Hi all, (Reposting because I didn't know how to format) TL;DR: Insurance denying approximately 40K worth of costs (approved line items, just more expensive in the region than their estimate), went to appraisal with adjusters, umpire selected, month later learn that insurance company is now represented by lawyers. We experienced a water damage claim impacting a 3-story townhouse, all continuous wood flooring, walls, and kitchen cabinets, counter, backsplash, with Traveler's in Dec 2023. We are located in King County, Washington; the house is built into a slope not directly accessible to the street and is stand-alone (no shared walls) on a plot with 3 other homes. My initial quotes from contractors up to 100K. I went with a contractor who quoted around 80K, good guy. Escalated through several Traveler's adjusters in Winter 2024 until an adjuster came in person in late Winter and agreed with our contractor and the work moved forward. The insurance company adjuster recognized that the costs were going to be pretty high and was working well with our contractor, it seemed. I handled cabinets, backsplash, and counters directly with a subcontractor and my contractor handled drywall, paint, flooring, pack-out and move in, and more. I got approval from insurance adjuster along the way and ended up getting approval for all of the kitchen work, fully covered, around 33K. Due to delays from Travelers and subcontractors, with materials being hard to come by, our kitchen floor was unfinished with nails sticking out until May 2024. We wanted to keep things moving and settled on cheaper flooring than an exact match that was available sooner than the Fall, so we moved out in May (I had gotten approval for housing costs in early May from insurance for several weeks). Then, for whatever reason, their adjuster stopped responding to my contractor for a few weeks in, approximately, late-May and June. The flooring and painting work was finally done and the cabinetry, counters, etc. mostly got done in mid-late July. The work was mostly completed by August except for a few small things. The final costs of the new installation of cabinets, counters, backsplash in the kitchen, which I had handled and which had been covered, was approximately 33K which has all been paid out and completed. Mitigation was done for 6.6K with a separate company. The remainder of the tear down, pack out, dry wall, painting, flooring, cleaning, plumbing, electrical, etc., onwards from my contractor ended up being 105K. With the previous adjuster, the claim was sitting around 70k estimate from the insurance side with an expectation that it would go up conveyed verbally with their adjuster several times. In this period, since the insurance adjuster had stopped responding, my contractor had reached out directly to Traveler's. At some point a new adjuster was assigned and then, in June/July, the case was passed through, I believe, 3 more adjusters. The final adjuster basically went through and wrapped up the claim, including recoverable depreciation, but didn't really acknowledge the actual costs of the materials, labor, compared to their estimate and essentially closed the claim at approximately 95K total, which included mitigation, kitchen, and the contractor's work. That left a gap of approximately 40K still due to my contractor. After a month or so of back and forth, we agreed with the final insurance adjuster, to go to appraisal in November. We selected an adjuster. It seems that nothing was happening for several weeks and then eventually Travelers selected their adjuster and he actually came to inspect the house in December. Then per our adjuster, unable to be reached/unresponsive for several weeks. Once they did get into contact and went back and forth in late February, they finally agreed on an umpire. Then, out of nowhere, in mid-March, the third party adjuster representing Travelers informed our adjuster that Traveler's had assigned or hired lawyers to handle this claim and they were no longer continuing the appraisal as previously agreed upon. Here is the policy language regarding appraisal: ...7. Appraisal. If you and we fail to agree on the amount of loss, either party may demand an appraisal of the loss. In this event, each party will choose a competent and impartial appraiser within 20 days after receiving a written request from the other. The two appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, you or we may request that the choice be made by a judge of a court of record in the state where the “residence premises” is located. The appraisers will separately set the amount of loss. If the appraisers submit a report of an agreement to us, the amount agreed upon will be the amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will set the amount of loss. Each party will: a. Pay its own appraiser; and b. Bear the other expenses of the appraisal and umpire equally. My question is - why did Travelers go with attorneys after there was an umpire selected? - Could it be something as simple as the timeline being so protracted? We have emails showing the umpire was agreed upon a month ago. - I am concerned that, as I see in this community, our adjuster was filling the costs to try to get a better negotiating position... Not sure if that would play into this...? - The work was expensive and challenging to complete but there are no line items that were not previously approved - they just cost more than what the insurance company estimated. I have not heard anything directly from Travelers. My contractor has been wrecked in this process, it's been tough for me as well. The idea that we need to face an attorney is rough. Appreciate anyone's insights or guidance! TL;DR: Insurance denying approximately 40K worth of costs (approved line items, just more expensive in the region than their estimate), went to appraisal with adjusters, umpire selected, month later learn that insurance company is now represented by lawyers.

I have a question about prior authorization. I am trying to get one of the weight loss meds like wegovy, zepbound etc. I had several appts with my primary care Dr and she informed me she would try but that most likely insurance wouldn't cover it. The Dr office called me today to tell me about bloodwork, etc and informed me I should call my insurance provider and ask if it would be covered. I did that, with blue cross blue shield, and the lady on the phone was extremely helpful. She informed me ozempic and something else wouldn't be covered but wegovy and zepbound are and she would need prior authorization. She put me on hold to call my Dr, then when she got back on the line she said the Dr would not do prior authorization. She also informed me I should find a new Doc because your Dr is supposed to help you. My question is why would my Dr then deny it after asking me to call and see if it's covered and it was? I'm just confused. Thank you for any insight.

He's fine, but the vehicle is totaled. His fault. He's pushing 81, and his memory is starting to go, so neither of us realized his insurance wasn't up to date. It expired at the end of June, and he usually does the 6 month payment thing. We dont know if it got lost in the mail or what, but he's currently uninsured. He's with Allstate and has been with them for decades, but they simply referred him to another insurance company when they called him back to explain his account was no longer active. Despite him funneling thousands and thousands to them through the decades hes been with them, one missed payment seems to be the end all be all. I'm going to call them personally tomorrow to try and figure this out, but I was wondering if you guys had any advice for me?

I just had a Total Loss on my home which was insured by Amica Mutual. Almost all reputable insurance carriers pay out the face value of the policy. Amica decided to use an obscure New York loophole to "AVERAGE" out what THEY feel I should get instead of what I paid for. They offered me less than 50% of THEIR ADJUSTOR'S replacement cost with the balance paid out after "THEIR REVIEW AND APPROVAL".

I cancelled my Direct Auto policy before payment was due in June, I got a letter in the mail saying I owed direct auto $289.45... I called them and wanted to know why I owed money to them when I was caught up and decided to cancel it. I only had their insurance for 3 months before I decided to go to progressive and cancel their insurance. When I was canceling the insurance over the phone in June, he didn't tell me I would owe money or anything like that. He just said "Okay, I can cancel that for you. No problem." No warning about having to pay the remaining balance of the policy or anything...

I had a home claim, and State Farm issued a check made out to me, my mortgage company, and the down payment assistance program I used. I had both parties endorse the check (which was already kind of tedious process that took 2 weeks) and now US Bank says they won’t accept the mobile deposit because the payee doesn’t match the name on my account. I called customer service to explain, and they said US Bank won’t accept deposits unless the account names match. I did call after regular hours so maybe it’s an overnight service that has bad info. But surely 1) this isn’t a particularly unique situation and someone at US Bank has to know what the protocol 2) the standard here can’t be that I have to open up a bank account with both the down payment assistance program and my mortgage holder, can it? I feel insane that I can’t find any info about this online, so I’m hoping that means there is a way. ETA: Ended up having to mail it to a branch! But for future readers, no, you are not expected to set up an account with you and your mortgage lender, thank goodness!

Just got a letter from Erie Insurance a few weeks ago that my broker was dropping Erie and I need to find new insurance. I have a damaged chimney that I was planning on having an adjuster out to investigate to see if it was covered or not. I noticed the damage months ago, but decided to get quotes from brick masons before calling my agent. It took a very long time to even get anyone who would show up to quote it for me. Was told that it was structural and the chimney needed to be demoed down to the roof line and rebuilt, adding some new lintel. Quote was $7,500. I called my insurance agent and left messages on a few occasions. There does seem to be water damage under the roof, but I think it’s on old repair from where I had the chimney flashing and sheeting replaced around the base of the chimney at the roof years ago. So a few weeks ago, I get a letter stating that my policy was not renewing. I just talked to my broker and mentioned the potential claim (probably stupid move on my part) and what to do. After some questions, it looks like if I start a claim with Erie, it will show up on reports the new company can see and will have an open claim without a disposition. I could just jump ship altogether and get a new policy and hope they don’t do an inspection and find the chimney damage. I obviously need to get this fixed, and I will, but the timing of all this is terrible. If I can’t get a new policy because there is existing damage, there will be a lapse in coverage which could also screw me. Anyone got any advice? I’m thinking of just rolling the dice with a new claim and hope for no inspection, get the chimney fixed out of pocket and move on with my life. My dad recently switched from Erie to Farmer’s and they didn’t require any inspection that I’m aware of.

So our Lemonade pet insurance is starting to be somewhat outrageous - $150 (80% Preventative) and growing at 7 years old. Healthy dog currently, but when we first got it, visited quite a few times. Lumps but not cancerous. Etc. Pet insurance ALSO does not always work. Lemonade also does not have a straight-forward appeal process when one of their staff misunderstands an issue and mis-categorizes it and denies a claim. I'm wondering if it makes sense to just start a savings account and put in $150/month into it? (And grow it by 25% yearly - the same rate that Lemonade has been increasing)

I have a 2025 Toyota Camry with 14,000 miles. It got covered with a coating of cement. The insurance company offered me $3,700. My Toyota dealership has said they will take the car plus $5,500 and give me a new 2025 Toyota Camry. Is there any way to negotiate with my insurance company for the additional $1,800? The body shops are coming back saying it's going to cost between $5000 and $8,000 to fix. That doesn't include diminished value which I could file after it's fixed. It seems to me that offering the insurance company $5,500 to close this claim forever is a really good deal for the insurance company because they will almost certainly spend more if I get the car fixed. Any advice on how to get the insurance company to agree? I'm buying the new car regardless. It's being shipped in and I'm picking it up Thursday. Edit to add: my insurance company will have to subrogate with the contractors insurance company. The contractor is 100% at fault.

I got the preventive care option which meant I had a 0 day waiting period for accidents and preventive care. My dog got his teeth cleaning and, preventive anesthetic bloodworksoon after. I submitted the claim but the denied it, saying it was an illness. He never had an illness for it bwfore and didnt have any symptoms for the bloodwork. Can I appeal? Please help it was $1500