West Bend Mutual Insurance Company

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 I do not agree with West Bends Response and at this time will have to seek legal council to litigate this matterI also urge West bend to fix my clue report as it states that I had a claim for water damage in and (three separate claims)When originally placing the claim they used the date that the repairs were done and then changed it to when the damages were noticedThis is incorrect and would like to have this rectifiedThey are also showing a claim for the Ford in and this claim was never acted upon, it was paid for out of pocketWest Bend should teach their estimator how to communicate with their insured so this unfortunate situation does not happen to someone elseIt's a shame that a loyal customer of years gets to go through all of this through no fault of her own due to poor communication and finger pointingRegards, [redacted]

[A default letter is provided here which indicates your acceptance of the business's response If you wish, you may update it before sending it.] Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Regards, [redacted]

This is in response to the complainant's most recent correspondence forwarded to us under coverof yours dated March 25, 2015.Both claims and underwriting management have reviewed this matterWe do feel ourinvestigation led to the correct resultHowever, we also recognize that the complainant isdissatisfied with both the level of communication and the outcome of the claimSince this was arelatively minor incident and the facts are disputed, we have decided to change our policy recordto show this incident as a not at fault accident

[redacted] , A Division of West Bend is the workers compensation insurer handling a [redacted] workers compensation claim for the complainant from injury date 8/4/2014.This response is to complainant's 12/22/2014, follconcerns to the Revdex.com, which hedid not feel were properly addressed in our 11/15/or 12/18/responses.The State of [redacted] , Department of Workforce Development has established thelaws governing workers compensation benefits to all [redacted] employees, employersand insurance companies/benefit administrators not otherwise governed under anotherState or Federal workers compensation program [redacted] has explained to complainant [redacted] 's out-of-state treatment parameters as outlined in statute 02.42(2)(a) whichstate an injured worker may have the choice of a qualified practitioner not licensed inthis state ( [redacted] ) upon the referral of injured workers in-state practitioner.As stated in our previous responses, [redacted] has not denied benefits to complainantrelative to his 8/4/ [redacted] workers compensation claimThe last [redacted] practitioner referral [redacted] received was 9/26/At that time, complainant's [redacted] practitioner made a referral to a [redacted] doctor, however, that [redacted] doctorrefused to treat a patient on workers compensation benefits [redacted] has received noother referrals from complainant's [redacted] doctor.If complainant believes [redacted] has denied medical treatment as outlined in [redacted] statute 102.42(2)(a), he can file an Application for Hearing with the State of [redacted] ,Department of Workforce Development, [redacted] , Complainant can also call the Workers CompensationDivision at ###-###-#### to ask if [redacted] has failed to administer his claim pursuant to [redacted] workers compensation statutes and receive additional instruction for filing aformal Application for Hearing.If you would like any supporting material or further clarification, please advise theundersigned at your earliest convenience

The complainant presented a claim on July 28,for water damage to the interior ofher home that resulted from moisture build up in the attic due to improper ventilation.During the claims process, we informed the customer her policy covers the resultingdamage to the home, but it would be her responsibility to make any necessary correctionsto alleviate future problems and this cost would not be covered by her policy.The claim was investigated, adjusted and paid in accordance with the terms of theinsurance policy.In March of 2015, the complainant informed us that she again had ice damming andmoisture built up in her atticWe advised the customer this new damage would again becovered under her policy and a new claim could be set up, as this would be considered asanother occurrence.If the complainant decides to proceed with the second claim, the water damage would becovered under the policy but she would again be responsible for making any necessarycorrections to her home that may be causing the water infiltration

This is in response to the complainant's most recent correspondence forwardedto us under cover of yours dated April 9, 2015.We have looked into this account and had further conversations with the insureddirectly correcting this matter. In conclusion, an error had occurred whileprocessing the... cancellation request. The agent had informed our office and wewere already in the process of correcting the error. As soon as West Bend wasaware of the error, it was immediately addressed and West Bend madeadditional contact with the insured to be sure the issue was resolved.

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

We looked into this account and have found that the decision was warranted based on theduration of the account and claims historyHowever, before this complaint was received in ouroffice, we were already working with the agency on a possible solutionFurther discussionswith the agency and the
insured together, we have reached a solution.We appreciate the contact and hope this satisfies this matter

This is in response to the complainant's most recent correspondence forwarded to usunder cover of yours dated March 30, 2015.The initial damage we inspected was the result of condensation due to an improperlyvented atticWe paid to remove the wet insulation and install new insulation and alsotake care of the resulting interior damage caused by the condensation in the atticAfterrepairs were completed , the complainant's contractor found soffit vents had insulationpartially covering themIt is not known whether this insulation was a result of workperformed by the contractor that insulated the attic or the repair contractor who attendedto the condensation damageRegardless, West Bend's responsibility is to pay fordamage covered by the policyWe are not responsible for the supervision of contractorsor the quality of work they perform.The complainant was told at the initial inspection that necessary corrections to properlyventilate the attic would not be covered under her policyWest Bend does not have anobligation under the policy to diagnose or pay costs to rectify the ventilation problem .We have offered to consider the new damage from the second incident as a separateclaimThe complainant remains unwilling to handle the damage as a separate claim

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.
Regards,
*** ***

This claim was reported to us on July 4, and assigned to a Claims representative forinvestigation.During our investigation, we contacted the parties involved and obtained their respective accountsof the incidentWe a lso gathered photographic evidence of the claimed damage from the
adverseparty.After a review of all the evidencewe determined our insured driver was responsible for theclaimed damage and we handled the claim according to the terms of the insuring agreement of thepolicy in force at the time of the loss

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.
I do not agree with West Bends Response and at this time will have to seek legal council to litigate this matter. I also urge West bend to fix my clue report as it states that I had a claim for water damage in 2012 and 2014 (three separate claims). When originally placing the claim they used the date that the repairs were done and then changed it to 2014 when the damages were noticed. This is incorrect and would like to have this rectified. They are also showing a claim for the Ford in 2011 and this claim was never acted upon, it was paid for out of pocket. West Bend should teach their estimator how to communicate with their insured so this unfortunate situation does not happen to someone else. It's a shame that a loyal customer of 6 years gets to go through all of this through no fault of her own due to poor communication and finger pointing. Regards,
[redacted]

Attn: [redacted]
 
We are looking into your account and working through this matter. In order for West Bend to cancel a policy or coverage portion, it is required we received a signed cancellation request from the insured. We have found that this request was not received, which is why we continued...

to provide coverage since premium was paid/applied to the package policy. As of 11/12/14, we have received the signed cancellation request and proof of replacement auto coverage effective 4/11/14. We have updated our records and our accounting department has compiled a revised billing breakdown. This breakdown along with your refund check will be out in the mail shortly. We appreciate your contact and hope this satisfies your request.
 
Thank you!

This complaint arises from an accident which occurred on November 6, 2014. The complainantasserted the amount offered to repair his vehicle was insufficient and that we denied his claim fordiminution in value of his car.The claim was reported to us on November 7, 2014. We received the police report,...

whichidentified the complainant, on November 17th. On November 21st, our appraiser met with thecomplainant to inspect his vehicle, and on November 26th, an offer was extended to thecomplainant for the settlement of his claim.Our appraiser contacted two of the three shops that the complainant had submitted estimatesfrom , and both agreed to do the repair for the amount of our estimate. All three of the estimatessubmitted by the complainant included the cost of a new bumper cover. The bumper cover is nolonger available and both shops stated they included it in their estimate at the request of thecomplainant.We reviewed the complainant's claim for diminution in value but the evidence he supplied didnot support his claim. When our appraiser met with the complainant, he showed him evidence ofprior repair work to both the front and rear of the vehicle. We were able to verify that the vehiclewas involved in an accident in 2004 and it was reported that the car sustained front and reardamage. Based on the minor damage from this accident, coupled with the prior damage to thecar, we do not believe there is a basis for a diminution in value claimIn the time since your office received this complaint, we resolved the matter with thecomplainant and secured his release and discharge of any complaints against West Bend.

West Bend's response is attached.

We have looked into this account and have found that the signed cancellation request was norreceived in our office until 5/ 18/ 15. This account was set up on automatic monthly EFTwithdrawals and since the required documentation to cancel a policy was not received until 5/18/15the automatic EFT...

withdrawal was drafted on 5/15/15. A schedule of future withdrawals wascommunicated to the insured prior to withdrawal.We understand the frustration you have experienced with the changes to your policy that were madeafter the policy was issued. Our policy requires that we insure homes at the full replacement cost sothat you are covered in the event of a loss. After inspection of your home, the results showed thereplacement cost was materially higher than originally submitted by your agent. Thus the reason forthe increase in premium. I have asked our accounting department to compile a detailed breakdownpertaining to your billing questions. This will be in the mail shortly. We appreciate the contact andhope this satisfies your request.

[redacted], A Division of West Bend is the workers compensation insurer handling a[redacted] workers compensation claim for the complainant from injury date 8/4/2014.This response is to complainant's 12/22/2014, follow-up concerns to the Revdex.com, which hedid not feel were properly addressed in our 11/15/14 or 12/18/2014 responses.The State of [redacted], Department of Workforce Development has established thelaws governing workers compensation benefits to all [redacted] employees, employersand insurance companies/benefit administrators not otherwise governed under anotherState or Federal workers compensation program. [redacted] has explained to complainant[redacted]'s out-of-state treatment parameters as outlined in statute 1 02.42(2)(a) whichstate an injured worker may have the choice of a qualified practitioner not licensed inthis state ([redacted]) upon the referral of injured workers in-state practitioner.As stated in our previous responses, [redacted] has not denied benefits to complainantrelative to his 8/4/2014 [redacted] workers compensation claim. The last [redacted]practitioner referral [redacted] received was 9/26/2014. At that time, complainant's[redacted] practitioner made a referral to a [redacted] doctor, however, that [redacted] doctorrefused to treat a patient on workers compensation benefits. [redacted] has received noother referrals from complainant's [redacted] doctor.If complainant believes [redacted] has denied medical treatment as outlined in [redacted]statute 102.42(2)(a), he can file an Application for Hearing with the State of [redacted],Department of Workforce Development, [redacted]
[redacted] , Complainant can also call the Workers CompensationDivision at ###-###-#### to ask if [redacted] has failed to administer his claim pursuant to[redacted] workers compensation statutes and receive additional instruction for filing aformal Application for Hearing.If you would like any supporting material or further clarification, please advise theundersigned at your earliest convenience.

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 10295647, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.I have now gotten 4 referrals to 4 different doctors who will not accept [redacted] Workman's Comp or [redacted] Ins. Since I do not have insurance and have been asking for referrals from my FORMER Insurance carrier and Doctor they have now told me that this last referral would the the past one they send. So now I cannot even get a referral from my past Doctor. So I wrote to [redacted] Insurance to see if they would help me to find a doctor that might be in their network. But they never replied. They also never mentioned all the times I called asking for help which they REFUSE to help me. I am now walking with a cane to take the weight off my back and it is getting worse every day.Not once have they said just go to any doctor that will accept [redacted] Workman's Comp. Instead they throw around dates and what they allegedly told me which is incorrect too.They are not in the help business at all. They are in the "How can we avoid helping someone who we insure, who was in a car accident and now suffering business." I am quite certain I would have been better by now if they had just let me seek treatment but as I said they refuse too help me and my condition is worsening. Imagine no being able to get out of bed in the morning, being able to shower or get ready for work. When at work need to get up from my desk every 10 minutes to bend and stretch my back to try to get some relief.An insurance company, [redacted], paid by my former employer to help victims of accidents like me and they are not doing what Kayser Auto has paid them to do. Instead they throw out excuses why they won't help me.I asked can I just go to any Doctor that would accept this case and of course they will now reply. They will however reply to this Revdex.com post to say nothing but dates and this and that.This is the absolute worst customer service I have ever seen. I guess the only way I can get help is to fly back to [redacted] to see the original doctor according to them that's the only way they will cover it. I can't afford that. I will however move back to [redacted] because the pain is so great that I cannot stand it and go for permanent disability. This is the reality of this case. They won't help, I can't afford help so as long as my pain keeps getting worse I will have no choice than to not to be able to work.I would like supporting material that they will allow me to see any Doctor here in [redacted] but they will not provide that. What do they care? I'm in pain and they are being typical big business by trying to avoid payment. I am sure the Vice President Jim [redacted] get's paid a pretty good salary and that his time is worth money. Instead of paying for my severe injury he has time to write the Revdex.com back. FOr the time and money he wasted writing back that would have been at least 2 appointments for me to seek help.I truly believe their position is, "let's not pay the injured person's claim and hopefully they will go away." At least this is the position they've taken up till now.I am not sure if I need to take this to the news in [redacted] or work with Social Media for which I am an expert. Before I do that I will write the [redacted] [redacted].The sad part is, I was only seeking help from an accident that happened at work and for which they are the Insurer.  My father was in insurance his whole life. When something happened to someone he was there for them. My how times have change. Corporate policy to not help an insured patient is unreal.Now I am certain Mr. [redacted] will make time to respond to this instead of just getting me taken care or.#[redacted]Regards,
[redacted]

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.
Clearly West Bend Mutual is dodging their responsibility to provide the coverage for the premiums they collected from us for 16 years.  Their offer is not fair and they failed to inform us in a timely matter of their opinion (and the coverage they would provide) to mitigate the mold damage.  It was only after I contacted them two weeks after my initial contact did they inform us of their position.  We had an accepted offer to sell the house and had a very limited time frame to correct the mold damage.We seem to be at an impasse with this resolution process through the Revdex.com.  Since it's not economically feasible for us to take legal action, I'll resort to expressing our opinion about how they've treated us on various review sites on the internet.  We may be "sunk" but hopefully many others will read about how we were treated and take their business elsewhere. 
Regards,
Michael [redacted]