QuestionQUESTION: Hello,
I am having a heck of a time with my insurance company(progressive)
First of all my motorcycle was stolen while attending a motorcycle swap meet that I was working at.well the hotel nearby.
I also own a motorcycle shop, which I believe is the issue here.
But the claim was referred to an investigator and I gave him all the statements,paperwork,receipts, signed consumer info release
then I suspected they were trying to deny the claim by silent accusations which really pissed me off and I revoked the release after 22 days, now they say they need the release to adjust the claim.which specifically says by revoking does not have any bearing on there decision...
they want credit info,phone records,ledgers,financial all that stuff,.I am no longer willing to give them access to what they want because they have and want to continue contacting my distributors in my business and are being way to intrusive.
I have had a lawyer intervene and stop the harassment but after reading one of your responses I am hiring a more experienced bad faith lawyer.I called the adjuster last Fri. to find out what the status was and she said she sent another release to my lawyer and they needed that to proceed...do i need to sign that? they have not denied the claim but it has been 35 days and I think they are looking for a way out of replacing this bike.
thank you mark
ANSWER: Hi Mark,
You have an assortment of issues here. Let me approach one at a time.
"they were trying to deny the claim by silent accusations"
I'm not sure exactly what you mean here, but insurance companies cannot deny by "silent accusations". Either they have to be able to support a claim denial, or they have to pay your claim. And, if they do deny your claim, they must cite in their denial correspondence, the exact portion of the policy that was violated. In your case, sounds like they are investigating you for suspected insurance fraud. If they were to deny your claim for fraud, they would have to be able to defend that denial. In other words, they would need evidence to support their denial, that you committed insurance fraud.
Now to the information they have requested:
"credit info,phone records,ledgers,financial all that stuff"
They can request that information if they are conducting a legitimate investigation into your claim. They cannot use this as a means to simply delay your claim.
However, revoking their access to that information can be interpreted as your refusal to cooperate. Your policy requires you to cooperate. If you refuse, they can deny your claim based on that alone. It seems like a moot point. You provided the information once, provided a credit authorization, etc. Why revoke it now? By doing so, you are likely to have your claim denied for failure to cooperate.
And, speaking of cooperating, I would expect they will require you to appear for sworn testimony, known as an EUO (Examination Under Oath). You MUST attend - and you must answer their questions - or they can deny your claim outright. You have an attorney - he must go with you. While he cannot interfere with the EUO, he can be there to represent you and to provide counsel to you.
Speaking of the attorney, the adjuster knows (or should know!) that it is unethical for her to speak to you directly. All contacts must be made via your attorney. And don't call her. Bad idea!
As to Bad Faith, whether or not you have a bad faith claim depends on whether or not they actually deny the claim and on the laws of your state. That's why you have an attorney! At this point, if your attorney is familiar with insurance law, that is sufficient. Not all insurance lawyers also specialize in Bad Faith. But at this point, it is your lawyer's job to defend you and do what he can to get the claim paid.
Let your attorney do his job. If you have questions as to the progress of your claim call him, not the adjuster. I do not want to usurp your attorney's job, nor do I want to offer legal advice. However, speaking as an insurance professional, my advice would be yes, you should sign the release. Check with your attorney. He might be making a case concerning your business distributors, so he has more information than I do.
As for the distributors, insurance companies do not have the right to interfere with your business. An investigator would have the authority to speak with distributors who might have direct knowledge of the theft, but the purpose must be to conduct legitimate investigation - not to attempt to damage your business. Hopefully your lawyer has stopped any inappropriate conduct.
35 days does not meet unreasonable limits as long as they are legitimately investigating. However, your refusal to cooperate, to provide required authorizations, is apparently contributing to the delay, and will no doubt factor into their decisions and into their ultimate defense in the event of suit. Better discuss this with your attorney.
Hopes this helps.
Jane Pytel
http://SolutionsForyourinsuranceClaim.com
---------- FOLLOW-UP ----------
QUESTION: thank you for your quick response
What I meant by silent was without actually saying we think you have something to do with this..asking questions that are offensive..I guess thats their job though. the atty told them its not ok to invade the privacy of third parties that have anything to do with my business.
I have just ,after reading your responses to another ,hired a more experienced insurance lawyer that knows insurance law.
I revoked the disclosure statement because the investigator said he wanted to contact my one of my distributors, and get in touch with a old girlfriend who was part of my business until 2 yrs ago,(bad breakup and do not want any contact)now corp dissolved.
but also the disclosure reads; i understand this authorization is voluntary and that I may revoke it at any time by submitting my revocation in writing to progressive. any such revocation will not have any affect on any actions taken by progressive prior to receiving the revocation... I have fully cooperated up until that point. I guess I really dont like the fact that I am suspected of fraud, I have a good reputation as a person and shop owner.
Answer Hi Mark,
You are their insured. They have a contractual obligation to pay valid claims on your behalf. They do have a duty to investigate those claims. There is nothing wrong with that. However, they do not have the right to harass you, and they certainly don't have the right to damage your business. Nor do they have the right to seek out parties who might have an axe to grind with you, such as your ex girlfriend. Unless she is material to this claim, there would be no valid or ethical reason to involve her in your claim.
As your insurance company, they have a fiduciary duty to you. Fiduciary meaning they have a relationship of trust with you. Unless they have evidence to defend that you have committed insurance fraud, they cannot accuse you of it, no matter how discretely.
In all my years, I have never heard of a valid investigation that includes a "disclosure statement". I don't know what state you live in, and if that is allowed, but from my experience that is simply not done. Something akin to a fishing expedition in my opinion.
You need a final opinion from your attorney. However, if the disclosure statement allows you to revoke it, you probably should. From your description they appear to be using this disclosure in a manner, which in my opinion, is unethical. But again, discuss this with your attorney.
Jane Pytel
http://SolutionsForyourInsuranceClaim.com
