AAA Denial of Claim

by job jacob » Fri Aug 24, 2012 07:12 am

Hi Max,

About 2 weeks ago I was rear ended at an intersection in redwood city, ca while waiting for a pedestrian to walk through at the crosswalk The lady who hit was driving a larger pickup truck. The truck was so large that her bumper hit my trunk and left a huge dent in it. We stopped, exchanged insurance information and went along our business. She asked me if I can wait for couple days before I can file a claim against her insurance, meanwhile she will check with a body shop she works with if they can repair my car and she will pay for the repairs. She asked me via email for additional photos of the damage, and I emailed them to her.

3-4 days passed by and instead, she filled a claim with AAA, and a AAA agent adjuster called me to take a statement. Meanwhile they wrote me a letter requesting more information about the accident. Then they scheduled time to send an inspector who came down took pictures and measurements of the damage. I didn’t hear back from AAA for 3 days, so I called, got hold of the adjuster who now is claiming that the shape of the damage on my car does not coincide with the shape of the bumper in her car. The adjuster also said that his insured does not believe that she had hit my car, because she didn’t feel any impact. His final statement to me on the phone was: ”As far as I am concerned there has not been an accident”.

I have photos I took on the street at the time of the accident of both her car and mine. How can I prove that this accident had occurred when it truly had occurred and both got out, looked at the damage, talked, and exchanged insurance information ?

I am shocked, this is straight forward scam by AAA to deny paying for a claim using such cheap tactics. Short of suing this lady who hit my car, what other choices do I have in settle this claim ?

Any help will be greatly appreciated
Thanks
jacob

Total Comments: 13

Posted: Fri Aug 24, 2012 12:45 pm Post Subject:

When you are in an accident you are required to exchange contact and insurance information. If the accident did not happen... how would you have obtained this? You state that you have an email from their insured asking for photos. Send that to the adjuster and ask why their insured would be asking for photos if there was no accident.

If you have this info, it should be enough to show the adjuster that their insured is lying (if they are denying that the accident happened... not that she did not cause the damage). There is a difference.

Setting that aside, do you have a a mobile phone with a camera? If yes... you should _always_ take photos at the time of the accident. I don't see why everyone does not do this.

Posted: Sun Aug 26, 2012 02:59 pm Post Subject:

Short of suing this lady who hit my car, what other choices do I have in settle this claim ?


I can only agree 100% with tcope on this.

If an accident did not occur, why would AAA even be contacting you? What reason would she have for filing a claim with AAA?

Your choices are (1) Follow tcope's advice and provide your evidence to AAA -- perhaps to the adjuster's supervisor, if not the adjuster himself. Or . . .

(2) You can always sue the other party in Small Claims Court (up to $7500 in damages in CA), or Superior Court if the amount is larger than that. The best evidence -- or storyteller -- in Small Claims Court usually wins.

There are the only two ways to settle this -- be cooperative and work with the insurance company to resolve the matter, or go to court. You have up to three years to go to court. You probably want to do that sooner rather than later, but give the insurance company a second chance to make things right.

There are also two ways to possibly influence the outcome under (1) above:

(A) You can always file a complaint with the CA Dept of Insurance about the insurance company's behavior. It can sometimes change their way of thinking.

B) You can make a phone call to the Claims Supervisor in which you mention the "magic words" . . . unfair claims practices . . . which can often bring about the same change of heart. I've recommended that numerous times and seen it work almost as often.

Posted: Sun Aug 26, 2012 03:14 pm Post Subject:

An additional thought:

About 2 weeks ago I was rear ended at an intersection in redwood city, ca while waiting for a pedestrian to walk through at the crosswalk


You did get the pedestrian's name and contact information as a witness, didn't you?

Posted: Wed Aug 29, 2012 05:14 pm Post Subject: Update

First, thank you all for the great feedback. I have always known about the option of having to go court. Going to court means prepare a case, since i don't go unless I am well prepared and that takes a lot of time.

2 days ago I received a letter that officially denies the claim in writing. The language in the letter was so vague and said that their decision was based on "facts currently available."

At the scene I did take photos of the cars, plates, and damage. AAA has these photos, yet they still deny the occurrence of the accident. I took your advice and spoke to AAA adjuster supervisor, she was sympathetic, but said the claim had been denied.

Yesterday I sent an email to the adjuster, and his supervisor stating my side of the story, demand for payment, and raised the issue of their unfair claim practices, I also have filed a claim with the department of insurance.

The problem in these kinds of cases is that the insurance company in my opinion is committing an act of fraud. They know an accident had occurred; the adjuster and inspector usually have enough experience to know an accident when they see pictures and take statements. In this case, they chose make the process so difficult for me to collect in the hope that I will go away.

The very sad part when an individual make up for an accident to collect from a claim, it is called it "fraud" and rightly so. But when an insurance company denies the occurrence of an accident that had truly occured, so it does not have to pay, it is called "dispute".

Posted: Thu Aug 30, 2012 02:42 am Post Subject:

Yesterday I sent an email to the adjuster, and his supervisor stating my side of the story, demand for payment, and raised the issue of their unfair claim practices, I also have filed a claim with the department of insurance.


You hit the nail on the head on all accounts.

In this case, they chose make the process so difficult for me to collect in the hope that I will go away.


I think something is missing. If you have photos of the vehicle's together and have all the insurance and contact information for the other party then I don't see how they could deny that the accident happened. I can't see any adjuster or insurance company doing something like that.

Posted: Thu Aug 30, 2012 05:10 am Post Subject:

This is obviously a bad faith effort on the part of the insurance company. Aside from the complaint to the CDI, it could be actionable as a civil case -- just not much money involved since the damages are relatively small. Knowing that most attorneys will not get involved because there is no real money here, they deny the claim out of hand in order to starve you into submission. A well-known and unlawful tactic. It is prohibited under the Unfair Claims Settlement Practices Act.

There is no private attorney general right of action for unfair claims practices in California, but is it subject to examination in a court trial as the basis for a bad faith claim -- specifically, CIC Section 790.03(h) "Knowingly committing or performing with such frequency as to indicate a general business practice any of the following unfair claims settlement practices:
(3) Failing to adopt and implement reasonable standards for the prompt investigation and processing of claims arising under insurance policies.
****
(5) Not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear.
(6) Compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by the insureds, when the insureds have made claims for amounts reasonably similar to the amounts ultimately recovered."

Even though this third section states "insureds", it has been construed in favor of claimants, as well.

If the CDI refuses to get involved (a recent, and growing problem due to the state's mythical budget crisis), contact me and we'll see if we can't find you an attorney who wants to take on AAA.

A rear-end collision is essentially indefensible 99% of the time. Given the claims denial, if your damages are less than $7500, take it to small claims court right away. AAA may file a motion to remove to Superior Court, which is fine. That's where you get to file your "First Amended Complaint" seeking additional damages -- as a starting point, you might ask for triple the physical damage claim -- and attorney's fees for bad faith on the part of AAA for its violations of the Unfair Claims Settlement Practices Act -- CIC Section 790.03 et seq. Write to me for additional insight.

Posted: Sat Sep 01, 2012 12:33 am Post Subject: Update

Thank you again for the great feedback.

I received another letter today from AAA basically telling me that there is no dispute that their insured was at the location. But the pictures they took and measurements of damage's height do not coincide to the damages that I am claiming. They further are making a claim that no impact had taken place per the statement they got from their insured. Also they mentioned that I don't have witnesses or police report to support my claim. Based on these facts, they are denying this claim.

In my earlier email to them last week, I asked if they can have both cars inspected side by side at their office, they refused my request over the phone, and ignored the request when I raised it again in writing.

Do I have the right to ask for an independent third party to examine the damage, and their insured’s vehicle to put an end to their twisted version of the facts?

They indirectly closed their letter threatening me that they reserve the right to raise additional legal or factual bases to support their decision to the extent permitted by law.

Max Herr, thank you so much for your offer to find me a lawyer. Let’s see how far we can go without having to go the legal route

Posted: Sat Sep 01, 2012 02:53 am Post Subject:

They indirectly closed their letter threatening me that they reserve the right to raise additional legal or factual bases to support their decision to the extent permitted by law.


Don't take it personally, this is just legal mumbo jumbo that doesn't mean much legally. It's designed to rattle you, as it sort of did.

Do I have the right to ask for an independent third party to examine the damage, and their insured’s vehicle to put an end to their twisted version of the facts?


You can hire a Public Adjuster -- a licensed person -- to conduct an inquiry such as this. Problem is, the other party doesn't have to cooperate. If she refuses to let the PA view her vehicle or make measurements, there's not much the PA can do about that.

Your best course of action is to file a suit -- either in small claims or Superior Court. Again, AAA is likely to petition for removal to Superior Court if you file a small claims action because they cannot send their attorney to argue in that venue. Their insured is supposed to notify them if she is sued -- her failure to notify them will cause her to not be covered if you win the case, and then you'll probably have trouble collecting on your claim.

You can represent yourself in Superior Court, but you run the risk of not properly articulating your case, and by not being able to cite relevant precedential case law at a moments notice to support your position concerning bad faith on AAA's part. You only get one chance at this, and you need to make it the best and strongest case that you can.

Please email me copies of the photos you sent to AAA. I'd like to see them and offer you more guidance on how to approach this claim.

We stopped, exchanged insurance information and went along our business. She asked me if I can wait for couple days before I can file a claim against her insurance, meanwhile she will check with a body shop she works with if they can repair my car and she will pay for the repairs. She asked me via email for additional photos of the damage, and I emailed them to her.


I hope you still have this email you received from the other party. That would be prima facie evidence of her involvement in the collision.

Did you send a copy of that to AAA? If you didn't, you need to! I fail to see how they can reject the claim in light of her admission of involvement such as this. Send me a copy of that email with your photos.

Posted: Sat Sep 01, 2012 09:10 pm Post Subject:

Almost always the person who filed has the choice of courts. About the only time they don't is when something else requires that it be moved. This would usually only happen if AAA filed a counter claim... which won't happen. So it's pretty safe to say it would stay in small claims.

OP, write a letter to AAA and request that you either be allowed to inspect their insureds property or that they preserve it. Send it certified mailed. Do it now. In the letter give them xx days to contact you to make arrangements so that you can inspect their insured's vehicle.

If/When you file in court, you can then bring up the fact that you asked them to inspect the vehicle to confirm their information but they refused.

What AAA is probably claiming is that there is no damage to their insured's vehicle. It's also likely that they did not spend a lot of time confirming this. They are also not considering that, given today's bumpers, that this situation happens all of the time... one vehicle is damage and other is not.

I will also say that you have a _very_ good chance of winning in small claims court. You can pretty much show that the impact occurred and that you have damage. That is all that you need to show. AAA would then need to show a judge how that impact did not cause the damage to your vehicle. That is just not going to fly in court. People are not always going to have video of accidents. Most of the time you just need a few things to add up to support your claim. After that, the other person needs to disprove your claim.

If it were me, I'd fill out a small claims Complaint and send a copy to their insured and AAA. Give then 20 days to pay the claim. If they don't pay it in 20 days, serve their insured and file the Complaint. In the complaint, ask for all of your damages, loss of use, diminished of value and court costs.

Posted: Sat Sep 01, 2012 09:27 pm Post Subject:

I will also say that you have a _very_ good chance of winning in small claims court. You can pretty much show that the impact occurred and that you have damage. That is all that you need to show. AAA would then need to show a judge how that impact did not cause the damage to your vehicle.


This is the reason AAA would remove the case to Superior Court. They are prohibited from sending an attorney to represent their insured in Small Claims court. Their insured can only represent herself in that venue.

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