When Should You Go to the Consumer Services Bureau?

[USF3983]

Can't forget the other facts. The policy you want coverage through is a commercial policy for a cab. I think that has something to do with it.

 

[ny86]

Go ahead and go to the state about it, doing so isn't going to hurt your cause any.

It's possible they're denying it because there is no coverage (in NY u must have PIP) on that policy and suggesting there is a possibility the brother's policy may cover it. It's entirely possible you're in a situation where there is no coverage. If you're in a rental car in another state it's possible the NY PIP isn't going to cover it. If memory serves, your brother was driving the car.

One thing is very clear, you believe the insurance company should pay and you say they aren't. Again, you have nothing to lose by going to the state about it, but I wouldn't rule out the (unfortunate) likelihood that there just isn't coverage for your accident.

As had been addressed earlier, this is a great reason to have health insurance. Unfortunately the premiums in NY are off the charts, but that would be a way of making sure you were covered against medical bills.

Josh, did u read my post above?

My brother was NOT involved in any way and again i have coverage. Thats not a question here, its the insurance company not wanting to pay or be reasonable.

If you pay for PIP, all of your household members are covered, so how am i not covered? I lived at the same place with my dad my entire life. Where do you see i'm not covered?

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Can't forget the other facts. The policy you want coverage through is a commercial policy for a cab. I think that has something to do with it.

My dad uses his car as a business and personal use. It doesnt mean anything either way because PIP is for any injured passengers he may have or family members.

 

[Josh]

Josh, did u read my post above?

My brother was NOT involved in any way and again i have coverage. Thats not a question here, its the insurance company not wanting to pay or be reasonable.

If you pay for PIP, all of your household members are covered, so how am i not covered? I lived at the same place with my dad my entire life. Where do you see i'm not covered?

I've been trying to follow your situation and read through the other post. Admittedly I have other projects I'm working on and haven't been licensed to sell personal auto in NY for a number of years, but I am trying to keep all the facts in place.

Do you have a copy of the policy? It will usually specifically state what is or is not covered. for example, my motorcycle policy will not cover any vehicle with more than three wheels. It also talks about a number of different things. What does your father's policy say? Is it a commercial policy? The coverage on a commercial policy can be substantially different than a personal auto policy.

You're on a forum looking for help and a number of us, myself included, have tried to help you with your question(s) to the best of our ability.

Most of the time when a consumer is upset about the way a claim is being handled and it's this severe of a discrepancy between what the customer wants and what the carrier is doing, the carrier is right. Carriers can and do make mistakes, but it's much less often of an occurrence than when consumers have unreasonable expectations about what carriers can do. If I'm understanding the situation correctly, you're expecting your dad's policy in NY to cover you in a rental car while you were in Florida with someone else driving. There is a lot going on here and I think it's a stretch.

Outside of the advice you've already given I don't believe anyone else here is going to be able to give you more help. This is a very specific claim situation. Again, generally carriers pay claims, even tricky ones. If you feel the carrier is jerking you around by denying the claim than go to the state and file a complaint. They will look into it and the carrier will have to explain why they aren't paying the claim.

If you really are feeling ambitious you can review the actual law here:

Guide to Recovery of PIP in New York. (With Other Selected Subrogation Laws)

 

[ny86]

I've been trying to follow your situation and read through the other post. Admittedly I have other projects I'm working on and haven't been licensed to sell personal auto in NY for a number of years, but I am trying to keep all the facts in place.

Do you have a copy of the policy? It will usually specifically state what is or is not covered. for example, my motorcycle policy will not cover any vehicle with more than three wheels. It also talks about a number of different things. What does your father's policy say? Is it a commercial policy? The coverage on a commercial policy can be substantially different than a personal auto policy.

You're on a forum looking for help and a number of us, myself included, have tried to help you with your question(s) to the best of our ability.

Most of the time when a consumer is upset about the way a claim is being handled and it's this severe of a discrepancy between what the customer wants and what the carrier is doing, the carrier is right. Carriers can and do make mistakes, but it's much less often of an occurrence than when consumers have unreasonable expectations about what carriers can do. If I'm understanding the situation correctly, you're expecting your dad's policy in NY to cover you in a rental car while you were in Florida with someone else driving. There is a lot going on here and I think it's a stretch.

Outside of the advice you've already given I don't believe anyone else here is going to be able to give you more help. This is a very specific claim situation. Again, generally carriers pay claims, even tricky ones. If you feel the carrier is jerking you around by denying the claim than go to the state and file a complaint. They will look into it and the carrier will have to explain why they aren't paying the claim.

If you really are feeling ambitious you can review the actual law here:

Thanks Josh!

I do not have a copy of his policy right now but I know for a fact i'm covered. I was never denied saying im not covered. PIP is something that covers you anywhere in the USA. It doesn't matter where the accident occurred.

I really do feel they are jerking me around. I will reach out to the state

 

[Accelerated]

Thanks Josh!

I do not have a copy of his policy right now but I know for a fact i'm covered. I was never denied saying im not covered. PIP is something that covers you anywhere in the USA. It doesn't matter where the accident occurred.

I really do feel they are jerking me around. I will reach out to the state

Absent actually having and reading the policy, how do you "know for a fact that you are covered"? People have asked you in this thread and the other how you know you have coverage in place, and all they get back is "trust me, I know I am covered". This is a common occurrence, and I am in no way trying to be cynical here. It is very, very common for people to believe that they have coverage in place for things that they do not, and the primary reason for this is not actually reading the policy language. The best advice that I can give you here is that if you think the insurance carrier should pay, you have to answer the 5 basics for them (who, what, where, when & why).

• What happened?
• Who did it happen to?
• Where did it happen?
• When did it happen?
• Why are they liable?

(The last one is the important one here, and relevant to your situation, since the rest has been established already. "I know I have coverage" is simply not sufficient, especially if you had a second party as a driver, in another state, in a rental car, on personal vacation and on a commercial policy. I am not saying that you have no coverage, because I do not have a copy of your policy either. You need to determine where in the policy it states that you have coverage and be able to quote it word for word).

As far as why they are telling you to go to your (as you stated, completely uninvolved) brother's carrier, I am a bit confused as well. I have never heard of a carrier arbitrarily stating that the loss responsibility rests with an uninvolved party. Maybe we are missing something or reading you incorrectly, and there is more information out there.

 

[ny86]

Absent actually having and reading the policy, how do you "know for a fact that you are covered"? People have asked you in this thread and the other how you know you have coverage in place, and all they get back is "trust me, I know I am covered". This is a common occurrence, and I am in no way trying to be cynical here. It is very, very common for people to believe that they have coverage in place for things that they do not, and the primary reason for this is not actually reading the policy language. The best advice that I can give you here is that if you think the insurance carrier should pay, you have to answer the 5 basics for them (who, what, where, when & why).

• What happened?
• Who did it happen to?
• Where did it happen?
• When did it happen?
• Why are they liable?

(The last one is the important one here, and relevant to your situation, since the rest has been established already. "I know I have coverage" is simply not sufficient, especially if you had a second party as a driver, in another state, in a rental car, on personal vacation and on a commercial policy. I am not saying that you have no coverage, because I do not have a copy of your policy either. You need to determine where in the policy it states that you have coverage and be able to quote it word for word).

As far as why they are telling you to go to your (as you stated, completely uninvolved) brother's carrier, I am a bit confused as well. I have never heard of a carrier arbitrarily stating that the loss responsibility rests with an uninvolved party. Maybe we are missing something or reading you incorrectly, and there is more information out there.

Again i get your concern but lets just assume you know for a fact im covered (which i am).

 

[VolAgent]

Again i get your concern but lets just assume you know for a fact im covered (which i am).

I will again give the advice I gave you in the other thread. If you are certain, go get an attorney. Let him see the policy. Assuming you are covered and they are trying to avoid the claim, it is a slam dunk. Your attorney will have an easy pay day and you'll get this settled.

You can go around and around with us and even the adjuster. But at this point, nothing is getting accomplished. You aren't giving us any new information. It is likely you aren't given the adjuster any new information. If there is nothing new, then you shouldn't expect the answer to change.

If you want your situation to change, you are going to have to make it change. Go to the state and/or hire an attorney. Just know, neither the state nor the attorney are going to accept, "I haven't read the policy, but I'm certain I'm covered."

 

[ny86]

I will again give the advice I gave you in the other thread. If you are certain, go get an attorney. Let him see the policy. Assuming you are covered and they are trying to avoid the claim, it is a slam dunk. Your attorney will have an easy pay day and you'll get this settled.

You can go around and around with us and even the adjuster. But at this point, nothing is getting accomplished. You aren't giving us any new information. It is likely you aren't given the adjuster any new information. If there is nothing new, then you shouldn't expect the answer to change.

If you want your situation to change, you are going to have to make it change. Go to the state and/or hire an attorney. Just know, neither the state nor the attorney are going to accept, "I haven't read the policy, but I'm certain I'm covered."

Thanks for the advice and i have started the process of going to the state.
Not sure if you guys know this or not, but all family members that share a household with the policy holder are covered automatically under PIP. That is the law in NY so there isn't any doubt about coverage. A lawyer confirmed this for me as well.

I will surely update you guys

 

[USF3983]

That is similar to Florida, but it can still be denied. Happens all the time in Florida. I know it can be different in NY but there is a reason you're having an issue.

With commercial policies, you have to specifically be listed on the policy. If there is a personal policy active, the application the policyholder signed at the time of application might have asked if "all household members of driving age were listed." If that is the case, you having lived with your parents your whole life, there might be a misrepresentation on the application. This is grounds for a claim denial. I almost had it happen to me. Fortunately, the company was willing to comply because the driver of the vehicle was listed. There was a claim for passengers who lived in the household. Typically they flat-cancel the policy and refund your money for the term.

 

[ny86]

That is similar to Florida, but it can still be denied. Happens all the time in Florida. I know it can be different in NY but there is a reason you're having an issue.

With commercial policies, you have to specifically be listed on the policy. If there is a personal policy active, the application the policyholder signed at the time of application might have asked if "all household members of driving age were listed." If that is the case, you having lived with your parents your whole life, there might be a misrepresentation on the application. This is grounds for a claim denial. I almost had it happen to me. Fortunately, the company was willing to comply because the driver of the vehicle was listed. There was a claim for passengers who lived in the household. Typically they flat-cancel the policy and refund your money for the term.

PIP insurance doesnt just protect drivers in NY. You can be a non-driver who gets hit by a car and still get the coverage. I've spoken to numerous people and they have confirmed the insurance company is playing games and not being fair.