West Bend Mutual Insurance Company

We received our first notice of this claim on May 27, 2014 and made contact with the complainant by telephone the same day.  In that conversation, we asked the complainant to obtain an estimate of repair for the damage caused by our insured when he backed into the complainant’s...

railing. 
 
On June 24, 2014, we received only photos from the complainant, which showed an iron railing with what appeared to be minimal damage.  The complainant also sent photos of concrete which appeared to have been cracked long ago.  Having received no estimate of repair, we sent a good-faith offer to the complainant for the minimal railing damage visible in the photos.   
 
When the complainant refused our offer in a phone conversation on July 3, 2014, we assigned an appraiser to inspect the complainant’s property and estimate the damage caused by our insured.  That appraiser determined the cost to repair the railing, however, due to the fact the railing is 20 years old and was in worn and rusted condition prior to this incident, he suggested a depreciation percentage would apply to the cost of repairs.  Furthermore, the appraiser advised it is evident the cracking of concrete around the stairway pre-existed this occurrence and was caused by settling of the concrete. 
 
We’ve offered a settlement to the complainant, which represents the replacement cost of repairs less depreciation, for the damage caused by our insured.  We stand ready to forward payment upon receipt of the complainant’s signed release.

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 matter. We do feel ourinvestigation led to the correct result. However, we also recognize that the complainant isdissatisfied with both the level of communication and the outcome of the claim. Since 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.

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.

The damage to the roof occurred on 7-21-16.  This claim was first reported to West Bend on 8-25-16.  Our insured was hired to prune trees at the claimant’s residence.  The claimant informed the insured that the garage was not in good condition. The insured stated he could do the job...

without going on the roof.    However, the insured stepped on the garage roof and it was in such poor condition his foot went through the decking on the roof. The roof is missing roof covering in several areas on the roof.  Our insured received a bid to repair the hole for $200.   We offered to pay the actual cash value of the replacement of the roof.  The claimant was also given the opportunity to present the claim to his own carrier and they could subrogate us. Unfortunately, the claim value was below his deductible.  Based on the evidence provided, we feel a fair offer has been made and no other offers will be made.

Please accept this as our response to the complaint we received on July 9, 2015.THE SILVER LlNING ®On April 29, 2015, we received a claim for hail damage to the complainant's property. Our claimrepresentatives inspected the complainant's camper and home. Hail damage was found on the camper, aswell...

as window wraps and fascia on the home. Subsequently, our payment reflecting the cost of repairsfor the damage covered by the policy, less the deductible, was sent to the complainant.It is our position that additional damage to the roof and siding is not covered by the policy.

Attached is West Bend's Response.

This will acknowledge receipt of your follow e-mail
regarding Mr. [redacted]'s addition concerns.As we stated
previously, the video documents that the technician did not do any work near
the damaged condenser. In addition, we find nothing to support the allegations
that the employee may have deleted a portion the video or that, our insured's
are covering something up to avoid paying Mr. [redacted].While it is true that the
condenser failed while Mr. [redacted]'s vehicle was in our care, they did not do
anything to cause the failure to occur. It is our insured's position that the
damage to the condenser was pre-existing and that failure just happened to have
occurred while the vehicle was in their shop.

Revdex.com ID#                11741493 Dear [redacted]This complaint arises out of a claim submitted to West Bend on July 29, 2016 for broken trusses in the attic of the home of Lynda and Wade W[redacted]. As part of West Bend's...

investigation an inspection was completed by a West Bend claims adjuster and an independent structural engineer. The conclusion reached by the engineer states:"The cracked ridge board is a condition that had existed and developed over an extended period of time the ridge board crack because it was improperly supported at elevation changes. As load shifted to the nearby valley rafter, it's weakened condition, due to the presence of the large knot, was exacerbated. A better quality board should’ve been used for the valley rafters. It is our opinion the cracked ridge board and cracked valley rafter are the result of improper construction. Improper construction of the roof rendered it unable to support code required roof loads.”The cause of the damage was not covered by the Homeowners policy. The following policy language applies to the situation:"We do not ensure however for loss due to:wear and tear, marring, deterioration; Settling shrinking bulging or expansion, including resultant cracking, of bulkheads, pavements, patios, footings, foundations, walls, floors, roofs or ceilings;”  The policy also has the following exclusionary language:"We do not insure for loss due to faulty, inadequate or defective: Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; Materials used in repair, construction, renovation or remodeling." Due to the cause of the damage and the terms of our policy, the claims was not covered under West Bend’s policy.

[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.Since receipt of the complaint, we have corresponded with the complainant addressingthe issues he identified in his I 115/2014 complaint...

letter.Prior to complainant's move from [redacted] to [redacted] paid all of the medicaltreatment incurred related to his 8/4/2014 accident. No medical bills incurred relative tocomplainant's 8/4/2014 work injury have been denied. On 9/23/2014, complainantcontacted our fi le handler to ask if there were any parameters for out-of-statetreatment. Complainant did not indicate during that conversation he was intending tomove to [redacted]. Our file handler advised complainant of [redacted]'s choice ofpractitioners rule, including up to two (2) choices of providers licensed to practice andpracticing in [redacted], and that a referral from the practicing [redacted] doctor to anout-of-state practitioner would not be considered a second choice. Our file handler alsoexplained how bordering state's treatment was handled. On 9/26/2014, complainantsecured a referral from his [redacted] doctor, to a doctor in Fort Meyers, [redacted], butevidently, the new [redacted] doctor refused to provide medical treatment because he statedhe does not treat workers compensation patients. The Workers Compensation Act of[redacted] states, "By mutual agreement, the employee may have the choice of aqualified practitioner not licensed in this state ... "(102.42(2)(a)), and effective 1/ 1/2000,an employee's right to out-of-state treatment when referred by an in-state practitioner isnot limited by a requirement for prior approval. From reviewing our file, it is evident ourfile handler explained these rights under the Act. Because the [redacted] Act does notpermit the insurance carrier to direct medical care, the responsibility of choosing apractitioner is that of the injured worker, regardless of where the treatment is sought.On 10/15/2014, our file handler advised complainant via email that we could not directhis medical care. She further advised that she was requesting complainant's priormedical records in order to obtain an independent medical opinion to address the natureand extent of the injury. We advised that if an independent medical review determines aplateau in recovery has been reached, at any point, we have the right to adapt that opinionand extent of the injury. We advised that if an independent medical review determines aplateau in recovery has been reached, at any point, we have the right to adapt that opinionand discontinue benefits. As of this date, there has been no written correspondence fromour file handler or summary of conversations that we are denying complainant's claim.We have asked our file handler why she believes complainant would make the statementabout her being rude. She believes the primary issue from the 11 /5/2014 telephoneconversation was that she would not provide a denial letter to complainant because hecontinued to come back to that question. Evidently, complainant wanted a written denialof workers compensation benefits letter from [redacted] to provide to his auto insured.If you would like any supporting material or further clarification, please contact [redacted], Assistant Vice President [redacted] Claims at ###-###-####.

[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]

Dear Mr. [redacted].On November I l, 2015, Mr. [redacted] brought his 2010 Chrysler
Town & Country into our insured's store for the purchase and installation
of four new tires. As part of their service, [redacted] checks the
condition of batteries for their customers.[redacted] videos the...

work of their technicians to
verify that they are following the required procedures +e repairing vehicles.
In this instance, the video documents the technician opening the hood on the
vehicle and then setting the support rod located on the passenger side of the
vehicle. The technician then retrieved the battery tester, returns to the
vehicle, and then tests the battery, which is located on the front driver's
side of the vehicle. The technician then picks up the battery tester, returns
it to the and returns the front passenger
side of the vehicle and closes the hood.After the technician completed the tire change, he started
the vehicle to move it to the alignment rack when he noticed there was liquid
coming up on the windshield. Upon inspection, he found that the condenser was
leaking and it appeared to him that there was an ongoing problem with the
hood's safety latch causing damage to the condenser.The video documents that the technician did not do any work
near the damaged condenser, which is located in the front of the engine
compartment in the center of the vehicle. The video also documents that the
technician did not use any hand tools during the period that the hood was open
so the allegation that he left a tool under the hood is unfounded.It is our position of our insured and our company that
the technician did not do improper that have caused the damage to the
condenser and as such, our insured is not responsible for the cost to replace
the condenser.

The complainant presented a claim on July 28,2014 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 attic. We 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 company is awful. They just tried to double charge my first year homeowners premium. They sent a bill to the mortgage company stating they needed to be paid the premium for the first year's coverage. This is 9 month's after the policy was written. Really? They were paid the day we closed on the house. The check was cashed. The policy wouldn't have even been issued had it not been paid up front. Then you try to call them and can't get an actual person on the phone. Less than a year and I'm switching companies already. Worst customer service.

Still currently working on a claim with these people. Their insured was at fault. They determined fault. Dragging their feet making me an offer. I had to get the estimate. I had to submit pictures. I have done all the work. No one has called or emailed me for days. This is cut and dried. Tired of waiting.

Review: I called the West Bend Insurance Company to ask a billing question about my policy and was directed to ***, and *** of a local agency *** in *** ###-###-####. She was rude, over talked me when I was asking questions, evaded answers, I told her that she was not being a polite customer service agent and to just email me an itemized bill of charges and payments for the last year and she said "no". I told her rudeness warranted cancellasion of my policy. She said "put that in writing" and hung up.Desired Settlement: I want a copy of my itemized bill to make sure that I have not been charged incorrectly.

I also want West Bend to send me a copy of a letter of reprimand placed in this woman's file or some action taken to correct her unprofessional behavior.

Business

Response:

July 3, 2013

Revdex.com of Wisconsin

10019 W Greenfield Ave

Milwaukee, WI 53214

Revdex.com ID: ***

Customer: ***

Dear Ms. ***,

I am sorry you had a poor service experience with one of our independent agents. I've

asked our accounting department to compile a breakdown pertaining to your billing

questions. This will be in the mail shortly. I hope that this will answer any questions you

have in this matter.

West Bend Mutual Insurance is an independent agency company which means our

agencies are individually owned and operated business. These independent agents are

not employees of our company and therefore it would not be appropriate for us to send

a 'reprimand' letter. We do take steps to make sure we do business with quality

agencies and have discussed this situation with the agent involved.

If you would feel more comfortable with another agency, please refer to our website

www.thesilverlining.com to find an agency in your area.

We appreciate your feedback and hope this satisfies your request.

Sincerely,

**:**

Review: After being a home, multiple auto and umbrella policy customer for nine years I decided to move out of state where West Bend Mutual (WBM) is not licensed to sell insurance. I gave proper notice to WBM regarding the closing date of my WI home, and when I would no longer require the home policy. I was informed that WBM would only continue the multiple car policy through expiration of 6/9/2015, because they only write multiple product policies, and I choose to drop the home. I didn't care for it, but understood and moved forward with the understanding that I had a little over two months to replace my automobile insurance. The home policy ended on 3/27/2015. On 4/7/2015 I received a small refund from WBM at my new location with a cryptic note stating pro rated cancellation refund. On 4/8/2015 I called and learned that WBM had indeed cancelled the entire policy, autos included, on 3/27/2015 without my knowledge, meaning I was without automobile insurance for 12 days. To make matters worse when I finally found an insurance company to begin a new policy on 4/8/2015 there was a penalty because from their view I had a lapse in coverage. My annual coverage costs MORE than doubled due to WBM dropping me versus informing me of their plan and allowing me to find coverage without a lapse.Desired Settlement: WBM to pay the difference of my new auto policy due to their cause of coverage lapse.

Business

Response:

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.

Consumer

Response:

[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.]

I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me.

Review: An insured of west bend mutual ins caused damage with their vehicle to my wrought iron stairs and concrete at my business, at which time we filed a police report.

It took a few days to get the insured persons insurance information as they were not very cooperative and then the police report itself took around two weeks to receive from the *** department.

I finally spoke with a west bend agent and was told to get estimates and photos of the damaged stairs and concrete. At that time I sent in damage estimated totaling about $7685.00 at which time west bend mutual sent me a letter and offered me $150 for the repairs.

I don't even know what to say about that other then when I called and spoke with someone at west bend mutual after she was rude and argumentative she made a comment that they offered me that because they thought that I was just after some money. How professional is this?

I asked to talk to a supervisor and after a I spoke with her she assured me they would take care of my problem and sent out their insurance adjustor at which time he told me that they are only willing to pay 60 or 70 percent of the damaged stair claim and not the cracked concrete claim which he said I had to prove that it was a new and not an old crack. At this point they sent me a letter to sign of on this deal after I informed them that they should hire their own contractors and do what needs to be done if they do not like the estimates I provided at which they replied that I should go through my own insurance if I do not like it.

Very rude and unprofessional people I'm dealing with. One of the agents also told me that they are not used to dealing with property damage but auto damage claims. And they call themselves an accredited Insurance company.

I was treated rudely, unprofessionally and caused and is causing a lot of upset and problems. I still have damaged stairs at my property and an insurance that is not trying to solve the problem but worried about their bottom line.Desired Settlement: I would like my damaged stairs and concrete to be fixed to their original condition. I don't know why I should be going through all this to get West Bend Mutual to do what they are required to do.

Business

Response:

We received our first notice of this claim on May 27, 2014 and made contact with the complainant by telephone the same day. In that conversation, we asked the complainant to obtain an estimate of repair for the damage caused by our insured when he backed into the complainant’s railing.

On June 24, 2014, we received only photos from the complainant, which showed an iron railing with what appeared to be minimal damage. The complainant also sent photos of concrete which appeared to have been cracked long ago. Having received no estimate of repair, we sent a good-faith offer to the complainant for the minimal railing damage visible in the photos.

When the complainant refused our offer in a phone conversation on July 3, 2014, we assigned an appraiser to inspect the complainant’s property and estimate the damage caused by our insured. That appraiser determined the cost to repair the railing, however, due to the fact the railing is 20 years old and was in worn and rusted condition prior to this incident, he suggested a depreciation percentage would apply to the cost of repairs. Furthermore, the appraiser advised it is evident the cracking of concrete around the stairway pre-existed this occurrence and was caused by settling of the concrete.

We’ve offered a settlement to the complainant, which represents the replacement cost of repairs less depreciation, for the damage caused by our insured. We stand ready to forward payment upon receipt of the complainant’s signed release.

Review: Your agent *** is the rudest person I have ever spoken too. I wan IN a work vehicle ans WAS HIT from behind by an uninsured motorist WHILE I was working.

I was seeking treatment in *** and now moved to ***, Ms. *** said she suspended my case and that she was waiting on my medical records. She said she sent me a letter, which she did not. I told her over and over I need to seek treatment in *** because the result of the accident I cannot move, get out of bed, ride bike, walk, run or do anything else without pain in my back.

I am convinced her job there is to deny claims. Let me recap: I was AT WORK, in a car OWNED by my company, I WAS HIT by another car I am IN PAIN and DISCOMFORT and YOUR COMPANY AND AGENT DENY me services. Oh hold it, not deny me services just WON'T PAY.

How can you have a more clear cut case???

Now I am without insurance and no treatment because I cannot afford it is this how your company handles clear cut cases? There is not even a question. The police report? Check. The letter from my doctor saying because of the accident I need treatment? Check.

I ask that Ms. *** be disciplined from her position for a clear act of NOT taking care of the injured party which is me.

Even when I talked to the State they said it was clear cut. Now I have to file a claim to get it paid with an attorney for which I will ask the courts to pay attorney fees. All I was asking for was treatment. Now since I cannot do anything without severe pain I will have to look into other areas.Desired Settlement: The Workman's Comp Division needs to take care of my medical needs.

Business

Response:

***, A Division of West Bend is the workers compensation insurer handling a*** workers compensation claim for the complainant from injury date 8/4/2014.Since receipt of the complaint, we have corresponded with the complainant addressingthe issues he identified in his I 115/2014 complaint letter.Prior to complainant's move from *** to ***, *** paid all of the medicaltreatment incurred related to his 8/4/2014 accident. No medical bills incurred relative tocomplainant's 8/4/2014 work injury have been denied. On 9/23/2014, complainantcontacted our fi le handler to ask if there were any parameters for out-of-statetreatment. Complainant did not indicate during that conversation he was intending tomove to ***. Our file handler advised complainant of ***'s choice ofpractitioners rule, including up to two (2) choices of providers licensed to practice andpracticing in ***, and that a referral from the practicing *** doctor to anout-of-state practitioner would not be considered a second choice. Our file handler alsoexplained how bordering state's treatment was handled. On 9/26/2014, complainantsecured a referral from his *** doctor, to a doctor in Fort Meyers, ***, butevidently, the new *** doctor refused to provide medical treatment because he statedhe does not treat workers compensation patients. The Workers Compensation Act of* states, "By mutual agreement, the employee may have the choice of aqualified practitioner not licensed in this state ... "(102.42(2)(a)), and effective 1/ 1/2000,an employee's right to out-of-state treatment when referred by an in-state practitioner isnot limited by a requirement for prior approval. From reviewing our file, it is evident ourfile handler explained these rights under the Act. Because the *** Act does notpermit the insurance carrier to direct medical care, the responsibility of choosing apractitioner is that of the injured worker, regardless of where the treatment is sought.On 10/15/2014, our file handler advised complainant via email that we could not directhis medical care. She further advised that she was requesting complainant's priormedical records in order to obtain an independent medical opinion to address the natureand extent of the injury. We advised that if an independent medical review determines aplateau in recovery has been reached, at any point, we have the right to adapt that opinionand extent of the injury. We advised that if an independent medical review determines aplateau in recovery has been reached, at any point, we have the right to adapt that opinionand discontinue benefits. As of this date, there has been no written correspondence fromour file handler or summary of conversations that we are denying complainant's claim.We have asked our file handler why she believes complainant would make the statementabout her being rude. She believes the primary issue from the 11 /5/2014 telephoneconversation was that she would not provide a denial letter to complainant because hecontinued to come back to that question. Evidently, complainant wanted a written denialof workers compensation benefits letter from *** to provide to his auto insured.If you would like any supporting material or further clarification, please contact ***, Assistant Vice President *** Claims at ###-###-####.

Consumer

Response:

Review: I received a quote on May 18, 2012 stating that West Bend insurance would honor their quote through June 17, 2012. I purchased my policy on May 24, 2012. The cost was $2937 annually for my policy. On May 24 they requested that I pay them $3024. They then refunded me $54 on June 1. June 18 the indicate my policy cost was $2970. I received another statement on August 21 thing the cost is $3269. I received another statement yet again on August 28 staying the policy cost was $3580. We added a property on August 29 in our policy stated we would be charged $424 from that date through May 22, 2013. The bill we received statement would charge for $63 for that policy in that is what we paid. The statements on the policies do not match the bills that we paid and received for the cost of the policies.Desired Settlement: I believe we should be refunded the difference in the original price we paid from the final cost we ended up paying. I also would like to get it itemized list of how much each policy cost and how much I paid for each property which I need for tax purposes. I did request this but the numbers did not match the bills I received. According to the policies total premium for all of my policies should have equaled $3294. We ended up paying a total of $3755. This is an over payment of $461. I believe it was unfair of West Bend mutual to increase the cost of my policies three months after I paid for them. I did pay the policy in full for a full year and they guaranteed me that price.

Business

Response:

July 12, 2013

Review: "The Silver Lining" is not so silver. We have had west bend mutual for many years. We had a hail storm in Hartland on 08/01/02014 and we had damage to two vehicles and our roof on our house. Four years ago hail storm took out our garage roof. West Bend paid both claims, and repairs were done no problems. BUT now they are not renewing our policy when it comes time to renew it!!! To me that is bad practice and wrong!!Desired Settlement: We would just like to renew our policies and stay with West Bend Mutual

Business

Response:

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