MPC Energy

First, this complaint involves the actions of RIS Risk Management Services, LLC, not Recreation Insurance Specialists, LLCBoth entities are under common ownership, but are separate entities and provide separate servicesRecreation Insurance Specialists is not involved in the claims handling process that resulted in this individuals' complaintHowever, we do have access to the information related to the claim and will respond This individual's complaint involves provisions of an insurance policy contractPayment for this claim was made in November A broken skylight allowed water to enter and damage the carpetThe repair shop submitted an estimate for supplemental repairs in December The supplemental repairs involved water damage to the walls, flooring and ceiling coverings An engineer was retained to review this additional damage and the engineer’s report was received on 3/9/ The engineer's report indicated that the additional damage is the result of improper maintenance and unrelated to the initial skylight damage The improper maintenance allowed water to gradually leak into the unit causing gradual deteriorationThere is an exclusion in the policy contract for that occurrenceThe exclusion in the insurance policy contract was approved by the state Department of Insurance in North CarolinaThe insurance contract stipulates what the insured can do if they do not agree with the determination regarding the applicability of the exclusionFurthermore, the state Department of Insurance has a complaint process for any policyholder that believes they were not treated properly in a claim situation

The initial damage to the RV occurred on 10/8/16. The insured reported the claim to us on 10/19/16. We assigned an appraiser to inspect the RV that same day. The insured advised that she would need to be present at the inspection and that it would need to take place on a Saturday. The appraiser made several attempts to schedule an inspection with the owner. The insured cancelled at least one appointment. It was finally inspected on 12/14/16. The appraisal was submitted to our office and the claim was settled on 12/21/ The shop contacted the appraiser on 12/7/advising that a supplement estimate would be needed. The shop did not send all the supplement photos to the appraiser until 2/5/18. There were still some questions as to what the cause of the additional damage was. We assigned the appraiser and an engineer to re-inspect the RV on 2/16/18. The vehicle was re-inspected on 2/22/18. The engineer’s report was provided to us on 3/9/18. RLI approved the coverage denial on 3/19. The insured was informed of the denial on 3/23/ The appraiser did share a copy of the supplement estimate with the shop. However, at no time did they authorize the shop to start or continue repairs to the RV The supplement estimate provided to the shop states the following: NOTICE TO REPAIRER: This is NOT an authorization to repair. This is an appraisal of damages only No appraiser or adjuster has authority to authorize repairs. Authorization to repair and guarantee of payment can only be made by the owner Any delay in the initial inspection of the RV was the result of a scheduling issue with RV owner Payment was issued for the original repairs shortly after receipt of the estimate. An additional inspection was needed for the supplemental damages in order to determine the cause and extent of damages. The coverage denial was issued once we received the engineer’s report that confirmed the damage was the result of improper maintenanceYou will see from the above timeline that the response time for all actions was reasonableThe policyholder's statement that the appraiser approved the damages is incorrect; the language on the estimate explicitly states that it is not an authorization to repair or a guarantee of payment. Tell us why here

Initial Business Response /* (1000, 5, 2016/06/20) */
This dispute involves the payment of an insurance claimMs*** is alleging that we have a "loophole" to avoid paying claimsNothing could be further from the truthWe have paid 10s of millions of dollars in recreation vehicle related
claims in this program
Ms*** was sent documents for her renewal insurance policy in late June Included with those renewal documents were two notices: a "Change in Risk Notification" and a "Recreation Vehicle Program Forms Revision Advisory Notice to Policyholders." Both forms have been attachedEarlier in the insurance company received approval from the Texas Department of Insurance for changes to the insurance policy issued to Texas policyholdersThis was the first renewal for Ms***'s policy since these form changes were approved by the state, so they were included with her renewal documentsThe latter form referenced above provides information about policy exclusions that have been added for vehicles that are not registeredRather than just adding this "loophole" to the policy, we sent a separate notice created to highlight these important changes
I have highlighted multiple sections of the "Change in Risk Notification" form- those highlighted sections specifically reference the requirement that insured vehicles remain registered at all timesMs*** has stated that we did not notify her of this requirement, but the attached document clearly proves that to be incorrect
The insurance policy is a contractChanges to the contract can only be made by written notification to the policyholder in advance of those changes being madeAdvance notice provides the policyholder with the opportunity to determine if they would rather take their business elsewhere, or remain with the insurance companyWe provided the notice of these changes to the policy, but if the policyholder chooses not to review the documentation that we sent, we can't control that
We would like to assist Ms***, but payment of her claim would be outside of the language of the insurance policy that has been provided to her
Initial Consumer Rebuttal /* (3000, 7, 2016/06/27) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The paper work that they are speaking of for my renewal is sent via emailI printed out the page document entitled "Policy Declarations"It BASICALLY states your payment and amount that your policy coversThere are no explanations that the policy has changed and a warning to be sure and check to see if your trailer road tags are currentAgain, my tags were not current because it hasn't been on the road in over a yearThe "seals" issue is not mentioned in his statement because it is a loop hole using terms such as "as needed"If something as important as a new "VOID your policy" change did accrue, then they should have you agree to the changes in writing so that both parties are awareThey kept taking my money each month, without an issueSomething that voids my policy should be monitoredWe have taken a $17,lossI want them to honor our agreement and total the trailer, as the adjustor suggested
Final Business Response /* (4000, 9, 2016/07/07) */
During the initial policy term (7/30/2014) the policyholder agreed to receive all insurance documents electronicallyIn doing so the policyholder was provided with terms and conditions of receiving their documents electronicallyThe terms and conditions state that all documents regarding the policy will be sent electronicallyThe renewal documents were emailed to the policyholder on 6/29/for the renewal term to be effective on 8/8/The email included a number of attachments, including the renewal policy Declarations cited by the policyholder in their prior response, but also included the renewal invoice, and the important notices that we attached with our prior responseThe onus is on the policyholder to review all of those attached renewal documents, not just the documents that indicate the premium dueTo draw attention to important policy changes, the insurance company drafted a specific notice, RV (attached previously)This notice provided specific information about the need to have all insured vehicles registeredThe insurance company cannot hold every policyholder's hand to ensure they read and review the documents sent to them- that is the policyholder's responsibility
This dispute involves an insurance claim, and the interpretation of the insurance contract provided to the policyholderThe policyholder has remedies under the law if they disagree with our interpretation of the insurance contact that was applied in this claim situationThe Revdex.com cannot be a forum for arguing the merits of our decision
Final Consumer Response /* (4200, 11, 2016/07/11) */
(The consumer indicated he/she DID NOT accept the response from the business.)
They stated it best, "The email included a number of attachments' and that is my pointThey hide the loop hole in documents that VOID your policy, a new policy at thatThe bottom line is that Blue Sky Insurance is not an insurance company in the business to help peopleThis has been the most difficult months with all the water damage to our home and RVOur home repairs are coming along, but take timeThe RV is totaled with no help in sightYou hope you never need to use your insurance, but rely on it when you need itDON'T RELY ON BLUE SKY INSURANCE AS THEY HAVE POLICIES YOU ARE NOT AWARE OFThis has been a heartbreaking experience and a very difficult and expensive lessonDON'T DO BUSINESS WITH INSURANCE CO ONLINEUse a local company that will take care of your needs and that you can trust

I am rejecting this response because:
The company did not address my concern of delays in handling of my claim On two occasions my claims was unnecessarily delayed due to improper claims handling First it took their appraiser approximately days to inspect my coach which resulted in additional water damage After my shop submitted a supplement to the appraiser, the appraiser agreed with my shops supplemental repairs and released a copy of his estimate to the repair shop In doing so he asked the repair shop for their tax ID number to which the shop responded The repair shop was under the impression from this communication that the check for the additional damage was being issued and therefore continued to work on my coach After nearly days the company then denied my claim for additional damage During that time I was never contacted by anyone to advise that the claim was under any type of additional investigation This clearly constitutes bad faith claim handling

First, this complaint involves the actions of RIS Risk Management Services, LLC, not Recreation Insurance Specialists, LLC. Both entities are under common ownership, but are separate entities and provide separate services. Recreation Insurance Specialists is not involved in the claims handling...

process that resulted in this individuals' complaint. However, we do have access to the information related to the claim and will respond.  This individual's complaint involves provisions of an insurance policy contract. Payment for this claim was made in November 2016. A broken skylight allowed water to enter and damage the carpet. The repair shop submitted an estimate for supplemental repairs in December 2017.  The supplemental repairs involved water damage to the walls, flooring and ceiling coverings.  An engineer was retained to review this additional damage and the engineer’s report was received on 3/9/18.  The engineer's report indicated that the additional damage is the result of improper maintenance and unrelated to the initial skylight damage.  The improper maintenance allowed water to gradually leak into the unit causing gradual deterioration. There is an exclusion in the policy contract for that occurrence. The exclusion in the insurance policy contract was approved by the state Department of Insurance in North Carolina. The insurance contract stipulates what the insured can do if they do not agree with the  determination regarding the applicability of the exclusion. Furthermore, the state Department of Insurance has a complaint process for any policyholder that believes they were not treated properly in a claim situation.