Register now to get rid of these ads!

Insurance Claims Class 102

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

  1. Fenders
    Joined: Sep 8, 2007
    Posts: 3,922

    Fenders
    Member

    This is a lot of doubletalk. They lose money on homeowners -- do you mean the payout exceeds the premiums? So what? You said their profit comes from investments. Investment of what money? Investment of the premiums received? If so, they do not lose money on homeowners.

    Reminds me of the saying, "we lose money on every sale, but make up for it on quantity."
     
  2. " The big joke is the last paragraph. That the insurance company should write the shop a blank check. And make no mistake, that is what Mr Shop Owner is implying. While it is try that the contract to repair the vehicle is between the shop and the insured, nowhere is it stated that the insurance company has to pay this if they disagree. The choice of shop is yours; chose wisely so you don't pull money out of your pocket.

    Insurance companies owe 'reasonable & customary'. This means fair. It doesn't mean a restoration shop can bill at his own hour and think I will pay for it. I warn my customers that using such shops can cause money to dribble out of their pockets. You can lead a horse to water but you can't make them drink."

    I should have been clearer in my statement. The cost of the repair is authorized by the owner of the property and he is responsible for the payment to the shop for the repair. The insurer is responsible for reimbursing the policy holder according to the terms of the policy. . If there is disagreement as to what the insurer wants to pay that is between them and the policyholder . I in no way stated the insurance company should write a blank check to the shop or the insured . I stated "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 .( I should have inserted the word "and" here instead of the period ) 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 ( I should have used the word repair instead of loss ) to the property not an insurer or appraisers estimate."

    Over the years I cant count the number of requests we have had for final invoices from attorneys subrogating a loss on the behalf of the insurance company and insured . Why do they need the final bill from the shop and not the insurance estimate to settle in court ??????????

    Swifter , yes I'm the " Shop Owner " that has endured 40+ years of the shenanigans of less than ethical insurance employees you described in your reply and consumers that think its OK to pad an estimate so they can make money at the expense of the insurer or shop. You have been fortunate to work for ethical companies that want to settle a loss fairly and appear to have a personal ethic to be honest with all involved but there seems to be a trend in the insurance industry today to try to pass their financial burdens and commitments onto the backs of others. Sometimes they are very blatant and extortive in how they go about it and other times they are very subtle. Today's consumer and business owner are more knowledgeable and know who is treating them fairly.

    The statement " Insurance companies owe 'reasonable & customary'. This means fair. It doesn't mean a restoration shop can bill at his own hour and think I will pay for it. " Who sets "reasonable and customary " puzzles me? We have insurers in our area that will tell you $20.00 is R&C and have shops conspiring with them to defraud people out of the true value of the damage. R&C would be great if it were not manipulated by others outside and within the industry of repair .You lead one to believe that a shop has no control over his door rate only you ( or the insurance company ) do " . A shops rate is based on their cost of doing business not the shops down the street or any other entity. Its not any different than saying you have to work for $XXX.XX because that is what Joe next door operates his household on . Statements like that one cause me to ask for a clearer definition of the statement .
    "And don't expect me to pay on your hour if you won't open your books to me to show me what you are charging for (these shops get ALL upset when you ask them to). " is like saying to someone " I need to see your wife naked or I cant pay this ". You should not be surprised you have received the responses you got . The door rate is the door rate set by one's cost of doing business. If you needed documentation or an explanation of the hours logged in by a tech on a job. That should be clearly shown on the invoice.

    After rereading your response to my post and my unfamiliarity with Florida's Appraisers Guidelines I'm assuming you are acting on the behalf of the insurance company to negotiate a settlement with the policy owner / claimant. I know that public adjusters and appraisers have different definitions and obligations here in Illinois and I'm sure it varies widely from state to state.

    All in all it boils down to a negotiation between the policy holder and the company on what they willing to settle the loss for among themselves. Sometimes a final repair bill is the needed figure , sometimes its an agreed price for repair that an insurance rep may be able to negotiate with a third party vendor, sometimes the guy just wants dinner for his inconvinence but its between the company and the policy holder/claimant . No one else. The business of insurance is settling the obligation the carrier has to the policy holder. The business of repair and its costs are between the property owner and the contractor. The current system is like a couple of pictures that have been weathered gray and stuck together over the years from a separate black and a white photograph and they no longer resemble anything of the originals.

    If you really want a good understanding of your insurance policy , take the Business Law 101 and 102 course at you local community college. Its basic contract law. You would scare yourself if you were to read your policy before and after completing the classes. If you have kids attending college these are must take classes even if they are not required.
     
  3. I am stealing this one...:D

    I'm 47 years old, my insurance has not gone down since I was 16 ($1200/yr.)... Never had a claim, never in an accident... My only crime, not being married. Insurance companies generalize when it benefits them too.
     
  4. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    I didn't stutter or lie. Keep in mind that AAA is an Auto Club first. They are an insurance company second. How many pies does the Auto Club have their fingers in? Money invested was on all revenues, not just homeowners.

    AAA Michigan at the time only insured Michigan at the time. If one or two good storms came thru in the spring, good bye profits. Again, one department of many. Ask State Farm or Allstate how much money they made in HO during 2005 or 2007...
     
  5. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    Larry, I'll respond to this tonight...

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

    Swifster
    Member

    I'm 48 and single and my rates haven't dropped either. I always recommend shopping your insurance at least every two years if not more often.
     
  7. Shaner's74
    Joined: Dec 19, 2011
    Posts: 76

    Shaner's74
    Member

    That was a good thing about the company that I had worked for. We paid the shop's labor rates and did not try to get them to discount them. I agree, why should you pay one shop with a ton of overhead the same amount as the hacker down the street with a "paint room" and no frame machine.
     
  8. Shaner's74
    Joined: Dec 19, 2011
    Posts: 76

    Shaner's74
    Member

    No double talk. An insurance company has a reserve of money set to what they expect to lose on claims. If they exceed that amount by 1% they feel very fortunate that is was only 1%, that is a good year. Companies are going to lose money on claims guaranteed. They now that. They take the policy money and invest it and that is how they make money. They take the total they make off investments and deduct what they pay out in claims and that is how much they made that year. If they took the policy money and put it in the bank and then paid out claims from that, hell yes they are going to lose money.
     
  9. 48FordFanatic
    Joined: Feb 26, 2011
    Posts: 1,335

    48FordFanatic
    Member
    from Maine

    Something I thought was interesting....several years ago my wife hit a patch of ice on a back road, spun out and hit a large tree stump. Her almost new car was totaled. The insurance company settled to my satisfaction and I waited for a rate increase ...but it never happened. I'm not one to ask why someone isn't charging me more , but after a few years my curiosity got the best of me and I asked my agent why our rates hadn't gone up. Answer...the state trooper noted on the accident report that the accident was " unavoidable due to changing road conditions and untreated road surface". For this reason the claim was made against my comprehensive coverage , not the collision, and for that reason there was no rate increase. Something to keep in mind .
     
  10. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    There is an old saying about looking a gift horse in the mouth...

    No matter how you slice it, that is a single car collision. The way it was written my have eliminated liability and made her not at fault. You may pay your deductible without your rates going up.
     
  11. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    OK, so he's not concerned about the door locks (though two won't open). This is about the trim panels the repair shop wants to drill holes thru to get to the lock mechanism. Hmmmmm. $1600
     
  12. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    So does anyone want to take a stab why I don't think this is a covered loss?
     
  13. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    OK, no one took a shot this...COWARDS! LOL!

    The reason this would not be covered is that there is no named peril. In otherwords, the damage will not be from fire, earthquake, theft, vanndalism, etc. There is also no current damage to those panels and his repair facility wants to intentionally damage these panels.

    I have a voicemail in with Mercedes-Benz USA to see if there are any ways to get the doors unlocked without destroying the trim panels.
     
  14. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    I hate to use the term price fixing, but that is the insurance business. Yes, insurance companies set the rate. Over the course of the last 26 years, I've done work in Michigan, Ohio, Indiana, Illinois, Missouri, Nebraska, North Carolina and Florida. Every state has been the same. The rates have varied by area. For the sake of the discussion, I will stick with the Orlando and Central Florida areas.

    Most of the labor rates are at either $40 or $42 an hour and material rates between $22 and $26. Whose fault are those labor rates? To me, it's the shop. Why? None of the shops care enough to even post their rates in their offices. None bother to stand up to the insurance companies. A labor rate is a labor rate, but that rate hasn't changed since I moved to Florida in 2006. The material rates are the same thing. Paint is expensive. There is no way a shop can make money at $22 an hour. Yet even a shop that deals primarily with BMWs had $22 on HIS supplement estimate.

    Now, if everyother shop BUT yours will do work at a certain rate means that I can get an agreed price out of any other shop. It is no different in my business. I CAN price myself out of business. If a shop is out of line on his rates, why would I do work with you?

    The car owner is caught between the shop and the insurance company. The customer is allowed to take the vehicle any place he wishes. And I will deal with anyone. Trying to say the shop and appraiser/adjuster have no dealings with each other and shouldn't is something that is really not practical. How many customers know anything about body and paint work. It sounds to me like you are preying on the uninformed.

    I have something I call Tom's DRP. If someone doesn't know where they will take their car, I'll give them the names of three shops in their area they can take the car to and I'LL know they will have no problems. And if they choose one of the three shops, THE CUSTOMER made that decision.

    As for the difference between what I write on my estimate and what you might charge (and if you are billing at your own pie-in-the-sky rate vs flat rate) that ends up going to the insured. If someone says I'm taking my car to Shop X, don't you think I'll make a call to you to see what you are about? And if I think you'll be taking extra money from my insured, I warn them of this. They make the decision.

    I've had one owner who wanted to play contractor between myself and the shop. He ended up spending $14,000 out of his pocket. The repairs to his truck were above and beyond what the truck was prior to the loss. The insurance company told the guy to take a hike.

    I look at these people as MY customers. Not just the insurance company's customer or your customer. They are MY customer. I don't leave them hanging. I have some customers who call me now (not that I told them to) before they talk to their insurance company. I've called claims in for customers. I've walked them thru the process. I've looked at a few cars once repaired at their request. I'm a hard grader and they know it.

    My instructions once the vehicle has been inspected?

    "You'll get two copies of the estimate. One is for you and one is for the body shop. Take a copy of the estimate with the car to your choice of shop so that they can see what was written and get your parts ordered. The shop will work off of this estimate. If the shop finds anymore damage, or if they disagree with what is on it, they will contact me. If what they want/need is minor, the supplement will be handled by phone. If it's something major, then I will go to the shop and reinspect the vehicle. The insurance company will issue you a check made out to you. DO NOT CASH THE CHECK!. Hold the check until ALL repairs have been completed. When you are satisfied with the repairs, sign the check over to the repair facility. If there is a supplement, a seperate check will be mailed to you and it works the same as the first; hold the check until the work has been completed and you are satisfied with the repair. If you are not happy with the repair, explain what you are unhappy with and make sure this is corrected prior to signing the check(s). If the shop is extremely proud of the dirt (or what ever) they put in the paint, do not argue. I will go to the shop. I'm a hard grader."

    "What if the shop wants money to buy parts or whatever?"

    "Walk away and find another shop. They have your car to hold if you don't pay the bill. If the shop can not afford the parts to repair your car without a deposit, their is a problem. There is not difference in how a claim is handled between your hot rod and your daily driver."

    Some people don't listen, they cash the check, and wonder why the shop didn't do everything they said they would do.

    And if anyone is worried about the process, it is basically the same as your daily driver. The difference is all in the estimate.

    There are no restoration policies. Only repair policies.

    I let a shop set their own estimate to a point. I don't go past $75 an hour. If the shop wants more, I let the customer know that the difference will come out of his pocket. Most shops will do vintage work in this area for $50. I run my materials at $30 and I don't have a limit set on those costs. I have only one shop ever call me cheap. He was a theif.

    Customers have no idea in most cases what is involved in the repairs. Appraisers/adjusters negotiate those costs with the shop. And yes, it is cost control. This is done up front, not at the end of the repair.
     
    Last edited: May 14, 2012
  15. nrgwizard
    Joined: Aug 18, 2006
    Posts: 1,413

    nrgwizard
    Member
    from Minn. uSA

    Hey, Tom;

    Just a little thank you for putting this out there.

    Have had some very bad experiences w/insurance co.s myself, but no need to air them here. & I don't think anyone, least of all me, wants to get me started on the backgrounds of insurance, BAR, statutes, & related etc.

    I do enjoy reading things from your point-of-view. It's always interesting, & I do like that you respond to the Qs in a very rational manner. Good on you! :D .

    Marcus...
     
  16. jcapps
    Joined: Dec 30, 2008
    Posts: 473

    jcapps
    Member
    from SoCal

    When my full custom Harley was stolen, I wanted what I paid for it 6 months earlier. I paid 16k (bad time for Harleys) It was a new build, only 500 miles on it. I had 50 pictures of my bike so it was obvious it was a high dollar build. The adjuster calls eaglesnest, a rental company that sells them, and offers me 12k. I had the bill of sale and said I wanted the 16k. She refused. Told me to provide comparable sales, so I sent her a bunch of craigslist ads. She said she would not accept an ad without a vin number
    I talked to my agent who informed me they must replace with like kind and quality. I told the adjuster you are acting in bad faith. But I will find comparable bikes.. I told the adjuster that I found three dealers with comparable bikes, all were 26k+ So I told her I will go get the bike pictured and she can pay the 26k.
    She told me she will call me back. Called me 10 minutes later and offered me 21k+, I took it. She cost her company over 5k more than I wanted. Key is like kind and quality. Had she not tried to compare my bike with 3 year old rentals with 30k + miles she would have saved money. She played and she lost
     
  17. jcapps
    Joined: Dec 30, 2008
    Posts: 473

    jcapps
    Member
    from SoCal

    Those rates are all well and good in timbuktoo but in socal, shop rates are typically $90 on average. Insurance company cannot tell you they will pay less than the prevailing rate in your jurisdiction.
    I can see not paying 125 and hour but no way they can pay less than the average rate for a good shop

    BTW thanks for all the info. It is interesting to read the experiences of others and your knowledge of the field
     
  18. lukey
    Joined: May 27, 2009
    Posts: 668

    lukey
    Member

    With my insurance, squashing bambi is collision. Learned that the hard way, i always figured it was comprehensive. Nope!


    -LUKEY-
     
  19. Terrence
    Joined: Jan 9, 2003
    Posts: 317

    Terrence
    Member

    Does anyone have experience with USAA? I am thinking about switching to them but don't want to move to a bad less than fair Ins. Co. BTW I have been with State Farm for 18+ years with no issues, but I had a good agent. I have recently moved and USAA seems like a good choice?
    Thanks Terrence
     
  20. pwschuh
    Joined: Oct 27, 2008
    Posts: 2,475

    pwschuh
    ALLIANCE MEMBER

    USAA is outstanding for a daily driver. They don't offer much in the way of "specialty car" coverage.
     
  21. Ricola
    Joined: Sep 8, 2007
    Posts: 100

    Ricola
    Member
    from MN

    Former bodyshop owner, auto phyiscal damage appraiser and now a property adjuster. As a professional I believe it is our job to find coverage if it exists. As stated your typical policy holder doesn't know what is covered and what is excluded. We are bound as professionals to understand the policy and comunicate clearly when there is a coverage question.

    With regard to damage to a specialty car. I always suggest that a vehicle owner do his homework before the appraiser arrives. Get values and locate comparative vehicles for the appraiser. Some guys will welcome the information others will reject it. Not all appraisers are knowedgeable when it comes to specialty cars like Swiftster. I worked for a company that hired collage guys that knew nothing about cars other than what they could work out on an estimating program. Really... nothing about cars just numbers.
     
  22. Cyclone Kevin
    Joined: Apr 15, 2002
    Posts: 4,084

    Cyclone Kevin
    Alliance Vendor

    Swifter and Ricola,
    I also was a both a APD and Mechanical Claims adjuster for M.I.C-GM, Western General, Farmers, Wynn's-Phoenix American and NMAC-Nissan Mtr Corp.

    The claim cited appears to be a Mechanical Claim,if there is no Physical Damage caused by collision or attempted theft-vandalism. This is a 28 yr old vehicle, not really sure how collectible a 300-D is,but I'm sure that there are some MBZ enthusiasts out in the automotive world.

    I would have the insured read the policies and provissions in their copy of their policy provided to them by their carrier. It may clear up a few things and open their eyes to others. There are times when the claims that I had were cut & dry, others where there was a gray area and it became a topic of discussion for a claims manager and the adjuster. Most often,if we covered something that was "that gray area" it would be at our discretion-That doesn't mean that it would be covered everytime, it would be a case by case basis.

    When I received a claim, I always pulled a copy of the insured's policy so that we'd be on the same page,made isure that I kept both a written and electronic log in my claim notes and followed company protocol.

    Since I was a driver @ 16, I was kinda suspicious of the insurance business-never had a claim in 32yrs of driving and could've built one hell of a Hot Rod with what I have spent on my own coverage, but I do know that all it would take is one loss and it could wipe me out all the way around.

    When I attended Farmers APD School I recall how they hired many college grads that had absolutely no business being there.They had no interest in APD and they were only there because it was a job that their degree allowed them to qualify for.
    They did well on tests that were given in class,but put out in the shop, they failed miserably as they didn't know the actual component and the result of its failure,which could be a result of physical damage or a mechanical failure resulting from lack of maintanence.

    I not presently adjusting claims as a profession and the stress really gets to one, I feel for you guys out there as insurance companies tighten their financial belts and refine their policies in order to stay economically solvent.

    With the advent of pathways back in the late 90's, estimating seemed to have taken on a whole new way of programmed labor time ops, material prices etc.
    Glad that I'm out of that game for now! :).
     
  23. pwschuh
    Joined: Oct 27, 2008
    Posts: 2,475

    pwschuh
    ALLIANCE MEMBER

    Sometimes, before buying specialty insurance for their car, a custom or hot rod owner will get a professional appraisal of its value. If such a car is totaled, how much difference does this make in the settlement, if the owner has previously had a professional appraisal done on the vehicle?
     
  24. S_Mazza
    Joined: Apr 27, 2011
    Posts: 363

    S_Mazza
    Member

    Depends on if the policy covers the actual cash value, stated value, or agreed value.

    In any case, even if the policy is for ACV, the owner might be able to get a settlement increased, but the burden of proof would be on the owner in that case. IE, the owner would have to prove what similar cars are selling for. In that case, the previous appraisal would be of use, since it would presumably have documentation of the car's condition. Of course, if there was damage or neglect between the appraisal and the loss, that would change things, but that's another can of worms.
     
  25. Fenders
    Joined: Sep 8, 2007
    Posts: 3,922

    Fenders
    Member

    Yah, must be a bunch of Cuban dryfeet working in FLA, $90 - $120 here in Mass. Swifter wouldn't fly very well here.
     
  26. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    Thanks Marcus and others.

    I find that there is a lack of information and knowledge, even amoung those who should know. Obviously, things CAN differ depending on your area. But the written policy does not vary that much from state to state. Yes, some minor changes can be made to taylor a policy to a given policy, but the base policy states as a standard form and modified from there.

    One other thing to think about. Insurance companies don't train sales agents on claims and they don't train adjusters on sales. The intentionally keep both seperated. So keep in mind that not everything your agent tells you may be true.
     
  27. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    I had the former GMAC (now Ally?) low ball a friend's mother when she totaled her car. I KNEW the management, and they tried playing me. By the time I was done, they paid me more than I was looking for as well. I won't say they tried to screw her on purpose, but there were a few that were lazy and wouldn't do their job.

    Rates vary by region. The rates were for Florida ONLY and will not necessarily reflect CA, MA, IL or MO. The rates are close to MI. Obviously if the rates are considerably higher on personal lines (daily driver type repairs) claims, the rates will be higher for collector car repairs. This was simply an example of what goes on in a given area.

    I have shops here who consider themselves restoration shops and they want to bill different than flat rate. And THAT is the problem. I have most of the older Mitchell Crash Books going back to the 1950's and 1960's. I would never be able to get a shop to do the work on a car if I wrote them at straight book time. You have to ADJUST (hense the term adjuster) to suit the job. I guess what I was trying to get across is that those of us on the insurance side want an agreement on the scope of repair before the repair begin and to deal with any supplements as they come. No at the end as the shop owner was suggesting. If there is a problem, we need to address it BEFORE the repairs start, not when it's finished. Attorney's should never be needed during the repairs or after. If there is a problem, handle before the repairs agreed upon.
     
    Last edited: May 15, 2012
  28. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    An insurance company has the ability to change a policy to suit it's book of business. I'm just saying I've never seen a policy where animals were considered collision. I don't think I would agree with it either. This allows the insurance company to make a deer loss an At-Fault collision. That makes your rates rise. A comp loss by it's very nature should not raise your rates unless you've had your car stolen 8 times. Then they look at this as a trend.
     
  29. Swifster
    Joined: Dec 16, 2006
    Posts: 1,456

    Swifster
    Member

    USAA is excellent and their customer service is second to none. They are typically more expensive than other companies, but they will bend over backwards to make you happy.

    As for vintage, I believe they insure them as a Stated Value policy. Not sure how claims are handled with these if they do.
     
  30. hinklejd
    Joined: Jan 20, 2010
    Posts: 146

    hinklejd
    Member
    from Fort Worth

    I switched to USAA away from Allstate a couple years ago...less expensive and better coverage. Before Allstate, I had Progressive...left Progressive for the same reason.
     

Share This Page

Register now to get rid of these ads!

Archive

Copyright © 1995-2021 The Jalopy Journal: Steal our stuff, we'll kick your teeth in. Terms of Service. Privacy Policy.

Atomic Industry
Forum software by XenForo™ ©2010-2014 XenForo Ltd.