Deductible Question

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PostPosted: Fri Mar 22, 2013 7:54 pm   Post subject:   

Sorry to rehash an old topic. Trying to understand what is legal and not...

In the example above, where the insurance values for $8,500 RCV, if the contractor bills me for $7,000 and bills the insurance company for $8,500, isn't that insurance fraud?

Isn't that the contractor paying for my deductible? which would be illegal?

I realize it would not be getting any more money from the insurance company than what they agreed to pay for, BUT doesn't the deductible mean that it comes out first?

So as given in the example, should $7,000 be billed to both home owner and insurance company, and since $4,800 was already given to homeowner, the insurance company would then pay out another $700, with the owner paying $1,500 for his/her deductible?

It doesn't seem fair (and different from auto where they give $x - deductible and you go buy whatever car you want), but isn't that the legal way to go?

Otherwise I just don't understand the difference between the method max suggested and what is usually referred to as the contractor paying for the owner's deductible...

Thank you -

- confused home owner...

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PostPosted: Fri Mar 22, 2013 8:51 pm   Post subject:   

OK, Lom, here's the math.

When the insurance company values the loss at $8500, that's the total basis of the claim. Minus the $1500 deductible, the total the insurance company will pay (absent any hidden damage found during repairs) is $7000 ($8500 minus $1500 equals $7000). The $4800 ACV payment reduces the $7000 total payment to a "balance due" of $2200.

Your contractor can submit a claim for $8500. The insurance company will write a check for $2200. That plus the $4800 check they first wrote PLUS the $1500 deductible equals $8500.

If the contractor agrees to take $7000 as the total amount due, fine. You essentially got a credit from the contractor for $1500. But in some circles, that would still amount to fraud because the contractor never intended to charge more than $7000 for the job. In which case the insurance company should only have written the second check for $700, not $2200. (An analog to this is found in some states' insurance laws that prohibit doctors from not charging HMO/PPO patients their office copay. It effectively is seen as overbilling on the part of the doctor -- if he wasn't going to accept the $20 copay, he should not have billed for the full amount of the visit.)

What you want is a contract that completely spells out the total price for the work to be done. You accept the insurance company money minus your deductible and pay the contractor what you and he agreed on. If the contractor later wants to rebate an amount equal to the deductible, well, only state contractor laws would prevent that.


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PostPosted: Sun Apr 08, 2018 1:28 am   Post subject: deductible question  

I received a check from my insurance company here in Florida and they deducted my $2500 deductible from the total and sent me a check from the balance. My contractor says that he paid my deductible and I owe him $2500 that he suppossibly paid. I never recieved paperwork, nor signed any agreement. Am I liable? I thought I paid my deductible when the insurance company deducted it from my check.

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PostPosted: Fri Sep 14, 2018 6:00 am   Post subject:   

You a roof replaced by storm damage.

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