American Family insurance fraud or just poor ethics

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PostPosted: Fri Nov 06, 2009 6:55 pm   Post subject: American Family insurance fraud or just poor ethics  

My wife and children were in a parked car (ignition off) and was backed into by another vehicle. The individual got out, claimed 100% fault (of course) gave my wife her insurance info. Open and shut case right??? Not according to American family insurance co. It seems they feel my wife was partly to blame...Huh? They suggested if we do not contact our insurer that we will need to litigate to get our damages paid. We contacted the driver and she maintains her 100% fault and is apologetic for our treatment from her insurer.You have got to be kidding! All for approximately $1000 worth of damages.Is this considered insurance fraud by American Family since they are misrepresenting their policyholder? In Missouri ...


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PostPosted: Fri Nov 06, 2009 8:34 pm   Post subject:   

Was your wife "legally parked?" That can have an effect on the apportionment of damages. "Parked" and "legally parked" are potentially two different things.



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PostPosted: Sat Nov 07, 2009 12:32 am   Post subject:   

Quote:
It seems they feel my wife was partly to blame...Huh?
They have/had to give you a reason for this. Was your wife parked illegally?
Quote:
Is this considered insurance fraud by American Family since they are misrepresenting their policyholder?
No it wouldn't be fraud, and they are not misrepresenting their insured. It's there job to determine liabilitiy...not their insured's...regardless of what their insured says...so no, no fraud...
Quote:
In Missouri ...
I'm in MO as well...MO is a pure comparative negligence state, which means any percentage of fault can be found..10% at fault means you pay the other guy 10% of his damages, he pays you 90%...



You need to turn it into your carrier, and have them help you with this..worse case scenerio, your carrier takes care of your damages, then subrogates AmFam..if your adjuster and their adjuster cannot agree on a percentage, then the claim will go to arbitration. The arb. decision is final...and binding...



I just can't imagine their thinking, UNLESS your wife was illegally parked...still it's a stretch (depending on where she was and the 'degree' of illegally parked)...



Let us know the circumstances, and we'll see if we can figure this out..



Keep in mind..anything less than 100% to you means you pay the opposite amount to the other vehicle owner for her damages if there were any..and I would assume with 1k to your vehicle there is..


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PostPosted: Sat Nov 07, 2009 8:02 pm   Post subject:   

Hmm, maybe the claims people from Colorado got transferred to Missouri. The ones that paid claims only when pigs fly?



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PostPosted: Sat Nov 07, 2009 8:24 pm   Post subject:   

Quote:
Hmm, maybe the claims people from Colorado got transferred to Missouri. The ones that paid claims only when pigs fly?
Laughing I don't know Mike, somethings missin' from this post...In my area anyway, AMFAM, enjoys a good rep...They HAD to have a reason for the comp neg.


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PostPosted: Mon Nov 09, 2009 8:16 pm   Post subject:   

Quote:
I don't know Mike, somethings missin' from this post...In my area anyway, AMFAM, enjoys a good rep...They HAD to have a reason for the comp neg.




They must have made changes based on answers received from those J.D. Power and Associates questionaires they send out annually.



They and others still fail to adhere to the recommendations found by J.D.Powers that determined consumers are most satisfied when they are left alone to choose their shops instead of being told they must use a shop in the preferred networks.



Wow! even though they are just in the top third in ratings, it's hard to believe the lizard/caveman company beat them out in customer satisfaction ratings.



http://www.c-a-r-a.org/news/jd-power-insurance-ratings


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PostPosted: Tue Nov 10, 2009 12:56 am   Post subject:   

AmFam is a strange company. I just did a reinspect for for them last week. A driver was in reverse in a parking lot (going the wrong way) and rear ended a vehicle that was backing out of a parking space. The driver who was in reverse had AmFam, they laid responsibility on the driver who was backing out of the space.



Mike, there is a reason why the Caveman and the Gecko have better CSI Wink

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PostPosted: Thu Nov 19, 2009 3:14 pm   Post subject:   

WOW! ... Thanks for all the input. I just now rechecked this site.



For all those interested - American Family is willing to pay 85% of the damages, unless WE can prove that my wife was not moving. If we do, they said they would pay 100%. Also, my wife was not illegally parked, she was in a waiting line at my kid's school event with other vehicles.



My "big picture" view ... I am tired and disgusted with the people/companies working the system for the almighty dollar. What happened to being ethical and doing what is right??? Because we are going to contact everybody that may have been at the event (email) to find the witnesses, American Family is willing to embarass their policy holder and keep this claim open for the paltry sum of $150 (15% of $1,000)! Simply unbelievable.



One thing is sure, I will never recommend anybody to American Family and if I ever get in an accident with an individual insured by American Family I will immediate call the Police and have a report filed. Sad ...


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PostPosted: Thu Nov 19, 2009 8:49 pm   Post subject:   

85% sounds like a claim minimising exercise on thier part. Seems to me like they are offering you an almost complete settlement hoping that you'll just accept this rather than going for the full 100% which it sounds like you're entitled to.



Makes sense from their perspective - if you take the deal they save 15% of the claims cost, if you don't then they get to delay settlement until the issue is resolved and at the end of the day still only end up paying what they would have initially.



as far as the "prove she wasn't moving" thing goes - that sounds specious at best. I doubt you'd have any real trouble convincing anyone of the circumstances here.



did you take an photo's at the scene? If you did it'd be pretty obvious from the positions of the cars that your car was stationary. even without thhis, if the other driver has agreed on numerous occasions that they were at fault and agrees that your wifes car wasn't moving - case closed i would think - might have to get it in writing from them though just to save hassle later.



Short answer - don't get bullied or scared off, go for the 100%. See if you can get the other driver to sign a statement for you and you're golden.



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PostPosted: Fri Nov 20, 2009 1:42 am   Post subject:   

OP, you need to keep a couple of things in mind, then I have a suggestion...If you settle for 85%, and you are in a PURE comparative negligence state, then that means you and/or your carrier will owe them 15% of their insured's damages.



A couple of suggestions...



1. Does the school have cameras?

2. Certainly contact all those there and see if they would swear that your wife was in park and ignition off.

3. Contact the nice lady that hit her, see if she will put something in writing for you that, it was all her 'bad' your wife was not moving

4. Once you have all of this, ask the (stupid) adjuster if she is really willing to go to court over this (small claims), and embarass both herself and her company, because you are prepared to file this in small claims (on principal alone) and will call their insured as YOUR witness. Then the adjuster can explain to both the judge and your states dept of insurance, why she/he has refused to pay this claim and protect her insured. And further, if your state allows third party bad faith, you are also prepared, (after you win your case) to get an attorney to represent you for a bad faith suit against american family for malicous refusal to pay.



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PostPosted: Tue Feb 01, 2011 10:12 pm   Post subject: AFI  

We have had AFI for approximately 10 yrs and have

never had a claim. We live in the part of the country

where we can have significant hail damage. Within the

last 2 years, lots of our area neighbors have had their

roofs replaced due to hail damage. We finally had a roofer out and he also said ours had approx 70% damage. An AFI adjuster came out and said our roof

was not damaged (it was put in 19yr ago) because he

"couldn't see any damage on the gutter helmet." None

of our neighbors were asked for specific dates when

this occured (What if you're home?). The adjuster needed

a specific date. Very unhappy with AFI


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PostPosted: Wed Feb 02, 2011 9:29 am   Post subject:   

You can always contact the insurer and request a second adjuster visit the property and inspect the roof. If that doesn't work, then you could hire a Public Adjuster to represent your claim. The PA will take about 10% of your damage award as his fee.



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PostPosted: Wed Feb 02, 2011 4:48 pm   Post subject:   

Or you could simply notify them of your right to invoke the appraisal clause in your policy, if they haven't eliminated it like they have in Missouri. You can use your contractor as your appraiser and they have to hire an independent appraiser to attempt to settle the difference. Those two appraisers have to elect an umpire in advance that they both agree to. If the appraisers can not settle the differences, it goes to the umpire which can be a retired judge or any citizen in good standing in the community as long as they can objectively and impartially decide the outcome by judging the merits of the dispute.



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