Insurance claim denied: Body Shop after me for $$

What is the name of your state?State: Washington
City: Olympia

I made a insurance claim for my mini-van. Insurance (AIG) company assessed and approved the claim. Clearly mentioned within the claim was wording indicating that there was the possibility of more damage (relating to the sliding door mechanism) that could only be assessed with the vehicle in the body shop.

The body shop made the repairs and submitted a supplemental claim, which has been denied. AIG claims that the body shop did not follow protocol and inform the inusrance adjustor / inspection company and went ahead and made the repairs. Hence they are not paying on the pretext that the claim could be construed as fraudulent.

So the body shop says that they did everything by the book, and the insurance company is denying the claim because they think that protocol was not followed. I'm stuck in the middle of this mess.

Now the body-shop is after me, saying that it is my responsibility to repay them for the repairs made to my car. As far as I'm concerned, I've paid my dues ($500, as part of the deductible). At no point during the process was I informaed by the body shop of the fact that this additional repair expense had not yet been approved by the insurance company, nor about the $$ value of the repair in question.

My question is: Am I legally exposed to being sued etc. if I do nothing and let the body shop duke it out with the insurance company ?

Pay the money and you won't get sued. You have no claim.

WRONG!!!! Had the same thing happen to me. I fought it and won! I did not approve the additional repairs to the vehicle therefore I was not liable. The insurance co. intitally refused to pay therefore, the garage was comming after me. I told them...YOU EAT IT!!. I recorded their phone calls and actually sued them for harassment.

shellandty said:

WRONG!!!! Had the same thing happen to me. I fought it and won! I did not approve the additional repairs to the vehicle therefore I was not liable. The insurance co. intitally refused to pay therefore, the garage was comming after me. I told them...YOU EAT IT!!. I recorded their phone calls and actually sued them for harassment.

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And this of course, is irrelevant. Unless you can show this poster the exact statute in their state that allows them to receive services without paying.

I suggest you either go to law school or temper your 'opinion' with a modicum of legal fact.

I don't know what to tell you, but it is true "at least in my state". I have a copy of the check to prove it!!!

shellandty said:

I don't know what to tell you, but it is true "at least in my state". I have a copy of the check to prove it!!!

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Which means nothing to this poster's situation because you do not live in the same state, the circumstances are not the same and neither is the judge who will hear the case or the insurance company that denied the claim.

First of all....it never went to a judge!

Second: How do you know where I live?

Who approved the additional repairs?

I say fight it. Did you ever sign a paper when they did the intial estimate? Usually on that paper it will allow them to make repairs, as long as it is reasonable to the original estimate.

You can also have them prove they did everything correct, Id bet money they wont provide you with facts or paperwork, stating they sent the claim to the insurance company properly.

Usually when a body shop wants to due more work than on the original itemized estimate they have to get an "approval" from someone, usually from the adjuster who represents the insurance company that is paying. The body shop has to have some documentation (not just a verbal OK) from the adjuster approving the repairs or they have no right to do them. By law in our state a body shop will state in writting when the vehicle is dropped off for repairs that the $$$$amount of the repairs is "as per estimate" and additional repairs may not to exceed 10% of the original estimate without prior approval. I also initialed that I wanted my old parts back. When they tried to force me to pay for a new outer quarter panel, I said.......Where's my old one?" You get my drift.

Go on the web and you can look this up under "Consumer protection act".

stephenk: For your question: Who authorized the secondary claim ?

No one, in writing. I had informed the body shop that we needed to get the door fixed, with the explicit intent that they would go through the appropriate insurance channels to get the repair done. I did not ever (verbally or in a signed document) state that I would want the repairs made at my own expense !!

1. Was a supplemental claim filed ? YES
2. Was the claim acknowledged by the Insurnace Co. / Adjuster ? NO [This is the insurance Co.'s story]
3. Was the claim approved / authorized prior to the repair ? NO
4. Was I informed of suuplementary claim which had not been approved prior to repair ? NO
5. Did I authorize repairs not covered by insurance, either verbally or through a signed contract ? NO
6. Was I informed of the $$ value of the supplementary claim prior to the repair, or the fact that the vehicle was going through the repair procedure even though the claim was not approved ? NO

Given these facts, I do not feel that I should pay the body shop out of my pocket. In fact I'd feel foolish if I did. I wouldn't mind taking on the Insurance Co. because they are being hard asses about this...

shellandty said:

Usually when a body shop wants to due more work than on the original itemized estimate they have to get an "approval" from someone, usually from the adjuster who represents the insurance company that is paying. By law in our state a body shop will state in writting when the vehicle is dropped off for repairs that the $$$$amount of the repairs is "as per estimate" and additional repairs may not to exceed 10% of the original estimate without prior approval.

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BTW, just to get some numbers into perspective:
The intial assessed and approved repair were ~ $1600.
The supplementary (non-approved) claim is ~$800.

So the supplementary claim was 50% in excess of the initial approved amount, so certainly much more than the 10% clause "shellandty" writes about. BTW, "shellandty" when you refer to "our" state... what state are you referring to ?

Do you know of any laws in the state of WA which specifically dispositions the interests of the consumer in preference of bussinesses that fail to follow protocol and procedure ?

I agree. I wouldn't pay them a dime. You did not approve the repairs, therefore let them eat it!!!!

the body shop made a mistake in repairing the door without authorization. however, you wanted to get the door fixed right? Try and negotiate a deal (pay for the parts or just pay for the labor).

The shop can sue you in small claims court and they may win. You never know.

You should also press on your carrier to pay for the repairs since they would have authorized it anyway.

stephenk said:

the body shop made a mistake in repairing the door without authorization. however, you wanted to get the door fixed right? Try and negotiate a deal (pay for the parts or just pay for the labor).

The shop can sue you in small claims court and they may win. You never know.

You should also press on your carrier to pay for the repairs since they would have authorized it anyway.

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The automatic sliding door is more of a convenience feature than a neccesity. Sure I wanted the sliding door mechanism repaired, assuming that this was part and parcel of the insurance claim. If this were to be a non-covered expense, then I would have certainly thought long and hard before authorizing the charge.

I am persuing this with the Insurance company (AIG). However, I've switched insurnance Co.'s since then - so I guess there would be less incentive for them to pay this amount. It's not like they would like to retain me as a paying customer...