policy to cover this gap. I reached out to my Insurance provider (USAA) and they informed me that the policy limits Loss Assessment Coverage to $10,000. There is no option to increase it.

    Is it possible to get Loss Assessment Coverage through another carrier as a standalone product? Or would it most likely require switching providers? Other than switching providers who may or may not have increased Loss Assessment coverage, it seems that the only option left is to just ensure I have $13k on hand to cover the expense.

    I would love to hear if there are any other options that I am missing.

    submitted by /u/ndrew452
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    California - AAA - Subrogation

    Posted: 04 Jan 2022 08:31 PM PST

    Is it standard protocol to get a written summary on the outcome of a subrogation?

    submitted by /u/Myrodeway
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    How do i apply my defensive driving discount with Geico?

    Posted: 04 Jan 2022 08:16 PM PST

    Hey guys,

    I'm located in NYC and I completed my defensive driving course. I have the certificate in hand. Does anyone know what I do with it now (I have Geico)? Is there a place I have to mail it to or an email to send it?

    Thanks!

    submitted by /u/Danny__NYC
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    Temporary Health Insurance in USA

    Posted: 04 Jan 2022 04:03 PM PST

    I am a Canadian resident who will be relocating to the USA for work. There is a two week period between when I land and when my health insurance starts through my job. I am looking to get covered in case I get hit by a car or something lol. The US insurers I called won't cover me because I wasn't a US resident in the past 12 months and I'm not eligible for Canadian travel insurance because I won't be a Canadian resident once I leave. If anyone has advice it would be much appreciated. Thank you!

    submitted by /u/Mid-Tier-Sadboi
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    How long after a home insurance claim is opened can attributable damage be part of the claim?

    Posted: 04 Jan 2022 03:34 PM PST

    I recently had flooding as a result of grossly abnormal pressure during city maintenance work. This cause visible leaks in several pipes spontaneously near my water main.

    Unfortunately the rest of the pipes are in my finished basement ceiling and there is a vapor barrier between the drywall and pipes. This means a slow drip could easily be accumulating water that is directly attributed to this claim (several other pipes required fixing).

    My insurer could not provide me details as to how long damages clearly related to the original claim would be considered part of the current claim.

    Clearly if I found water damage 2 months from now or I had a leaking toilet it's unrelated, but if I discover the exact same damage and failure from the original incident somewhere else in my own 7-14 days after opening a claim it's a new claim? That wouldn't make much sense to me.

    Somewhat related question, if the insurer pursues subrogation with the city will the claim negatively effect me and future premiums/risk assessment by insurers? My understanding is it's less about the amount (dollar wise) of claims, but more the amount of claims opened.

    I'm in Quebec, Canada if that helps.

    submitted by /u/ProBonerCounsel
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    Ontario: Home insurance policy with my name while the house is under my dad's name?

    Posted: 04 Jan 2022 02:07 PM PST

    Location: Ontario

    So the only person in the title of the house is my dad. But my fiancé and I are the actual residents here, while my parents live in another city. Can I put the home insurance (not the tenant insurance) under my name? If I do, in the event of an insurance claim, will this be a problem at all?
    Thanks!

    submitted by /u/JohnLdoe
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    Industry rate increase practices

    Posted: 04 Jan 2022 05:06 PM PST

    About 10 years ago I got fed up with my long time insurer's practice of jacking my rates up every year for no reason and went shopping for new policies (homeowner + auto) and saved some 40%. Three years later the same cycle repeated itself and I realized rate increases for existing customers and discounts for new customers seem to be an industry standard.

    At this point I literally have a calendar event to re-shop insurance every three years and just make sure the coverages match the old policies. This has worked really well for me.

    Do other people take advantage of this? Is there an optimum number of years for this pattern? Why would anyone keep their insurer long-term? Why does the industry encourage this kind of customer churn?

    submitted by /u/pantalanaga11
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    Will my claim be accepted?

    Posted: 04 Jan 2022 04:59 PM PST

    Hi guys, This reckless women "running away from her boyfriend" ran a red light and damaged the front of my car. She doesn't have car insurance because she's 21? Her dad called me the other day asking if he can insure the vehicle and lodge a claim. I'm aware that is illegal so I told him no. I have car insurance for over 1month now however, I did not submit the online vehicle inspection prior to the incident (because I'm stupid ). I'm not sure what my options are since I have not submitted the vehicle inspection will my claim be accepted and if not what are my options?
    I'm afraid I will have to pay for this out of pocket

    submitted by /u/Aware_Produce7420
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    21 days to respond to denial of appeal - does this mean get a lawyer?

    Posted: 04 Jan 2022 04:53 PM PST

    HELP PLEASE ! MADE AN ACCIDENT CLAIM AND OTHER PARTY CLAIMING THEY’RE INJURED

    Posted: 04 Jan 2022 01:01 PM PST

    I recently had a car accident and took a claim recording saying I am basically at fault. I went to court and took responsibility saying I am not admitting fault. Now the other victim has an attorney and is claiming they were injured. I am confused now what will happened, did I do something wrong? My dad keeps getting mad at me because I said that but I had no idea what to say. So what is most likely to happened?

    submitted by /u/baabyruuthh
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    General liability Contractors policy canceled by mistake

    Posted: 04 Jan 2022 04:46 PM PST

    First let me start off by saying that I did NOT request to cancel my policy. A couple of weeks ago I received a letter stating that my policy had been canceled at my request. I talk to my agent and explain what's going on, he calls me back saying that he was told I requested the cancellation through American Family directly. He sorted it out and it was an error on AF but this really had me worried considering I'm currently working on a historical society home. My question is, does this happen often and if something catastrophic occurred in this situation would it be covered?

    submitted by /u/MetalTedKoppeltits
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