You did your research. You went out of your way to make sure you have “good” insurance on your car. So you think you know what’s really in your policy, right?
Unfortunately, probably not. Many insurance companies try to dupe you in the fine print.
Unless you’re an expert in insurance, I am going to assume you haven’t read every line of your insurance policy. Most people don’t.
How do insurance companies get away with this? Let’s look at an example.
Your Declarations Sheet
Most people receive and review their Declarations sheet and assume they know what they have in their policy. The Declarations sheet is the first page of your policy. It’s supposed to be a clear, concise, and accurate summary of your coverage that does not mislead you. Here’s an example of a USAA Declarations sheet:
If you find it confusing, don’t worry. Most people have a difficult time figuring out exactly what is on this “summary” sheet. Here is what it says:
- There are two vehicles that are insured: A 1995 Dodge and a 1996 Olds.
- There is $100,000 of liability coverage per person and up to $300,000 for a total claim value in the event that you are at fault for a crash and other people are injured by you.
- There is up to $50,000 of property damage coverage.
- There is up to $25,000 in Medical Payment coverage per person (note that this only costs $6.98 per 6 months).
- There is Lost wages benefits up to $2,000 per 30 day period.
- There is Uninsured Motorist coverage up to $100,000 per person up to $300,000 per incident.
- There is Underinsured Motorist coverage up to $100,000 per person and up to $300,000 per incident.
- There is a $500 deductible for comprehensive and collision coverage to fix your own vehicle.
By most standards, this should be pretty good coverage. But look a little deeper and you see a different picture. USAA doesn’t tell you about the ridiculous restrictions they place on these coverages. The most egregious is the Medical Payment coverage. This person paid for up to $25,000 in medical payment coverage. What USAA doesn’t tell you is that there are severe limits on this coverage.
Let’s go through them one at a time.
1. They will only pay your medical bills for one year.
If you need medical treatment, USAA will refuse to pay for any bills after the one year deadline. So, whether you pay for $10,000 in coverage or $100,000 in coverage, it is all only good for one year.
The vast majority of people take longer than one year to fully recover from a serious crash. That means this coverage will not cover all your bills in an average case.
2. USAA decides what medical bills are “necessary and appropriate.”
So, if they decide that any medical treatment wasn’t necessary and appropriate, they won’t pay for it. This tends to be more the rule than the exception.
3. USAA will decide on their own when you have had enough treatment.
If they feel that you are taking too long to get better, they will have one of their own doctors look at your medical records. They will almost always say that you are over treating, and they will not pay for additional treatment.
4.They will let bills go unpaid.
Unless you dispute their denials and really push them on a refusal to pay certain bills, they will simply deny them, and if you don’t do anything, they will remain unpaid and potentially go to collections.
What Should You Do?
At the end of the day, insurance companies try to get you to pay a larger deductible every month by promising better and more coverage. But that may not be what you’re really getting. They are tricking you with the fine print by refusing to pay bills and claims that they are duty bound to pay.
Don’t sit back and take it! Have a talk with your agent today about terms like this and see if your insurance company is ripping you off.
If you think your insurance company has illegally refused to pay your bills, I can help.
Call me for a free consultation at 406-721-3354.
Marty is a former criminal prosecutor in the Cascade County Attorney’s Office and now uses that experience to defend those accused of crimes. A University of Montana School of Law graduate, Marty focuses his practice on personal injury and criminal defense and is a premier DUI defense attorney. He is also well versed in the insurance claims industry and has negotiated significant settlements with nearly every major insurance company.