Insurance Claim

Aetna, the health insurance giant, may soon be insuring Fluffy the kitty or Fido your pooch.

Pets Best Insurance is the new pet insurance company under the Aetna banner. They began underwriting policies last week in six states, and plan to sell in all 50 states before long.

Pets Best intends to trade on the market visibility of Aetna and sell its policies through the 40,000-plus veterinarians in the United States. The policies will also be offered through the company website. Policy premiums will range between $300 and $500 per year per pet, based upon the chosen coverage.

Should you buy Pet Insurance?

About 60 percent of American households have a pet and spend over $10 billion a year on veterinary care.

The policies will pay 80% of costs, subject to a deductible, for each illness. Routine checkups, lab tests, prescriptions emergency room visits and other services are covered.

Pet Best’s policies are comparable to those that have been on the market since about 1998. Some insurers exclude hereditary and chronic conditions, others don’t.

If a pet lives an average of ten years, you could shell out between $3,000 and $5,000 on premiums for each pet. Without insurance, you might not ever spend that much on medical treatment. But if you are the kind of person who will do anything to take care of your pet, then medical insurance for your pet might make sense.

One of the things you might consider next time you’re shopping for a pet...remember that dogs are in veterinary offices twice as often as cats. So, if you’re a person on a budget who can’t stand the thought of life without a pet, consider a cat. Also, do some reading about the health problems inherent in the cat or dog breed you want to own.

Drivers and passengers in moving vehicles regularly get injured in low speed, low impact collisions. The best example is a rear-end collision while in slowly moving traffic. Many times, the injuries are soft tissue injuries, like neck injuries, that are hard to diagnose and take time to treat. Insurance adjusters, whether independent or company adjusters, have a difficult time believing that you could have gotten injured in a low speed, low impact car wreck.

They think you’re lying.

So, if you’ve had a car wreck that could be considered low speed or low impact, know that the adjuster is going to start out at best skeptical, and at worst committed to proving that you weren’t injured.

Low speed accidents are self explanatory. But if you're traveling at 45 mph and are struck by car going 55 mph, there's only a 10 mph difference between cars, so that's low impact.

Back in October 2004, I had a rear-end collision accident. The driver behind me wasn’t watching carefully when we slowed before a red light, and he struck me from behind. The impact drove my car’s front bumper into the car in front of me. The driver behind me got a ticket. The collision damage totaled $3,474.13, and my soft tissue neck injuries settled for $2,640.00, for a total of $6,114.00.

There is a lot more to the story than just that I got a settlement. I actually got $1,640.00 more than my insurance company initially offered. These are strategies you can learn.

But let’s get back to your accident. If you got rear-ended, the other driver is at fault to some degree. If he is uninsured, or if his insurance company will not accept liability, you might consider submitting a first party claim. If you’re making a first party claim, which is you making a claim to your own insurance company, your Collision coverage will cover damage to your car. That’s pretty clear-cut. Your injuries will be covered by your health insurance, not your car insurance. Your insurance company will then “subrogate,” or ask the other driver’s insurer to reimburse them for your claim.

The adjuster for the other driver is going to do an investigation, consisting of:

1. Photos of all four sides of your vehicle to document the damage, but also to determine if there was pre-existing damage.

2. Vehicle appraisal of damages

3. Recorded statement from you. The other adjuster is going to ask you questions meant to get you to say something that could allow them to deny your claim. Understand that you do not have any legal obligation to give a recorded statement to the other driver’s adjuster. If you decide to grant a recorded statement, ONLY do it in the presence of your own attorney. And, you should include your attorney’s bill in your insurance claim.

4. Witness interviews and statements.

5. Background information. The adjuster will run your name through several databases, including ISO Claimsearch and the National Insurance Crimes Bureau to see if you’ve filed previous insurance claims. Don’t give your Social Security number to the adjuster. That just makes his job of getting your background information easier.

6. Collect your medical bills and medical history. The adjuster will likely present you with a Medical Authorization Form for your signature. READ THIS FORM VERY CAREFULLY!! Most times, the form is so vaguely worded that you give them permission to collect medical information for your entire lifetime. Only sign an authorization that permits them to have the medical records and bills for this single incident, not your life history. Have your attorney read the form before you sign it.

7. Have experts evaluate your damages. The reason insurers hire experts is to find ways to deny or minimize claims, not help you prove your claim.

8. Waiting and delay. The greatest tool in the hands of the insurance companies is delay. They can certainly afford to wait, even though you may not be able to wait. Delay leads to compromise and compromise very often leads to lower claim settlements.

9. Negotiate your settlement with you or your attorney. Please understand that adjusters are not intimidated by personal injury attorneys. They actually prefer to deal with them, since they won’t have to deal with you anymore. It also adds more delays to the claims process, which puts financial pressure on YOU.

10. Settlement. Low speed/low impact claims usually have a low price tag, many times below $25,000. It doesn’t usually make economic sense for a personal injury attorney to litigate a case this small, as it could cost them $5000-$10,000 to litigate. So, if the adjuster makes a “take it or leave it” offer of $15,000 (on a $25,000 case), your attorney will likely take it. That saves a ton of money for the insurer, and the adjuster gets to close another file and look good to his boss.

Remember, friends...this claims process is all about the money. It is not about truth, or justice, fair or unfair claims practices.

It is all about the money.

If you have experienced a property loss, whether fire, wind, flood or other, you need to know winning insurance claim strategies. The insurance company will not tell you the claims process, but I will. I will show you how to take control of your insurance claim, and add hundreds or even thousands more dollars to your claim settlement. For more information, go to the website listed here.

A claim supplement is a claim for additional repair or replacement costs. Supplements are commonplace in the claims process. However, if you are a policyholder unaware of your policy rights, you could be walking away from hundreds or thousands of dollars that you are entitled to collect.

Claim supplements usually occur after a policyholder submits a claim, gets paid and gets the repairs or replacements completed. Then, additional damage is discovered some time later.

Many people erroneously think that, once the claim is closed, it cannot be re-opened. And, insurance companies and their adjusters usually don’t rush to tell you how to submit a claim supplement. So, what to do? Let’s look at car insurance claims and property insurance claims.

For any kind of supplemental claim, you must contact your insurance company and give them your original claim number. The best way to notify the company is in writing, sent Certified Mail. That way, you’ll know who signed for the letter. The insurer will have to re-open the claim. You might get the same adjuster as before, but maybe not.

Car Insurance Supplemental Claims

Lots of supplements happen when cars are getting repaired. Many times, hidden damages are discovered when the body shop begins dismantling the car. So, while the insurance company may have issued payment to the body shop from the original repair estimate, they will issue a second check for the supplemental repairs. Happens all the time, no big deal.

However, sometimes post-repair problems don’t show up right away. A good example is the Air Conditioning system. If you have a car wreck in July, you might not notice that your heater is malfunctioning until fall or winter. But when any damages are discovered that can be directly related to the original insured loss, you can submit a supplement. Simply document the damages and their cause and send the supplement to the insurance company. No additional deductible is assessed, since you already paid it once.

Property Insurance Supplemental Claims

Homeowners, Renters or Business insurance claims can find a need for a supplemental claim for some of the same reasons found in car insurance claims. Seasonal issues can bring up damages related to the original loss. But, some other issues might present themselves. You may have an expert’s report that shows additional damage attributable to the original loss. Your contractor may have found hidden damage that must be repaired. In any event, carefully document your claim and submit it to the insurance company.

Be sure that you are collecting all the money you are entitled to collect. Use supplemental claims whenever your claim requires it.

If you have experienced a property loss, whether fire, wind, flood or other, you need to know winning insurance claim strategies. The insurance company will not tell you the claims process, but I will. I will show you how to take control of your insurance claim, and add hundreds or even thousands more dollars to your claim settlement. For more information, go to the website listed here.

If you do not know how to handle overhead and profit (OHP) issues in your insurance claim settlement, you could lose tens of thousands of dollars that you are entitled to collect.

Yet, many policyholders find themselves forced to use savings or borrowed money to complete repairs. It should almost never be so.

In any property or insurance claim, if you have to come out of pocket more than your deductible for repairs or replacement, your claim has not been handled correctly.

There have been disagreements over how to handle overhead and profit between insurance companies for years. I have handled claims for insurers who mandated that OHP must be removed on all repair estimates. Some insurers will pay OHP, but limit it to 10% overhead and 10% profit. Some pay OHP, but will only pay it when the policyholder provides a signed contractor repair contract.

But you should know that OHP is a legitimate expense of repair in a property loss, and your insurance company should not dispute OHP. Contractors have to manage sub-contractors, get building permits, pay their labor, materials and the rent, and get the work done while earning a profit.

Traditionally, in a homeowners, renters or business policy, insurance companies will consider OHP when there are three or more building trades involved in the repairs. For example, when there are carpenters, electricians and plumbers doing repairs, OHP is paid. However, if you only had a painter and a wallpaper hanger, most insurers would not pay OHP costs.

But consider how much this could affect your claim. If you had a fire claim with a $50,000 repair estimate with a general contractor handling the loss, 10% overhead is $5,000 and 10% profit is another $5,000. Together, that’s $10,000 more money owed to you.

So, if you submit your repair estimate and it has OHP built into it, make sure that the insurance company pays the OHP. It could be the difference between getting all your repairs paid for, and you having to pay some repairs yourself.

If you have experienced a property loss, whether fire, wind, flood or other, you need to know winning insurance claim strategies. The insurance company will not tell you the claims process, but I will. I will show you how to take control of your insurance claim, and add hundreds or even thousands more dollars to your claim settlement. For more information, go to the website listed here.

The newspaper has a story today about a 60-year-old Southern California man who was mauled to death by two pit bulls. Seems the man was standing in his own back yard having a cigarette when the attack occurred. These dogs belonged to his grandson, and the victim was familiar with the dogs. Neither dog had been neutered.

Perhaps these dogs were radical non-smokers. Doubt it, though. But this is certainly a story of a family tragedy. But, if you have one or more dogs at your home, you could have a tragedy waiting to happen.

Pit Bulls and Rottweilers are the two most fatal attackers. Next are the Akita and Chow. Dogs that are tied up are very dangerous, and male un-neutered dogs are the most dangerous.

Dog bite law is an unusual area of the law, and can affect you and your home or business quite negatively if you own a dog. How?

Depending upon your circumstances, you could be subject to both civil and criminal charges if your dog bites someone. Compare that to having the postman slip and fall on your sidewalk, which could only involve simple negligence on your part.

The law consists of both civil and criminal law, and varies widely between state and local jurisdictions. The reason it varies is the interpretation of the old “One-Bite Rule.” That rule, with its basis in English common law, protects a dog owner until he gains knowledge that his dog is vicious or dangerous. Once the owner learns this, he becomes strictly liable for injuries the dog causes.

Most all states hold the dog owner liable if injuries are caused by negligent handling, or violating a leash law. In almost two-thirds of the states, the owner is statutorily liable, meaning he is liable simply because he owns the dog.

Here are six tips on what to do after your dog bites someone:

1. Stay calm and be nice to the victim. Don’t argue about who is at fault. Don’t accuse the victim of anything. Remember that this person is going to make a decision now about whether to hire a lawyer to sue you.

2. Take the victim to a doctor or hospital and get medical attention. Pay for it yourself, no matter whether you have insurance or not.

3. Take precautions to protect other people from your dog.

4. Secure the name, address and phone number of ALL witnesses to the incident.

5. Do not make ANY statements to ANYONE but your own attorney about the incident.

6. Call your homeowners, renters or business insurance company and immediately report the incident. If the victim decides to pursue a damage claim against you, the insurance company will likely have to provide legal counsel and defend you in the lawsuit. If you do not report the incident right away, they might deny your claim for late reporting.

When you’re shopping for new insurance, most insurance companies will ask you the breed of the dog you own. Most insurers will either charge you higher rates for certain breeds, or refuse to insure you at all.

If you’re interested in reading more about dog bite law, go to the website of Attorney Kenneth Phillips at: www.dogbitelaw.com

Kenneth Phillips is the nation’s leading authority on dog bite law. His Beverly Hills, California law practice is unique in that he only represents dog bite victims. Mr. Phillips has done hundreds of radio and TV interviews, and featured in scores of print articles over the years. He represents clients all over the United States.

If you have experienced a property loss, whether fire, wind, flood or other, you need to know winning insurance claim strategies. The insurance company will not tell you the claims process, but I will. I will show you how to take control of your insurance claim, and add hundreds or even thousands more dollars to your claim settlement. For more information, go to the website listed here.

In March 2007, a disgruntled nurse set fire to a six-story atrium office building in Houston, Texas. The building suffered extensive damage, and three people died from smoke inhalation.

The primary insurance company with a $1 million policy on the building has accepted liability. However, there is another insurance company involved.

Great American Insurance Company has Excess coverage on this building over and above the underlying $1 million policy up to a limit of $25 million. They have appeared in the courtroom of US District Judge Lee Rosenthal and argued that the deaths were caused by “pollution,” which in their view, is the smoke generated by the fire.

Most all policies have a coverage exclusion for Pollution, which is meant to exclude coverage for seepage or discharges of pollutants that cause damages. But the Pollution Exclusion also mentions smoke, fumes and soot.

And that is where Great American is hanging its hat.

Great American is arguing that coverage for the property damage and deaths should be denied because the smoke from the fire qualifies as “pollution,” and as such the claim should be denied.

In my opinion, this argument violates the intent and clear words of the Pollution Exclusion.

I hope that you are as outraged as I am over this travesty unfolding in a Houston courtroom. But, stop for a moment and consider how smoking mad the families of the three victims of the fire must be. There’s no question how these people died. Smoke inhalation is one of the most common causes of death in fires, much more common than injuries from flame. And the reason is that the building materials of today create deadly toxic fumes when they ignite. Many times, it only takes one breath of these fumes to kill a person.

I pray that the judge will use common sense and rule against Great American. It’s too bad that the judge cannot punish them for violating Unfair Claims Practices regulations here. But, proffering a bogus motion in court is likely not enough to qualify as bad faith.

But, wouldn’t you agree that this effort by Great American is as close to Bad Faith as possible?

If you have experienced a property loss, whether fire, wind, flood or other, you need to know winning insurance claim strategies. The insurance company will not tell you the claims process, but I will. I will show you how to take control of your insurance claim, and add hundreds or even thousands more dollars to your claim settlement. For more information, go to the website listed here.

The worsening recession and mounting job losses are causing an unexpected increase in uninsured motorists.

Hundreds of thousands of people all over North America are canceling their car insurance or allowing the policies to lapse. One reason is the increasing unemployment rate. As people lose their income, they begin to cut back on their expenses. Tragically, one of the things they cut is their car insurance policies.

However, some drivers are just trimming their coverages, lowering their coverage to the minimum liability level that keeps them legal drivers.

Even in good times, insurance studies show that about 15% of drivers nationwide are driving without insurance. In states that have a large immigrant population, it can be as high as 25% uninsured drivers.

What happens to you if you are in an accident with an uninsured driver? If the accident is the uninsured driver’s fault, you will not have his insurance to pay for your damages or injuries. Statistically, those who drive without insurance have very few assets. So, even if you file a lawsuit to recover damages, the uninsured driver is likely not collectable.

What can you do to protect yourself and your family? Make sure that your car insurance policy includes Uninsured Motorist AND Underinsured Motorist coverages. Choose the highest liability limits available through your agent. UM coverage also protects you from hit-and-run accidents and injuries if you are a pedestrian. And Underinsured Motorist coverage protects you from those drivers who have chosen minimum coverage.

If you are thinking about dropping your car insurance, know that people who allow their policies to cancel for any reason can face surcharges of 25% to 50% when they try to buy insurance again. The companies consider them to be high risk drivers, which they are!

Many states require drivers to buy Uninsured and Underinsured Motorist coverage. Driving without insurance is illegal in 48 states. Only Wisconsin and New Hampshire will allow drivers to file a financial responsibility form with the state to drive legally.

If you have experienced a loss, whether car wreck, fire, wind, flood or other, you need to know winning insurance claim strategies. The insurance company will not tell you the claims process, but I will. I will show you how to take control of your insurance claim, and add hundreds or even thousands more dollars to your claim settlement. For more information, go to the website listed below.

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