Insurance Company Bad Faith on my PIP Claim?

[ny86]

Hi,

Long story short, my insurance company is trying to not pay my PIP (145K). They denied my claim telling me to go to my siblings insurance company to pay the PIP but he no insurance coverage at the time of the accident. My brother's policy was cancelled 4 months before the accident!

I gathered all the proof and sent it to my insurance company to have them reverse their decision on my claim and they keep coming back saying "this isn't enough".

What should i do? This has been going on for a year !! My PIP bills are on my credit report now and i'm really worried about that.

Is there a law that says they must handle this in a timely fair manner?

Here is a timeline of my claim:

Does this look like a fair timeline to you?

Accident 07/02/2012

Request for X-ray and test records 9/11/2012
Request for Hospital records 9/19/2012
Request for EUO 12/7/2012
EUO 1/8/2013
EUO request for Docs 1/23/2013
Denial letter from the insurance co. 6/18/2013

Denial reason is go to my brother's insurance company.

Provided proof from my brothers insurance it was cancelled before the accident occured on 6/18/2013

Still going on requesting more documents which makes no sense at this point. I even provided the original cancellation form from my brother.

I live in New York by the way

 

[USF3983]

I'm curious to know what the reason behind their denial of your PIP is. In Florida, PIP caps at 80% medical up to $10,000.

From what I just read online about NY, is that it caps out at $50,000. If you had additional PIP coverage, you can seek more if you were in someone else's car or from other household relatives policies'. Active policies of course.

Did you live with any other relatives with an active auto policy? Was the accident not your fault? If it wasn't your fault, did the at-fault party have an active policy?

 

[ny86]

I'm curious to know what the reason behind their denial of your PIP is. In Florida, PIP caps at 80% medical up to $10,000.

From what I just read online about NY, is that it caps out at $50,000. If you had additional PIP coverage, you can seek more if you were in someone else's car or from other household relatives policies'. Active policies of course.

Did you live with any other relatives with an active auto policy? Was the accident not your fault? If it wasn't your fault, did the at-fault party have an active policy?

The accident was not our fault. It occurred in Florida on a trip and i had additional PIP at $100,000.

There is only one active policy at my household.

 

[djs]

If I understand NY PIP correctly, it covers passengers in your car, not you in someone elses car. While you didn't say it directly, I assume the car you had the accident in was not your car.

This would explain why they denied the claim.

While I'm not licensed in New York and really don't know the ins and outs of their laws, this would follow along with most other states laws. Insurance follows the vehicle more than the driver. Your policy may cover some elements of risk if you are driving another vehicle, but not all parts of your own policy transfer to a non-owned car. NY PIP is likely one of these coverages that stay with the car (or cars on the policy).

Also, since the accident happened in Florida, where was the car you were in registered at? I'm assuming you are going to be dealing with Florida law, not New York law on this. Not sure what, if any, impact that has.

And, just because I get a bit anal about this stuff, I doubt your PIP bills are showing up on your credit. I assume your medical bills are, or the ones you are trying to get covered through PIP.

Dan

 

[ny86]

If I understand NY PIP correctly, it covers passengers in your car, not you in someone elses car. While you didn't say it directly, I assume the car you had the accident in was not your car.

This would explain why they denied the claim.

While I'm not licensed in New York and really don't know the ins and outs of their laws, this would follow along with most other states laws. Insurance follows the vehicle more than the driver. Your policy may cover some elements of risk if you are driving another vehicle, but not all parts of your own policy transfer to a non-owned car. NY PIP is likely one of these coverages that stay with the car (or cars on the policy).

Also, since the accident happened in Florida, where was the car you were in registered at? I'm assuming you are going to be dealing with Florida law, not New York law on this. Not sure what, if any, impact that has.

And, just because I get a bit anal about this stuff, I doubt your PIP bills are showing up on your credit. I assume your medical bills are, or the ones you are trying to get covered through PIP.

Dan

PIP covers everyone in the household in any type of injury. It denied because they said to go to a policy that was no longer valid at the time.

 

[djs]

PIP covers everyone in the household in any type of injury. It denied because they said to go to a policy that was no longer valid at the time.

In my quick check, it covers anyone in your car at time of accident, including people around the car.

Can you quote policy language? It would help me learn something. Like I said, I don't know the answer to this, but I'm assuming (and some quick googling somewhat confirms) that NY PIP is based on the insurance of the car, not the insurance of the household. Hopefully, someone in NY can confirm or deny this.

This is one time, I hope I'm wrong.

Dan

 

[ny86]

In my quick check, it covers anyone in your car at time of accident, including people around the car.

Can you quote policy language? It would help me learn something. Like I said, I don't know the answer to this, but I'm assuming (and some quick googling somewhat confirms) that NY PIP is based on the insurance of the car, not the insurance of the household. Hopefully, someone in NY can confirm or deny this.

This is one time, I hope I'm wrong.

Dan

NY PIP covers a household anywhere and any car.

It's for medical injuries which can occur in many ways

 

[Milkman1265]

I would check NY PIP for you again, but i believe the car's owner/registrant's insurance will cover anyone in the car 50k per person. + 50k if he purchased the additional pip.

But the problem is, whose car was it? And you say there was no insurance, so how were you able to take the car and drive it? You have your own insurance, but if the insurance for the car you were driving was canceled how did it legally have plates and drive?

if it was your car and your insurance, they would cover up to the 100k coverage you have. I think we should determine whose car and whose insurance it has first.

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here is some languages to look at DJS

Spoiler

Mandatory Personal Injury Protection
The company will pay first-party benefits to reimburse for basic economic loss sustained by an eligible i injured person on account of personal i injuries caused by an accident arising out of the use or operation of a motor vehicle or a motorcycle during the policy period and within the United States of America, i its territories or possessions, or Canada.

Eligible Injured Person
Subject to the exclusions and conditions set forth below, an eligible i injured person i is:
(a) the named i insured and any relative who sustains personal i injury arising out of the use or operation of any motor vehicle;
(b) the named i insured and any relative who sustains personal i injury arising out of the use or operation of any motorcycle, while not occupying a motorcycle;
(c) any other person who sustains personal i injury arising out of the use or operation of the i insured motor vehicle i in the State of New York while not occupying another motor vehicle; or
(d) any New York State resident who sustains personal i injury arising out of the use or operation of the i insured motor vehicle outside of New York while not occupying another motor vehicle.

Exclusions
This coverage does not apply to personal i injury sustained by:
(a) the named i insured while occupying, or while a pedestrian through being struck by, any motor vehicle owned by the named i insured with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act i is not i in effect;
(b) any relative while occupying, or while a pedestrian through being struck by, any motor vehicle owned by the relative with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act i is not i in effect;
(c) the named i insured or relative while occupying, or while a pedestrian through being struck by, a motor vehicle i in New York State, other than the i insured motor vehicle, with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act i is i in effect; however, this exclusion does not apply to personal i injury sustained i in New York State by the named i insured or relative while occupying a bus or school bus, as defined in sections 104 and 142 of the New York Vehicle and Traffic Law, unless that person i is the operator, an owner, or an employee of the owner or operator, of such bus or school bus;
(d) any person while occupying a motorcycle;
(e) any person who i intentionally causes his or her own personal i injury;
(f) any person as a result of operating a motor vehicle while i in an i intoxicated condition or while his ability to operate such vehicle i is i impaired by the use of a drug (within the meaning of section 1192 of the New York Vehicle and Traffic Law); or
10
(g) any person while:
(1) committing an act which would constitute a felony, or seeking to avoid lawful apprehension or arrest by a law enforcement officer;
(2) operating a motor vehicle i in a race or speed test;
(3) operating or occupying a motor vehicle known to that person to be stolen; or
(4) repairing, servicing or otherwise maintaining a motor vehicle i if such conduct is within the course of a business of repairing, servicing or otherwise maintaining a motor vehicle and the i injury occurs on the business premises;
(h) the named i insured or relative while not occupying a motor vehicle or a motorcycle when struck by a motorcycle i in New York State with respect to which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act i is i in effect;
(i) any New York State resident other than the named i insured or relative i injured through the use or operation of the i insured motor vehicle outside of New York State i if such resident i is the owner or a relative of the owner of a motor vehicle insured under another policy providing the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act;
(j) any New York State resident other than the named i insured or relative i injured through the use or operation of the i insured motor vehicle outside of New York State i if such resident i is the owner of a motor vehicle for which the coverage required by the New York Comprehensive Motor Vehicle Insurance Reparations Act i is not i in effect.

everywhere i read, shows

No-Fault Insurance to insure payment for medical expenses and lost wages for a driver, passenger or a pedestrian injured by the owner’s car

so the car's owners insurance will cover?

 

[USF3983]

I believe you follow the regulations for the state you were in. Florida is 80% medical expense, 60% lost wages up to $10,000. After that you just have to sue the at-fault party. You might be out of luck.

 

[djs]

Was the car involved in the accident registered to you in any way?

Just curious.