our claim was denied

[alicia57]

What is the name of your state (only U.S. law)?
Arizona
Our truck and trailer were hit by an individual that fled the scene running. After contacting the insurance Company the investigated and said that the spoke to the witnesses and everything pointed to their insured being at fault so they were going to pay the damages incurred. They sent an adjuster to access the damages on the trailer and declared it a total loss, the truck was also a total loss and they removed it from the owners custody to their impound facility. I e-mailed 4 times and finaly was able to speak to the ajuster who then informed me that they were going to deny the claim based on the assumption that it may or may have been driven by an excluded driver. I told him that they already said they were going to pay and even removed the truck and now they were going to deny based on what may have happened ? can you please advise me on this situation?

 

[justalayman]

tell them to either deny because the driver was an excluded party or pay if they cannot prove otherwise.

they cannot pay because it might have been an excluded driver. Either they claim the driver was excluded or not.

 

[ecmst12]

They are INVESTIGATING whether it was driven by an excluded driver. If it was, there is no coverage, and you will have to sue the driver and owner to recover your loss. Hopefully small claims court will cover it, if not hire a lawyer. The driver and owner are still liable, it's only the INSURANCE COMPANY that might not be (and allowing an excluded driver to drive your car can easily be considered negligent by the court, making the owner liable).

 

[alicia57]

Omg

thank you so much, I just spoke to the senior adjuster and he said this was a "soft denial" an and that they would not pay because they did not know who the driver was. I told him the ajuster already told us the claim was covered and they even took possesion of the totaled truck as of last week. He became very irritated and I told him to wait for a call from my attorney and from the Dept of Insurance as I am filing a formal complaint.

 

[Seanscott]

Good for you! Quite often the insurance company hopes people will just say "oh, well" and forget about it. Keep pushing & good luck.

 

[ecmst12]

There is no such thing as a "soft denial" and that adjuster is full of crap. If they can't prove that an excluded driver was driving, they have no basis to deny coverage and their insured could win a nice lawsuit for bad faith. File suit in small claims court, that should kick some butts into gear.

 

[justalayman]

but also understand that what your agent or whomever told you they were going to pay, especially prior to their investigation, is not binding on them.

If they said they were going to pay and subsequently learned of information that would give them the right to deny the claim, they can change their stance and refuse to pay the claim.

 

[LSCAP]

I’m curious. They say “Excluded” driver. Does that mean specifically excluded, or some one who has not been added to the list of drivers?

I mean, shouldn’t the insurance company have a list of drivers? And are they claiming that the driver was NOT allowed to drive?
Or are they checking his record or something?

 

[ecmst12]

"Excluded driver" refers to a specific person named as excluded from the policy.

 

[justalayman]

>>>>Our truck and trailer were hit by an individual that fled the scene running. After contacting the insurance Company the investigated and said that the spoke to the witnesses and everything pointed to their insured being at fault so they were going to pay the damages incurred.<<<<<<


(we lost our tags again?)

time out!!! are we misunderstanding whose insurance company is denying the claim?

are you saying the at fault party (the other guy) insurance company is trying to deny payment based on you had a possible excluded driver driving your vehicle?

If so, do not wait, sue the guy.

but just one thing before you do:

if they and your truly mean excluded driver and not something that would infer an illegal driver, such as your driver was not legally allowed to drive.

that would change things a lot.

 

[ecmst12]

The person who hit OP's (parked, I believe) truck and trailer left the car and fled the scene ON FOOT. So the vehicle was identified, but not the driver.

If the owner is not alleging a theft and the insurance company has no conclusive proof of who the driver was and that they were excluded, then they have no basis to deny coverage for an excluded driver. They can't deny just because the driver is unknown. It's just as likely that the driver fled because he didn't want to get a DUI as because he was excluded from coverage.

 

[justalayman]

.....ecmst12;2335566]The person who hit OP's (parked, I believe) truck and trailer left the car and fled the scene ON FOOT. So the vehicle was identified, but not the driver**************

I had it ass backwards and where are our damn tags!!!



**************......If the owner is not alleging a theft and the insurance company has no conclusive proof of who the driver was and that they were excluded, then they have no basis to deny coverage for an excluded driver. They can't deny just because the driver is unknown. It's just as likely that the driver fled because he didn't want to get a DUI as because he was excluded from coverage**************...


well, for the insurance company to pay the claim, the at fault party will have to name the driver. Either it is the excluded driver, and as such, no liability to the insurer, or it was another person that, I doubt, will take the hit for a hit and run.

I suspect the insurance company has been told it is an excluded driver and simply does not want to be that direct with the OP.

I think that may also cause the owner to be in a bit of a legal bind since they presumablly allowed their vehicle to be driven without the states required insurance in place.


If so, OP is relegated to suing the owner of the car and the unnamed driver with hopes the owner will name the driver.

 

[alicia57]

More Info

you are right in understanding that our trailer and truck were hit while it was legaly parked on the street. the witnesses said that two individuals fled the scene on foot. the police arrived,took a report and gave us the insurance company's information for us to contact and file a claim. the adjuster on the case told me that they were going to cover the claim cause all the witness information, pictures and police report pointed to their insured's vehicle. he had our truck picked up from our home and towed to an impound as it had been declared a total loss and they were going to pay for it instead of repairing it. this was one week ago today that the truck was taken. the asseses the damages on the trailer and also declared it a total loss. I have a paper trail where the adjuster states the coverages involved in this coverages. when I told the supervising adjuster that we were to told the claim was covered he only said"yeah and that's something I will have to take up with Ernesto" (the adjuster). what will happen to the truck? I told him "you took posession of the vehicle you just bought yourself a truck, we don't want it back" he said "we havn't bought anything" are we abligated to tkae the truck back? I'm filing a complaint with the Dept of insurance, what else can I do?

 

[justalayman]

you aren't obligated to take the truck back but they may not be obligated to pay you either. If they are not liable to pay you, then what you do with your truck is up to you. They have no responsibility other than possibly towing it back to your house.


<<<<<<<<<<<<what else can I do?>>>>>>>>>>>>>>>>>


sue the owner of the vehicle that hit your car and the unnamed driver

 

[LSCAP]

ecmst12 and Justalayman ...Help!

Do you have insurance on your truck and trailer?