Denied insurance claim because of lacking driving restriction

[grazer73]

could anybody define what is insurance?

[derf8666]

From wikipedia...

Insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment.

The transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate (indemnify) the insured in the case of a financial (personal) loss. The insured receives a contract, called the insurance policy, which details the [SIZE=3]conditions and circumstances[/SIZE] under which the insured will be financially compensated.

And one of the conditions of an insurance policy is that the vehicle must be driven by an authorized driver, meaning he should be legally allowed to drive that vehicle, aside from having consent from the registered owner. So if he is not authorized to drive that vehicle, then the policy or contract will not respond from any accident that arises out of it.

I hope you dont take it against me. I'm just trying to be objective about the issue at hand. I understand your friends including your lawyer friend will have your interest at heart. A forum like this is the best way to get some objective viewpoints. Most or all of the posters here do not have any personal relationship with you so their judgments may be more reliable, especially for those with knowledge in the insurance industry. Some may run against what you have in mind. But as you can see from the postings, I think majority agreed that your claim is deniable indeed. Although I'm involved in the insurance industry, your unit is not insured with me so I have no intention of trying to be legalistic to avoid paying your claim. I have no whatsoever personal interest in your case. In fact, if I'm a mischief, I would have told you to go all out against your particular insurer para pwede kong siraan yung insurance company mo and to get some pogi points for the companies I'm representing.

But then again, this is just my interpretation of your case. I may and could be wrong. I still hope you would be able to get something out of your insurer though. Good luck and God bless!

[mark_t]

From wikipedia...



And one of the conditions of an insurance policy is that the vehicle must be driven by an authorized driver, meaning he should be legally allowed to drive that vehicle, aside from having consent from the registered owner. So if he is not authorized to drive that vehicle, then the policy or contract will not respond from any accident that arises out of it.

I hope you dont take it against me. I'm just trying to be objective about the issue at hand. I understand your friends including your lawyer friend will have your interest at heart. A forum like this is the best way to get some objective viewpoints. Most or all of the posters here do not have any personal relationship with you so their judgments may be more reliable, especially for those with knowledge in the insurance industry. Some may run against what you have in mind. But as you can see from the postings, I think majority agreed that your claim is deniable indeed. Although I'm involved in the insurance industry, your unit is not insured with me so I have no intention of trying to be legalistic to avoid paying your claim. I have no whatsoever personal interest in your case. In fact, if I'm a mischief, I would have told you to go all out against your particular insurer para pwede kong siraan yung insurance company mo and to get some pogi points for the companies I'm representing.

But then again, this is just my interpretation of your case. I may and could be wrong. I still hope you would be able to get something out of your insurer though. Good luck and God bless!

When the driver is unauthorized by the owner.

And Section III a) is deniable

then Section III b) by fire, external explosion, self ignition or lightning
or burglary, house breaking or theft;

will apply to cover subject to the limits of liability, indemnify the insured
against loss of or damage to the scheduled vehicle and spare parts
whilst thereon.

another point of view is

http://scholarship.law.wm.edu/cgi/vi...4&context=wmlr

http://www.russoandkiecklawoffice.co...le-Belief.aspx

We also have a local jurisprudence on this, I can't remember where I kept the
copy.


It is not what your claims manager thinks. Most often they do not read Law.
They are too busy to read jurisprudence.

So they deny, deny ,deny, anyway you would not go to court.

[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.

Your lawyer is right. It is his job to memorize and read law.

The supreme court has already decided on a similar case,
and very rarely do they overturn their jurisprudence.

[ericbalajadia]

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.

I think that is "legally" right within the bounds of what was written, agreed upon and signed between the owner and the insurance company. Listed on the policy are the limits of liabilities, who are authorized to drive the vehicle; meaning does he/she have the proper license for it, what are the types of accidents that are to be compensated etc.

Now, the "unauthorized driver" clause should not apply to a 7 yr old child tinkering inside a car or a dog inadvertently hitting a lever because they are not actually "driving" or "operating", are they?

In the scenario of the good Samaritan, the insurance company can cite that he is still an unqualified driver, however the circumstances and deny claims.

This is where considerations come to play and sad to say, most insurance companies are not the considerate types. Our customer's valid claim on his Audi was met with trivial delays and petty matters such as insufficient pictures and an endless out-of-town trips by the adjuster or his superior, whomever was not in the mood to entertain my follow-ups by phone (I'm sure!) which took 6 months to settle, not to mention another month to have the check signed by the boss who was (surprise!) the next in line for the out-of-town escape! I even had my secretary lie about our identity and the purpose of our phone calls para lang may makausap sa kanila. Halos murahin ko talaga pag natyempuhan ko na sa telepono.

In contrast, there are companies which are accommodating and relatively fast in processing such claims. Employees or adjusters are courteous, helpful and are willing to discuss in detail whatever problems one may be having with the claim.

As in every laws, policies or contracts, there would always be technicalities such as these that would arise. In the end, it's how an insurance company or their adjusters interpret their own clauses and limitations and consider special case like these and for the owners to contest if deemed necessary.

[Dr.Kamiya]

Indeed there is a local jurisprudence on this. And the court ruled in favor of the insurance company. Claim was denied and costs awarded to the insurance company.

Read: http://www.lawphil.net/judjuris/juri...7312_1965.html

Here is the relevant part of the decision, emphasis on license requirements are mine:

The cases cited by appellant are apropos. In Crahan v. Automobile Underwriters, Inc., et al., 176 A. (Pa.) 817, a clause in the policy excluding loss while the motor vehicle "is being operated by any person prohibited by law from driving an automobile" was held to be free from doubt or ambiguity, reasonable in its terms and in furtherance of the policy of the law prohibiting unlicensed drivers to operate motor vehicles. In Zabonick v. Ralston, et al., 261 N.W. (Mich.) 316, the insured was driving with an expired license, in violation of law (Act No. 91 of the Public Acts of 1931), when the accident occurred. Under a provision in the policy that the insurer "shall not be liable while the automobile is operated ... by any person prohibited by law from driving," the insurance company was absolved, the Supreme Court of Michigan saying: "To require a person to secure an operator's license and meet certain requirements before driving an automobile is a regulation for the protection of life and property, the wisdom of which can scarcely be questioned. The Legislature has also provided that every three years such licenses expire and may be renewed under certain conditions. If one fails to comply with the regulation, the statute says, he or she shall not drive a motor vehicle upon the highway. Under the terms of the contract, while under such statutory prohibition, plaintiff could not recover under his policy. To permit such recovery, notwithstanding the lack of a driver's license, would tend to undermine the protection afforded the public by virtue of Act No. 91."

The exclusion clause in the contract invoked by appellant is clear. It does not refer to violations of law in general, which indeed would tend to render automobile insurance practically a sham, but to a specific situation where a person other than the insured himself, even upon his order or with his permission, drives the motor vehicle without a license or with one that has already expired. No principle of law or of public policy militates against the validity of such a provision.

The judgment appealed from is reversed, with costs.

Don't drive without a license. Don't drive without the necessary restrictions. Don't sue your insurance company when they are almost certainly in the right.

[grazer73]

well see na lang after we file the case. update you all...thanks for the replies