does your insurance company have to pay you?

freddyray21 · Dec 12, 2008

For those of you that believe just because you have insurance the insurance company has to pay a claim imagine this scenerio.

You have a dead tree in your yard and call a tree surgeon to look at it. He advises to cut it down as the roots are also weak and the tree could fall on it's own. You ignore the advice and 6 months later the tree falls and crushes your car. You file a claim and during the insurance companies investigation they find out about the advice the tree surgeon gave you and deny the claim. Are they right in doing so?

tashasdaddy · Dec 12, 2008

Re: does your insurance company have to pay you?

negligence on your part, to safely operate and care for the car. i think that would be their stand.

freddyray21 · Dec 12, 2008

Re: does your insurance company have to pay you?

my point exactly. I did not want to cloud another thread with this discussion, but there seems to be a misconception that if you have insurance and make a claim the company has to pay you. Not true if they have a good reason not to pay.

Last Memorial Day at Ken Lake a boat sunk tied to the dock. Turned out the guy knew he had a leak and was counting on the bilge pump to keep the water out. The pump quit for whatever reason. Insuance company did not pay as it was his negligence.

Hitech · Dec 12, 2008

Re: does your insurance company have to pay you?

As always, it depends. I didn't cut down the tree because I did not believe the tree surgeon and was sure he was just trying to get work that didn't need to be done.

With the leak/bilge pump issue the insurance company may end up paying if it goes to court. The insured can easily claim that be believed that was what the pump was for, and he believed it work work properly. He wasn't negligent, just ignorant. You aren't required to be intelligent...

freddyray21 · Dec 12, 2008

Re: does your insurance company have to pay you?

Hitech said:
As always, it depends.

my point exactly. It depends. they don't always have to pay just because you have a claim. Often times in a DUI situation where you have an accident the company will pay to fix the damage to the car you hit, but refuse to pay for your car due to your negligence. There are good reasons for them to not pay.

Hitech · Dec 12, 2008

Re: does your insurance company have to pay you?

Also, it depends on what your definition of "have to" is. They can come up with any reason they want to give you as to why they are not paying you. Whether that will hold up in court is a whole different story. There are things that insurance companies do that are not enforceable in court (driver exclusions are one example). However, they require you to sue them to get them to pay.

And, just as they may have to pay when they don't think they have, they may not have to pay you when you think they do.

mthieme · Dec 12, 2008

Re: does your insurance company have to pay you?

If the tree is dead, it is your responsibility.
If it is alive and lands on your car, that's a different story.

I remember when I was a kid, there was this grumpy old man that lived in between me and my friends. Across the street from this guy's house was a huge Locust tree. During a storm, lightning hit it and knocked it over right on top of his station wagon. It couldn't have been more perfect - smack down the center of the car. We figured the Lord liked kids better than he did!
Thanks for the flashback.

TilliamWe · Dec 12, 2008

Re: does your insurance company have to pay you?

freddyray21 said:
Often times in a DUI situation where you have an accident the company will pay to fix the damage to the car you hit, but refuse to pay for your car due to your negligence. There are good reasons for them to not pay.

Where are you getting this stuff from? This "example" is not correct. It doesn't work that way.

TilliamWe · Dec 12, 2008

Re: does your insurance company have to pay you?

Plain and simple, read your policy and have someone explain it to you when you don't understand it. Coverage is actually fairly clear, in most policies.

freddyray21 · Dec 12, 2008

Re: does your insurance company have to pay you?

TilliamWe said:
Where are you getting this stuff from? This "example" is not correct. It doesn't work that way.

this is not a real life situation. I am not making a claim so I don't need to read my policy. However most insurance policies have a clause that if the claim was a result of your committing a crime then they do not have to pay. It does and has worked this way.

grego · Dec 12, 2008

Re: does your insurance company have to pay you?

complete surprise!! had tree fall on my truck in my yard, total loss of truck!! Called ins. I said that i knew the tree had a SMALL!!! hollow spot. THEY! said I was aware of problem and that I should have paid to take down tree. $800.oo just to clean up downed tree, after it fell. So they did not pay!!! 5,000.00 dollar truck, 800.00 clean up. [AND FULL COVERAGE INS>] If ever again, I will say that I did not know of a problem. COMPLETE SURPRISE!!! I had NO! idea!!! NOW!!!! others say that you should say that you knew that tree was problem and was afraid to deal with[bodily injury]. [Why are all sentences jammed together???]

a70eliminator · Dec 13, 2008

Re: does your insurance company have to pay you?

Recently we had a very heavy snowfall that ended collapsing my rear patio awning 10x30 alluminum with 4 support ploes, insurance adjuster came to look at it, he informed me that it's the homeowners responsibility (me) to remove the snow if the structure is being threatened, I told the guy I was afraid to get near it let alone start shoveling snow off it, the insurance did end up replacing the awning 4500.00 less deductable.

mthieme · Dec 13, 2008

Re: does your insurance company have to pay you?

Did he suggest a way to clear the snow off the awning? hovering over it?
That's a pet peeve of mine - having to fight with them. And then once you put in a claim, you're blacklisted.

Drowned Rat · Dec 13, 2008

Re: does your insurance company have to pay you?

Seems an insurance company could find some evidence in nearly every scenario how the insured could have avoided it. But I don't think that's the point. I've never heard of such a problem first hand.

TilliamWe · Dec 13, 2008

Re: does your insurance company have to pay you?

freddyray21 said:
However most insurance policies have a clause that if the claim was a result of your committing a crime then they do not have to pay. It does and has worked this way.

Wrong again.

TilliamWe · Dec 13, 2008

Re: does your insurance company have to pay you?

Freddie you don't know what you are talking about. You just wanted to start a thread so people would complain about insurance companies. Well, fine, but you are not correct in your assumptions.

a70eliminator · Dec 13, 2008

Re: does your insurance company have to pay you?

mthieme said:
Did he suggest a way to clear the snow off the awning? hovering over it?
That's a pet peeve of mine - having to fight with them. And then once you put in a claim, you're blacklisted.

What he did suggest was that I also could have made an attemp to add some additional bracing, like I'm going to go out and buy some 2x4's to brace up my patio just in case the snow gets too heavy for it, actually I probably would have done that had I known the structure wasn't going to handle the weight. Insurance companys, people love to hate em, They did pay for it, thats why I've stayed with Grange Ins. they have always been good about paying with claims, even though the adjusters can be a little intimidating, but I guess it's part of their job.

freddyray21 · Dec 13, 2008

Re: does your insurance company have to pay you?

I started this thread to not cloud another thread. Some in that thread are under the assumption that if you have insurance and make a claim then the company has to pay you. 99% of the time they do pay, but there are the other 1% that end up in court and sometimes they do have to pay then and sometimes not. You are a fool if you believe that they will always have to pay. If you check closely your insurance policy you will find exclusions. If your scenerio includes one of these exclusions then they don't have to pay. It's a simple as that.

ooldschooll · Dec 13, 2008

Re: does your insurance company have to pay you?

A few years back I saw a news report where an area had a prolonged heavy snow. Insurance companies were calling home owners and telling them if they didnt remove the snow an their roofs they would not cover a collapse.

NSBCraig · Dec 13, 2008

Re: does your insurance company have to pay you?

Hitech said:
With the leak/bilge pump issue the insurance company may end up paying if it goes to court. The insured can easily claim that be believed that was what the pump was for, and he believed it work work properly. He wasn't negligent, just ignorant. You aren't required to be intelligent...

No way!

Being ignorant is never a way out of anything!

You are required to be intelligent. Everything to do with our legal system requires that you know everything that a reasonable person would know.

does your insurance company have to pay you?

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