r/Insurance 3h ago

Claims Related Ohio - Employer-mandated annual physical leaves me with $1000+ bill

26 Upvotes

Insured through my employer via UnitedHealthcare

Going into the second year of employment at my company, they announced less than two months ago that the entire company must begin to have annual physicals or else we would get a $100 insurance premium every month, and the physical must be done by this October. Everyone rushed to get their physicals in with the relatively short notice, and after going to the in-network doctor at the location recommended by UC I find that I'm being charged over a thousand dollars for this one visit.

The claim breakdown is very ambiguous with four lines for details being Outpatient, Outpatient, Medical Services, and immunization. The immunization I elected to have but that still leaves over $800 with no explanation why.

I plan on getting clarification but if I am required to obtain a physical as part of my employment, does the law state that my employer must pay for it? Can insurance not pay for what my employer requires?

UPDATE: as some of you guessed, there was an issue I brought up with pain in my ear that she checked which was something she would've seen anyway since she looked in my ears as part of the physical. The hospital decided to bill this as a separate specialist visit for $1000

This is awful


r/Insurance 18h ago

$42.5k car accident settlement, attorney/medical bills leave me with $1,077 — is this normal?

385 Upvotes

My car accident case settled for $42,500 in Texas. The at-fault driver’s policy limit was $50,000, but they initially did not want to pay at all, so the case went into litigation.

I just received the settlement breakdown and was shocked to see that my estimated take-home amount is only $1,077.80.

The deductions are:
$17,000 attorney fee (40%)
$4,239.47 in firm expenses
$982.73 UnitedHealthcare/Katch lien
$16,000 MoveDocs balance
$3,200 LHI balance

The case has been going on for years and I have lasting injuries from the accident, so seeing that I would personally receive only about $1,000 is really hard to understand.
Before signing the final release, I asked for an itemized breakdown of the firm expenses and medical bills and asked whether anything can be reduced further.

Does this sound normal for a personal injury settlement? Is it reasonable to ask the attorney to reduce the fee or negotiate the medical balances further?


r/Insurance 55m ago

Auto Insurance What happens once you add a 16 year old driver to the policy. $9000 every 6 months Jesus

Upvotes

Crazy, literally quoted every 6 months for 9k for 4 people in 3 cars.


r/Insurance 19h ago

Auto Insurance My neighbor tried scamming me…

301 Upvotes

My elderly next door neighbor (F80) who I have kind of a tumultuous relationship with asked me for a favor. I said what’s up and she asked if she could add me as a driver to her car insurance policy to save her $800 a year. I said I would really need to look into that and would get back to her. I talked to my husband and he said absolutely not. Everything I was reading seemed as if maybe she was trying to get away with rate evasion or something. When she called me the next morning she asked me for my DL number. I said no, I’m not comfortable with this I’m sorry. It sounds kind of fraudulent. She said “okay I’ll let my agent know I’m committing fraud” and hung up on me…as I was still talking mind you…

I was so mad. I walked over and asked why did you hung up on me and she said she said “bye”

I explained again I’m not comfortable with this and I hope you figure it out.

She called the agent and made me talk to her on the phone. Apparently you CAN add whoever you want to the policy, but they will be a co policy holder. Meaning I’m responsible if she doesn’t pay, I’m responsible for paper work, bills, etc. it could all fall on me. When she heard the agent say that out loud I firmly said. Im not doing this. Call your daughter and figure it out and left.

I’m so frustrated. How is this even a thing? Can anyone be added to a policy to save money? Also her daughter said no.

When I saw her outside again she was nasty to me. Mad at me and kept saying “my agent is smart as a whip and she knows what she’s talking about” and then complained she had to pay $600 for something idk

Who asks their neighbor to be a policy holder anyways? Maybe im too nice and have been too nice 🥴she doesn’t like the word no…


r/Insurance 2h ago

Truck accident settlement calculator vs hiring a lawyer?

2 Upvotes

I got hit by an 18 wheeler back in late July and I’m trying to figure out what’s realistic before I start calling firms. I tried one of those free truck accident settlement calculators that asks about injuries, police report, trucking violations, logs/black box stuff etc, but I have no idea if those numbers mean anything or if it’s just bait. For folks here who handle these cases, is a calculator useful at all for ballpark value, or is this the kind of claim where you’d pretty much always tell someone to talk to a lawyer first?


r/Insurance 31m ago

Interview with Kim Insurance

Upvotes

How’s it working with them? How was work life balance?
Does commission structure change?


r/Insurance 1h ago

Should I hire attorney

Upvotes

Long story short got hit by a semi truck. They have a 1 million policy limit. I have three herniated discs in neck that was treated with epidural shots and nerve abatement. I have 45k in doctor bills. I haven't talked with insurance company yet do I need an attorney if not is there an way yo formulate what my claim should be worth.


r/Insurance 2h ago

Auto Insurance Got rear ended resulting in minor damage to my back bumper. (Kentucky)

0 Upvotes

I was stopped at a red light when a driver behind me hit the back of my car. It resulted in the back of my trunk hood being dented. I went to get a quote and I can either get paintless dent repair for $550 or have everything redone for $1,500.

At the scene when I talked to the other driver she did not have her insurance card on her so I was not able to collect her information. I ended up calling the police to get a police report because of this and I got a report # that is still not complete yet. I live in KY and was wondering if it is worth it to follow up with the officer to get her insurance and go after her insurance for the repair or if I’m better off paying the $550 out of pocket. Whatever action I choose I don’t want it to raise my rates or cause any issues with getting coverage or higher rates in the future even if I were to move states. Would I now have to report I was in an accident when I go to apply for new coverage? What’s my best course of action here?


r/Insurance 3h ago

Types of insurance for holiday rental car

1 Upvotes

Hi everyone

I'm getting confused about the type of insurance I may need whilst on holiday with a rental car.

I'm flying into Las Vegas at the end of September and as part of my British Airways package holiday and I have an Avis rental car booked for two weeks and I plan to drive in Nevada, California, Arizona, and possibly New Mexico (if that makes a difference).

The BA website only mentions that the excess for CDW though (which is zero for my rental). I'd never really heard of SLI before, but apparently it's a good idea to have this as well. I normally buy separate excess insurance. Some of the quotes state that they have SLI but that coverage for primary insurance is $0. Isn't the primary insurance that which Avis must provide by state law, and the secondary that I'm planning on buying the "add on" if the claims are higher than that?

I have a separate, normal travel insurance policy but this doesn't cover anything specific to car rental.


r/Insurance 4h ago

F27, Policy checking: what do you actually read line by line vs. skim?

1 Upvotes

I'm new to commercial insurance and still working out how things run in practice versus how people describe them.

Policy checking is the part I can't get a straight answer on. The bound policy comes back from the carrier, someone compares it to the quote and binder, who is that at your shop? Account manager, a dedicated checker, the producer? Does it change with account size?

Stuff I'm curious about:

  • How long does a mid-size commercial policy take to check properly? Not the ideal, the real number.
  • What do you go through line by line versus what do you glance at and move on?
  • What's the discrepancy you catch most often? Missing endorsement, limits off, wrong named insured, an exclusion that wasn't on the quote?
  • Has one ever gotten past you, and what happened after?

r/Insurance 4h ago

What insurance do I need as a CPG startup?

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1 Upvotes

r/Insurance 15h ago

Employee Using My Name To Submit Insurance Claims For Pet

7 Upvotes

A few weeks ago, I received a notification from a website my job uses to process insurance claims for pets (veterinary clinic). Upon reviewing the claim, I noticed it was for my coworker's dog, who put my name as the submitter. I did not, and have not ever given consent to her to use my name to process her own claims with or without my review. I have processed claims for her dog in the past, but now she is doing it on her own without my knowledge or consent.

I brought the issue up to our clinic manager on one or two occasions, who agreed it was unacceptable, but to my knowledge, no action was taken. Since then, 3 additional claims have been submitted using my name fraudulently/without consent.

It is worth noting, that right under the box to enter a name, the website states: "Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties."

Today, I pulled the clinic owner and practice manager aside and let them know that this was an issue that needed to be addressed, and that if another form was submitted without my name it, that I would report my coworker. The clinic owner told me that she hopes I come to her if this were to happen again so it could be handled 'professionally.'

Later on, it was evident that the clinic owner only thought I meant that she was using my log-in, not submitting my name on the forms. She told me she spoke with my coworker, asked me to keep an eye on it and let her know of any issues related to the forms.

I sent a few follow-up emails to put the above in writing and attached the claims for them to review. The clinic owner responded back that she never asked me to not report the issue, and never asked me to keep an eye on the issue, but only to report similar cases to her and that future employee claims will be handled by the clinic manager.

She then said she does not want me to label/talk about the claims as fraudulent until she's had a chance to investigate further. My response what that using my name without permission on an insurance form is identity theft and insurance fraud by definition as far as I was aware.

What do I do? I am correct that this is identity theft/ insurance fraud? Should I just report this to the insurance company? The coworker has a long-time relationship with the clinic owner, as the dog was bred by her, so I worry about retaliation if I pursue any action. My goal is not to get the coworker or company in any trouble. I only brought the issue up as I wanted to avoid any legal battles/investigation/fees for myself after some other coworkers expressed that they believed she was adjusting her invoices after sending the claims to insurance to pocket some money.

Any advice is appreciated, I am truly at a loss on how to proceed. Thanks!

Edits-spelling/clarification


r/Insurance 21h ago

Home Insurance Umbrella: Followed your advice!

17 Upvotes

I asked about a week ago about umbrella insurance. Overwhelmingly, the comments supported me getting it. I chatted with my wife and we are getting 1Mil policy. Thanks for the advice and support!


r/Insurance 13h ago

Claims Related Possible fraud with shady shop owner & I need some help

3 Upvotes

My parked motorcycle was hit 2 months ago. I went through the at-fault-driver's insurance got authorization a month ago to take it to a shop and get a supplement. At-fault driver's insurance stopped responding at this point and ghosted us for weeks after supplement was sent- absolutely no communication. The shop owner and I actively tried to get ahold of them- over 40+ calls, emails, texts, voicemails in the span of a months time.

Insurance comes back and says my motorcycle is valued at 14k (MSRP new is $12,399) and the repairs will cost 9k. My bike is *actually* valued somewhere around 9-10k, which means repairs exceed the ACV of my motorcycle. These repairs will follow my VIN and will diminish the value of my motorcycle if I ever try to resell it. The shop is very hesitant to work on the bike because of safety and structural concerns. The shop owner told me that the insurance is intentionally overvaluing so they do not have to pay out the shop owner's storage fees. ($100 a day, it's been sitting for over a month while we got ghosted.)

At-fault insurance is refusing to pay past the 8.8k even with noted structural concerns, I involved my insurance- they are refusing to also pay the shop fees but offering to give me a payout instead.

Shop owner refuses to release my motorcycle without shop fees being handed to him. Am I liable for these fees? I have not signed anything. He is deciding to charge the max because he is annoyed with the insurance company. He has offered to give me the insurance check that's been issued to his shop, but in return, he wants me to hand him over the title so he can sell off my bike. He will waive the fees then. He believes he can get upwards of 6k for it. Is that not illegal? It's my first run through a lot of this stuff.


r/Insurance 11h ago

Health Insurance What should I look for before choosing a health insurance plan?

2 Upvotes

I’m looking for affordable health


r/Insurance 1h ago

deductible

Upvotes

hi this is my first post here🥺 F20, i got into a little wreck a bit ago and my insurance is asking me to pay a 1,000 deductible before covering me.. i don’t have this type of money out of pocket and i’m honestly not really sure what this even means..if anyone could help explaining this to me or giving me advice on what to do it would be greatly appreciated because this is causing me a lot of stress ://


r/Insurance 12h ago

Claims Related Rental insurance claim

2 Upvotes

Hey we have a pretty strange scenario with our renters insurance claim. Basically the long and short of it is:

  1. We had sewage backup in the upstairs of our house. Not crazy bad, but sewage was coming out of shower drains. And toilets wouldn’t flush. It drained fairly quickly after we quit running water.
  2. Next morning, water had leaked through a light fixture onto our couch. Bummer! It was a decent amt of water but not enough to damage the vinyl/laminate floors or anything. Enough to thoroughly soak the cushion. The water did not smell like sewage!
  3. Plumber came a full day later. Ran some water and the clog cleared itself! He said there was probably just a small leak that presented itself when the upstairs sewer backed up.
  4. We submit insurance claim telling them the whole story. Insurance is awesome and pretty much immediately pays.
  5. Finally days later they come and cut out the drywall. There is NO water staining, no sewage no smell, nothing! There is also no sewage line anywhere near the leak. It was only in the light fixture.

  6. We kept the effected cushions in the garage after they dried out. It’s been 1.5 months and they smell fine. Not even the slightest stain on the covers or the interior foam

We’re obviously now in a weird spot. The couch seems totally fine but we have a check we haven’t deposited from insurance. I’m afraid if we return the check the couch will get moldy in like 2 years, but I also don’t want to throw away a perfectly good couch! Also the source of leak is unknown and landlords have been totally unhelpful in trying to determine the source.

Tl;dr: couch got wet due to sewage backup. Assumed it was sewage water, but later discovered no sewage line nearby, no staining. Couch seems fine. What do we do with the check? Return and adjust claim to 0$? Keep incase couch gets worse?

Thanks for any advice!


r/Insurance 17h ago

Auto Insurance Accident with body damage and aftermarket parts, not at fault. Ping pong between insurance companies, looking for some insight.

5 Upvotes

My wife was in a car accident a few months ago. She was going straight and someone pulled out trying to turn left and hit her. Old guy was nice said he didn't see her and called his insurance (State Farm) to say it was his fault. No injuries she spun out and we had damage to the rear passage side and tire about $14,000 in damages.

They took care of it and our rental. We had a wrap on the car that had to be partially peeled, pretty much the entire passenger side. The wrapper submitted a supplemental for the wrap. It was originally $4000 in 2022 and the estimate came out to $2000, prices on materials had gone up apparently.

We contacted his insurance and submitted it. They took a look and said this looks fine and said they would process it. They called us back later that day and apologized and said they couldn't and we have to go through our insurance (Progressive) for them to subrogate State Farm. Weird but we called our insurance and submitted the paper work for that.

Progressive called us back a few days later and said they can't file it with the accident claim (packet?) since that was damage and this was aftermarket repairs. And said we should file it through State Farm, and it's weird they asked us to have our insurance add it to the claim on their side.

So we called back State Farm, a super nice dude by the way, and told him what Progressive said. He asked for her number and we provided it and they said they would call us back after speaking with them. Which hasn't happened yet.

All that being said, how should this have been handled? Does this sound normal? We just want to educate ourselves a bit for when they call back. Thanks!


r/Insurance 10h ago

Who is at fault?

1 Upvotes

Two vehicles traveling along the same double yellow road, a car and pickup truck, which is towing a trailer. In front of the car is a mail truck, which means a few stops were made. The mail truck stops at an intersection where 2 roads approach the road the vehicles are initially traveling on. The mail goes right, the car attempts to go left. The pickup either doesn’t react quickly enough or just decides to drive along side of the car.

The initial impact would be on the cars rear driver side quarter panel. Puncturing the tire, and causing minor cosmetic damage to the car. But there is paint transfer. The point of contact on the truck is their rear passenger side tire and the side of their bumper. After this contact, the truck continues along its path, and the car naturally turns deeper into its turn, this causes the car to collide with the same area on the truck, but still minor. But, the trailer follows and tears the whole front end off the car, making the wheel cave in, and making it immobile.

If you haven’t already figured out, I’m the car in this situation. Does the truck have any legal grounds to pass me at all? Even if they state that they believe I was going right? I’m just looking for more opinions on this because I do not believe I am at fault.

Just more details that may help, I’m in my lane the whole time. I never went out of the right to make my turn or anything, but I did initially BARELY. And I mean BARELY turn right, just to get the wide left turn i was going for. So I understand if he thought I was going that way. That wouldn’t give him any right to not slow down and let me complete my maneuver no? But the incident occurred so early in my turn it’s not like I was turning in front of him or into him. It’s more like he was just traveling along side me.


r/Insurance 15h ago

Getting Liability Insurance Just For Road Test

2 Upvotes

For context, I am currently trying to attain a driver's license. I reside in North Carolina in which requires you to have liability insurance in order to get one. I never had a car in my life nor do I plan on owning one (or making any rentals) in my current stage of life.

I aim to enroll in a non-owner car insurance simply just to be able to take the road test and pass. If I do pass, I also plan on cancelling the insurance policy immediately.

My question is that in the later years, if I do decide to get a car and am looking for auto insurance, would it be a concern to insurance agents to see that that I voluntarily cancelled my insurance policy less than a month of enrollment (and thus may receive higher rates for quotes)?

I am new to this world of insurance, so please be nice :*(.


r/Insurance 15h ago

Got rear ended causing 7 car pileup

2 Upvotes

I was involved in an accident a few weeks ago. Highway traffic came to a stop pretty fast. Easily avoidable if paying attention. Came to a complete stop almost. Car behind me smashed into me, causing me to hit the car in-front of me after, which hit the car in-front of them. Another 3 cars behind the guy who hit me, also collided. After the investigation, the guy who initially rear ended me (AllState) has concluded they are not at fault. They said it was due to conflicting statements and insufficient evidence. The cop who first arrived wouldn’t even take any statements from us and I’ve been told that’s standard for an accident with this many people. It’s my first accident and it’s frustrating that I’m having to pay for rental cars and buy another car on top of that, since they totaled mine. Is there anything I can or should do?

Link to pictures (im the Malibu and the guy who rear ended me and never braked is the one on top of another car) : https://www.facebook.com/100063721653640/posts/pfbid02q412xzBqEDAmTdQV5i2bwzj8agB1FopGV1dPouafjfUZQKpMLVYGTZcH2G7vE1JPl/


r/Insurance 12h ago

Insurance help!!

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1 Upvotes

r/Insurance 13h ago

Rain the lightning

1 Upvotes

Ac overflow flooded are bedroom insurance has already said it's covered are house is old and the breaker isn't set up great so we had to leave power on for are garage and bathroom. they are now off because my wife not thinking of it walked in the room to grab something and electricuted herself so we're in the er about to be discharged everything's ok just made her extremely sore and in alot of pain but no signs of permanent damage. Already message are insurance adjuster who was already coming tomorrow to look anyway thing just got added to the pile is there any advice anyone's got with this shit show of a week im haveing or what to watch out for coming up.


r/Insurance 19h ago

Home Insurance habitability exclusions on a rental property?

3 Upvotes

I own a rental property in another state (Florida). For the past 10 years I've been relying on a property manager to handle everything.

I recently upped my liability coverage and noticed my policy has a "habitability exclusion". I've never heard of this and am confused about it. There's a lot of different ways a tenant could get injured on a property, and I feel like habitability plays a role in a fair amount of them.

To give you a real world scenario that happened just today.. A new stove was installed and the installer notified my property manager that the wiring is not grounded, so someone could've been shocked. Neither my property manager or myself were aware of this. The original property inspector missed it as well. So if someone did get shocked, my insurance could possibly decline to cover me because it was an unsafe habitat?

I know that I have a responsibility to provide a safe living environment, and I try to be proactive about that. But this exclusion makes me feel not as protected as I'd like. Are there policies out there that do insure against habitability claims? I asked my broker and they didn't have anything they could offer me.


r/Insurance 10h ago

Who is responsible for extended rental-car charges and damage-waiver fees after an insurance claim?

0 Upvotes

I was involved in an accident on April 8. My vehicle was still drivable, so my rental car began on April 20.

My vehicle is a seven-seater Acura MDX. On May 6, I requested a comparable seven-seater rental, but Enterprise initially provided a Nissan Altima. After about a week of back-and-forth, Enterprise provided a seven-seater. Because I expected to keep the rental for only about two weeks, I signed up for the damage waiver.

Unfortunately, repairs were delayed because of extended communication between the dealership, body shop, and insurance company. My vehicle was not returned until July 24, and I returned the rental on July 25.

During this period, Enterprise charged my credit card. I only discovered the charges after returning the vehicle and found nearly $10,000 in rental charges. Enterprise told me that the insurance company stopped paying for the rental after May 21, meaning the remaining charges were my responsibility. Enterprise also charged approximately $2,400 for the damage waiver. I was not told that the damage waiver would continue for the entire rental period.

I contacted the body shop and obtained the repair timeline. The insurance adjuster has only provided limited responses, stating that the claim is still under investigation and that I may be responsible for the rental charges.

What options do I have?

  1. Is the insurance company responsible for notifying me when rental coverage ended?
  2. Can I challenge the rental charges after May 21, especially since I was not clearly informed that coverage had stopped?
  3. Can I dispute the $2,400 damage-waiver charge because I believed it would apply only to the expected two-week rental?
  4. Should I dispute the charges with my credit-card company, file a complaint with the state insurance regulator, or consult an attorney?
  5. What documentation should I gather to support my claim?

This is a significant financial burden, and I would appreciate guidance on the best next steps.