Oakland Branch Claims Office
7717 Edgewater Drive, Ste 100
Oakland, CA 94621

RE: Claim Number: T4-062485
Policy Number: 96 14014 6215
Date of Loss: January 4, 1999
Insured: Raquel R. Ross

Mr. Levan,

I received two letters from Kim Gray, Liability Claims Associate, on Wednesday, January 6, 1999. I am writing this letter in response to these letters and the manner in which my claim is being handled. A copy of this letter and the enclosed attachments are being sent to the Ted Harper, Officer in Charge at the California State Executive office.

In response to the letter dated January 2, 1999:

The accident occurred on January 4, 1999. The letter is dated January 2, 1999.

The first paragraph states "Please be advised that after thoroughly investigating the above loss we have determined that you are not at fault for the above loss." A thorough investigation as of this date is impossible. The accident occurred Monday, January 4, 1999, at 6:00 pm PT. I first spoke with Ms. Gray at 1:00 pm PT on Tuesday, January 5, 1999, and received the letter on Wednesday, January 6, 1999.

Ms. Gray has refused to accept or document any of the information necessary for a thorough investigation. When I offered to provide the following information: the first 4 characters of the license plate for the hit and run vehicle; the corresponding police report number; and the name/address/phone number information of my two independent witnesses; Ms. Gray informed me that she did not require this information.

A ten-minute phone call with the insured can not constitute a thorough investigation.

The final paragraph states "Absent contrary instructions from you, we will be closing our file at this time." In my January 5 conversation with Ms. Gray, I was provided with the names of two Auto Body Shops in my area for an estimate. She also stated that I should call her the day prior to taking my car in for an estimate so the Claims Adjuster could come to the Auto Body Shop to view the damage. Therefore I am assuming that this claim is open and will not be closed before the matter is satisfactorily resolved.

My other concerns are related to the conflicting information that I have received from Ms. Gray and her supervisor, Geri Lang.

In my January 5 conversation with Ms. Gray, she stated that due to the lack of a full license number for the hit and run vehicle, my Uninsured Motorist Coverage would not cover the accident. This means that I have both a $500.00 medical and a $500.00 property damage deductible.

As Part II, Uninsured Motorist of my policy specifically states:

"3. Uninsured motor vehicle means a motor vehicle which is:

A hit-and-run vehicle whose operator or owner has not been identified and which strikes:

A vehicle which you or a family member are occupying.

This description fits my claim exactly. When I followed up with Ms. Lang on Wednesday, January 6, 1999, to clarify why I would be subject to a deductible when my policy clearly states that this claim is covered by Uninsured Motorist, she had to research the question. Her response was that I am subject to Endorsement E9007, California 2nd Edition. Although I have quite a few Endorsements attached to my policy, I do not have that Endorsement. Ms. Lang did not offer to provide me with a copy and said that I should contact my agent for further clarification. I did contact my agent, Ray McCauley, who was unable to provide any information regarding this Endorsement.

I have offered to provide information regarding the hit and run vehicle in each of my conversations with Ms. Lang and Ms. Gray. Both times the information has been refused and I was informed that I must have the full license number of the hit and run vehicle in order to be subject to Uninsured Motorist Coverage and the Uninsured Motorist Property Damage deductible waiver. This is contrary to what is stated in my policy.

In my January 5 conversation with Ms. Gray, she stated that the medical injuries sustained by my daughter and I would be covered by my Medical Coverage, not Uninsured Motorist, and that I would be subject to a $500.00 deductible. Based on this information, I chose not to claim our injuries.

During my January 6 conversation with Ms. Lang I was informed that if there had been injuries in this accident they would have been covered under Uninsured Motorist coverage. I replied that there had been injuries but I had been informed by Ms. Gray they were covered by Medical Coverage and included a deductible. Ms. Lang insinuated that there is no deductible, however when I tried to pinpoint whether or not I would have a deductible no clear answer was provided.

During this conversation I did elect to move forward with claiming our injuries through my auto insurance. In response to Ms. Lang’s question ‘why should it matter if I have a deductible or not, either we were injured or we weren’t’, my daughter and I were injured. The question of payment is my concern. My HMO will not bill me for visiting the Urgent Care facility, however if the insurance company submits a claim to the HMO, I may be required to pay the $500.00 deductible out of pocket.

Because I have had a great deal of difficulty in obtaining clear and straightforward responses from the Claims Department, I have asked my agent to step in and try to clarify these questions:

Why is this not considered an Uninsured Motorist claim?

Exactly where is it stated in my policy that I must have the full license number of the hit and run vehicle?

Am I covered by Uninsured Motorist for our medical injuries? Is there a deductible?

Is my property damage covered by Uninsured Motorist? Is there a deductible?

Additionally, I have lost 2 days of work because of this accident and its aftermath. My daughter has been unable to write at school because the neck injury she sustained seems to have pinched a nerve into her arm. I have lost 2 nights of sleep due to the back and neck discomfort I experienced as a result of the accident; as well as the added stress of having to argue with the insurance company regarding my legitimate claim. I pay my insurance so that I am protected, not so my insurance company can continue to injure me.

I am extremely dismayed at the manner in which this claim has been handled. I expected to be treated honestly and respectfully but feel that somehow I am considered a fraud because I was the victim of a legitimate hit and run accident. I found Ms. Gray and Ms. Lang lacking in the friendly and helpful people skills I would expect from the Claims Department, especially as I am their insured and the innocent victim. Not once has anyone expressed concern for the health and welfare of my daughter and I.

This claim is open and I will be obtaining an estimate from an Auto Body Shop. Additionally, I will expect the property damage and medical injuries to be fully covered under the Uninsured Motorist Coverage of my Auto Insurance policy.

Thank you for your attention to this matter.

Raquel Ross

CC: Ted Harper

Ray McCauley

Geri Lang

Kimberly Gray