However, certain steps are common to most claims investigations. We’ll review these steps here.
Immediately After the Claim Is Filed
After you file your claim, a claims adjustor will be assigned to your case. The adjustor will review your policy to make sure that you are covered. He or she may contact you to ask for more details about the accident.
During the investigation, the adjustor may:
- Request you send a copy of the police report for review.
- Contact the other driver.
- Talk to any listed witnesses to the accident.
- Visit the accident scene.
- Inspect your car for damages.
- Take photos of your car.
- Ask you to sign a medical release form in order to view your records.
- Contact your medical providers for information regarding your injury expenses.
Medical Care and Vehicle Repair
Your insurance company will cover your injuries and repairs until fault is determined and then will negotiate with the other driver's insurance company to decide who pays in the end.
The process of initial payment is “indemnification,” which means coverage for damages and losses.
If the other driver is found to be at fault, your insurance company will seek payment from his insurance company through the process of “subrogation.”
Repairs
Typically, you have several options when it comes to getting repairs for your vehicle:
- Using an approved body shop. Your adjuster may request that you take your car to one of your car insurance company’s approved body shops for an estimate.
- Getting quotes. The adjuster may ask you to go to several shops of your choice and obtain quotes to compare.
- Choosing your own repair shop. You can get the repairs done at any location you choose; however, you may have to pay the difference between that shop's estimate and the amount the insurer determines is a fair price.
Medical Bills
If your claim includes medical expenses from injuries from the accident, your claims adjuster will need to see evidence of your medical bills.
He or she may request that you sign a waiver to grant permission for your car insurance company to access your medical records. Before signing this document, you may wish to speak to a personal injury attorney about whether signing it is in your best interest. Once she has access to your records, information in your medical history may be used to lower your claim.
Review of Your Side of the Story
You will need to provide as much information as you can to get the best possible settlement. The adjuster will ask for your recollection of the events.
In addition, you may need to submit the following to your car insurance company.
- Policy number (can be found on your insurance card).
- Date of the accident.
- Location of the accident.
- Description of how the accident occurred.
- Name and insurance information for the other party involved.
- Name of the police department involved and the police report number (if applicable).
Review of Official Records
During the investigation phase, the adjuster reviews the case. Your rep may review the following information:
- Amount of property damage.
- Police reports.
- DMV accident report.
Determination of Fault
One of the roles of your insurance adjuster is to determine fault. In most states, a driver does not need to be 0% or 100% at fault.
Your adjuster may decide that you are partially at fault (e.g., 70% responsible for the accident). If you are 70% responsible and the other driver is 30% responsible, your company may pay 70% of the settlement and the other driver’s car insurance company may pay the remaining 30%.
In some cases, the settlement is entirely paid by the car insurance company of the driver who has the majority of fault. Speak to your auto insurance agent to learn more.
Review of Claims
While reviewing claims, the claims adjuster may look at evidence such as:
- Medical records.
- Bills.
- Evidence of property damage.
- Proof of wage loss
The Role of Social Media
The adjuster will investigate the claimant (you). In addition to reviewing your claims history, car insurance companies are also likely to look you up online.
They may go to Facebook, Twitter, or other social media sites to make sure that you are not lying. For example, if you are claiming car damage for an accident Tuesday morning, and you post a picture of you with your car intact on Wednesday, your company will recognize the fraud.
Your car insurance company has a special investigations unit (SIU) to investigate suspected fraud. You can protect yourself on social media by:
- Setting your privacy settings so that only approved people can look at your photos.
- Avoiding posting photos or anything about your accident online.
- Not filing a fraudulent claim.
Options to Resolve Claim Disputes
If you are unhappy with the settlement offer, you have some options:
- Take the claim to the adjuster’s supervisor.
- Mediation.
- Arbitration.
- Small claims court.
- Hiring an attorney.