by Guest » Sat Feb 18, 2006 10:21 am
My cousin Bob and another guy went for a long drive last Saturday evening and got struck by a rash driver from a distance. The bully escaped narrowly but was trapped later in the morning .The repair works for Bob would be somewhat around $4000. Bob's insurer had agreed to support him with aftermarket body parts for his vehicle, to which Bob's reaction was simple and stern. He did not want his insurer to provide him with aftermarket parts. He maintained that it was his insurer's job to collect the new parts from the tormentor. He had a hard time convincing the insurance representative till he revealed his other identity as an attorney.
Of late his insurance company has offered him new market parts, and also expressed their willingness to resolve matters soon. Could we ever look forward to a hassle-free world ?
Regards,
Blackberry
Of late his insurance company has offered him new market parts, and also expressed their willingness to resolve matters soon. Could we ever look forward to a hassle-free world ?
Regards,
Blackberry
Posted: Wed Jul 16, 2008 05:25 pm Post Subject:
What is the basis for correct charges of a private business that has no agreeement or contract with an insurer and is not regulated by the insurance industry?
Did you read my prior post when you mentioned this before?It's clear from the rest of the post that you are not even thinking about the actual situation rather, your just trying to mention things to support your way of thinking. There is not mention of "cost shifting", crooked appraisers, or "buying' anything. Much of what you mention in your prior post has _nothing_ to do with Progressive's claim of fraud. Buying something from Sears is completely different then _being charged_ for something. To help you understand... you hire me to landscape your lawn and we sign a contract stating what I'll do and what I'll charge. I then only so 1/2 the work but I charge you the full price. Also, the items I used were different then what we agreed upon. _That's_ fraud.
Don't answer because you are paying the bill. You aren't paying the bill, the insurer is indemnifying the policyholder for a loss in which those funds are used to pay a contracted party for services. Or the insurer is paying a third party settlement based on a negotiation between the insurer and a shop that is not licensed to represent the damaged party in a civil settlement.
Again, I'm not sure you understand the simple principle of transferring the right of recovery. It's easy to see that the customer could file the suit against the body shop. Anyone can assume this right from the customer (it's done in recovery all the time... debts get sent to collection agencies and attorneys all the time). The insurance company has a contract with the insured that states they assume the insured's right of recovery for anything they pay for. So the transfer of recovery is automatic. That is probably one reason why Progressive paid the bill in full... so they could file the suit in the first place.To me this is very clear and simple. Perhaps for most it's not as it's not what they do every day. When I first started writing apprasials I did not understand why the newly painted panel was not blended to match instead of the adjacent, undamaged, panels being blended. This so very simple and obvious... but only once you understand the concept.
As I have stated... if you choose to think about how you can apply this situation to further your unrelated points, you won't understand what is really going on and why as you will be ignoring the _real_ situation. It's not (only) a question of how much the shop is charging (that might be a part of it). There are/can be many other issues we don't know about. Your just going by what Connaco has stated. As such, you have your head buried in the sand.
Posted: Wed Jul 16, 2008 05:52 pm Post Subject:
They are all relative to each other based on the fact that the shop has no agreement with the insurer nor contract. The suit will be defended upon the basis of contract law and the duty of the contractual parties.
An insurer has no legal or statutory right to determine what I or any other private business can charge for their services. If the vehicle owner was in agreement with the charges and requested the insurer pay the bill as promised by contract, why are they not charging both with conspiracy to commit insurance fraud?
You nor I do not know if the vehicle owner was notified of additional damages and that the final bill would be higher than the insurance guestimate and the vehicle owner agreed to be responsible for the charges by contract. The vehicle owner simply asked to be indemnified based on the proof of loss based on a final invoice.
Based on the fact that Ms Eversmen is part of the legal team, I am betting it will define contractual parties responsibilities to each other.
Are you implying that if the insurer prepares an estimate and elects to pay for repairs, that all shops are required to adhere to the insurance estimate?
Posted: Wed Jul 16, 2008 06:09 pm Post Subject:
An insurer has no legal or statutory right to determine what I or any other private business can charge for their services. If the vehicle owner was in agreement with the charges and requested the insurer pay the bill as promised by contract, why are they not charging both with conspiracy to commit insurance fraud?
Again, you talk about there being no contract between the body shop and the insurance company and that the body shop can charge whatever they want. I keep telling you that this is probably not the basis for Progressive's suit. Only you have brought up this thought. _I_ have time and time again pointed out that no one else has said one work about this. _That_ is why I point out that you are looking at this issue with only your interest in mind.I think my post above was _extremely_ clear on how the fraud charge could have come about. I can't go any further as none of us know exactly what Progressive is alleging. That is why _I've_ refrained from guessing. It appears that you don't mind guessing... as long as theses guesses further your opinion.
You nor I do not know if the vehicle owner was notified of additional damages and that the final bill would be higher than the insurance guestimate and the vehicle owner agreed to be responsible for the charges by contract. The vehicle owner simply asked to be indemnified based on the proof of loss based on a final invoice.
As mentioned above, _YOU_choose to post several _guesses_ as to what happened. I think I only responded with one possible scenario to point out that all your guesses were one sided and that they were simply wild guesses.As Lori mentioned, this is not some big huge earth shattering case. It's one of those that happens every day. You won't find any credible _news_ covering this issue as it's not... news. You will only find it mentioned if you go looking for sites that promote independent body shops rights... which is what you are promoting here.
Posted: Wed Jul 16, 2008 06:56 pm Post Subject:
See you in a couple of weeks then after the trial. It is no run of the mill case. I can assure you that there is national interest in this case as it has many implications regarding "what is" the business of insurance and "what isn't", and "what is" the business of collision repair and their contractual rights.
And if he is a scheister, which I seriously doubt, he'll deserve any judgement or decision against him.
Posted: Wed Jul 16, 2008 07:57 pm Post Subject:
Progressive's fraud case will be heard in the next few weeks. Coccoro's counter complaint trial does not start until after that. Even then, Coccoro's case against Progressive is only that in specific cases Progressive violated the anti-steering laws in NY. Recommending DRPs is 100% legal. Read that again. DRPs have been and are 100% legal. This won't be changed by this one case. As mentioned several times above, your ignoring what this case is _really_ about.
It's national news? Find me one reputable news agency that has mentioned this case.
Posted: Thu Jul 17, 2008 12:35 am Post Subject:
The insurer uses the repair data information arbitrarily or picks and chooses out it desires to use the procedural pages.
Nope they cannot, the system that any carrier chooses to use, must be used in it's entirety...That is probably one reason why Progressive paid the bill in full... so they could file the suit in the first place.
I'm just sure of this T....Your just going by what Connaco has stated. As such, you have your head buried in the sand.
And just exactly what is he saying about the orginal suit? I've read about six posts/stories and all he talks about is his counter suit....interesting..course Progressive is mum on the subject...An insurer has no legal or statutory right to determine what I or any other private business can charge for their services. If the vehicle owner was in agreement with the charges and requested the insurer pay the bill as promised by contract, why are they not charging both with conspiracy to commit insurance fraud?
This isn't necessarily true Mike, what you've made it sound like is a body shop or anyone for that matter, can charge a thousand dollars for a fifty dollar job and the carrier is contractual bound thru the indemnifying contract...not so...as a matter of fact I'll quote it for you from a standard MO auto policy...First, because we've had this discussion as well, under the heading of additional duties of insureds, "Allow us to inspect and appraise the damaged vehicle or part before it is disposed of and before any repairs are started"then, "Cost to repair means the amount of money [color=Red]WE determine will be reasonably required to pay for the repair of the vehicle or part. Cost to repair is determined by US. We base that determination on OUR knowledge of the prices repair facilities charge in the geographic area where the repair is to be done. To aid us in determining cost to repair, WE may use any one or more of the databases, appraisal tools and other methods the insurance industry commonly uses to determine those charges."[/color] Mike you're right when you say, that
An insurer has no legal or statutory right to determine what I or any other private business can charge for their services
But you are wrong when you say or imply that the insurer is contractually bound to pay your price, they are not....in any way shape or form.The vehicle owner simply asked to be indemnified based on the proof of loss based on a final invoice.
Invoice, shimvoice, you and I know they can be doctored and even sell programs to actually counterfeit them...and insurance carrier is not in any way contractually bound to pay anyones final 'invoice.'Posted: Thu Jul 17, 2008 01:52 am Post Subject:
I said,
You nor I do not know if the vehicle owner was notified of additional damages and that the final bill would be higher than the insurance guestimate and the vehicle owner agreed to be responsible for the charges by contract. The vehicle owner simply asked to be indemnified based on the proof of loss based on a final invoice.
Lori retorted
But you are wrong when you say or imply that the insurer is contractually bound to pay your price, they are not....in any way shape or form.
You imply something I did not say!
You know since the insurers took away the insureds remedy of appraisal and they became the expert, what other choice does an insured have other than to contract with a shop to repair their vehicle based on oem recommendations rather than the insurer specified repairs and submit a final invoice to challenge the insurer estimate either in court or by request in a letter.
Where did I say the insurer was contractually bound to pay based on the shop invoice, are you referring to the above quote. I am saying a contract with the consumer has no bearing on the contract they may have with their own insurer. If their final invoice reflects procedures and requirements that the insurer underpaid, then the insurer may contractually owe the vehicle owner not the shop if the vehicle owner can prove it was necessary.
It's a slippery slope that insurers are taking claiming they are experts at determining the extent and amount of damage as they have the contractual right to do so with their consumer but not the shop. Insurers want to specify the repairs but not accept the liability for them. They have that option (Avery vs State Farm) made it abundantly clear the insurer had the option.
Somebody posted this on another forum and it's really this simple. The consumer questioned their insurer why their estimate failed to restore their vehicle to pre-loss condition or why they had to pay an amount above their policy deductible.
simple question. Good customer paid balance of payment for repairs and then wrote great letter to insurance company CEO. He asked a simple question, did the insurance company fail to live up to their contract to him, or do they think the repairer defrauded him?
He called today and said a claims rep. called and informed him they made a mistake and the balance is being sent today. They even added for his postage expense.
The letter goes to the President or CEO of the company, not the local claims employees. Most states mandate the insurers explain their policy in detail when they deny a portion of the claim. If there already has been, will be, or potential to be bad faith case brewing (and there always are with these companies). The last thing they need is a well educated, well spoken 30 year policyholder joining the class.
Posted: Thu Jul 17, 2008 02:16 am Post Subject:
I stated
The insurer uses the repair data information arbitrarily or picks and chooses out it desires to use the procedural pages.
Lori, replied
Nope they cannot, the system that any carrier chooses to use, must be used in it's entirety...
Mike asks, Lori do you include payment for denib and buff and how much de-nib and buff time does the procedural pages allow for a complete paint job. Do you pay for repair of clamp marks on the rocker panels and refinishing? Does the company you work for place a threshold or cap on total clear coat. Do they use the blend within panel formula full clear coat not described in the p-pages?
Posted: Thu Jul 17, 2008 10:10 am Post Subject:
Do they use the blend within panel formula full clear coat not described in the p-pages?
NopeMike asks, Lori do you include payment for denib and buff and how much de-nib and buff time does the procedural pages allow for a complete paint job
Got a dirt issue do ya? ........let me quote it for ya'...."Finish Sand and buff labor time formula is provided SHOULD IT BE NECESSARY TO PERFORM THIS OPERATION. This process is NOT limited to 'nib sanding' or 'finessing' which is the removal of isolated dirt/dust particles only, as this operation is included in the refinish labor times." This procedure includes the removal of orange peepl and any blemishes that affect paint textured in order to produce a smooth finish to the entire panel surface."
I don't pay de-nib because that is included for one, and the amount of denib and buff required is a direct result of the quality of the paint application...(I'm sure you know this)...Do you pay for repair of clamp marks on the rocker panels and refinishing?
Nope, honestly never had a issue here either, I pay full set up when warranted, again this is not addressed AT ALL in any p pages that I'm aware of....I also don't pay to re-black in the tow hook either... :roll:Posted: Thu Jul 17, 2008 03:15 pm Post Subject:
So, LORI,you do use the p-pages arbitrarily then! So typical. We didn't even talk about feather fill and prime that insurers refuse to pay for. When this subject is brought up, the adjusters are trained to demean the shops and ridicule their paint application skills and equipment or to simply say that is included, I paid for that. But since this seems to be a huge problem in the industry, the data providers devised a formula for shops to be compensated for the necessity and product manufacturers devote a tremendous amount of products and equipment to remedy the predicted occurances. I suppose 3M developed that entire line of products for dirty painters that are isolated incidences.
Not sure where you are getting your p page stuff, must be the company version. All shops have orange peel, texture, debri, dirt, lint, etc in their paint as shops do not have the multi million dollar static free facilities in which the manufacturer paints vehicles and even they have issues with dirt.
I don't pay de-nib because that is included for one, and the amount of denib and buff required is a direct result of the quality of the paint application...(I'm sure you know this)...
Mitchell P page 47
Finish Sand & Buff
A labor time formula is provided should it be necessary to perform this operation. This procedure includes the removal of orange peel and any blemishes that affect paint texture in order to procduce a smooth finish to the entire panel surface. This process is NOT limited to "nib sanding" or "finessing" which is the removal of isolated dirt/dust particles only. The performance of this operation is NOT INCLUDED in the Mitchell refinish labor time.
Finish Sand and buff outside surface area(s).
Allow .3 per refinish hour (30)% to finish sand and buff each surface area(s).
De-Nib & Finesse
A labor time formula is provided should it be necessary to perform this operation. This procedure includes the removal of small isolated dust particles (nibs) and the application of a finishing glaze.
The performance of this operation is NOT INCLUDED in the Mitchell refinish labor time.
The de-nib and finesse formula is intended to be calculated as a percentage of the base refinish hours excluding overlap and clear coat. It DOES NOT APPLY to edge, jambs, and undersides. For blended panels, the formula should be applied to the full panel refinish time. No deduction for refinish overlap should be taken.
CCC version
DE-NIB & POLISH
SPECIAL NOTATION:
Refinished panels may or may not require a varying amount of de-nibbing, a process used to remove small particles in final finish surface. The clear coat contains ultraviolet screeners and reducing the clear coat thickness (mils) may result in early paint failure. Follow vehicle manufacturer's recommendations when performing this type of repairs. Calculations should be based upon the base refinish time outer surface only and should not include additions for clear coat, underside, inside or edges. In the event that this type of operation will be performed, MOTOR suggests the following formula be considered:
Each panel requiring de-nibbing (refinish or blend)
HOOD, ROOF, TRUNK LID, SPOILER
First panel add up to 20% of full base refinish time, each additional panel add up to10%
FENDER, DOOR, QUARTER PANEL, BUMPER COVER
First panel add up to 10% of full base refinish time, each additional panel add up to 5%
INCLUDED:
• Panel outer surface only
• Paint nib removal as required (spot only)
• Spot polish only
DOES NOT INCLUDE:
• Acid rain damage
• Full panel polish
• Overspray removal
• Removal of residual material from recessed edges and jambs if required
• Scratch damage
• Wash, clean, wax or detail entire vehicle prior to delivery if required
• Wet sand full panel
Under the included denib operations above, de-nib included operations refers to the process of de-nib, and not refinnishing.
Audatex
Replaced Panel Refinish
Current Audatex refinish labor is based on the use of new and undamaged
panels. Additional steps or processes that may be required should be
considered during estimate preparation.
Repaired Panel Refinish
When a repaired panel is being refinished, the estimator provides
time for the repair of the panel. Consequently, the estimator also
determines included operations. When Audatex refinish labor is used
for repaired panels, Audatex refinish times assume that the panel
has been returned to the condition of a new, undamaged OEM panel
or equivalent.
Operations that might be considered in the repair refinish time
include any steps required to bring the panel to the condition of a
new, undamaged panel. This may include feather edge, blow off and
clean, mask to prime, tack off, mix etch primer, prime bare metal, mix
and apply primer filler, guide coat application, unmask as required
and block sand. Panel scuff to facilitate application of clear may also
be considered for two- or three-stage refinish.
Feather / Prime / Block
Audatex recognizes that Feather/Prime/Block are required operations
in the panel repair process, that occurs after 150 grit, to bring the
repaired panel to the condition of a new, undamaged panel for the
purpose of refinish. Audatex does not provide labor allowance for
repaired panels, as this is a judgment time, nor does Audatex
provide material allowance for the Feather/Prime/Block process. The
determination and assessment for this operation is best provided by
the estimate preparer for consideration and allowance during the
estimate preparation process.
Nib Sanding/De-nib
Nib sanding (or de-nib) is defined as the removal of isolated dirt and dust
particles, and polishing the affected area(s).
�� Audatex's formula for Final Sand, Polish, and Buff does not apply to
this operation. Additional steps or processes that may be required
should be considered during estimate preparation.
Section 4-5 Refinish Operations
Single-stage
�� Gather additional materials to apply clear coat
�� Add flex additive (if required)
�� Mix, apply, and flash clear coat
Three-stage
Audatex's three-stage refinish formula includes the following operations:
�� Spray test panel/let down panel
�� Mix, apply and flash pearlescent / mica coat
�� Tack wipe (between pearlescent / mica coat and clear coat, if required)
�� Mix, apply and flash clear coat
�� Mix second color
Chipguard
Audatex's chipguard refinish formula includes the following operations:
�� Gather chipguard materials
Audatex's single-stage refinish formula includes all two-stage refinish
operations except:
�� Spray test panel/let down panel
�� Tack wipe for clear coat
�� Gather additional materials
�� Tack wipe (between color and pearlescent / mica coat, if required)
�� Clean gun
�� Clean gun
Two-Tone
Audatex's two-tone refinish formula includes the following operations:
�� Tack wipe (between colors)
�� Additional masking
�� Color tint and check second color
�� Apply and flash second color
�� Clean gun
Blending
Audatex's blending refinish formula includes the following operations:
�� Complete preparation of blended panel
�� Scuff or buff
�� Application of color to blended panel
�� Application of clear coat to entire blended panel in two-stage and
three-stage systems
�� Masking
�� Application of chipguard
�� Cleanup
© 2006-2007 Audatex North America, Inc. 156
Wow, I didn't see the operation included anywhere in any of the data provider p pages. Is it possible that Lori was incorrect or merely stating company inclusions and exclusions?
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