Denied insurance claim because of lacking driving restriction

[grazer73]

Tama ba na ma deny ang pagclaim ng insurance kung ang driver lacks driving restriction sa drivers license nya?May nagsubstitute sa driver ng truck and he has only restriction 1 and 2. Nabangga sa isang van ang truck. We claim insurance kasi comprehensive naman ang insurance coverage ng truck. Now the insurance company is denying claims dahil not authorize daw ang driver to drive the truck. This is not stated on the police report we got from the traffic inspector. In short wala syang violation. Later nakita ng insurance company na 1 and 2 lng restriction nya. Tama ba na hindi sila mag bayad ng claim?

[lazyfoot]

Tama ba na ma deny ang pagclaim ng insurance kung ang driver lacks driving restriction sa drivers license nya?May nagsubstitute sa driver ng truck and he has only restriction 1 and 2. Nabangga sa isang van ang truck. We claim insurance kasi comprehensive naman ang insurance coverage ng truck. Now the insurance company is denying claims dahil not authorize daw ang driver to drive the truck. This is not stated on the police report we got from the traffic inspector. In short wala syang violation. Later nakita ng insurance company na 1 and 2 lng restriction nya. Tama ba na hindi sila mag bayad ng claim?

Sorry to say this but yeah, they have the right to deny a claim if the one driving isn't authorized to drive the vehicle.

[ChoyJo]

Yes..M/T 6 wheeler dapat 3.. more than 6 wheeler M/T need mo 8..

[mark_t]

Tama ba na ma deny ang pagclaim ng insurance kung ang driver lacks driving restriction sa drivers license nya?May nagsubstitute sa driver ng truck and he has only restriction 1 and 2. Nabangga sa isang van ang truck. We claim insurance kasi comprehensive naman ang insurance coverage ng truck. Now the insurance company is denying claims dahil not authorize daw ang driver to drive the truck. This is not stated on the police report we got from the traffic inspector. In short wala syang violation. Later nakita ng insurance company na 1 and 2 lng restriction nya. Tama ba na hindi sila mag bayad ng claim?

So wala kayo ahente na nag service sa policy ninyo.

Always be compliant.
Always have a servicing agent for your policies.

Huwag kayo maniwala na diretso kayo sa insurance co.
Maraming nagsasabi nito. Walang ganoon.

The insurance industry is a regulated industry.

Mag appeal kayo. Do you have a written notice from the insurer that
they are denying your claim? Get a copy. If you have other business
with that insurer mag refund ka na ang transfer it to another co.
Hindi maayos ang claims resolution dyan. It is all in the people
behind the claims department.

Tingnan mo sa OR/CR kung ano weight ng truck.
Then match it to the DL.

Wala bang insurance ang Van?

[vinj]

Yup, they have the right to deny the claim as the driver of the vehicle is basically not qualified to drive it; its somewhat like driving with no DL at all IMO.

The traffic police may have not noticed the restriction on the license.

[grazer73]

Walang OD yong van. My kilala kaming lawyer he said, we will file case against the insurance company kasi may decided case na daw before ang supreme court sa mga ganong case. Sa LTO dapat daw managot ang driver what ever violation nya. Pero ang damage daw sa property, in this case sa van, dapat e cover ng insurance company. Ibang tao daw kasi takot na mag habol sa insurance company pag meron violoation sa part ng driver.

[derf8666]

Walang OD yong van. My kilala kaming lawyer he said, we will file case against the insurance company kasi may decided case na daw before ang supreme court sa mga ganong case. Sa LTO dapat daw managot ang driver what ever violation nya. Pero ang damage daw sa property, in this case sa van, dapat e cover ng insurance company. Ibang tao daw kasi takot na mag habol sa insurance company pag meron violoation sa part ng driver.

Unfortunately the insurance company can deny your claim. This is clearly a policy violation. If a driver is not qualified to drive a truck, chances are claims will be much higher. This is tantamount to driving without a license. And regarding your friend lawyer's advice, I'm not sure about your winnability. Chances are that case involved a pedestrian, in which case, the insurer cannot avoid paying the claim. A different matter altogether if you bumped into a van. This is a lesson learned. But it's your choice. If the amount involved is too big, then you can go for it. whio knows? Just my opinion. My only qualification is that I handled claims for a small company some years back..

If you have other businesses with that particular company, try to use that as a leverage. Makiusap ka na lang that they shoulder part of the expenses. What they called "ex-gratia".. Good luck!

[jimnyeatworld]

that is bullshit crap from insurance company. what if binangga ng 7 yrs. old mong anak ang truck mo sa garahe nyo, di ka na din pwede mag-claim? what if you suddenly you become incapacitated and a good samaritan takes over your wheel to get you to the hospital, tapos nabangga sya kakamadali. and the samaritan has that lacking driver limitation.

the sole purpose of insurance is to claim for damaged property. if they are posting so many technicalities to avoid claims, then clearly walang kwentang insurance and they only want to get your money.


pls. post the name of the insurance company here para maiwasan yan.

[grazer73]

I even give a scenario to the manager. What if nasa downhill ang truck, nilagyan ko ng bato ang gulong, tapos may umakyat sa truck at natanggal ang bato at tumakbo ang truck then na bangga ang van na nakapark sa baba at saka yong nasa manubela ng truck walang drivers license; tanong macover ba ng insurance ang van na nabangga. Ang sagot ng manager, "tanong mo sa insurance adjuster".

[vinj]

I even give a scenario to the manager. What if nasa downhill ang truck, nilagyan ko ng bato ang gulong, tapos may umakyat sa truck at natanggal ang bato at tumakbo ang truck then na bangga ang van na nakapark sa baba at saka yong nasa manubela ng truck walang drivers license; tanong macover ba ng insurance ang van na nabangga. Ang sagot ng manager, "tanong mo sa insurance adjuster".

There are a lot of possible scenarios (i.e. my dog hit the handbrake, my kid was playing around) but the basis of the denial is what actually happened and its that the vehicle figured in an accident and is said to be operated by someone not qualified to drive it in the first place (if the restrictions on the DL are indeed not matched to the vehicle type). This is even harder to contest if on the accident report it is shown that your vehicle was at fault and thus it is really the fault of the driver.

You can contest it in court if you're willing to pay for it. The insurance company may also claim that there is negligence on your side as you did not verify such data to your driver's qualifications. They are in business to earn profit, that's basically it so they will not pay up if there is reason to. I'd also go with what derf8666 mentioned that you would have better chances in first making pakiusap and offering more compensating business for them in the future (especially if you are a long time client or have good dealings with them).

My two cents.

[grazer73]

yes, theres a lot of scenario. What we are discussing here is the logic of the scenario. Lots of people dont pursue the claim thinking that they commit violation.Lets go back to the reason why we need to have a property damage insurance coverage. This is between property to property. IF the driver commits violation on his DL, I think LTO will run after him and charge whatever penalty. But the damage incurred by the property(truck) to a certain property (van) should be covered by the insurance. that is the very reason why we have it covered by property damage claim.

[mark_t]

Walang OD yong van. My kilala kaming lawyer he said, we will file case against the insurance company kasi may decided case na daw before ang supreme court sa mga ganong case. Sa LTO dapat daw managot ang driver what ever violation nya. Pero ang damage daw sa property, in this case sa van, dapat e cover ng insurance company. Ibang tao daw kasi takot na mag habol sa insurance company pag meron violoation sa part ng driver.

Go for it, me counsel ka na.

[raine]

pinakamaganda diyan basahin mo kung ano ang sinasabi sa insurance policy mo, then pabasa mo rin sa kaibigan mong lawyer then doon kayo magdecide kung ano ang next step ninyo.

[grazer73]

Update ko na lng kayo what happen after I filed the case. Thanks sa lahat na nag reply on my post.

[vinj]

Update ko na lng kayo what happen after I filed the case. Thanks sa lahat na nag reply on my post.

Goodluck, updates on the case will be quite useful for the benefit of all.

[bencel]

[QUOTE=jimnyeatworld;1627576]that is bullshit crap from insurance company. what if binangga ng 7 yrs. old mong anak ang truck mo sa garahe nyo, di ka na din pwede mag-claim? what if you suddenly you become incapacitated and a good samaritan takes over your wheel to get you to the hospital, tapos nabangga sya kakamadali. and the samaritan has that lacking driver limitation.

the sole purpose of insurance is to claim for damaged property. if they are posting so many technicalities to avoid claims, then clearly walang kwentang insurance and they only want to get your money.


ACCIDENT INSURANCE if this is the case, eto ang affidavit, palagay ko makaka claim kasi nga accident, hindi naman natin gusto na bangain ng 7 years old ang sasakyan, hindi mo din naman kagustuhan na ma incapacitate habang nagmamaneho, kaya for me considered as accident claim pa din.

As far sa DL restriction 1 n 2, prior to accident kasi may negligience na, hindi inalam na 1 & 2 hindi pwedeng mag drive ng truck.
So before mangyari ang accident may pagkukulang na sa may ari ng truck, cannot claim what happen was an accident, kasi nga hindi competent yun nag drive kaya may accident na nangyari, it's LIKE ACCIDENT WAITING TO HAPPEN SINCE HINDI NAMAN SYA LICENSE TO DRIVE THE SAID VEHICLE.
Section 3 i think states this scenario regarding an qualified driver's claims will be denied.

[puroy]

to TS, ano pong insurance company yan? at nang maiwasan...

[jimnyeatworld]

[quote=bencel;1631625]

that is bullshit crap from insurance company. what if binangga ng 7 yrs. old mong anak ang truck mo sa garahe nyo, di ka na din pwede mag-claim? what if you suddenly you become incapacitated and a good samaritan takes over your wheel to get you to the hospital, tapos nabangga sya kakamadali. and the samaritan has that lacking driver limitation.

the sole purpose of insurance is to claim for damaged property. if they are posting so many technicalities to avoid claims, then clearly walang kwentang insurance and they only want to get your money.

ACCIDENT INSURANCE if this is the case, eto ang affidavit, palagay ko makaka claim kasi nga accident, hindi naman natin gusto na bangain ng 7 years old ang sasakyan, hindi mo din naman kagustuhan na ma incapacitate habang nagmamaneho, kaya for me considered as accident claim pa din.

As far sa DL restriction 1 n 2, prior to accident kasi may negligience na, hindi inalam na 1 & 2 hindi pwedeng mag drive ng truck.
So before mangyari ang accident may pagkukulang na sa may ari ng truck, cannot claim what happen was an accident, kasi nga hindi competent yun nag drive kaya may accident na nangyari, it's LIKE ACCIDENT WAITING TO HAPPEN SINCE HINDI NAMAN SYA LICENSE TO DRIVE THE SAID VEHICLE.
Section 3 i think states this scenario regarding an qualified driver's claims will be denied.

so r u saying mas ok pang walang lisensya yun driver kaysa may restriction 1 and 2, at mas ma-claim pa sya kasi yun 7 yrs. old walang license

eh di technicality nga. granted that they are right by law and by contract, and they won't budge on the claim. then mabuti na nga na-ipost dito kung sino ang kumpanya na yan para maiwasan, kasi mahilig nga tumakbo.

yun attitude kase ng kumpanya ang problema.

the bringing in more business for them para maka-claim is a good suggestion. pero what does that imply, technicality nga na puwede naman nila i-overlook basta ba mag-insure ang TS sa ibang pang trucks nila

tsk tsk tsk. and you'll give more money to this kind of people.

[Dr.Kamiya]

yes, theres a lot of scenario. What we are discussing here is the logic of the scenario. Lots of people dont pursue the claim thinking that they commit violation.Lets go back to the reason why we need to have a property damage insurance coverage. This is between property to property. IF the driver commits violation on his DL, I think LTO will run after him and charge whatever penalty. But the damage incurred by the property(truck) to a certain property (van) should be covered by the insurance. that is the very reason why we have it covered by property damage claim.

I took up basic first aid back in college. You should allow me to operate on your kidneys. And your insurance company should pay your wife and kids in case you die while I do so.

No, no, don't argue about my lack of a medical license. That's between me and the PRC. My lack of qualification has nothing to do with any harm that may come to you while you allow me to dissect your spleen.

[derf8666]

I took up basic first aid back in college. You should allow me to operate on your kidneys. And your insurance company should pay your wife and kids in case you die while I do so.

No, no, don't argue about my lack of a medical license. That's between me and the PRC. My lack of qualification has nothing to do with any harm that may come to you while you allow me to dissect your spleen.

Hehe great analogy doc!

so r u saying mas ok pang walang lisensya yun driver kaysa may restriction 1 and 2, at mas ma-claim pa sya kasi yun 7 yrs. old walang license

eh di technicality nga. granted that they are right by law and by contract, and they won't budge on the claim. then mabuti na nga na-ipost dito kung sino ang kumpanya na yan para maiwasan, kasi mahilig nga tumakbo.

yun attitude kase ng kumpanya ang problema.

the bringing in more business for them para maka-claim is a good suggestion. pero what does that imply, technicality nga na puwede naman nila i-overlook basta ba mag-insure ang TS sa ibang pang trucks nila

tsk tsk tsk. and you'll give more money to this kind of people.

to TS, ano pong insurance company yan? at nang maiwasan...

Kahit anong insurance company ay idedeny yan, unless youre a very valued client. Tawag diyan ay ex-gratia. ganun talaga sa business, its just like giving big discounts to wholesale clients or suki.

that is bullshit crap from insurance company. what if binangga ng 7 yrs. old mong anak ang truck mo sa garahe nyo, di ka na din pwede mag-claim? what if you suddenly you become incapacitated and a good samaritan takes over your wheel to get you to the hospital, tapos nabangga sya kakamadali. and the samaritan has that lacking driver limitation.

the sole purpose of insurance is to claim for damaged property. if they are posting so many technicalities to avoid claims, then clearly walang kwentang insurance and they only want to get your money.


ACCIDENT INSURANCE if this is the case, eto ang affidavit, palagay ko makaka claim kasi nga accident, hindi naman natin gusto na bangain ng 7 years old ang sasakyan, hindi mo din naman kagustuhan na ma incapacitate habang nagmamaneho, kaya for me considered as accident claim pa din.

As far sa DL restriction 1 n 2, prior to accident kasi may negligience na, hindi inalam na 1 & 2 hindi pwedeng mag drive ng truck.
So before mangyari ang accident may pagkukulang na sa may ari ng truck, cannot claim what happen was an accident, kasi nga hindi competent yun nag drive kaya may accident na nangyari, it's LIKE ACCIDENT WAITING TO HAPPEN SINCE HINDI NAMAN SYA LICENSE TO DRIVE THE SAID VEHICLE.
Section 3 i think states this scenario regarding an qualified driver's claims will be denied.

The purpose of insurance is so that we can be indemnified in case of loss. VALID loss. It's a business entity and they will pay you if the loss falls within the scope of the coverage. Now, if it's outside of the coverage and if there are any violations to the contract, then the insurer has the right not to pay your claim. For insurance neophytes and hotheads who think that insurance should pay for every damage whether legal or not, here are some other violations aside from driving without license: Drunk driving, racing (for you racers out there, beware), loading unusually heavy objects, using it for hire (unless specifically declared as for hire vehicles), using your car in towing another vehicle. Some examples lang po.

As for taking the insurance company to court, that is an option that is actually not recommended. You should have just negotiated for an ex-gratia payment. That will just add to your burden and frustration. The reason why a lot of people dont claim when they are caught with a violation is because yun na nga, its a violation. lawyers will always say theres a case even if there are none. Sayang din ang professional fees. You cant win every battle in life. Charge it to experience. Be more careful next time.