Beyond Insurance Gods!!

[w_man]

Hello Beyond Insurance Gurus ... two questions.

I was recently involved in a car accident where I got hit from behind. I got the police report and reported it to my insurance company 'Meloche'. They waved my deductible and I took the car to their appraiser to get some damages figured out. He is replacing my bumper cover and also the exhaust but decided to state that I will have to cover 10% of the cost of exhaust?!?! This is roughly $150 which I would have to pay out of my own pocket. He stated the reason for this is because they are replacing a 4 year old exhaust with a brand new one? then he said something about the exhaust being aluminum?!?! When I started asking questions, he said that he'll leave a note in my file for the adjuster in the head office to call me to go over the quote and she'll explain things to me. I haven't heard from her yet but I'm wondering if this is common?!?! the accident wasn't my fault yet I am in the hole for $150 bucks?!!?

Also, my wife and I experience a minor whiplash from the accident so an 'injury adjuster' was appointed to our case. When he called me, he went over the details and the forms but he made it very clear that the injury cost will NOT be forwarded to the other insurance company (like the repair cost of my car goes to the other insurance company) because this being a 'no fault' claim? I asked him if it will effect my insurance premium and he wasn't sure of this.

So how does this work? Even though I'm not at fault for the accident, am I responsible for any cost at all for repairing my car and will any expenses (physio) go against my personal insurance/premiums?

Thanks in advance.

[Masked Bandit]

1. The exhaust - I'm not 100% sure on the details (I'm a broker, not an adjuster) but there are situations where depreciation of a particular component come into play. The best example I can offer is on tires. If someone slashes your tires in an act of vandalism the tread depth is measured. If the tires are half worn you are covered for half the value of the tires (less your deductible).


2. Injury - the coverage for this stuff falls under "Accident Benefits" and goes under your own policy. This is how it works with all companies, not just MM. It's not going to affect your rates in the future.

[bubbley]

Seems pretty fair to me :dunno:

[Ruggzy_McTuggz]

Unfortunately that is the way it goes. You will be charged the betterment even though it was not your fault... just the way it goes :(

None of this will affect your premiums

[inline6turbo]

Did you go to the hospital? Did you claim there were injuries? Then it should be forwarded.

I'm going through the exact same thing right now. Was rear ended at a red light. My insurance (TD Meloche) called me theday after the accident, explained everything to me, asked for my story and what was hurting, then forwarded my info to the at fault dudes insurance (Wawanesa scumbags) and their rep called me about a day and a half later. I've hired a lawyer and now my lawyer deals directly with wawanesa.

[Ruggzy_McTuggz]

Originally posted by inline6turbo
Did you go to the hospital? Did you claim there were injuries? Then it should be forwarded.

I'm going through the exact same thing right now. Was rear ended at a red light. My insurance (TD Meloche) called me theday after the accident, explained everything to me, asked for my story and what was hurting, then forwarded my info to the at fault dudes insurance (Wawanesa scumbags) and their rep called me about a day and a half later. I've hired a lawyer and now my lawyer deals directly with wawanesa.

If all you have is a soft tissue injury you are wasting your money on the lawyer. Any soft tissue injuries it is pretty easy to get the cap without representation. Most you will get is $4504 if your accident was in 2009 or $4518 if your accident was in 2010.

[w_man]

Originally posted by Masked Bandit
1. The exhaust - I'm not 100% sure on the details (I'm a broker, not an adjuster) but there are situations where depreciation of a particular component come into play. The best example I can offer is on tires. If someone slashes your tires in an act of vandalism the tread depth is measured. If the tires are half worn you are covered for half the value of the tires (less your deductible).


2. Injury - the coverage for this stuff falls under "Accident Benefits" and goes under your own policy. This is how it works with all companies, not just MM. It's not going to affect your rates in the future.

Thanks for this.

The logic makes sense but that's quite the bummer ... I am being a good driver doing my own thing ... someone who's probably on their cell phone hit me and now i'm stuck with the bill.

Anyways .. it is what it is .. but the shop adjuster did tell me to give the office adjuster a hard time and she might even wave this off ... this was a bit strange to me so I am planning on 'giving her a hard time' about this to see if it can be waved off.

Also, no we didn't have to go to the hospital - it wasn't anything super bad ... as a matter of fact the minor pains in neck/shoulder/mid back didn't even start until later in the evening/next morning.

Thanks for the input ... it does put things in to perspective.

[Ruggzy_McTuggz]

Originally posted by w_man


Also, no we didn't have to go to the hospital - it wasn't anything super bad ... as a matter of fact the minor pains in neck/shoulder/mid back didn't even start until later in the evening/next morning.



Milk it man, call the third party adjuster. You will easily be able to get enough money to make up for the $150 they will charge you for betterment.

[Zewind]

Can I be an insurance Guru too? :P


I cant answer those question any better at all.

[w_man]

Originally posted by Ruggzy_McTuggz


Milk it man, call the third party adjuster. You will easily be able to get enough money to make up for the $150 they will charge you for betterment.

Hmm .. I would but I wouldn't know where to start and probably end up saying something stupid .. then get caught in some sort of an insurance fraud scenario.

Thanks for the info ... I'll talk to the adjuster when she calls me to discuss this further and see if I can get her to wave this $150 cost .. otherwise I'll suck it up and pay the damn bill ... Still think it's bullshit though!!

[Ruggzy_McTuggz]

Originally posted by w_man


Hmm .. I would but I wouldn't know where to start and probably end up saying something stupid .. then get caught in some sort of an insurance fraud scenario.

Thanks for the info ... I'll talk to the adjuster when she calls me to discuss this further and see if I can get her to wave this $150 cost .. otherwise I'll suck it up and pay the damn bill ... Still think it's bullshit though!!

You wouldnt need to worry about saying something stupid. Just tell them that you are sore after the accident and would like to be lined up for some treatments. They may line you up for physio, chiropractic, or massage therapy. Go to 10 or so physio sessions, just advise your therapist that you are still sore. At that point the adjuster would likely offer you $2000.

If you want to go all out, go to 21 sessions, and you are pretty much guaranteed $4500.

The thing with soft tissue injuries is that you can be vague. Say you are sore, have been having headaches, and you are pretty much golden.

At the VERY least just demand that the adjuster waive the $150 betterment. They would be stupid not to, due to how easy it is to milk them for the cap.

**Edit** for the physio sessions, speak with your AB adjuster (accident benefits) they will line you up for treatments.

It is only after the treatments that you would discuss settlement with the third party bodily injury adjuster

[Zewind]

Originally posted by w_man


Hmm .. I would but I wouldn't know where to start and probably end up saying something stupid .. then get caught in some sort of an insurance fraud scenario.

Thanks for the info ... I'll talk to the adjuster when she calls me to discuss this further and see if I can get her to wave this $150 cost .. otherwise I'll suck it up and pay the damn bill ... Still think it's bullshit though!!

Maybe look into getting a more aggressive exhaust and get them to just pay the portion on what they would have paid for the regular exhausted.


*insert Beyonce - Upgrade U Song*

[core_upt]

massage is also covered under your 21 initial visits. Real massage, not a rub-n-tug, but they will cover it, along with physio and chiro and accupuncture.

Meloche will cover this for you.

edit: take it and use it! a minor accident can have long term damages if left unattended. Feeling sore a few days later means that you were injured - have a professional treat it, ASAP.

[tom_9109]

Ask the appraiser to check the betterment guidelines for the company. A lot of companies waive betterment under $200 or so. Also I've never seen betterment applied to a non wear item like an exhaust. I can see it if has holes rusted though it that it would be reasonable but if your exhaust is in good shape with no holes or issues I feel betterment is unreasonable and you should make that argument that a new exhaust is no better or worse than what you have and will perform a similar function and experience a similar life.

Tell your companies insurance adjuster to smarten up on the betterment because they are going to subrogate it anyway and recover 100% of your damages.


As for the Section B / Accident benefits Masked Bandit mentioned. This is your own policy covering you in in the case of injuries. It covers medical expenses related to the claim to a max of $50,000 (some smaller limits on chiro / massage) and there is coverage for lost wages and death (but you probably don't need that). It does not cover pain and suffering or anything you'd sue the other company for. Accessing your Section B / Accident benefits does not affect your rates regardless of fault.

If you are in a little pain and feel chiro / massage might help I'd suggest talking to your injury adjust about "Protocol" option. I'm fuzzy on the details (had a couple ;) already ) but it is definitely they was I'd go if I need massage or Chiro.

[w_man]

Thanks guys!! There's some good information here.

I'll wait for the adjuster to call me in regards to the repairs and be a tad more assertive on the issue ... *oh and no the exhaust was in perfect condition .. it's only an 06*

My wife and I already started the physio sessions this week since we are both feeling stiffness in the neck/shoulder - her quite a bit more than myself - so that's not a big deal. I want to make sure it's cured as best as possible .. don't want this coming back. It's fairly uncomfortable.

Thanks again guys.

[G-ZUS]

Originally posted by Ruggzy_McTuggz


If all you have is a soft tissue injury you are wasting your money on the lawyer. Any soft tissue injuries it is pretty easy to get the cap without representation. Most you will get is $4504 if your accident was in 2009 or $4518 if your accident was in 2010.



Originally posted by Ruggzy_McTuggz


You wouldnt need to worry about saying something stupid. Just tell them that you are sore after the accident and would like to be lined up for some treatments. They may line you up for physio, chiropractic, or massage therapy. Go to 10 or so physio sessions, just advise your therapist that you are still sore. At that point the adjuster would likely offer you $2000.

If you want to go all out, go to 21 sessions, and you are pretty much guaranteed $4500.

The thing with soft tissue injuries is that you can be vague. Say you are sore, have been having headaches, and you are pretty much golden.

At the VERY least just demand that the adjuster waive the $150 betterment. They would be stupid not to, due to how easy it is to milk them for the cap.

**Edit** for the physio sessions, speak with your AB adjuster (accident benefits) they will line you up for treatments.

It is only after the treatments that you would discuss settlement with the third party bodily injury adjuster


:werd: I was rear ended in Oct. Did 21 physio sessions approx, 5 massage sessions. Then I used $250 worth of massage and $750 worth of chiro. I got offered $4504 right off the bat but I am still sore.