Part 1: https://www.reddit.com/r/Insurance/s/8qn9zVGFds
She asked for a copy of the denial letter and below is it with obvious personal information redacted
Dear redacted,
Please be advised that First Acceptance Services, Inc. is the claims firm for First Acceptance Insurance
Company, Inc. that is the insurer for the above insured.
Our investigation to date reveals that there is no coverage for the above referenced loss under the terms and
conditions of policy redacted due to material misrepresentation. Your failure to disclose redacted on your application for insurance is false, misleading and a misrepresentation and/or omission
which was material to our acceptance of risk.
When you signed your application, you agreed to be bound by the following language, which appears above your signature.
[ Applicant statement was here ]
There are restrictions in your policy regarding coverage. The policy states in pertinent part:
PART E – GENERAL PROVISIONS
By acceptance of this policy, you affirm and agree that:
1. This policy is issued in reliance upon your statements made in the application.
2. Your statements made in the application are true and complete
3. Your statements made in the application are incorporated into and form a part of this policy.
4. Your statements as reflected in the Declarations page and all endorsements are incorporated
into and form a part of this policy
5. The insurance application, Declarations page and all endorsements are incorporated into and
form a part of this policy
6. Any material misrepresentation on your part may render this policy null and voice from
inception
7. This policy embodies all agreement existing between you and us; and
8. You have the affirmative obligation to report all accidents regardless of fault and to promptly
advise us of any change in circumstances or in the information you supplied to us on your
application.
MISREPRESENTATION AND FRAUD
Fraud or Misrepresentation in the Application or Notification of Change
The statements made by you in the application are deemed to be representations. If any
representation contained in the application is false, misleading, or materially affects the
acceptance or rating of the risk by us, this policy will be void from its inception.
This provision shall apply to statements or representations that contain fraudulent, false,
misleading or deceptive statements, direct misrepresentations, and omissions or concealments of
fact. We may void this policy or deny coverage even after the occurrence of an accident or loss.
This means that we will not be liable for any claims or damages that would otherwise have been
covered in the absence of the fraud or misrepresentation. No coverage will be afforded to any
relative or resident in your household unless named in the application for coverage and/or listed
on the Declarations Page or added by endorsement.
Please be advised that your failure to disclose redacted on your application for insurance is
false, misleading and a misrepresentation and/or omission which was material to our acceptance of
risk. Because you failed to disclose this information, there is no coverage for this loss.
No coverage will be afforded under policy number redacted. Any applicable premium refund will be
mailed to you.
Part 2 of my GF claim got denied because I was there at the time of theft
byu/Snoo76619 inInsurance
Posted by Snoo76619
8 Comments
This was denied because they believe you to be an undisclosed resident of the household.
Prove you don’t live with her then contact the department of insurance for assistance.
Sorry, I missed part 1. Do you live with your GF?
In your last post you state that she told her insurance that you live there. So what’s the truth here?
As long as OP isn’t obfuscating facts, you should file a DOI complaint.
If you have your own policy, with a different address you can submit that to show you are not a resident nor an operator of her vehicle
Lots of good points made above and I agree with all of them. This whole situation is baffling to me.
I’ve been in the industry 20+ years and although I don’t work for an insurance company, I’m more than familiar with policy language.
This really smells like them paying low level legal fees to try to deny claims. Without divulging it, is this a large/well recognized insurance company?
Ouch! They’ve got to have pretty solid evidence (I am sure that they feel that they do) to rescind a policy due to material misrepresentation. OP and his g/f know best what is going on, and I certainly understand the redactions for their privacy. OP’s g/f needs to speak with her carrier/agent/broker and provide any documentation available to help them reverse their decision. Short of that, it’s time to get lawyered up, and unlike a bodily injury suit where the fee is contingent on a recovery, this matter is straight coverage law, and you will need to pay the attorney regardless of the outcome. Oh, for clarity, the fact that OP was napping at the home at that particular time ***- in and of itself -*** was not the reason the carrier has made this decision.