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Insurance Claims Class 102

Discussion in 'The Hokey Ass Message Board' started by Swifster, May 14, 2012.

  1. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456


    As many of you may know I'm an insurance appraiser for a few companies that handle vintage car policies. I know we've discussed what an appraiser (and the insurance company) looks at when we come out to look at your car.


    I'd like to think we all know what collision damage is. Other than running over Bambi, or some other critter, and think you physically strike with the car is a collision. If it's another car, a tree, a building or even a person, it is considered a collision loss. I think this is pretty straight forward.


    Comp is the coverage for 'Other than Collision'. This can include hitting Bambi (or any other critter), theft, fire, vandalism, hail or other storm damage, flood, etc. These are known as perils.

    There are exclusions under Comp. These exclusions are wear & tear, freezing, mechanical or electrical failure and road damage limited to tires.

    Other exclusions are out there are little bit. Unless you are walking arould with tin foil on your head, you'll probably never have to worry about...
    Radioactive contamination, discharge of any nuclear weapon, war, civil war, insurrection, rebellion or revolution.

    I'll let you discuss these for the balance of the day. One reason I brought this up was that I have to make a 6 hour round trip to West Palm Beach to deny a claim. I can see the anti-insurance guys now...'Deny the claim!?! See the insurance company just looks for ways not to pay claims!!!'

    The car is a (O/T) 1984 Mercedes-Benz 300D 4-door sedan. The problem? The driver's front door and right rear door will not unlock. The claim assignment even came with a vacuum diagram from the owner. Yes, these cars have vacuum operated power locks.

    All vacuum used to operate the locks goes thru the driver's door. Each lock actuator has a diaphragm. The vacuum lines and connectors are plastic. The pieces that make up this system get brittle over time and they break. This system also operates the locks for the fuel door and the trunk. With other locks operating past the driver's main lock, the driver's door actuator has a bad diaphragm. As for the right rear door, it is either the line running to the door or the door lock diaphragm. This system in an older car is diagnosed with a vacuum pump. Most Mercedes dealers don't even want to play with this system.

    Why do I bring this up? Because I bet that since the date of loss was on 05/04 that he's already been told what the problem was by the dealer. And worse yet, he was probably already given a sky high price to diagnose the problem (at $135 an hour). When I find that there is no damage to the exterior of the door lock (no vandalism), I'll be asked why and have to explain wear & tear and mechanical failure.

    With comprehensive claims, there must be a peril for coverage. It can even be a stupid peril. I've seen stuff fall of shelves, people drop stuff, etc. If it's not listed as an exclusion, there is usually coverage. I'll get back to this after I see the car.
  2. Over rated< overpriced<,,,kruat krap,,ts
  3. jcapps
    Joined: Dec 30, 2008
    Posts: 473

    from SoCal

    Why would anyone think that would be covered by insurance.

    A question. What happens if you have your car on a lift and it falls off either due to earthquake or some other reason?
  4. GassersGarage
    Joined: Jul 1, 2007
    Posts: 4,727


    How about those guys that damage their cars on the track, but since insurance doesn't cover that kind of activity, they claim it happened on the street. The incident was even posted on YouTube.

  5. pwschuh
    Joined: Oct 27, 2008
    Posts: 2,468


    You would submit a claim and get a payment from your insurance company. It's covered.

    What do you mean "How about" them? They are commiting insurance fraud. Most adjusters are smart enough to figure this kind of thing out, especially in the specialty industry.
  6. Swiftster,
    Insurance companies and adjusters in general have left a bad taste in my mouth. I don't doubt that people that like myself have left a bad taste in yours.

    Maybe you'll get there and discover that someone has tampered with the car, then you are in a bad position. You will have to decide if it is the owner, a mechanic or a friend or family of the owner, correct? I mean surely if someone tampered with the car it could be vandalism. or it could be insurance fraud. Maybe some of the parts are worn out but if the car is tampered with how to do determine what has been tampered with and what would have worn out and quit on its own in the time period within which it was tampered with?

    Ah the world we live in can be such a tricky place.

    So I have a question, I recently discovered just prior to dropping my life insurance (cost not a disdain for the policy) that I was not cover if my loss of life was caused by an act of war. So I checked my auto policies as well as my homeowners and they same clause. I guess no one normally covers acts of war. Do you know is there something written down somewhere what constitutes an act of war?

    The reason I ask is that war by most peoples definition is defined by war being declared by one side or the other or both sides. So is an act of terrorism for instance considered an act of war? What if for instance the wife's truck is parked near a forest fire and it is determined that the fire was started by one of the nations enemies. Would that be considered an act of war?

    Would the adjuster be the one who makes that determination or would he just relay information to the provider and they are the ones who make that determination.

    Just questions here.
  7. boutlaw
    Joined: Apr 30, 2010
    Posts: 1,236


    Thanks for the explanation Swifster, very interesting. I am interested in your answer to Porknbeaner's "Act of War" question, but since it refers to Life Insurance, that may not be your area of expertise.

  8. Slag Kustom
    Joined: May 10, 2004
    Posts: 4,312

    Slag Kustom

    hitting any animal (or anything) that is standing in the road way is collision. if the animal (or anything else) is in the air when you hit it (never touching the road like a 2x4 falling out of a truck) it is comprehensive.

    If the car rolls down a hill and crashes into some thing while you are not in it it is comprehensive.
  9. As usual, the private sector, due to lying, cheating and scheming causes companies to adopt clauses to try to quell the problem. Not unlike our legislators passing thousands of laws because of idiot people's mistake, stupidity, lack of conscience, and complete lack of common sense! That being said, insurance companies aren't above trying to weedle out of paying with some obscure situations. We are our own worst enemies, people.
  10. All my policies have that clause, car, home, even health. My life insurance was what made me delve deeper into the other policies.

    I had a tree fall on a car once and was told by the adjuster that it was an act of god and not covered. I lied to him and said well I am an athiest and you owe me a car. Didn't work they still didn't pay. Like I said earlier I am not to impressed with insurance companies and adjusters in general.
  11. "Other than running over Bambi, or some other critter, and think you physically strike with the car is a collision. "

    If you run into Bambi ... collision but lets just say Bambi (RIP) runs INTO the front-side of my car, rips out the whole side from headlight to taillight and is left decapitated doing the death-jerks on the road then its comprehesive . location, location, location!

    That little pause (the side hit versus full frontal!) saved me a $1000 (deductable) .... thank-you!
  12. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456


    In the realm of vintage insurance, there are a lot of Mercedes-Benz. All cars have their quirks. I typically refer to them as German taxi cabs.

    Some people honestly don't know if insurance will cover something. Others throw crap at the wall to see what sticks.

    Loss by Earthquake is covered. A car falling off of a shops lift/hoist is covered, though the insurance company would seek reimbursement from the shops insurance company.
  13. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456


    Yes, this is insurance fraud. It wouldn't be hard to track down as such. Even if it got by the appraiser, look at all those witnesses at the track. Do you think they would all keep quiet? I always get a kick how someone like the SCCA asks to see your insurance if the car is registered for the street. I'm at the track. The insurance will cover nothing if the car is raced, and that includes liability.
  14. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456


    If the car was vandalized, it will be rather obvious. It will only be at the lock cylinder. You would need to get into the car and either rip the doors apart or pull the seats and carpeting out to get to the vacuum line.

    I don't deny anything until after I've seen the car. I don't tell the owner it's not covered, but I'm coming anyways. And yes, I've been wrong about my assumptions in the past. Again, the reason I don't say something is covered or not covered to the owner until I get there. If the lock was tampered with and it's consistent with someone trying to break into the car, I'll write up an estimate and the insurance company will write him a check. It's what will be owed.

    The owner didn't say his car was vandalized though. He said two of the four door locks will not unlock.

    You are on your own regarding life insurance. As for the cars, that is usually determined by the higher ups if there is coverage or not. Considering the amount of vehicle traffic and the amount of vehicles in the garage, the World Trade Center (9/11) would be a good example of this. Not being in New York at the time, I can not honestly say if the damages to any of the vehicles in the area were excluded under the 'War' clause. But I would also think because of the problems of dealing with the New York Insurance Commission, that this would have to be agreed upon with the state whether a certain loss is subject to the 'WAR' exclusion. I don't think one company can make this determination on it's own.

    Now if your '41 Packard was sitting at the commissary at Pearl Harbor on December 7, 1941, I think you would be SOL.
  15. jam0o0
    Joined: Nov 17, 2010
    Posts: 7


    does this mean that if i race on sunday and hit a phone pole on monday i will not be covered?
  16. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456


    Animals are not collision. And yes, just about anything striking your vehicle in the air would be comp. If I'm looking at an animal claim, I'm looking for fur, shit or amything else related to a critter. DON'T WASH YOUR CAR!!! It can make the difference between the claim being listed as a collision or comp.

    If the car rolls down the hill and hits a tree, it is collision (but can change depending on the circumstances). If you take your car to the mall and someone slams their car door into yours, it is collision. What act of God caused the car to roll down the hill? Put the car in gear or park. I've seen a lot of Fords where park wasn't completely engaged and the car rolled backward hitting another car.
  17. manyolcars
    Joined: Mar 30, 2001
    Posts: 8,510


    Insurance is a socialist concept, Take from many, give to a few.

    Insurance companies are not in the insurance business, they are in the making-a-profit business
  18. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456


    That adjuster was wrong. I've covered many cars (including vintage claims) where trees or branches fell on a car. In cases like this where the adjuster clearly has his head up his behind, you need to move up the chain of command (supervisor, manger, regional manager, etc.). Comp covers an act of God. If lightning strikes your daily driver and shorts the computer, that is covered. A wind storm knocking over a tree or breaking a branch is covered. I'm sorry that happened, because it gives the rest of us a bad name.
  19. It has just become a curiosity to me I guess.

    That is actually just scratching the surface. I could burn lots of bandwidth with many worse stories than that one all of them true. Auto, home, even medical. But the thread is not about my poor fortune with insurance companies it is about information. I think that you have given some good information to the masses, let's leave it at that.
    Last edited: May 14, 2012
  20. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456


    Bambi is not collision. The only 'animal' that falls under collision is the human animal. And Bambi lives in the suburbs too. Bambi strikes leave fur, crap and blood. And it doesn't hurt to take pictures (camera phones) or to call the police/sheriff/trouper to get a report made.

    Bigger than the deductible is being charged with an 'At-Fault' collision and watching your insurance rates go up.
  21. unkledaddy
    Joined: Jul 21, 2006
    Posts: 2,865


    I'm already worried about these possibilities.

    So why did the owner call his insurance company and not a mechanic?
  22. He probably did call a mechanic and decided that an insurance claim was worth a shot. :rolleyes:

    I too am worried about the same possibilities as you are and don't expect an insurance company or even NATO forces to help me out in the given situation. Asd they said when I was little in case of a nuclear attack put your head between your legs and kiss your ass goodbye. :D:D
  23. mustang6147
    Joined: Feb 26, 2010
    Posts: 1,847

    from Kent, Ohio

    Great posts, and info swifster.... I read it objectivley, and with out creating hypotheticals, I have a better understanding.

    Scenarios are like chasing ghosts. I have had some bad luck with ins companies. I recently had my life ins cancelled (Ullco) and then was told I was approved to reapply, my first policy was taken when I was 24 now 46, I am sure my rates are higher...

    As far as cars go, I always get an appraisal, and get a letter of acceptance for the apraisal, and I have had no problems.
  24. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456


    Not at all. But cover your yourself. My little car wasn't worth squat and I never wanted to go thru the hassel. I only had liability on it. I've seen a lot of vintage cars with roll cages. That will not deny your claim.

    Let's use your telephone pole loss above. If you hit a telephone pole, odds are you will have a police report made because you damaged the electric company's pole and blacked out half of your neighborhood. No one will argue what happened. That and you will have chunks of wood for that pole stuffed into your car. If you hit an aluminum pole, there will be color transfer from your car to the pole.

    But if this was a car like a 2007 Mustang and there was a cage in it, and if this was insured with standard auto insurance, they will probably pay the claim and then cancel you (they don't insure race cars). That cage will scare them off. And unless you have a bolt-in cage you can remove, good luck getting a car policy with it. An agent would look at your car and run.

    I ran in SCCA in Improved Touring (glorified street car) with a Suzuki Swift. I insured the car with liability only with State Farm because the agent didn't bother looking at the car unless it had comp or collision. They insured my race car, whether they knew it or not, for 4 years. I banged the car up at the track a couple of times and fixed it myself. I never had a problem. And if I had hit another car, I had insurance and I would have made sure there was a police report to document where the loss happened so no one confused this with a track loss.
  25. wsdad
    Joined: Dec 31, 2005
    Posts: 1,258


    Every business is in the making-a-profit business. If they weren't, you wouldn't have ever had a job!

    What's wrong with making a profit??? That's why we all go to work every day. Your portion of the profits is your paycheck! Would you work without collecting a paycheck? Do you expect entrepreneurs and corporations too?

    If an insurance company truly screwed everyone out of their money, their ratings would drop and no one would buy their insurance anymore. Believe me, companies make far more money in the long run by being honest than by cheating people. I know there are exceptions. I know once in a while something unfair or unethical happens, but generally, honesty = stay in business.
  26. I'm unsure of what exactly Swifster is trying to accomplish with this thread . If its an insurance definition thread that one thing . Coming to a conclusion about reported damage without an inspection that is another issue. May be he will define what an insurance who a claims rep is, their knowledge expierience. What an idependent appraiser is and their responsabilities to parties they represent. What errors and omissions coverage is ?

    There are many ins and outs written into an insurance policy or contract . They can favor the company or the insured. The real issue is that many of the 1st line claim reps are not well versed in the interpetation of the contract and many policy holders are even less so. This can vary from company to company and person to person. I thinking that this thread is heading toward adding more confusion if its direction is not clarified .

    Swifter needs to define exactly what his role is . Is he an agent for the insurance company or is he a licensed independent damage appraiser writing an unbaised report on damage to someones property ? There are different laws and statutes that govern an insurance company and the appraisers actions. They vary from state to state .

    I wish that everyone would finally start to realize that the contract of repairing damage to someones property is between the owner of the property and the repairer . The insurance contract binds the insurance company to pay for the covered loss to the policy holder. In a first party claim or comp claim the insurance company usually reserves the right to inspect the damaged property before repair but they owe the loss. The final repair invoice/bill sets the cost of the loss to the property not an insurer or appraisers estimate.
  27. unkledaddy
    Joined: Jul 21, 2006
    Posts: 2,865


    No wonder insurance is so freakin' high.............sending an adjuster on
    a 6 hour round trip because of a mechanical problem! My intake is leaking
    a little oil from the rear valley. I'm gonna give my insurance guy a call.
  28. Forest fire by nations enemies is not hypothetical my friend. It is a real option at this point and I do think it is a real valid question although I don't know that swifster is in a position to answer it. If he says yea and it doesn't fly one may blame him and if he says nea and it does fly one may think he is ill informed.

    Actually same with nuclear fall out is a real concern these days as well. We had slight nuclear fallout from Japan but we always run the threat of a dirty bomb. If your car just happened to be in the parking lot of the ball game where that happened who would be responsible for cleaning it up?

    I think they are valid questons, maybe better posed to those higher up the chain but when is one of them going to be present and can they be trusted as well as swifster to give a legitimate answer.

    Some people are crooked and other are just dumb.

    My ex mother inlaw called me one time to say that she had pipes leaking in here basement and that she had water damage written into her homeowners. She was told by the plumber who didn't repair the damage that the pipes were rusted through. She wanted to know if she should call her agent or was there another person she should call, she figured that the rust was water damage to her pipes.

    I gave her the number of a good plumber. If she had called someone else in the family they may have told her to make a claim because rusted pipes is clearly water damage.
    Last edited: May 14, 2012
  29. 1) I got rear ended. I had minor injuries saw a doctor maybe three times. The insurance adjuster looked at my truck and sent me a check for $100. It did not cover the trailer hitch damages. Insurance refused to negotiate. All I wanted was my truck fixed. I got a lawyer, out of court 5K settlement back to me - ridiculous. Truck repairs were $1200. (Progressive)

    2) I got robbed, they took some 40 Ford sheetmetal and a grille - some other stuff. Not covered because it was a car and I have to settle the car claim on the car insurance - ok but the car was under construction and not registered or insured - sorry not covered. But what if it was the wife's sewing machine - sorry, thats different. Oh, BTW, make sure you have replacement cost insurance, you will be shocked at the pro-rated value of your cool old stuff. (Erie)

    3) In 1982 I wrecked a 54 Harley t-boning a new driver that pulled out into the road in front of me. The adjuster came to my house. Said the bike was a total loss. Offered $1200 and that I could buy the bike back from them for $600 - are you kidding me. I took reciepts down to the insurance company - lots of them. They wanted me to leave them there. I said no, they could copy them. They didnt - but didnt change the offer. I got a lawyer, he got me 6K based on the value of the bike as represented in the reciepts. Which does not cover the two years it took to go out and find everything I needed (pre home computer days) or any of the labor that I had into it because labor was not documented as I am 'a hobbiest'. (State Farm) Oh, and my coverage was State Farm also!

    These are the kind of stories we share with one another that are real world and make it difficult for us to trust out insurance companies...just sayin!
  30. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456


    Everyone bitches about socialism until it benefits them.

    As for insurance companies being in the make-a-profit business, doesn't that fly in the face of your socialist comment? And other than the church or charitable business, who isn't out there to make a profit? I know I'm out to make a profit. When you go to work, are you not trying to make a profit from the amount of time you put in? Do you work for free?

    This stuff kills me. An insurance company is a contract, just like your mortgage or your auto loan. And no one reads the contract. No one reads their homeowners insurance policy either. Your two largest investments and you take 15 minutes on the phone, don't read the paperwork and become pissed when that contact is enforced. "Oh, I'm being screwed!" But if I asked you to tell me how and to point it out in the policy, there is dead silence. If I deny something, I can tell you why and what wording in the policy that says I have to. And for just about all conversations, the print on your vintage car policy is the same as your daily driver. You insure that, right?

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