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PostPosted: Wed Jul 16, 2008 12:45 am   Post subject:   

Quote:
You are right Lori, if he had listened to me instead of the insurer that put his life in harms way, he would have never had to make the trip. He was fearful of not complying with an ignorant bullying appraiser.
EXACTLY..even though you told and told and explained and explained that nothing could/would happen he still didn't get it...honestly Mike I know there are some jerk adjusters out there, but I truly think this old guy misunderstood, it just makes zero sense. Especially for a lazy adjuster...


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PostPosted: Wed Jul 16, 2008 2:34 am   Post subject: Insurance adjusters  

T and Lori, I think that insurance adjusters are right behind collision repair shops in this way. Let's take an expert repairer like Mike. No matter how many different ways his eperiences have lead him to choose the paint system, techs, equipment and materials that he has, with this current system, he shouldn't charge a consumer more than any shop in his market area is willing to do the job for. Isn't it similar with some ins. companies with their performance audits where your training and experience works against you? You know what I mean, some young kid who would sell out his own mother is lowering the bar. Will all claims departments be forced to become like the worst to survive?


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PostPosted: Wed Jul 16, 2008 10:09 am   Post subject:   

Quote:
Let's take an expert repairer like Mike. No matter how many different ways his eperiences have lead him to choose the paint system, techs, equipment and materials that he has, with this current system, he shouldn't charge a consumer more than any shop in his market area is willing to do the job for
I agree but Dave, Mike doesn't agree with this logic...He thinks that HE should be paid more than the other shops in his area. He has said that time and time again...



I think I know what you mean by this....
Quote:
You know what I mean, some young kid who would sell out his own mother is lowering the bar.
And I agree (I think)...
Quote:
Will all claims departments be forced to become like the worst to survive?
We'll hope not Dave, just as good shops won't develope fraud as a habit...There is no doubt there are good and bad in both industrys as well as extremes in both, and of course that is where the spot light and media light shines brightest (to the extreme examples). We as a society don't enjoy reading about the terrific shops that repair vehicles free of charge for under priviledged, or the adjuster that worked all night to get someone in a house, car whatever...shame.


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PostPosted: Wed Jul 16, 2008 3:15 pm   Post subject:   

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agree but Dave, Mike doesn't agree with this logic...He thinks that HE should be paid more than the other shops in his area. He has said that time and time again...




I do not believe that I have made this statement or implied it. Not sure how you arrived at that conclusion. I have stated that in comparison to other related professions that all collision repairers and shop owners are adversely underpaid in comparison of similar skills.



Let's consider what insurance fraud may be.



The shop desires to charge for a service that was performed and was even allowed in the procedural pages to be a compensated procedure. But the insurer/appraiser claims his company does not recognize or pay for that procedure but relies on the same data used by the shop to calculate costs for repairs. The insurer uses the repair data information arbitrarily or picks and chooses out it desires to use the procedural pages.



The unethical shop simply does not perform the procedure or service even though the vehicle owner is owed pre loss condition by the insurer or does it for free.



The unethical shop may conspire with the appraiser to cost shift to cover a procedure so the appraiser does not break the company mandate of forbidding payment for a procedure and it showing up on an estimate or supplement, where the shop owner can later say, you have paid for this procedure or supplies before. The appraiser simply overpays a repair related item, or adds time elsewhere to cover the additional repairs. In essence, the insurer knowingly paid for something it knew would not be needed to cover something they chose not to document a record of payment for and the shop agrees as long as they got paid.



The ethical shop does not rely on the insurer paper work and documentation but prepares a repair invoice and estimate based on their professional expertise and bills the vehicle owner, possibly what Mr. Cacarro did in the case above for which the insurer is alledging fraud.



The ethical shop informs the vehicle owner of unpaid procedures or those that the insurer refuses to pay for and allows the insurer to inform the vehicle owner that they do not owe them for this procedure even though the shop recommends and states that it is necessary to complete the job or to restore to pre loss condition. The shop has no obligation to negotiate the vehicle owners contract of repairs or to tortiously interfere with the insurer. Since the vehicle owner contracts with the shop they must make the decision to pay for those repairs above their deductible and look to their insurer for reimbursement or simply not have those procedures done. Failure to pay for those repairs may put the insurer in a bad faith situation or breach of contract, possibly.



I would be willing to bet that many appraisers that post here would have to state under oath that they have negotiated and cost shifted in this matter with a shop owner. If the insurer estimate is a legal blue print for the repair and procedures were not performed they placed the shop owner in jeopardy of commiting fraud for negotiating in this matter.


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PostPosted: Wed Jul 16, 2008 3:58 pm   Post subject:   

Huh? Are you simply posting a few thoughts about what you think might have happened to cause Progressive to file suit? If so, it's really a pointless post as almost anything could have happened and it seems like you are greatly limiting your post... even including many opinions that the apprasier for the insurance company was in on the fraud.



This is not a criminal case, it's civil. So most likely the claim of fraud has to do with charges the shop submitted which they knew or should have known to be incorrect in some way.

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PostPosted: Wed Jul 16, 2008 5:05 pm   Post subject:   

Quote:
Huh? Are you simply posting a few thoughts about what you think might have happened to cause Progressive to file suit?




Just asking what one considers cost shifting. Is it a fraudulent act perpetuated by whom?





Quote:
This is not a criminal case, it's civil. So most likely the claim of fraud has to do with charges the shop submitted which they knew or should have known to be incorrect in some way.




At this point we do not know if the shop submitted any bill to the insurer or if the bill was submitted to their contracted customer. Where is the violation if a consumer wishes to contract with a shop that has more experience and certification that charges more than a prevailing rate determined by another party not contracted to or regulated by the insurer or Department of Insurance. Did the customer submit the balance of the underpaid to the insurer or did the shop negotiate directly with the seven letter folks. If he did bill the insurer directly, a court could presume that the shop was working for the insurer and the vehicle owner. Lot's of questions to be answered in due time that may clear some legal and contractual issues for shops across the country and perhaps serve as a basis for future enaction of state law or statutes.



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?

Are list prices of parts, suggested list?

What if someone sells the list priced part for less? Are they in violation for changing the price?

Why are labor charges based on a non scientific, inconclusive labor rate survey that a state does not mandate by statutes?

Do you file a civil suit everytime you see Sears selling an item higher in price than the identical item at walmart?

Is there a state regulatory agency that determines the list prices a bodyshop can charge their consumers?

Does an policy of insurance state an amount that is the maximum they will pay for parts, labor and material and how is a third party or shop that contracts with a vehicle owner bound by that policy?

Why do they call them labor guides?

What if a business charges by the dollar instead of units?

What exactly is a unit?

How is it determined that the basis of units are accurate and who verifies?

What agency regulates that all bodyshops with varying overheads and cost of doing business must charge only a rate that an entity, not a part of that industry, determines?



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.



Shouldn't Applebees not be allowd to sell their hamburger for the same price as McDonalds and who is regulating them?


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PostPosted: Wed Jul 16, 2008 5:25 pm   Post subject:   

Quote:
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.

Quote:
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.
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PostPosted: Wed Jul 16, 2008 5:52 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?



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PostPosted: Wed Jul 16, 2008 6:09 pm   Post subject:   

Quote:
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.

Quote:
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.
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PostPosted: Wed Jul 16, 2008 6:56 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.



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PostPosted: Wed Jul 16, 2008 7:57 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.

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PostPosted: Thu Jul 17, 2008 12:35 am   Post subject:   

Quote:
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...
Quote:
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....
Quote:
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...
Quote:
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
Quote:
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.
Quote:
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.'


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PostPosted: Thu Jul 17, 2008 1:52 am   Post subject:   

I said,



Quote:
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

Quote:
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.



Quote:
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?


Quote:
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.




Quote:
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.


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PostPosted: Thu Jul 17, 2008 2:16 am   Post subject:   

I stated

Quote:
The insurer uses the repair data information arbitrarily or picks and chooses out it desires to use the procedural pages.




Lori, replied

Quote:
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?


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PostPosted: Thu Jul 17, 2008 10:10 am   Post subject:   

Quote:
Do they use the blend within panel formula full clear coat not described in the p-pages?
Nope
Quote:
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
Got a dirt issue do ya? ........let me quote it for ya'....
Quote:
"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)...
Quote:
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... Rolling Eyes


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