Will filing a complaint with the department of insurance get

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PostPosted: Fri Jan 07, 2011 8:11 pm   Post subject: Will filing a complaint with the department of insurance get  

I have a very strong case with tons of evidence yet the insurance company keeps denying my claim. They admitted that their insured did not have the proper documents. This...on top of my evidence ....the claim should have been paid. If I file a complaint with the department of insurance will that get them to pay my claim.

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PostPosted: Sat Jan 08, 2011 12:48 am   Post subject:   

Your post is rather, well, non-specific. If you could elaborate just a bit (read- elaborate a LOT), we would be more than willing and able to help.



We need the case specifics, please!



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PostPosted: Sat Jan 08, 2011 12:52 am   Post subject:   

Sounds like a liability issue. The DOI does not (can't) really get involved with this as it's more of a civil matter then an insurance company not operating correctly. You may see it as them not making the right decision but they are entitled to their view on a liability issue as well.

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PostPosted: Sat Jan 08, 2011 7:11 am   Post subject: elaboration  

OK....here it is ....Smile



I hit an unmarked pot hole in a construction zone. It was filled with water. The pot hole was approx. 3 feet wide and very deep. My car bottom out in the front and back.



I made a claim with the county and they denied it saying "they did not know about it prior to my hitting it". I then went on the hunt for evidence. I have 100's of pages of documentation from the county. I have pieced it all together.



The county new of this pot hole and broken irrigation line under the road because the county had repaired the irrigation line and the pot hole 5 days before I hit it. Now, the county workers returned to check the hole and remove the barricades the next morning and the barricades had been moved by the contractor. The documents go on to say that the contractor was working at 9:20 AM on the day after the repair. At least 5 county workers saw the milling company working on the road and the road had been milled.



I also have three independent witnesses and written statements to confirm that construction workers were working and the pot hole was unprotected.



I also had a teleconference , arranged by the county dept of transportation, with the actual worker that arrived to the scene that morning and stated, in this recorded conversation, that the barricades had been moved by the contractor and the road had been milled. He went on to say that the pot hole had been re-opened by the heavy milling equipment. I have this in writing as well. He stated the hole should have been blocked off when I hit it.



I have all of this either in writing or on a recorded conversation. I have pictures of the pot hole.



The damage was approx. $1000.00 to my car.



There was a main contractor and a sub contractor for this road work. The county repaired the pot hole and the irrigation line. I made a claim with the main contractor but they denied it. I spoke to a few managers and at one point they "said" they tried calling the county to see if they would take partial blame because they did not feel they were totally to blame. They county would not take any blame ($450.00). UNBELIEVABLE!! They are all to blame and need to share in the responsibility if you ask me. I don't care who pays it but it needs to be paid. The was negligence on many levels. There are a millions hands in the pot when it comes to getting information from the county. I have spent hours putting this all together. I got them to admit partial fault yet because the county would not come to the table they wont send me anything????? How is that right???



Oh I forgot to mention, the contractors insurance said that the contractor said "they weren't there". I asked them if they supplied the logs to show where they were and the adjuster said they could not produce this document. HELLO ...that's because they were there!



I have now requested certificates of insurance for additional contractors and to the sub for the milling (they refused to give it to me when I called them).



So, at this point my options are:

- make claims to the sub contractors (all 3 of them left)

then if they deny to file suit

- file suit now against the contractors in small claims

- file suit against the contractors and the county in civil court.



I have posted on some lawyer sites and they say my evidence is hearsay. I have called the small claims court and they say I can try to submit anything because it is up to the judge if he will allow it.



I have also heard from an adjuster that just to sue them because their insurance co. will just settle, which tcope you said as well, but after some research it appears they will most likely represent themselves since the claim is so small. They will most likely not submit it to their insurance because their deductible is most likely much higher than my claim.



Well, we will start there. I must go to bed. Smile I am torn with indecision. Any advice would be much appreciated.



Thank you!!

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PostPosted: Sat Jan 08, 2011 9:13 am   Post subject:   

I think making claims to the contractor could be your best bet that is if your evidence is really on a strong footing.

I think you should share your evidence and case with an experienced attorney and seek legal advise.



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PostPosted: Sat Jan 08, 2011 3:59 pm   Post subject:   

attorneys wont touch the case....its too small....

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PostPosted: Sat Jan 08, 2011 5:04 pm   Post subject:   

I would sue the primary contractor in small claims court and seek cost of court and process service against them. If you took your car to a body shop and the body shop sublet a suspension repair and it failed, you wouldn't sue the subcontractor, you'd sue the primary contractor. The primary contractor's duty is to make sure all the subs have insurance converage for their own liability as the primary contractor is liable for ALL the subs.



If I were in your situation, I would download all the court papers for process of service to small claims and fill them out. I would mark sample or copy on the pages, scan them and mail them with a certified letter of demand to the primary contractor giving them a certain number of days to respond and pay in full your damages or you will proceed to have the service of process executed and they will incur the additional expenses.



They have a duty to inform their insurance provider that they are being sued. They also, most likely, have a 2500 to 10,000 dollar deductible so they are liable for your damages out of pocket. If they stonewall you or ignore your demand, i'd file the suit and get satisfaction in small claims. You'll want to be sure and keep track that they have not gotten an extension and changed your court date. I believe you have sufficient documentation to win your case in my personal opinion. In the event they do not show up and you win by default and get a judgement, you'll still have the task of collecting your damages.



If the claim was against an individual, you'd garnish their wages. I suppose you could file a lein against the contractor with the county or state who pays their services based on the contract.



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PostPosted: Sat Jan 08, 2011 8:56 pm   Post subject:   

the main contractor's insurance has denied my claim already. Is there a way to make them pay?



Could I send a demand letter and the court papers to the insurance company?



Is there a chance if I file with the sub's insurance (since they are the one that was there and listed in all the evidence) that they will pay the claim?

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PostPosted: Sat Jan 08, 2011 9:17 pm   Post subject:   

Hope this will help! Don't expect people to just do the right thing on their own. Some will, most won"t without a little legal prodding.



Until you nail the actual tort feasor ( person, entity, corporation, etc) who"s negligence caused your damages, no one legally owes you a dime. You can not force or make anyone do anything nor can any department of insurance. Insurers, only when faced with the probability that they will owe for the loss, will step in and pay for the negligence caused by their insured. Until you prove your loss in some court of law, you are not going to change their opinion or make them do anything. Once the insured tort feasor becomes legally liable, only then is the insurer required by their contractual duty to the policyholder, to pay the damages. You are going to be running in circles and losing sleep nitely until you come to realize these facts. And if it under their deductible, you are still going to have to collect from the tort feasor or negligent person, persons, contractor or whatever.



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PostPosted: Sat Jan 08, 2011 9:33 pm   Post subject:   

So, what are my odds if I try to make a claim with the milling (sub) contractor? They are the ones named in all the paperwork as the guilty party. I explained to the head contractor they could subrogate against the sub as they are responsible for their subs and they said this was not true. They said if their sub has insurance then they are to be held responsible.



I have no problem suing them I just don't want to get to court and have them tell me all my evidence is hearsay and/or I needed to file suit against the county as well.



So, will talking to the head manager in the claims department - maybe writing a demand letter with the legal paperwork - get my claim paid?



Or. maybe I could file a claim with all the subs and attach a copy of my small claims filings as you stated and send it to the main contractor as well.



What s your opinion in filing suit on all the contractors in small claims or suing the county as well in civil court. The civil case is a bit more involved but it covers everyone involved. So, no one can can still try to blame the other. The only downfall to this again is is my evidence hearsay and the county will also have lawyers there and I have done a lot of research but I am no lawyer.

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PostPosted: Sat Jan 08, 2011 9:43 pm   Post subject:   

Also.....lets say I sue the contractor and the contractor does not submit it to their insurance, which they are suppose to do, and I send the insurance company a copy of the lawsuit. Will the insurance company make their insured turn the claim in and then hopefully settle the claim. Or, will they not care if they defend it themselves and not turn it in?

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PostPosted: Sat Jan 08, 2011 10:13 pm   Post subject:   

I suspect most contractor liability policies carry a deductible with the understanding that the policy holder takes care of the small claims. You take a water tower contractor that gets paint overspray on 200 cars within a quarter mile radius, there are going to be substantial losses. But if they only damage 4 cars, it's likely the contractor has factored that in to their cost of doing business and they will only pay those losses if push comes to shove.



I'd sue the big cheese if it were me. If he has to go to court because one of his subs is negligent, I'd be willing to bet he'll turn on the sub in a heartbeat making him take care of his own mess. If you sue him and the court says he's not liable, then you've spent a little money to find out who you have to sue, and the next round you can nail the sub. An attorney would sue all of them and any of the laborers that were not under the umbrella of the sub or primary contractor. Someone is liable. I would start at the top.



Another example would be, I operate a collision repair business (fact). The customer brings me an estimate prepared by the insurer, and says can you fix my car for this? I'd look at the bottom line total, calculate my own estimate and tell them if there were enough funds paid by the insurer to indemnify you for your loss and say yes or no. Another shop might say we'll fix it based on the insurer criteria, specifications, and estimate. Now the estimate has a used suspension figured and your shop buys and installs that used part. Later the repair fails due to the bad suspension part. Now who are you going to sue? The insurer who's estimate sourced the part? The shop that only used the sourced part or the salvage yard that supplied the part or the suspension and alignment shop that the shop subcontracted the installation to?



In this scenario the shop is liable. You formed a contract with the repair shop to repair your vehicle and it is they who are contractually liable for the repairs. Insurers do not repair cars, they pay for losses and they will gladly tell the judge that. The shop is deemed the expert, the subcontractor fulfilled it's obligation to the shop for the price agreed. You did not purchase the part from the salvage company so you can not sue them. I am not an attorney and this is not intended to be legal advice, but I would sue the primary contractor and forget about the subs.



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PostPosted: Sun Jan 09, 2011 12:00 am   Post subject:   

I'm having a hard time with this as you've posted in so many places its difficult to put all of the pieces together (you have some info on one post, some in another, etc). You even posted this same question again today! Even after I mentioned that you should avoid posting again and again and again! This does nothing but to make it more difficult for anyone to give you an answer. That is most of the reason why I simply gave up... you are not waiting to listen to anyone... you just keep posing the same thing. It's like talking to a 5 year old hop'ed up on candy. Rolling Eyes



What I don't understand is who exactly did what and who was responsible for doing certain things.



Who and what caused the pot hole to form? Was this a direct cause of work going on (i.e. someone created the pot hole as a part of their work) or did it form as a result of work being done elsewhere (i.e. water/work from another location caused the pot hole to form)?



Where these barricades up surrounding work nearby or were they up around the pot hole?



Here is what I will day... a General Contractor _is_ responsible for the people that they hire. This is the whole reason why a GC is paid for their service. GC should have some type of contract with their sub's, stating that the sub will protect the GC, but this does not apply to a 3rd party. That is, a 3rd party is free to hold the GC responsible for the subs work (rightfully so) and the GC can ask the sub to protect them (the GC) but this does not make the GC not responsible.



I _think_ a big part of your problem is that you are dealing with the repair companies directly and not any insurance companies. If you have contacted an insurance company have they sent out a written denial? The city should have insurance info on file for anyone working on their roads. Ask for it. If they don't want to give it, point out that you will include the city in your suit as they are giving you no other choice.



If you file suit, you file against _everyone_! It's not your job to determine who is how much at fault. You present 1 case against _all_ the parties. It's then up to each party to defended themselves against your proof. It's then up to a judge to figure out the rest. That is not to say that you still don't need to prove your case... just that you don't need to pick and choose who you file against. You are in court anyway... it's the same amount of work for you to drag 5 people in with you as it is to drag 1 person.



If you file suit or probably even show that you will file suit, those repair companies will probably file a claim with their carrier or even pay your claim. I'd recommend filling out the small claims paperwork and sending it to all of them. Give them 14 days to respond and pay your entire loss or let them know you will file the paperwork.

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PostPosted: Sun Jan 09, 2011 6:25 am   Post subject:   

Alright Mr. tcope. I really am tired of your rolling of the eyes and rude comments. I let the first one go. I have posted in other area's yes. I have emailed you directly and you dont respond. You "told" me not to post. Are you serious???? I can post where ever I want. I posted in other AREAS so other people in other areas could respond. I am seeking help. I apologize I am very indecisive and am am just paralyzed with this indecision I have given the same information in every post and from some of your comments you clearly did not read them. I even have the information you say I did not supply.



With that said.....



It was a county project. The county hired a contractor to resurface the roadways. The contractor hired a sub contractor to do the milling of the road.



There was a water main break under the roadway that they think created the pot hole. County workers repaired the irrigation line and the pot hole on one day and the next day they came out to check the hole and/or remove barricades from around the pot hole. I have it in writing that when the county crews arrived at 920 am the milling and overlay contractor moved the barricades, the road had been milled and they closed out their job at 9:20 AM. They left the job in the hands of the milling and overlay contractor. The milling company is the sub contractor.



I have a recorded call where one of those workers states they arrived and the barricades had been moved by the contractor and the road had been milled. He also said he saw that the pot hole had redeveloped and was unprotected. I asked him why he didn't barricade it again and he said "his crew can not do barricades". So, there lies liability with the county. The county was denying my claim saying they did not know about the pot hole after the last repair. Well, this county worker's testimony proves that is not true.



I think I forgot to mention I hit the pot hole 4 days after this repair. Since that repair I have three witness statements that said they saw construction workers working around the unprotected pot hole. I have county workers that left the job in their hands. I have a recorded conversation stating the same. The county worker flat out said the hole should have been blocked off when I hit it.



The construction company's insurance told me that the company "says" they were not there....well I gave them all the above proof and they are taking their word. They even told me that they asked them to provide logs to prove where they were on the dates i question and they were unable to provide those logs. HELLO !!!! They can't provide them because they were there!



I am baffled how they are all denying my claim.



What am I missing????



The construction companies insurance denied my claim and so did the county.

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PostPosted: Sun Jan 09, 2011 6:48 am   Post subject:   

I forgot to add that I have it in writing that the weight of the contractors equipment is what busted the hole back open.

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