GAP Insurance Claim Denied

[Joanna254]

Jurisdiction

Texas

My husband was in an automobile accident on 3/31. It was a single car accident and it was his fault. There are several medical factors involved, but alcohol was also cited as a possible cause of the accident. The did take blood at the hospital and the cops were there at the hospital, but he was never issued a citation or arrested.
We had really good insurance and the outstanding balance on our loan after the everything is about $2,200. GAP sent us a letter denying the claim stating:
Losses due to or as a consequence of a criminal act are not covered under the GAP Waiver Addendum.
According to Exclusions #17 on Page 4, "this GAP Waiver Addendum does not provide coverage for a loss when a Constructive Total Loss may reasonably be expected to result from intentional or criminal acts of a retail buyer or their permissive user while committing a felony, including but not limited to DUI/DWI or while seeking to elude lawful apprehension or arrest by a law enforcement official No GAP Amount will be waived until the charges have been dismissed or adjudicated not guilty".
If the charges filed against the driver are withdrawn or dismissed, please furnish us with the revised documentation. Upon receipt, we will reopen your claim for further consideration."

I have nothing to submit because there were never any charges filed, tickets issued or arrest. How can they deny the claim only based on the fact that alcohol "may have been a contributing factor" - but they did take blood and never charged him with DUI/DWI.

 

[adjusterjack]

How can they deny the claim only based on the fact that alcohol "may have been a contributing factor"

The how is explained by the did. And, according to the provision that you quoted, they have a contractual right to deny the claim until documentation is received that exonerates the driver.

they did take blood and never charged him with DUI/DWI.

There is likely to be something in writing in the case file that explains why he wasn't charged.

Start by getting a copy of the police report. Then follow up with the local prosecutor's office.

Meantime you'd best continue making your payments on the loan so you don't get your credit trashed.

 

[mightymoose]

Just because he was not arrested or cited at the time does not mean charges were not filed later. It could be done completely without his knowledge.
Once the prosecutor's office catches up with the paperwork a warrant would be issued and eventually the arrest or citation. Whether or not a warrant may be on the way likely depends on the result of that blood test.
He needs to find out of the car is still active for investigation or if it has been closed. If there is no action being taken you should be able to get a statement saying so that will satisfy your insurance.

 

[Joanna254]

The how is explained by the did. And, according to the provision that you quoted, they have a contractual right to deny the claim until documentation is received that exonerates the driver.



There is likely to be something in writing in the case file that explains why he wasn't charged.

Start by getting a copy of the police report. Then follow up with the local prosecutor's office.

Meantime you'd best continue making your payments on the loan so you don't get your credit trashed.

Ok - I will get in touch with the prosecutor's office, because I already have the police report and on the section that has "Charges" there are none.

 

[adjusterjack]

You'll need a letter stating that no charges are being filed.

 

[heatherlanee03]

I just had a similar situation. Can the gap insurance deny my claim even though I submitted proof that all the tickets issued were dismissed?

 

[army judge]

I just had a similar situation. Can the gap insurance deny my claim even though I submitted proof that all the tickets issued were dismissed?

Do you think anything told to you via an anonymous internet discussion site would sway the decision of a frugal insurance company?

I suggest you consult a lawyer in your jurisdiction, if you seek REAL legal advice.

===============================================================



Legal Disclaimer: The content appearing on our website is for general information purposes only.

When you submit a question or make a comment on our site or in our law forum, you clearly imply that you are interested in receiving answers, opinions and responses from other people.

The people providing legal help and who respond are volunteers who may not be lawyers, legal professionals or have any legal training or experience.

The law is also subject to change from time to time and legal statutes and regulations vary between states. It is possible that the law may not apply to you and may have changed from the time a post was made.

All information available on our site is available on an "AS-IS" basis. It is not a substitute for professional legal assistance.

Before making any decision or accepting any legal advice, you should have a proper legal consultation with a licensed attorney with whom you have an attorney-client privilege.

For purposes of New York and New Jersey State ethics rules, please take notice that this website and its case reviews may constitute attorney advertising.

 

[adjusterjack]

I just had a similar situation. Can the gap insurance deny my claim even though I submitted proof that all the tickets issued were dismissed?

It depends on the terms and conditions of YOUR gap insurance. The other poster quoted her exclusion, now you quote yours word for word.