Car insurance, Ontario edition
March 15, 2016 9:59 AM Subscribe
(Asking for a family member). They were rear-ended in someone else's car, as a passenger, in February. The insurance of the driver of the car she was in has told them that claims (for physio etc) need to go through their soon-to-be-ex-spouse's insurance--they separated in September. My family member said that the insurance adjuster used a specific word they can't remember, but that essentially as a married (on paper) person, the spouse's insurance takes precedence.
Naturally, this person does not want the soon-to-be-ex-spouse's insurance involved at all, because this will possibly open up contact which they absolutely do not want.
Frankly the whole thing sounds bizarre to me; as a non-driver I had always assumed that any insurance claims go through the policy of whoever is driving the vehicle. This is a family member who has a long history of getting the wrong end of the stick on everything, and having a fairly elastic relationship with the truth, so this may just be yet another bid for attention.
Is this really how insurance works in Ontario? If so, what steps can we take to avoid having the STBES insurance involved?
Naturally, this person does not want the soon-to-be-ex-spouse's insurance involved at all, because this will possibly open up contact which they absolutely do not want.
Frankly the whole thing sounds bizarre to me; as a non-driver I had always assumed that any insurance claims go through the policy of whoever is driving the vehicle. This is a family member who has a long history of getting the wrong end of the stick on everything, and having a fairly elastic relationship with the truth, so this may just be yet another bid for attention.
Is this really how insurance works in Ontario? If so, what steps can we take to avoid having the STBES insurance involved?
The word might have been "Priority". Here's the Ontario Government on order of priority for passenger claims.
posted by jacquilynne at 10:16 AM on March 15, 2016 [1 favorite]
posted by jacquilynne at 10:16 AM on March 15, 2016 [1 favorite]
Response by poster: Sorry, should have clarified. My relative has no insurance, the only insurance companies involved are the driver of the car they were in, the driver of the idiot who rear-ended them, and (potentially) the ex-spouse.
posted by feckless fecal fear mongering at 10:16 AM on March 15, 2016
posted by feckless fecal fear mongering at 10:16 AM on March 15, 2016
So, it looks like they file with the insurance company of the driver who's car they were in during the accident, if I understand this correctly.
posted by bonehead at 10:23 AM on March 15, 2016
posted by bonehead at 10:23 AM on March 15, 2016
If they care to, the person who hit them can make a deal with your relative's friend's insurance company, but your relative is covered either way then.
posted by bonehead at 10:25 AM on March 15, 2016
posted by bonehead at 10:25 AM on March 15, 2016
I would think that even if the ex-spouse's insurance company needs to be involved, that doesn't necessarily mean the ex-spouse needs to be involved. Your relative (or their lawyer or whomever) should just contact that insurance company and try to deal directly with them.
posted by Rock Steady at 10:59 AM on March 15, 2016 [1 favorite]
posted by Rock Steady at 10:59 AM on March 15, 2016 [1 favorite]
So this might be helpful to you
It looks like if your friend has coverage under her ex-spouse's coverage (or did at the time of the accident), then they may be correct. Which totally sucks, but here we are.
posted by Hoopo at 2:11 PM on March 15, 2016
It looks like if your friend has coverage under her ex-spouse's coverage (or did at the time of the accident), then they may be correct. Which totally sucks, but here we are.
posted by Hoopo at 2:11 PM on March 15, 2016
I only handle US auto insurance/injury claims (and my partner is a Canadian citizen hailing from Ontario, if that gives me any street cred... heh), but I'd agree with jacquilynne that they are very likely referring to the "priority" (sometimes referred to as "primacy" in the US) of who is responsible to pay the passenger's medical bills and in what order those parties are responsible to pay the bills.
As a similar real life example, to help illustrate what *might* be going on: in Pennsylvania, regardless of whose car you are occupying when you are in an accident and are injured - and regardless of which driver is at fault! - you have to use your own, household auto insurance policy (or, if you don't have one, the auto policy for the relative you live with) to pay your medical bills. Note that medical bill payments are an entirely separate matter from getting monetary compensation/a "settlement" for one's injuries from the party who is at fault. And if you don't have your own auto insurance/live with a relative who does have auto insurance, there is an order of priority in Pennsylvania dictating which insurance company is "next in line" to pay the medical bills (usually at that point, the insurance for the car you were occupying when the accident happened - for accidents in Pennsylvania, anyway).
Whenever I had to explain this to folks in Pennsylvania, I'd get the same reaction from them that you're having now ("the whole thing sounds bizarre to me") so, 1) you aren't alone in feeling this way, and 2) I couldn't agree with you more. But... there you have it!
So while I cannot specifically vouch for Ontario, I can say that this is definitely a thing in certain jurisdictions.
The insurance company has an obligation (from a customer service standpoint, anyway) to make sure that your family member understands and is clear on this information. I can tell you from personal experience that although a lot of my customers will express understanding of the information I'm dumping on them, I can almost always sense when they don't understand and are afraid to say so, because, hell, I was confused about it when I was first learning how to do the job. I now try to anticipate what questions people are likely to have, and have developed ways to explain concepts so that they make sense, or at least lay down the foundation for getting to a place where it starts to make sense.
For the sake of their and your own sanity, I encourage your family member (who I realize you noted as "having a fairly elastic relationship with the truth") to do the following:
1) Contact the claims adjuster for the insurance company for the car he or she was occupying. Ask them (calmly, politely - remember, they aren't the ones who write these crazy insurance regulations, they just have to explain/enforce them) to explain which insurance company is responsible to pay her medical bills first, and who would be responsible to pay them if that first line of coverage runs out (for all we know it may have a limit/cap of $X).
2) If necessary, ask them to put the information from #1 above in writing. If they are agreeable to this she'll probably receive something along the lines of: "As we discussed in our telephone conversation today, this letter will confirm that we are not primary/first priority to pay your medical bills. Please contact your own personal insurance company/the insurance company for the relative you reside with concerning your medical bills, so that they may investigate if you indeed qualify for coverage with them" - that's just an example
3) In the unfortunate event that they give her a hard time about #2/putting it in writing, sometimes the best way to get something in writing for this situation is to have the doctor's office send the bill to them anyway. They'll have to respond with a denial, usually explaining why they aren't responsible to pay it. "We aren't the primary/priority insurance. Please contact the patient directly to determine who their household auto insurance carrier is" etc. She may have to request a copy of the denial from the doctor; better yet, ask if the insurance company will just cc her on the denial letter.
4) Concerning the estranged/soon-to-be-ex spouse: Does he or she know who their spouse's auto insurance carrier is, and have the policy number? Without the policy number, they can still probably get that info just by contacting the insurance company, providing spouse's name/address/date of birth and then filing a claim. The insurance company, yeah, will have to contact the estranged spouse to let them know a claim has been set up. I would recommend they let the insurance company know that they are estranged/separated (which they're going to need to know anyway, because residency may affect whether or not he or she qualifies for medical bill payment coverage under the policy) and that they do not want any of their personal contact information being released.
5) If they are unable to find out who their spouse's insurance carrier is, this is just one of many areas where lawyers come in handy. Insurance is often complicated and messy. Your family member is an innocent party (passenger). It may be worth consulting an injury attorney and letting them handle the paperwork and headache.
Again, this is all just general information and is not legal advice/I am not an attorney.
Good luck!
posted by nightrecordings at 2:56 PM on March 15, 2016 [1 favorite]
As a similar real life example, to help illustrate what *might* be going on: in Pennsylvania, regardless of whose car you are occupying when you are in an accident and are injured - and regardless of which driver is at fault! - you have to use your own, household auto insurance policy (or, if you don't have one, the auto policy for the relative you live with) to pay your medical bills. Note that medical bill payments are an entirely separate matter from getting monetary compensation/a "settlement" for one's injuries from the party who is at fault. And if you don't have your own auto insurance/live with a relative who does have auto insurance, there is an order of priority in Pennsylvania dictating which insurance company is "next in line" to pay the medical bills (usually at that point, the insurance for the car you were occupying when the accident happened - for accidents in Pennsylvania, anyway).
Whenever I had to explain this to folks in Pennsylvania, I'd get the same reaction from them that you're having now ("the whole thing sounds bizarre to me") so, 1) you aren't alone in feeling this way, and 2) I couldn't agree with you more. But... there you have it!
So while I cannot specifically vouch for Ontario, I can say that this is definitely a thing in certain jurisdictions.
The insurance company has an obligation (from a customer service standpoint, anyway) to make sure that your family member understands and is clear on this information. I can tell you from personal experience that although a lot of my customers will express understanding of the information I'm dumping on them, I can almost always sense when they don't understand and are afraid to say so, because, hell, I was confused about it when I was first learning how to do the job. I now try to anticipate what questions people are likely to have, and have developed ways to explain concepts so that they make sense, or at least lay down the foundation for getting to a place where it starts to make sense.
For the sake of their and your own sanity, I encourage your family member (who I realize you noted as "having a fairly elastic relationship with the truth") to do the following:
1) Contact the claims adjuster for the insurance company for the car he or she was occupying. Ask them (calmly, politely - remember, they aren't the ones who write these crazy insurance regulations, they just have to explain/enforce them) to explain which insurance company is responsible to pay her medical bills first, and who would be responsible to pay them if that first line of coverage runs out (for all we know it may have a limit/cap of $X).
2) If necessary, ask them to put the information from #1 above in writing. If they are agreeable to this she'll probably receive something along the lines of: "As we discussed in our telephone conversation today, this letter will confirm that we are not primary/first priority to pay your medical bills. Please contact your own personal insurance company/the insurance company for the relative you reside with concerning your medical bills, so that they may investigate if you indeed qualify for coverage with them" - that's just an example
3) In the unfortunate event that they give her a hard time about #2/putting it in writing, sometimes the best way to get something in writing for this situation is to have the doctor's office send the bill to them anyway. They'll have to respond with a denial, usually explaining why they aren't responsible to pay it. "We aren't the primary/priority insurance. Please contact the patient directly to determine who their household auto insurance carrier is" etc. She may have to request a copy of the denial from the doctor; better yet, ask if the insurance company will just cc her on the denial letter.
4) Concerning the estranged/soon-to-be-ex spouse: Does he or she know who their spouse's auto insurance carrier is, and have the policy number? Without the policy number, they can still probably get that info just by contacting the insurance company, providing spouse's name/address/date of birth and then filing a claim. The insurance company, yeah, will have to contact the estranged spouse to let them know a claim has been set up. I would recommend they let the insurance company know that they are estranged/separated (which they're going to need to know anyway, because residency may affect whether or not he or she qualifies for medical bill payment coverage under the policy) and that they do not want any of their personal contact information being released.
5) If they are unable to find out who their spouse's insurance carrier is, this is just one of many areas where lawyers come in handy. Insurance is often complicated and messy. Your family member is an innocent party (passenger). It may be worth consulting an injury attorney and letting them handle the paperwork and headache.
Again, this is all just general information and is not legal advice/I am not an attorney.
Good luck!
posted by nightrecordings at 2:56 PM on March 15, 2016 [1 favorite]
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It's not super common, but it happens when a third-party takes over the liability for someone else, a company paying for an employee's car on business for example. It's not necessarily hinky, but it may be a bit more complicated. Your family member may want to get their insurance adjustor to handle it. It should be fairly transparent to them.
The at-fault person may be able to get what they want, but it's easier if your relative's insurance is the mediator here. Your relative could and perhaps should just be dealing with their claims adjustor if they don't want to get burned.
If not, I'd talk to a family lawyer for help.
posted by bonehead at 10:10 AM on March 15, 2016