I left off the last post after I talked with the State Farm rep. She said she needed to talk to her manager about the possibility of them denying my claim because of mold. That was on Tuesday, August 20th. Nothing else happened that day. Nothing happened Wednesday. For some odd reason I was just pure exhausted Wednesday night and ended up going to bed at 8:30. WAY early, even for me. As I was bedding down, I logged into the State Farm app to see if anything had changed. There was some confusing things there. The claim was still listed as open. It showed that they were assessing the damage and I'd hear from them in 2 to 4 days. It was even still asking if I wanted to have a rental car (part of my insurance coverage). But in the documents section, where all of my photos were listed, there was a document I hadn't seen before. It was a denial letter. And it was dated Tuesday, August 20th.
Now, the letter wasn't signed. I figured/hoped that it was a matter of their process. They were considering denying it and had the letter written up, but as it wasn't signed and I wasn't informed on the 20th or the 21st about it, they were still thinking about it.
Going to sleep at 8:30 at night naturally leads to getting up WAY too early. I was out of bed at 3:30 AM. That gave me plenty of time to wake up. When 10:00 rolled around I was done waiting and gave them a call. The call went to a voicemail and I told them what I saw on my account, that the claim was still obviously open but there was a letter denying my coverage.
They called back about 15 minutes later with the excuse of "I just talked to my manager..." Uh huh... sure. You may have just talked to your manager, but you did so because you heard my message and knew I was owed an answer. Anyway, they were denying the claim. I was sent an email with the formal letter of denial and it was now signed. To be clear with this, there are some definitions and policies to go over.
In their policy book (specific to Michigan) State Farm defines Fungi as:
- Any type or form of fungus or fungi that includes
- Mold
- Mildew
- Any of the following that are produced or released by fungi
- Mycotoxins
- Spores
- Scents
- Byproducts
So, whenever we talk about 'Mold' or 'Fungi' we're referring to this specific definition.
It's important to know that as the denial letter includes the exclusions to physical damage that they'll cover. That section reads:
"There is no coverage for... Loss to any covered vehicle due to Fungi. This applies regardless of whether or not the fungi result from a loss that is payable under any of the physical damage coverages."
Basically, I read that as they won't cover removing mold, even if the mold comes from damage that IS payable. Consider, if someone came up and bashed out my back window but I didn't notice for a few days. It rained in the meantime, got ultra humid and hot in my car, and I got mold from that. They'd pay for the window, as that would be a covered loss, but they wouldn't cover the mold even though it was caused by a covered loss.
So, I spilled milk which is covered, and they believe the white spots are mold, so they're not going to cover anything.
No, it doesn't make sense to me either. The spilled milk should be covered. So should the smell from the spilled milk. If the body shop said that fixing the spilled milk would cost $10,000 and the rest was repairing the mold, then State Farm should still cover $10,000.
I tried to make these arguments but I got nowhere. Her answer was always a variation on "But the manager said..." She did say, however, that they'd talked to my agent and if I had further questions I could talk to him. I knew this was a BS technique as my insurance agent is, more or less, a glorified salesman. Yes, he's a licensed insurance agent, but he has nothing to do with writing policy, performing claims, assessing damages, or determining coverages. He's told me that as well as several friends who have worked in the insurance industry. As I said in an earlier post, both my good friend A in Dallas and his wife worked for State Farm. They both also worked for other insurance companies including Progressive, AAA, and Farmer's Life. A also now works in a law firm and one of his areas of expertise is dealing with insurance companies.
BUT, if I'm going to go through this process, I can't just tell them they're spouting BS. I have to go through the motions. Even before I had the thought formed, I knew that staying within the lines was going to benefit me. I next called my agent's office. The woman I talked to said she was aware of my situation but that the agent himself was out of the office and the person who spoke with the insurance adjustor (the person who looked at the car and talked to the service manager at the body shop) was on another call. She'd pass my question off to the agent and he'd call me back.
Many hours later, toward the end of the business day, my insurance agent called me back. As I suspected, he wasn't really aware of what was going on. He even admitted that "I don't write the checks", i.e. he has no power over insurance claims. But he said he'd look into it and call the body shop at least. And if nothing else, his office (meaning the woman I spoke to on the phone initially) would help me fill out a complaint form to State Farm.
That was yesterday. When I got up this morning, I started thinking of what I'd do if the insurance just denied everything and I was left without a car. I'd have to pay what was owed for services rendered so far (the body shop's assessment and estimate, the tow...) which would be around $1000, but then I could sell or junk Tiffany. But I could also decide to fix her. But would that be a good idea? What would the body shop recommend? If I did fix it, how much would I be willing to spend?
There were too many questions and I realized I was unlikely to get answers to all of the questions today. That worried me. I'm on day for without a migraine. I've only gone more than 4 consecutive days without a migraine once in the last four months. When I'm in a migraine status, there's a good chance that I won't be able to think clearly. So, at the very least, I needed to make a decision tree. I needed to know what decisions needed to be made in what order and then I could tackle a decision and know it was the right decision to make.
For example, is it worth cashing out my 401k? That's certainly a decision that might have to be made, but before that I need to know if the insurance paid out, if they paid anything at all, if Tiffany is being repaired by me or the insurance company, or if I'm buying another car.
So, after about an hour of work, here's the decision tree I came up with:
Insurance takes responsibility and pays in full
- They decide to repair Tiffany
- The repairs work
- I get Tiffany back in good condition
- The repairs fail
- They decide to do more repairs
- It works and I get Tiffany back in good condition
- They decide its no longer worth it and they write off Tiffany as a total loss
- I can buy a replacement with the money they give me
- I can buy a replacement with the money they give me plus my savings
- I can buy a replacement with the money they give me, my savings, and money from my 401k
- The decide to write off Tiffany as a total loss
- I can buy a replacement with the money they give me
- I can buy a replacement with the money they give me plus my savings
- I can buy a replacement with the money they give me, my savings, and money from my 401k
Insurance takes responsibility for the milk/smell but not the mold and only pays a partial claim
- I decide to repair Tiffany
- In addition to what the insurance company pays, I add my savings to fix it
- I get Tiffany back in good condition
- In addition to what the insurance company pays, I add my savings and more from my 401k (up to the value of Tiffany)
- I get Tiffany back in good condition
- I decide to not repair Tiffany
- I buy a replacement for Tiffany with whatever the insurance company was going to pay plus my savings
- I buy a replacement for Tiffany with whatever the insurance company was going to pay plus my savings and some/all of my 401k
- I try to get Tiffany repaired
- Once I start paying, I continue to pay and she gets fixed. The $17,000 estimate already means I have to dig into my 401k, so it's spend and keep spending until I get her back in good condition
- I have to have the possibility that I spend ALL of my savings and 401k and that she's still not repairable. I'm then screwed as I'd have no money and a car that's unrepairable
- I write off Tiffany
- I buy a replacement with my savings and whatever I can sell Tiffany for
- I buy a replacement with my savings, whatever I can sell Tiffany for, and some/all of my 401k
At that point I already had the insurance company as saying they weren't going to take any responsibility but I had my agent looking into it. A and his wife also suggested I get the body shop to say that their estimate was to remove the milk and it's smell and had nothing to do with mold.
My next call was to the body shop. When we connected, I told him what was going on and he was very nice. Again, I've dealt with this shop before and I really do respect them and know that they're customer focused. I explained that I was trying to get this done today as I had migraine problems and that made it hard to think. He actually took initiative and said he'd call State Farm and explain that his estimate had nothing to do with mold and he believes it should be covered.
When he called back he had talked to them and they had discussed it, but said they were still going to deny the claim. He told me that he was still going to talk to my agent to see if there was anything else to do and he'd wait until that happened. I asked him about repairing Tiffany, assuming that the insurance company wouldn't pay, should I pay for it. His answer was immediate and definite. No. Even in his $17,000 estimate, he didn't know if he'd be able to get rid of the smell. He stopped his estimate when it got that high as he knew it was an amount that the insurance company would use to total the vehicle out. He wouldn't recommend that they pay to get it fixed and he certainly wouldn't recommend that I pay for it either.
I just glanced at the clock and realized it's after 5:00 on a Friday. In other words, I won't hear from my insurance agent or the body shop until Monday at the earliest.
But I learned several things that dramatically changed the decision tree. I still can't make a decision on my next action as I want to hear from my agent that there is nothing else to do. I'll then call the insurance company one more time and make a plea. Only if they say no at that point will I consider this to be done.
I also talked to Mom and she reminded me that I had another option in cars that I wasn't thinking of. Hers. I could drive her car. We'll get to that later, but for now I included it in my new tree.
So, by eliminating all options of repair, here's what my decision tree looks:
- Insurance pays full (assuming around a $22,000 payout)
- Buy a replacement with the insurance money
- Buy a replacement with the insurance money plus my savings
- Buy a replacement with the insurance money plus my savings and 401k
- Insurance pays partial (assuming around a $5,000 payout)
- Drive mom's car, bank the insurance money, don't buy a replacement
- Buy a replacement with the insurance money and my savings
- Buy a replacement with the insurance money, my savings, and my 401k
- Insurance doesn't pay anything
- Drive mom's car, don't buy a replacement
- Buy a replacement with my savings
- Buy a replacement with my savings and my 401k
A couple numbers are important. First, I have about $14,000 in savings. That number goes up each month as I put more in when I don't spend all of my LTD money. More will be there on the 1st of September. I checked my 401k and after paying the taxes and saving for the fees, I'd have up to about $32,000.
Then there's the level of cars I would want to buy.
The first is to go balls to the wall and get a replacement for Tiffany. A high end luxury SUV with practically all the options. That costs between $30,000 and $40,000. No matter what insurance pays, it means digging into my savings and unless I get the best outcome, it means digging into my 401k.
Next is getting a good replacement for Tiffany. A car that would have most of her features and that I could easily commute to a new job with. I focused on Ford Edges as I can get one with all the bells and whistles for as low as $25,000 and can get them easily at $30,000. In other words, if insurance pays in full, I can get that and be sure to save my 401k.
Next is some version of a 'Beater with a Heater'. A car that I can drive around to pick up grocers, go to my doctor's appointments, and just get around town with. I may or may not trust a car in this category to go across country with. I would only spend up to my savings on this and would ideally get something for less. I wouldn't touch my 401k at all. IF/When I got a new job, I'd have to get a new car fairly early as this wouldn't be a car to commute long distances with.
Finally, no replacement. Use mom's escape.
Now, at first blush, using mom's escape seems like a good option. Especially if State Farm tries to dick me over. It'll cost me between $25,000 and just over $30,000 to get a vehicle I'm comfortable driving across the country with and would serve me as a commuter car. There are a lot of features I look at for this, but one is simply adaptive cruise control. After having that for several years, I'd be a screaming mess if I had to drive for 40 minutes twice a day withOUT it.
Thankfully, I don't have to make this decision yet. That's what's lovely about decision trees. I need to know if State Farm is paying full, paying partial, or I'm on the hook for everything. And even then, except for State Farm paying for everything, I need to know what I get for Tiffany. It's a big difference between selling her for $1,000 to a junk yard and getting between $5,000 and $10,000 (which is possible).
I will say, driving mom's Escape today to go get the groceries reminded me what it is to drive someone else's car. I've driven her car occasionally when I had to but never thought of it in terms of it being my main mode of transportation. Well, if it's not mine, then I don't want to mess around with it. Mom has coasters in the cup holders. She has fuzzy dice on the mirror. She has her walker in the back. She has the stock radio which means Bluetooth audio from the phone, but no Android Auto. I have a memory setting for the door mirrors and the seat, but even that doesn't cover the rearview mirror. If that's my main mode of transportation it would be a constant reminder that I don't have a car. And that, as pathetic as it is to admit it, would be a big blow to my ego.
Anyway, that's a decision for a different day.
Another thing that came to mind while I was picking up the groceries was considering what A said. And what A does for a living. And what he used to do. If State Farm denies this claim because of 'mold' couldn't I just sue them?
Insurance companies get sued a lot. They have a ton of lawyers. But they also have a natural fear of going to trial. If there's a case that has an even small chance of getting a jury verdict, they'll offer to settle out of court. Because a jury ruling can invalidate their policy and that affects thousands if not millions of customers.
For instance, the body shop manager said that his estimate didn't include anything about cleaning up mold. Whether there was mold there or not, his estimate and suggestion of totaling Tiffany out would stay the same. The spoiled milk and it's smell comes from bacteria and that's likely what the white spots were in Tiffany. Not mold. I thought that maybe bacteria would be covered under their Fungi definition, but remember they define fungi as:
- Any type or form of fungus or fungi that includes
- Mold
- Mildew
- Any of the following that are produced or released by fungi
- Mycotoxins
- Spores
- Scents
- Byproducts
Fungus, Mold, Mildew, or products released by those things. Bacteria eating away at the milk proteins are specifically and explicitly NOT fungus, mold, or mildew.
I can have the shop manager write up that he didn't see any mold. I can also have him write up that his estimate does not include mold removal. Either way, State Farm's exception for fungi doesn't apply to it. Them denying my claim would be costing me upwards of $22,000. Sure, I wouldn't get all of that in my pocket as the lawyers will get a big chunk, but it's better than getting nothing. And I'd be happy that State Farm has to pay.
Anyway, that's where I'm at. Tiffany is gone. I'm waiting on State Farm to make their final decision. I need to pick what level of car I want next and then find that specific car, and I may have to decide on suing State Farm.
Wish me luck!
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