QuestionQUESTION: We have a commercial truck policy, where a truck, trailer, and non-owned trailer are insured, truck and trailer each insured with own value and each covered with comp/collision and general liability. We had an accident with the truck and trailer and both were declared total losses.
I have been told by the insurance adjuster that this accident is considered one claim. We pay premiums on both vehicles involved and each has its own value and policy limit, as well as separate deductibles.
Without going into detail of the specifics I just want to know if this is how insurance companies in general treat such instances.
Thank you for your opinion,
Diane
ANSWER: Hello Diane,
I am going to answer this assuming you are talking about your own insurance coverage (two policies), not an at fault driver's liability.
From an accident standpoint, it would be one instance. And, depending on how they sequence their claim numbers,perhaps it falls under just one number. But logically this would seem to me to be two claims - one for each policy.
First, consider coverage. Is there enough coverage for the damages to both to satisfy one claim? If both components are totaled, how could there possibly be enough collision insurance for both under one policy? That makes no sense.
Plus, since you apparently have separate policies for each, I would think you would be responsible for two deductibles.
Of course, I do not have all the details, nor access to your policy. But from what you are saying it doesn't make sense to me.
I suggest you read your policies and see if this is explained. Everything an insurance company or an adjuster does must be defined under the terms of your policy. If you have questions, or you don't understand the process, ask what policy provision is governing the decisions. And ask for an explanation. And ultimately you need to know if these decisions aregoing to harm or restrict your coverage?
No, the short answer is this does not seem "normal".
If you have other details that are directly pertinent to your questions, I'll be happy to follow up.
Jane Pytel
http://SolutionsForYourInsuranceClaim.com
http://FloridaAutoInsuranceCentral.com
---------- FOLLOW-UP ----------
QUESTION: Ms. Pytel,
Thank you for your response. You are correct that this is our own insurance collision coverage. Your answer follows what my insurance agent and what we logically believe to be correct concerning coverage.
We have excess coverage that goes above and beyond the basic coverage. It covers "Downtime and Rental reimbursement". The insurance adjuster is denying coverage on the trailer stating the downtime was exhausted with the tractor. I am going to give you the clause so that you better understand what I am referring to. This has been added to the physical damage portion of our policy. "We will pay any resulting "downtime loss" and rental reimbursement expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a combined maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss,". It goes on to subject this clause to certain conditions, none of which affect coverage for our vehicles. The insurance adjuster states the word "combined" is referring to the tractor and trailer and since the tractor used up the $3000 maximum(he uses $3000 max,however this terminology is not used in policy)there is nothing left for the trailer. He has also said the tractor and trailer are considered on physical damage loss. I as well as our insurance agent find his interpretation illogical. This clause is referring to a benefit for each covered "auto" and the "combined" is clearly referring to "downtime and rental reimbursement" being combined. As stated previously, we pay separate premiums, each has a deductible(however with this excess coverage there is an aggregate deductible and no matter how many covered "autos" are involved in the same "loss", only the highest deductible applies and also with this excess coverage, because we have never had a claim in x amount of years the deductible was waived), each has their own policy limit. It doesn't make sense that one could call this the same physical damage "loss".
I know this policy backward and forward. I have been dealing with it for over 4 months now. There is no definition or clause that states an accident or occurence is considered the same physical damage "loss". There are many places in the policy that refer to "accident" or "occurence" however. I would assume that if it was there intention for the downtime benefit they would have used the same language. I requested that the insurance adjuster send this matter to their legal department along with my insurance agent's interpretation of the benefit. That was 2 weeks ago, I have not heard a peep from the insurance company. I surmise it could take some time for a review.
I will just add that I have been given blatantly erroneous information by the ajuster and each time I have provided proof refuting his claim the adjuster has backpeddled and cleared up the "confusion" in my favor.
At this point this downtime is the last hurdle. Tractor has been settled and paid. Trailer settlement is just about there. I am just surprised by the amount of resistance from the insurance company. I guess I thought our insurance company worked on our behalf and I am sure the insurance company is surprised by the knowledge I have concerning my policy and my benefits and their inability thus far to hoodwink me.
Again, thank you so much for your time in reviewing these requests, people need this resource in order to what they had paid premiums for.
Diane
P.S. I was thinking. If they consider this one claim, shouldn't the limits(ACV) of both tractor and trailer be combined. In that event I wouldn't have reached the $50,000 combined limit and they would have to pay the registration and tax on the tractor that they will not pay because they paid policy limit on the tractor. Trailer will settle for about $2,000 under its policy limit so that would bring us to $48,000, $2,000 under the proposed combined limits. Just a thought if it is truly on claim, but I don't think that would fly.
Answer Hello again Diane,
I am impressed and relieved that you are so familiar with your policy. As you well know, your policy is a contract between you and the insurance company. To best explain that, here is a quote from my website, http://solutionsforyourinsuranceclaim.com
"When you invest in insurance, you are entering into a contract with your insurance company.
This contract, or policy, defines the terms and conditions of your insurance coverage.
The policy is prepared exclusively by the insurance company. It is extremely important to understand that because the insured has no power to alter the terms and conditions of the insurance policy, the insurance company assumes the burden of defending its interpretations of the policy.
Simply put, any questions of doubt must be answered in favor of the insured. In legal terms, the insurance contract is considered a contract of adhesion.
Regrettably, insurance companies generally take the position that their policy and coverage decisions are above question. Your only recourse is to challenge these flawed decisions.
When flawed and unfair insurance policy interpretations are made to your disadvantage, the insurance company has in fact revised the terms of your coverage by redefining the intent of your insurance policy. It is your job to understand the terms, conditions, and benefits of your policy.
Do not assume that the insurance company, the adjuster, is an expert. To the contrary, you need to become the expert."
And fortunately you have become the expert!
Let's bring this down to basics. From what you told me you have TWO policies, one for the tractor and one for the trailer. That being the case, you have two policy limits. How is it even conceivable that two policies can be combined to achieve one limit??
I cannot determine what "combined maximum" means, but certainly it is not intended to "combine policies"!! The point is, the language is confusing and because it is, the resolution must be made to your favor. Case closed.
Now this does not mean they will do that! Have you been to my website?
The legal department? Really? Who do you think they represent?
Here's what you need to do. First of all NEVER accept that the adjuster is an expert. Now you need to contact his claims manager (who you can find by calling with your claim number and asking for his/her contact information. Then present your objections in writing. You can do email, but I would strongly suggest you also forward the same correspondence to the manager via return receipt mail. In that correspondence, precisely detail your objections, and be certain to add that you are aware that any ambiguities must be resolved in favor of the insured. Give them a deadline to make a decision as you would like to resolve this amicably rather than with your legal counsel.
As for your PS on policy limits. Again, I cannot see how combining policy limits is even remotely plausible. No you are not entitled go beyond your limits, but you have not reached your limits! If your limits under 1 of the two policies is $50,000, then that is what you are entitled to.
Continue to be proactive! You are entitled to collect on what you have paid for. And, by the way, sounds like you have a great agent, but bear in mind the agent's job is to sell insurance. They have no connection to, or power over, claims. Just an FYI.
Hope this helps. Good luck!
Jane Pytel
http://SolutionsForYourInsuranceClaim.com
http://FloridaAutoInsuranceCentral.com
