How do we resolve it?

Message

Author

	Add to del.icio.us
	Add to YahooMyWeb
	Add to Simpy
	Add to BlinkList

Posted: Wed Dec 02, 2009 9:36 am Post subject: How do we resolve it?

If I think certain words in my policy mean something different from what my insurance company says they mean, how do we resolve it?

HullyJacob

New member

Joined: 09 Sep 2009
Posts: 12

Location: New York
8.66 Dollars($)

Posted: Wed Dec 02, 2009 12:25 pm Post subject:

You won't ... most policys have definition in them that tell you what those terms 'mean' as they relate to the policy.. What word/term are you talking about and what do you think it means, and your carrier? _________________ "Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr.

Lori

Moderator

Joined: 10 Sep 2007
Posts: 8173

Location: Missouri
287.90 Dollars($)

Posted: Wed Dec 02, 2009 10:18 pm Post subject:

waht are the specific terms in question? Are they defined in the policy wording as Lori mentions? If they are, then that is the definition that will be used, regardless of what you think the terms should mean. If they are not defined then they MAY be open for debate. _________________ Get free insurance quotes or Purchase auto Insurance online in minutes.

heidrek

Senior member

Joined: 19 Oct 2009
Posts: 236

36.87 Dollars($)

Posted: Thu Dec 03, 2009 12:58 am Post subject:

Even terms such as, "you", "we", "us" "our" are defined, (usually in the front-and if any changes, in the front section of each coverage) in all policys I've ever read.. _________________ "Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr.

Lori

Moderator

Joined: 10 Sep 2007
Posts: 8173

Location: Missouri
287.90 Dollars($)

Posted: Thu Dec 03, 2009 5:38 am Post subject:

Contrary to what Lori says, there is a principle in contract law (especially so in insurance contracts) known as "adhesion." It deals with, specifically, ambiguities in a contract. An ambiguity arises when two persons, giving ordinary meaning to the words they read, have two entirely opposite understandings of what they have read. If it comes down to a dispute in court over you read a clause in a way that says "the insurer must pay," and when the insurer reads it, it says, "We don't pay at all," then the judge/jury will have to decide. If the decision is, "Yes, this is ambiguous," the rule of law says that the provision must either be read on favor of the party that did not write the words in questions (insured), or the provision eliminated from consideration as a reason to not pay a claim, forcing the insurer to look for other grounds to not pay a claim. Having said that, Lori is right when she says there will be a list of definitions in the policy to help guide everyone in their understanding of the contract. It would be very helpful if you post the contract language you are concerned about, so we can help you understand it, as Lori and Heidrek have posted. _________________ California-licensed Property & Casualty Broker-Agent and Life & Health Agent. CA Insurance License #0596197. Send me your questions, and I'll send you my answers. I live, breathe, and teach insurance!

MaxHerr

Moderator

Joined: 29 Nov 2009
Posts: 4223

Location: Pomona CA
163.12 Dollars($)

Posted: Thu Dec 03, 2009 6:23 am Post subject:

Quote:

Posted: 30 Sep 2009 05:58 Post subject: Kids insurance!!

---------------------------------------------------------------------- ----------

Hi,

I took my kids to the pediatrician where they received vaccinations, but one of those vaccines was not covered by my insurance. Am I responsible to pay? Shouldn't the physician's office have told me that it was not covered?

This was posted by the OP back on September 30th. I would assume he is still having a problem with this claim.
_________________
Can I say I’m working if I stare blankly at my computer all day?

Dasfuk

Senior member

Joined: 27 Feb 2008
Posts: 597

Location: Ohio
24.03 Dollars($)

Posted: Thu Dec 03, 2009 6:52 am Post subject:

Quote:

policys I've ever read

Read a policy. We don't need to read no stinking policy.
_________________
Can I say I’m working if I stare blankly at my computer all day?

Dasfuk

Senior member

Joined: 27 Feb 2008
Posts: 597

Location: Ohio
24.03 Dollars($)

Posted: Thu Dec 03, 2009 7:14 am Post subject:

"One of those vaccines was not covered by my insurance. Am I responsible t pay? Shouldn't the physician's office have told me that it was not covered?" Certainly clears the air a bit! Yes, you would be responsible to pay. I'm sure you signed an agreement to that effect with the doctor. Is the doctor's office supposed to know everything that is or is not covered by your insurance? No. Are they required to call the insurer for authorization? Perhaps. Did they? Don't know. If they didn't, and they don't have to, there is no recourse against the doctor's office. What was the vaccination for? Almost all routine vaccinations for children are covered. Perhaps the doctor's office inadvertently submitted the wrong claim code. Have you inquired about that possibility? Still a few loose ends to clear up. _________________ California-licensed Property & Casualty Broker-Agent and Life & Health Agent. CA Insurance License #0596197. Send me your questions, and I'll send you my answers. I live, breathe, and teach insurance!

MaxHerr