High Country Construction

If the insured does not agree with our damage assessment, the insured has the right to proceed with an Appraisal per their policy.  The insured was issued a Homeowners Homeowners 3-Special Form policy, [redacted].  Followingis the appraisal language within said policy: HOMEOWNERS 3 - SPECIAL FORMSECTION I - CONDITIONS6. Appraisal. If you and we fail to agree on the amount of loss, either may demand an appraisal of the loss. In this event, each party will choose a competent and impartial appraiser within 20 days after receiving a written request from the other.  Thetwo appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, you or we may request that the choice be made by a judge of a court of record in the state where the residence premises is located. The appraisers willseparately set the amount of loss. If the appraisers submit a written report of an agreement to us, the amount agreed upon will be the amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to byany two will set the amount of loss. Each party will:a. Pay its own appraiser; andb. Bear the other expenses of the appraisal and umpire equally.If the insured would like to proceed with exercising their right of appraisal, we ask that the insured advise us who their appraiser will be and we will proceed accordingly.  Per the appraisal language, the insured is responsible for the cost of their appraiser and for half of the cost of the umpire fees. We are always here to answer any questions and address any concerns the insured has and we would welcome the insured to do so.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
[To assist us in bringing this matter to a close, we would like to know your view on the matter.]
Regards,
[redacted]
 
 The back and forth of the situation is ridiculous. Acuity misrepresentation of the facts and evidence to this point are to continue to deny the claim. We do not accept acuity a option based on the evidence we have.

Mr. [redacted]'s claim was settled and the file was closed on 7-16-13. The injuries were his low back and feet and the medical was open subject to our defenses. On 4-21-15 I received a voice message from Mr. [redacted] stating he understood his claim was closed. I returned his call and he stated he went...

to [redacted] and they told him his file was closed. He said he used his health insurance to pay for the treatment. He filed for medicare part a and applied for part b and his health insurance shut him down now that he is on medicare.  He was getting injection in his neck and back and the prescriptions were $470.00 per month. He is also diabetic but understood I would not be paying for that medication. Acuity is not responsible for his neck issues.Mr. [redacted] was represented by [redacted] and I recommended he call him for advice. He said he did but the attorney never got back to him.I have sent the file for an Independent Medical Evaluation which will be done on 7-8-15 to obtain a second opinion as to whether the present condition is related to the 2009 injury. If it is related I will be reimbursing Mr. [redacted] for his out of pocket expenses.

I am writing to
respond to the above-referenced complaint. 
The allegations are contrary to the facts, as well as the information
provided to Acuity’s insured, [redacted]. 
After Acuity carefully reviewed the claim and information provided to
it, as well as hiring an independent...

architect who is a Haag Certified
Inspector, it was determined that the incident causing the subject damage
occurred outside of the relevant coverage period.  Mr. [redacted] was provided information and the
reasons for the denial throughout the investigation process. 
 
Specifically,
after Mr. [redacted] reported the claim, Acuity hired an independent adjuster to
inspect Mr. [redacted]’s roof.  Following the
inspection, Acuity denied the claim because the alleged damages were below Mr.
[redacted]’s deductible.  Mr. [redacted] was
informed in writing of the denial on March 24, 2015.  Mr. [redacted] then appealed the decision by
requesting an appraisal of the property.  
During the appeal process, Acuity hired an independent architect to
inspect the roof damages.  The architect
determined that the damages did not occur during our policy period based upon
his inspection and his own review of historical weather data (NOAA).  After reviewing the historical weather data
(Verisk Climate) it was determined that there was no storm that could have
caused damage to his roof during the policy period.  The architect determined that the damages did
not occur during our policy period based upon his inspection and his own review
of historical weather data (NOAA).  The
report was provided to Mr. [redacted] on May 13, 2015.  Mr. [redacted]’s claim was denied again on May 29,
2015 based on information discovered during the appeal process.  Based on the policy provisions, the appeal
decision is the final step in the process and Acuity’s decision to deny
coverage.  Acuity has no knowledge and
has not been notified of any legal action or dispute with the Department of
Insurance.
 
Neither Mr. [redacted]
or his contractor provided any information to rebut the findings of the
independent adjuster or architect. 
Acuity invited input from Mr. [redacted] throughout the investigation.   Therefore, there are no grounds to support
the complaint and the matter should be closed. 
 
v

November 10, 2016     Revdex.com OF WISCONSIN ATTN STACY [redacted] 10019 W GREENFIELD AVE MILWAUKEE WI 53214                        RE:         Our Claim Number:  [redacted]                                                     ...⇄ Our Insured:  Janie [redacted]                                                     ...⇄ Claimant/Consumer:  Janie [redacted]                                                     ...⇄ Your ID Number:  11786613                                                     ...⇄ Company Name:  ACUITY, A Mutual                         Insurance Company                                                     ...⇄ Dear Ms. [redacted]:               Janie [redacted] has submitted a response in regard to her complaint alleging Acuity, A Mutual Insurance Company promised to make payment for medical treatment under her Personal Injury Protection (PIP) benefits, and now we are refusing to do so.    Ms. [redacted] states she was led to believe her medical bills would be covered for up to one year.  At no time was it written or verbally stated or implied that Acuity would automatically handle any medical bills for one year, or for any definite amount of time.  It was stated that we would obtain her medical records and bills so we could consider payment for her treatment.  She was also advised of the Minnesota Statute which provides that eligibility for no-fault benefits will terminate upon a one-year lapse in disability and medical treatment.               The nurse and IME reports agree that Ms. [redacted] did sustain an aggravation of her pre-existing condition.  The reports also state that after a month of treatment following the accident, she had returned to her pre-existing condition, and any further treatment was solely related to her pre-existing condition.               In regard to Ms. [redacted]’s wage loss claim, we have not received any documentation to support this, nor do the medical records indicate her physicians giving her restrictions from working.  As previously advised, Acuity will gladly review any submitted documentation in regard to any wage loss benefits.                                     Please let us know if you have any questions, or if you need further clarification or additional documentation.                                              ...⇄ Sincerely,                                               ...⇄ Kelly L. [redacted], INS AIS                                         ...⇄ Senior Inside Claims Repr[redacted] Cc:  Janie [redacted] Tell us why here...