ComplaintsforUtica National Insurance Group

• Initial Complaint

  04/27/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Water damage happened at my house on 2/3/22. **** *** started mitigation the next day. I then received an estimate from **** *** for repairs on 2/18/22. The insurance reviewed, disagreed with the estimate and sent a check for less than the estimate on 3/4/22. **** *** was unable to complete work until insurance approved. I then obtained a second opinion to prove to insurance work needed to be done. I submitted that estimate on 3/14 with still no responses on repairs. It has been three months and no completed work. The repairs companies do not want to do the work until guaranteed the insurance will pay. I have two small children in my home and I have broken tile, wood, nails and electrical outlets and wiring exposed. This needs to be addressed.

  Business response

  05/23/2022

     ********-******** Insurance Company (hereafter, the “Company”) acknowledges receipt of a complaint filed by our insured, Ms. ******** *******, concerning our denial of coverage for certain cost of repairs to her home resulting from water damage.     This claim was reported on 2-3-22 with mitigation under way by *******, a contractor hired by choice of the insured. An Independent Adjuster from ******** **** Inc. was assigned by the Company and inspection of the property took place on 2-7-22.  The Independent Adjuster’s initial estimate was completed and their report was sent to an internal Claims Representative at the Company (see copy attached) and was approved for processing. A payment of $9,451.27 for the amount of the original actual cash value from the initial estimate of the Independent Adjuster was issued the same day to ******** ******* and her lender, ******** **** ********.  The insured was asked to have ******* provide the mitigation estimate so payment could be issued.  ******* did not return the estimate to the Company until 3-23-22, (see copy attached), and payment of $205.70 for water mitigation services was made same day. Ms. ******* made clear that she was unsure who she wanted to do the re-construction work that was needed to repair her property and that she may not want ******* to do it.. A request was made by the insured on 4-19-22 for a supplemental review of the claim. The supplemental review was conducted by ******** **** Inc. and a repair estimate was provided to the Company on 5-3-22 (see copy attached). This estimate was reviewed with the insured and it was explained to her that some items were agreed for payment by the Company, while others could not be paid without confirmation and proper documentation. A supplemental payment for review items that could be confirmed for the agreed-upon amount of $1,175.34 was paid to ******** ******* and ******** **** ******** on 5-18-22.  The Claims Associate contacted Ms. ******* on 5-19-22 to advise of supplemental payment and to request confirmation as to who she secured as a mitigation contractor in order to review their mitigation estimate. Ms. ******* did confirm that she used ******* to complete the mitigation work and that their original estimate was the one to be reviewed.  The claims associate discovered some overlap with their estimate and the reconstruction estimate and has reached out the ******* to discuss and have corrected.   Currently, the water mitigation repair estimate and evaluation are still pending as the insured has not confirmed who she had do the reconstruction work.  Additionally, the Claims Associate is making effort to work with both the insured and ******* to determine who performed the work and to obtain an updated, accurate estimate for cost of repair.  Without this estimate, we are unable to make any additional payment.  Once Ms. ******* provides her contractors information, the Company will begin the review process with that contractor to discuss our estimate and evaluate if any changes need to be made.    The Company believes we have paid the known damages according to results of our investigation based off documentation received to date. We maintain that we are in compliance with the policy expectations and state statutes. There has been no delay on the part of our Company’s Claims staff and the claim has been processed to date within legal time limits allowed and according to the Company’s underwriting guidelines and procedures.  The Company is more than willing to continue our evaluation of any documentation provided by Ms. ******* and her selected contractor.  If you have any questions, please feel free to contact me at john.gionti@uticanational.com.   Sincerely,     John G*****, Claims Supervisor – Property Lines Telephone:  ###-###-####   Enclosures  

  Business response

  06/13/2022

  June 13, 2022
  
  Ms. Lou Ann Pederson
  Better Business Bureau of Upstate New York
  100 Bryant Woods South
  Amherst, NY  14228
  
  Company:  ********-******** Insurance Company; NAIC:  12475
  Complainant:  ******** *******
  Claim #: 10307019; Policy #: 5490022 
  RE:  Complaint File:  17116221
    
  Dear Ms. Pedersen,
  
  This letter is in response to the complaint as filed above by our insured, ******** *******. 
  
  Utica National acknowledges receipt of Ms. *******’s request for a reinspection of her property due to concerns over the accuracy of our inspection and estimate prepared by our Independent Adjuster.   That request was not honored as Ms. ******* had provided a few different estimates from contractors she was not actually going to retain their services.   We had our IA review those estimates and it was discovered that each of them had different pricing and quality of the flooring in question as well as the amount of flooring needed to be addressed. 
  
  We did, however, reach out to Ms. ******* immediately and requested that she advise who she actually wanted to do the repairs so that our IA could work directly with them.  She eventually settled on a contractor, Paul Davis of Greater Richmond.  Our IA has been and continues to be in contact with Paul Davis working to secure the needed information for correct evaluation of the flooring materials.  An ITEL report was secured and the pricing is being adjusted accordingly.
   
  Since the securing of a contractor by Ms. *******, our IA has been in constant contact with the contractor and are approaching a resolution to the matter at hand.  It is our understanding that an agreed scope and estimate will be completed with this latest documentation recently provided by Paul Davis. Utica will be issuing any supplemental payments owed.  The matter is moving forward amicably with no known further issues. 
  
  Sincerely,
   
  
  John Gionti, Claims Supervisor – Property Lines
  Telephone:  (315) 734-2393
  

  
  

  Customer response

  06/18/2022

  Better Business Bureau: I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.While Utica National claims they are working with my contractor, they are still being difficult. They did update some items in the estimate, but I have still not been cleared to have my house restored because of the ongoing issues and debate they are having with my contractor. It has been 4 1/2 months with no work done. I need a resolution and agreement by the end of the week next week (6/24/22). Spiders and other insects are consistently crawling up through the exposed parts of my walls/flooring downstairs because repairs have not been completed. There are large nails that are a danger to my children.  Regards, ******** *******

• Initial Complaint

  12/09/2021

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  ***** ******* ****** ******** holds a commercial insurance policy from Utica national. On 5/17/2021 we suffered a loss due to a hail storm. On 5/29/2021 the building was inspected and terms were agreed upon by the church and Utica National. On this date. 12.8.2021 Utica National has disputed agreeing to finalizing this claim with our roofing contractor. The church has met their deductible. Utica is now refusing to uphold their agreement with us to fund the remaining payment. We have sought resolution throughout this process and despite the insurance provider asking our contractor to use substandard materials, to violate code on replacing the roof and upholding to their contractual obligation with the church they refuse to pay what is owed to our contractor.

  Business response

  12/27/2021

  The attached documents are provided in response to complaint file *******.  I am unable to attach one (1) additional document (First Notice of Loss) that I will send directly to the Bureau via e-mail following this submission of documents.  If you have any questions, or further information, please do not hesitate to contact me at ***** ******** or e-mail, ************************************

   

  Sincerely,

   

  Kathleen P*****

  Compliance Analyst

   

  Customer response

  12/29/2021

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
  Regards,
  ***** *****
  
  
  
  
  

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩