PSU insurance company files motion for denial of coverage

[wartknight]

How so? You really think I would make this stuff up? The one with the wall still standing put up a sign on the side of the road to advertise how well his insurance company was taking care of him. Shortly afterwards the company came to their senses and deemed the house a total loss. Feel free to ask anyone from Parkersburg if you doubt what I am saying.

Not all companies were like this, most were very good and took care of their customers right away.

I grew up in Pburg and will verify this. It was a house on the north side of 57 going through town. They spray painted on the lone wall standing of the house "Ameri(something, I don't remember company) says this is not a total loss". That is the extreme one way that everyone hears about.
I also know of at least 2 cases where adjusters came in and found cracks in foundations of homes that homeowners thought there was just roof damage done, and the owners ended up getting brand new homes out of the deal.

 

[Golfer]

Duffman is dead right here. All liability insurance policies have specific exclusions pertaining to intentional acts, and most have exclusions for and will not cover unlawful behavior.
Personally, I think the insurance company has a pretty good case on this.

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Not all, but pretty close. Sexual molestation is a specialty coverage, and it covers intention acts, as these acts cannot be unintentional, but it does require the insured to report circumstances that might lead to a claim in a timely manner. They are saying, if they were on this risk in 1997 as an example, maybe we cover 1997 backwards, notwithstanding the fact of the late reporting (and even this is doubtful), but 1998 and after? No way, no how never.

If the courts rule they most pay, a precedent will have been set, and everyone's cost for this coverage will increase significantly. It was priced to pay claims they are reported, and then thye can mandate certian things, like make employment changes, or we non-renew, with cause. We non-renew, because if you do not make employee changes, we know another claim is coming, and we cover clims, not certainity. These policies weren't priced with a multi-year cover up included, with no chance to mitigate the current, or future loss.

 

[hawkfan340]

How so? You really think I would make this stuff up? The one with the wall still standing put up a sign on the side of the road to advertise how well his insurance company was taking care of him. Shortly afterwards the company came to their senses and deemed the house a total loss. Feel free to ask anyone from Parkersburg if you doubt what I am saying.

Not all companies were like this, most were very good and took care of their customers right away.

Not saying you made it up... just that it might be a story that got passed through many ears/mouths and might not be totally accurate.

I have no idea, though. Could be perfectly accurate. From my experience, it sounds very out of the ordinary. People/companies of all stripes try to get a way with all kinds of stuff though so I don't know.

Contacting the Iowa Insurance Division is a good idea if you think you're getting ripped off.

 

[Golfer]

Contacting the Iowa Insurance Division is a good idea if you think you're getting ripped off.

Yes. Many take it to an attorney. Quickest way to get this dealt with is to write this letter. If that doesn't work, than maybe an attorney after that. That is, if you didn't bind yourself to arbitration. It's a contract. They made an offer, you accepted. In Iowa, Courts uphold agents to be nothing more than order takers, and also uphold the fact that policyholders need to actually read their policies.

 

[H8IAST8]

if I remember correctly American Family had a large share of the damaged houses.

 

[03bizHawk]

Guessing H8iastate works for nationwide. Shot in the dark, but the looking for a reason to pay comment....

 

[hoffahawk]

What are the particulars if you don't mind?

Since this has not yet gone to court I don't know how much I can or should say. Basically my son requires an expensive medicine if he gets hurt and it is a constant battle to get insurance companies to pay. They will go through any means possible to fight the claims and we have been put in a bind twice scrambling to get medicine because of their processes.

That's tough for sure, I know several people going through the same thing. As others have said HI is a different ball game but it really is tough in some cases for patients, doctors and insurance companies to be all on the same page. In SOME cases (not saying in your case) I have seen doctors not prescribe generics when they are available or prescribe a similar drug that treats the same ailment but costs 800% more than another covered drug. To use a PC insurance comparison if one contractor says they can repair a roof for $5K and another says $25K, which one is the insurance company want to pay? The roof will be fixed in both cases just contractors (drugs) going about in different ways. Again, not saying in your specific case but I have seen it a lot. I have also seen companies go to far in avoiding trying to pay a legitimate claim.

 

[ssckelley]

That's tough for sure, I know several people going through the same thing. As others have said HI is a different ball game but it really is tough in some cases for patients, doctors and insurance companies to be all on the same page. In SOME cases (not saying in your case) I have seen doctors not prescribe generics when they are available or prescribe a similar drug that treats the same ailment but costs 800% more than another covered drug. To use a PC insurance comparison if one contractor says they can repair a roof for $5K and another says $25K, which one is the insurance company want to pay? The roof will be fixed in both cases just contractors (drugs) going about in different ways. Again, not saying in your specific case but I have seen it a lot. I have also seen companies go to far in avoiding trying to pay a legitimate claim.

I see what you are saying but in my case we are suspecting the insurance company wants to bury this pharmacy into the ground with legal fees. The medicine my son has to take there is no such thing as a generic. It is a big waste of everyone's time and money on why they are refusing to pay and I really have nothing good to say about them.

 

[ThunderHawk]

An insurance company trying to avoid paying claims? <shock>

Intentional tort. I'd do exactly the same if I were them.

 

[ThunderHawk]

Sure, they can't turn down reasonable claims. But that doesn't mean they won't turn over every stone to find a viable reason to turn down a claim.

In PSU's case, it's completely justified. But they will almost always try to get out of paying, when possible.

Insurers have to walk a fine line when trying to deny legit claims. Getting tagged with a bad faith claim usually isn't worth the risk.

 

[Golfer]

Bad faith would be much less expensive than potential precedent, making case law. Bad faith is expensive though.

 

[Cyhawk]

There are several issues here:

1. This is not one claim, it could be hundreds? Each one with the limit exposed.
2. There are policy coverages in place for sexual molestation. Several carriers (insurance companies) have limited this coverage to $100,000 or less, or exclude it all together.
3. Proving (tangible evidence - witness) is tough 20 years removed.

If the Insurance carrier is denying the claims, that may be there, they must have good reason to feel the coverage contract is in their favor.