Customer Advocacy

The vast majority of all claims move smoothly through each administrator’s system without autopom!’s involvement. However, occasionally a few claims may need a little help. When this happens, we encourage our customers to reach out for assistance.  We call this our Customer Advocacy Program.

Every claim involves multiple parties including:

• Customer
• Repair Shop
• Claims Administrator
• Sometimes, the claim will also involve an Inspector.

Occasionally when a claim does not meet a client’s expectations, they will give us a call. Our team here at autopom! will carefully listen to the customer’s concern or complaint, review the customer’s contract, and will call the applicable claims Administrator and/or shop as necessary.

In some cases, it is just a matter of helping the customer understand the terms of their contract. In other cases, we have successfully gotten claims approved when they were initially denied by ensuring our clients’ Administrators were adjudicating claims per the terms of the contract and treating our clients fairly.

It should be understood that autopom! will do its best to advocate for a positive outcome to your claim however, autopom! is not the obligor of the contract and cannot promise success in all cases. Here are a few examples with positive outcomes.

Date: 3/31/2020

Vehicle: 2014 Mercedes E550

Reason for customer’s call to autopom!:  Partial claim denial.

1. Customer’s statement of issue #1: The rear passenger side window will not operate from the driver’s master control panel and this portion of the claim was denied.
2. Customer’s statement of issue #2: The shop was told that diagnostic fees are not covered.

Administrator’s stated reason for claim denial:  Diagnotic fees and damage due to physical impact are not covered per the terms of the contract.

1. Reviewed issues with customer
2. Reviewed terms of customer’s contract
3. Reviewed claim record online
4. Reviewed inspector’s report
5. Called the plan Administrator and reviewed claim notes on file
6. Determined legitimate claim issues exist in favor of the customer
7. The following email was sent

From: autopom! CEO

To: Administrator Claims Supervisor:

Subject: Claim denial for rear passenger window control and diagnostic fee

“Issue #1: Rear passenger side window will not operate from the driver’s master control panel.

The claims Inspector reported that there were “impact” marks on the button. The claim was denied due to “impact,” because any physical damage from collisions/other objects are not covered under the customer’s policy.

The customer, however, states there has been no impact and reported that the plastic window switch had a rubberized coating that had blistered on that button as well as other plastics in the vehicle. Evidence of the blistering was also shown in one of the photos from the inspectors report.

The “blister” left a permanent bubble which is easily worn off and exposes the white plastic underneath. According to the customer, that was the situation with the window switch.

Since there was no impact, the mechanical/electrical issue casing the failure of the window control should be covered per the terms of the contract.”

“Issue #2: The shop was told diagnostic fees were not covered.

While some plans do not cover diagnostic fees, this was not the case for this customer’s contract. Therefore the claim needed to be amended to include the diagnostic fees.”

Outcome:

Email response was received same day. Claims supervisor approved repair (parts and labor) for the faulty window switch and also approved time for diagnostics. Notified customer with text and follow up phone call. Customer was satisfied with the outcome.

Claim Authorization:
Initial: $634.00
Final: $983.00

Date: 4/24/2020

Vehicle: 2011 Mercedes SL550

Reason for customer’s call to autopom!:  Partial claim denial.

1. Customer’s statement of issue #1: The oil filter housing gasket is leaking and the claim for this part of the repair has been denied.

Administrator’s stated reason for claim denial: Because there is a TSB (Technical Service Bulletin) published in November of 2018 announcing the gasket as a potential issue, the Administrator stated the gasket is not eligible for coverage per the terms of the contract.

1. Reviewed issues with customer
2. Reviewed terms of customer’s contract
3. Called the plan Administrator and reviewed claim notes on file
4. Called the Service Advisor at the repair facility
5. Determined legitimate claim issue exists in favor of the customer
6. The following email was sent:

From: autopom! CEO

To: Administrator Claims Supervisor:

Subject: Claim denial for oil filter housing gasket

As we discussed on the phone, Section V – Exclusions – What Is Not Covered, fifth paragraph of the customer’s contract states: “Coverage under this Agreement is similarly limited in the event of a Breakdown if the manufacturer has announced its responsibility through any means, including public recalls and factory service bulletins.”  I asked the service advisor at the repair facility if the TSB is Mercedes responsibility.  The Service Advisor responded that the TSB is informational only and Mercedes takes no responsibility for the repair and replacement of the Gasket.  Because the TSB is informational and because the manufacturer does not take responsibility, per the terms of the contract the failed gasket would be eligible for coverage.  Please escalate this request to the Director for reconsideration of eligibility for coverage.  Thank you.

Outcome:

Email response received next day. Approved repair (parts and labor) for the faulty gasket. Notified customer with text and follow up phone call. Customer was satisfied with the outcome.

Additional Claim Authorization:

Approximate: $700

Lesson Learned: 

Read your contract so you will know if something is off.  Make sure that the Service Adviser at the repair facility is communicating with the Adjuster at the Administrator’s office.  If you have questions, call the Administrator and ask to speak to the Adjuster yourself.  If not satisfied with the answers to your concerns, give us a call.