“They Can’t Do Anything But Say No”

We’ve al been in situations where we have to ask for something but at the same time, doubting whether we’ll get what we want. And the only way to justify asking is to rationalize the request by thinking that we’ll never get what we want without asking. So, we inevitably conclude that “they can’t do anything but say no”. The same thing happens when people submit claims to their insurance carrier. You have to put your claim in someone else’s hands and wait for them to decide whether you have a valid claim. Usually, it boils down to a settlement between the carrier and insured. However, there are those instances that arise when damage occurs and the insured feels that it should be covered but, it likely is not. A case in point recently arose when an insured driver hit a plastic five gallon container with his car and filed a claim alleging damage to the transmission oil cooler. Upon investigation, it was also learned that the drainage of transmission fluid, which the driver claimed never to have noticed, resulted in the complete destruction of the transmission. For those that are not aware of the location of a transmission oil cooler, it is usually located in the radiator/condenser area, in the front of the vehicle, where air can come in contact. Knowing that the plastic container would have had to enter the air opening in order to contact the cooler, the bumper and grille areas were examined for damage and none was found. In addition, the air opening was much too small to allow even a part of the container to enter and make contact with the cooler. Furthermore, none of the cooling fins or tubes that were part of the cooler were damaged by anything external to the vehicle. Needless to say, the claim was denied much to the disappointment of the insured.

The message here is if you, as the insured, know that there is element of uncertainty in your explanation, then don’t be surprised if your claim is denied. That is not to say that all claims have to have a reasonable explanation. There are times when only an expert can explain the circumstances that are not obvious to a layman. But, when the explanation is bordering on the absurd, it’s time to reconsider your claim. Remember, you can submit your claim because they can’t do anything but say no.

Buyer Beware!

Recently, we were called to investigate damage to a residential air conditioning unit. The allegation was that the unit was destroyed by fire.  Upon examining the unit, no evidence of fire was found.  That is, there was no evidence that any wiring or controls were burned and the compressor and condenser were both undamaged (as far as fire was concerned). However, during the examination of the unit, the compressor was found to have blown a terminal and caused its destruction. Most HVAC technicians will recognize this scenario. The possibility of lightning causing the damage was also explored and eliminated because there was no lightning in the area at the time of the compressor failure.  Instead of replacing the compressor, the homeowner had the entire unit replaced with a unit of greater capacity.  In doing so, the homeowner assumed that the insurance company would pay for the new installation which amounted to more than $8000.00.  Without a covered loss, the insurance company denied the homeowner’s claim leaving the homeowner to  absorb the entire cost of the new installation.   The lesson to be learned here is that you do not want to commit to a major purchase unless you can handle the expenditure if your insurer denies your claim. In this case, the cost to replace the compressor and recharge the unit would have been in the neighborhood of $1200.00 to $1500.00, which is significant lower than the new unit.

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