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Auto Insurance Claims/Rv damage due to lightning strike.. Claim denied

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QUESTION: While driving through Texas in our motor home we were hit by a lightnng strike. When the lightning hit us it stalled the motor home for a second or two, unbeknown to us that  activated the auto park brake. All the lights on the dash started flashing as the engine restarted. We continued driving trying to figure out what had just happened. We were on a freeway lookng for a safe place to pull over, and finally found a rest stop a few miles up the road.
When we stopped  my wife who was driving pushed the parking brake button , and a big cloud of smoke  came up from underneath the motor hme, we thought it was on fire. we turned the engine off  and got out of the motorhome and The smoking stopped.  Upon further investigating I determined that the smoke was brake fluid leaking on the hot auto parking brake when  my wife put it in park.
The parking brake that is located on the end of the transmission was totally fried and would not work or hold the veh. In place.  I managed to disconnect it and we made our way home.
The motor home jacks did not work at that time either, and started flashing the second the lightning strike hit us.  
Upon arriving home we were told that the damages should be covered by our comprehensive insurance policy by a relative who works for another insurance company.
We filed a claim with our insurance company and they denied our claim, stating the damage was due to driving several miles with the parking brake on. The denial letter did not even state  anythng about the lighting or storm that we were in or the circumstances leading up to the brake being activated.
Although our comprehensive policy does not state anything about lightning , it does say that we would be covered for hail, flood, water damage. Personnel property might be covered  in a lightnng strike.  
Several other insurance agents that work for other companies review our case and believe the damage would be covered.
Was hoping to get another option from an expert to see what your opinion  is and what my options are.

ANSWER:   Hello John,

You say the carrier denied your claim.  Did they send you actual denial correspondence?  And, if so, what portion of your policy was cited as the basis for the denial?

The point is, if you are denied benefits, the terms of the policy must support that denial.  And it is the responsibility of the insurance company - not you - to defend their interpretation of you policy.  

Hail, flood, or water damage would not include lightning. Ordinarily policies include language for things such as "storms, natural disaster, acts of God" or something similar.  And, yes, in my experience lightning damage would be covered under the comprehensive portion of the policy.

But there are other issues here.  First of all, consider that some insurance adjusters, some insurance companies, will selectively deny claims (in order to avoid payment) by selectively interpreting the policy.  This is both unfair and improper.  If you have read your policy, and if you believe that has occurred here, you might consider obtaining a legal opinion from a qualified insurance attorney.

But I think the problem is larger than that.

I am concerned if the claim was adequately investigated.  You are not contesting that the damage was caused by the parking brake, but did anyone investigate why?  Did they dispatch a qualified appraiser who had the expertise to analyze the problem?  Was the vehicle in a shop where qualified mechanics could analyze the damages?  Did the appraiser confer with qualified mechanics?  Or did someone simply take a cursory look at the vehicle and "determine" that the damage was purely brake related?

The point is, this type of a claim requires a more detailed investigation than if, for example, you crunched a fender.

My sense tells me that no one actually took the time to properly evaluate your damages.  It was reported back as damage from the brake.  No one considered anything differently, and you were confronted with a denial. Certainly an "easy" denial - but also an improper denial.

I would suggest that you do the following.

If you have not already done so, have a qualified mechanic asses your damages, in writing.

Next, call the carrier with your claim number and ask for the name and contact information for the claims manager that supervised the claim (and who would have had to approve a denial).  Call the manager and present the information.  Ask that the claim be re-opened (assuming it has actually been denied) for further investigation.

If the manager fails to cooperate, and if you can confirm that the damages indeed stem from the lightning strike, you will need to seek legal advice.  There may be policy provisions that apply.  Speak to an attorney who can properly advise you. Sometimes, simply a call or letter from an attorney can change the course of a claim.

Bottom line.  You have a variety of issues here that go beyond a simple denial of coverage for lightning.  To the contrary, the company is not even addressing the lightning.  Instead, they are considering this as damage caused by actions beyond the scope of the policy.  If you can prove this was indeed caused by lightning, their reasoning is way off base.  

Good luck.

Jane Pytel

http://InsuranceExpertAdvice.com
http://SolutionsForYourInsuranceClaim.com
http://FloridaAutoInsuranceCentral.com



---------- FOLLOW-UP ----------

denial letter page 1
denial letter page 1  

deniel letter page 2
deniel letter page 2  
QUESTION: I thank you for you excellent response, I attached the denial letter and was hoping if you have time could read it and tell me what you think.
There 10 loss caused by other than collision. It does not state anything about weather, lightning act of god etc. I think this is where they got me.  
But there policy does state that they will pay to repair or replace personal property inside of motor home if damages is caused by lightning.

Thanks again

John

Answer
 Hello again John,

As I expected, the denial is not about lightning - it is about "damage due and confined to: wear and tear; mechanical or electrical breakdown or failure".  This is an entirely separate issue.

As I explained before, this claim needs to be fully investigated.  Who examined the vehicle?  Do you have a copy of the appraisal as you should?  Did anyone diagnose the electrical system and any other components which should substantiate damage from a lightning strike?

My guess is that this was a predetermined decision that you drove with the parking brake on - case closed.  If there is physical evidence to substantiate that the parking brake failure was directly related to a lightning strike, an experienced mechanic has the diagnostics to establish this.  An appraiser - absent the proper diagnostics - more than likely cannot make this determination.

The adjuster is reasonable. He encourages you to call him.  And in my experience, your company - formerly known as GMAC Insurance - is a reasonable company.  Here's what you need to do.  Obtain a well qualified mechanic who can diagnose the source of the damages.  If he can substantiate that the damage is lightning related, recontact your adjuster and present him with the evidence.  That should be a no-brainer.

As for "lightning coverage", that should be included as part of the windstorm peril. I really do not think there is any question about that.  Unless excluded, insurance standards deem that lightning is covered as a comprehensive "non-collision" loss.

https://www.vocabulary.com/dictionary/windstorm
DEFINITIONS OF:
windstorm
a storm consisting of violent winds
Types:
show 8 types...
Type of:
storm, violent storm
a violent weather condition with winds 64-72 knots (11 on the Beaufort scale) and precipitation and thunder and lightning

Good luck.  

Jane

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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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