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Recent Posts

Will your insurance pay?

12:55 PM Thu, Mar 06, 2008 |

Last fall, voters approved stiffer penalties for insurance companies if they unreasonably deny or delay a claim. So is the problem solved? The industry says there wasn't a problem to begin with. Critics say, the problem still exists, that the pressure on profits means companies are paying out less in claims. What's your experience?
Note: We're rebroadcasting this show March 9, 2008.

Up Front this week, the KING 5 Investigators report on homeowners who are still waiting to settle claims from last year's windstorm. The Northwest Insurance Council says the number of complaints from that storm represents fewer than 1% of all claims paid. Meanwhile, trial attorney Chris Davis says insurance adjusters don't have consumers' best interest in mind--and many of those people who settled, may not have gotten a fair amount.

So what do you think?



59 Comments

T-Boned said:

I was injured on 405 when a vehicle tried to cut off another from getting in front of her. She then lost control of her car and swivered across the hwy (let go of the steering wheel) and t-boned me @ 60 mph, almost forcing me head on into the concrete barrier. I have two bulging disks in my neck, one herniated and one bulging disk in my upper back, and carpultunnle in my wrists. It's been three years and my insurance company (Allstate) has offered me $5,000 for damages. I have no health insurance and have been left to suffer and can no longer do marine electrical work. My life has been turned upside down and I can only pray that a jury sees past the insurance company’s lies, my life is in the jury's hands, not Allstate's (February 19, 2008).

Dave Martin said:

In Feb-March '07, we discovered that a broken water pipe under our house had eroded our foundation, and cracked our garage floor, driveway, and caused our foundation to "settle" by about 2 inches downward. Farmers insurance has completely DENIED any coverage of the damage stating an exclusion for damage that is not "sudden and accidental". We are currently undergoing $55,000.00 in repairs to fixe the foundation, garage floor, and driveway. We are forced to sue Farmers in an attempt to collect for damages. Beware of the wording included in the pages and pages of "exclusions" attached to your policy!!!!!! That's where they get you.....things that appear to be covered, like water damage, may be excluded later depending on the how fast or slowly the damage occurred.
Beware!

If you would like to get a FREE copy of Mr. Davis' book visit WashingtonAccidentBook.com

Teri Starke said:

I am watching Up Front right now. I absolutely do not trust insurance companies, I think they are for the profit of the company with incentives to not pay. Insurance companies, both medical and personal property insurers are the biggest crooks out there right now. I was so horrified after Katrina, I made sure we are insured for as much as possible. We are lucky and can afford that much insurance. But the reality is I do not know if we are covered. We have alstate and they are one of the worst companies out there. I will be looking into changing on our anniversary date, this time when I compare insurance companies the cost will not be the primary consideration for changing companies. We need the trial lawyers to hold these crooks in check.

Heather said:

This story is one of the most poorly-researched investigations I have seen. A true investigation, should be unbiased (which this obviously was not), well researched (with this was not- go look at the insurance laws, the contracts, ask the insurance companies the actual process that is gone through in making a payment, etc.), and reported showing both sides of the story (true, unbiased sides). One of the biggest problems in this country is that people believe they deserve to be compensated (and over compensated) for whatever happens to them. In fact, insurance is a contractual agreement between the insurance company and the insured- the limits of the contract are well documented for the insured to read- and sign. You get what you pay for- you can pay for extra coverage if you want the coverage. An insurance company is not a not-for-profit industry- it is a business, just like Microsoft, Boeing, Doctor's offices, etc. There are some years when insurance companies have a loss (no profit in that year).

King 5 investigators have an ethical requirement to do thorough research so as to not show an incorrect and biased story. The news is the avenue for individuals to gain correct information, and it is apalling when information is shared in this way. Also, while your poll was interesting, I am guessing this poll was not done in a blinded, scientific manner, like a true poll that has statistical significance should be conducted. I also find it funny that the trial lawyers (individuals we usually dont trust) are being touted as the heroes in this story, those who are looking out for the best for their clients. In truth, they are looking out for themselves- the more claims they adjudicate, the more money they make.

I hope in the future, King 5 investigators do a better job to show the true unbiased story.

Rick Weishaupt said:

MY issue wasn't a claim.My issue was when Farmers doubled our insurance rates because we went from a 3 car family to 1. The rate was higher than what we paid for all three cars combined.Because we had 3 drivers in our family they wanted to charge us for each driver, not for the vehicle, even though only one person was going to be the 98% main driver. Our agent told us this was Washington law that because we only had one car they could charge us per driver because any of us could driver the vehicle. So they were insuring the drivers not the vehicle? I asked her how this worked for a college student in the dorms, if there are hundreds of people maybe available to drive that students car, how do they charge the student? She couldn't answer, I changed company's and after seeing the show may call the state.

Delaine VanderLinden said:

May 04, I was Ins. through Allstate, was T-boned, flipped, ended up in the ditch with a light pole on top of me, I had to be cut out of the Toyota truck I was in and taken to the E.R., by Ambulance. The lady who hit me was also insured through Allstate, so they had a hard time paying for my injuries. I had to hire an attorney to make them keep the policies seperate.? ha it took 3 years for them to pay me $3,000 for my $15.000. truck (all up grades Roll bars,(which saved my life)lights ect)I am still hurting and the Dr. says because of my age I always will, but the ins. co. payed my med bills and that was good for them. I dropped Allstate right when they started messing with me, which was with in a month of the accident. Delaine (360)708-8663

Lori said:

I watched the show today with Robert Mak as it's one of the best shows and explained so well, simple and thoroughly.

I believe that the insurance companies do their best to make a profit and train their employees to do so and I believe that there are people who pay the price for that, as the ones shown on today's show.

I was a little disappointed though to not see the other side of things. I've personally known people in my past that have scammed insurance companies for medical reasons to stay out of work and get paid, they get addicted to pain pills and find doctors that will continue to say they can't work etc.

I feel there's room for imporovement on both sides but I only heard one side. The insurane companies I'm sure have to be careful not to talk about people trying to scam them but we all know they are out there.

I think it's important to have the insurance companies be fair and the people or their customer's too.

Jenifer Brigham said:

I just saw your upfront episode about "will the insurance pay". Last November 15th we had two trees fall on our home. It took 25 days for our insurance company to even come and look at our house.
It has been hell since then. It is now been over a year and our home is still not fixed. We our currently living in a 24' camping trailer and our garage.I thought if you payed your insurance every month you would be taken care of if something like this ever happened. I guess this is what happens when you think.

Sincerely
Jenifer Brigham

pat said:

Almost three years ago a 100 ft. Douglas Fir fell across our house and demolished it. Our insurance company put us in a local motel found us a rental house, arranged to have it furnished down to the dish towels in the kitchen. Our house was rebuilt and our furnishiungs replaced without any trouble/argument. We lost things (old family stuff) they could never replace, but we are back home and have nothing but good to say about the insurance company who provides our homeowners coverage. Maybe it depends on where the policy is purchased. Years ago (many of them) we had an issue with Allstate and switched - we are not sorry.

Jim Wilker said:

My question is what is the State Insurance Commission's duty in protecting our states residents from unethical business practices? How many times must a insurance company be taken to court before they are no longer allowed to operate in our state? We are forced to have insurance under the law or by financial requirements to qualify for a loan or operate an automobile, why can't insurers be forced to pay claims first and make any adjustments after the claim is settled? In the wake of Hurricane Katarina and other natural disasters perhaps our governmental resources should be used to reign in abusive insurance companies their agents and make them serve the purpose that we have hired them for, that is to help in a time of emergency.

Jim Wilker

James B. said:

Insurance for profit is Insurance denied. this is the reason we need national auto and medical insurance. You cannot pay out claims and make profit. you could be a non profit and break even. Allstate is topping the list on the worst insurance companies out there. just Google worst insurance companies. They leave YOU open to lawsuit if you injure someone or damage property and they deny your claim. You could loose your home and your paycheck for life.

Connie Wittler said:

My father, 85 yrs old, has Allstate homeowners. During the big storm last year he lost all of the food in his freezer. We both live in double wide mobile homes on the same property. Our loss was paid by Uniguard within the week. We argued with Allstate repeatedly and they finally denied the claim because they don't cover freezer loss when in a mobile home! I did not fight it any further due to his age and the fear of being cancelled. Pretty sad after paying high premiums for so many years.
Have you reviewed their use of "Colossus"?

Eric Wolfson said:

Are insurance companies dishonest?
You betcha! Insurance coverage is manditory for home loans, and require the homeowner to meet very high standards to comply. Miss any one of the many policy conditions and you are denied coverage. Lose any official documents, proof of compliance, certifications, have one signature smudged or misplaced and you are denied coverage.

Ever play 'Monkey in the Middle'? Thats a insurance trick where the insurance companies deny coverage until after another insurance company, eg. credit card, appliance maker, even another division of the same company, pays up first. And guess what that other insurance company will do?

The insurance company will make you run around like you never will beleive!

pat said:

I agree with Heather -

"I hope in the future, King 5 investigators do a better job to show the true unbiased story."

I think the media in general likes to focus on the victims - it makes a better story. In this case there is another side tho.

Eric Wolfson said:

I was hit and hurt driving in Oregon a few years back.
After visiting the local hospital I called my auto and travel/health insurance companies.

Both companies said because the other driver was responsible that they didnt have to do anything for me - I would have to deal/fight with the other insurance company on my own!

This is how the Insurance companies protect themselves.

But dont miss a payment, sucker!

Eric Wagener said:

My wife was hit head on by a driver heading north in Lynnwood on 44th at 204th SW. She was sitting at a red light turning left waiting for her light. Driver moved to the left and hit her. The problem is both ours and their insurance company is the same one. They delayed getting her a rental, they gave a low ball value when they issued the payment for the salvaged vehicle (94 Chev Lumina with just 44K on the clock.) Van was family owned so we know where it has been. Van was in excellent condition. For example they had to come back to auto body shop and try to find faults with it and go over every square inch when we said NO WAY to the 1st low ball. Even with the 2nd offer they still came back lower than estimate to fix it.

Kathleen Anderson said:

In April of 2006, my son stopped to make a left turn across 35 mph traffic and was rear-ended by a motorist covered by State Farm Insurance. His older car was totaled by a State Farm adjustor within days of the accident, yet State Farm denied his medical claims of neck and back injuries or pain and suffering.
In the later part of this year (2007), State Farm considered reimbursement to DSHS for the medical care my son sought for injuries as a result of the accident. The amount they are offering for settlement regarding his medical claims is a mere $276.67.
I am very pleased Washington has this new law regarding stiffer penalties for insurance companies who deny claims on behalf of their stockholders.

Eric Wagener said:

I had a former insuance company cancell me when they (claim) I did'nt make a payment after a not at fault accident claim (hit by a drunk driver) The insurance company even went as far as to call the insuarce guy and say DON'T CALL CUSTOMER IF THIS POLICY LAPSES. I was left with no insuance and not even aware of this fact. When I found out it shows that I was canceled and there for my insuance was REALLY HIGH for the next 3 years. Don't you just love the insuance company NOT!

bill said:

The problem with this report was that they keep referring to the rate payers as customers, when the fact is they are the revenue source and the customers are THE COMPANY SHAREHOLDERS. It amazes me that with that much money at stake, why doesn't the state sell insurance as a revenue source

Trace DeHaven said:

In 2003 I was injured when I was hit by a large pickup truck while legally in a crosswalk on my bicycle. At the time, I did nearly everything that has been suggested. I talked to attorneys and did research. I decided to go it alone, without an attorney. The insurance company followed the same practice as car dealerships: At first they give you someone nice and reassuring to talk to. This person says "don't worry, we'll take care of everything, we'll settle your claim, etc etc." Then when it comes time to actually negotiate a settlement amount (months later, when it's too late to get an attorney interested in your case), they bring in a hardball person to do the negotiation. It was an absolutely grueling process over a period of a couple of hours. Near the end, we had a reached an amount that I thought was fair. Then the negotiator reneged, essentially saying "I'm not allowed to go that high." The final amount was $6000 less than I negotiated for. I feel the company did not negotiate in good faith. And unfortunately my whiplash injury lingers. I'll probably have to see a chiropractor for the rest of my life. I don't know how any amount of money can compensate me for what I've been through. And I am not altogether sure I would have received more if I'd hired an attorney, since they take 1/3 of the settlement. In addition the police officer on the scene was taken in by the lies of the driver of the vehicle, weakening my case. Instead of trying to the best for an injured party, these types of situations become a war of experts. The whole system is in need of a serious overhaul.

Cathy Green said:

I also agree with HEATHER.

The December 2006 storm laid 3 trees on our home. Farmers Insurance took very good care of our claim, and just as they said the claim would remain open until the repairs were done. Their "local response representatives", were quick to respond and paid our intial claim amount within weeks. Once we found a general contractor, it was determined the roof repair would be higher, we met again with Farmers, and they agreed to more money, and paid it very quickly. During the tear down of our home,(basically it was gutted down to the studs), again the general contractor found additional problems caused by the tree impact and water damage, again Farmers agreed to more money and paid very quickly.

We have had FARMERS for 28 years, for homeowners on two properties, auto insurance and life insurance for a family of five. The few times we have had claims, we have been completely satisified.

Why didn't KING 5 profile satisfied insurance customers?

Cathy Green

Cathy Green said:

I also agree with HEATHER.

The December 2006 storm laid 3 trees on our home. FARMERS INSURANCE took very good care of our claim, and just as they said the claim would remain open until the repairs were done. Their "local response representatives", were quick to respond and paid our intial claim amount within weeks. Once we found a general contractor, it was determined the roof repair would be higher, we met again with Farmers, and they agreed to more money, and paid it very quickly. During the tear down of our home,(basically it was gutted down to the studs), again the general contractor found additional problems caused by the tree impact and water damage, again Farmers agreed to more money and paid very quickly.

We have had FARMERS for 28 years, for homeowners on two properties, auto insurance and life insurance for a family of five. The few times we have had claims, we have been completely satisified.

Why didn't KING 5 profile satisfied insurance customers?

Cathy Green

D said:

Like any business, insurance companies operate to make a profit. It makes little business sense to puposefully deny a claim. The insurance industry is one of the most heavily regulated, not only in the country, but in this state, meaning it's very difficult to low-ball customers even if companies wanted to. People simply need to understand how insurance works. You get what you pay for. Water damage is almost always excluded. It's right there in black and white in your policy. You can't expect your company to pay for coverage you didn't pay for. You certainly wouldn't expect your cable company to provide you with HBO if you weren't paying for it. There are literally millions of claims filed every year from car accidents to natural disasters. Insurance companies help millions of people every year get back on their feet and recover from life-changing events.

Brandon said:

Thank You, Heather and D. Most of the comments I've read so far have been compalints from customers who have had a bad experience with a claim they made with their insurance company.
For one thing, every insurance company is under completely separate and independent management - not all companies make it their objective to low-ball their customers. In addition, if there is a group of companies out there who are making a concious effort to low-ball their customers on loss payments, they should be individually singled out and investigated rather than grouping all "Insurance Companies" together like they are all cohorts. So like any business, even in the case of a perfectly fair insurance company there will occasionally be a customer that slips through the cracks and does not get the level of service that they deserve. This does not mean that the company has not made an effort to try to offer fair settlements to every customer. Before you judge an industry, it would be good to consider differences in the rates of customer complaints with different companies, rather than picking on the industry as a whole.
People tend to want to be put in a better position than they were before their loss, but the whole purpose of insurance is to get you back to where you were before your loss, no more and no less.
I have had two claims in my lifetime, one with Unigard and the other with Progressive. I was 100% compensated for my loss in a matter of days in both cases. By my experience, both of these companies have excellent customer service policies and strive to make their insureds happy with their settlement. Maybe there are other companies out there that aren't as good.
Anyway, I would like to see King5 run a special that depicts the other side of the picture - the side of the insurance companies and their satisfied customers, and not the lawyers and the minority of unhappy customers.

jenifer brigham said:

I do not agree with heather. I believe the stories were to make people aware of what your insurance companies could do to you if you file a claim. I pay for a service when I pay my insurance every month and I expect them to handle it quickly and nicely. Remember we are the ones paying so they can have a paycheck. Its like if you go to a restaurant, you want quick friendly service. I believe people have the coverage they need the companies just dont want to pay. If this was to happen to any of these people who do not agree with the story I think they would think differently about insurance companies. It is not fair what they have done to me and numerous other people.

Jeni brigham

Brandon said:

Jeni Brigham,
I was not intending to discount the stories of those, like yourself, who have for various reasons run into difficulties when trying to get what they deserve from their insurance company. In fact, I am curious about the details behind why your insurance company claims that they do not owe you money. Jeni, I'm not saying you are one of them, but I think many people may not be aware of the policy coverages, limits, and conditions whose purpose is to keep your premiums down to a manageable level for the general public. If insurance company had to pay any claim from any customer, just because that customer feels like they "deserve" coverage for the loss, premiums would have to be so high that most ordinary people could not afford coverage.
So I do feel for you that you have been getting the run-around by your company and I would expect and hope that you would go shopping for another insurance company b/c yours has left you with a sour taste. But let me just indulge in one more analogy. Remember that insurance companies are businesses just like all other businesses in our country. They have to strive for efficiency like any other private enterprise and simply do not have the resources to be 100% perfect 100% of the time. Think of the airlines. when you pay for your ticket, you expect to be delivered to your destination in a relatively timely fashion, without any drama, and with your belongings in tact. Think about how often people you know have lost luggage or been "bumped" to a later flight. This is a great inconvenience to the customer at the time and may even cause them to refuse to use that airline again. However, these types of inconveniences are inevitable b/c they just can't hire enough employees to watch over each and every passenger's personal well-being throughout the entire trip. Not to mention weather-related issues that the airline has no control over. In the same way, insurance companies have to deal with helping as many people as they can the best that they can manage with the resources they have to work with.
Many of the complaints today were related to the windstorm last winter. Well, it makes sense that when there is a catastrophic event, and claim some in by the truckload all at once, the systems just get clogged up and there just aren't enough employees to make sure that every customer is getting the treatment they would deserve in an ordinary circumstance. However, any company that has not at least been responsive to your requests a year later is not worth staying with. Just my two-cents.

R Callard said:

As a retired general adjuster (property) and a regional claims manager of a major insurance company (you may think is pro-insurance, but I think not), I would like to say that, yes there are companies that try to "cheap out". I worked for a major company headquartered in Boston who published a paper called the "32 Points" which was basically a paper on how to 'screw' insureds. My claims manager told me to do what it said or I could lose my job, but when I told him some of the points were in violation of policy conditions. He told me most don't read their policies. I quit two weeks after my one 1 year contract was up.

When I was a regional claims manager of another company, the State of New Jersey (one of the toughest on insurers) did a compliance audit on our office. No complaints after they reviewed two years of closed claims, property, auto physical damage and automobile bodily injury. All claims adjusters, examiners and supervisors were strictly accountable for upholding the State's insurance laws.

The injured party must understand that when they seek an attorney, the attorney is usually (but not always) interested in their fee, which ranges from 33% to 50% plus expenses of any settlement; so the injured party must look at their 'net' to the injured party.

When Chris Ingalls did his outline, I dropped a note to him outlining that his description of "loss ratio" was not technically correct. Secondly, companies were beholding to their stockholders, well, State Farm has none, it's a privately held company (also the largest insurer).

I did offer my thoughts to Mr. Ingalls and he did call me, but I got the feeling that he blew me off although I told him I retired as an officer of major insurer.

Yes, there are still companies that try to 'dump' claims without listening to their clients, but the majority of insurers are reputable and settle claims fairly and promptly. Don't forget those insureds or claimants that think that an insurance settlement is going to be like 'manna from heaven', it is not and as a speaker stated, an insurance policy is a CONTRACT and buyers must understand it. They have a agent, broker or salesperson who collects a commission, thus is under a fiduciary responsibility to answer questions and explain what is covered and what is not. Should they fail to do this, then they could be held partially responsible for their errors or omissions.

If I were doing a story, I would like the facts and would have listened and then reviewed the insurers' required annual filings with each state -- specifically page 14 of the filing. But, unfortunately we live in a time of 10 second sound bites and want to 'top sheet' (reading only the bullet points) and no looking at both sides of the story.

Respectfully submitted,

R. Callard, Retired insurance executive

Brian said:

Clearly, Heather, Pat and Cathy Green are all employees of the insurance companies. I know of no one other than employees that have not had bad experiences with the industry. I had luggage lost on a trip to the east coast. The airlines had no idea where it had been misplaced and were not very willing to provide compensation. As a precaution I filed a claim against my renter's insurance. It ended up that the luggage was found after 2 weeks, sooner than my claim had even been processed. So the claim to Allstate ended up being $0.00. But when it came time to renew, they held the one claim against me and would not renew. Now I have to wait for a year for any other company to provide the same insurance. The industry is really just a racket where you pay for something you never get. The same is true for every person and relative I know with claims from the wind storms, car accidents, etc.

Heidi & Kirk Hackler said:

Four years ago our 40 sailboat was damaged in a wind storm. We filed a claim with our then yacht insurance, MARKEL, and they promptly denied it.

We got estimates for getting our boat fixed for around $30,000 and again tried to re-file the claim, submitting a marine survey from a well known and excellent surveyor. Again Markel denied our claim, so we were forced to hire a maritime attorney, because we KNEW (as did our attorney) that the damage WAS included in our all perils policy.

Long story short, after 18 months of legal battles, Markel was forced to pay over $120,000 including all of our attorney’s fees, to repair our boat. As soon as they cut the check, they dropped our policy for life.

The whole situation was SO frustrating for us, because not only did we waist 18-months time fighting the insurance company, and not being able to use our boat, they also ended up paying 4-times what it would have cost if they had paid the claim up front, which only serves to increase EVERYONE’S insurance rates.

During our 18-month ordeal, we heard from many other boaters who had also had claims denied by Markel, and most of them did not go to the lengths that we did to fight them, even though their claims were just as valid as ours.

Insurance companies count on people rolling over and not wanting to go through the hassle that we did, so ultimately they only pay out a very small percentage of claims, and do not fulfill their obligation to their policy holders.

In another unrelated incident, the agent we delt with was trained to automatically deny all claims. There needs to be legislation againt this!!

Paula Williams said:

I accidentally stumbled on Mr. Robert Mak's show on Will Your Insurance Pay and became increasingly glued to the set. I am currently struggling with Allstate on a home owners insurance claim that involved and accidental fire. The problem I have is that because the home was just purchased in Aug 07 and the home "accidently" according to the fire investigation caught fire one month later. Allstate is putting me through the ringer. I didn't realize that Allstate would be so complicated. I am asked for personal information down to my marital lifestyle to back taxes information for 4 years to depositions and recorded conversations with Allstate representatives. Allstate has mislead me to believe that I was in good hands only to cancel my policy and fire the adjuster shortly after the fire. I am now asked to attend a court recorded deposition along with my husband and other person whom was doing some minor repairs on the home. I have contacted a lawyer for legal consultation but I am sure Allstate is not willing to pay this claim based on the fact there was hardly any premiums made to this policy. Aside from me being extremely cooperative with all of Allstate demands and request I see this leading down the hill of NO THEY WON'T PAY, its as if they are looking for some kind of loop hole or inconsistency in my story...and believe me there isn't any. I'm a very angry person when it comes to insurance companies and can't understand why they market their product as willing and caring people when in actuality its thier profit that matters.

b lindberg said:

Some good comments here.

I was totally screwed over by my own PIP insurance by Allstate and currently suing them. 3 years later, same thing with Liberty Mutual.Allstates adjuster said in depositions when asked why they cut off my medical benefits after 6 months that it was standard procedure. When asked if he knew what fiduciary duty was he answered no.When my lawyer explained they had a duty to investigate validity of claims he told my lawyer it was his duty to minimize claims. I think that says it all. My recommendation is stay away from heavily advertised insurance cuz they are not spending money on claims they are spending on lawyers , adjusters, and commercials. Check the Ins. Commissioners web site for complaints. My big question is how do they find so many employees with no conscience?
What kind of a world are they leaving to their children.

W Fry said:

When we were with Famers insurance and had a claim it was always the same answer. Your policy does not cover that even though the policy clearly staed it did. When we pressed our agent she said that they would probably pay but that our rates would rise as a result. The answer for us was to cancel all of our Farmers policys and go with Ameriprise. i have to tell you the first claim they listened to us and paid out a fair amount to solve our claim. No run around no threats. just good service. So my advice is if you dont like the way your company or agent trats you . Shop around and vote with your premiums.

Scott Peterson said:

Having worked for many insurance companies as an adjuster, I always treated the insured fairly, on one occasion asking an insured to file an insurance commissioner complaint because she was being treated unfairly. Only one carrier required me to "cheat" a customer, and I promptly quit working for them. I won't mention that company name because I may be a Traveler again. One point that is probably not realistic was when an adjuster for Farmers wanted to pay $40,000 for a claim, and the "insured's adjuster" felt damages were $200,000. You wouldn't believe the number of claims that have gone to appraisal, the adjuster was at $5,000 and the public adjuster was at $150,000, and the independent umpire sided with the insurance company. When public adjusters make outrageous demands, it should not reflect poorly on the insurance company adjuster.

Wes said:

There is absolutely no denying that there is a problem here. When 50% of your polled audience suggest that they being treated unfairly by insurance companies the only other explanation for it is conspiracy; highly unlikely.

Heather said:

Jeni- You may be one that has not been teated well by your insurance company. I do ask if you knew exactly what was covered in your policy and what all the conditions were? It is your responsibility as a signer of a contract to know what you signed. Also, yes, when you go to a restaurant you expect quick and friendly service- but you do not always get it. Does that make you hate all restaurants? No. You may not want to go to that restaurant again, or be served by the same person, but you would not boycott all restaurants. In the same manner, you should not hate all insurance companies because you felt treated poorly by one.

Brian- I do not work for an insurance company (however, if I did, that should not discount my opinion- in order to prove someone wrong or better your side of the argument, you must know the other side (rule #1 of debate). I work at a pharmaceutical company and have had extensive training in proper investigations as well as ethics. The majority of my post dealt with the incomplete investigation done by King 5 investigators. Are there individuals who do not get treated properly by their insurance companies? Sure, but they are not in the majority (look at the actual numbers of complaints- they are in the extreme minority). It seems that way on this message board because those who feel like they were "screwed" by their insurance company are the ones who will get on the message board to complain. Have I had a claim with an insurance company in the past? Yes- and it was handled very well, with great compensation.

Wes- in answer to your comment about the poll, in order to get an accurate reading of who feels like they are treated fairly or unfairly by their insurance company, you would have to do a randomized poll that is not biased. Unfortunately, when you place a poll on a website that is mostly viewed by those who are already biased to one way, you will inevitabley get a skewed sample, and therefore a misrepresentation of what everyone in WA actually thinks. I am not saying that the results would positively be different, just that you cannot trust polls placed on websites to be accurate, especially when one individual can usually vote more than once.

Once again, I think people also have to remember that we do not live in a socialist country. The government does not pay for our insurance (which would greatly increase our taxes). Insurance is a private industry and will remain one. Therefore, there will always be differences in contracts, a need to make money, and a need to run a business.

You also should not equate one bad experience with an entire industry. I have had a bad experience with one cable company, however, I do not blame every cable company that exists for that one bad experience.

We also need to remember that none of the problems that bring us to need insurance companies are their fault. These problems ar weather related or people related (vandalism, theft, car accidents). Many times, people are angry at what happened to them, and the insurance company can become the scapegoat because they are placed in the forefront of the situation.

My number one piece of advice is to know your insurance contract- know what is covered and if you want more coverage- purchase the extra insurance- it is available (and I know this as an insured individual, not as someone who works in the industry as others have stated).

All I ask is to do your research, know both sides of the story so you can determine what you agree with in an informed manner, and for those who really do feel that they were mistreated- you can always switch insurance companies, agents, etc. Not every agent or company is evil as this story and many individuals posting here are trying to claim.

Janet Stegall said:

I saw the story on the Dec Storm of 2006 and I have still to get all my damage fixed. The under amount for the damage the insurance company gave us was about $15,000. I can not get a contractor to even look for the amount the insurance company gave us. I have done a number of temporary repairs and finished some. but others remain undone because of the price. I have until the 11th of DEC. to get a solid bid and get the insurance company to do something or file a notice of suit or a suit I don't quite know which. I have tried until I am about to give up. What should we do?

THOMAS BRAMHALL said:

WATCHED YOUR SPECIAL ON SUNDAY 12/2/2007 IN REGARDS TO INSURANCE CO.S AND CLAIMS.BEEING A REPAIR SHOP AND DEALING WITH CLAIMS FROM INSURANCE CO.S I CAN HONESTLY SAY THAT THE INSURANCE CO.S DO WAIT AS LONG AS THEY CAN TO PAY CLAIMS.I HAVE WAITED AS LONG AS 90 DAYS TO GET PAID FROM WORK DONE ON CUSTOMERS CARS.THIS INDUSTRY HAS AND IS RUNNING THE BODY SHOPS TO THE LOWEST COSTS AND DICTATING COSTS UNREASONABLY.INSURANCE CO.S DON'T WORK FOR THEIR CUSTOMERS THEY WORK FOR THEIR PROFITS.
WHEN INSURANCE CO.S CAN TELL CUSTOMERS TO GO TO SPECIFIC REPAIR SHOPS THAT OFFER THEM(INSURANCE CO.S)DISCOUNTS ON PARTS AND LABOR.HOW WOULD THE PUBLIC FEEL IF THEY KNEW OF THIS (AND ALOT DOESN'T)AND THEY CAN'T GET THE SAME DEAL FOR THEMSELVES.FOR SOME PEOPLE THE SAVINGS COULD GO TOWARDS THEIR DEDUCTABLES THAT IS SOMETIMES HARD TO COME UP WITH.
I HAVE THOUGHT ALOT ABOUT SUBMITTING A LETTER TO THE NEWS PAPERS TELLING OF MY EXPERIANCES BUT WAS TOLD IT WOULD COME BACK TO HURT ME.
THANKS FOR YOUR COMMENTS ON SUNDAY HOPEFULLY ALOT OF PEOPLE WATCHED IT.HOWEVER THERE IS ALOT MORE THEY COULD LEARN.
THANKS
THOMAS BRAMHALL

Homer said:

Insurance is a SCAM
Just another way to Mandate that
citizens Fork over their money.

pat said:

Brian - I am not now or ever have been employed by an insurance agency or any other part of the industry! There obviously is a problem, but painting them all with the same brush is wrong. And KING presenting just one side of the issue is wrong as well. But the way it was told made for a good story.

Theresa Morgan said:

I will start out by saying that I used to work for an insurance company, but do not anymore.

Insurance companies are a business, and most of them are ethical, pay their claims, rated policies fairly. Those that do not are in the tiny minority, and do not tend to stay in business.

The absolute best thing you can do is actually read and know what you are buying. Surprisingly, few people do this - they say, oh, I have full coverage. Without ever knowing what "full coverage" actually means. It's like someone buying a tv that they are told "will do everything" - then feeling cheated because it doesn't play DVD's. It's not a DVD player - it's a tv.

Insurance companies do not and will not compensate you for every bad thing that happens. Or even for every financial loss that you suffer for covered property. They don't personally care about you - they aren't your mom, your best friend, or your kindly neighbor. They are ONE party in a financial contract. And you are the other party.

Sometimes, it doesn't make sense to file a claim. Especially if it's a fairly "small" (meaning, less than a years premium) claim. It WILL usually raise your rates. You're better off absorbing the cost yourself, no matter who is at fault.

The other thing people don't really realize is, insurance companies HAVE to have a profit. They need to hold reserves of cash to pay potential claims, by law. In order to do that, they estimate how much they need to charge you (and all the other customers) in order to cover not only those claims that occur, but those that might occur. If they do not charge enough, they could very well be wiped out with one catastrophe (like the windstorm of last year) and no one would get their claims paid.

One more thing that not everyone is aware of is that you are not required to take the first - or any - offer that an insurance company gives you. Many times they WILL lowball a figure for an "immediate settlement", and if you need the money bad enough, you may take it. If you can hold out - do so. But don't try to hold out for "more" - insurance companies aren't there to make your financial situation better.

As far as what is wrong with insurance companies in WA - they aren't off the hook in my opinion either. The big problem is an appointed insurance commissioner. This should be an elected position. By making it an appointed one, it's like the foxes deciding which one of them will guard the henhouse.

My suggestion is this. Read the fine print ahead of time. Compare companies and agents. It will take time, and it takes work, but is well worth it. If you need extra insurance - buy it. Don't expect them to solve all your financial problems. And get to actually KNOW your insurance agent. Buying insurance off the internet has done a lot of damage to companies reputations, because you can simply buy what's there, without ever having talked with a professional about what you actually need.

Evelyn Pinkerman said:

What good is this? The insurarnce companies have had free reign since at least 2001. Everyone is sposed to feel sorry for them because they suffered such big losses. This seems to entitle them to raise deductibles and premiums and lower or refuse to pay or delay benefits. If it is the law they are sposed to pay in a timely manner, then why arent they? Who is sposed to enforce it? Is it the state? or federal government? Why do we always have to have a lawyer or an election to get what is due?

Mitch Allen said:

I had a sizeable loss when a pipe broke on the top floor of my house and flooded the entire bottom floor. My Farmer's Insurance claim was substantial and they strung me along a couple years. Finally they told me they wouldn't pay and I'd have to sue them. Having spent my own money to get myself back during the stall, I did't have any left to hire legal help that could realistically challenge their team of lawyers. I gave up just as they had calculated I would.

Doug said:

I was rear ended and had mild back and neck pain that was remedied through doctor prescribed physiotherapy. My insurance company stopped paying the bills and demanded I see their doctor. I suggested we get another "independent " opinion. I eventually spoke with a lawyer who went after them with a vengeance.

The end result it cost the insurance company a lot more than it should have and they ended up in a class action suit from which I collected more money and an apology several years later. They then turn around and blame law suits for rising premiums.

Kristine said:

Try getting hurt on the job in Washington State!!! YOu have absolutely no rights, especially when a company is self insured rather than being required to pay into the state L&I insurance plan.

My husband was hurt and the company paid no benefits or paid medical bills for years. We were in court for just one month's pay for over 3 years. The court consitently ruled in our favor but the company could file another appeal. The settlement we finally received came after 7 years of constant pain, being unable to work, being unable to leave the house on a regular basis and no medical care. Yet our elected officials told me there is nothing wrong with our laws.

wayne sageman said:

My wife and I had allstate auto insurance. She was driving south on highway 7, in Spanaway, when another car ran through a stop sign and T-boned her. The "at-fault" driver also had allstate. Allstate spent their efforts in defense of their "at-fault" driver and really screwed around with my wife. My wife suffered from severe pain in her neck and back that required spinal injections by a neurosurgeon. This went on for a couple of years. Allstate took the position that my wife's injuries were not a result of that accident. Allstate was unresponsive to my wife's calls. They changed the case representatives and offered very little for us to close the claim while my wife was still under going medical treatment. Allstate essentially forced us to take the claim to court. Allstate had a unscrupuluos lawyer that was good at working the jury. We ended up receiving almost enough money to cover medical costs and nothing else. Needless to say, we will never have anything good to say about Allstate. Their "GOOD HANDS" are their good hands,not your good hands. Allstate put my wife through more than 3 years of hell.

Tim McMonigle said:

We lost our house in a fire in October of 2003. We have Mutual of Enumclaw for both our house and car insurance and I can testify that they are a fantastic company.

It took close to two years to go through all the nonsense around rebuilding, permits, IRS issues, etc. Mutual of Enumclaw was with us every step of the way. Our adjuster was very fair with us and worked through the difficult parts with us, all the way to the last payment. We had heard all the horror stories, so we were prepared for the worst. While losing everything we had was very difficult, our insurance was one thing we didn't have to worry about.

mark derbyshire said:

Interesting topic as I recently had an incident with my insurance company (Allstate) which makes me really wonder about their honesty.

I was paying almost $1100 per six month period on my auto insurance (two cars). My wife and I have great driving records and have been with Allstate for six years. I also have home insurance with them, so I get a discount for having multiple policies.

I started to call other insurance companies to see if this $1100 figure was based in reality. The first two companies I called quoted me significantly less than Allstate.

I called Allstate up and told them I was ready to jump ship with them and go to another company. They started to back pedal and told me to hold on, that they've got some new policies and that I was on their "call list" to discuss these new policies in the near future (yah, right).

They called back after an hour and adjusted my rate to just under $600 per six months (from $1100!). I thought, hey this is great that I've gotten my rates lowered...but then I thought about all of the years that they've been overcharging me. That's a lot of money!

I asked them if any of this was retroactive...would they send me a check for any of the past...of course the answer was no.

It really made me angry, and makes me want to schedule a monthly call with them in which I threaten to jump ship just to keep my rates in check and keep them on their toes.

Grace said:

Thank you Theresa Morgan for your post. I am fortunate enough to have a great State Farm agent in Seattle; she actually talked to me specificlly about was excluded on the policies that I purchased. Now that I have read and UNDERSTAND my policy coverages and exclusions, I feel protected.

mar said:

Interesting topic as I recently had an incident with my insurance company (Allstate) which makes me really wonder about their honesty.

I was paying almost $1100 per six month period on my auto insurance (two cars). My wife and I have great driving records and have been with Allstate for six years. I also have home insurance with them, so I get a discount for having multiple policies.

I started to call other insurance companies to see if this $1100 figure was based in reality. The first two companies I called quoted me significantly less than Allstate.

I called Allstate up and told them I was ready to jump ship with them and go to another company. They started to back pedal and told me to hold on, that they've got some new policies and that I was on their "call list" to discuss these new policies in the near future (yah, right).

They called back after an hour and adjusted my rate to just under $600 per six months (from $1100!). I thought, hey this is great that I've gotten my rates lowered...but then I thought about all of the years that they've been overcharging me. That's a lot of money!

I asked them if any of this was retroactive...would they send me a check for any of the past...of course the answer was no.

It really made me angry, and makes me want to schedule a monthly call with them in which I threaten to jump ship just to keep my rates in check and keep them on their toes.

Chris said:

My health insurer (United Healthcare) has completely mishandled my claims relating to a surgery I had 8 months ago! They approved 2 or 3
but denied another. The worst part is I have $8700 claim for the hospital visit that hasn't been processed at all! It's now been sent to collections - that's never happened to me before. I wasn't even made aware it was going to collections.The customer service people at United are worthless. They never know what's going on with my claim. It's frustrating to talk with them because the conversation ends with me not knowing any more than I did before I called.
United Healthcare has completely ruined my life and taken away any peace of mind I had. Healthcare shouldn't even be in their name.
Thanks for reading.

Sondra said:

A claims adjuster for two decades. The insurance contract is not a warranty & believe it or not some people think it covers everything because when they purchased the contract they told their agent they wanted "full" coverage. What is full coverage? Does anyone read their contract of insurance (policy), most people don't because they don't understand what it says, they are unable to interpret the policy language so they rely on their agent to provide the coverage they need however, just like any contract there are limitations & exclusions. I can't believe how many comments I've reviewed to this Broadcast where people haven't received the actual final cost of repairs or that they had to negotiate repairs, that just isn't right! I think of an estimate as just that "an estimate", meaning the final cost of repairs has not yet been determined. I also believe that additional damage is a legitimate claim depending on if it is related to the loss that is being claimed, it could be hidden damage just like on a car, an initial estimate may be written but until the car is "torn down" or put on a lift, it is impossible to determine if there is hidden damage relative to a loss. You should be indemnified for the cost of repairs or replacement (depending on if you have replacement cost coverage, if you didn't purchase it you probably don't have it) to pre-loss condition. Insurance companies audit estimates from autobody shops & contractors, etc...just as you yourself would audit an estimate if you had no insurance, they don't want to pay for any repairs that are not necessary or more than is required to make repairs than you would out of your own pocket. Nor do they want to pay to repair something if it cost less to replace it. But it sounds to me like many of you have had to pay out-of-pocket where you should not have to. Don't be scared to discuss issues with your insurance company & if you need to go over your adjuster's head to a manager or supervisor then do so as I have to admit that I have worked with some adjusters who have made adjusting claims "personal" which doesn't do the insurance company whom they represent any favors, or possibly the adjuster is just in-experienced or flat out "lazy". Some adjusters see an exclusion & fail to do a proper investigation to determine if there are any circumstances under which coverage might otherwise be available. Unless something is excluded, it is likely covered however it could be limited. I have found many people thought they had coverage because they relied on their insurance agents to sell them the coverage they needed when in fact it's not until they have a claim that they find out they have no coverage so I suggest people take the initiative to research coverage & frequently asked questions so you know what kind of coverage to ask for since some agents are not as thorough as others or they just don't know your circumstances because you didn't bother to tell them. Don't expect that the insurance agent is going to ask you all of the questions necessary to determine what kind of coverage you need. Educate yourself as to what type of insurance is available. Tell your agent about things such as upgrades you've done to your auto's i.e. electronic equipment such as after- market stereos, DVD players, MP-3's, Navagating Systems, if you keep several CD's in your auto(usually not covered if in a vehicle) as most of this type of equipment requires a rider on your policy & the majority of new cars even though they may come with this equipment doesn't mean it's covered. Check on limitations under your policy i.e. for cash, jewelry, guns, art, etc...& if the limit is not enough to cover what you have you'll need to carry a rider. One of the most frequently disputed coverages is on first party (policy holder) auto rental, some policies don't have any or else they carry a set amount of coverage for a set amount of time i.e. $15/day for 30 days...but it's never enough for a rental if you get into an accident & lose use of your car during repairs or a total loss, but most companies offer increased limits of transportation (increases the dollar amount but not the time) for an additional premium & even though the increasd limits may still not be enough to cover the daily cost of a rental it still covers more than what you would get if you didn't purchase increased limits. Too many people expect their insurance company to cover "everything" no matter what the cost but as said in previous comments to this Broadcast, you may not have the coverage if you didn't pay for it. So there are two sides to this story, I think that all insurance companies should handle their claims in compliance with the regulations to the extent that they prevent unnecessary complaints from consumers & that they should be staffed adequetly to do so during normal times & to get extra help during catastrophes. I believe if you pay your premium on time you should get your loss handled on time. Because I too have had good & bad service from my own carriers. I have had great service from Unigard! But I have not had great service with other companies. One such company resulted in my having to make a commisioner's complaint for a claim which was clearly covered & involved a crack in a shower pan that caused water damage to the subfloor but the water damage didn't manifest itself until the subfloor rotted & a stain appeared on the common wall. The policy said it covered water damage caused by a plumbing system & I researched what a plumbing system was & found that a shower pan is considered an integral part of a plumbing system & since the rotten subfloor was the result of water damage from a plumbing system vs. rot inherent of itself, it appeared there should be coverage, (as an adjuster I did have access to research material whereas most people would not have that available to them). What was "not" covered was the cost of the worn out shower pan (a minor amount) because wear & tear is not covered but the tear out to get to the worn out shower pan was covered as well as all of the damages, this meant tearing out the entire shower & floor to get to the damaged subfloor. Typically the item that failed or wore out is not covered but the ensuing damage is...read your policy. Had the insurance company done a proper coverage investigation instead of coming out & shining a flashlight thru the wall to the subfloor & stated "the floor is rotted out, there is no coverage" & went back to their office & wrote a denial letter, they could have avoided an insurance commissioner's complaint which if accepted results in a penalty. Now I handled a claim for someone who had a pipe that was leaking under their bathroom sink & instead of mitigating their damages & fixing the pipe before it caused any damage they just wrapped it with a towel for a year until the water finally rotted out the vanity & the floor below & they called to report a claim because they couldn't stand the damage anymore. I denied that claim for neglect & repeated seepage & leakage of water, the leak was apparent & had not caused any damage at the time it appeared & the homeowner neglected to repair it at a time when they could have prevented a loss. Okay the other bad claim experience I had of my own was for a high performance motorcycle my husband had for sale & a guy saw the ad in the Cycle Trader & came to take a test drive, he arrived with someone else in a car, he brought his own helmet but borrowed my husband's gloves, my husband did not get any information on the buyer before he took it for a test drive, the guy asked where he could get some "curves" to test the bike's performance & my husband directed him where to go so the guy went to test drive the motorcycle, then the guy who drove the car asked where he could get a bite to eat & my husband directed him of a nearby store, neither the driver of the car nor the test driver of the motorcycle returned after 20 minutes so my husband drove to where he told the guy to take the bike to test drive it thinking maybe he got into an accident or the bike broke down though it was in excellent condition but he didn't locate the guy so he immediately called the police to report the motorcycle stolen & they couldn't do anything for 72 hours because my husband has given they guy permission to take it for a test drive. After several hours had gone by we argued with the Sheriff to take a report so they did the following day when they came to our house. The insurance company denied the claim under the exclusion no coverage for "theft or larceny when you give possession of your motorcycle to another". There was a loan on the motorcycle, the Bank held the title of ownership. The word "possession" was ambiguous in that it had several different meanings one of them being ownership & we nor the bank signed the title of ownership over to the guy who took the motorcycle for a test drive, no money was exchanged, the guy flat out stole the bike. I had to fight with the insurance company for almost 3 years at whicxh time the statute would run so I decided to hire an attorney to tell the insurance company everything I had already told them in my own coverage investigation & they paid it but not willingly, they said it was a compromise...to what...to coverage??? The loan was roughly $11,000, the motorcycle was for sale for roughly $8,500. We had to continue to pay the loan as scheduled for a couple more years which included another $2000 in interest for a bike we didn't even have & we of course had cancelled the motorcycle policy after the loss occurred since we no longer had the motorcycle so then the bank called us & said that since we still had a loan we had to prove we had insurance on the motorcycle & they wanted us to carry their insurance which is very expensive & we asked why we would carry insurance on a motorcycle that didn't exist so they waived the requirment after reviewing the police report. But the claim was finally paid & we had to sign a release. I think for the most part insurers comply with regulations. I think the biggest problem is so many people don't know anything about the insurance they buy & are too quick to complain before they find out what they paid for or they are not pro-active in their claim, they think they don't have to do anything like protect their property from further damage or take the time out of their busy schedule to tend to getting an estimate for example...you have to participate to a certain extent in the handling of your own claim & the insurance company is not going to pay you for the time you took to do that i.e. time off work to get an estimate. I think if everyone were a claims adjuster just for a day they would find it very interesting indeed. I'm not biased toward the insurance indusry, even though most people might think I am since I'm an adjuster. Remember I'm a customer too. People take the time out to read your policy, ask your agent questions, ask your adjuster questions, question ambiguous coverage, if you have questions check out "frequently asked questions" on the WA St Dept of Ins website, they also have a toll-free number you can call if you have questions before you decide to make a complaint or hire an attorney as it may not be necessary. I feel there is no "negotiation" needed on certain repairs, repairs are what they are, it costs what it cost, a good audit of the estimate should be all that is necessary to make sure your contractor or body shop is in-line with industry standards/pricing & if they are & the repairs are necessary & required to indemnify you & put you back to pre-loss condition then that's what's owed. What I've discussed above all has to do with real property, tangible property. And all you people who think your cars should be totalled, if they are repairable the insurance company is going to repair them with used parts or after-market parts unless they are not available then they will use new parts & you ask why...unless a car is new, it's used & why would they owe a new part in place of an old part? In order to determine if a car is a total loss most companies usually have a threshold they adhere to i.e. if the cost of repairs is within 70% of the market value (or typically called "actual cash value") they may consider it a total loss, different companies have different thresholds, some consider the cost of rental & the advance charges (towing/storage) in addition to the repairs when determining whether or not a vehicle is a total loss. I've seen more arguments regarding total losses than anything else, remember most vehicles depreciate the day they are driven off the new car lot, if upgrades add to value you'll get an allowance for them but not necessarily what you spent on the upgrades, otherwise you won't. Most companies if a vehicle is a total loss will let you remove aftermarket equipment but then won't make any allowances for it when totalling the vehicle, if it's new tires you want to remove you'll have to put other tires in their place & you won't get an allowance for "new" tires if you remove them. Also, do yourselves a favor & purchase GAP insurance from the dealer or purchase a "loan endorsement" if your insurance company offers it, when you buy a new car (I think you can get GAP on used cars up to a certain age). All too often someone totals their vehicle before the loan has time to catch up with the value & you will end up paying the difference to the bank out of your own pocket if the value of the vehicle is less than your loan payoff... remember the insurance company is not responsible for interest on your loan or the upside down balance tacked onto your loan from a vehicle you may have traded-in on the loss vehicle when you purchased it. People forget that those things effect the payoff of their loan. There's so much I can say, so I'm stopping here, hope that helps some of you out there avoid disputes & assist you in the claims process.

Anonymous said:

A claims adjuster for two decades. The insurance contract is not a warranty & believe it or not some people think it covers everything because when they purchased the contract they told their agent they wanted "full" coverage. What is full coverage? Does anyone read their contract of insurance (policy), most people don't because they don't understand what it says, they are unable to interpret the policy language so they rely on their agent to provide the coverage they need however, just like any contract there are limitations & exclusions. I can't believe how many comments I've reviewed to this Broadcast where people haven't received the actual final cost of repairs or that they had to negotiate repairs, that just isn't right! I think of an estimate as just that "an estimate", meaning the final cost of repairs has not yet been determined. I also believe that additional damage is a legitimate claim depending on if it is related to the loss that is being claimed, it could be hidden damage just like on a car, an initial estimate may be written but until the car is "torn down" or put on a lift, it is impossible to determine if there is hidden damage relative to a loss. You should be indemnified for the cost of repairs or replacement (depending on if you have replacement cost coverage, if you didn't purchase it you probably don't have it) to pre-loss condition. Insurance companies audit estimates from autobody shops & contractors, etc...just as you yourself would audit an estimate if you had no insurance, they don't want to pay for any repairs that are not necessary or more than is required to make repairs than you would out of your own pocket. Nor do they want to pay to repair something if it cost less to replace it. But it sounds to me like many of you have had to pay out-of-pocket where you should not have to. Don't be scared to discuss issues with your insurance company & if you need to go over your adjuster's head to a manager or supervisor then do so as I have to admit that I have worked with some adjusters who have made adjusting claims "personal" which doesn't do the insurance company whom they represent any favors, or possibly the adjuster is just in-experienced or flat out "lazy". Some adjusters see an exclusion & fail to do a proper investigation to determine if there are any circumstances under which coverage might otherwise be available. Unless something is excluded, it is likely covered however it could be limited. I have found many people thought they had coverage because they relied on their insurance agents to sell them the coverage they needed when in fact it's not until they have a claim that they find out they have no coverage so I suggest people take the initiative to research coverage & frequently asked questions so you know what kind of coverage to ask for since some agents are not as thorough as others or they just don't know your circumstances because you didn't bother to tell them. Don't expect that the insurance agent is going to ask you all of the questions necessary to determine what kind of coverage you need. Educate yourself as to what type of insurance is available. Tell your agent about things such as upgrades you've done to your auto's i.e. electronic equipment such as after- market stereos, DVD players, MP-3's, Navagating Systems, if you keep several CD's in your auto(usually not covered if in a vehicle) as most of this type of equipment requires a rider on your policy & the majority of new cars even though they may come with this equipment doesn't mean it's covered. Check on limitations under your policy i.e. for cash, jewelry, guns, art, etc...& if the limit is not enough to cover what you have you'll need to carry a rider. One of the most frequently disputed coverages is on first party (policy holder) auto rental, some policies don't have any or else they carry a set amount of coverage for a set amount of time i.e. $15/day for 30 days...but it's never enough for a rental if you get into an accident & lose use of your car during repairs or a total loss, but most companies offer increased limits of transportation (increases the dollar amount but not the time) for an additional premium & even though the increasd limits may still not be enough to cover the daily cost of a rental it still covers more than what you would get if you didn't purchase increased limits. Too many people expect their insurance company to cover "everything" no matter what the cost but as said in previous comments to this Broadcast, you may not have the coverage if you didn't pay for it. So there are two sides to this story, I think that all insurance companies should handle their claims in compliance with the regulations to the extent that they prevent unnecessary complaints from consumers & that they should be staffed adequetly to do so during normal times & to get extra help during catastrophes. I believe if you pay your premium on time you should get your loss handled on time. Because I too have had good & bad service from my own carriers. I have had great service from Unigard! But I have not had great service with other companies. One such company resulted in my having to make a commisioner's complaint for a claim which was clearly covered & involved a crack in a shower pan that caused water damage to the subfloor but the water damage didn't manifest itself until the subfloor rotted & a stain appeared on the common wall. The policy said it covered water damage caused by a plumbing system & I researched what a plumbing system was & found that a shower pan is considered an integral part of a plumbing system & since the rotten subfloor was the result of water damage from a plumbing system vs. rot inherent of itself, it appeared there should be coverage, (as an adjuster I did have access to research material whereas most people would not have that available to them). What was "not" covered was the cost of the worn out shower pan (a minor amount) because wear & tear is not covered but the tear out to get to the worn out shower pan was covered as well as all of the damages, this meant tearing out the entire shower & floor to get to the damaged subfloor. Typically the item that failed or wore out is not covered but the ensuing damage is...read your policy. Had the insurance company done a proper coverage investigation instead of coming out & shining a flashlight thru the wall to the subfloor & stated "the floor is rotted out, there is no coverage" & went back to their office & wrote a denial letter, they could have avoided an insurance commissioner's complaint which if accepted results in a penalty. Now I handled a claim for someone who had a pipe that was leaking under their bathroom sink & instead of mitigating their damages & fixing the pipe before it caused any damage they just wrapped it with a towel for a year until the water finally rotted out the vanity & the floor below & they called to report a claim because they couldn't stand the damage anymore. I denied that claim for neglect & repeated seepage & leakage of water, the leak was apparent & had not caused any damage at the time it appeared & the homeowner neglected to repair it at a time when they could have prevented a loss. Okay the other bad claim experience I had of my own was for a high performance motorcycle my husband had for sale & a guy saw the ad in the Cycle Trader & came to take a test drive, he arrived with someone else in a car, he brought his own helmet but borrowed my husband's gloves, my husband did not get any information on the buyer before he took it for a test drive, the guy asked where he could get some "curves" to test the bike's performance & my husband directed him where to go so the guy went to test drive the motorcycle, then the guy who drove the car asked where he could get a bite to eat & my husband directed him of a nearby store, neither the driver of the car nor the test driver of the motorcycle returned after 20 minutes so my husband drove to where he told the guy to take the bike to test drive it thinking maybe he got into an accident or the bike broke down though it was in excellent condition but he didn't locate the guy so he immediately called the police to report the motorcycle stolen & they couldn't do anything for 72 hours because my husband has given they guy permission to take it for a test drive. After several hours had gone by we argued with the Sheriff to take a report so they did the following day when they came to our house. The insurance company denied the claim under the exclusion no coverage for "theft or larceny when you give possession of your motorcycle to another". There was a loan on the motorcycle, the Bank held the title of ownership. The word "possession" was ambiguous in that it had several different meanings one of them being ownership & we nor the bank signed the title of ownership over to the guy who took the motorcycle for a test drive, no money was exchanged, the guy flat out stole the bike. I had to fight with the insurance company for almost 3 years at whicxh time the statute would run so I decided to hire an attorney to tell the insurance company everything I had already told them in my own coverage investigation & they paid it but not willingly, they said it was a compromise...to what...to coverage??? The loan was roughly $11,000, the motorcycle was for sale for roughly $8,500. We had to continue to pay the loan as scheduled for a couple more years which included another $2000 in interest for a bike we didn't even have & we of course had cancelled the motorcycle policy after the loss occurred since we no longer had the motorcycle so then the bank called us & said that since we still had a loan we had to prove we had insurance on the motorcycle & they wanted us to carry their insurance which is very expensive & we asked why we would carry insurance on a motorcycle that didn't exist so they waived the requirment after reviewing the police report. But the claim was finally paid & we had to sign a release. I think for the most part insurers comply with regulations. I think the biggest problem is so many people don't know anything about the insurance they buy & are too quick to complain before they find out what they paid for or they are not pro-active in their claim, they think they don't have to do anything like protect their property from further damage or take the time out of their busy schedule to tend to getting an estimate for example...you have to participate to a certain extent in the handling of your own claim & the insurance company is not going to pay you for the time you took to do that i.e. time off work to get an estimate. I think if everyone were a claims adjuster just for a day they would find it very interesting indeed. I'm not biased toward the insurance indusry, even though most people might think I am since I'm an adjuster. Remember I'm a customer too. People take the time out to read your policy, ask your agent questions, ask your adjuster questions, question ambiguous coverage, if you have questions check out "frequently asked questions" on the WA St Dept of Ins website, they also have a toll-free number you can call if you have questions before you decide to make a complaint or hire an attorney as it may not be necessary. I feel there is no "negotiation" needed on certain repairs, repairs are what they are, it costs what it cost, a good audit of the estimate should be all that is necessary to make sure your contractor or body shop is in-line with industry standards/pricing & if they are & the repairs are necessary & required to indemnify you & put you back to pre-loss condition then that's what's owed. What I've discussed above all has to do with real property, tangible property. And all you people who think your cars should be totalled, if they are repairable the insurance company is going to repair them with used parts or after-market parts unless they are not available then they will use new parts & you ask why...unless a car is new, it's used & why would they owe a new part in place of an old part? In order to determine if a car is a total loss most companies usually have a threshold they adhere to i.e. if the cost of repairs is within 70% of the market value (or typically called "actual cash value") they may consider it a total loss, different companies have different thresholds, some consider the cost of rental & the advance charges (towing/storage) in addition to the repairs when determining whether or not a vehicle is a total loss. I've seen more arguments regarding total losses than anything else, remember most vehicles depreciate the day they are driven off the new car lot, if upgrades add to value you'll get an allowance for them but not necessarily what you spent on the upgrades, otherwise you won't. Most companies if a vehicle is a total loss will let you remove aftermarket equipment but then won't make any allowances for it when totalling the vehicle, if it's new tires you want to remove you'll have to put other tires in their place & you won't get an allowance for "new" tires if you remove them. Also, do yourselves a favor & purchase GAP insurance from the dealer or purchase a "loan endorsement" if your insurance company offers it, when you buy a new car (I think you can get GAP on used cars up to a certain age). All too often someone totals their vehicle before the loan has time to catch up with the value & you will end up paying the difference to the bank out of your own pocket if the value of the vehicle is less than your loan payoff... remember the insurance company is not responsible for interest on your loan or the upside down balance tacked onto your loan from a vehicle you may have traded-in on the loss vehicle when you purchased it. People forget that those things effect the payoff of their loan. There's so much I can say, so I'm stopping here, hope that helps some of you out there avoid disputes & assist you in the claims process.

ledog3 said:

How many people actually read all of that last post??

Kylene said:

Last June my husband and I had a house fire and filed a claim with Allstate. The fire destroyed our roof and our home had major water damage, however, Allstate refused to open walls in certain areas of our home saying there was no damage even where dirty water marks were clearly visible in those "undamaged" areas. We hired an insurance consultant shortly after the fire and even though we have a professional consultant Allstate is still delaying our claim after 10 months now. Allstate initially offered to settle our claim for about a third of the amount of the original estimate from a contractor who is on Allstate's "approved" contractor list and because it wasn't fair we did not accept their offer. We feel Allstate is purposefully dragging their feet and they failed to secure our roof until after the winter rains and storms which has caused significant additional water damage to our house wich made things even worse. That's a brief outline of our unpleasant insurance dealings, but I wanted to comment on something else that you didn't address in your insurance story that aired.
We had to shell out major cash just for basic things like clothes & laundry and over extend our credit lines in order to hire a professional to help us. For the past 10 months we have paid out of our own pockets for many additional living expenses. We have been reimbursed for some of our expenses like our hotel stays, but never up front which stuck us with more interest rate fees and higher credit card payments. They also did horrible things. For example over the 4th of July weekend they suddenly stopped paying for our hotel and didn't bother to notify us. The hotel we were staying in was overbooked and so was every other hotel in town that weekend, so we were basically asked to pack up and leave along with our three dogs with nowhere to go. They also tried to make us pay for our hotel the night before our rental lease commenced which was completely ridiculous since we couldn't occupy our rental until the next morning. Also, at one point they tried to deny coverage to pay for any of my expenses because I have a different last name than my husband and they wanted us to produce a marriage certificate to prove we were married. Personally it felt harrassing and stressed our marriage, so I can't imagine what happens to people who simply don't have any extra cash for a lawyer/consultant or already have maxed out credit.
There's a simple solution! Insurance companies should be forced to issue a $5k check to claimants the day they file a major claim especially if they have to leave because their home is detroyed. It's only fair and it should be a simple matter for insurance companies to later account for the upfront check in the final settlement.

Carrie said:

Are you kidding me?? I'm sorry but when are people going to step up and take responsibility for themselves?!?! And since when have "ambulance chasing" trial lawyers become our salvation and hope?!?! What is happening is a disgrace...placing the blame on everyone else. For the poster who said they got in an accident AND THEN realized their policy was cancelled because the bill was never paid and that somehow is the insurance company's fault...Are you kidding me?!?! How is that the insurance companies fault? Don't you know you have bills and when they are due? Does the power company call you when you haven't paid your bill and they're about to shut off your power? NO!! And is it possible that the reason there was a note on your policies to not make a COURTESY call to you about a past due bill was because the last time they called you on a past due you were rude? Why call you as a courtesy to remind you to pay your bill if all you're going to be is rude. I certainly wouldn't call you again! And for all the people that are claiming that they should have been compensated for flooding...do you not read your policy. Specifically stated in my renewal under Losses Not Insured it states in plain english...flooding of lakes, streams, surface water are specifically excluded. Same goes for wet rot, dry rot and mold. Maybe instead of blaming someone else for not covering your losses and then running to a trial lawyer, you should read your policy. Every renewal, I call my insurance agent and review my policies to make sure I know what is covered and to make sure the coverage is adequate. Contrary to what people have posted here...it is NOT the insurance companies job to make sure you covered. You are given options, suggestions and from there...YOU puchase the coverages YOU think are adequate. Insurance companies can only give you options, make suggestions and provide prices. The final decision on coverages and ultimate responsible party is YOU if you have insufficient coverages.
And, those people that will shop every 6mos for auto insurance looking for the best price with the lowest coverage....these are the first in line to complain when something is not covered because of the coverages they chose!
Insurance is an indemnity policy...to indemnify you to where you were before the loss up to the limits of coverage YOU have chosen. It is your fault if at each homeowners renewal you don't open your renewal envelope and review your coverages and call your agent to review your coverages and make changes if needed. If you purchase a house 5 yrs ago and never change the dwelling coverage to reflect current building costs and you have a fire...whose fault is it that you will not get full rebuild value of your home?? YOURS. But people in todays' society would rather blame someone else instead of themselves.
Insurance companies are no different than other business out there. Where insurance is different is when it comes to the individual insurance company you choose. If the customer service is lacking (As Allstate and Progressive certainly are), the level of advisement will be lacking as well. If you need babysitting when it comes to bill payments, coverage reviews...maybe going to a company that is customer service orientated and willing to babysit you is a better option. Getting on some blog like this complaining about the insurance company YOU chose is not covering you because the coverages YOU chose wasn't adequate is just another way to point the finger as somebody other than ourselves. Those trial lawyers that are now our "salvation" will rob us blind from what we demand we deserve. How much of your $55,000 lawsuit does your trial lawyer get???

JuLee said:

Wow Carrie, I couldn't have said it better!
It is MY responsibility to know what I am, and what I am NOT buying. If I go to a grocery store and pick up and pay for a dozen eggs, why should I go home, complain and blame the store that I didn't get 18 eggs... or 13! I knew what I was buying, and I didn't expect anything more. Should I go find a lawyer to make the store give me an extra egg???
If I don't pay my power bill my lights get turned off. Why??? Because I didn't PAY THE BILL! Everyone has bills, everyone has to be responsible enough to PAY their bills. I don't want to be babysat and I don't want to babysit. Why should they call you and ask if you've sent in your payment for the month??? Shouldn't YOU know that??
C'mon guys, become smart consumers. You can all try and understand what you are buying. Don't be rude to your Agent. Take the time to actually listen. You might learn something.
And by the way... Insurance Agents,their employees, claims adjusters, and all workers within the insurance industry are working hard to support themselves and their families. Why is that so wrong? Should they all sit at home and expect YOU to support them?? But that's another story, isn't it?

Someone Who Cares said:

To Kylene about your fire. I can't tell if the water damage is from the water the fire dept used to extinguish the fire or if the water damage is from the home being exposed to the elements after the roof burned. I assume it's from the rain because you mentioned Allstate failed to secure your roof until after the winter rains and storms which had caused significant additional water damage making things worse. First know that your policy probably requires you (meaning you hire a contractor to do it) to make the necessary repairs to prevent further damage, right? You are the homeowner so it is your responsibility to hire a contractor to cover the roof to prevent further damage, then it will be harder for Allstate to deny coverage for further damage if you complied with the policy requirement "even if it didn't work", at least you tried. But waiting for Allstate to do it is like waiting until hell freezes over! Of course I understand the hardship of paying & waiting for reimbursement from Allstate! If your adjuster was a good adjuster he or she would have suggested doing whatever was necessary to protect the property from further damage in the best interest of both you & Allstate...less damage to your home & less payout from Allstate. Temporary repairs are usually covered & include whatever is necessary to protect the property from further damage until permanent repairs or replacement can be done. And it makes me sick that you got treated so badly regarding the "loss of use", temporary living expenses, etc... Your policy has a limit for loss of use, it should cover temp housing costs, clothes & toiletries if you don't have access to yours, cost of meals (extra expense over & above what you would normally spend on meals), care for your pets, extra expense for laundry (you normally do laundry at home but it cost nothing but if you have to pay to have it done it's extra expense). Typically most insurance companies give an "advance payment" when you have a loss as severe as you did so I have a lot of sympathy for you! And Allstate had a responsibility to let you know when & if they were cutting off your loss of use coverage--I can't believe they left you high & dry over the 4th of July holiday! And about proving your marriage, what does it matter, if you both are members of the household that is insured... I don't understand what it mattered to them that your names were different if you both reside in the insured residence. Obviously Allstate doesn't have enough adjusters to handle all of the claims in a timely manner & they need to staff adequately. You have a legitimate complaint! If you are still trying to get these repairs done you need to step up & make clear what you expect be done & give them a deadline or you'll contact the DOI--that will get their move on! About the water damage & there "not being any" even though evidence of dirty water marks, sometimes that is just water marks where there may have been water that is dry now & the residual is the water marks. The contractor can use moisture meters or infra-red scan to detect moisture.

Kylene said:

In response to Someone Who Cares, thank you for your sincere response along with your advice and concerns. To answer your question about the water marks and stains, yes they were a direct result from the fire dept! And yes, you are right about the residual damage! Thanks for pointing that out. This is a deeply personal subject to me and in retrospect I realize my story was two-fold regarding water damage, but I was referring to the immediate and additional residual damage that directly occurred from the fire fight. The fire dept. actually placed garbage cans/buckets under several light fixtures or ceilings in certain areas of our house where sooty water dripped for a few days. The dripping spots were located in areas Allstate refused to recognize as "water damaged" areas even though the stains were still visible after they brought in their industrial driers and used their moisture meters. I just think it's crummy Allstate basically drew an imaginary line to areas of our home they wouldn't fix b/c it registered dry on their moisture meter. All we wanted was peace of mind by opening up small sections of those areas to prove their was no mold or moisture lingering because we didn't want to leave it up to the reading of one moisture meter in the hands of someone hired by Allstate. We later learned from the opinion of other adjustors and contractors that opening up small sections of drywall is relatively cheap and easy to repair in the scope of damage so I don't understand why the standard is to rely on the battery operated devices which I've also heard can vary in their measurements. I'm not an expert in those meters and I understand they can be a helpful device, but there is no way to verify any one meter is 100% accurate especially as they are used in the field.
Again this is just one small part of our ordeal with Allsate and a way to clear up some details since someone who cares took the time to comment.
This is just a small venue to voice a small part of our dealings, so really I just want people to hear about some of the tactics and/or lack of care & responsibility insurance companies seem to use as a normal standard to treat regular people who not only pay for a full insurance coverage policy but simply want a timely and reasonable resolution.


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