Denied Insurance Claim- Help!

[reactor]

kung in-house ang insurance mo dapat alalayan ka ng sales agent / dealer mo unless sarili mo ang insurance (not in-house). worst case try to get in touch with insurance commission kasi kahit wala police report basta may notarized affidavit acceptable na yan

[novidjaff]

Salamat sa lahat ng nagreply.

First- Hindi sya inhouse, Apparently the agent got an insurance from Peoples instead.
Second- It should have been covered,kasi comprehensive sya and I submitted all docs. I also submitted the pictures of the Car with the damage, in fact, asa casa na and my dealer forwarded the estimate to them,

As far as the advise goes, these is what I have gathered:

-Seek the help of the attorney
-Get at least 3 witness to submit an affidavit to prove that we were there
-Submit my response to them

Gano katagal bago maprocess yun? Mas matagal ba? And if ever I loose, hahaba pa ba ang usapan and will they file a criminal case? Ganon ba talaga kahassel to?

[Cbstodomingo77]

Hi po,

Good day! Hingi lang kami ng opinion nyo dito. Bale dalawang beses ng na-deny ung claim namin sa Commonwealth Insurance dahil may concealment daw. Kaya humingi kami ng mediation sa Insurance Commission. Nagkaron kami ng meeting with Commonwealth Insurance.

Nung first meeting, pabor ung Insurance Commission na tulungan kami ng Commonwealth at sinabihan pa nya ung adjuster ng Commonwealth na wag lang ex gratia ang ibigay dahil may aksidente namang nangyari at comprehensive ung insurance. Kaya ang suggestion ng taga-Insurance Commission na bigyan kami ng settlement na 350k. Sinabihan pa nya ung taga-Commonwealth na mas maganda kung tseke na dala nya para sa Second meeting at sinabi pa ng taga-Insurance Commission na tatawagan nya ung manager ng adjuster. Maayos ang naging usapan at naghintay kami ng dalawang linggo para sa Second meeting.

Nung dumating ung second meeting, 13th October, nagulat na lang kami na ang dalang balita ng taga-Commonwealth Insurance is ex gratia lang na 50k ang na-approve. :-( At pati ung taga-Insurance Commission naging pabor na dun sa taga-Commonwealth Insurance. Sobrang lungkot namin talaga kasi umasa kami na mabibigay ung 350k na settlement amount.

Ngayon po, hihingi sana kami ng payo sa inyo kung ano ang dapat naming gawin. Dahil sobrang liit naman ung 50k para sa pagpapaayos ng sasakyan. Ang estimates ng taga-Toyota is 626k.

Maraming salamat po.

[shadow]

Hinde issue kung makakatakbo pa yun bumangga, kahit sinadya pa ni TS na ibangga sa pased Tucson niya dapat bayaran ng insurance.

[Retz]

Ano ang pwedeng ikaso dyan sa haoshao sa insurance company?

[jhnkvn]

Correct me if I'm wrong but since the insurance company labeled your case as that of "fraud", shouldn't they be responsible in producing documents that proves that the threadstarter had an intent to defraud the insurance company? Alam ko ganito dapat yun way of thinking and not the other way around. Seems a pretty weak case to me without proof that you'll benefit from getting a brand new unit (let's say it was a complete loss) in fact, additional hassle pa nga sayo!

The reason I suggested consulting a lawyer is, even though you'll be burdened with the additional fees, is that you are not a legal major. Hence it's better to (A) seek help from an expert (B) make sure to hit the insurance company back.

I also understand rnillas point of view since I also weighted the view of the insurance company before I voiced my opinion on the case. However, as long as the intent is not fraudulent, they cannot simply deny a service that they were guaranteeing. It's not like you have an accident every 2 months or so (where they might prove that you are intentionally damaging your vehicle for claims).

EDIT: Same pala sinabi namin ni vinj :D

[phezthie]

a harmonic discussion i might say...

EDIT: since no one responded, i will push my view (but not too hard) about the golden rule in saving an insurance company from dissolution...

the golden rule in claims department... DENY
exception - the claimant has proven that his claim is VALID and LEGITIMATE
exception to the exception - "no fault clause" or the claimant's claim is ordered by the court..

NB: no other exception guys... sorry

[vinj]

a harmonic discussion i might say...

EDIT: since no one responded, i will push my view (but not too hard) about the golden rule in saving an insurance company from dissolution...

the golden rule in claims department... DENY
exception - the claimant has proven that his claim is VALID and LEGITIMATE
exception to the exception - "no fault clause" or the claimant's claim is ordered by the court..

NB: no other exception guys... sorry

That's the bottomline to what Shadow is also pointing out. Insurance companies are in the business to make money. ;)

* Battlestar, i'll send you a PM. I course it through Chinabank Insurance Brokers, which is a subsidiary of Chinabank. They would get a policy with the competitive rate amongst their pool of accredited insurance companies and when i have a claim, question, renewal or concern, I just talk to or email them. I was satisfied with the way they handled the Ondoy insurance claim of my in-laws before.

[shadow]

Pero grabe naman ito...talagang ayaw bayaran eh

[Retz]

Ang masaklap pa, bago lang ang tsikot at ganon pa ang nangyari.

[cast_no_shadow]

^

What happened ba?

May concealment ba talaga? Sounded like the insurance company has something concrete kaya denied claim ka to add the insurance commission agreed for the ex gratia.


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[Cbstodomingo77]

^

What happened ba?

May concealment ba talaga? Sounded like the insurance company has something concrete kaya denied claim ka to add the insurance commission agreed for the ex gratia.


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Hi po,

Bale ung nangyari po nagtiwala kami dun sa kakilala ng bayaw ko na isang insurance agent daw na sya na po bahala sa police report. Kaya po ginawan na lang nya ng kwento dun sa PNP at para makagawa ng police report na ang nakasaad po ay hit and run pero ung adjuster hindi sya naniniwalang hit and run po un. At ung kakilala ng bayaw ko na insurance agent daw, umamin sya dun sa adjuster na hindi nga sya hit and run. Na fabricated ung police report. Kaya po sya na-deny nung una.

Kaya pinakuha nya po kami ng totoong police report nung adjuster at sinalaysay po ung totoong nangyari dun sa HPG. Kaso pagdating po sa report ni adjuster, ang cause of denial nung second time, conflict statement daw po ung first and second police report.

First time po kasi namin nagkaron ng kotse at naaksidente, kaya po wala kami talagang alam pagdating sa pag-file ng claim. Naniwala kami dun sa kakilala ng bayaw ko kaya po nagkapeste-peste ung filing namin ng claim. :-(

Humingi po kami ng tulong sa Insurance Commission para humingi ng mediation. Kaso un nga po ung nangyari. Nung 1st meeting kala namin okay na lahat, pero biglang nagbago ung ihip ng hangin nung 2nd meeting. :-(

Salamat po.

[Cbstodomingo77]

Hi po,

Bale ung nangyari po nagtiwala kami dun sa kakilala ng bayaw ko na isang insurance agent daw na sya na po bahala sa police report. Kaya po ginawan na lang nya ng kwento dun sa PNP at para makagawa ng police report na ang nakasaad po ay hit and run pero ung adjuster hindi sya naniniwalang hit and run po un. At ung kakilala ng bayaw ko na insurance agent daw, umamin sya dun sa adjuster na hindi nga sya hit and run. Na fabricated ung police report. Kaya po sya na-deny nung una.

Kaya pinakuha nya po kami ng totoong police report nung adjuster at sinalaysay po ung totoong nangyari dun sa HPG. Kaso pagdating po sa report ni adjuster, ang cause of denial nung second time, conflict statement daw po ung first and second police report.

First time po kasi namin nagkaron ng kotse at naaksidente, kaya po wala kami talagang alam pagdating sa pag-file ng claim. Naniwala kami dun sa kakilala ng bayaw ko kaya po nagkapeste-peste ung filing namin ng claim. :-(

Humingi po kami ng tulong sa Insurance Commission para humingi ng mediation. Kaso un nga po ung nangyari. Nung 1st meeting kala namin okay na lahat, pero biglang nagbago ung ihip ng hangin nung 2nd meeting. :-(

Salamat po.

Tapos po hindi po sya declared as total loss dahil hindi daw po umabot ng 75% nung coverage which is 880k po. Un po daw ung policy ng Commonwealth. At may mga nababasa pa po kaming blog na mahirap makakuha ng claim sa Commonwealth Insurance. :-( Ang laki pa naman po ng binayaran namin sa Comprehensive insurance sa commonwealth, almost 40k po. :-(

Gusto po kasi naming humingi ng opinyon kung tatanggapin ba namin ung ex gratia na ibibigay nila na 50k? Although nung last meeting, humingi kami ng reconsideration ulit na kung pede nila dagdagan ung 50k.

Thanks a lot po ulit. :-)

[mda]

Tapos po hindi po sya declared as total loss dahil hindi daw po umabot ng 75% nung coverage which is 880k po. Un po daw ung policy ng Commonwealth. At may mga nababasa pa po kaming blog na mahirap makakuha ng claim sa Commonwealth Insurance. :-( Ang laki pa naman po ng binayaran namin sa Comprehensive insurance sa commonwealth, almost 40k po. :-(

Gusto po kasi naming humingi ng opinyon kung tatanggapin ba namin ung ex gratia na ibibigay nila na 50k? Although nung last meeting, humingi kami ng reconsideration ulit na kung pede nila dagdagan ung 50k.

Thanks a lot po ulit. :-)

Since umamin yung gumawa ng report na peke pala yung report... you are now at the mercy of the insurance...

In the first place, hindi dapat kayo pumayag dito... expensive lesson learned.

[99moves]

teka ano ba nangyari at kailangan peke-in yung report?

[pobre24]

Tapos po hindi po sya declared as total loss dahil hindi daw po umabot ng 75% nung coverage which is 880k po. Un po daw ung policy ng Commonwealth. At may mga nababasa pa po kaming blog na mahirap makakuha ng claim sa Commonwealth Insurance. :-( Ang laki pa naman po ng binayaran namin sa Comprehensive insurance sa commonwealth, almost 40k po. :-(

Gusto po kasi naming humingi ng opinyon kung tatanggapin ba namin ung ex gratia na ibibigay nila na 50k? Although nung last meeting, humingi kami ng reconsideration ulit na kung pede nila dagdagan ung 50k.

Thanks a lot po ulit. :-)

If I were you, take it. Wala na ibibigay yan. Mabait pa nga sila actually. They can decide not to give anything and just thresh it out in court if you decide to elevate it pa. Even the IC is not pressuring them because concrete yung hawak nila na there is an attempt to claim in bad faith kasi. Sayang.

[shadow]

Ano ba nangyaring accident? I mean dapat total loss na yan.


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[cast_no_shadow]

Ano ba nangyaring accident? I mean dapat total loss na yan.


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If it is approved. Kaso denied nga.

Happened to me before, late reporting / filing naman for my front bumper. Ayun outright denied too.

I filed reconsideration denied pa din. Policy eh which hindi ko alam. Pinabayaan ko na lang.

On the same year nasabitan ako on the other side front bumper pa din, ayun replacement! Problem solved hehe


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[cast_no_shadow]

Aray.

Hit and run ba talaga? Even a notarized affidavit will do, file mo lang as own damage.

Get the 50K, buti nga nag alok pa sila.

Napatunayan na pala na fraud, kahit magsabi na kayo ng totoo talo na kayo.

Lesson learned. Charge to experience na lang.


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[falken]

Tanggapin niyo na yung 50k, kung sakin ok na yung ginawa ng insurance at binigyan pa kayo kahit nameke kayo.
Lesson learned, huwag makinig sa mga taong nagmamarunong. And kahit tinatamad kayo, kung importante ang lakad, pumunta ka.

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