Denied insurance claim because of lacking driving restriction

**grazer73** · December 8th, 2010 12:35 AM

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** · December 8th, 2010 01:01 AM

Originally Posted by 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?

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** · December 8th, 2010 01:13 AM

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

**mark_t** · December 8th, 2010 09:47 AM

Originally Posted by 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?

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** · December 8th, 2010 12:50 PM

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** · December 8th, 2010 12:52 PM

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** · December 8th, 2010 01:23 PM

Originally Posted by 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.

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** · December 8th, 2010 02:47 PM

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** · December 8th, 2010 05:47 PM

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** · December 9th, 2010 09:53 AM

Originally Posted by 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".

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.