Claim Question

[Hefe]

Being a producer, I don't see too much of what happens on my clients' claims. The only time my clients need me is when an adjuster isn't calling them back and that only takes a quick call to a supervisor to resolve. I've got a situation now that I could use some help on.

My insured was in a parking lot, not moving, waiting for a parking space. Another vehicle (not the one she was waiting for) backed out and hit her.

My insured turned in her claim to her carrier and the other party turned in their claim.

My insured got an estimate at $1050. Her adjuster spoke with the body shop and revised the estimate to $450. Her deductible is $500. Since the adjuster's estimate is under $500, the adjuster has essentially stopped working on the claim because they aren't going to pay anything out. I have advised my insured to go to the body shop with the $450 estimate and ask for that repair. She would like the other party's company to pay the body shop directly.

The problem is that the other party's company determined liability to be 50/50 and isn't paying. My carrier determined liability to be 100% the other party's fault.

One of my biggest issues is that my insured's adjuster has abandoned her, basically telling her to deal only with the other party's adjuster. When we talk about claims service, doesn't that include dealing with the other adjuster and making sure liability is determined correctly?

I am also confused as to how the other party's adjuster determined fault at 50/50. I'm assuming my insured can dispute this, is this correct?

 

[xrac]

Shouldn't your company subrogate against the other company for her deductible?

 

[Hefe]

That's what I thought would happen. They said that the typical claim involves the insured paying their deductible to get the car repaired. The company subrogates the full amount and refunds the deductible after fault is determined and payment is made by the other company.

Since the adjuster's estimate is under the deductible, they wouldn't have a payment to make and also won't subrogate for just the deductible.

Like I mentioned, I'm very rarely involved in the claim process. This is terrible customer service if this is how it works though.

 

[Guest]

shouldnt you ask the agent you work for?

 

[Hefe]

I could but 1. he's not here right now and 2. he's involved in claims about as often as I am (albeit for a much longer career).

I thought some of you guys might have insight into the claims process to understand why they would leave an insured hanging like that and if it was common.

 

[VolAgent]

I could but 1. he's not here right now and 2. he's involved in claims about as often as I am (albeit for a much longer career).

I thought some of you guys might have insight into the claims process to understand why they would leave an insured hanging like that and if it was common.

I'm no P&C agent or expert. But sounds like a raging case of, "Not my problem." Their insured is not at fault, and the damage does not meet the deductible. Sounds like the adjuster said "Next!"

Your client is going to have rattle the sword or go after the other party/insurance company in small claims court to possibly get it paid.

 

[djs]

This is an easy question to answer, but a much more difficult process to actually pull off.

The other insurance company is the problem. If she was not moving (for more than a couple of seconds), then the other driver is at fault, not 50/50. Of course, the other driver has told a different story, which is why this gets complicated.

Assuming she has a $500 deductible, there is NO WAY the repair will be done for $450, so your choices are:
- Take the car to the body shop, let them start the repairs, get a supplement, putting repairs over $500, then the carrier will get involved.
- Call the other party's carrier (with your insured) and ask for an explanation of the 50/50 when your client was stopped. They will give a different story (I've done this several times, have your client in the office and watch the expressions to see who is correct). sometimes a little push back goes a long way.
- Have your insured sue the other carrier in court, along with the driver. Chances are, the carrier will pay before worrying about court stuff, since at 50/50, they already know its very questionable.


Dan

 

[Hefe]

We're going with the first of those options, thanks Dan.

Both the insured and I agreed $450 would never happen and if going to $500.01 will get the carrier back involved, we'll try that.

 

[FullAuto]

Keeping a repair under the deductible isn't really that big of a deal. What kind of damage was it? If it's isolated to a single panel like a bumper cover or a door/fender and the color isn't something that blatantly requires blending, it looks like it's just a few hours of repair and refinish within panel. This would be pretty common in a low speed, backing, parking lot style accident. The body shop's original estimate would have been to replace whatever was hit with a new OEM part (doesn't matter how bad it was, they'll bid it to replace) and blend every direction they can. A bodyshop HAS to write their estimates high. Send out 5 adjusters and you'll get 5 different estimates. The body shop MUST be over all 5 of those. If they aren't, the customer will tell the shop to repair for their quote and pocket the rest the insurance paid them. Body shops typically have walk in rates as well. The insurance companies receive a discount on work. Some body shops provide various insurance companies with other discounts that vary (usually only the DRPs, but everyone does the walk in rate thing). But with that big of a difference, that's a repair vs. replace call and likely some additional refinish work.

Your company should still subrogate back to the other carrier for the insured's deductible though. That's pretty poor service if they won't. To be totally honest, that would be reason enough for me to leave.

50/50 liability doesn't mean you each pay your own damage. It means each person is responsible for half the damage to each car. The other person's carrier should be sending out an adjuster to write an estimate for your customers car and cutting them a check for half that as well as leaving an estimate. In theory, you can take their estimate in to have your car repaired and they'll pay half of any supplements. Then they'll write an estimate for their own insured and subrogate your company for half. That's when your company tells them to screw themselves. But if they write an $800 estimate and pay out $400.... yeah, unlikely, but I've seen stranger things.

Do you know the company that is saying it's 50/50? If so, post it.

 

[djs]

There are some risks to that plan, just for completeness....

- I haven't seen the damage, perhaps it CAN be done for $450. Body shops right now are overquoting everything and adding work until the insurance company comes along. Usually though, if they have to paint, it can't be done under $500.
- Insured will have to come out of pocket for the deductible. Once subrogation is complete, the insured will get the deductible back, if full payment is obtained from the other carrier.

I'm the first to admit that claims are a pain in the @#$@#$@, but the more you get involved in them, you actually become a better agent and understand a few things that normally go missing on policies. You also begin to get a better feel for why some carriers are worth a bit more than others and can explain it to clients without a moments hesitation.

Dan