Email us your question: AskAdvocate.INS@oregon.gov​

Let's start with the tree or branch falling on your car. If your car insurance policy includes comprehensive coverage, damage caused by falling or flying objects is covered. You would be responsible for your deductible. To find out if you have this coverage, check your most recent bill or the declarations page of your policy. Each coverage you selected will show a premium next to it. If you are not sure, check with your agent or company.

Homeowner policies also cover damage caused by a tree or branch falling on your house. Your homeowner policy will pay to remove the tree or branch from the roof, repair the structure, and pay for property that is damaged by the tree or branch falling. Your deductible would apply and there may be limits on debris removal. Your policy also covers reasonable additional living expenses if the damage is so extensive you can't live there while repairs are done. Some property policies do not include this coverage.

Sometimes, the tree or branch that falls on your house or car belongs to a neighbor, so we receive calls asking whether the neighbor is responsible for the damage to your property. There really isn't an easy answer to this question. Your homeowner policy or the comprehensive coverage on your car will cover the damage whether it is your tree or your neighbor's. Your insurance company will then investigate to determine if there is responsibility on the part of your neighbor. If you use your own car insurance or homeowner insurance, the insurance companies can work it out between them.

Homeowner policies generally cover damage caused by collapse due to the weight of ice or snow, as well. The key for coverage is usually actual collapse. Sometimes, melting ice or snow will cause ice dams that lead to interior damage caused by leaks. If there no actual damage to the roof structure caused by the weight of ice or snow, a leaky roof is generally not going to be covered.

The TV coverage was for a commercial building. Commercial policies may also provide this coverage. We recommend business owners review their policy documents with their insurance agent or company to be sure there is a good understanding of the types of losses that are covered.

As always, if you have questions or experience difficulties with an insurance company, our advocates are available at 1-888-877-4894 (toll-free).

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Water from a leaking pipe can cause a lot of damage to a home and personal property. For example, a burst pipe under the kitchen sink could damage walls, cabinets, floor coverings, and items stored in the cabinets. The good news is homeowner policies generally cover the accidental discharge of water from a plumbing or heating system caused by freezing. The repair of the pipe is usually the responsibility of the homeowner, but the insurance company would take care of any resulting damage. This includes repair or replacement of damaged property. It also includes the added cost to live somewhere else if the damage is so great that the home cannot be lived in.

Once the water is turned off, make sure to promptly start the process of getting the water cleaned up to keep the damage to a minimum. There are contractors who specialize in water extraction and the drying process. Most insurance companies can recommend services if the homeowner needs help.

If you have issues with your insurance company or agent or have questions, call the Division of Financial Regulation Consumer Advocacy Team at 1-888-877-4894 (toll-free). Information is also on our website, dfr.oregon.gov.  

No. Oregon law prohibits an insurer from making the use of a certain repair shop a condition for payment. Many insurers have established relationships with repair shops, and many consumers view this as a value added service and choose to use those shops, but it’s up to you who repairs your car.

A little history might be helpful. Consumers used to get estimates and send them in to their insurance company.  Then in the 70’s, many insurance companies established drive in claims services where a consumer could bring the car in and an adjuster would evaluate the damage. In the 90’s, many insurance companies started direct repair networks, kind of like the preferred provider organizations that we see in health insurance. 

Sometimes consumers already have an established relationship with a repair shop. If you don’t, we would suggest you approach your car repair in the same way you would when selecting any product or service. Do your research, ask around for referrals, check with the Better Business Bureau and possibly visit more than one repair shop to find the best combination of price and performance.

Once you have made your choice, notify your insurer and be sure you have agreement regarding what the shop is charging and what the insurance company will pay  (before you sign any contracts with the shop)Oregon administrative rules state an estimate prepared by an insurer or repair shop shall be in the amount for which the damage may reasonably be expected to be satisfactorily repaired. If you choose the most expensive shop in town, the insurance company may not be willing to pay the whole amount.

If you run into problems with your insurance company, you can always contact the Oregon Division of Financial Regulation at (888) 877-4894 and an advocate can assist you.​

We share your concern about the cost of car insurance. Any changes in car insurance rates are subject to review by actuaries on our staff. Sometimes changes in the law that are intended to benefit consumers can also affect the cost of insurance. The 2015 legislature passed Senate Bill 411 which made changes in two required coverages, Personal Injury Protection (PIP) and Uninsured Motorist (UM). Let’s take Personal Injury Protection first.

PIP pays for medical expenses, lost income and other benefits for you and your passengers who get hurt in a car accident. It doesn’t matter who is at fault. Before this bill became law, medical expenses had to be incurred within one year. Now the time period is two years. For example, Jane was hurt in a car accident and had to have physical therapy for fourteen months. Under the prior law, her car insurance company would have paid for twelve months and Jane would have had to use other resources for the last two. Now all fourteen months may be paid. There is also a dollar limit but that was not changed, so the amount available to be paid could be used up before the time limit runs out.

Uninsured Motorist coverage is a little more confusing for most people. If you’re hurt in a car accident and someone else is responsible but doesn’t have car insurance, then your insurance company steps in and pays what the responsible party’s insurance company would have paid.  UM also applies if the responsible party doesn’t have enough insurance to cover all of your damages. When you buy car insurance, you choose the limits for this coverage. Let’s look at a couple of examples.

1. Jane selected the minimum limits for UM coverage when she bought her policy. The maximum payment is $25,000 for each person injured. She was involved in an accident with Joe and it was determined that he was 100% responsible. He does not have car insurance. Her accident was very serious and she had hospital bills, doctor bills, lost income, and months of discomfort. Her claim for all damages could be $60,000. Since there is no insurance available from Joe, Jane’s company would pay $25,000.

2. Now let’s change the facts. Joe does have insurance, but he also chose minimum limits of $25,000 per person for his liability coverage. His company would pay the $25,000. Under the prior law, Jane’s UM limits would not apply because her limits were the same as Joe’s. Now Jane’s limits will apply and she may be paid up to an additional $25,000 by her insurance company.

These changes may result in higher claim payments and insurance companies may adjust their rates to cover the increased claim payments. The affect of these changes should be relatively modest, so if you are seeing substantial increases, we suggest asking for a detailed explanation. You may also want to consider shopping for the best combination of coverage, rates and service.

If you have questions or are having difficulties with your insurance company or agent, our advocates are available at 1-888-877-4894.​ ​​

I turned to consumer advocates Tricia Goldsmith, Sue Lefferts, and Lisa White for this one. Here is their response:

A Flexible Premium Adjustable Life Insurance policy is commonly referred to as a Universal Life policy. A simple way to think of a Universal Life policy is to think of it as a “bucket.” The bucket fills up with money, or cash value, by premium payments you make, and interest credited to you from your insurance company.  Money is taken out of the bucket by the cost of insurance and the expense charges of the policy.

 As an example, say you start your policy when you are age 25, and you pay $50.00 month.  $50.00 a month is dumped into your bucket. Your cost of insurance at age 25 is only $6.00 per month and the expense charges are $4.00, so after the $10.00 is deducted, $40.00 stays in your bucket. As you get older, the internal cost of insurance continues to increase, but ideally you are able to pay the same $50.00 per month, because your bucket filled with cash value pays the difference. Using our same example, you are now 65 years old. You pay the same $50.00 a month, and dump it into your bucket. The cost of insurance now is $75.00 per month, and the expense charges are still $4.00.  The additional $29.00 needed for that month’s payment is taken from the cash value, or the money in the bucket. At this point, the $50.00 is less than the true cost of insurance causing the policy’s cash value to decrease.

It is common for your insurance company to come up with the monthly premium by estimating what payment would provide coverage to age 100 without depleting the cash value. This premium will never be exact, however, because insurance companies can only make educated predictions on future interest rates, based on history and current data. There are also other factors that could cause the bucket to run out of money prematurely. Not making premium payments for a period of time, withdrawing some of the cash value, taking loans against the policy, or increasing the coverage but not the premium are just a few examples.   

The best way to protect your Universal Life policy is to review your annual statement with your agent or insurance company. This way, you can adjust your premium by small amounts along the way if needed, and avoid your policy being in danger of cancelation or in need of a large sum of money. 

Please click on the link below for more in-depth information on Universal Life policies. If you have additional questions or have a concern regarding your Universal Life policy, you can reach a consumer advocate by phone at 1-888-877-4894 or by email at cp.ins@oregon.gov. ​​ 

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I remember as a kid going to see the new car models every fall with my dad. There was a time when car models changed every year, and the only source of crash parts was the car manufacturers. When car models began staying substantially the same for years, other manufacturers entered the crash parts market. In a competitive market place, there are going to be differences in the cost of crash parts.  Oregon law allows for the use of after market parts, but there are important safeguards. The part must be certified by an independent test facility to be at least the same quality with respect to fit, finish, function and corrosion resistance as a factory part. The insurance company is also required to provide a warranty for crash parts not made by the original equipment manufacturer.

The use of recycled parts has also become quite common. The parts on your car aren’t brand new, they’re four years old. If a salvage yard has a car like yours, a quality recycled part may be available.

If you run into problems with your insurance company, experienced consumer advocates are available to assist you at the Oregon Division of Financial Regulation, (888) 877-4894.​​ ​ ​​​

We appealed and got the same result. We had to hire a lawyer and are just filing for external review. We contacted the Insurance Division but you appear powerless to do anything, even though you tried.

Thankfully, medical science is constantly developing new medicines and treatments. However, experimental or investigational treatments are typically excluded in health insurance contracts until such time as there is enough evidence to support their safety and effectiveness.  You’ve identified an important safeguard in Oregon law to make sure insurance companies apply this exclusion appropriately: external review.

Insurers in Oregon offering health benefit plans are required to have an external review program. This means your wife’s medical records and any other documentation you wish to submit may be reviewed by independent medical professionals. The State of Oregon contracts with several external review organizations which are assigned at random and are not affiliated with the state or the insurance company.  There is no charge to you for this process.

Independent reviewers must base their determination whether the decision of an insurer should be upheld or overturned on expert clinical judgment, after considering relevant medical, scientific and cost-effectiveness evidence and medical standards of practice in the United States. About a third of the denials are overturned.

While we can’t always get the desired result, our advocacy team is available to help when you experience difficulties with your insurance company or agent. Advocates answer questions, explain processes, and may contact the insurance company on your behalf to be sure the company is in compliance with the law and the terms of the contract.  We can also help you understand the appeals process and what types of materials may be helpful to make your case. Help is available on our website​. The advocacy line is (888) 877-4894.

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