USAA trying to push claim to Total Loss

by delanok » Wed Mar 27, 2013 05:08 pm

06 Scion XB first party accident. USAA is insurer. Some inflating of the repair estimate to get to a total loss by adding fog lights which my vehicle does not have, etc. On the total loss valuation, then they attempted to undervalue the vehicle by $1300 using the fraud of under grading the condition of my vehicle while using CCC guidelines that apply to higher grades. State guidelines specify when a monetary settlement is made and repairs exceed 75% of fair retail value equals total loss. USAA sent a senior adjustor from 700 miles away to redo the repair estimate who took off $1000 of fake repairs and added back $1300 more, some of these questionable as well. They refuse to pay for a teardown estimate. Applying the less strict policy definition for total loss, I am below the total loss threshold by $700. Using the state guidelines, I am above the loss threshold by $40 of repairs. I have identified a source for CAPA repair parts that will reduce the repair estimate by $900, but USAA is hard set that this is a total loss. Since their total loss offer is still too low, I just want to have it repaired and submit the bill to USAA as long as it is below the state threshold and also below their repair estimate. Besides the potential for exeeding the estimate are there any pitfalls in this? I retain the title full and clear. Appraisal clause would be stymied by lack of agreement on umpire.

Total Comments: 17

Posted: Wed Mar 27, 2013 06:55 pm Post Subject:

Using the state guidelines, I am above the loss threshold by $40 of repairs

Despite language to the contrary, your policy almost certain includes language that makes it conform to state law.

Since their total loss offer is still too low, I just want to have it repaired and submit the bill to USAA as long as it is below the state threshold

Not your call. You can arrange to purchase the vehicle from the insurance company as a salvage and use the balance of funds any way you choose to effect repairs.

Your only dispute is over the value of the vehicle. If you provide a better set of comps to support your higher valuation, they may be willing to increase the loss valuation.

You can always file a complaint with your state's dept of insurance.

Posted: Wed Mar 27, 2013 08:31 pm Post Subject:

USAA's actions regarding this claim are not exactly above board. Some of them are downright fraudulent. No matter how much they wish, USAA cannot arbitrarily abrogate the policy language and declare a vehicle a total loss if the cost to repair is less than the ACV minus salvage, so I would say it is "not THEIR call" to declare it a total loss, especially given they inflated the repair estimate and deflated the ACV in an attempt to get it to a total loss. If I remove replacement of one hubcap from the repair estimate that was not damaged or even scratched in the accident that they falsely included, both policy language and state regulation agree that this is not a total loss.

Now how reasonable is USAA being if they insist a hubcap that was not damaged needs to be replaced and refuses to correct this? I have sent them additional LOCAL comps and they refuse to include them. It seems they only follow thier valuation process when THEY control the variables, not the insured. After I caught them in the $1300 condition fraud, they refused to make any other changes to the valuation, including removing vehicles with prioir accidents from 150 miles away that are obviously not comps.

My question is how to proceed with complying with the policy provisions and having the car repaired given USAA has chosen not to and displaying bad faith in delaying payment. I have raised the issues to the state dept of insurance and have submitted a request for hearing based on USAA's violations and the state's failure to enforce their regulations. I await the state's reply, but hey this is Alabama, so I don't hold out much hope for that route.

Posted: Thu Mar 28, 2013 01:34 am Post Subject:

No matter how much they wish, USAA cannot arbitrarily abrogate the policy language and declare a vehicle a total loss if the cost to repair is less than the ACV minus salvage, so I would say it is "not THEIR call" to declare it a total loss



Moot point from their view. I have no doubt that the numbers they are coming up with allow them to pay for the vehicle as a total loss. It's just that _you_ are stating that those numbers are incorrect. Two different things there.

I'm not sure I follow your post. You seem to be saying that they are inflating the repair cost in order to consider the vehicle a total loss. But then you also state they are under evaluating the value. These things would go against each other. It would be tough to hit the sweet spot that would over-evaluate the repair amount and under evaluate the value so as to work in USAA's favor both ways.

My question is how to proceed with complying with the policy provisions and having the car repaired given USAA has chosen not to and displaying bad faith in delaying payment


If I recall correctly, your policy spells this out. I'm pretty sure there is an appraisal clause.

Usually when a person complains that the carrier is over-evaluating the repair cost (i.e. it can be repaired for less) I tell them to take the total loss amount and have the vehicle repaired. They can then pocket the difference. But in this case you seem to be saying that they are also paying less then the value... but are they still under their repair cost?

You are not giving enough information (i.e. real numbers).

Appraisal clause would be stymied by lack of agreement on umpire


I've attempted for forsee the future but it never has worked out for me. Why do you think you could not agree to an umpire? You submit a list of parties that would be acceptable. It's then USAA's choice to either agree to one of those or to submit their own list to you. Technically, your appraiser and their appraiser need to agree. You and USAA don't actually agree. If you have an independent party agreeing to be your appraiser then I'd recommend you read the appraisal clause to see if this then means that USAA needs to hire an appraiser. That is, not the USAA employee.

Posted: Thu Mar 28, 2013 11:48 am Post Subject:

No matter how much they wish, USAA cannot arbitrarily abrogate the policy language and declare a vehicle a total loss

As tcope has said, from USAA's perspective, they are not violating the language of the contract. You apparently disagree. So you can fight them until you turn blue.

It seems they only follow thier valuation process when THEY control the variables, not the insured

This is insurance, not Burger King. You don't get it your way.

What exactly do you want? Repairs or money? Do you want to keep the car?

As I surmised in my previous response, if you want to keep the car, the only sticking point is the value of the vehicle. You provide absolutely no information here that could lead to estimating the value of the vehicle (mileage, market, equipment, etc). I'm guessing they are valuing the vehicle around $5000-$6000 and you think it should be valued at $6300-$7300. An independent appraisal would settle that discussion, but you don't seem to want to go down that path.

You don't think USAA is being reasonable, and it appears that you aren't either. But you like to use cute phrases like "fraud" and "abrogate the policy language". That can happen from your side of the contract, too, you know.

My question is how to proceed with complying with the policy provisions and having the car repaired given USAA has chosen not to

It's Scion XB -- an unsightly little box of a vehicle without any damage. Maybe that's the reason they want to declare it a total loss. What more can I say?

Your question has already been answered. Salvage the vehicle, negotiate a salvage amount, which will be deducted from the ACV of the vehicle, and you will get a check for the difference. With that money, you can fix or not fix, replace or not replace, any part of the vehicle you choose -- now it's like Burger King, because insurance is no longer involved.

Your repaired vehicle will have to pass DMV inspection to receive a clear salvage title. Make sure all of the hubcaps are in compliance.

Posted: Thu Mar 28, 2013 03:18 pm Post Subject:

First total loss valuation $8667 (includes tax & title). Repair estimate $6658 , so the ratio is 76.8% = total loss. Obviously they tried to hit a *very* sweet spot for themselves. Next iteration with the adjustor supervisor after I pointed out errors was Total Loss $8878, repair $7763 = 87% (once they figured out I was scrutinizing the numbers). Third iteration after I pointed out the condition fraud in the total loss vaulation is Total loss $10282, repair $7763 = 75.50%. Now they are back on the margin, and I'm pointing out other problems with comps so they stand firm against any other changes. A repair cost of $7711 (a difference of $52) would result in a repair not total loss. Coincidentially, the hubcap that does not need replacing is $53. The rocker panel moulding that was not even scratched is $393, and there is more. Average market value around here for equal condition (CCC excellent) vehicle is $11000+ with tax and title. I know the book value is lower but apparently they sell for more than book here. USAA does not use book value because they can't manipulate the variables. In 99.99% of the cases, it yields a lower ACV because they under grade the loss vehicle and cherry pick comps. This is the one case where following the process (correctly) is gonna cost them more, and they hate it. I have been somewhat successful in forcing them to use their method fairly, and as a result am close to a fair valuation. If they would remove the $800 baseline adjustement, we would be there. Since my vehicle is superior to the condition of probably all the (uninspected) dealer comps the used, there should be no adjustment for making it "dealer ready". They have to protect the CCC valuation integrity for the industry, so they will never agree to remove this fake adjustment. Even though state requires them to, they will not give me the CCC condition evaluation guidelines and associated values, so I think there is still some fudging there (can anyone provide this?). Don't hate me cuz I was able to use their process against them. BTW, did you know 100% of their employees received an 18% (yes 18%) bonus last year? This is a mutual insurance company, and I'm not feeling the love. I would rather receive the (correct) ACV, but I am not going to let them rip me off after 30 years of paying premiums without a claim. The appraisal clause is a joke and does not call for independent unbiassed appraisers, so their employee would appraise, I would act as my own appraiser, and I would never agree to use one of their umpires as this stacks it 2 against 1, and I am sure they would not agree to use mine, so stymied. In fact they have involked the clause themselves, so I know who it is designed to benefit. Even though they involked the clause, they did not send a check for the undisputed amount, so again, bad faith. Bottom line, I can spend $800+ to get a similar vehicle in lesser condition, or spend nothing *shop will pay deductible* and get it repaired without a salvage title and drive the wheels off it. What I can't understand is why USAA won't beg to have it repaired now that their supposed claim costs (ACV - $1800 salvage) would be $8500 vs $7763 for repair. I think they lowballed the salvage value to make the numbers work in their favor for total loss, before they found out I was gonna make them follow their method properly. Once they gave me the salvage value, they could not change it. Screwing the policyholder is a numbers balancing game (hit that sweet spot), but I also know numbers and the valuation process well. I have managed to screw this up for them, and they don't like it. My way is to follow the policy provisions and state regulations, so yes, I am going to have it my way and USAA is going to have to make a fair payout whether it is for ACV or repair.

Posted: Thu Mar 28, 2013 11:20 pm Post Subject:

First total loss valuation $8667 (includes tax & title). Repair estimate $6658 , so the ratio is 76.8% = total loss. Obviously they tried to hit a *very* sweet spot for themselves. Next iteration with the adjustor supervisor after I pointed out errors was Total Loss $8878, repair $7763 = 87% (once they figured out I was scrutinizing the numbers).

Okay... so you pointed out errors and the value increased by $200 and the repair cost jumped by $1100. So it appears you got them to increase the repair cost by a lot and the value by next to nothing.

Third iteration after I pointed out the condition fraud in the total loss vaulation is Total loss $10282, repair $7763 = 75.50%.



So now the value increased by about $1,800 and the repair cost stayed the same. This is where I'm confused.... first your complaint increased the repair cost then your complaint increased the value (pretty much cancelling themselves out). It seems to me that you have just been shooting yourself in the foot. The ratio started aty 76.8% and ended up at 75.5% (pretty much the same).

At one point you got them to increase the repair cost (appears to be something you did not want) but you are now complaining that they are including repairs that are not needed.

Since my vehicle is superior to the condition of probably all the (uninspected) dealer comps the used, there should be no adjustment for making it "dealer ready". They have to protect the CCC valuation integrity for the industry, so they will never agree to remove this fake adjustment.



Yup. CCC values are _crap_ and USAA's "baseline" adjustment is incorrect. My friend just sued USAA over this "baseline" adjustment and won in small claims court. The attorney USAA hired stated USAA would probably appeal but they did not and USAA paid the judgement.

Even though they involked the clause, they did not send a check for the undisputed amount, so again, bad faith.

Yup, they did this to my friend as well. When he pointed this out (and that interest was owed) they paid the undisputed amount plus interest (prior to any judgement).

Posted: Fri Mar 29, 2013 12:12 am Post Subject:

My initial intent was to point out errors to reduce the repair and bring it back from total loss, as they weren't offering me anything realistic as ACV. Once they figured this out, they sent in the big gun to up the repair cost by $1100, instead of reducing it as I had intended by pointing out some errors. They took out those errors and inserted even more questionable stuff which they refused to remove. So I gave up on repair and went for getting a realistic ACV. This is where I got them to go up by pointing out the grading fraud. Of course, since I don't have the dollar amounts associated with the grades, I don't know if the $1800 value is correct for the top grade. They might have fudged those numbers to keep the ratio above 75%. Now since they are so close to 75%, and their repair estimate is still wrong, I might as well just get it fixed. Suing over the baseline adjustement sounds like a good idea in my case, since given the condition, it cannot be justified. What rationale did your friend use in his case? Did he sue after or before claim settlement?

Posted: Fri Mar 29, 2013 03:36 am Post Subject:

fraud

You keep using this word without any evidence of intent. Without intent, there is no fraud, but there could be a case of bad faith. The two are not the same.

Again, and for the last time, your issue concerns the ACV of the vehicle, not the repairs or the repair cost, since whatever is wrong you believe can be fixed for less money. So if they won't come to terms with you over the ACV, then you simply sue them and hope that your evidence to support your claim is stronger than theirs that supports a lower value.

The bigger issue behind this is that your talking about a value that far exceeds the Small Claims Court's jurisdiction. To take this to the next level can be done in pro persona, but you are going to be completely overwhelmed by the insurance company's attorney, who will be able cite numerous examples of case law that support the company's position, and you will probably be ill-equipped at best to respond appropriately to those citations.

The end result would be that you would win, but you would only win what the insurance company is already prepared to offer, and maybe a smidgeon more if the court takes pity on you. With an attorney, you will come away with even less than could be in your pocket today, because the attorney will get 30%-40% of the judgment/settlement. Pressing a case for bad faith, and your likelihood of prevailing in that is minimal at this point.

Your best bet is to simply hold out for a better ACV, and to do that, you will have to supply valid documentation that more adequately supports your contention as to the value of the vehicle. The longer they take to settle, the stronger your bad faith case might become. But from my point of view, there is no fraud here.

Posted: Fri Mar 29, 2013 02:04 pm Post Subject:

It would be helpful if you or someone could provide me with the CCC condition guidelines and associated dollar adjustments. Do you have access to these? USAA treats them like they are top secret, even though the CCC valuation report I received has a blank column where they should be. Whether it is fraud or bad faith does not really matter to me. What matters is that this is a strong indication on how USAA's representatives have and most likley will continue to treat this claim. I have requested this info from USAA, and have submitted better comps to support raising the ACV both in writing. That was over two months ago. All I have received is a short letter (as required by state regulations, but late) acknowledging my request and stating that it is "under review". They sent me a letter involking the appraisal clause. I responded acknowledging their request and stating that it is "under review" pending receipt of the information I requested from them first. My mistake was letting them move the vehicle from my repair facility to the copart lot after the accident. I lost a lot of leverage when that happened. At the time I trusted them. Lesson learned.

Posted: Fri Mar 29, 2013 03:52 pm Post Subject:

Whether it is fraud or bad faith does not really matter to me

It matters to the court.

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