#1 Employee
AUTHOR: Laura F - Arlington Heights, IL (U.S.A.)
SUBMITTED: Thursday, June 04, 2009
POSTED: Thursday, June 04, 2009
We would like the opportunity to review your claim and address your concerns with the Wheelz auto warranty that you purchased from American Auto Guardian. Please provide your vehicle service contract number, the VIN number of your vehicle, and/or your name so that we can identify and review your claim.
Thank you.
Laura F.
Legal/Compliance Department
American Auto Guardian, Inc.
Arlington Heights, IL
#2 Employee
AUTHOR: Laura F - Arlington Heights, IL (U.S.A.)
SUBMITTED: Thursday, June 18, 2009
POSTED: Thursday, June 18, 2009
Since the contract holder did not respond to our request for information, after much research we have been able to locate the radiator and transmission claims that are the subject of this complaint. We have reviewed recorded telephone calls with the repair facility and the contract holder, and our claim notes and files. The facts are as follows:
The Wheelz vehicle service contract coverage that was selected by the contract holder covers those parts that are specifically listed in the contract. The contract holder also elected to be responsible for a $100 deductible on any repairs. The radiator was a listed item, so it was covered along with the labor to install it, and replacement of coolant. Consequently, 100% of the cost of the radiator was covered, less the contract holder's deductible – not 20% of the cost as the contract holder claims. Moreover, the radiator repair was authorized the same day it was called in, so we also disagree with the contract holder's statement that it was “like pulling teeth” to get coverage.
The repair facility additionally performed a transmission flush at the same time as the radiator repair. However, there was no failure to the transmission at that time (only breakdowns are covered), and normal maintenance is not included in coverage under the Wheelz service contract. We advised the repair facility that if the contract holder decided to go ahead with the optional flush, the cost would be the contract holder's responsibility.
Almost a year after the radiator repair, and after driving an additional 15,000 miles, a different repair facility contacted us with regard to a transmission problem on the contract holder's vehicle. Our adjuster read to the repair facility from the Wheelz contract those parts of the transmission that were covered, and those that were not. The adjuster then specifically told the repair facility that it needed to tear down the transmission, and then call us back so that an inspector could be sent to investigate the cause of failure before any work was done. We would then review the inspector's report and determine whether there was coverage, and whether the repair would be approved. The Wheelz service contract does contain certain exclusions to coverage, such as if the failure is caused by failure to maintain the vehicle, or by abuse or neglect.
We never heard back from the repair facility until April 29, 2009, almost 3 weeks later. At that time, the repair facility said the repair had already been completed, and that the vehicle had been taken by the customer. The repair was done even though no approval or authorization code to do the work had been given. Since an inspector had not been sent to determine the cause of failure because the repair facility never called back to advise us that the vehicle was ready to be inspected, and since the customer had taken the vehicle, we were deprived of the opportunity to determine whether the cause of the transmission problem was covered.
The front page of the contract holder's Wheelz contract states in all bold capital letters: “CALL FOR PRIOR AUTHORIZATION ON ALL CLAIMS.” Exclusion No. 2 states that the contract does not cover any repairs or services performed on the vehicle prior to obtaining authorization from us. Under the Section “How to Submit a Claim” it states: “Our Administrator will issue a claim authorization number. The authorization number must appear on all repair bills. Failure to obtain authorization PRIOR TO REPAIRS will result in non-payment of claim.” Finally, under the Section entitled “Reimbursement,” the contract provides: “You will be solely responsible for payment to the repair facility unless prior authorization has been given by Us.”
It is unfortunate that the repair facility failed to obtain prior approval for the repair, and therefore, we were prevented from determining coverage. Throughout the claim process the procedures were clearly explained, and both the repair facility and the contract holder were treated professionally and with courtesy. We are disappointed with the language used by the contract holder, and believe that the facts show that we acted appropriately.