Anyone get a letter from Safelite Network about not getting paid for jobs if you are not on their network.
This starts at the end of the month. I am supposed to see this letter Friday morning.

Nice teaser!

What starts at the end of the month?

Golly, I actually hope you're right about this......but at this point, just more details, even if they are still rumor, would be nice....(hint hint).

I am not an attorney but I would be interested to know the legal opinion on a TPA refusing to pay a claim when they have no jurisdiction over the insured or the glass company?

I recently sent out a letter to all the shops I have used in the past advising them that as of May 31st we will no longer accept a first report of loss from anyone other than our Insured or Agent. Might you be seeing something of this sort?

My letter suggested that YOU have the Insured call to report the claim right from your shop, and at that time secure a referral number so your invoice will be promptly honored. Seems like that should work.

hal,

i remember the days when the agent actally did something. i cannot understand the reason the insurance agent wont handle the calling, i have alot of old people who are completely lost when talking to the 800 number people.

i would think the agent should give the impression that he can handle what ever the insured needs, plus it gives the agent another opportunity to try and sell them something. i guess customer service is a thing of the past from big companies.

i am a dinasour, i don't like the ways things have changed since computers have become common plate. i pay my agent to do this stuff, of course i realize leaving the agent handle this opens the door for steering.

i've had horrendus luck with networks in the last 2 days, i had a tempered part progressive wanted to pay me less than what i paid, and farmers group is trying to do the same with a mopar w/s. i guess i am just a little irritated.

Ralph-

I understand your concerns. My comments weren't an effort to get glass shops to handle claims, but rather to suggest a method to work within the system we insurers impose.

We do appreciate everyone's efforts to resolve a claim--but we rarely have an opportunity to say thanks.

I don't think any insurance company would ask you work at a loss. If our case for special parts, we would ask for evidence of you cost for the part, and then we would allow a mark up.

Hal,

In a perfect world this would be great. But as many of our customers are working people who are either dropping the vehicle off before work or during a 30 minute lunch break they don't have the time to spend 20 - 30 minutes on the phone with safelite. At the time the job is scheduled every customer is told that they need to notify their insurance agent. Most do, but some don't. What about then????

Hal's letter as well as others from SGC/LYNX/Other TPA's clearly state the insured OR the agent must call in the claim....you are not to perform the work w/o a claim number, that's all, it can't be more clear or simply stated than that.

If you have received the letter HAL is talking about can you share the name of the insurance company with us?
I always had a feeling that HAL is from The Hartford Insurance Group (Hartford Auto & Life.) They are second only to Progressive Insurance, when it comes to taking advantage of the current system?

SB, Hal is employed by State Auto, but many SGC insurance co.s' use the same form letter describing how to process claims....

Hal being doing that for years because your TPA steers get a clue!

Hal,

Why is that we need to call Safelite to get a claim #, leaving us in the position to accept your (Safelite) rates or inform the insured that we might charge more than you are willing to pay the shop. But, on the other hand if I charged the insured what I think is fair and reasonable and they paid the claim themselves and turned it in to you, you would reimburse them the full amount. This happened with another Safelite claim (for Progressive also for Farmers). How do you come up with fair and reasonable? Your own data or Safelites?

Ralph what do you want your invoice amount to say? I will be happy to sell you and send you a invoice for evidence as Hal states. I will also rebate you back at the end of the month as you qualified for our rebate program.

Hal, The network requests we work at a loss for lots of special priced parts. We recently replaced a windshield that we paid freight and crate charges. Your TPA would only pay us for our cost on those charges. Meaning no mark up at all. Sure we got paid labor and a lovely 10% above cost for the glass itself. Just makes me wonder what the TPA turned around and charged the insurance company.
Have you EVER looked at the actual invoices the TPA gets from the glass shops? Then compared it to what the TPA is billing YOU? If not, maybe you should.

Glasssgod, you said:
"Hal's letter as well as others from SGC/LYNX/Other TPA's clearly state the insured OR the agent must call in the claim....you are not to perform the work w/o a claim number, that's all, it can't be more clear or simply stated than that."

This would apply IF the insurer or network had ANY authority WHATSOEVER to AUTHORIZE REPAIRS to property THEY DO NOT OWN.

Did they did not sell the customer an automotive repair contract? Or did they sell an insurance policy to indemnify the contract holder against loss? A party that does not own the property, nor has a contract with the property owner to manage or provide repairs to that property, has no authority to deny or authorize repairs to property not under their control or management or ownership.

Hal, are you contracting for repairs under the policy of insurance?

Mark...the policy holder or agent can, do, and will authorize the work, the shops are 'spose to wait for a claim number before performing services...I don't agree/like it but it's so black and white to me.

Hal,
who is responsible when the glass shop properly gets a referral number from Safelite, does the work, then the invoice gets rejected because the policy lapsed, was cancelled, etc. but somehow your communication did not reach Safelite before they issued us the referral. We are out so far! I think you or SGC is contractually obligated to pay us, don't you think?

Glasssgod,

The point is that insurers are NOT contracting the repairs.

Try asking the network or insurer next time you're in the set up when they try to tell you price, "Are you (network) or is (insurer) contracting for repairs on this car?".

You'll get a NO, even if it takes a while while the operator stutters and goes and speaks to a supervisor. They will explain they are only setting up a claim.

So, once again, if insurers are contracted with the insured to indemnify against loss, and consumers ("consumers always have the right to choose the shop and do every time") contract the repairs to the car they own with the repair shop, why is the insurer involved in the negotiation (ya right) of the monies for the repair bill? If they assume no liability for the repairs, what legal right do they have to decide what is being PAID for those repairs?

I know how it's working, I'm just saying that that's not how it really works. This isn't my grand revelation, it's from listening to lawyers speak/write on the subject.

The exception to this is Progressive, who IS taking the car from the customer who has collision damage, and gives the car owner/policyholder a rental and a beeper, and then Progressive takes the car to the repair shop and dictates repairs and prices to be paid. They stand fully in the liability boat under this "Concierge" program, and they're risking it. They are the only ones to date to my knowledge.

This is not happening in glass, but it works this way because we let it happen.

This is not my opinion, it's others, but it makes perfect sense to me. It's boils down to who our customer is, from a contractural standpoint, and who would be in hot water if a sharp consumer or lawyer comes after the shop because they negotiated price, and therefore the level/quality of repairs, behind the consumers back with the insurer. Whom does the shop have a primary fiduciary responsibility to? The car owner. When a shop signs network agreements, it is serving two masters, and straddling a razor wire fence.

End of book. lol Supper is waiting.

Virtually every insurer that works with Safelite has implemented the same process as Hal's within the last month. This includes: Hartford, Nationwide, Lib Mutual, etc. The language is all the same, what no one has mentioned is that if the insured calls Safelite for a referral not only is the likelihood high that it will be steered or attempted to be steered, you are agreeing to rates. Once a referral is generated you are faxed a referral sheet. On every referral sheet it states "performance of work constitutes acceptance of pricing and billing procedures." According to the insurance company and tpa you have now accepted the rates because you did the work. It states nowhere in the ins. policy that an insured must call Safelite to report the claim, it might say they need to call and report the claim. Have the insured call the ins. company NOT the tpa or you will be stuck with Safelite's pricing. They are hoping that no one is seeing this on the referral sheets and the ins. company has already used this in defense on an arbitration claim.

RSS,

What if I sent you a fax stating that for every customer that comes in your door, you must pay me $1.00. I would state in this fax that performance of work by you on your customer's vehicle constitutes your acceptance of my $1.00 charge.

Would you pay it to me?

What if, before I went into a restaurant, I faxed them stating that I would only be paying $10 for the meal they serve me rather than the $15 price on the menu. I would tell them in the fax that serving me my meal constitutes their acceptance of my pricing.

What would happen when I went to the cashier to pay my bill and leave?

So, why is any of this any different, UNLESS a shop signs the network contract agreeing to these terms?

I just can't get my mind wrapped around this issue of somebody telling me what I 'must do' in my business, especially when I have no signed agreements with them.

I especially like the clauses that tell me what I must do about informing the consumer about the insurance company's policy on this or that. I am not a liscensed insurance professional, and have no right or business doing such, and in some states, could be fined for doing so because I am not liscensed to do so.

Too dang funny.

Perhaps we should be faxing insurers and networks with conditions and terms and telling them that by forcing us to enter into supposed conditions of claims handling procedures as a condition of payment to us constitutes their acceptance of our terms.

Again, what's the difference?

Mark1, I do not disagree with you I am only mentioning what is happening. The point was argued that we accepted the pricing because of this fax, we won the argument.

My point is why are we as an industry always giving into the demands of the network? Now everyone is required to have the insured call Safelite for a referral number before the work is completed. This will ensure that the insured will hear a pitch trying to steer them to Safelite. The clause of "performance of work constitutes acceptance of prices" gives us the right not to call in the claim to Safelite. The problem is that if you call in the claim to the insurer directly they will not take it and pass you on to Safelite. Who is going to be brave enough to risk a delay on payment and fight this? I believe this needs to be done as a group, maybe IGA? Every time you obtain a referral you are giving them exactly what they want and will be short paid every single time!!

Thanks for the reply, RSS, I didn't think you were disagreeing with me, I was just elaborating on the topic for the hopeful benefit of others reading.

I'm glad you "won the arguement", and applaud you for "argueing". The only thing I can think in all of this, is that if insurers and networks cloud the issues of "basic contractural obligations" and spew forth enough times that "you must do this, and you must do that, and if you do this, then this will be that..." so much that we just fold and believe what is coming from their collective mouths(or faxes). WHat's that old saying? "If you tell a lie often enough, people begin to believe it."

I've read the recent changes in the "agreements" on both sides, glass and collision, and there is a distinct set of changes taking place. The irony of all this is, to watch this set of "conditions" in these agreements be given, told, pronounced, set, or forced on those that did NOT agree to them.

I keep thinking of my mother slapping me in the back of the head when I did something stupid growing up, saying "If everyone else jumped off a cliff, would you do it too???"

My point is that this industry as a whole better start taking a long hard look at what it does, and does NOT do, because they aren't willing to "risk" things in the short term, and realize what they are risking in the long term, and in the bigger picture.

I'm convinced that the bigger players, and one specifically that's buying up shops around the country, have this "long term" issue clearly in focus. I believe that the smaller shops should start focusing on the long term issues as well, and consider whom they've jumped into bed with, to avoid "risking" things.

PS: KNow your state's laws on timely payment of claims, and file complaints when they are broken. Most of these laws were written long before fax machines existed, let alone the internet. It's highly unlikely that with the speed of communication available today, those limits will ever be extended.

JMHO

Gotta go mow the grass and set up the grill for the 'lil woman's dinner! Happy Mother's day to all the ladies on the board!

Good points Mark 1. As I get older it starts to dawn on me that just becausea big company says we have to things a certain way doesn't make it law. They have their rules and I have mine. Mark hit the nail on the head, everyone had better quit looking for a quick fix and look long term.

Jim 2-
I agree with you. My TPA sometimes does make a mistake and they do honor obligations when this happens. This only seems fair. If it doesn't happen--let the Insurance company know about the incident. IMHO You shouldn't be held responsible for our errors.

KB-
If this was a State Auto claim, let me have more information and I will review our tpa's handling and audit for proper payment.

Hal,

Just wondering if you were going to answer the questions I asked earlier in the post?

Hal-no it wasn't a State Auto but even if it was, that is all I would have been paid by your TPA anyway. They claim it's the insurance companies rules when in fact it is their own. They need room for the correct mark up I guess...

Hal, I have called the insurance co and talked to a 'claims' person only to be told that I have to talk with safelite. I have spend almost 3 hrs going is circles trying to get paid. I have faxed my invoice of what I had to pay for a part and still get "I need the invoice." how many times do you have to fax, mail and refax. can anyone think outside their little box any more. It is too funny how the insurance co's and say well you need to talk to the TPA (safelite)

Skip,
Yes, everyone has to run in circles to get paid by Safelite. I believe that in most instances Safelite has already been paid by the insurer and will find any excuse to delay payment. Think about how much interest they collect by sitting on millions of dollars they have already collected from the insurer as they laugh at the many ridiculous reasons they come up with to reject an invoice. How many times have they rejected an invoice that was correct for a wrong VIN, policy number, part number, etc? They do this so the money can sit in their account and draw interest. We all fall for it every time.

As far as contacting the insurer you must be contacting the wrong people. You need to be talking to the decision makers at the insurance company, a guy such as Hal. It amazes me how far I get when speaking to these individuals. They always mention that I am one of the few that ever call in. I just spoke to Hal earlier in the week, and he said he never gets to talk to anyone from the glass industry. I have dealt with Hal for years and although I don't agree or like Safelite or some of the policies, Hal has always been fair and promptly looked into my concerns. Simply speaking to claims adjusters will get you nowhere, go to the top. I provided a contact list of decision makers at the insurers to the IGA that was sent out as a Beacon Bulletin and I have also provided it on this board.

RSS-

As was stated above, when a TPA delays payments, you MUST file a complaint with the your states ins. commissioner. We have had success with this in the past. File the complaint, and forward the accompanying letter with all CC: to Safelite and the particular ins co. president, and glass claim manager. In some states ins co. can be fined if to many untimely payment complaints are filed. Some states can even suspend their insurance license, however unlikely that is, it does get the ins. co all over their TPA to pay claims in a "timely" fashion. It really can and does help speed up the process. As many of you know some TPAs do like to "sit" on the funds and most ins. co. do pay the TPA within a week, so their is no legitimate reason the TPA caanot have the funds released to you in a week or two from the time the claim is filed.

And as Mark 1 stated, you should research and understand the timely payment law in your state. Most of the laws are very simple, to the point, range from 20 to 45 days, and some even include the language "Third party administrator" in the law, which keeps TPA's from saying these laws do not apply to them.

I hope everyone has a busy and prosperous summer.

RSS, sorry I must of missed your list some how. how can I get a copy?
thanks

George-
You asked
-1-Why is that we need to call Safelite to get a claim #, leaving us in the position to accept your (Safelite) rates or inform the insured that we might charge more than you are willing to pay the shop.
-2-But, on the other hand if I charged the insured what I think is fair and reasonable and they paid the claim themselves and turned it in to you, you would reimburse them the full amount. This happened with another Safelite claim (for Progressive also for Farmers). -3-How do you come up with fair and reasonable? Your own data or Safelites?

RESPONSE
-1-Safelite is my TPA and they manage our claims claim handling. Our script doesn't have the language you describe.
-2-Yes, we would reimburse our Insured their cost paid.
-3-We review average market price paid on both a National and Local basis. Then I decide how we wish to place ourselves in a particular market.
-4-We are a regional company and only have 25,000 glass claims per year. As a TPA, Safelite helps us look at the big picture--then I decide what pricing best fits our business model.

Hal would you ride with Safelite glass in your car installed by any old tech that they sent out to your location ? Be realistic.


Do you have any data on comebacks and customer complaints ? or does the "TPA" handle your customer satisfaction (the insured believe theyre talking to you the insurer when they call the 1-800 #)So Im sure they are able to sweep the leaks and cut up dashboards under the rug before its in the BBB's and courtrooms of Americas hands.

Hal,

Thanks for the reply. Your TPA helps you arrive at a pricing system. How can that be fair and reseasonable? I have never been surveyed by an insurance company, just sent faxes of the rates, Safelite is just a tool you and other insures use to artificially lower the price of glass services. How, you may be asking! As a smaller shop wanting to balance the pricing between insurance work and cash work I have to compete with your TPA's sister company, who, for the most part are the low cost leaders. We have to keep our prices down to almost no profit to compete, and then get it used against us on the insurance side. Yes, fair and reseasonable!!!
I shall just start billing your insured and let them deal with their insurer. You will reimburse them fully, but not the glass shops. Time I become a glass shop again and not a billing service...

TSi-
I have had my personal auto w/s repaired and/or replaced by Safelite over the years and have no reservations about using them. I do ride with Safelite glass in my car. I do not equate them with sub-standard glass or sub-standard installers as many posters to this board infer. I feel that Safelite is an industry leader.

I agree that CSI surveys can be self serving. We conduct our own--and we receive very few complaints about anyone. In fact, we receive more praise letters letters than complaints!

While Safelite is my TPA, Safelite reps introduce themselves as such when speaking with our Insureds. We are attempting to be open and honest.

George-
This sounds harsh, but is not meant to be so. You appear to be using a broadbrush to paint a picture that my pricing is out of line. I don't know that is accurate. I would ask you review State Auto price offer. My pricing is not the most aggressive, but fair. If you cannot prosper with the pricing State Auto offers, you may always decline the job.

Best wishes,

Hal said: "I do ride with Safelite glass in my car. I do not equate them with sub-standard glass or sub-standard installers as many posters to this board infer. I feel that Safelite is an industry leader."

Wow...Is all I can say...to your thinking they produce good quality glass, and installations. You evidently don't have a clue on what a good quality glass or installation's are.

Recently, I talked to a person who had a w/s replaced in 03 Ford F250, $200 cash was the cost. They were in and out in 15 min. They (Safelite) never told this person, about safe drive away times. Off the person went driving home. How safe is that???

In my opinion...the only thing about Safelite being the leader in... is in the corruption of this industry!

Hal,

We don't deal with State Auto, but in my state it is the law that the customer gets to choose the shop at which he/she wishes to have the repairs performed.

If the shop's prices are reasonable, you, the insurer, must pay them.

It is not about whether YOUR prices are fair and reasonable, it is about whether MY prices are. And if they are, you must pay.

In other words, there is not only one reasonable price. While your prices may be reasonable, they are likely to be on the low side of reasonable. And my prices are more likely to be on the higher side of reasonable. You are not allowed to dictate my price (unless I agree through joining your network, which I do not).

Please also note that if your insured has a claim number from thier insurance company or agent you do not have to have the insured call the networks for a "referral" number, because the claim has been created from the source which does not have to be routed through the networks.

So, assuming that this link to bytes below "is" the letter which this string was started over....

http://www.glassbytes.com/news30days20060525.php

The question is, can an agreement between a shop and a claims processor override and supercede state laws that govern the contractural obligations between an insurer and the insured?

I still say this is just too funny......

we have received the notices about having the insured contact company about the loss to get a claim started. i can agree with a couple of points made---agents used to give personalized service to their customers and handle calls for them (now all they want is the business and the premiums paid) and most customers are lost on the phone (especially the elderly). that said we have had the insureds standing in our office using our phone to call in the loss and have safelite tell them that can't gaurantee our work and that we are not a preferred provider BUT WE CAN REFER YOU TO SOMEONE THAT IS!! now don't that beat all. it is so bad that when our customer is talking to safelite we will listen on the other phone and put them on the spot when they start their spill. they have even told them that they, the insured, are responsible for anything billed over what insurance pays. then we have to explain to our customers that we don't make them responsible for picking up the slack when the insurance is wanting a big discount off of already low material prices. don't know about anyone else but our cutomers believe in us and know that we stand behind our work and that we are honest and that we do things the right way (we don't work out of a van/pickup truck and we spend more than 30 minutes to replace your windshield.)!!!!

I have a question for HAL, what are your personal auto rates? Are they the "lowest?" or are they "fair and resonalble" If not the lowest, why not, Why should anyone want to buy auto insurance from you if YOU ARE NOT THE LOWEST. And, does your company use the customers credit score to deside if they get a lower rate, well, lets see, I seam to recall Safelite filed bankrupcy a few yrs back and left alot of their vendors hanging without getting paid for the matterial they bought. If you use a credit score to rate customers on wheather they would get a better rate or if they would get insurance at all, why should an agent recommend the use of the 800# when they know the company that is going to install the windshield for the customer is going to be safelite that had filed for bankrupcy. What does that say about State Auto?