whats up with insurance companies?

Question

I know 2 people who have filled claims with insurance companies. One was over a year ago where he broke his bak and he got 80k and is back to work without any problems. The other one got his foot partially amputated and hasnt been able to walk since and his claim got denied because it was amputated enough. One cant walk gets denied and the other is fine but gets 80k. Does anybody else see anything wrong with that?

No the foot didnt happen at work it happened at home. The iunsurance company he has is one of the best i just dont remember the name.

Answer 1

you are asking for justice when the insurance company is operating under a contract or state law that specifies when a covered injury has occurred.

justice and law are not the same things, even though, in America, both are tried in the same court.

however, state laws say that insurance companies must follow the laws, rules, and regs of the state insurance departments, so their hands are tied.

you need to ask your legislators to change the laws to include a just outcome in insurance settlements.

of course, that will raise many more quaetions of how much and to whom (plus when), so you can expect lawsuits to increase and therefore insurance premiums.


GL

{Btw, if either injury occurred at work, the workmen's compensation system in their state, which is wholely under the Legislature's thumb, made the decision about the amount of recovery, if any.}

oh

Answer 2

Each of the persons claims should have been handed in accordance with the provisions of their policies and the laws in their states. There is way more to the story that you don't know or that you did not put here.

Your friend whose claim was denied needs to speak to his adjuster. The adjuster will be able to say why his claim was not covered. Your friend will not like the answer, but the adjuster should try to explain it in simple terms.

However, I find that when I try to explain to someone why their claim was not covered, they tend to be so busy fussing/cussing and arguing that they do not listen and the conversation ends with them still having no understanding of why. Then they get to run around telling all their friends and family how bad the mean ol' insurance company treated them.

Answer 3

Sounds like with the back injury there was someone else liable, meaning, someone ELSE caused the injury, whether it was in a car wreck or he was at someone's house & they left ice on the walkway, something like that.
If the foot injury happened at his OWN home, since you can't be liable to YOURSELF, there would be no liability & no pain & suffering payment. He should have health insurance to cover the medical bills but that would be all he would get. Sounds like nobody caused the injury but himself.
I don't see anything wrong with that.
I fractured my back in 2 places many years ago. I fell due to my own clumsiness, not even on my own property. I took responsibility for my own actions, realized it was MY OWN FAULT and didn't even attempt to sue anyone. Yes I had pain, still do, SO WHAT!!!! I live with it, it is part of my life.
If liability was paid to everyone that injured themselves, talk about HIGH premiums, wow!!! The insurance companies would collapse, if coverage was even available, it would be so expensive, only the rich could afford it. Think about it.

Answer 4

Well, there are LOTS of other variables involved! Did the guy who lost his foot have WORKERS COMP? Did his employer have an active policy?

Insurance won't pay if your policy is cancelled. Workers comp only pays if the accident is WORK RELATED. So if it happened at home, well, does he have DISABILITY and HEALTH insurance?

You can't pay for a Ford Focus, then get upset that the dealer doens't deliver a Mercedes to your door. You get what you pay for - that's how it works at the grocery store, at the car dealer, and in insurance.

Answer 5

Yes, and the one who was denied should appeal ASAP.

Answer 6

Insurance companies are an organization to steal money in an organizational way so we wont be able to understand by having the government support.