Robert Moreno Insurance Services

Review: On 12/14/14 I was hit by one of the company's insured in a parking lot. As we were leaving the lot. We came up on the insured's car as he backed out. We stopped to wait. He stopped and put the car in drive and proceeded to move forward. For some reason, he put the car back into reverse and hit the gas. He was traveling at 5-7 mph and back into my [redacted]. The insured, [redacted], got out of his car immediately apologizing and offered to pay me right there. Since I didn't know that extent of the damage I refused and asked for his insurance info. He's insured by [redacted] Insurance Services. I contacted them to submit the claim. I filled out in detail the claimants report of accident on 12/23/14 and mailed it immediately. After not hearing anything for a couple weeks, I contacted the agent, [redacted], to see what the status was of the claim. He informed me that the insured is claiming that I hit him. As you can imagine this frustrated me. Why if I hit him would he not ask for my insurance info on site let alone my name or phone number? A week later on 1/22/15 I called [redacted] to check in again and was told that they have to support their insured and believe him. Robert [redacted] Insurance Services is fraudulent. On 1/12/15 when I spoke with [redacted] he informed me that the insured said on his claimant report of accident that he was rear ended with no detail. That he was trying to contact him to get more info and was unsuccessful. When I spoke with him on 1/22/15 he said that he still hasn't been able to contact him. How can he of come to a decision if he hasn't gotten any more info from the insured. It doesn't add up.Desired Settlement: I expect RMIS to pay for the damages to my car that was done by a client of theirs. He was at fault. They had no intention on paying me for the damage from day 1.

Business

Response:

Review: On 12/28/12 I was driving my friends van. I had recently moved to Modesto, CA and did not have a vehicle. He put me on his insurance policy so I could legal drive it for my own personal use. At approximately 10:45 a.m., while sitting at a stop light, I was rear ended by Ms [redacted] daughter who was driving the insured's automobile. As a result of the collision, I suffered whiplash, and a previous back injury was re-aggravated. I was contacted during the first week of January 2013 by [redacted], Liability Claims Examiner for Ms [redacted] auto insurance company, ROBERT MORENO INSURANCE SERVICES(RMIS). A few days later, I received a packet in the mail from RMIS stating I needed to fill out the paperwork, sign and date the documents and return it to them. I did so. In March 2013, Ms [redacted] claimed that she had not received the paperwork I had signed and returned. She resent the packet, I filled it out again, signed it again, and mailed it back again. In April 2013, Ms [redacted] claimed that, again. She did not receive the paperwork. I kept a copy the second time around, so the third time I sent the papers, I did via fax.Then it in April 2013, it started all over again with the Medical records. At first the doctor sent them to me. I, in turn, sent them on to RMIS. Ms [redacted] claimed she never received them. Then The Doctors office faxed them to Ms [redacted]e, who again claimed only the impertinent forms actually came over the line to her. The Doctor then faxed them to her AGAIN - delivering the records to her for the third time before she acknowledged having them in receipt. In April 1013 I had gone to a different state due to a family emergency for 2 months. I informed Ms [redacted] of this when we spoke in May, and June. Finally, near the end of July 2013, during a telephone conversation, Ms [redacted] informed me that she needed my employer information and the insurance information for the vehicle I was driving at the time of the accident.Desired Settlement: Robert Moreno Insurance Services should be prosecuted for Insurance Fraud in the state of California; their licenses revoked, and the appropriate state and federal sanctions and criminal penalties should be fully enacted against them to the fullest extent possible!

Business

Response:

Dear Mr. [redacted]:

Our insured reported the loss to Robert Moreno Insurance

Services on Friday, December 28, 2012.

She reported that your, 2002 Ford Econoline E150 was rear-ended by our

insured’s vehicle.

The file was initially assigned to [redacted] on

January 2, 2013, for further investigation.

On January 3, 2013, the initial adjuster secured your verbal statement,

and verified you were driving a company vehicle on date of loss. You were experiencing neck pain, and you did

not seek medical treatment yet.

On January 22, 2013, we received a copy of the police

report, which confirmed the loss facts.

On February 4, 2013, the adjuster completed her liability decision and

found our insured at fault for this loss.

The adjuster sent an at fault letter to our insured. On the same day, the adjuster informed you

of our liability decision, and verified that you were treating with a

chiropractor three times a week for about a month.

On February 12, 2013, we received the repair estimate of

$1,013.87 with damage photos of the 2002 Ford Econoline. The adjuster processed the property damage

payment. On February 13, 2013, we mailed

out the property damage settlement check to the registered owner, [redacted].

On March 4, 2013, the adjuster spoke with you and confirmed

that you were still treating with the chiropractor’s office two times a

week. On May 22, 2013, you advised the

adjuster that you were in Arizona, and when you return home you would gather

all your medical bills and send them to us.

On June 20, 2013, you informed us that you were still in Arizona due to

a family issue. You would gather all

your medical bills and send to us when you return home.

On July 18, 2013, we received your medical report from

Modesto Chiropractic Center, but the medical bills were not included. On July 18, 2013, the adjusters acknowledged

receipt of your Medi-Care document, the chiropractic report, and the progress

notes. The adjuster also informed you

that some of the pages came out very dark, and she was unable to read them, and

no actual bills were included. On July

30, 2013, we received the medical bill from Modesto Chiropractic office, but no

ICD-9 (Diagnostic codes) or CPT (Procedural codes) were listed on the medical

bill. The adjuster immediately contacted

the Modesto Chiropractic office and spoke with [redacted] to have them re-fax their

medical bill including the ICD-9 and CPT codes to us for review.

On August 1, 2013, the adjuster explained to you that we

needed the auto liability insurance information to rule out Proposition 213,

and we also need to verify with your employer of any workers’ compensation

claim open related to this loss, so that we could review your injury claim

properly. During our telephone

conversation on January 3, 2013, you advised us that you were driving your

boss’s vehicle on date of loss.

On August 2, 2013, you left a voicemail message to the

adjuster that the vehicle registered owner[redacted] is your friend and not your

employer, and you borrowed his vehicle on date of loss. You stated that there was not a workers’

compensation claim for this loss.

On August 15, 2013, the file was reassigned to adjuster

named [redacted]. The new adjuster

sent the reassignment letter to you, and also called and left you a message to

discuss the workers’ compensation claim issue.

On August 22, 2013, you informed the adjuster that you were

self-employed. You were using your

friend’s vehicle to pick up pool supplies on the date of loss.

On September 11, 2013, the adjuster called and left a

message to the vehicle registered owner[redacted] to secure his auto liability

insurance information. The adjuster also

told you that we needed to obtain the liability insurance information to rule

out Proposition 213 for your injury claim.

On October 11, 2103, the adjuster informed you that we still

had not obtained the liability insurance information from you or the registered

owner. On October 30, 2013, the adjuster

advised you that we did not receive the fax from the vehicle-registered

owner. On October 31, 2013, you advised

us that the vehicle-registered owner was out of town. You indicated you would follow up with the

owner and call us back with the information.

On November 8, 2013, the adjuster obtained the liability

insurance information and ruled out Proposition 213 with the adjuster at Wesco

Insurance Company. They advised us that

they resolved your medical payment claim.

As you may know, Proposition 213 is the ballot initiative passed by

California voters to limit the amount of recoverable damages for uninsured

motorist after a traffic accident.

Proposition 213 only allows uninsured motorist to recover special

damages (medical bills, loss wages, etc), not entitle to recover for pain and

suffering.

On November 19, 2013, the adjuster informed you that we

needed a signed declaration from you to confirm that you were self-employed at

the time of this loss. On the same day,

I personally spoke with you in regards to your injury claim status. You explained that you were self-employed on

date of loss. You borrowed your friend,

Ted’s vehicle to get the supplies for his pool.

You confirmed that you would not be pursuing a loss of earnings claim on

this loss, and there is no workers’ compensation claim open. I sent a letter to you to confirm our

telephone conversation and request you to sign and return the letter, which we

received on November 26,2013 by fax.

Your chiropractic treatments began on January 7, 2013 and

ended on June 26, 2013. It was total of

28 visits in the amount of $3,000.00.

The chiropractic diagnosis were lumboscaral sprain/strain, thoracic

sprain/strain, cervical sprain/strain, and spasms. No prognosis was provided in the report.

According to the repair estimate, the van sustained minimal damage the rear end

area. We paid out $1,103.87, and this

included the replacement parts of $510, and the labor costs of $503.20. This appears to be a minimal impact loss. Therefore, we feel that six weeks of

treatments from January 7, 2013 to February 4, 2013 would be reasonable for a

minimal impact loss with soft tissue injuries.

The chiropractic costs from January 7, 2013 to February 4, 2013 that we

considered would be $1,095 plus general damage, and our initial offer was

$1,500.00.

After we received your signed letter, the adjuster contacted

you and extended an initial offer of $1,500.00, which you rejected the

offer. You made a counter demand of

$42,000 to resolve your injury claim.

Our offer was based on the minimal vehicle damages, and the chiropractic

diagnoses.

On December 20, 2013, January 13 and February 7, 2014, the

adjuster had left you messages on your voicemail to discuss your bodily injury

claim, and we did not receive a response from you.

On February 10, 2014, the adjuster reiterated the last offer

of $1,500.00, and once again you rejected the offer, and made a counter demand

of $25,000.00. You did not provide us

with any supporting documentation to support your counter demand. We feel that our initial offer of $1,500.00

was reasonable based on a minimal impact loss.

We're hopeful that you now have a better understanding of exactly what had occurred with your claim.

Thank you.