Limo Accident Between States. Reasons for Denial?

In general, threatening an insurance adjuster is about the last thing you want to do. It seriously slows down claims, same with involving a lawyer.

This is not out of spite, but a byproduct of the concerns. As soon as a lawyer is involved, the claim time will double if not triple. There are a lot more i's to dot and t's to cross. Insurance companies will also send everything through their legal department. They have to protect themselves.

My recommendation above was that there was no need to get a lawyer involved. Why? I knew it would slow the claim down.

Now, you are threatening them with a DOI complaint, after the lawyer thing. Now, they need to not only dot i's and cross t's, but make sure the placement of the dot is correct and the slant of the cross is perfect. Hence, they now need a letter rather than a verbal statement.

At this point, you have made the situation worse for yourself. There is no good way to back out of this. You'll have to get the letter from the lawyer. You'll have to apologize to the adjuster, explain you are under some stress to get back into business, but don't expect him to budge much. You have been pegged as a bit of a hothead that can cause trouble (tell me I'm wrong on this).

It will get resolved, but you need to start working with the process, not fighting it. Also, understand that if it is approaching 30 days (or over 30 days), they have already filed with the DOI that the claim is being delayed. A complaint at this point, without a resolution offer, will fall in pretty deaf ears.

You have ran into a lot of very standard stuff. A lawyer should tell you up front that a claim will be slower if they are involved, but they never do. Threatening someone about a complaint for not following procedure (effectively what you complain to the DOi about) makes them follow procedure to the letter.

So, my advice:
- Get the letter from your lawyer.
- Don't threaten a complaint to the DOI. If you want to send one, just send it. Don't do this till you have a settlement offer or 90 days into the process. Doing it before this will bring everything to a complete stop. This is not an effective way to expedite anything, but can change the outcome of things.
- Cooperate with the adjuster.
- If they make a settlement offer and you are not happy with it and they are unwilling to negotiate, then hire your attorney again.
- Don't feel threatened by the process. Let it runs its course.

Basically, having a claim referred to special investigations is no big deal. It happens all the time. Having special investigations refer a claim to the legal department (i.e., getting a lawyer involved) is a bummer. You are close to being there.

I don't want to imply having a lawyer is a bad thing. Its usually an unnessecary thing. It always slows claims down (with some exceptions, but they are rare) and it almost always has claims run through the insurance companies attorneys, rather than through the normal process.

Unfortunately, not much I can do for you at this point.

Dan
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I meant to add, your agent should have walked you through all of this already. Doing so is why I get paid the mediocre bucks!

Dan
 
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Well Dan, I don't know what to say. I appreciate all your advice first of all. And you know what is the craziest thing about what you told me? That my agent was the one who suggested me I should them about the complaint and that could make the ball roll faster. He also said he talked to the general agent and then to one of the main managers in the claim management company (the one who's giving me trouble), and they said they didn't see any problem and this should get resolved eventually. Problem is, I don't have too much time anymore. And besides, I got my brother and my father who are part of the company (my brother actually makes a living out of this business and he hasn't got any income for two months already) on my back, they don't really want to be part of any of their games because it is the way they see it. And on top of that, next week I'll be leaving for three weeks on a project from work out of the country. I will leave a power of attorney to my dad, and let him take care of this when I'm absent. And that's why I'm thinking I have to send the complaint to the DOI and let it run its course. Unless they said something that could show progress on Monday.
I understand perfectly what you said, and I shouldnt have followed the advice from my agent and just send the complaint without telling them. But the truth is that I dont know if it's normal, but they are really really uncooperative with me, I have done nothing but what they have asked me for, and they ignore me completely and always giving me more and more obstacles. That's why I am so desperate and that';s why I want to follow your advice, but I just don't have time anymore.
I cant believe you pay your premiums, you get your insurance the correct way, never paying late, and this is what you get when you have an accident. The are supposed to be on my side, but it is just the opposite.
Thank you very much Dan, you have been really helpful so far. I dont have experience with this things, and that's probably because I never really get in trouble and try to be as honest as possible, and run my business the best way I can. I just hope this gets resolved soon.
 
Do yourself a few favors:
- Let the adjuster / investigator who is working on this know your dad has power of attorney and that they can talk to him. Unless you tell them, they won't know and this will continue to cause delays.
- Don't bother with the DOI complaint yet. Seriously, this will slow the process down further. In addition, the DOI will do nothing to help you at this point.
- Enjoy your trip. Check in every once in a while with family, but get this out of your system for a bit.

Now, look at your business policy (not auto, but the actual business policy). See if you have loss of income coverage. Then look at what triggers this and see if having the limo out of service will make this pay. Not great odds on this happening, but its a possibility.

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For the record, the reason I say to not bother with the DOI complaint is you really need something solid to complain about. This is somewhat harsh, I understand that, but until the time becomes excessive (figure 90 days) or you have a negative outcome, the DOI getting involved just muddies up the water and slows down the process.

In my experience, most special investigations are solved in a couple of weeks, when they run over a month, something serious is being looked at, or there has been a lack of cooperation in resolving issues. I've had a few run much longer, most were caused by extreme lack of cooperation from the claimant, the others from lack of responses from 3rd parties. Stuff happens. Overwhelming majority of claims were paid, even claims that were probably bogus because they couldn't be proven.


Dan
 
Dan, you are really nice and helpful and I hate to bother you so much, but I almost feel like you are my best advisor in this situation. I hope you dont mind me asking your thoughts on something again.

Turns out the insurance company called me today and said the attorney who took my EUO now wants the driver to go there too and take one as well.

Problem is, the driver doesn't want to do it. He says he doesn't have time and he's willing to answer any questions on the phone and cooperate buy he cannot go to the attorneys office.
I kind of ended up in bad terms with him after all this problem because I didnt like the way he took everything and once, after an argument, I actually told him we were going to look for somebody else to drive when we resume operations. He didn't take it well, but I had my reasons, besides he already has a job; and that is his excuse for not being able to go take the EUO. Actually, I have a feeling that his current employer doesn't even know what happened and he's afraid they will find out. He says there is no way he will be able to leave work to take this, and he cannot ask for permission, because he is on trial and he just started less than a month ago. I think he doesn't want them to find out what happened now that he is on trial, and I cannot really force him to, because in a way, he's right to be afraid.

I actually prefer him not to go (I have a feeling he can get us into more trouble cause he has a tendency to speak his mind and has little common sense, hence the accident), but what can I do? Should I tell the attorney I just cant convince him, although he is available for questioning and take a statement on the phone? After all, he doesn't work for me anymore, there's not much I can do, is it?

I already did everything they asked me for and this is something that I can't control. I gave my statement, I gave all the papers they asked me for and I have cooperated with everything they have asked me to do. What do you suggest?

Thanks again
 
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Cooperation is important, but I would suggest that the investigator start with a recorded phone statement with the driver. After that, if there really is enough inconsistencies to worry about, then work on the EUO but at a time the driver can make (evening? Saturday?)

We seemed to have skipped a step here though.... are they talking to you again? I thought you were waiting for a letter from your attorney?

Without the ability to talk to the investigator and not being the agent on the policy, I'm not sure how much help I can be on this. It is a process where it has to run the process. There is a second side to the story that I am missing entirely.

Dan
 
Oh yeah, sorry I forgot to mention I got the letter from the attorney last Monday (turned out he was available on Monday, his secretary had told he he would not be there, but I called him anyway). He sent it to them and that's why they called me yesterday to let me know they had received it and they could talk to me now, but the last thing they needed was the EUO from the driver. I also think it's weird they want to go through that before even speaking with him at all (he's been waiting for them to call him, and they never had).
I guess I'll talk to their attorney and tell him the driver can be reached on the phone and he can call him, but he said he cannot go to make his statement in the office because of work. If he wants to convince him then, by all means, but I cannot force him. And if he needs anything else from me, I'll be happy to do it. I just want this to be finished as soon as possible.
I'll also send him the power of attorney like you said.

There's been something I've been meaning to ask you. Are you an agent? Are you by any chance in California? I have a feeling a need a new agent.

Thanks again
 
I'm an agent in Northern California. Get this claim resolved then we can talk.

Dan
 
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