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 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!

InsTeacher 8)

Posted: 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.

Posted: Sat Jan 08, 2011 07:11 am Post Subject: elaboration

OK....here it is ....:)

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. :) I am torn with indecision. Any advice would be much appreciated.

Thank you!!

Posted: Sat Jan 08, 2011 09:13 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.

Posted: Sat Jan 08, 2011 03:59 pm Post Subject:

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

Posted: Sat Jan 08, 2011 05:04 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.

Posted: Sat Jan 08, 2011 08:56 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?

Posted: Sat Jan 08, 2011 09:17 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.

Posted: Sat Jan 08, 2011 09:33 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.

Posted: Sat Jan 08, 2011 09:43 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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