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what is reasonable for a insurance company to ask for?

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What is the name of your state? Colorado

I am submitting a claim for PIP benefits.
The claim is for Vocational rehabilitation benefits. I have given the insurance company(IC) a copy of the diploma I received, a copy of a letter from the school that states the cost of attendance, and copies of the receipts for the loans I took out for the school. and transcripts of the classes take. BUT the IC wants receipts for the books and tutition and I don't have these. Haven't I already given them enough reasonable proof that I incurred these expenses?

I am also filing a claim for lost wages. They are asking for a tax return from 1997 and 14 pay stubs from that same time. Is that reasonable or unreasonable? I only could find a couple of pay stubs from that period and I definately do not have any copies of my tax return from 1997.

Thanks, in advance, for your advice on this matter.
 


You Are Guilty

Senior Member
You can get old tax returns via Form 4056 from the IRS, available on their website (www.irs.gov?) The paystubs are another story, and if you can't get copies from your 1997 employer, I'd say your tax return (with a W2/1099) is more than enough proof to support your claim.
 
You can get old tax returns via Form 4056 from the IRS, available on their website (www.irs.gov?) The paystubs are another story, and if you can't get copies from your 1997 employer, I'd say your tax return (with a W2/1099) is more than enough proof to support your claim.
I actually did look into getting the tax return, but 1st I would have to file a change of address form, which would take 4-8wks to process, and then file a 4056 and who knows how long until I would actually get the tax return. I plan on filing this compliant within the next 3 weeks so I realistically can't get a tax return in time.

What I have to support my claim right now, is a payroll sheet from the employer that lists 6 checks for 6 straight weeks<which the employer will certify as true and correct>, 2 actual checks from that 6 week period, proof of the hourly wage I was making from the job contract, and a copy of from worker's comp of the amount that they were paying me per week in lost wages.

Isn't JUST this stuff more than reasonable?

ALSO in situations like this who gets to define the terms; such as "reasonable"? The insurance company, me, or the courts?

Thanks for your advice.
 

alnorth

Member
ALSO in situations like this who gets to define the terms; such as "reasonable"? The insurance company, me, or the courts?
Ultimately the courts would decide.

Regarding the lost wages, you said they were asking for proof of income from 1997. Are you only NOW submitting the claim 10 years later, or is this an issue that was submitted long ago and has been dragging on for years?

If you are only now putting in a claim 10 years after your loss, I can see why the insurance company is not enthusiastic about paying. That would be far too long to wait on a claim.

If this is a claim that was put in shortly after the loss and its been going on this long without a resolution, then that would be quite a bit different. In that case, you may want to complain to the Colorado Division of Insurance, and possibly start talking to a lawyer if the claim is large.
 
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Regarding the lost wages, you said they were asking for proof of income from 1997. Are you only NOW submitting the claim 10 years later, or is this an issue that was submitted long ago and has been dragging on for years?

If you are only now putting in a claim 10 years after your loss, I can see why the insurance company is not enthusiastic about paying. That would be far too long to wait on a claim.
Well the issue is that the policy I was covered under was judicially reformed on 12/19/03 to include "enhanced" PIP benefits. The case then went to the 10th district appeals twice until the defendants ran out of appeals in 2005. I didn't find out about the reformation until 1 month ago when I was researching my claim for Voc. Rehab benefits.

Originally I had used up the entire lost wage benefit because it was only for a period of 52 weeks. With the "enhanced" policy the lost wages are available for an unlimited amount of time, and pay up to a aggregate $200,000 policy limit.

Fortunately the person who brought the class action suit to against the insurance company did so within 3 years of my accident, so I am assuming I don't have a problem there. The case then took 5 years to conclude.

I am thinking about asking for punitive damages because the Insurance company was ordered to look into inactive cases that may be due these benefits. They obviously didn't look into my case, or most likely have a policy in place to make their adjusters aware of this benefit. I say this because I had recently told the adjuster that I had to quit the job I was at because of the pain and discomfort that my injuries were giving me and the adjuster didn't tell me anything about the lost wage benefit that are available to me. And when I finally told the IC that I was claiming lost wages they said "we are having are underwriters see if you are actually eligible for this coverage" I know I am because the reformation was all about an exclusion, for pedestrians, (which I was in this catastrophic accident), that the insurance company had in the policy that was deemed illegal and thus the cause of the reformation.

Thanks for your helpful advice. It is greatly appreicated.
 
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