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progressive denying repairs to my claim and medical bills

Discussion in 'Automobile & Car Insurance' started by abdel khalaily, Apr 20, 2021.

  1. abdel khalaily

    abdel khalaily Law Topic Starter New Member

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    Jurisdiction:
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    Hello , progressive have denied me car repairs coverage and medical treatment covarage. I was in a car accident in brooklyn NY on March 3rd 2021 it happened when some one cut me off and i swerved to avoid that car and in the process I hit a tree on the sidewalk. After the accident a claim rep called me and he realy sounded friendly a very sweet ,he painted a beautiful picture of the whole thing. He told me he wants me to be and feel well and wants to get my car fixed and get me driving driving again. He was telling jokes trying to connet with. My first thought was what a nice guy he is. He told me " I'll call you tomorrow I'll need to ask you few routine questions and we'll start working on your claim".
    He called the next day and told me that our conversation going to be recorded. When the questions started I felt unease ,he didnt sound friendly and nice and I found myself on the defense and to be honest felt trapped with my own answers he started using them against me. By the end of the coversation I was accused of trying to fraud the insuranse company.
    He claimed that I live and work in Brooklyn NY while paying PA premium rate. They demanded a list of document to prove otherwise.
    I provided them with prove of PA residency from mortagage payment for my PA house , utilities (electric ,water and credit card bill). I provided him with details about a business that I own and run in Brooklyn such as lease and bills.He told me public record shows that you live in Brooklyn. He asked Ezpass logs for Nov and Dec 2020 showing me leaving and entering NY , asked for community gate logs ( My house is in a gated community you enter with special electronic card assigned to each residence in good standing).
    He aske for my son's name and phone number when I told him that my son lives in my old brooklyn house. He asked for my mother in law name and phone number when I told him that my spouse and I where visiting her that day. He aske for bank statement showing purchases in and around my community in PA eventhough I told him I pay the bills and my spouse do groceries.
    At this point I don't know where to go from here ,I provided him with everything except bank statements because I think its an over reach by an insurance company. I need an advise on what to do and if there is a lawyer who is willing to take the case.
     

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  2. Zigner

    Zigner Well-Known Member

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    Your thread title says they are denying coverage, yet your post simply says they are investigating. Have they actually denied coverage?
     
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  3. abdel khalaily

    abdel khalaily Law Topic Starter New Member

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    Point well taken ,they used the term potentially denied unless they receive bank statement ,cars service record
     
  4. zddoodah

    zddoodah Well-Known Member

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    Any chance your son has the same name as you?
     
  5. Zigner

    Zigner Well-Known Member

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    Then I would suggest that you comply as best as possible - it will be cheaper than an attorney.
     
  6. abdel khalaily

    abdel khalaily Law Topic Starter New Member

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    No, The brooklyn house I passed on to my son but its still under both our names my spouse and I. Progressive did call him and asked him some questions in regards the house. Progressive are trying by all means to make me a Brooklyn residence to meet a clause in the policy that will deny me coverage.
     
  7. Zigner

    Zigner Well-Known Member

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    Said from a different perspective: They are performing their required due diligence prior to paying out a large claim.
     
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  8. PayrollHRGuy

    PayrollHRGuy Well-Known Member

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    Think about it this way. You had the accident in NY. You own a house in NY. Why shouldn't check to make sure you don't live in NY.
     
  9. abdel khalaily

    abdel khalaily Law Topic Starter New Member

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    They asked for Nov and Dec EZpass logs , which I gave them. The logs show me entering and existing NYC roughly at the same time several time a week.
     
  10. adjusterjack

    adjusterjack Super Moderator

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    It isn't. It's rather common when a claim appears suspicious. My guess is that Progressive ran a background check after the first conversation and found you owned homes in PA and NY. Once a claim is suspicious it gets thoroughly investigated to determine if the insured misrepresented or concealed a fact that was material to the underwriting of the policy.

    Materiality is this. If the underwriter had known the fact he would have done one of the following:

    1 - Refused to write the policy.
    2 - Write the policy at a higher premium.
    3 - Write the policy with reduced coverage.

    If, after the investigation, you are found to have misrepresented or concealed a material fact, the claim can be denied and the policy rescinded.

    Your policy requires your cooperation. A lawyer isn't going to do you any good while the investigation is in progress. There is time enough for a lawyer if the claim gets wrongly denied.
     
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  11. PayrollHRGuy

    PayrollHRGuy Well-Known Member

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    And assuming the logs show evidence in your favor great. But the investigation is still underway and the logs are but one piece of evidence.
     
  12. abdel khalaily

    abdel khalaily Law Topic Starter New Member

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    Now the insurance company wants to examine me under oath. I was involved in a car accident where I hit a tree on the sidewalk avoiding hitting the car that cut me off. The accident happened in march /2121 in Brooklyn NY ,and the insurance company has an issue with that. They say I have PA insurance premium and I live in NY. They asked me for over 50 different documents which I provided them with. It included prove of residency ,gated community logs ,ez pass logs, speaking with three of my family members, W2 ,Job number ,supervisor name and number, credit report, bank statements, mailings, utility bills, car service receipts. Now they asked me to be examined under oath this month and I am little worried i don't knw what to expect and its going to be virtual conducted by their lawyer or accident investigator . Any advice or help. do I need a lawyer? I should also mention that they put all medical payment on hold pending the examination.
     
  13. army judge

    army judge Super Moderator

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    Yes, you've REQUIRED the services of a lawyer since this saga began.

    I suggest you hire an attorney to protect your liberties and freedom.

    There is nothing you can do seeking free advice from strangers.
     
  14. adjusterjack

    adjusterjack Super Moderator

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    An examination under oath is, essentially, the same as a deposition. It's usually the last event to occur in a suspicious claim, before a decision is made. You will be questioned by a trained interrogator. It may take 1 hour to 4 hours. It will feel like the Spanish Inquisition. The purpose is to see if you slip up and contradict any of the information that you have already provided.

    Here is a site that provides several depositions. You can read them and learn how questions are asked and answered. There's also an explanation of how depositions work.

    Example Deposition Transcripts | Personal Injury & Malpractice (millerandzois.com)

    Wouldn't hurt to consult one and see if he/she thinks your insurance company is going overboard. It's going to cost you quite a bit of money (which you don't get back) to hire an attorney to take on your insurance company. At the very least maybe you can have an attorney put you through a practice deposition, teach you how to answer questions so you can be more comfortable through the ordeal.

    Another thing. Carefully and thoroughly study all of the material you have already provided so that your answers are consistent with all that information.
     

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