Good Situation for Comment

Discussion in 'P&C Insurance Forum' started by ToddC, Nov 7, 2006.

  1. ToddC
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    ToddC Expert

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    Hey I actually have a topic I can add for discussion... and you can feel free to response with your thoughts... but they had better agree with mine! :)

    (Very) quick background:

    Loss occurred in AZ (no PIP), insured lives in UT ($3000 PIP coverage and PIP is recoverable). Claimant is at fault:

    Insured's carrier pays about $2k in PIP and requests claimant carrier to reimburse. Now I think there is a possibility that they did not need to pay back, as PIP carriers action would need to be in AZ and AZ does not have PIP recovery (as no PIP) but that is a moot point as claimants carrier does pay PIP carrier back. Clear?

    So much later the claimants BI adjuster realizes that our insured's BI claim will exceed his $15k BI limits. To interject, what the BI adjuster _should_ have done was to obtain a PIP waiver from the insured's carrier as well as a BI waiver (as the insured has UMBI). But he does not. Instead he sends a $15k BI release to his claimant, which she signs and returns.

    So here we are. The BI adjuster wants me to "waive" our PIP subrogation rights. Well, I have some news... how can there be a waiver of subrogation when it's already been paid! I say it's now a different animal. It's no longer a waiver the BI adjuster is looking for but rather a guarantee that the PIP carrier will pay them back. Perhaps you has a legal right to have us waive our right of recovery on PIP but now that you have voluntarily paid it, it's a different set of rules. Some disagree with this.

    To add to the situation, the BI adjuster realized his mistake after getting the BI release back and in addition to asking me to "waive" PIP recovery, he also mailed his claimant _another- release, this one for around $12k (the difference of his $15k and what he paid)!!!! What!!!! Come on.... clearly this cannot be done. You offered $15k to your claimant in writing, they accepted... you now _have to pay that person the $15k. If your not only doing something illegal (breaking a contract) but also opening yourself WIDE open for a bad faith claim from your own insured. When your insured gets sued by the claimant, how are you going to explain why you did not issue the $15k payment as promised and avoided the suit all together.

    The BI adjuster is really trying to blame me for holding everything up. Now I don't take offense to that but it really is insulting. If he had done his job correctly, he would not be in this situation. So bottom line, don't blame me for your screw up.

    Now... can I fix the screw up? Perhaps. But again, don't try to blame me for your screw up and you really should kiss my A** if I do offer to fix it by paying back the PIP.

    As I mentioned, some disagree. I have no doubt they are wrong and they _insist_ that I'm an idiot and wrong. They say that I have an obligation to pay the money back as they were entitled to a PIP waiver. I say once they made a voluntary payment, the required waiver is moot. I also say, perhaps I'm wrong. But it's certainly my right to deny their request and have it go to PIP Arb to decide. You can complain all you want but that is my right. And you should still not blame me for doing that as it's still "your" screw up for offering more then your limits.

    Also, one could argue that had the BI adjuster done everything right and asked for the waiver that it would have been granted (I agree) and therefor it's the right thing to do and pay the money back. Okay... good point. But I say two things... send me a written request for the money back (as it's the proper thing to do) and I really don't think it's up to me. I think it's up to my recovery dept. It's their bottom line your asking for them to give up. They collected the money in first place. Who am I to mess with that?

    BTW- the BI adjuster also thinks the statute of limitations runs on the claim 11/15 (which is the 2 year mark). What he does not realize is that the BI claim has already been settled with that $15k release.

    Hope you can follow that. It's confusing, I know.

    Anyone want to give their input on this situation?
     
  2. saieddie
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    saieddie Guru

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    The appraiser screwed up. Let them take it to arbitration.
     

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