Insurance Provision Letter - The Texas A&M University System: Fill & Download for Free

There is a police report and I did file with her insurance. She's covered but they require her to make a statement before they do anything. The agent said that if she doesn't return their calls, they will not move based on the police report until they have tried to get her for 6 weeks because as their client that's their benchmark for “diligence in making contact.” Is that a standard practice?… I am missing days of work and have no means to get to my doctor for medical attention. I was only three days into a new job so I fear that I could lose it.If you were injured, get to a doctor as soon as possible for evaluation and treatment. Since you were injured you have greater leverage in getting your property damage claim settled.No six week is not a standard for diligent contact. They have a duty to handle your claim promptly. Liability is clear; she rear-ended you. If there was a police report, they do not have to have her statement before proceeding with your claim.I assume you have already submitted your estimates or they have sent an appraiser to see your car. Tell them they should immediately arrange direct billing for a rental car. They owe temporary substitute transportation.Tell them the clock is ticking and their delay is causing you inconvenience and wage loss. If the adjuster does not immediately agree to pay your claim, ask to talk to the supervisor.You can reference The Insurance Code, Chapter 542Sec. 542.003. UNFAIR CLAIM SETTLEMENT PRACTICES PROHIBITED. (a) An insurer engaging in business in this state may not engage in an unfair claim settlement practice.(b) Any of the following acts by an insurer constitutes unfair claim settlement practices:(1) knowingly misrepresenting to a claimant pertinent facts or policy provisions relating to coverage at issue;(2) failing to acknowledge with reasonable promptness pertinent communications relating to a claim arising under the insurer's policy;(3) failing to adopt and implement reasonable standards for the prompt investigation of claims arising under the insurer's policies;(4) not attempting in good faith to effect a prompt, fair, and equitable settlement of a claim submitted in which liability has become reasonably clear;Liability is clear. They have no valid justification for putting you off. If they don’t immediately agree to set up a car rental and take care of your property damage claim, send a complaint letter to the Texas Dept of Insurance.Your property damage claim should be settled first. Your injury claim can be settled later after you have recovered. You are entitled to medical expenses, wage loss due to the injury, and “pain and suffering”.AAA Insurance is a reputable company, so I’m surprised that the adjuster is giving you a run around. I suspect that the adjuster is a rookie. If you can’t make headway, demand to talk to the supervisor. If that doesn’t work, ask for the Claims Manager. Someone there should have the sense to go over this adjuster’s head.

He or she was.From Slate magazine in July 2015:In February 2011, after two years of defending that provision of DOMA in court, the Justice Department announced that it would no longer do so. At the time, Attorney General Eric Holder announced that the president had concluded that the provision of DOMA was unconstitutional as applied to legally married same-sex couples. The president thus instructed the Department of Justice not to defend the law, even though the federal government “has a longstanding practice of defending the constitutionality of duly-enacted statutes if reasonable arguments can be made in their defense.” (…)(Thanks, President Obama, for the Thing You Didn’t Do on the Path to Marriage Equality)Of course, once the White House changed hands in January 2017, that precedent applied to other political priorities. As we learned in the Washington Post in June 2018:The Trump administration said Thursday night that it will not defend the Affordable Care Act against the latest legal challenge to its constitutionality — a dramatic break from the executive branch’s tradition of arguing to uphold existing statutes and a land mine for health insurance changes the ACA brought about.In a brief filed in a Texas federal court and an accompanying letter to the House and Senate leaders of both parties, the Justice Department agrees in large part with the 20 Republican-led states that brought the suit. They contend that the ACA provision requiring most Americans to carry health insurance soon will no longer be constitutional and that, as a result, consumer insurance protections under the law will not be valid, either…(Trump administration won’t defend ACA in case brought by GOP states)Goose. Gander.

Hopefully veeerrrry slowly. Repealing the Affordable Care Act is one thing, coming up with a replacement is another. That leaves Republicans in Congress caught between a rock and a hard place.The problem is there is no way at the moment (at least none has been identified) to enact a “better, more affordable” alternative as President-elect Trump and the Republicans have promised.That’s why the American Medical Association, the nation’s largest medical group, The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) oppose repeal, as do a growing number of Republican governors. Allowing insurance companies to sell insurance across state lines simply doesn’t work.The problem is three fold.A large number of people are too poor to afford health insurance under any circumstances and place a huge burden on emergency rooms and hospitals, the cost of which are paid by taxpayers. Hospitals across the country are bracing for a financial apocalypse if Congress repeals the Affordable Care Act (ACA), also known as ObamaCare. Two hospital groups spelled out the details in a new report. The American Hospital Association (AHA) and the Federation of American Hospitals (FAH) sent letters to Trump and Congressional leaders calling attention to problem. It details the impact, if an estimated 20 million people lose health insurance coverage.A large number of people, mostly but not all elderly, require more health services, or have “pre-existing” conditions. It’s a fact, most people require the lion’s share of medical attention in the last 15 years of their lives. Per capita lifetime expenditure is $316,600, a third higher for females ($361,200) than males ($268,700). Two-fifths of this difference owes to women's longer life expectancy. Nearly one-third of lifetime expenditures is incurred during middle age, and nearly half during the senior years. For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years, according to the National Institutes of Health.Young healthy people who are rarely sick, mostly because of their age, spend very little on health services and may even forego health insurance until the begin a family. Many of these people are in college for an extended period of time without access to health insurance.The ACA addresses all three of these groups. First, it has expanded Medicaid and provides subsidies to low-income families to make insurance affordable. In 2014, alone, the ACA cut uncompensated hospital costs by $7 billion, according to the Department of Health and Human Services. Of significance, the ACA provides preventive health services to this group to head off illnesses before they become serious.The ACA is helping pre-Medicare older people by preventing insurance companies from denying coverage for “pre-existing” conditions and banning life-time caps on coverage. This greatly benefits people who are laid off from jobs and lose health care coverage, people who work for companies that don’t provide health insurance and people who are older, but too young for Medicare. They can also receive subsidies depending on their income to make insurance affordable.Young people have proved to be more problematic. They balk at having to buy insurance, or game the ban on “pre-existing conditions” by waiting to buy insurance only when they get sick, knowing they can’t be turned down. But insurance companies say it’s imperative to have this group participate because they are the “most profitable.” Thus, the ACA imposes a penalty on anyone who refuses to buy insurance, essentially, to help protect insurance company profits. To help pay for the ACA, the measure also includes a surtax on high-income households.Because of all of the above, the ACA has made insurance affordable for more than 20 million people. But it also falls short for several reasons.The ACA is set up so health exchanges are administered by states. In exchange, they get an increase in federal funds to cover costs. If you live in a state that strongly embraces the program like Maryland, California, New York (not surprisingly, mostly Blue states), it’s working pretty well. But many Republican governors, mostly in red states, have refused to cooperate with the program for political reasons and have refused to accept federal funds. Most notable is Texas, but there are other red states as well. If you live in a red state, chances are you are unhappy with the law because policies are far more expensive with high deductibles, and fewer alternatives.Secondly, because insurance companies had no experience with the ACA they did not know how to price their policies. This has resulted in big premium increases as rates were adjusted to reflect actual health care expenditures. But that’s largely a one-time phenomenon. Overall, premium increases have been shrinking.Third, Congress killed two key provisions of the ACA that would have improved competition and lowered costs. They caved to insurance and drug industry lobbyists and refused to allow a public option and they refused to allow the government to negotiate lower drug prices for Medicare and Medicaid. As a result, it’s impossible to foster true competition in the health insurance market. Drug costs in the United States remain the highest in the developed world, including three or four times the cost in nearby Canada.If there is a system that can do everything the ACA does that’s better and more affordable, I’m all for it. But what is it? Republicans and Trump appear not to have a clue. That’s why they’re talking about repealing the ACA, but delaying the effective date by a few years, probably until after the mid-term elections to avoid the political backlash.The only real alternative is to move to a single-payor system, or at the very least a public option. But that’s anathema to conservatives. Hopefully, cooler heads will prevail in Congress and the ACA will be improved, not repealed.