Auto Insurance claim denied

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My wife recently was involved in an accident she was at fault. I was in the passenger seat at that time and agree that she was at fault. No injuries of any sort for both parties. At the time of the accident, she was on a learners permit and i always thought that your spouse or kids with learners permit are automatically allowed to drive the car(with guidance) until they attain an actual drivers license. I remember this from my previous auto policies which i had a few years back. At the time of accident, i was with this other insurance company which i bought from AAA agent who lured me in to this 2nd grade insurance company with less premium compared to my previous insurer.

Anyways, after i filed the Claim with this insurance company (Infinity Casualty Insurance), they denied my claim stating that there is a following exclusion in the policy.

Exclusion:
'Caused to the insured auto when it is driven, operated, or used by any person who resides in your household and such person is not listed or endorsed on the policy prior to loss'

I know (and feel sorry for my mistake) that i was so complacent in not reading my policy and thinking that my wife with learners permit can drive the car with out adding her explicitly to the policy as noted in the policy language.

They are covering damages caused to other party's car but the adjuster is not even willing to talk to me regarding damages to my car. The damages to my car are significant and may be more than $8k.

What should i do? Do i have any options or should i forget about it completely? I spoke to my states insurance commissioners office but they could not help me at all.

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That may indeed be one argument .
Note however that' insurers can have different requirements for when liability is cover... (more)

SUCKISSTAPLES (Jan. 05, 2013 @ 7:32p) |

Somewhat off topic, but how technically inclined are you? I just ran my van into a cement wall, doing some pretty ugly ... (more)

OliverQuackenbush (Jan. 05, 2013 @ 7:48p) |

Actually one of my colleagues lived in NYC for a decade before she joined us in sales. We thought we were going to die w... (more)

hkgfnt (Jan. 05, 2013 @ 8:41p) |

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I think you've done all you can do, and I don't believe anything else will provide you any further assistance from external sources. In allowing your wife to drive the vehicle, you've taken onto yourself the costs associated with damages to your vehicle.

csisking said:   Anyways, after i filed the Claim with this insurance company (Infinity Casualty Insurance), they denied my claim stating that there is a following exclusion in the policy.

Exclusion:
'Caused to the insured auto when it is driven, operated, or used by any person who resides in your household and such person is not listed or endorsed on the policy prior to loss'
He stated that this exclusion is in your policy, or the exclusion IS in your policy?

I recently had an adjuster try to tell me that a homeowners claim would be denied because "most policies don't cover that." Turned out that mine did. Read your policy.

Definitely read the policy. The twenty minutes you spend doing that may well be worth it.

I was told by an insurance adjuster that I was "at fault" for a car accident due to black ice, even though my policy specifically stated accidents caused by black ice are considered no-fault. (I had to take that to the CA Department of Insurance, ultimately.)

First get them to pay the liability claim

Then get a copy of your actual policy

Then take that policy To 3-4 bad faith insurance lawyers. They will analyze it and determine if there's an Angle to attack the insurer

You probably won't get them to pay you voluntarily without a lawsuit. , unless that exclusion isn't in your policy they mail to you. However there are a number of arguments in a lawsuit a good lawyer can use to spur a payment or settlement

Sorry if i was being vague.
As per the denial letter, the following is the wording.

'your policy contains the below exclusion, which removes coverage from the insured auto when being operated by an unlisted driver:

Exclusions - Part D ONLY
Caused to the insured auto when it is driven, operated, or used by any person who resides in your household and such person is not listed or endorsed on the policy prior to loss'

I guess, the exclusion is listed in my policy

Don't guess at anything . Do what we told you- get a copy of the actual full policy .

Denial letters often take out a paragraph from an incorrect policy version or a different one than you were provided with. Also if there are any ambiguities they must be resolved in the customers favor . A good bad faith lawyer will review all this , plus the claims handling process of your claim, and give you an expert opinion . Most do not charge a penny to review it and will work for a percentage of what they recover. Therefore they only take strong cases they can win or settle . You need an actual expert to review these materials not fwf

Sorry, but think about it for a minute.

If they allowed spouses and children to drive unlisted because its only a learners permit, they would be allowing some of the riskiest drivers to operate the vehicles without having the chance to reprice the policy.

How long has your wife lived with you? How long had she had a permit when the accident occurred?

Maybe it was soon enough you might find some sort of grace period in your policy.

RWAnderson72 said:   Definitely read the policy. The twenty minutes you spend doing that may well be worth it.

I was told by an insurance adjuster that I was "at fault" for a car accident due to black ice, even though my policy specifically stated accidents caused by black ice are considered no-fault. (I had to take that to the CA Department of Insurance, ultimately.)


I agree. That's probably a good take away from my experience. Always read the policy documents and if you feel under insured, never hesitate to pay for good insurance as we cannot anticipate future events.

The exclusion you quoted is not particularly unheard of. Insurance carriers know that if multiple people live in your household they are almost certainly going to drive your car and as such they want to rate for them. This is exactly what happened here and the reason that they denied the coverage. They rated on your driving experience and weren't informed there was a low experience driver in the house and they didn't get rate for the exposure.

Infinity Casualty is an AM Best A Financial Size X rated company so it isn't like you are dealing with a complete no-name insurance company.

Now, if you told your insurance agent that your wife was going to drive the car and he placed you with this carrier knowing that, you may have a claim against the insurance agent and his E&O. Insurance Agent E&O policies are frequently known as backup insurance carriers as they frequently end up paying out when a carrier doesn't because the agent gets hit with the claim that they were negligent in placing your coverage. If you did tell your agent that your wife was learning to drive and may drive your car, threaten the agent with a claim. Most agents E&O policies will consider that a claim under their policies and the agent's E&O carrier will get involved and might offer you what you want to make it go away.

If you did not tell your agent, then you really don't have much of a leg to stand on. The policy is clear and is intended to prevent this exact scenario.

SUCKISSTAPLES said:   Don't guess at anything . Do what we told you- get a copy of the actual full policy .

Denial letters often take out a paragraph from an incorrect policy version or a different one than you were provided with. Also if there are any ambiguities they must be resolved in the customers favor . A good bad faith lawyer will review all this , plus the claims handling process of your claim, and give you an expert opinion . Most do not charge a penny to review it and will work for a percentage of what they recover. Therefore they only take strong cases they can win or settle . You need an actual expert to review these materials not fwf


Thanks for the advice. I will surely consult an expert in this field and see if they can find any loose angles.

barbcole said:   Sorry, but think about it for a minute. If they allowed spouses and children to drive unlisted because its only a learners permit, they would be allowing some of the riskiest drivers to operate the vehicles without having the chance to reprice the policy.I agree. If anything, I would like to know which insurance companies would actually cover damage to a vehicle committed in violation of this exclusion and avoid them, since clearly they disrespect their customers so much, having those who abide by the exclusion (adding those other drivers who live in the house to the policy) and pay a higher premium as a result, effectively subsidizing those customers who expect to receive the same coverage without adding those other drivers who live in the house to the policy.

csisking said:   Thanks for the advice. I will surely consult an expert in this field and see if they can find any loose angles.You skipped a step. Have you even read your policy yet? SIS is right that denial letters pull language from standard policy templates that may or may not match what is in your actual policy. Adjusters often work for multiple companies and may not even know what is in your actual policy. Their job is to deny claims.

Not saying that the denial isn't legitimate, but this will be a whole lot easier if you find out that the exclusion doesn't even exist in your policy.

dcwilbur said:   csisking said:   Thanks for the advice. I will surely consult an expert in this field and see if they can find any loose angles.You skipped a step. Have you even read your policy yet? SIS is right that denial letters pull language from standard policy templates that may or may not match what is in your actual policy. Adjusters often work for multiple companies and may not even know what is in your actual policy. Their job is to deny claims.

Not saying that the denial isn't legitimate, but this will be a whole lot easier if you find out that the exclusion doesn't even exist in your policy.


I read my policy document and it does have this exclusion listed.

csisking said:   My wife recently was involved in an accident she was at fault... At the time of the accident, she was on a learners permit and i always thought that your spouse or kids with learners permit are automatically allowed to drive the car(with guidance) until they attain an actual drivers license.

No, I don't think so. Most states allow those with their learner's permits who are still teens living at home to be covered by their parents' or legal guardians' insurance. This means they can drive under their parents' supervision without technically having insurance but they must be a household member and a dependent. By not listing your wife as a driver of your vehicle, you misrepresented yourself and potential exposures to the insurer. The fact that they're still covering the liability claim(s) means that they haven't rescinded the policy altogether, but I would think they can deny any collision claim you're making based upon policy language. As others have said, though, you should still read through your policy for clarification.

csisking said:   I read my policy document and it does have this exclusion listed.
You're not crazy. I saw you say so the two prior times you said so.

turtlebug said:   csisking said:   My wife recently was involved in an accident she was at fault... At the time of the accident, she was on a learners permit and i always thought that your spouse or kids with learners permit are automatically allowed to drive the car(with guidance) until they attain an actual drivers license.

No, I don't think so. Most states allow those with their learner's permits who are still teens living at home to be covered by their parents' or legal guardians' insurance. This means they can drive under their parents' supervision without technically having insurance but they must be a household member and a dependent. By not listing your wife as a driver of your vehicle, you misrepresented yourself and potential exposures to the insurer. The fact that they're still covering the liability claim(s) means that they haven't rescinded the policy altogether, but I would think they can deny any collision claim you're making based upon policy language. As others have said, though, you should still read through your policy for clarification.
In NJ, when my kids had learners permits, in advance of the drivers license, the insurance company wanted them added to the policy as named drivers

I may be wrong, but I'm pretty sure that every time I've applied for insurance either online or on the phone, it has asked me for a list of "Licensed Drivers" in the household. I wonder what kind of argument a lawyer could make about that being the only question that was asked when applying for the policy, as your wife is not yet licensed...

ellory said:   In NJ, when my kids had learners permits, in advance of the drivers license, the insurance company wanted them added to the policy as named drivers

Yup, and not just New Jersey.

Varies by company.

This is <yet> another one of those reasons why you want to read your insurance policy.

barbcole said:   How long has your wife lived with you? How long had she had a permit when the accident occurred?

Your wife is on a learners permit? How old is she? Like 15 or 16? You from Utah?

OP, unfortunately I have no useful advice for you. I just wanted to ask that you please update the thread with the final resolution as I'm curious what will happen.

atikovi said:   barbcole said:   How long has your wife lived with you? How long had she had a permit when the accident occurred?

Your wife is on a learners permit? How old is she? Like 15 or 16? You from Utah?


I am thinking that the OP is a recent immigrant and his wife is just learning to drive.

OP: The policy language applies only when you did not disclose a licensed driver residing in the household. The key here is that your wife is not licensed and trying to get licensed. She is similar to a teenage kid that's on learner's permit. If let's say that the accident happened with your teenage kid on learner's permit driving, the policy will cover it.

Think about the questions you answered while you applied for insurance. Did they ask you if there were any other licenced drivers in your household. Were there questions that you answered make them believe that you were either not married or your wife did not live with you?

Veeekay said:   atikovi said:   barbcole said:   How long has your wife lived with you? How long had she had a permit when the accident occurred?

Your wife is on a learners permit? How old is she? Like 15 or 16? You from Utah?


I am thinking that the OP is a recent immigrant and his wife is just learning to drive.

OP: The policy language applies only when you did not disclose a licensed driver residing in the household. The key here is that your wife is not licensed and trying to get licensed. She is similar to a teenage kid that's on learner's permit. If let's say that the accident happened with your teenage kid on learner's permit driving, the policy will cover it.

Think about the questions you answered while you applied for insurance. Did they ask you if there were any other licenced drivers in your household. Were there questions that you answered make them believe that you were either not married or your wife did not live with you?


You are right!! She is an immigrant and was trying to get comfortable driving in US. There may be a point in your statement. During the time of underwriting this policy (almost 3.5 years back), we were not married and she was not living in my household. Maybe this will help me when i speak to a bad faith attorney. Thanks for pointing it out!!

I not understand why your insurance company is paying anything.

csisking said: barbcole said:   How long has your wife lived with you? How long had she had a permit when the accident occurred? There may be a point in your statement. During the time of underwriting this policy (almost 3.5 years back), we were not married and she was not living in my household. Maybe this will help me when i speak to a bad faith attorney. Thanks for pointing it out!!

I'm guessing there is also a clause in your policy requiring you to notify the insurance company when your situation (married, new driver) changes.

I remember a discussion recently where someone - actually, several people - were questioning long, detailed terms and conditions - I think it was for DVDs or maybe e-books. Given how hard so many of us work to find whatever loophole or exploit we can, it is surprising to me that terms and conditions for things aren't much longer than they are.

Veeekay said:   
I am thinking that the OP is a recent immigrant and his wife is just learning to drive.

OP: The policy language applies only when you did not disclose a licensed driver residing in the household. The key here is that your wife is not licensed and trying to get licensed. She is similar to a teenage kid that's on learner's permit. If let's say that the accident happened with your teenage kid on learner's permit driving, the policy will cover it.
Not necessarily the key. Some companies and some states require that learners be named on the policy
At renewal, my company's questionnaire specifically asks if there will be any people who will be learning to drive in the next policy period

Please people. stop "thinking" OP, still has not read the policy Until that happens everyone is guessing. The only thing we know is that some states and some companies require learners to be specifically added to the policy
We don't know what OP's policy says because OP has not read it.

atikovi said:   barbcole said:   How long has your wife lived with you? How long had she had a permit when the accident occurred?

Your wife is on a learners permit? How old is she? Like 15 or 16? You from Utah?


My wife is Korean. She got her Learner's Permit at 29 years old. I do not know which was worse taking my two teenage daughters out for driving practice or taking my wife out to practice. At least the daughters went through Driver's Ed .

KYBOSH said:   I'm guessing there is also a clause in your policy requiring you to notify the insurance company when your situation (married, new driver) changes.

And that clause (or elsewhere in the policy) defines a notification period during which the insured is expected to notify the company.

Some companies/policies do not allow any drivers other than those specifically named on the policy. Others do allow specific uses under specific circumstances.

If you have adult drivers in your house who are not listed on your policy, or you have soon-to-be-drivers who are about to get their permits, you should have a heart-to-heart discussion with your insurance company. Even then, there will be choices to be made.

SUCKISSTAPLES said:   First get them to pay the liability claim

Then get a copy of your actual policy

Then take that policy To 3-4 bad faith insurance lawyers. They will analyze it and determine if there's an Angle to attack the insurer

You probably won't get them to pay you voluntarily without a lawsuit. , unless that exclusion isn't in your policy they mail to you. However there are a number of arguments in a lawsuit a good lawyer can use to spur a payment or settlement

After they pay the liability claim, can you then make the argument that it's covered simply because they paid the liability - either the incident is covered or its not, they cant be on both sides of the fence. And they already affirmatively concluded it was covered when they paid the liability portion.

Scifiguy123 said:   

My wife is Korean. She got her Learner's Permit at 29 years old. I do not know which was worse taking my two teenage daughters out for driving practice or taking my wife out to practice. At least the daughters went through Driver's Ed .


A lot of immigrants, coming from large cities with excellent public transportation, do not get their driver licenses until much later.

Every morning on the highway I have witnessed crazy drivers, old and young, zipping by in their Crown Vics who are American born and educated, took their driver ed classes and passed. I am not sure which is worse?

Or they could live in NYC and never learned how to drive and then moved out of the city and can't drive worth a hoot....

Glitch99 said:   SUCKISSTAPLES said:   First get them to pay the liability claim

Then get a copy of your actual policy

Then take that policy To 3-4 bad faith insurance lawyers. They will analyze it and determine if there's an Angle to attack the insurer

You probably won't get them to pay you voluntarily without a lawsuit. , unless that exclusion isn't in your policy they mail to you. However there are a number of arguments in a lawsuit a good lawyer can use to spur a payment or settlement

After they pay the liability claim, can you then make the argument that it's covered simply because they paid the liability - either the incident is covered or its not, they cant be on both sides of the fence. And they already affirmatively concluded it was covered when they paid the liability portion.

That may indeed be one argument .
Note however that' insurers can have different requirements for when liability is covered vs when a collision claim is covered. So then we start getting into the ambiguity arguments and how they need to be resolved in favor of the customer

Somewhat off topic, but how technically inclined are you? I just ran my van into a cement wall, doing some pretty ugly damage. For less than $250 I got the parts needed for the repair online and slapped em on myself. If you get denied, want the car, but have a hard time coughing up 8 thousand clams, consider becoming self-sufficient. Don't pay people to do what you can do for yourself.

Get a Haynes repair manual, some tools at Harbor Freight, and find the replacement parts you need on eBay, AutoPartsWarehouse, and/or rockauto.

I've seen some $8k repair jobs require nothing more than an outter and inner fender and a little paint. Easy! And you will restore your self esteem after making this insurance mistake, and your wife will view you as a MAN! Everyone wins.

cr3s said:   Or they could live in NYC and never learned how to drive and then moved out of the city and can't drive worth a hoot....

Actually one of my colleagues lived in NYC for a decade before she joined us in sales. We thought we were going to die when she drove us to a restaurant for dinner during training. She apologized because she had no need to drive nor owned a car for all those years.



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