How Insurance Companies Inspect Your Car Accident Claims

Why Do Car Insurance Companies Need To Investigate A Car Accident?

Insurance companies need adequate information to handle claims promptly and fairly. Thus, they need to investigate all claims, including car accidents. Below are three reasons your insurer will investigate your car accident:

Protect Itself Against Fraud

Cases of policyholders intentionally deceiving their insurance companies to receive a payout they are not entitled to have been reported for years. To offset the financial burden of fraudulent claims, insurers typically increase premiums for all policyholders. 

Therefore, car insurance companies conduct in-depth investigations of car accidents to prevent potential insurance fraud and, in turn, protect themselves and policyholders.

Properly Assess Your Claim

Investigating a car accident allows an insurance company to assess a claim, as they gather adequate information regarding the accident, including how it happened and the extent of the damages and injuries it caused. 

During the investigation, the company can gather evidence using different ways, such as getting details about the accident from you, talking to the other driver and witnesses, visiting the accident scene, examining the photos you took at the accident scene, and reviewing the police report if one is available. 

Accordingly, they can learn more about the accident and identify how much to pay out.

Determine Liability

Your insurance company needs to investigate the crash you were involved in to determine liability. The evidence they gather when assessing your claim can be vital in helping with this aspect.

The company may find you or the other driver at fault. Or you may both be at fault (modified comparative negligence). The party found at fault compensates the other, or you may be compensated based on your percentage of fault.

The Investigation Process Begins When You Make A Claim

A claim begins when you contact your insurance company. You can use a form on their website or call the company to report the claim. The insurance company then assigns someone to the case — their representative is called an adjuster. The adjuster will contact you to ask for more information and then do the following:

Visit the Accident Scene

If they believe it would be helpful, the insurance adjuster may visit the accident scene. The visit may help the adjuster answer questions about how the accident occurred and help them create a clear picture of the case. Usually, the insurance adjuster doesn’t travel to the scene of an accident unless fault isn’t apparent or it’s a severe accident.

Ask You for Information

When you hear from the insurance company, expect them to start by asking you what happened. They want a summary of how the accident occurred and will likely want to ask follow-up questions. The insurance adjuster may also ask you for additional information, including any of the following:

• The police accident investigation report
• A police report if the police generate one
• Photos that you took at the scene
• Any additional images
• Copies of your medical records and bills
• A release to look at your medical records

The adjuster may also want to look at your vehicle.

Contact And Interview Other Drivers And Witnesses

The insurance adjuster may want to talk to others involved in the case. They might contact the other driver and any witnesses. The insurance adjuster wants to know if their version of the accident matches yours.

Gather Evidence

The insurance adjuster might ask you to go for a medical examination with a doctor they choose. It’s called an independent medical examination, but it’s really not independent because the person who gives you the examination works for the insurance company. For this reason, nowadays, it’s mostly referred to as Compulsory Medical Examination (CME).

The examination gathers information about your injuries, treatment, and future medical costs. Its results are crucial, as they are used to determine the outcome of a claim. 

The insurance company may want your medical records to evaluate your injuries. Besides the medical records directly related to the accident, your insurer may request access to those unrelated to the crash to identify if you had a pre-existing condition that may have been worsened by the accident. 

Thus, you need to be extra careful when your insurer requests a medical examination. If they begin to ask questions about the nature and extent of your injuries, it’s time to ask for an attorney to help you respond to their requests.

Preliminary Determination Of Fault And Payment

Once the claims adjuster reviews all the information they think is helpful, they determine fault and complete a report. They may take modified comparative negligence into account when they make their decision.

The insurance adjuster looks at the policy or policies that may apply to the case. If there’s an insurance policy that covers the damages based on how the accident occurred, the insurance adjuster approves payment up to the policy limits.

You can begin making repairs even while the claims process is ongoing. The insurance company may have a preferred body shop for vehicle repairs, or you may be able to get quotes from a few body shops of your choice. You can use the body shop you want, but the insurance company may disagree with you about the price of the repairs.

What If I Disagree With The Insurance Company’s Decision?

If you disagree with the insurance adjuster’s decision, there are things that you can do. You can provide more information to the insurance adjuster and ask them to review their decision. You can also ask a supervisor to review the adjuster’s decision. You can also send a formal demand letter to the insurance company or begin formal litigation proceedings.

How Long Does An Insurance Claim Investigation Take?

In a simple case, the insurance claim investigation process may be over in a few short weeks. In complicated cases, it can take several months. Each company has its own unique method for investigating a claim. Even within a company, the investigation process depends on the severity of the accident and the complexity of the issues in the claim.

Why Do I Have To Prove My Case To The Insurance Company? Shouldn’t They Just Pay?

It can sometimes feel like the insurance company is making you prove your case. It can be frustrating when it feels like the insurance company is not on your side. Unfortunately, however, some people try to commit fraud with insurance.

The FBI says that insurance fraud increases premiums for each family by $400 to $700 per year. It may be routine practice for the insurance company to put extra effort into each investigation to prevent fraud. 

However, if the insurance company is willfully dragging its feet or denied a valid claim, you have rights. The insurance company may face penalties for denying your claim in bad faith.

Can I Cancel An Insurance Claim Under Investigation?

Before any payments are made, you can cancel a car insurance claim under investigation. Different reasons can lead you to this. Firstly, you may cancel your insurance claim if you determine the deductible (the amount of money you pay out of pocket for damages to your vehicle before your insurer starts to pay for the damages) is higher than the total cost of repairs. You can also cancel a claim if the circumstances in your life change. Perhaps you relocate to a new area or have new responsibilities in your life that make it difficult for you to cooperate with the ongoing investigation or the whole claim process.

Some people cancel their car insurance claims to avoid a potential increase in premiums. This is especially common when a driver is found fully or partially at fault. Nonetheless, canceling doesn’t always mean premiums won’t be increased because the claim would already be in the policyholder’s record, which may be factored in when calculating future premiums. Therefore, if this is your primary reason for canceling your claim, get more information from your insurance provider to determine the best way forward.

Other common reasons for canceling an insurance claim under investigation are insufficient evidence and inability to afford deductibles.

To cancel your insurance claim, you need to notify your insurance company by phone, email, or in writing. The company may ask you to provide a clear written statement confirming your intent to cancel the claim. It may also request you to provide relevant documentation supporting your decision, such as new evidence proving you were fully/partially at fault or estimates showing the repair costs are less than your deductible.

Observing the policies for canceling an insurance claim under investigation is vital. Your insurer may have a deadline for canceling after you file a claim. You may also be required to pay fees for the investigation that has already been done. Thus, obtain as much information as possible to make informed decisions.

Can Someone Claim On My Car Insurance Without Me Knowing?

If you unknowingly cause damage to someone else’s car, they may make a claim on your insurance without you knowing it first. For example, if you accidentally brush up against another car when leaving a parking lot and you fail to notice. The car owner may present the case to the parking lot owner, who may provide your license plate information through security cameras. The individual may then obtain your other details, including insurance information, from the police or Department of Motor Vehicles (DMV) if they present a good case.

Another scenario, although not recommended, is if you and the other driver agree that the damage of the accident you are involved in is minor enough to warrant not filing a claim. You may then be surprised when they make a claim on your insurance anyway. You might have decided to exchange information as a legal requirement but opted to handle the minor repairs out of pocket. However, the other driver then changed their mind after leaving the scene and contacted your insurance provider. 

Additionally, a claim may be made on your insurance without you knowing if you brush up against another vehicle when the owner is not around. You may leave a note with your contact information, believing the driver will call you so you can agree on a way forward. But they may not do so. Instead, they may find your insurance details and file a case without informing you first.

Nonetheless, it’s rare for you not to know a claim on your car insurance has been made at all because it’s standard procedure for insurance companies to inform policyholders of any claims made. Thus, even when unaware of an accident or damage, your insurer will notify you to confirm its authenticity.

What Happens When A Car Accident Claim Exceeds The Insurance Limits?

It’s not uncommon for car accident claims to exceed insurance limits. Expenses resulting from accidents, such as medical bills (existing and future), lost wages, lost earning capacity, and pain and suffering, among others, can be significantly high.

If a claim exceeds the insurance limits of an at-fault driver, their insurance company may only pay up to the maximum amount specified in their policy. You may be responsible for getting the remaining balance, which you can obtain from your underinsured motorist (UIM) coverage if you have one. 

With this option, you need to file a claim against your own insurance company to receive compensation for expenses the at-fault party can’t cover fully. You should send your insurer a demand letter, providing details of the accident, the nature and extent of your injuries, and how the accident has impacted your life. You can then provide evidence of the losses you have incurred as a result of the accident and state the amount you are demanding to settle the claim.

Upon receiving your demand letter, your insurance company will assess it and send you a response. It may reject your demand or can reply with a settlement offer. If it denies your demand or replies with an unfair offer, consider legal guidance to fight for your rights.

If you don’t have UIM coverage or you seem not to receive a fair settlement from your insurance company, you can file a lawsuit against the at-fault party. The court may request them to pay you from their personal assets. 

Filing a lawsuit to recover the remaining damages on a car accident claim can be complicated, particularly if the other party does not have enough assets to cover your damages or they file for bankruptcy.

Thus, you should know the steps to take for a smooth experience. For starters, assess the strength of your case. Do you have sufficient evidence to build a strong case? Do you have adequate medical records to link your injuries to the accident? Can you prove the other driver was at fault? And so on. Our car accident claim lawyers can help you establish this factor.

Once you have determined you have a strong case, you need to notify the other driver before filing a lawsuit through a demand letter detailing the accident, the injuries sustained, and the amount you are claiming. You will also state the deadline by which they should respond.

From the letter, the other party should understand that you will be filing a lawsuit if they fail to settle the claim. We can help you draft a clear demand letter that includes all the relevant details.

The other party may respond within the specified deadline to negotiate a settlement with you. If they fail to respond or your negotiations do not end in a satisfactory settlement, you can proceed with filing a lawsuit. 

Should I Get A Lawyer To Help With My Car Insurance Claim?

If you’re making an insurance claim, you will want to work with an experienced lawyer to ensure the best outcome possible. Your attorney will help you ask for all the types of damages you deserve and will help streamline the process.

Your attorney will also use their expertise to skillfully negotiate with the insurance company to get you the maximum settlement possible. They will also help make sure your claim is not denied in bad faith.