Results 1 to 2 of 2

Hybrid View

  1. #1

    Default Claims Adjuster Violating Many Rules

    My question involves insurance law for the state of: California

    I had a slip and fall at a business (see thread here) a couple of years ago. I contacted the business and they sent me over to their insurance company. I was set up with a claim's adjuster with a claim number, and I had to sign something claiming my injury was NOT taken by Medicad or Medicare.

    However, I got the run around from my so-called claims adjuster, trying to be illusive and not forth coming. They had violated many of the laws in the insurance code and the California Code of Regulations pertaining to my claim. The did not accept or deny my claim within 40 days of acknowledgment, they sent me a written statement acknowledging the date of injury and than telling me that the statutes expire 2 years + 1 week. And other small false statements they made.

    SO, I reported them to the Department of Insurance. The DOI informs me that the claims adjuster that is handling my claim is not the insurance agency for the business, but acting as a third part representative. The business where I got injured at, turns out, is its own entity. In California, a business does not have to have CGL (Commercial General Liability) insurance. In my case, the insurance claims adjuster was acting like a claim adjuster to resolve the issue, but in reality they are not representing the business because of a claim.

    I guess this is another one of those tricks played by claims adjusters and businesses. The Department of Insurance has informed me that there is nothing they can do, because this issue does not fall under their jurisdiction, because the business is exempt from the Insurance Codes, because they are acting on their own accord, as their own entity. Very new and fascinating to me.

    Somehow and in some way, it doesn't make sense that this legitimate insurance company, with a California insurance license can falsely lead someone about the SOL and act as if they were handling a claim, but in reality, they are not. I have a claim number and all. Does this mean the insurance company is above the laws in the State of California? They are free to do whatever they want and have no recourse of act. There has got to be something out there, since according to the DOI, the Insurance Codes or California Codes of Regulations do not apply here.

  2. #2
    Join Date
    Sep 2005
    Location
    Behind a Desk
    Posts
    98,846

    Default Re: Claims Adjuster Violating Many Rules

    If a company is self-insured and does not fall under state regulations of insurance companies, then they're neither an insurance company nor subject to that regulation.

    The only person you should ever count on in relation to the calculation of the statute of limitations is your own lawyer.

    1. Sponsored Links
       

Similar Threads

  1. Applying for Unemployment: What Questions Will an Unemployment Insurance Claims Adjuster Ask
    By thisdudefromnj in forum Employment and Labor
    Replies: 3
    Last Post: 02-16-2013, 04:58 PM
  2. Disciplinary Issues: Can You Be Held Responsible for Violating Employer Rules From Your Annual Review
    By Anonymous Office Worker in forum Employment and Labor
    Replies: 7
    Last Post: 08-04-2012, 10:50 AM
  3. Speeding Tickets: Speeding and Violating HOV Lane Rules
    By malice9999 in forum Moving Violations, Parking and Traffic Tickets
    Replies: 3
    Last Post: 03-07-2012, 11:59 AM
  4. Problems With My Claims Adjuster
    By tlatina6 in forum Worker's Compensation
    Replies: 1
    Last Post: 12-12-2007, 08:36 AM
  5. Getting a New Claims Adjuster
    By injuredinMA in forum Worker's Compensation
    Replies: 4
    Last Post: 10-24-2007, 08:05 PM
 
 
Sponsored Links

Legal Help, Information and Resources