Will filing a complaint with the department of insurance get

by Frekals » Fri Jan 07, 2011 08:11 pm

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.

Total Comments: 24

Posted: 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.

Posted: 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. :roll:

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.

Posted: Sun Jan 09, 2011 06:25 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.

Posted: Sun Jan 09, 2011 06:48 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.

Posted: Sun Jan 09, 2011 07:55 am Post Subject:

You have a lot in writing but I'm guessing from what attorneys have told you, it's one party putting in writing that another party was at fault. This is why they are telling you it's hearsay... because that information is about worthless.

Posted: Sun Jan 09, 2011 04:38 pm Post Subject:

Really....after all your questions and this is your response....thanks a lot! They witnessed the fault that is evidence...recently lawyers on the forum say that small claims is more relaxed and I should be able to present it all....I see know you know nothing....

Posted: Wed Jan 12, 2011 02:30 am Post Subject:

why not file a claim with your own insurance. the cost of the lawyer and everything else is going to go over $500 which is probably your deductible.

Posted: Thu Jan 13, 2011 03:34 pm Post Subject:

The damage was approx. $1000.00 to my car.



The contractor denied your claim, the county denied your claim. It's not very complex.

Take your claim to small claims court where the rules of evidence that apply in more formal civil trials are suspended -- you can bring in all the hearsay evidence you want. Sue everyone connected to the pothole, and subpoena as many witnesses as you want. Then let the judge decide if any or all are at fault or if none are. You'll either get your $1000 or you won't.

Way too much posted about this above.

Posted: Wed Apr 06, 2011 01:27 pm Post Subject:

Hi,

Your case seems to be quite crucial. I think you take some professional assistance. Alone you will not be able to get through your claim.

Today people hire the services of loss assessors who help them with all the paperwork and documentation. Basically they do entire filing of a claim.

These professionals work on "no-win no-gain" basis. In other words they charge only a small amount of percentage of the total amount the claimant receives from the insurance company.

Posted: Wed Apr 06, 2011 03:50 pm Post Subject:

In India, they might be "loss assessors", in America they are known as "public adjusters" -- they typically take 10% of the settlement amount.

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