I believe all assignment of claims the customer signs state, they agree to pay any amount the Insurance company does not pay. problem is, if you go after the Insured for the $$$ you will probably loose a customer. This also validates the TPA party line "if you do not use one of our vendors you may be responsible for out of pocket expenses"
Up side would be if the customers actually got behind this movement & complained and threatened to drop their Insurance Co. Maybe we would see a change. Problem is: most Insured are to afraid to fight back to their own company.

If you have a valid assignment that puts you in the shoes of the insured. There's no reason to sue the customer, and every reason to sue the insurance company. Most assignments state that the insured is obligated to pay their deductible. It also states if they have no insurance they are obligated to pay. But suing your customer for a short pay is like telling your wife you're going to divorce her because your boss was mean to you. It makes now sense. Insurers are aware that shops rarely go after customers for short pays. That's what makes them so reprehensible.

What reputable company would do a job, when they did not negotiate a price before hand with the insurance company, or at least, let the insured know that their insurance company would not pay what the glass shop / body shop wanted, before they did the job? Get approval for the price ahead of time. I know that there are consumer protection laws that says the consumer should be aware of the cost of the job (in writing), before the shop proceeds with the job. If the customer AGREES to pay extra for the job (in writing), above and beyond what the insurance company is willing to pay, and they refuse to pay when the job is completed, why would you release the car, if they did not pay? Or why would you not sue them, if you were dumb enough to release the vehicle without payment?
Ooops...

Why penalize the customer for choosing your shop? Obviously the insurance company needs to be notified before the work is done, but let the insurer/tpa dictate what they will pay? Why not make them do what their policy promises their insured? Sorry but I think your post was an oops. Just my opinion.

I have to go with Smiley on this one. First off the only approval needed is by the customer as they are the only entity that can contract for repairs to the vehicle they own.

Next there are 2 types of shops, network shops and non network shops. Network shops enjoy the "benefits of membership" by being dictated to on what they can charge. Non network shops are NOT obligated to anything from a network.

Verification of coverage is all that is required IF they are using an insurance policy as payment. If not Cash, check, credit, can be established between shop and customer.

If the method of payment IS a policy to cover the customer for a loss, then it needs verification and any deductible if it applies.

Finally, The customer is responsible for their deductible, and nothing more. Approval of any pricing is not a requirement. Itemized documentation for the customer to approve and sign the assignment of proceeds, should ALWAYS be followed to the letter.

When direct billing we always inform the customer exactly, the differences of network and NON network shops, and the type of work and quality they can expect from us.

From there it is completely up to the customer of how we can proceed to take care of them. I never have, or never would charge a customer more than what they deserve to pay, or the difference of what their ins co. wishes they could pay for my services.

Those who don't understand this simple process, well that is the BIG Oppps.......

and of course this is just my humble opinion, but has worked very well for 30+ years.

I am with Smiley. Insurance companies must issue policies in good faith. Policyholders and their chosen repair facilities have every reason to believe that the insurance company will live up to its promise and pay any reasonable invoice minus any applicable deductible.

If the state law says the policyholder has the right to freely choose the repair facility, nothing in the policy can interfere with that right. Auto glass damage can be documented with photos. Windshield repairs mitigate further damage and can be done right away especially if documented and especially since damage can still be verified after the repair. In fact, the insurance policy makes it the duty of the policyholder to mitigate damage. The insurance policy also makes an affirmative statement that the insurance company WILL pay reasonable expenses for said mitigation.

So the only question remaining is whether the invoice submitted to the insurance company is reasonable. So far, arbitrators and judges are ruling in favor of the glass repair facilities.

Insurance companies are the ones being unreasonable. How is it fair to only offer payments that are equal to or less than they were 20 years ago? They have been abusing their power and now those shops that will not capitulate are receiving their just rewards.

Insurance companies need to stick to the business of insurance. Prudent insurers calculate their premiums based on statistics, chance of loss and what the could reasonably have to pay out. One way to generate profit is to pay out less than they calculated they might.

In the auto glass business, referrals have pretty well dried up due to one company's desire to corner the market so that is one less reason to negotiate or capitulate to auto insurer "offers".

Rather than ask what reputable glass shop would do a job without getting permission from the insurer, why not ask what reputable insurance company wouldn't pay a reasonable invoice when a loss has been verified and the customers chosen repair facility has completed the work?

Why not ask what reputable insurance company would hire a biased company to settle their claims? Why not ask what reputable company would ask an insurance company to let them settle claims their own claims? Why not ask what reputable company would ask an insurance company to let them ride herd on and lord over their competitors? Why not ask what reputable company would agree to enforce insurance company prices out of date by twenty years on their competitors?

Ooops.............................

YOU are penalizing the customer for choosing YOU. Would you pay your bills that way?? I bet when you order glass or urethane you know the price before you order the products. I bet you shop around for the best insurance rates for you vehicle and shop, or do you just say OK send me an open ended invoice and you will pay it. The problem with you Right Answer and JB is that you seem to think you can write your own check.
I did not say to take what ever they say, but I did say NEGOCIATE a price ahead of time. If you had an insurance claim on you shops roof, you and your insurance company would not let the contractor charge you or them for a whole roof, when a few packs of shingles was all that was needed. But, if you allowed the contractor to replace the whole roof, without approval, do not be surprised when the contractor sues you. Or how about this one, you are covered under your dental policy for cleanings 2 times a year, but your dentist wants to get paid 5 times the amount of what the insurance company will allow. Would you expect them to pay the bill?? Or better yet, wouldn't you think your dentist is a rip off and go somewhere else?
You guys do not sound like the solution, you sound like you are the problem. Get the insured involved, to say that they want to use you and that they do not want to go else where and that they think you are worth what you are asking for the job.
Look in the mirror, if you were the claims representative for the insurance company, would you pay what you were asking for that claim, if your job was on the line?
Ooops...

Sorry Oooops but you're living on an alternate universe. If we did what you suggest with every customer we would have to hire 4 new csrs. And train them well. And we would be wasting our time because most insurance companies and TPAs will not negotiate, rather they dictate. To them it's take it or leave it. So we direct bill at a reasonable rate and collect our short pays from the insurance company.
How do you negotiate with a tpa that won't give you your customers name and info unless you agree to their pricing?
I'll take my chances with a neutral party to decide if I billed fairly. Because I always do, and I can prove it.

Here is the deal, the question noted on this post was " Would an AGRR Company Sue an Individual Over an Alleged Short Pay?, please read and stick to the question asked. Read my original post and see if it addresses the question asked. An alternate universe?? Why is that, because I think it is unethical not let the insured know that you will invoice the insurance company for more than the insurance company will allow?? That you would not let them make a decision to pay out of pocket for you services, rather than you suing them, with no prior notice so you could get more $$ than their insurance company would allow!!
A key part of your post is "How do you negotiate with a tpa that won't give you your customers name and info unless you agree to their pricing?", WELL I guess that it is not your customer after all, because you would know who they were. Correct me if I am wrong.
Ooops...

Oops, I can look into the mirror just fine. If my pricing is fair and reasonable, there is nothing to negotiate.

You didn't answer my questions. How are my customers penalized? Where in your auto policy does it say that your policyholders have to negotiate price? If part of my roof blows off, my policy says it is my duty to mitigate further damage, so I pay to have a tarp put over it. My policy says my insurer will pay reasonable expenses to cover that cost. It does not say anything about my insurer getting to determine what is reasonable.

Comparing auto glass claims to teeth cleening claims is like comparing apples to oranges. Auto policies are not defined benefit policies. Our state insurance code specifically states that on auto glass claims, insurers must inform policyholders of their right to freely choose the repair facility. It further states that insurers will pay reasonable rates and that can vary on a case by case basis. In other words, the insurance company cannot depend on paying a set price but must consider a range of prices. Instead most insurers redirect glass only claim calls directly to my direct competitor!

What reputable insurer would force a chosen glass repair facility to call a direct competitor to make the FNOL? Said direct competitor has a vested interest in stealing my customers and selling them reverse engineered glass. They also have a vested interest in depressing the rates of their competitors so that they can stay within the guaranteed average invoice agreed upon with their auto insurer customers. All the while they advetise rate that are more than double what they demand of my shop.

I am sorry that you are caught in the middle of this egregious and insideous situation and sincerely hope that you do not lose your job but we have families to take care of too.

Please go back and reread my posts and answer each of my questions honestly and then see if you can still look in the mirror with a smile on your face.

In that there's a TON of potential good information here, let's not start shooting each other and kill the moment. In other words gang, there's a great string going here, let's be nice, OK?

Now, to what JB said, I know of a ton of evidence where the customer on hold is CONFIRMED to have requested the shop to the TPA MULTIPLE times, yet the TPA will NOT allow the shop to speak to the customer or give the shop the customer information until the shop agrees to the Network pricing.

Again, the confirmation that the customer HAD indeed requested the shop to the network CSR multiple times was in place. Yet, the Network CSR will NOT give the shop the customer's information or allow the shop to speak to the customer, even in threeway call, unless the shop agrees to the network pricing terms FIRST.

The shop knew who the customers were, had educated their customers, and I'm told many times the customer was standing right in front of them on their cell phones while on hold, while the network CSR spoke of the above to the shop.

So, I'm not surprised at all at JB's comments.

HTH, and JMHNLO

Thanks Mark1, your comments are correct. And while Ooops says they are not my customers, the fact is some of them call me after the tpa refused to give me their name. I'm not making this up.

In regards to negotiating, if you litigate numerous times with insurance companies that pay thousands to save a few hundred yet lose every time and still refuse to work out an agreement, how could you ever expect them to negotiate in good faith?

I'm not trying to bad mouth anyone, I just don't understand Ooops position.

My position is what I stated earlier: I DO NOT believe it is ethical or even LEGAL, in many states, to invoice for auto glass claims, for more than the insurance company will allow, WITHOUT, informing the car owner that you are doing so. That is it, nothing more.

Here is an excerpt from the GlassBYTEs article:
Caleb Brickey hit an individual’s vehicle in early June 2014. That is not in debate. What is in debate is who will cover the full cost to repair the vehicle? Columbus, Ohio-based Three-C Body Shop, which worked on the vehicle, says Brickey should cover the cost if his insurance company won’t.

The collision repair shop alleges Brickey’s insurer, Allstate, has “short paid” the company and has sued Brickey in the Municipal Court of Franklin County, Ohio, for the difference.

“On or about June 3, 2014, defendant [Caleb Brickey] failed to yield to oncoming traffic while turning and as a result, struck a 2005 Jeep Liberty owned by Andrew Kirk,” according to court documents.

Kirk took his vehicle to Three-C and signed an agreement authorizing repairs.

“An initial estimate of the work was prepared but as work progressed, additional repairs were required to restore the vehicle to pre-accident condition,” according to Three-C’s attorneys.

The cost for repairs was $5,687.83. Allstate paid $3,585.43, “but refused to pay for all necessary repairs to return Kirk’s vehicle to pre-accident condition,” according to the court documents.

In addition to signing an agreement authorizing repairs, Kirk provided Three-C with a power of attorney to collect services not paid under the agreement and repair authorization.

“A balance of $2,102.40 remains unpaid for the work performed by Three-C,” according to the attorneys.

But, if you did my windshield or repaired my car, I surely would want to know what you were charging my insurance company vs. what they allowed. I ask you, does your POL's fine print contain something that says the customer is responsible for any charges the insurance company does not cover? And, if you charged them more than the allowed amount, I surely would not want to be on the hook for it. It is sort of like the contract I sign to get a "Locked Price" on my home fuel oil, they said all you have to do is buy all of your oil from us and you got the stated price. OK fine, I sign it and he leaves. But, guess what. I read the fine print and it says I have to use 500+ gallons per year, if I do not they will back charge me, at some ridiculous rate, for not using the prescribed amount. Well, there is no way I will ever use 500 gallons in 2 years, so when I called them to point this out, they say it is just in there to make sure customers do not buy oil from a discount company, "Trust Me", we will not back charge you. But they could back charge me, couldn't they?
Here is the deal, as most posts do, they morph into something different than the original post. But, Mr. JB and you, do what all good politicians do, they do not answer the question asked, they respond to something else in the statement and go off on that. You said, "There's no reason to sue the customer, and every reason to sue the insurance company" I guess you could take that to mean you would not sue the customer, you still do not actually say it. Right Answer actually answered the question and seemed to be doing the correct thing by informing the customer, great. I merely asked the others to answer the original question. First off, I am NOT an insurance person, so lets put that to rest. Now, with that said, my guess is the all three of you do not belong to any networks and do most or all of your on a direct bill basis, that would explain why the insurance company would not give up the customer info until you agreed to match TPA pricing. In addition, you are probably red flagged as a constant problem, because you take them to court for short pays. But I knew someone in the North East, some 10+ years ago, he even became the IGA President, who loved to fight the insurance companies and boasted how successful he was at doing it. Well guess what, he is long gone, finished, KaPut. So if all you can do is fight over the short pays on a 1549, 1504, 1658 or a 1265, so be it. Just remember, many do not spread a good word, but when someone thinks you did them wrong, that bad word can spread like wild fire.
Ooops....

The individual was not a customer of the agrr shop !!??

Nope, a body shop. The question was, would a glass shop do this to their customers if the insurance company short paid a claim. A few shops interviewed said no, that was the point of this post.
Ooops...

Ooops, you say "My position is what I stated earlier: I DO NOT believe it is ethical or even LEGAL, in many states, to invoice for auto glass claims, for more than the insurance company will allow, WITHOUT, informing the car owner that you are doing so. That is it, nothing more."

Here is my position: Insurance companies have no business dictating what a company in another industry can charge. Insurance companies already have the deck stacked in their favor. They write the contracts! Policyholders are intimidated by their own insurance companies. Insurance companies have always abused their positions of authority to try to get out from under that which they have promised in supposed good faith. Insurance companies know most of their policyholders are intimidated and do not have the knowledge to argue their side of a claim. Insurance companies know most of their policyholders do not have the time or money to fight for what had been promised to them. Many times claims are outright denied when the claim was valid but the policyholder, not knowing any better, gives up. Does the insurance company use that windfall to reduce premiums or keep premiums from rising? Or does it count it as profit and pay it out as dividends to stockholders?

For many years, while not participating in the TPA networks, my company submitted invoices at the same rate network participants agreed to. However, the insurance companies through their biased TPA's kept demanding deeper discounts and kept repair rates depressed to 1995 levels or less!

I had to face facts. Insurance companies will continue to fleece me if I let them. I have studied auto insurance policies from many different insurance companies. I will continue to submit invoices based on todays cost of living. Invoices that are fair and reasonable and if the insurance company doesn't pay in full, I will litigate. If I do not win, I will accept the judges ruling but so far that has not been a problem. At least now I can pay my bills and keep the wolves away from the door and tuck a little away for retirement.

JB, I understand and support your position. Here is what I have learned about insurance throughout my many years in AGRR: The insurance companies are exempt from anti-trust laws. They CAN "fix" a price or agree to pay a market price, on a particular type of claim, because they need to have enough cash in reserve, so that when the claims come in, they will have sufficient funds to pay them all. BUT, of all of the claims that insurance companies deal with, auto glass is easy and predictable: a piece of glass is broken, you take it out, you put in a new one, it has a part #, they know what the glass costs, they know what your overhead costs are and (this is the one that causes the problems)they will pay you what they think you need to make on a particular glass replacement. So your not wanting to play the insurance game is fine and understandable.
BUT that was not the question asked on this post:
Do you think an AGRR company should sue an individual over a short pay??
We can discuss all of the other things you state later, but what is your answer to the question?
Ooops...

WOW ok lets play. lets just take a few things you commented on. First off before I forget, yes we always inform the customer what to expect.

Ins co's are exempt? Really? They can price fix? Really? you honestly believe this crap?

I do not believe you have ever or are in the AGRR business, you sound like you are in the networking end of AGRR and make money off others work.

SO lets get to your big question Would I sue the insured? Never have never will. They are responsible to pay their deductible, nothing else. please get this in your brain. If they do not pay their deductible they do not get their vehicle back. After 30 year never had this problem and never will.

MR. Opps has reviled himself. In my opinion Mr. opps is not in the agrr business but actually in the network end of the business. That is where a 3rd party makes money off others efforts. steal from others and justify your existence. BIG TIME OPPSSSS

First:
The McCarran–Ferguson Act, 15 U.S.C. §§ 1011-1015, also known as Public Law 15,[1] is a United States federal law that exempts the business of insurance from most federal regulation, including federal antitrust laws to a limited extent. The McCarran–Ferguson Act was passed by the 79th Congress in 1945 after the Supreme Court ruled in United States v. South-Eastern Underwriters Association that the federal government could regulate insurance companies under the authority of the Commerce Clause in the U.S. Constitution.

Second:
Mr Right Answer, is wrong again, I am NOT a TPA. What ever I learned about insurance came from a close friend who was an independent insurance agent and our involvement with various insurance associations, as we tried to get referrals for our retail customers, back in the 80's. Read some of my other posts, and you would know. I was agreeing with what you were doing, and you attack me? Many of my customers want to be able to bill insurance companies directly and get a "fair" price. But they are intimidated by the insurance companies and the customer who will not "fight" their insurance carrier to go to an independent, rather than the 300 Pound Gorilla in the room. Who wants to support a TPA? But, once again, that was not the question posed in the post. You said that you would not sue the customer and you would let them know what you were doing up front, GREAT.

Third:
TPA's were born out of the excess and greed in the 80's. Insurance agents had drafting privileges and when a glass, that should have sold for, say 2 Boxes of Rocks, they paid out say, 5-10 Boxes of Rocks, for the same job. Well you and I both know that the insurance companies do not want to give all of their Rocks away. Somebody once told me, do not get too greedy, if the gap between your selling price and your purchase price gets too large, someone will surely jump in the middle. Joe Kellman, Globe Glass & Mirror, USA Glass and the like, turned a very profitable industry into what it is today, where the discounts keep getting larger all of the time. As someone I know used to say, "We have met the enemy, and the enemy is me", or something like that.

Fourth:
What is the most difficult part of a glass replacement, or any service?
No, it is not doing the job, or getting paid, it is getting the job in the first place. Because, if you do not "get" the job, NOTHING else matters. The TPA's have figured out a way to get the job. Shame on everyone else, most glass shops in the late 80's to early 90's were eager to drop their prices to have Joe Kellman "give" their work back to them, at a huge discount. He was a genius, he may not have been very well liked, but he ruled the roost for quite some time. Look at how many independent auto glass distributors went out of business and independent installers either went out of business or stopped doing auto glass all together. The precedent was set and it still lives on.

Ooops...

WOW now here is the best example of regurgitation I have heard in, ah, maybe FOREVER. WOW. Give me a little time to sort through this BULL CRUD, As I am in no mood to read this garbage at this time. Maybe a few others may have the fortitude to respond to your last poop pile post. Ooops I did NOT say you were a TPA I said it sounds like you are affiliated with or "in " a network implying working for. DO you understand the difference? It is clear now you are not in the AGRR Business, but working for an out side entity. I will get back to you on the rest of your BS. Just not now too tired,,, time for rest.......

Here was my answer.....If I do not win, I will accept the judges ruling but so far that has not been a problem.

Since when is auto glass repair and replacement the "business of insurance"?
Insurance companies bet that their policyholders will not get glass damage and for the most part they are right. That is the business of insurance. Settling claims is part of the business of insurance, but that is where the business of insurance ends.

Fixing rock chips and replacing auto glass is not the business of insurance. Just because a shop down the road will accept what an insurance company wants to pay doesn't mean my price can't be more (or less for that matter) as long as my price is reasonable. My customers pay no more than their deductible if it applies.

Ok guys, I'll admit I'm not the sharpest tool in the shed, but let me dumb this down as I see it. My customer is the car owner, not the insurance company. My customer chooses to pay me by signing an assignment of proceeds, allowing me to bill his insurance company. He chooses my company because while he's had bad experiences with other auto glass companies, he's used us and has been very satisfied with our service and quality of work. He knows we're not the cheapest, but he also realizes the importance of protecting his investment and his family. And he knows we won't bill him for more than his deductible, if he has one.

The assignment puts me in the shoes of the insured. Many, not all, insurance companies refuse to negotiate with me. I bill a fair and reasonable price, and the insurance company pays less than my invoice resulting in a short pay. I sue the insurance company based on the policy language, or the contract, which I'm privy to because of the assignment. I win 99.9% of the time.

Why would I ever sue my customer, the car owner? His insurance company is in breach of contract and aware that many shops don't have the kahonahs to do anything about it. And the car owner is usually at a disadvantage because he's not used to dealing with insurance companies and is easily bullied or intimidated. I take the fight where it belongs, to the insurance company. And I get paid. End of story.

Smiley, Thank you! You are pretty darn sharp. You are one who "get's it"! Well stated.

Opps, I apologize to you if you in fact THINK I attacked you! I have no interest to attack anyone out here, but my PASSION for all things I do, sometimes rubs someone wrong.

All 4 examples you expounded on has many flaws and to try to discuss this will only divert attention from this thread and may just bring more frustration. But just might be a good place to start new interesting threads. I will not try to re-educate or sway your opinions.

I am in the AGRR business and have been for a very long time. I am transparent. how about you? who do you serve? I have also seen many come and go. You 3rd example just is hilarious, because the excess greed you speak of in my opinion was another illusion trumped up by insurance companies wanting to control the agrr business they are not in. And the REAL GREED has been never so flagrant as what has been, and is happening, since 2005 and the second re-balance of NAGS. The formation of TPA's was and has been all about "CONTROL", Everything else is "smoke and mirrors". By the way, I have saved Ins Co's more $$$$$$$$$$ than they have paid me, and many of them know it. It has been my goal to save Insurers so they can save insured's to keep premiums down, it's just nearly impossible to find, or document, as most insured's do not, never have, seen the benefits of those savings WOWOWWOWOWOOWOW THAT PART IS HUGE. Let it sink in.

So in keeping with the "good will" as Mark1 stated let's keep a good post going, and maybe a few more good one's. I don't know how much further this post can go, as Smiley stated to this post just about perfectly.

I think I need to focus more upon what is happening in certain states that networks and ins co's are trying to stop the ability of shops to collect on the thefts of service by short paying proper invoices. Also I have never lost in Collecting short pays since I left the networks..... 10 years later I am still here. Collecting from those who steal is very very worth it! And well worth my time....

I want to bill direct but have no clue how. I have been in business for 7 yrs, installer for 15 yrs. i didn't do much general public or insurance the last 7yrs. So I never had a need to do this but times are changing.

Just a comment about the "excess and greed" of the 80's that necessitated TPAs. We made a decent living in the 80's and 90's. I didn't trust the TPAs when they began even though they pretended to be our friends. Some thought I was paranoid to not trust them, but look where we are now.

Many installers are woefully underpaid. Shop owners can't afford to provide decent health insurance and other benefits. Replacing work vans is out of the question, and while tools should be upgraded that too doesn't happen.

We have never overcharged, but have billed a price that allows us to run a first class business. Insurance companies know that auto glass claims are a bargain compared to other claims but when sharks taste blood they can't turn back. TPAs and shops who can't say no have allowed them to beat the AGRR shops down and demoralize them to the point that they think maybe they are charging too much.

I will never apologize for providing the best auto glass service in my area while making a decent living for my employees and myself. I never intended to be a non-profit.

ATX at the top of this page is a search box type in direct billing. There are pages of information Note Find a post that has a fair number of other posts with it then you don't have to go back and forth too much. The info is already out there.

I have read it all on here. I have a general idea but still not 100% sure.

I'm in a situation right now where a tpa's fax did not come thru and I was trying to be nice guy and get the broken glass done before the up coming rain. Well when fax finally came referral # was all xxxx. Now the tpa won't pay and customer won't pay more than deductible and get reimbursed. So who would I go after?

If you have a proper assignment and the insurance company was notified before you did the work sue the insurance company. If you didn't get an assignment your customer will have to pay you. Depending on where you live small claims might be the route to go.

In addition, his xxxxx fax is proof they were notified per policy reqs. The network has no legal rite to assign the job. He's holding all the cards. I'm talking about network job assigning not assignment of proceeds, that the fax had no claim number on it. Obviously they called it in or he wouldn't have the xxxxx fax.

Good point. I should have had more coffee this morning.

Usually an XXXXXX fax indicates that the coverage has not been verified. Most of the ones we get turn out to be liability only or no comp coverage.

He has coverage. Tpa said the xxxx meant they where sending out an inspector (safelite tech with the parts on his van). Call customer again today he called his agent, his agent called me asking for invoice to be send to him.