My Claim Was Moved to Progressive SIU Due to Change in Coverage Before Accident

Mishti

New Member
I was wondering if anyone could provide me incite on the following.
I received an email from Progressive to review my policy as the policy was scheduled to renew. When looking it over I found that numerous types of coverage were marked rejected. Well, I obviously never rejected anything; how could I? I was never even asked about it. So here I am thinking that I was paying for full coverage ... turns out I was paying for what they considered full coverage. I called in to Progressive and had a long convo of what I should in fact have on my policy and what I shouldnt. Long story short, I ended up getting PIP and raising a few other things.

That same month, on DEC. 25th I met with an accident. It was snowing like crazy in TX and the roads were bad. I was driving in the right lane with my 4 ways on when a white truck side swiped my car. The truck kept going and never stopped. I was too scared to stay and wait for police. I thought if I did I would risk the chance of another car hitting me. Since the truck kept going and the roads were bad, I decided to go home and file a report in the morning.

Ok so, now I go and file a crash report and mail it to the address provided. I call Progressive and report the claim. The insurance adjuster called me later that evening to go over what needed to be completed next. My original plan was to take my car to VW. However, after speaking to the adjuster I found that I did not have rental coverage. At this point I am irate because I had just reviewed my policy a few weeks prior and was sure I had EVERYTHING. So, I tell her that I only have one car and that Im frustrated because I would have to pay for rental and my doctors bills if I needed to go. She then told me I have PIP coverage so, I wouldnt have to pay the doctors bills. She then told me due to the holidays, the personal injury adjuster would call me within a week. She told me if I needed to see a doctor that I could. I even asked her If I should pay the doctor until the other adjuster called. She said no, that I would just have to have who ever I go to call them.

I wasn't in excruciating pain at the time of the accident. The next day I was sore, but thought it would go away with some IB prophen. The following day I woke up feeling like my back was "stuck" and decided to go to the doctor. My physician told me I should see a chiro. I was referred to a chiro whom claimed to have confirmed my coverage and provided me treatment.

This was the first time I have ever reported a claim. I wasnt and still am not sure how the whole process works. I never received a call from the personal injury adjuster. I just thought the chiro confirmed coverage and everything was in place.

About a month ago my Chiro submitted the bills to Progressive. She then calls me during that week to tell me my claim was denied and that I would be responsible for the payment. I called Progressive who said they did not decline the claim. Long story short, I was the told my claim has been moved to special investigations due to change in policy coverage 2-3 weeks before the accident. They also told me that I never received permission to go to a Doctor. At this point I am completely confused and frustrated. The SIU person assigned to my case is so rude on the phone. When speaking to me it seems as if he is putting words into my mouth. I tell him to go back and listen to the recorded calls, but he still continues to seemingly try to convince me of something other than the truth. He then goes on to say that law enforcement is on the case.

At this point I feel as if I have been paying them every month for years only to be treated as a fraud when I file a claim. It seems as if they are trying to find a reason to decline the claim rather than assisting me with the claim process. How was I supposed to know that 2-3 weeks after reviewing my policy, it would snow in TX and I would be side swiped? Why do I pay for full coverage when I all I get is never ending interrogation for filing a claim? Why was my claim moved to SIU in the first place? Why am I still made out to be the "questionable" one even after I answered all of their questions? Why are they trying to make me believe things were said and done that actually weren't? Also, what should I expect in regards to this ongoing "investigation"? Neither do I want to be stuck with a judgement from the Chiro nor continue to have to subject myself to the less than respectful treatment of Progressive.

Any incite, advice, answers, etc would be greatly appreciated.
Thanks
 
The short answer is that anytime there is a coverage change to enhance the policy and then a claim is made right afterwards (30-60 days), the claim will go to SIU. That's an almost certainty.

Usually they go in and come out and not more than a 24 hour delay. Sometimes it takes a week, sometimes a year (very rarely).

Think about it from the insurance companies perspective for half a second and you'll understand why. They fully understand claims still happen, but they want to make sure the change wasn't done prior to the incident because the incident is planned. You would be surprised how often this happens.

Has the car been fixed?
Why is this claim still going on? Its 4 months old.

Ask the chiro for the confirmation they received about coverage before treatment. Send a copy of that to the SIU team. It doesn't sound like anything was denied yet though, so its probably not an issue.

Problem is, from what you are saying, the time elapsed, and its still going on, something isn't adding up. Did you have back problems prior to this? Any medical history? Something raised a big red flag and its not in what you stated.

Dan
 
My car has been fixed. No, I had no prior medical injuries. Ive actually never been in an auto accident and Ive never even had any traffic tickets.

I was told by the collision adjuster that I was able to go to the DR if needed and a personal injury adjuster would call me after the holidays. I was never contacted by the PI adjuster. Being this is my first time filing a claim, I just thought all was fine and was being taken care of between the Chiro and Progressive. The SIU said they didnt even know I was going to the DR so, they were surprised when the Chiro submitted invoices/bills. Today I spoke with the SIU adj who said he requested the bills to be sent in a different format because the ones the Chiro submitted were not the type they require. He also keeps asking if I am still in TX...which is odd.

The questioning of change in coverage did not bother me. What bothers me is every time I answer a question, he basically tells me I am wrong. However, I know for sure I was given permission to be treated. I have told him to review all recorded calls and that what he is claiming is false.
 
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