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Completely unrelated but... I had a issue with lightning instead. We were paying some rather expensive home insurance, one time a thief broke inside, and they

Completely unrelated but... I had a issue with lightning instead. We were paying some rather expensive home insurance, one time a thief broke inside, and they did all they could to avoid paying us, ended paying the bare mininum they could, barely covering the stolen goods costs. Still at the time it didn't looked like bad faith, just fraud checking... But then this time lightning hit our house, the insurance response was that unless we can prove it was a direct strike against the house, it would count as "electrical fault" that is not covered, because it would be blamed on the electric company instead... So we argued that yes, the lightning DID hit our house directly (because well, it did, the path the electricity did was very obvious, with the endpoint being the pointy metal end of the structure that holds our gate upright), they just flat out refused to come check, because the likelihood of this happening was so low that they were sure it was a waste of their time to check, and that we should bother the electricity company... The electricity company in turn, said they detected zero fluctuations on the grid, and would not send a technician to check, that it wasn't their fault. So that day I learned that "lightning coverage" only cover a strike on the hourse itself... a strike on the lamp-post right outside for example, doesn't count, even if it blows up everything inside your house, becase the "fault" then is the electric company.

3JPLW 7y ago
My recent encounter with this comes from healthcare. Healthcare companies love to brag that their "prenatal maternity care is 100% covered, no deductible, no copay." Turns out "prenatal maternity care" is simply defined as the blood pressure, weight, and fundal measurements. That's all that bullet point means. * Ultrasound? Well, that's different. It's a lab procedure. Yep, even the 20-week "standard" anatomy scan. * Get a non-stress test done (literally just 10 minutes worth of heart-rate monitoring)? Then it becomes a "specialist visit." You'll pay for that. * Get any bloodwork done? Even if it's for the mother's health and not trying to do some sort of pre-natal screening? It's a diagnostic lab procedure. * Urine samples for pre-eclampsia? Diagnostic testing. * Mandatory (state-required) STD panel? That's diagnostic testing, too. Turns out the ACA requires "pre-natal care" to be covered, so bragging about it in the first place is just absurd.
dclowd9901 7y ago
Is there not law on the books that cover... gosh what's it called. When something causes something else to happen in a direct way? I know in some places, there's laws that say, "If Person A slams on their brakes for no reason, and Person B has to slam on their brakes causing Person C to go off road and hit a pole, person A could be at fault"?
- lgeorget 7y ago
  I'm not a lawyer but I think it's the basis of civil law (I speak for France specifically but it's kind of a general principle): any damage must be repaired by the one who caused it, by action or lack thereof, voluntarily or not. Then of course, the difficult part is deciding who is at fault.
TheOtherHobbes 7y ago
This is absolutely standard for the home insurance industry, which is notorious for trying to use technicalities and legalistic excuses to avoid paying out. It's essentially trading on fraud, dead centre in that grey area of contract law where your only hope of winning a case is court action with the help of top flight lawyers - whose services you can't afford. Of course some companies are more reputable, but there is a huge - huge - spread of integrity within the industry. No one should ever believe that just because they pay $x/yr they're covered to the extent they hope they are without checking small print and doing plenty of searches for customer feedback.

3JPLW 7y ago

My recent encounter with this comes from healthcare. Healthcare companies love to brag that their "prenatal maternity care is 100% covered, no deductible, no copay." Turns out "prenatal maternity care" is simply defined as the blood pressure, weight, and fundal measurements. That's all that bullet point means. * Ultrasound? Well, that's different. It's a lab procedure. Yep, even the 20-week "standard" anatomy scan. * Get a non-stress test done (literally just 10 minutes worth of heart-rate monitoring)? Then it becomes a "specialist visit." You'll pay for that. * Get any bloodwork done? Even if it's for the mother's health and not trying to do some sort of pre-natal screening? It's a diagnostic lab procedure. * Urine samples for pre-eclampsia? Diagnostic testing. * Mandatory (state-required) STD panel? That's diagnostic testing, too. Turns out the ACA requires "pre-natal care" to be covered, so bragging about it in the first place is just absurd.

dclowd9901 7y ago

Is there not law on the books that cover... gosh what's it called. When something causes something else to happen in a direct way? I know in some places, there's laws that say, "If Person A slams on their brakes for no reason, and Person B has to slam on their brakes causing Person C to go off road and hit a pole, person A could be at fault"?

lgeorget 7y ago
I'm not a lawyer but I think it's the basis of civil law (I speak for France specifically but it's kind of a general principle): any damage must be repaired by the one who caused it, by action or lack thereof, voluntarily or not. Then of course, the difficult part is deciding who is at fault.

TheOtherHobbes 7y ago

This is absolutely standard for the home insurance industry, which is notorious for trying to use technicalities and legalistic excuses to avoid paying out. It's essentially trading on fraud, dead centre in that grey area of contract law where your only hope of winning a case is court action with the help of top flight lawyers - whose services you can't afford. Of course some companies are more reputable, but there is a huge - huge - spread of integrity within the industry. No one should ever believe that just because they pay $x/yr they're covered to the extent they hope they are without checking small print and doing plenty of searches for customer feedback.