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Travellers - Condo liability question help?
Here's the situation:
**The unit below me reported ongoing water damage on their ceiling/wall.** The building paid a plumber to do an investigation. After many hours, they were able to determine there was water coming from my toilet.
I brought in my own plumber and he figured out there was a leak inside the wall where the toilet connects to the pipe (its a wall mount toilet and the gasket wasn't forming a tight seal with the pipe). This toilet pre-dates my ownership, if that matters. I had him fix it and paid him.
Obviously the apartment below has repair costs. I immediately engaged a claim with my homeowner policy provider (Travellers), sent them the plumbers reports (both mine and the building), the by-laws of the building, and put my insurance in touch with the owners of the below unit.
Fast forward, after some research, **my claim person says 'I'm not liable because there was no way for me to know about the leak, so the owners of the below unit should file with their insurance'** It is true there was no visible leak or damage in my apartment.
Now the unit below me sent me an estimate from their contractor and says 'As you’ll see, they have denied the claim, stating there was “no evidence of neglect” on your part. **Given the damages I sustained, I need to understand how you intend to address this situation and take responsibility for the repairs.**' It's not clear if they've filed with their insurance. The husband and wife don't always seem to be on the same page.
They are claiming repairs cost $30,000! I don't know how much of this is really related to the damage, as they are also in the midst of a major reno and might be using this to pay for some of that on the sly. I don't have a relationship with them. To clarify the leak was a long slow drip, which only occurred when the toilet flushed, which is why it took so long for the building plumbers to track down.
Regardless, it seems weird to me that the insurance judges I'm not liable, just because I couldn't know about the problem. Especially since the policy seems to explicitly cover damage from water seepage where the insured is unaware because its hidden in a wall (in the DOES NOT COVER section for liability it says: CONTINUOUS OR REPEATED SEEPAGE OR LEAKAGE OF WATER OR STEAM OVER A PERIOD OF TIME, WEEKS, MONTHS, OR YEARS, FROM WITHIN A PLUMBING, DRAINAGE, HEATING, AIR CONDITIONING,SYSTEM OR AUTOMATIC FIRE PROTECTIVE SPRINKLER SYSTEM OR FROM WITHIN A HOUSEHOLD APPLIANCE **UNLESS SUCH SEEPAGE OR LEAKAGE OF WATER OR STEAM AND THE RESULTING DAMAGE ARE UNKNOWN TO ALL insureds AND ARE HIDDEN WITHIN THE WALLS OR CEILINGS OR BENEATH THE FLOORS OR ABOVE THE CEILINGS OF A STRUCTURE**).
**Right now I'm waiting for response from my insurer and also the apartment below** (to see if they have filed with their insurer and if that insurer is in contact with mine). Up until now my interactions on this issue with the apartment below have been pretty even tempered, but their latest email feels like they are escalating and I'm concerned I might even need a lawyer (I live in NYC btw).
(added highlights to help with TLDR)
Pets Best - If your Pets Best claims are being denied
I’ve received a series of new and confusing EOBs denying claims I usually had had no problem getting approved quickly before. Pets Best informed me on the phone that they have a new automated system that some claims get filtered into that is causing some claims to be incorrectly denied. Wanted to update and post here because their customer service truly is so helpful and kind, and if you call them they will fix your issues by flagging your denials for manual review.
Allstate - Washington State Wreckers License?
Received this correspondence from our go to body shop. Pre repair/estimate of record phase. Can someone tell me what this means? Wondering if I should look for a less expensive shop, or if this is the case for all legit WA state auto body shops (and our best bet is to ask AllState to pony up). Thank you in advance —
THEM:
Hi,
Allstate has selected a used headlamp from Texas junk yard. I’m not able to buy used parts out of state unless they have a Washington State Wrecker’s License.
This could be an out of pocket cost to you up to $1000 if Allstate does not budge on this subject.
‘
Thank you,
Apple - $700 Stolen from Apple Gift Card – Apple Refusing to Help or Escalate
Location: Texas. I’m beyond frustrated. $700 was stolen from an Apple gift card in my Apple account, and Apple is refusing to refund the money. I’ve contacted support multiple times, and every advisor says the same thing — they can’t connect me to a supervisor, and there’s nothing more they can do.
I provided all the evidence: the gift card purchase receipt, my account history, and the fact that the fraudulent charges happened without my authorization. Yet Apple won’t escalate the issue or involve their Apple ID Security team.
I know gift card fraud is a common issue, but this money was stolen from my account, and I feel completely stonewalled. Has anyone had success getting Apple to actually take action on something like this? Any advice on how to escalate this further?
This is seriously making me rethink using Apple services at all. $700 is a huge amount to just write off.
Dairyland - Dispute with 3rd party insurance company
On February 8th, my car was parked at a Miller’s Ale House, and it was hit by a truck that was parked right next to it. The restaurant manager found me and told me that the situation had happened, but the truck's owner was waiting for me. I went outside, the guy verbally confirmed it was his fault and offered 200$ to pay for a new bumper (that is the only thing that was damaged). I do not know much about the costs of parts and fixes, but it seemed not right to me, so I told him we should let the insurance deal with it. he agreed, and his wife showed me her insurance info from Dairyland on a screenshot. The truck that hit my car was not listed in that screenshot, but she assured me it was. I took a picture of the plate, and that was it. On Monday, I called their insurance and placed the claim. They asked many questions about the incident, and I answered them all. They gave me the name of the Adjuster and a reference number. She contacted me days later with more questions, which I answered, and asked me for pictures of my car from all angles. Since I heard any contact from the Adjuster I decided to call her today and she said that they haven't been able to gather evidence from the other party because and I am quoting her: “Since the police was not called the day of the incident, they have no direct way to contacted them, so we are at the mercy of them contacting us”.
I was not raised here in the US, and this is the first time I have had to deal with a situation like this in my life. In hindsight, I think I did not manage this very well. I didn't want to call the police since, yes, he probably was drinking inside the Ale House, but he was with his kids and wife, and I did not want the drama. Maybe I was wrong. I took a picture of his plate, and I have his wife's name and address. I did not get his phone number. I also have the manager’s restaurant as a witness.
I am incredibly frustrated. I handled this wrong. My beautiful Miata has a big dent in the front. And sure as hell don't have to be responsible for it. What should I do? Should I sue the guy? I do not get why the insurance can't contact them, maybe they gave me another insurance info. Is there any other way to deal with this? Help me Reddit!
Ambetter - I have an Ambetter policy through ACA (Pennie.com) and I am wondering if there is anyway to get out of it? It is the worst insurance ever.
They have declined every single submission I have made, saying out of network on everything (including doctors that are on their list). They won't even apply out of network payments I have made myself towards deductible. The insurance is a joke, I have to resubmit everything multiple times. I've been a massive fan of ACA till now (blue cross, Capital, etc).
Is there anyway to get out of this insurance?
school insurance - Approved For Medicaid, Now What?
Non-working graduate student recently approved for Medicaid, but prior to this I had purchased my schools shitty student coverage.
Obviously, the coverage for Medicaid beats the school insurance. I called the school insurance and asked them if I could cancel because I want Medicaid as my primary insurance but they told me that is not possible and won't give me a pro-rated refund.
I paid $2000 at the beginning of the school year for the insurance for the whole year coverage, and I figured they would be able to refund me a portion of that since I wanted to cancel, but they seemed appalled I even asked to cancel and told me to kick rocks. It wasn't even the insurer, it was the insurance broker who told me this.
Am I stuck with school insurance as my primary and Medicaid as my secondary? I don't want to just stop using my school insurance and start using Medicaid as that would technically be insurance fraud?
Sorry if this is a strange question; I am not well-versed in this world.
Thank you for your time
Fetch - Fetch Pet Insurance Prescription Sublimit
Hello, I am hoping someone can provide a bit of guidance as I’m a bit confused as to how my most recent claim was handled.
My Labrador has been on a fetch (formerly PetPlan) insurance policy since she was 12 weeks old. No issues with preexisting conditions and fetch covers a lot that some other insurances don’t when it comes to congenital issues. Recently she had to have TTA surgery to repair a torn knee ligament and we just got our reimbursement approved for the treatment
I noticed I was about 100 dollars short in my reimbursement, but received no communication that they partially approved or denied any part of the claim. I went and checked and they coded the surgical anesthetic medications under “prescription medication” and allocated all medications used during the surgery as prescriptions, which was applied toward the 1,500 sublimit I have on my plan for prescriptions
I have never seen this before and every single communication/review about fetch talks about how they covered surgeries in full and all that jazz, and it seems crazy to me that the anesthetic medications necessary for surgery would be coded the same as prescriptions and would prevent me from receiving a full reimbursement. Has anyone else experienced this with Fetch pet insurance?
I’m just concerned because it is likely she will need her other knee done and if it happens within the year then this entire surgery would have killed the entire prescription sublimit I have on my policy (that was also never communicated to me in the time I spent on the phone with the customer service agent)
Aditya Birla Health Insurance - My insurance from Aditya Birla health rejected the reimbursement claim.
UMPQUA - Stated income HELOCs? (California)
Are there any stated income HELOCs out there? I dragged my feet on UMPQUA which auto approved up to 100k, but when I finally got around to applying, they changed their DTI from 50 to 40% and their estimated DTI for me came 38-43% so it triggered stips.
I don't need a HELOC, but would like to open one just in case. Figure is popular, but requires you to draw the full applied amount for, and they charge you 5% off that (big no thanks).
I have about $200k in room for 85% CLTV, but I'm ok with max limits of $100k for auto approvals. Anything full doc is not worth my time, so I don't want to go down those avenues, and I don't want anything that requires a draw at open that you get a fat charge on.
Thanks!
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