American Colonial Administration, LLC

This correspondence is in response to Case # [redacted], filed by [redacted] regarding a denied claim on a 2009 Mercedes C300, VIN # [redacted].   As the contract administrator, it is our responsibility to evaluate claims filed with our call center for coverage under the specific...

terms and conditions of each service contract agreement.  Breakdowns are evaluated for coverage by determining the cause and extent of a failure using information provided by repair facility representatives, contract holders, and independent, third party inspectors who function as our “eyes and ears” in the field.   On 11/28/2016, Mercedes Benz of Chandler contacted our call center to file a claim on the contract holder’s behalf. At that time, the facility reported that the vehicle had arrived at their facility with a dead battery, the result of an electronically failed steering lock module.   Under the Advance vehicle service contract Preferred program level, the contract provides coverage for all components listed as covered, as detailed in Section II., Schedule of Coverages (“We will pay or reimburse You for Reasonable Costs to repair or replace any Breakdown of a mechanical or electrical part listed below, less any Deductible(s), in accordance with Section V. GENERAL PROVISIONS contained in this Contract.”) as well as in Section III, What is Not Covered (“This Contract does not provide Coverage:   A. FOR REPAIRS TO ANY PART OR PARTS OF THE DESCRIBED VEHICLE NOT SPECIFICALLY LISTED IN THE POWERTRAIN, STANDARD OR PREFERRED SCHEDULE OF COVERAGES SECTION OF THIS CONTRACT.”).   The Preferred level of coverage list the following components:   Steering gear housing and internal parts, power steering pump, its internal parts and reservoir, rack and pinion housing and internal parts, pitman arm, idler arm, tie rod ends, and center link. Seals and gaskets only in conjunction with the repair or replacement of a Covered Part, unless Optional Seals and Gaskets has been selected and the box marked Seals and Gaskets is checked on the Registration Page.   Since the component reported to have failed, the steering lock module, is not listed as a component eligible for coverage under the terms and conditions of the vehicle service contract, the claim was denied.   On 12/6/2016, I received a request for explanation from the contract holder via email.  A response was sent at 8:52am on 12/6/2016.  While we sincerely apologize for any perceived delay or misunderstanding of contract coverage, after thorough review, the claim was handled properly.  Unfortunately, the failed component is not covered under the terms and conditions of the vehicle service contract.   If you have further questions, please feel free to contact us.   Eric A[redacted] VSC National Claims Manager www.iasdirect.com p ###-###-#### f ###-###-####

Initial Business Response /* (1000, 5, 2015/07/02) */
Contact Name and Title: [redacted] Clns Mgr
Contact Phone: XXX-XXX-XXXX
Contact Email: [redacted]@acaadmin.com
July 2, 2015
Revdex.com of Central Oklahoma
Parrish White
17 South Dewey
Oklahoma City, OK XXXXX
RE: ...

Case # XXXXXXXX, [redacted]
Contract no: 9TTXXXXX
Claim dated: 6/18/2015
Dear Mr. [redacted]
This correspondence is in response to Case # XXXXXXXX, filed by [redacted] regarding a denied claim on a 2009 Mini Cooper S of VIN # WMWMFXXXXXTTXXXXX.
As the contract administrator, it is our responsibility to evaluate claims filed with our call center for coverage under the specific terms and conditions of each service contract agreement. Breakdowns are evaluated for coverage by determining the cause and extent of a failure using information provided by repair facility representatives, contract holders, and independent, third party inspectors who function as our "eyes and ears" in the field.
In this case, the repair facility reported the fuel high pressure pump had failed, which was covered under the manufacturer's warranty, and that the oil separator which is integrated into the valve cover was leaking oil. The oil separator failure could result in carbon accumulation on the engine valves. Having an indication this accumulation was causing a misfire, the facility requested that the valves be cleaned.
The vehicle service contract does specifically exclude "Cleaning" (Section III. WHAT IS NOT COVERED, Paragraph C.), however, we are sensitive to the expense the customer may incur as a result and would agree to provide assistance for the cleaning as an act of good faith. We would request the customer return to the facility to have this service performed, having the facility contact us on arrival, and we will make arrangements to reimburse the facility directly.
If you have any further questions or would like to discuss this matter, please feel free to contact us.
Regards,
[redacted]
National Claims Manager

To clarify the issue, an itemization of every part involved in the different repair is attached; both how much was invoiced by the facility, and how much was covered/paid under the vehicle service contract.When evaluating a claim for coverage, the covered portions are determined based on the contract terms and conditions.  Approvals are often based aftermarket components, as indicated in the vehicle service contract.  Other repairs fall under limits of liability that are established in the vehicle service contract.  In this case, the components used for the transmission repair total 3986.04, however, these are limited to a 3000.00 limit of liability.  Additionally, components that were approved using aftermarket parts for invoiced at higher amounts based on original equipment parts that were more expensive -- these additional amounts are not reimbursable.After a thorough review, it remains our opinion that the claim was accurately reimbursed under the terms and conditions of the vehicle service contract.

Please refer to the attachment.  I did receive a check for $292 for the overcharge of the axels.  This does not cover the labor costs associated with the removal and replacement of the wheel bearing.  The shop did not include any labor on the replacement like it should have and instead included all labor under the transmission replacement.  The total labor for both tasks totaled $1,198.94.  I removed $300 from this total for the removal and replacement of the wheel bearing.  The company and the shop can determine the correct amount associated with the removal and replacement, but based on talks with other shops this should be close to the labor cost.

Ms. [redacted]initiated a claim for possibleGAP benefits on 1/26/18 for a date of loss of 1/19/18.She was advised of the documents needed to process her claim on 1/26/18,
2/6/18, 2/8/18, 2/14/18, 2/16/18, 2/20/18, and on 2/21/18. The final document
for her claim was received on 2/22/18 and her claim...

was sent to review that day.The
Contract is designed to waive the difference between the Actual Cash Value of
the vehicle involved in the total loss and the outstanding balance still owed on that vehicle from the purchaser to the lender, when a total loss occurs, based on the terms and conditions of the contract.The claim was processed on 2/28/18. There was no GAP deficiency owed under Ms. [redacted]'sGAP Contract. The claim settlement breakdown was as follows:[redacted]     [redacted]     [redacted]     [redacted] [redacted]     [redacted]Ms. [redacted]'s claim for GAP
benefits was denied as there was no GAP deficiency owed under the Contract.Since Ms. [redacted]
financed the sales taxes (tt&l) into her loan on this vehicle, the sales taxes(tt&l) are considered in the GAP calculations. As indicated by Ms. [redacted]in her complaint, the insurance company reimbursed her sales
taxes however, she did not apply those funds
to her loan.The
insurance company deducted a conditional adjustment on Ms. [redacted]'s vehicle. Any
deductions taken by the insurance company in their settlement are also
considered in the GAP calculations.The servicecontract refund and the GAP refund are sent directly to the lienholder by another entity, therefore, are deducted in the
claim benefits.We regret Ms. [redacted] is not satisfied with the outcomeof her GAP claim however,there was not a
GAP deficiency owed under this contract.If you have any further
questions, please feel free to contact us at ###-###-####.

Dear Mr. [redacted]:   This correspondence is in response to Case # [redacted], regarding a claim for contract holder Luis Figueroa on a 2012 Hyundai Santa Fe VIN # [redacted].   As the contract administrator, it is our responsibility to evaluate claims filed with our call center for...

coverage under the specific terms and conditions of each service contract agreement.  Breakdowns are evaluated for coverage by determining the cause and extent of a failure using information provided by repair facility representatives, contract holders, and independent, third party inspectors who function as our “eyes and ears” in the field.   In this case, [redacted] with [redacted] Garage in Holland, Michigan, reported an internal engine failure of the connecting rod bearings.  No specific cause of bearing failure was provided.  An inspector was dispatched to evaluate the damage.   Upon inspection of the disassembled engine, the inspector verified significant damage to engine bearings from apparent lack of proper lubrication.  The bearings in the engine displayed severe discoloration due to heat and were blackened, galled, and flaking, and indication of not having sufficient lubrication.   Normal oil consumption according to the manufacture is 1 quart every 1000 miles, and it has been 5700 miles since the last reported oil change.  Not properly monitored, as required by the contract, engine oil levels could run significantly low during this period.  No evidence has been found to suggest the oil consumption is excessive and no leaks or other causes have been discovered.  The oil pump was inspected and found to be in good condition.    The inspector did discover that the oil in the pan was not the same condition as the oil in the filter. This is consistent with adding oil to the engine after it has seized.  When new oil is introduced to the engine, it accumulates in the oil pan. If the engine cannot be started, the new oil does not have an opportunity to mix with the old, black, existing oil.  This results in new, cleaner oil in the oil pan, and old, dirty oil in the oil filter.   All evidence found indicates that the engine has been run low on oil resulting severe engine bearing failure, an exclusion of contract coverage.  Accordingly, the breakdown was not eligible for coverage under the terms and conditions of the vehicle service contract.    If you have any questions or would like to discuss further, please feel free to contact us.   Regards,   Eric A[redacted] National Claims Manager

Revdex.com of Central Oklahoma ATTN: [redacted] 17 South Dewey Oklahoma City, OK  73102   RE:          Case # [redacted]                Contract no:  [redacted]  ...

Dear Ms. [redacted]:   This correspondence is in response to Case # [redacted], regarding a denied claim for contract holder [redacted] on a 2012 Thor motorhome VIN # [redacted] under Repair Care Superior vehicle service contract # [redacted].   As the contract administrator, it is our responsibility to evaluate claims filed with our call center for coverage under the specific terms and conditions of each service contract agreement.  Breakdowns are evaluated for coverage by determining the cause and extent of a failure using information provided by repair facility representatives, contract holders, and independent, third party inspectors who function as our “eyes and ears” in the field.   In June 2015, a claim was filed on the customer’s behalf by “RV Complete”.  The repair was evaluated and approved utilizing a part with a lifetime replacement warranty. American Colonial Administration does not offer a network of approved “network” repair facilities, rather, the vehicle service contract permits the contract holder to select any licensed repair facility and secure repairs, warranties, etc. from the elected repair facility.   In this case, the facility elected to use a part with an inferior warranty.  When the part failed, based on the prior approval of a lifetime part, the customer’s follow up claim was approved for labor only – the fact that the previous repair facility is out of business is not the primary issue – the lifetime parts warranty would be available at any licensed repair facility, had that part been used in the repair.   It is our opinion that the claim was appropriately handled, however, as an act of goodwill towards the customer, the cooling unit repair, for both parts and labor, was approved on April 10, 2018.   This should resolve the matter to the customer’s satisfaction.  If you have any further questions or would like to discuss this decision, please feel free to contact us.   Best regards,   [redacted] VSC National Claims Manager www.iasdirect.com p ###-###-#### f ###-###-####

Complaint: [redacted]
I am rejecting this response because:
Sincerely,
[redacted]

I reviewed the response made by the business in reference to complaint ID [redacted], and find the resolution is satisfactory to me. However, I am attaching the receipt I have received from Benz Dealership for the record. Also, I have never received any email or phone call back from the "extended warranty company". I would love to see any of the emails they have sent with the time stamp, if possible. Thank you so much for taking your time to resolve this matter. They are definitely neglecting their customers in terms of follow up, if I can rate this company, most-definitely it would be 0. 
Regards,
[redacted]

Mr. [redacted] initiated a claim for GAP benefits on August 21, 2017 for a loss occurring on August 8, 2017.  A letter was mailed to him advising of the required documents needed for his claim on that same day.   It appeared we had received the final information for his claim on 10/4/17. ...

His claim was sent to review on 10/9/17.  Mr. [redacted] called and left a message regarding the status of his claim on 10/10/17.  An e-mail was sent to him advising his claim had been sent to review.  After being reviewed, his claim was submitted for final adjudication on 10/16/17.  Mr. [redacted] was again advised of the status of his claim on 11/6/17.   On 11/14/17, we received the information regarding the adjudication of his claim.  Mr. [redacted] was sent a settlement letter explaining the GAP payment on that same date.   Contrary to Mr. [redacted]’ beliefs, the GAP contract does not pay the difference between his loan balance and the insurance check.  The GAP contract looks at the deficiency between the loan balance on the date of loss and the value of his vehicle.  The claim is calculated based on the terms of his GAP contract and does not cover items such as missed payments, extensions, refundable items, etc.   The promptness of documents being submitted determines the promptness of the claim resolution.  In addition, the recent storms have caused a larger volume of claims to be assessed.  We regret Mr. [redacted] feels there were any delays in the handling of his claim.   Please let me know if you have any questions or need any additional information.   Sincerely,   [redacted]   [redacted] Claims Supervisor

Initial Business Response /* (1000, 8, 2015/10/26) */