“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.

How do you tell if your transmission was damaged in an accident?

Earlier this year, we were asked to examine a vehicle that was involved in a two vehicle accident and make a determination of the condition of the transmission pre-impact. The vehicle that was involved was a 2008 Buick Enclave that had already been repaired by the owner’s insurance carrier. The issue of the condition of the transmission arose after the vehicle had been returned to the owner and the owner subsequently drove the vehicle an additional 3100 miles. The transmission became noisy and then failed to move the vehicle after being placed in “Drive”. While investigating this incident, it was learned that the vehicle had been taken to a Valvoline Instant Oil Change Center where all the fluid levels were checked and documented. The transmission was found to have been “full” shortly before the accident occurred.   It was further learned from the body shop that repaired the vehicle that no transmission fluid came out of the transmission fluid cooler lines when the cooler and radiator were removed for replacement – the fluid level was already “low” when the vehicle arrived at the shop. Furthermore, after the new cooler and radiator were installed, no transmission fluid was added before the vehicle was returned to the owner. The vehicle left the body shop with the transmission at some fluid level below “full”. Normal wear and tear on a transmission is a very gradual process. The speed of the wear process is increased when the transmission is forced to operate without lubrication, which is the purpose of the transmission fluid. However, when there is documentation of the fluid level, the process of determining transmission condition becomes a lot easier. The damage to the transmission most likely occurred as a result the accident. The transmission was leaking fluid after the vehicle was returned to the owner.

Which Came First: the Accident or the Transmission Damage?

 

Recently, we were asked to evaluate a vehicle in order to determine if the damage to the transmission occurred before or after the vehicle was involved in an accident. This was a situation where the accident involved two vehicles, a Pontiac Sunfire and a Buick Enclave. The impact occurred such that the Sunfire sustained damage on the right front side while the Enclave’s left front side was damaged. The Enclave was repaired, returned to the owner and approximately 3100 miles put on the vehicle before the transmission failed. Specifically, the transmission began making a whining noise and when put in gear, would not “pull”. One of the ways to assess when damage occurred is to construct a timeline of events that leads to the damage. That is, establish the condition of the transmission before and after the collision. In this case, the service record of the Enclave was obtained from the owner’s service garage. The record showed that the owner had the vehicle in for an oil change approximately one month prior to the accident. The particular servicing agency also provided a 21 point inspection which included checking all fluid levels. It was then established that the transmission was in good condition prior to the accident. From that piece of information, and without being able to prove that something else (like a sudden fluid leak) caused the damage, the benefit of the doubt has to go to the owner. The insurance company for the owner of the Pontiac was therefore responsible for the repair of the transmission in the Enclave. However, it should be noted that if the condition of the transmission could not have been established, the alternative would have been to remove the transmission and make a determination from the damaged parts. This is a process whereby someone is going to incur some charges. It is usually beneficial to all parties if an arrangement is made beforehand. The arrangement is usually one where the insurance company will pay for the disassembly and repair if the damage is found to have been caused by the accident. If not, then the owner has to agree to pay for the disassembly and repairs.

Be Careful How You Treat Your Engineering Investigator!

Consider the following incident involving a vehicular impact and damage to the vehicle’s transmission. Assume that the driver hit an object in the road and claimed that the object caused damage to the transmission’s oil pan.  In short, fluid leaked out and the transmission was ruined.  On the surface, this seems like a plausible scenario and it would be reasonable to conclude that the failure of the transmission could occur after being hit by flying debris from the object that was struck.  However, what if evidence was found to indicate that things were not  as they appeared?  Needles to say, the final conclusions went against the owner’s claim.  Understandably, the owner would be upset and most likely not open to an alternative explanation.  If you are trying to get your insurance company to pay off on a claim, the last thing you want to do is insult the investigator.  The investigator has no interest in the outcome of the settlement between you and your insurer.  As a result, if you accuse the investigator of acting improperly with no evidence to support your accusation, neither the investigator or your insurer is going to feel inclined to help you in any way.  Not many people know this but, whenever a claim arises, the policyholder can hire their own engineer, appraiser, adjuster, attorney and anyone else they need to help prove their claim.  However, professional help does cost which is why insurers are seldom opposed in the claims process.  So, when you are faced with talking to an engineer, adjuster, appraiser or anyone else hired by and insurance company, be as polite and honest as you can be.  If you disagree with something, you can ask questions but, don’t insult or accuse the inverstigator of taking a “kickback”.  Instead, the time for an appeal ccomes after the initital decision is made by the insurer.  After that, appeals can be made directly to the insurer.  If there is  no satisfaction, then file a complaint with your state consumers affairs department or the office that regulates insurance companies.