On a typical day, our Claims Department receives calls of
all kinds. Most are routine, but some are like this…
Mr. Smith took his RV to a repair shop to have some work
done. The shop completed the repairs, and under normal circumstances that would
be that. What Mr. Smith didn’t know was, although he had followed the rules of
his contract, the repair shop had not.
When you purchase one of our vehicle service contracts, you’ll
notice at the bottom of every page is a statement in all capital letters that
says, “AUTHORIZATION MUST BE OBTAINED FROM THE ADMINISTRATOR BEFORE STARTING
TEARDOWN OR REPAIRS.” This statement also provides a toll-free number to quickly
receive the necessary authorization. In addition, all contracts contain a
clearly defined procedure on what to do when a breakdown occurs.
Unfortunately, in Mr. Smith’s case, the shop had not
obtained authorization to perform the repair.
Not knowing that this had happened, Mr. Smith submitted a
claim to us for reimbursement of the amount he had paid to repair his RV. Soon
after, he was surprised to receive a letter of denial. He gave us a call to find
out why his claim had been denied. One of our Claims Adjudicators tried to help
Mr. Smith, but since the shop had not received authorization for the repair,
there appeared to be very little he could do. In a last-ditch effort, the
Adjudicator transferred Mr. Smith to Fred, his supervisor on duty that day.
Fred was able to determine that, although the repair
facility had received all of the correct instructions to allow the claim to
proceed normally, the shop had not followed those instructions. As a result,
through no fault of his own, Mr. Smith’s claim had been denied.
Fred carefully reviewed Mr. Smith’s claim, and began to
separate “the wheat from the chaff.” While some of the work performed on Mr.
Smith’s RV was for maintenance, and therefore not covered, several repairs were
indeed eligible for coverage under his ProTrek service contract. Once his
investigation was complete, Fred determined that Mr. Smith could be reimbursed
for a significant portion of his total repair bill.
Fred’s diligence and skill in this claim investigation
certainly paid off for a very grateful Mr. Smith, proving once again that
SouthwestRe’s Claims Department is “The Best in the Business!”