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If We Only Had to Pay Insurance Reimbursed, Reduced and/or Recommended Prices

I am amazed every day with comments made by insurance adjusters or agents, servants, and/or employees working on behalf of insurance companies. Regardless of whether it has to do with my personal health insuranceautomobile insurance, property insurance, and/or other types of insurance.

It all boils down to insurance companies belittling, discrediting, discounting, ignoring, amending, omitting, and/or re-creating invoices, or bills, legitimately charged by professionals for services rendered.–Trey Mills

Let’s look at a few recent examples I have run across just this week:

  1. I needed medical treatment so I went to a medical professional, aka, a medical doctor. This medical professional went to school for over 20 years to be a licensed medical professional. The physicianprovided me with medical advice and treatment I needed. I filed it on my health insurance and when it was all said and done out of the $110.00 bill, my insurance company discounted it by $55.00 for a “network discount”.  I paid my $25.00 co-pay and because I have not met my $2,000.00 deductible, I owe the $40.00  remainder.  What the heck did the insurance company pay for? I am pretty sure if I was uninsured and had the ability to pay in cash I would have gotten a 50% reduction = $55.00. Instead, since I had health insurance, I had to pay $65.00. (Health insurance is truly for cancer and other catastrophic injuries/illnesses that happen in life. Other than that, bend over). There was a great article in the A. Times entitled “Why Require People to Buy Health Insurance”. Admittedly, I would rather have things privatized than governmentalized but what is the difference between an extra tax and mandating people pay insurance premiums? You say tomato. I say tomato.
  2. wrecked my carso I went to the only local certified manufacturer of my car within 100 miles and had the parts repaired and replaced. Since the wreck was not my fault, I notified the at fault party’s insurance company and requested they pay my repair bill (actual costs), my rental bill (loss of use), and depreciation. The at fault insurance company discounted my repair bill by over $300.00 because they felt it was over priced, offered me $10 a day for a rental car, and said that they do not recognize depreciation. (South Carolina law does and when I filed “Arbitration Pleadings” they paid me almost double their original offer).
  3. I have rental property so I needed insurance for those rental properties. One of my houses is centrally located within four houses from Falls Park in Greenville,SC. The lot alone is valuable, not to mention the “historic” two story house that is being remodeled. However, the replacement costs for the house, per the insurance estimate, is astonishingly low. I wonder what builders or estimators are providing those costs? I need to get them in there remodeling the house but then again, it would probably be put back together with glue and toothpicks.

 

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South Carolina Property Arbitration for Depreciation, Loss of Use, & Actual Damages

I have always threatened to take an insurance company to arbitration over their ridiculous offers but never had a client that could afford to take the time and roll the dice on a Battle Royal. Ask and you shall receive. *(see a recent update on this article at the bottom).

Today, I partook in my first property arbitration over depreciation, or diminution of value, due to an automobile wreck and subsequent repair of their vehicle.  This was my first because, as an attorney and business venture, it is not worth the time, effort, or eventual outcome to pursue such action, especially when there are personal injuries that arise out of the accident. The personal injury claims are a much more valuable and worthwhile effort for attorneys to assist. However, I did this one pro bono, gratis, and/or “for free”. Although I did not gain financially from this venture, I was able to gain through experience.  A much more valuable weapon against evil insurance companies.

With most every car accident arises two causes of actions.

  1. Property Damage: A claim for property damage can be in the amount of actual damages (repair costs), loss of use(not having your car/having a rental), and depreciation/diminution of value (the value of your car before vs. after the accident-given that it was in a wreck); and
  2. Personal Injury:Any injury sustained as a result of the physical, mental, and/or emotional impact of the accident, or trauma.

In my case, the plaintiff had her brand new, candy apple red convertible slammed into by a dump truck.  The defendant did not dispute that they were at fault.  The defendant repaired the vehicle and provided a rental but when the plaintiff inquired about depreciation due to the stigma of the car being in an accident, the insurance company said they did not recognize such damages. WHICH IS BULLSHIT and ILLEGAL.  Insurance companies don’t make money paying it out, they make money keeping it.

The highest offer the defendant made was only a couple hundred dollars to my client, even after I became involved.  At arbitration the plaintiff was awarded almost triple the insurance company’s highest offer and it was the insurance company’s expert testimony that helped the arbitration panel make their determination.

Why would an insurance company drag this out and only offer a few hundred dollars? That would be because 80-90% of you will go away and the 10-20% that fight them are cheaper to pay off than the 80%.  It is a numbers game. The more you roll over to the insurance companies, the more money they make, and the more they laugh at you. Don’t let them laugh at you, fight back!

You don’t have to be an attorney to request an arbitration hearing or to file a claim in small claims court. Please go to this link to learn more:

http://www.doi.sc.gov/consumer/auto.htm

South Carolina allows for persons to request an arbitration through S.C. Code Ann. 38-77-730:

 

SECTION 38-77-730. Request for arbitration; no formal pleading and process; arbitration docket; filing of claim; service of summons to defendant.

(a) Any person who is a party to the disputed property damage liability claim may submit his claim for determination through arbitration. No formal pleading or process is required. The clerk of court of each county shall prepare and keep an arbitration docket and set the cases thereon for arbitration as provided by law for the settling of cases in the court of common pleas.

(b) The claim must be filed with the clerk of court in the county in which the cause of action arose or where the plaintiff or defendant resides. The claim must be filed in triplicate with the clerk of court on forms to be provided by him. The forms shall set forth the names of the parties, the date and place of the accident, and the amount of property damage claimed. The clerk shall file one copy in his office, and one copy must be served upon the defendant as provided by law for service of summons and complaints. The sheriff, or such other person, shall promptly serve the claim upon the defendant and shall receive the sum of five dollars to defray the cost of securing this service. The sheriff, or such other person, serving the process shall promptly file an affidavit of personal service with the clerk of court on forms to be provided by the clerk.

(c) There must be attached to, or made part of, the form a summons to the defendant named notifying him that he should file a response with the clerk of court within thirty days from the date of service and that failure to file a response within thirty days entitles the plaintiff to a default judgment. The form must be signed by the party filing it or his attorney, if any, and shall by order of reference show the address of the person signing it.

 

 

SECTION 38-77-740. Hearing; notice to parties; damages to be awarded; securing attendance of witnesses.

(a) The court, or the clerk acting for the court, shall assign the arbitrators to hear the matter at the courthouse, or other designated place in the county where the claim is filed, within sixty days after the date of filing, or as soon thereafter as is feasible. The clerk of court shall, on a form provided by him, advise the parties or their attorneys of record, if any, by mail as to the place, date, and time of hearing and shall advise the parties to bring all records which may pertain to the claim, including, but not limited to, the following:

(1) Two estimates of damage to the motor vehicle or its contents signed by the estimator.

(2) Signed receipts for car repairs.

(3) Bills or receipts for other property damages claimed.

The forms shall also contain notice to the parties that, if they cannot attend because of illness or otherwise, the clerk of court must be notified as soon as possible with the request that another date be set for the hearing.

(b) Property damages must be awarded as provided by law, including, but not limited to, actual damages, loss of use, depreciation, and any other property damages which are the direct and proximate result of the accident.

(c) The parties may secure the attendance of witnesses by their voluntary appearance or may secure their attendance by subpoenas prepared and issued in accordance with the laws of this State.

 

Don’t think being an attorney affords you any differences when dealing with insurance companies. I recently had to go through the same process with an insurance company as a result of a property damage claim. They forwarded me a check significantly lower than the actual repair costs, rental car invoice, and depreciation. I requested an explanation within 7 days and received none. I filed arbitration pleadings in the proper county and had an offer almost double the initial amount within 3-4 days.  Don’t play around with them. File the arbitration papers for $5.00 and then send them an original copy with a reasonable demand.