Auto Insurance Claims/short paid

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Question
I own a autoglass company in and we did a windshield replacement for a customer insured with esurance we submitted the claim after the job was completed, the insurance company did not want to pay the amount we billed so they invoked some kind of an appraisal clause and only paid half of the bill. I know of several cases throughout the united states where auto glass companies have sued the insurance company for short pay and they won. this is the first problem we have had with this appraisal clause, is this appraisal clause even legal after the work had already been performed and the customer signed the legal literature for my company to be paid in full?

Answer
 Hello Tommy

The customer has a policy - a contract - with the insurance company.  That being said, the policy must be adhered to on both sides.  If, in fact, there is an appraisal clause, meaning the insurance company has the right to "approve" appraisals prior to honoring them, then the insured has an obligation to adhere to that.  

The nuts and bolts of all of this depends on the exact language of the policy.  For example, is there a set limit on the amount the policy will pay for windshield repair or replacement?  Does the policy restrict the insured from using all but named vendors?  These are the types of policy language that will direct what an insured can and cannot expect in terms of coverage.  Unless you or the insured were to actually read the coverage, neither of you would know if anyone has a legitimate cause for action.  Nonetheless, regardless of knowing - or not - what the policy says, if there are terms similar to what I've suggested, and if the insured seeks repairs that exceed those authorized in the policy, then it would be the responsibility of the insured to pay you the difference.

If the insurance company was simply choosing policy terms at will, misrepresenting the terms of the policy, etc, then there might be a course of action.  What legal actions?  You would need to confer with an attorney on that.  But I doubt you would have the standing to move into the place of the insured, i.e., to "stand in the shoes" of the insured.  In other words, unless you have some type of an assignment of benefits and/or a pre-existing agreement with the insurance company, it is doubtful you would have any standing to initiate legal actions.  But, again, ultimately that would call for a legal opinion.

Speaking strictly as an insurance expert, I would suggest that there is probably nothing you can do about this except to bill the insured for the differences.  Unless, of course, your contract with the insured precludes this.

As you well know, most insurance companies have "preferred" vendors.  These vendors have agreements with insurance companies to perform work at a certain level, at specific prices, and usually with a guarantee.  If you have not pursued this option, you should consider it.  And, if you have, maybe you should expand your list of carriers.

Good luck.

Jane Pytel

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Jane Pytel

Expertise

I can answer questions related to auto accidents, auto damage, auto theft claims, or personal injury claims. I am specifically suited to answer questions concerning insurance investigations and the effects of those investigations such as claim delays, claim denials, examinations under oath, or the special investigations unit. I can answer most any question that relates to proper claims investigations, or claims handling procedures and processes. I have authored several ebooks which provide claim guidance for consumers. Those books are available on Amazon Kindle: Power To Profit - will provide you with the knowledge you need to overcome the patterned obstacles that insurance companies will use to delay, devalue, or deny your valid insurance claim. The No Nonsense Guide to Accident Settlement - Teaches you how to manage your claim, how to identify the precise tactics likely to be used against you, and how you must respond.

Experience

12 years of experience with 3 major insurance companies. I hold an all lines adjusters license in Florida. I am well versed in claims handling, claims investigations, and industry standards related to both. The bulk of my experience stems from my 10 years as a police officer / detective. Building on that investigative experience, I became an SIU (Special Investigations Unit) Investigator. Accordingly, my unique expertise lies in the investigation of claims. What is necessary and related, what is not necessary and related? What constitutes a fair claims investigation? What recourse is available for consumers who suspect they are experiencing unfair claims delays? During the course of my experience, I became a certified trainer, instructing adjusters and investigators proper techniques for claims investigation and claims handling.

Education/Credentials
B.A., Communications, University of Miami 350 credit hours of intense investigative training, Miami Dade Police 80 hours of investigative training, various Federal Agencies, Miami, Fl Intensive Accident Reconstruction and Pedestrian Injury Analysis, NHTSA, National Highway Traffic Safety Agency, Oklahoma City, OK 2 weeks Auto Damage Appraisal, Winston Salem, NC Legal Principles Claim Specialist, AEI

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