QuestionI own a autoglass company in and we did a windshield replacement for a customer insured with esurance we submitted the claim after the job was completed, the insurance company did not want to pay the amount we billed so they invoked some kind of an appraisal clause and only paid half of the bill. I know of several cases throughout the united states where auto glass companies have sued the insurance company for short pay and they won. this is the first problem we have had with this appraisal clause, is this appraisal clause even legal after the work had already been performed and the customer signed the legal literature for my company to be paid in full?
Answer Hello Tommy
The customer has a policy - a contract - with the insurance company. That being said, the policy must be adhered to on both sides. If, in fact, there is an appraisal clause, meaning the insurance company has the right to "approve" appraisals prior to honoring them, then the insured has an obligation to adhere to that.
The nuts and bolts of all of this depends on the exact language of the policy. For example, is there a set limit on the amount the policy will pay for windshield repair or replacement? Does the policy restrict the insured from using all but named vendors? These are the types of policy language that will direct what an insured can and cannot expect in terms of coverage. Unless you or the insured were to actually read the coverage, neither of you would know if anyone has a legitimate cause for action. Nonetheless, regardless of knowing - or not - what the policy says, if there are terms similar to what I've suggested, and if the insured seeks repairs that exceed those authorized in the policy, then it would be the responsibility of the insured to pay you the difference.
If the insurance company was simply choosing policy terms at will, misrepresenting the terms of the policy, etc, then there might be a course of action. What legal actions? You would need to confer with an attorney on that. But I doubt you would have the standing to move into the place of the insured, i.e., to "stand in the shoes" of the insured. In other words, unless you have some type of an assignment of benefits and/or a pre-existing agreement with the insurance company, it is doubtful you would have any standing to initiate legal actions. But, again, ultimately that would call for a legal opinion.
Speaking strictly as an insurance expert, I would suggest that there is probably nothing you can do about this except to bill the insured for the differences. Unless, of course, your contract with the insured precludes this.
As you well know, most insurance companies have "preferred" vendors. These vendors have agreements with insurance companies to perform work at a certain level, at specific prices, and usually with a guarantee. If you have not pursued this option, you should consider it. And, if you have, maybe you should expand your list of carriers.
Good luck.
Jane Pytel
http://InsuranceExpertAdvice.com
http://SolutionsForYourInsuranceClaim.com
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