insurance claim issue (need help)

[el_blacky06]

So a couple days ago, my car got vandalized (got keyed all around ) and someone hit my tail light and dented part of the trunk. I went to get the damage valued so I could go ahead and pay my deductible. As they were examining the damage, the had said that they won't repair my tail light and the trunk because it seemed like it was backed up into something (as saying like if I did it myself). So I'm really pissed that I'm about to pay my deductible and the car is not gonna be fully covered due to that reason. So my question is how can I go about this? I don't want to have a new paint job with a busted tail light and trunk. This is my first claim ever so I'm a newb to this

[ADDirishboy]

Do they have proof that it wasn't part of the vandalization? Ask what they are skeptical about.

[el_blacky06]

Nope no proof, they went by assuming that it wasant part of the vandalism.

[carloslebaron]

Bad news that your insurance company got such a conclusion.

I guess that replacing the tail light is not hard after all, and you can ask the body shop for not installing it back after the paint job is done, so you can install a new one (or a used one in good condition) by yourself, and avoid their fee for its installation.

You might have the right to choose the body shop to make the paint job, so you also can talk with the guy of the body shop about fixing the trunk dent or whatever, by giving him the job, so he might make you a discount for to fix it.

I did something similar several years ago, when I received a check -from Geico-to pay the repairs in any body shop that agrees with the amount shown on it. The guy over the body shop also agreed to paint the whole vehicle, after the repairs were made, at a very cheap price, so I paid a little more but the vehicle did look like new...everybody was a winner.

[PapaSmurf2k3]

I'd be pretty pissed.
I wonder how they came to that conclusion. I'd make it known that you intend on dropping them after the repairs if they don't intend on covering the tail light and trunk dent.

What insurance company is it?

[el_blacky06]

I was thinking of choosing my own body shop even tho I gotta pay the deductible plus 20% of the total cost. Imma try to talk to a body shop I got recommended to and hopde they could replace the tail light plus fixing the trunk for the same price. I'm still really pissed since the body shop owner said it looked "rusted" so it didn't match the key marks. My arguement was that how do they knw they didn't hit my car with an object that could make it look rusted when the marks also look rusted? Stressfull times ugghh and I got Infinity Insurance

[C-Kwik]

You have any photos we can look at to evaluate what they are looking at?

[el_blacky06]

This is the pic that they're talking about. They said that "it looks rusted " like if I did it like a couple days ago

[ADDirishboy]

It "looks" rusted? Either it is or it isn't. It's not that hard.

Also, if you take it to you're own body shop, they make you pay 20% of the total? What the hell company are you with?

[Bubba1]

That sucks about the treatment by your insurance company. If you backed into a wall, it seems more likely the bumper which sticks out farther would get hit. As far as going to the shop of your choosing, and your deductible amount, you better read the fine print of your policy. Some companies don't permit your choice unless they are pre-approved by them. That's done primarily to avoid fraud. In many cases, insurance company has a list of approved local body shops that act as representatives and direct bill the insurance company, which can be easier. If you have a stock paint job, it's not that bad. My wife's Altima was hit 5 times while we owned it. In every case the Alti was sitting still and got hit. We used each insurance company's bodyshop recommendation every time and it was never a problem.

I'm sure you're going to change insurance companies after this situation gets resolved. But instead of threatening them or announcing to them your dropping them, (which will make you feel better initially but is unwise while the case is open), you might consider speaking with a lawyer, whos in a better position to advise you of your options. The one thing you need to keep in mind is how expensive the part of the repair they don;t want to cover is versus the cost/hassle of hiring a lawyer and fighting them about it. Used Alti Tail light assemblies are not expensive and straightening the trunk lid might not be that much either. So if they cover repainting the entire car for the keying, then you're probably talking about a fairly small sum for the tail light/straightening the trunk lid. Might not be worth fighting even if you're right.

[el_blacky06]

Reason for the 20% more is because they had informed me that if I take it to a shop outside of their network, then ill pay part of the total cost. If its thru their body shops, then they'll cover all the damage and ill just pay my deductible. I'm planning to take it to another shop outside of their network since they really pissed me off about the tail light & trunk damage. Never again will I have Infinity insurance after I'm done with all this mess. I'm going back to allstate even tho its a bit more money

[PoorManQ45]

This is the pic that they're talking about. They said that "it looks rusted " like if I did it like a couple days ago

Did an appraiser come out to look at the vehicle or did they just ask for pictures?

If just pictures, that's effing retarded!

[el_blacky06]

I actually went to the body shop that was nearest to me (Infinitys own body shop) to get it appraised. Earlier in the day I received a phone call saying that they won't cover it because the damage with the key is one thing, the hit seems like if it was another incident. They're gonna make an investigation to even see if they will cover my car because of the hit I'm just hoping I won't get screwed for something that I didn't even caused.

[C-Kwik]

First, CA insurance code prohibits insurance companies from requiring that you use a specific shop. This is the first I've heard of in which an insurance policy specifies the shops you can use. You might ask them to elaborate on this further and ask for the specific policy language that states this. Make them put it in writing. Its not exactly forcing you to a specific shop per se, but this is the first I've heard of this from a company in CA, but I've been out of the industry for about 5 years now.

As for the damages, ask the adjuster to send out an inspector to evaluate this for themselves. From what I can see, there really isn't much basis for saying the damage to the taillight and trunk are unrelated to this loss. On the surface, I can understand why they are looking at it the way they are, but ultimately, they need to be pretty sure about it. A field inspector is going to generally have a lot more experience in evaluating damages and be somewhat aware of the legal risks of denying a legitimate claim. A body shop typically is not going to understand this aspect and are legally removed from the responsibility of their opinion anyways. Also, if you have any recent photos showing that the damage wasn't there or perhaps if you had recent work done on the car for which a shop can vouch that there was no damage there, it may be helpful or at least make it more difficult for them to want to deny this. Ultimately, short of a fairly scientific evaluation of the damage (at the microscopic level) it would be hard to prove the damages are unrelated. So anything that casts doubt on their current opinion is helpful.

If they still deny the claim, take it up with the supervisor first. Make sure they have a chance to review the file. There are legal risks that an adjuster may overlook but a supervisor with a reasonable amount of experience is more apt to keep in mind since they would be denying the case on a non-scientific opinion. If they are still going to deny the case at this point, ask them to confirm the partial denial in writing (which they are required to do anyways), but also ask them to be specific as to how and why they opined that the damage is unrelated. If they refuse to be specific, push them on this issue. Write a letter requesting this. If they still refuse, file a complaint with the department of insurance. While the DOI does not get involved in decisions the insurance companies make, they will ensure the file is in compliance with insurance code. I'm not sure if they can enforce your request for specific reasons for a denial (it never came up for me as I had no problem doing so in my files), but it certainly could not hurt.

The reason you want to push this is it tends to push them into making a decision where any ambiguity will be in your favor. A denial on a policy where coverage should have been afforded is bad faith lawsuit territory. Any knowledgeable adjuster or supervisor is going to always be aware of this potential in every file they handle. Considering bad faith suit payouts are punitive in nature, the awards can be huge. No insurance company is going to risk that against such an ambiguous issue. Unless, Infinity is going to be completely idiotic, it will be unlikely to ever get to the level of a bad faith suit. So I wouldn't get too excited about any potential lawsuit that you might have here.

All that said, I have little experience dealing with Infinity insurance at this level. But my old branch manager came from Infinity. There were a number of dealings I've had with him that made me feel that he wasn't the most honest claims personnel. Hopefully that doesn't speak to how Infinity adjusters are trained to think about claims.

[PoorManQ45]

What does a replacement tail lamp enclosure cost from Nissan?

That damage to the lens can not be repaired. It has to be replaced. If they are getting the enclosure/housing from Nissan I can see why they'd want to deny that portion. The cost of that part is probably really high!

[PapaSmurf2k3]

We throw away a bunch of them every day at work for reasons I do not understand...

[el_blacky06]

C_Kwik- thanks for the useful info. I'm definitely gonna get this done on paper for any future issues. I'm just waiting on their response if they're even gonna fix my car.

[DJ_B_Easy]

Did you file a police report for the vandilism? That would have helped a great deal.

[C-Kwik]

What does a replacement tail lamp enclosure cost from Nissan?

That damage to the lens can not be repaired. It has to be replaced. If they are getting the enclosure/housing from Nissan I can see why they'd want to deny that portion. The cost of that part is probably really high!

Its not going to be that much. Depending on how badly the car was keyed, the paint job will likely be quite a bit higher. If they thought the damage was related and they didn't want to pay for a new light, they would try and push a used or aftermarket part first. And denial of a claim based on the cost (outside of limitations of the policy itself) would be a huge bad faith exposure. Its more likely that the adjuster believes it is unrelated (though they are likely relying on the shop's opinion alone). An inexperienced adjuster might close their minds to other evidence, which, hopefully, would be corrected by a supervisor if reasonable evidence is presented or if they see that there is a lack of evidence on their part.

Did you file a police report for the vandilism? That would have helped a great deal.

A police report itself doesn't carry any weight as evidence in and of itself, but it does potentially add some credibility to one's statement as people are less likely to file a false report. But this is likely to only play an issue if the adjuster is on the fence on whether or not they believe the damage to be related or not.

[el_blacky06]

Yea I had filed the police report once I had found the damage done to my car.The good news now is that I talked to Infinity Insurance and now they're gonna start fixing my car within the next2 weeks. I still couldn't get them to pay for the tail light & trunk so its gonna have to come out of my own money unless I could work out a deal with the body shop. Until then all I could do now is file a complaint to the company.

[DJ_B_Easy]

But this is likely to only play an issue if the adjuster is on the fence on whether or not they believe the damage to be related or not.

This is what I was getting at. The sole documentation of the date of the incident I think would be enough in this case. If all of the damage was reported at the same time I dont see how they can deny its related. They have to prove its NOT.

[el_blacky06]

*update* I'm. Sending my car to the body shop and I filed a complaint to both my insurance provider and the person who appraised my car in the first place. I was informed that if it still dosent get resolved, then it will come out of my pocket and it will be under investigation to see if it was part of the damage (pretty stupid to me since I wnt damage my own car)

[PoorManQ45]

*update* I'm. Sending my car to the body shop and I filed a complaint to both my insurance provider and the person who appraised my car in the first place. I was informed that if it still dosent get resolved, then it will come out of my pocket and it will be under investigation to see if it was part of the damage (pretty stupid to me since I wnt damage my own car)

This is sending up a red flag to me for some reason.

They want you to pay to fix the issue and THEN they are going to investigate? The evidence is going to be removed. Yes, pictures are nice. No, they are not the same as seeing it in person.

[C-Kwik]

This is what I was getting at. The sole documentation of the date of the incident I think would be enough in this case. If all of the damage was reported at the same time I dont see how they can deny its related. They have to prove its NOT.

My point was that it is not. A police report typically contains hearsay evidence. That is, it contains only the information that is provided by people making statements in it. Its quite rare that police officers make reports in which they witnessed the actual event (in this type of case anyways). So there is no validation of the event that the report can provide in and of itself. Case in point, consider a vehicle theft. A person presenting a fraudulent theft claim would need to provide a false statement to the police. The officer will write in what was told to him. But that doesn't make the case valid in any way. In this particular case, it appears to be a difference of opinion as to whether or not the damage is related or not. There ultimately is more burden on the insurance company to prove its not, but the key to pushing that decision in the OP's favor is to try and make sure they are put to specific decisions where they may not feel comfortable defending if it came down to it.

*update* I'm. Sending my car to the body shop and I filed a complaint to both my insurance provider and the person who appraised my car in the first place. I was informed that if it still dosent get resolved, then it will come out of my pocket and it will be under investigation to see if it was part of the damage (pretty stupid to me since I wnt damage my own car)

This isn't providing a clear description of what Infinity will be doing to try and resolve this, but before any work is done on the vehicle make sure a representative qualified to loo at damages inspects it in person first. Most times, when shops write an estimate for an insurance company, a field inspector never reviews the estimate or photos. Inside adjusters aren't always qualified to make such an opinion on whether or not damages are related or not. I would at least make sure the opinion rendered by an inside adjuster can be quantified by their own observations of the photos submitted by the shop. In any case, demand they look at it personally. And take really good photos, including good close-ups.

Additionally, I can't say for certain as I am not viewing the damages directly, but I don't see any significant rust. If there are spots of rust, depending on the timing of the damages in relation to the rain we had recently, that could have been a factor. Depends on how far through the anti-rust coating the scratch got through. Also, I don't see any crinkling in the chrome colored trim in the taillights. Long term exposure to outside elements tends to cause crinkling/cracking in the chrome colored portions. Just some additional factors that might need to be considered.

[PapaSmurf2k3]

Let us know when you hear anything.
Sounds like your insurance adjuster needs a swift kick to the nads.

[el_blacky06]

*update* as of right now I'm really pissed off. I took it into my own body shop where I wanted to get the repairs done. So I found out that the adjustor is a freakin jerkoff when it comes to claims. It turns out that he has a history of doing this so he won't pay anything extra to save a few bucks on his end. I only found out this type of info because my body shop has dealt with this guy in the past. He's well known to apraise the damages low so my insurance won't pay much for it. My body shop will contact the adjustor tomorrow(or today if they had the chance) to get the trunk & taillight valued with the total cost.

[PoorManQ45]

Good to hear you're on the right track.

Others may know, is there someone that this can be reported to?

[el_blacky06]

Ok so the adjustor came out this time to the shop (same jerk) and he re-evaluated my damages again. He had a sudden change of heart when my bodyshop decided to get em a bit scared by threatening em with a lawyer if they don't get the rest of the damages included with the body work (total bluff) IT WORKED! Lol now I'm getting a new paintjob allaround plus a new taillight and the trunk fixed! It could've not gone any better and now I'm just waiting for the check to come in the mail for the bodyshop could receive it and start to work on my car. Id like to give many thanks to all of you who tried to help me in my case, I really appreciate it!

[PapaSmurf2k3]

Sounds like you owe the owner of the body shop a 6er of his favorite beer.

[PoorManQ45]

In addition to a thanks to the owner of the shop I would look into legal options.

This insurance company attempted to partially deny your claim without a proper assessment of the situation. This has to happen a lot and they probably get way with it a lot!

This s*** should not be happening. The company is already raking in the money for a service that the majority of their policy holders never use! On top of that the service is government mandated!