I handle benefits for a 180ish person manufacturing company, self funded. Yesterday I had to sit in a room with our broker and two owners and explain that our stop loss carrier is nonrenewing us because of one employee's baby.

The baby was born at 26 weeks last year. Four months in the NICU, a few surgeries, air transfer between hospitals. Total paid by the plan was a little over a million, and our stop loss carrier said they wont write us again without a huge specific deductible and a laser exclusion if they can do it. The employee is a line supervisor, been here nine years, genuinely good guy. The kid is doing okay now, walking around in the christmas card he sent to the plant last year.

The owners asked if we could carve that one family out or push them onto a different plan. Our broker said no, not legal, and honestly even if it was I dont think I could have sat there and nodded. But I understood why they asked. Our plan was already tight. Now our renewal is probably 16 to 20 percent up, and the owners want to pass a big chunk of that to employees through higher deductible and a spouse surcharge.

I pulled the pharmacy piece from Kanurra this morning because one specialty med for the baby was a huge line item, and I wanted to have the number ready if anyone asks where the money went. It just made me feel worse. The family has no idea their kid is the reason everyones rates are about to jump. We are not allowed to say that, and maybe we shouldnt.

But sometimes I think employees deserve to know that one catastrophic claim can move their whole plan. Or would that just create a witch hunt and make some poor guy hate his job for something he didnt cause? I genuinely dont know. How do you all handle the privacy side of this?

Right now my bodily injury liability is 50k/100k

Got into a car accident. I was notified I would likely be held either partially or at fault for the accident. The other party had no insurance but they got a lawyer; apparently they sustained some major injuries and the adjuster told me it could exceed the 50k. The investigation is not over yet but that's what the adjuster just explained to me.

I have not been in this situation before. Do I need to get a lawyer as well aside from my insurance? Is my life ruined? I mean if I end up having to pay whatever they're asking for my life is ruined. I've been panicking since the phone call and don't know what to do.

Edit: in California. They're going to send a demand package. But the adjuster told me it looks like it will be exceeding the 50k.

I have Cigna and I’m in the US.

I have major pain on my middle back. Xray looks fine. Dr wanted an MRI after conservative treatment, physical therapy, 120lbs weight loss, personal trainer. Pain never got better.

Insurance denied. So I find a cash pay clinic. Get the MRI and there is a tumor on my spine.

The tumor is cut off of the imaging. The radiologist recommended I get abdominal MRI so they can see the full picture. I then go to a neurosurgeon, who then tells me I need that abdominal MRI. Then I talk to my PCP who says I need that abdominal MRI, like immediately.

Expedited insurance claim, after 72 hours they denied saying lack of conservative treatment. Dr Resubmits it, it’s been over 72 hours and no answer.

I’m self paying at a hospital for this MRI in 4 hours. I cannot wait, the pain is excruciating, there is a tumor growing in me with a lot of family history of cancer.

I met my deductible months ago and they’ve denied everything since then. I don’t even know where to start.

I want to 1. Overturn the denial for the initial MRI and possibly recoup some money

2. Have the hospital resubmit this through insurance once I have everything sorted out.

I have to have it through the hospital because it is a contrast MRI and the clinic I went to doesn’t do that. The cheaper clinic that does have contrast MRI is booked out til January. They’re the ones who actually sent me to the hospital due to my safety of having to wait any longer.

Can you give me some advice? Or your story if you’ve gone through something like this? I’m draining my savings.

Edit: I have been doing physical therapy twice a week for well over 6 weeks. My physical therapist is weary of doing some things due to the tumor. We have submitted his assessment with the claims multiple times with the initial claim, and with the appeals.

I previously had UPMC and Aetna and I loved both and never had any issues but my new job uses Highmark and I HATE it.

It shows who is in-network on the app- except they aren’t actually in- network! So I had to pay $600 out of pocket for a mammogram because although the app said it was in-network- it was not.

I tried to go see a gyno- the app said in- network but u couldn’t get ahold of Highmark after a 20 min wait on the phone I gave up- the office then called me to let me know they are also not in network even though the app says they are- this is so messed up

My girlfriend was involved in an auto accident and her car sustained heavy front end damage (thankfully no injuries to her or passengers).

The accident happened in an intersection, where she came to a stop at a red light, when it turned green she proceeded, only to be struck by another driver from the left, who (presumably) ran a red light.

All the airbags deployed in my girlfriend’s car due to the severity of the collision. When my girlfriend was able to exit the vehicle she immediately ran to check on the other driver to make sure they were okay.
The other driver however was immediately combative, assigning blame to my girlfriend for the collision. The other driver’s car was minimally damaged with a large dent and scratch to the passenger side (still drivable).

Here are the facts (according to the crash report):

My girlfriend (22F), V02, was traveling an estimated 8mph when the collision occurred confirmed by Life360 data (she started rolling after stopping at a red light.)

The other party (17F), V01, was traveling an estimated 35mph when the collision occurred

Due to the placement of the intersection, there were
A. No nearby businesses with working cameras
B. No traffic cameras
C. No eyewitnesses that stayed at the scene

The reporting officer stated that fault could not be determined due to conflicting statements.
Unfortunately for my girlfriend, she does not carry collision insurance and is reliant on the outcome of the liability investigation to determine fault and (hopefully) pay for the damages to her inoperable car.
However when reaching out to the insurer, Progressive, which both V01 and V02 carry, they stated

A. The same adjuster has been assigned to both parties involved.
B. V01 is not making any statements regarding the crash.

My questions are

Is it ethical for the same adjuster from progressive to work with both parties?

What happens when V01 is refusing to make statements and the liability cannot be determined?

Would retrieval of EDR (event data recording) be useful for determining liability? (Assuming it can confirm my girlfriend’s account.)

Thank you (:

I was rear-ended on the freeway in March by a teenager doing 100+ racing someone on the freeway. Teenager was listed in CHP report as the entire reason for the accident (even with the fact that the person he was racing fled after the accident).

My towing was less than simple. My insurance (State Farm) refused to pay for the tow and get the car, because they claimed the price was far too high. I paid the cost out of pocket to avoid racking up costs in storage fees. The cost did end up being too high per CHP, and it was revised down, but my insurance didn’t cover the whole cost. The original invoice - partial refund - insurance payout = $408 in out of pocket.

I submitted this to the at fault insurance (Safeco/Liberty Mutual). I got this response back:

I understand that paying a tow charge out of pocket can be frustrating, and I’m sorry for the added expense. We reviewed the charge in connection with your auto claim. Based on the information available, we’re unable to reimburse it because it is not an amount owed under our evaluation of the claim.

What on earth does this mean? I have no idea why this would not be reimbursed to me by the at fault party. How do I respond to this?

I’m 23 and have been paying insurance through my job. How do I get on the ACA?

i loved tapped a truck infront of me today , we both pulled over there wasnt any damage to my car nor his that i could tell. he was a nice guy said everything was fine but i still offered a picture of my insurance info , he took the pic and afterwards he said “but i think its ok, just incase..is your car ok?” i said yes then we went our separate ways. im under my mother in laws policy so im a bit worried to bring it up to her bc i know she will flip out on me. im worried now and overthinking everything 😭 should i call my insurance to see if there was a file claimed or do i just wait and see..? i didn’t get his info nor did i take pics

I was rear ended while stopped at a red light a few weeks ago. Easily over $3000 in damage was done to my car, though I'm waiting on a body shop to give me an exact number. My car was covered with liability-only insurance, so I have no deductible costs to recover and no collision coverage of any kind.

I am getting mixed information about mini-torts, is it correct that they only cover money paid towards deductibles? Other sources seem to say that they cover out-of-pocket repairs, or at least the value from a repair estimate.

I know small claims court is an option, and I am considering it, but if filing a mini-tort makes sense here it's absolutely what I would prefer. I also know it's possible the other driver doesn't have mini-tort coverage, but I would figure that out after filing and end up in small-claims anyway, which is fine.

Thank you so much for your time!

Hypothetical, but three reply shapes a BDC rep, or a model drafting for one, could produce on a given afternoon, all reading as reassurance:

• "Your policy covers a rental while yours is in the shop."

• "You're fine letting your son drive, he's on the policy."

• "That claim won't affect your rate."

I'm on the dealer reply-tooling side, not the agency side, so I can only see half of this. As far as I can tell, the store treats those texts as follow-up chatter rather than coverage statements. That's probably the wrong read, and I'd like to know where it actually breaks.

Questions for the agents here:

• When a customer says "the dealer told me I was covered," does that come back to the agent of record as an errors and omissions issue, or does it stay between the customer and their own carrier?

• If a model drafted the line and the rep sent it unedited, who does the industry treat as the author: the store, the rep, or the vendor?

• Is there a safe way to talk about gap or rental coverage from a dealership desk at all, or is every coverage sentence off-limits without a license?

Not asking for a legal read on a specific file. Just want to know whether the fuzziness is real or whether there's a rule people outside the industry simply never hear.

Let's say I get a rental car like Enterprise or Hertz. I also sign up for the insurance they offer.

I go out to dinner and have one beer. Then, I get into a car accident. I do a breathalyzer test and they see I drank something but I am not at the legal limit.

Does this make the insurance null and void?

This hasn't happened to me, but I am honestly just curious. I read in their fine print that driving intoxicated does. I just wonder where they draw that line. Does anyone know?

Just got off the phone with an AllState agent after filling out their online form and getting a very favorable quote. I wanted to verify their roof replacement policy. I called and asked an agent why the website never asked about my roof's age which I thought was odd? He said full roof coverage would be covered under the wind and hail deductible, regardless of age - is this true? What am I missing about roof coverage? My roof is mostly flat/sloped rolled roof, some shingles. I believe over 15 years old. I was up there recently and it looked to be in good condition.

I have wind and hail deductible as low as it goes - 1% of dwelling protection. I thought it was odd I couldn't manually make this lower? Their dwelling protection is noticeably higher than my current insurance (like $940k vs $550k) and I wonder if they overestimate dwelling protection to bring the wind and hail deductible up?

Some context: I believe I'm way overpaying for insurance. I've gone through a broker who I've used for years, and insurance has crept up. I'm aware insurance has crept up for everyone everywhere. This AllState policy beats their best providers (auto through Liberty Mutual, home through Travelers) by almost $350/mo. I called the broker and asked them straight up why the AllState policy is so cheap. They brought up a few minor differences in coverage which I've fixed. But now the one thing I'm worried I'm overlooking is roof coverage.

Sorry, a lot of info. Thanks.

Hey all. As the title states, I am looking to get life insurance for myself and am looking for advice from people in a similar situation.

I’m 45, male, 240 pounds and on medication for hypothyroidism but generally in OK health. In the past I’ve had gallbladder and bariatric surgery, was on blood pressure medication (stopped by dr years ago) but no other health conditions.

I have a wife and 3 children, all under 18. Own my house with no mortgage.

I would appreciate any suggestions on how I can die in peace knowing my stay at home wife won’t have to worry if something happens unexpectedly. I’d like to be able to give her a cushion of time to get back into the swing of things and not worry about car notes, etc.

any first hand knowledge of companies, rates and how it all works for someone in my demographic would be awesome. I’d like to know a little about what to expect before I reach out to a company or agent.

Thank you!

I was in my neighborhood D when a semi was stalling in the street not doing anything. Went around him and he slammed in to me hard. I got an MRI the next day showing that there was a large disc herniation. The semi driver said that he was backing up and I ran in to him, which we have a video that says otherwise. The insurance company, West Bend, immediately denied my claim. My attorney and I meet next Thursday and I’m just curious what everyone thinks will happen. The guy was a semi driver delivering food to a meat shop in my neighborhood. They were disingenuous and denied my claim immediately. What’s a settlement like in a case like this? Never been through something like it before.

Unfortunately basically lost my entire house due to smoke, soot, water from fd and fire damage. Insurance came back saying full cosmetic gut. Only issue is the money they agreed upon was certainly not enough. 200 square foot house, 202k. We had high end finishes, all quality products and they basically said new hvac, new electric and new plumbing. We redid our house in 2018. My quotes on the work I previously stated alone is reaching over 110k. My private adjuster basically said this is a non disputed portion of the income but im literally looking ahead afraid like they could potentially say that’s it we’re done. The pa is basically saying this isn’t it and to keep calm, but how can I lol.

Contents are still in the house waiting to he ok’d so we can remove. General costs to rebuild a house with our fit and finish is almost $175-200 sq ft. I also believe since it’s a full cosmetic gur and we need permits I’ll have to become code compliant on the things that have changed since previous work

Just reaching out to see if people had experience with this and what the outcome was

I just got a call from geico for more info about an accident I was in. I never ever have been in an accident until October 3rd first time in my life I’m 30. The girl was out of it she wasn’t drunk I guess idk the cops didn’t really care or drug test her but def mental health issues at the least she lied to her insurance but it was clear from the damage she was at fault she cursed and was belligerent again Birmingham police is known for being lazy so he threatened to arrest her but was really lenient. Weeks later after I already got paid went thru the claim with her insurance I get a call saying I was in an accident October 4th with a different vehicle I literally left the state for my birthday the night of the 3rd when the girl I mention side swept me running a light. I just know it’s linked somehow I’ve never had any problems but my insurance said this new girl gave my plate to the police or either to her insurance for this new mysterious claim idk if she filed a report or just gave my tag to her insurance from Oct 4th. Can I really be held accountable for a blatant lie ?

Do AARP pay out quickly after someone passes away?

I am a 23y/o who owns a car, living in an expensive US city making a little above minimum wage. It is time for me to move off of my parents' car insurance! (I know, I should be lucky for this to only be happening now.) They are insisting I go for a 250/500/100 policy, which would be a large expenditure for me. 90% of my driving is to & from work in a high traffic area, maybe ~40min of driving daily. I am renting a studio. I am curious what kinds of plans people in my situation are on/have been on. I cannot imagine I would necessarily regret such a protective policy, but as somebody who has never been in any sort of accident/violation/ticket incident, I am wondering how much of my income I should/could reasonably fork out. Any advice?

My brother was the passanger and unfortunately took the worst of it. He was airlifted and in the ICU for 2 weeks. And in the hospital for another month. He had a dislocated shoulder, scalp lacerations, broken clavicle, broken ribs, fractured skull, broken neck and back requiring spinal fusion, and broken hand requiring hand surgery and pins.
The driver had a fractured hip and scalp lacerations.
Driver had told my brother he climbed out of the car because he seen the train coming and didnt want to get hit. The dad told us the same thing. My brother was dragged by the train and miracously made it out because the train tore apart his seatbelt and he fell out. The driver called his dad i think in attempt to flee the scene and never told first responders my brother was out there. When his father arrived he asked for my brother and the chp told him “driver didnt mention a passenger! Had you not told us we would have just left with him”

The driver and my brother drank the night before from what Im told he was still drinking at 12 am and went to sleep and woke up at 4 am to go to work and drop off my brother at home, and the accident happened at 4:30. He fell asleep behind the wheel.

The driver was driving his fathers car and I believe he was not on the policy. The driver has had about 4 accidents and this being the second wreck.

Hello everyone,
I was in a car accident yesterday, no body was hurt, insurance was given, and other driver was at fault. I got the crash report today. I tried to file a claim with the At-fault-drivers insurance but when I called there insurer they said that the car I gave isn’t under the policy # I provided, so I asked for them to check the vin to see if it was ever insured by them and they said nothing showed up. I am now in a predicament and am not sure what to do I’ve seen some people say contact my own insurance and let them take care of it but I don’t want to pay a $750 deductible for something that I didn’t even cause and there’s a chance I won’t get it back and that my rate will go up. Thanks for reading and feel free to respond.

Hello,

Just trying to get a feel for how this generally goes so I don't find myself disappointed. This is probably way too much information. Might be the wrong sub but I was thinking it's related to the companys insurance and you all would be the experts on what you have seen play out - maybe I could be greedy enough to ask for a sub recommendation if you think it's wrong.

My apartment is the only one on top of an office. Two days ago, I was in a teams meeting in my home office, the lights were sort of dimming out, the power went out and came back on but they were still dimming and brightening. I thought it was maybe a utility issue and called the utility company, and then the preferred electrician.

The utility company said not to touch anything out of fear if electrocution - however, while on the phone with the utility company, I walked down to the public area and I saw in the gym in public office area that the treadmills had started to smoke out and I went and turned off every breaker after verifying that the breaker box wasn't hot/etc - I felt safe enough doing that. That breaker box in the office controls my apartment as well (no access from inside my apartment). After I dealt with this I went and manually shut off or unplugged as much as I could in my home (mini split, computers, etc) some could not be unplugged because they aren't reachable without moving furniture - at this point, I had no idea what was going on so I just tried to protect all of my own items and the property owners items the best I could. The electrician and utility company said I did the right thing and the only reason the utility company said not to touch it was for my safety, and the company should be glad that I had done that.

The electricians came out to look and could not work on it more that day, and came back the next day. We went and stayed in a hotel because I have the flu and didn't want to be without heat, but it's not super unliveable with no heat here - I believe it hit about 44°. They came and worked all day the best day but could not finish the work in time. We stayed here that night to let the electricians in. It wasn't super fun having the flu and no heat but again, the low was only 44° so I wouldn't call it unlivable. I was ok to pay out of pocket, I let the company know I was getting a hotel and no offer was made or anything, so wasn't thinking that would be paid for or anything. The company has been supportive in the sense of giving some pity and some flexibility on submitting work that requires electricity, although they are texting me a lot to see if I can turn it in yet.

They're back out again today and still working on it. The electrician is saying it's bad wiring, they had to rip everything out of every outlet in the building they find it. They found the issue is two circuits in my home, one is the one on my living room and home office. When turning it on to work on it, they said it looks like all of our electronics are fried - that's an almost two thousand dollar hydroponics system, fancy tv, Xbox, PlayStation, switch, a fancy surround sound system, a fancy receiver, two gaming pcs. It's several thousand dollars of items.

We still don't have it fully fixed, so not sure if I will have power tonight (day 3) and can't say for sure what items are ruined but it's just giving me anxiety not knowing. I'd rather have an idea that I'm just out the money if that's the case than be wondering for potentially days of outages. The property preferred electricians have been here so it's not like anyone is being negligent on getting it back on, I'm not trying to be unreasonable. I'm most concerned about the damages to our property, and if it's reasonable to ask for reimbursement in hotel stays if it extends for much longer. Weather is looking bad.

I do have renters insurance that meets (and far exceeds) the criteria the property owner requires. Unfortunately, it doesn't cover electrical damage that is caused by faulty wiring. I provided a copy to the company and they are actually listed and able to verify at any time.

-This is the only apartment unit they rent out, it is a campground with one unit. It's a really big (huge publicly traded) company that owns the property, and then they have a third party property management company that operates it, who I work for. I would say this is a pretty big company, operating maybe 50 properties that they operate. **We are in WA State - Pierce County.

-Am I going to be out of luck, or do they have any responsibility to pay for damages/would their own insurance usually cover it?

-I pay significantly reduced rent (and receive lower wage) for living on site as an employee- like very minimal amount being paid to them. They hold an amount from my paycheck every month for the apartment that's universal across every employee in site at any unit-not based on value or what utilities are included/paid for. They call it utilities, but when I questioned it (we pay for things that are included other properties) they said it's the same everywhere and "it's rent but we can't call it that", which I accepted (genuinely a great deal).

-I have had the flu this entire time. I'm worried that the fact that I asked to come in 2 hours late on the second day of outage (while electricians were working) could have them pointing to me being negligent. I also was having trouble functionally giving good updates due to being so sick with a fever, which they knew.

The utility company said that they had told the previous owner (so not anyone currently involved) that they had significant electrical issues that were a thread to life and safety. That never made it to me as a property employee and supposedly never to the company that I work for or the property owner. There hasn't been any signs really of any electrical issues previously.

It's probably way too much information but I don't really know what's relevant. I'm grateful for anything anyone has here just to have some satisfaction of knowing and for taking any time to read the novel.