Insurance question.

Due to a little accident a few weeks back (wide trailer, narrow road) my boat is in the shop to have some repair work done. This is an insurance claim so of course I have that to deal with.

My problem is that the shop (dealer where I bought boat) charges $125 and hour and the insurance is saying they will only pay $110 an hour. The insurance claims that $110 is ?prevailing labor market rates? so I have to pay the difference. There are only two boat dealers within 50 miles and they boat charge $125 an hour.

The question is how do I get the insurance company to pay the full amount, and not stick me with the difference?

Re: Insurance question.

I dont think you will. This is not uncommon for any type of insurance to pay what they think is "reasonable and customary" Do you have a deductible? If not, eating $15 per hour may be worth it.

Re: Insurance question.

You could try to show the insurance company what the area avg. is and see if they can meet it. You could also talk to the shop about the insurance company and see if they can work with the insurance adjuster.

Otherwise, you may be eating the $15/hr difference if neither is willing to yield.

Re: Insurance question.

They have to do that to make sure that someone doesn't take their broken boat to their brother who is a "mechanic" and also happens to charge $500/hr.

Check your policy to make sure it doesn't expressly state that market rate is $110/hr (it probably doesn't). If not, then challenge their assertion that $110/hr represents prevailing market rates in your area. Tell them about the two shops that charge $125 an hour, and ask them which shops in your area charge prevailing market rates, or lower. The key is to make them focus on your area. It doesn't matter what someone across the country is charging. They knew where you lived when they took your money and agreed to insure you.

Re: Insurance question.

I am having to have body work done on two of my vehicles due to hail damage. An adjuster came out to appraise the damage. I asked her what would happen if I took them in to be repaired and the shop wanted more than her appraisal. She said I just have them call her and they "work it out".

If your shop doesn't really want the work and/or doesn't do much insurance work I guess you could have problems. But if they regularly do insurance work, they should know the drill.

Re: Insurance question.

notaz3 said:

The question is how do I get the insurance company to pay the full amount, and not stick me with the difference?

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You tell the shop and the insurance company to "work it out", or the insurance company can arrange for transportation to a qualified repair facility that can do the work at their price.

The ins co doesn't don't want the hassle or expense of transport, and the dealer doesn't want to lose the job, so they will work it out in most instances.

Re: Insurance question.

I'd challenge them on the usual and customary thing. If the prevailing labor rate is $125 in your area, than that's what usual and customary should be.
Perhaps their $115 rate is old, or in an area with cheaper labor rates.
Insist they give you the names of repair facilities in your area that charge the $115. If they can't, then you may have a leg to stand on. If they can provide you this, you may be on the hook.
You can always hint that you'll contact your state department of Insurance for their opinion- that may get them to move too. Insurance companies don't like getting complaints that way.

Re: Insurance question.

Keep in mind the insurance adjuster is there for this specific reason. He will fight on the insurance companies behalf to protect their financial interests. This way you don't get charged $200/hr. when you should get charged $125/hr. They will also make sure that the parts needed are replaced.

Likewise, the adjuster will 'adjust' for things like 'hidden damage'. You may get a quote and find out that there is more work or parts than initially anticipated. The adjuster will make sure that the insurance covers it, but will also make sure the work and parts are needed.

I spent many years communting into Boston and have been hit by other drivers many, many times (approx. 1-2 accidents a year) for 14 years. In all those accidents only 1 was my fault. In all those claims I NEVER paid out of pocket beyond my deductable.

The insurance company will give you what it wants in the hopes you'll roll over. They know only a small percentage will push back. Call the insurance company first and discuss it with them. Then call the boat yard. I've seen situations where they compromise and meet in the middle. (both agree on $115, or something along those lines). Again, this is what the insurance adjuster is there for.

Re: Insurance question.

Ask them to find a place that charges $115/hr...then submit a complaint to the state board on insurance. google it, each state should have one, except maybe Louisiana..cuz that place is weird

Re: Insurance question.

Actually, Louisiana does have a state department of insurance. A pretty thorough one, if memory from my state approval days serves me.

Re: Insurance question.

sltintexas said:

Ask them to find a place that charges $115/hr...then submit a complaint to the state board on insurance. google it, each state should have one, except maybe Louisiana..cuz that place is weird

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No need to go this far. That's just trying to fight for no reason.

As stated above, "ask" the adjuster, politely, what shop's charge the $115 that they base their prevailing rate upon. If the two shops you found are truly the ONLY two shops around, then the prevailing rate is their $125. And the adjuster will understand that. He/she may negotiate with the shop for the lower rate. That's between them.
Be polite and ask questions, don't make demands. You'll find things work much better than taking such an adversarial stand.
Just think, if you didn't have insurance, wouldn't you try to negotiate a lower rate than $125? You bet your arse you would!

{Regarding the hail damage above, it's not the same thing. You asked the same question that EVERY person asks when it comes to auto collision. The response had NOTHING to do with the shop's labor rate. What your adjuster was talking about was either supplemental damage (and every day occurance in the industry) or an actual disagreement between the adjuster and the body shop regarding repair times. And those things are handled as they happen. However, auto body rates are most definately set in every town/area. If the shops all charge $50/hr and you take to that one shop that tries to charge $55, the insurance company won't pay their rate. But guess what, that shop will actually charge you the $50/hr, cause they know who's paying the bill, the insurance company, and they don't want to p*** you off with out of pocket. }

Re: Insurance question.

advise them of your quotes, review your contract, if the labor rate isn't in it then simply state the claim will be honored or you will take care of getitng it fixed, or I will file a complaint with the department of insurance.

I work for Transamerica Life Insurance company, we do not want complaints, we like the chance to resolve the issue, if your crazy though just go complain to them instead of us.

So if you have a legit gripe, you will be answered, and it can result in penalties for the company.

Re: Insurance question.

Many insurance companies have a grievance or claims appeal process- if necessary, do it. They aren't always right when they deny claims.
If they are correct then they will likely stand their ground, but if the policy is vague on the issue, the outcome is usually in favor of the insured, since the next step for some people is a lawsuit- and insurance companies usually don't get much sympathy in courts. And they know it.

Re: Insurance question.

They are NOT denying this claim, people. They are simply stating that the prevailing labor rate is $110/hr, not the $125 that the owner's shop has quoted. All either side has to do is show reasonable evidence that their number is the true area rate. No complaints to anyone issued.
Geez, no wonder you peopl have such a problem with insurance claims, you are all trying to fight right off the bat. I loved people like you, cause you NEVER got anything extra, just EXACTLY what was in the contract or the state's laws. People that were polite and nice got over and above the state's laws and policy provisions, if need be. Like, I let them keep the rental car an extra day when they got done work at 4:30pm and had to drive 15 minutes to the shop that closes at five, and had to pick up their child by 5:15. People who were jerks, nope, the rental cut off at 5pm, and if they didn't get the car that afternoon, they paid the extra day. Nothing unprofessional or illegal, just following the letter and intent of the law/policy.

Re: Insurance question.

In a way they are denying the claim- the part they're denying is the $15 per hour difference in labor costs. I believe several posters have suggested documenting local labor rates and working at that angle. Great if it works.
If not, other suggestions were made on alternatives to be a bit more assertive if necessary. So what?
Sometimes the claims folk will often go the cheapest route for the company and hope the insured doesn't challenge them. What some of us are saying, is that it's very OK to challenge if you feel wronged. I certainly would.
Obviously being polite and courteous, and professional will go a long way, but you can challenge their decisions AND act in a businesslike manner.
The two things are not mutually exclusive.
Re read the posts in this thread- nobody posted anything untrue or extreme.
Just alternatives that can be persued if roadblocks are encountered.
And sometimes, people who are all nice and polite get run over. Be assertive if necessary, but not agressive, rude or abusive.

Re: Insurance question.

Only had 1 boat accident (on the highway) and 2 car accidents in 40+ years of having insurance. In all cases, the repair estimate did NOT say "X hours labor at $125", it said:

"replace transom - $1000"
"replace rear bumper" - $350
"replace trailer hitch - $250

Also, in every case, the adjuster and the shop worked it out to their own satisfaction - I wasn't even involved. And after the bumper was replaced and they found more damage than expected, the collision shop turned in a supplemental claim for the rest.

Sounds to me like your marine dealer didn't write the quote up right, and/or there has been no communication. You paid for insurance to cover damages - it should be covered in full minus deductable. IMHO, the hourly cost should not even be part of the equation.