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Complaint 10 of 36 in "Claim Denied or Delayed"

Insurance Carrier: United Automobile Insurance Services
State: Texas

Consumer Complaint:

I've sent letters to the insurance company, called and talked with claims adjuster, and have even left messages with the claims dept. manager, and have heard nothing from them. I would like to resolve this matter, and I do not believe that I'm being unfair. I still need to see an orthopedic Dr., but do not have the money to do so, and feel that I should not have to use the health insurance that I have now to do so, because this happened before I got health insurance.

Insurance Expert Answer:

Let me make sure I understand this. IF United is YOUR insurance carrier, it owes you a duty of good faith and should cover your medical bills. It does not "settle" with you. It does not pay for pain and suffering. It pays you what the policy promised when you took it out as bills and expenses are incurred. HOWEVER, if United is the OTHER Driver's carrier, its duty is to its insured. In one sense it owes you nothing. It is there to defend its driver, and while it must pay any judgment against the driver you get from a court -- up to the policy limit -- it need not settle with you, and won't if it concludes you are asking for too much, or have a less than compelling case or are unlikely to pursue the matter. IF the other driver's liability is absolutely clear, and you were in no sense at fault -- even a little -- then it usually will settle for what it regards as an acceptable amount. Most insurance companies do not want to run the risk that the injured person will be smart enough to go out and get a lawyer. Too often they find out what they could have settled for say $5,000 in medical bills will now cost them over $25,000 because the inured person did not know the value, while the lawyer knows what the case is really worth. Of course if you ask for $10,000, they will not pay $10,000 even though they may know a lawyer could get a verdict for at least $10,000. While they may be willing to offer the lawyer $10,000 to save defense costs, the insurance company still won't pay you $10,000. Why? Because they will undoubtedly get you to damage your own potential case and claim for damages in discussions with their people and adjusters. They also know many lawyers won't want to get involved after the prospective client has ruined his or her own case. They know as time passes the case is harder to bring. They also may conclude the amount you are asking is far lower than the threshold which good lawyers need to make it sufficiently worthwhile for them to sue on a claim. Finally, they may hope you get so disgusted that you go away and/or the statute of limitations passes. (Very often, and particularly when a governmental unit is involved, the statute of limitations or requirement for formal notice is very short, and if you snooze you lose.)