More than 220 million motor vehicles clog America’s roads today, making it likely that someday you will have an accident and file an auto insurance claim.
The good news is that in most auto accident claims, personal injury isn’t the problem.
“Sixty-three cents of every claim dollar goes to [pay for] physical damage on your car,” says John Eager, senior director of claims services for the National Association of Independent Insurers, based in Des Plaines, Ill.
Although a personal injury claim may require a different level of proof and persistence than a vehicle damage claim and insurance regulations vary from state to state, the basic steps to take information needed to file a claim are fairly similar.
For the most part, the claims process for vehicle damage is simple: You make a claim, the adjuster comes out to estimate the cost to repair the damage, the insurance company sends you a check for that amount and you use it to pay for the repairs.
Every insurance claim requires some kind of proof of damage or injury before a carrier will pay. On auto claims, Eager says, there are five elements of proof that will come into play: what you tell the insurance companies, what the other party tells them, a police report, witnesses and physical damage at the scene.
Step 1 (at the accident scene): Call 911 if someone has a life-threatening injury. If there’s no emergency, don’t tie up 911, but get any needed medical attention and call the police directly. Remember, you need that police report.
Step 2: Exchange license plate numbers, contact information and auto insurance information with the other parties involved. Most states require drivers to have an insurance identification card in the vehicle and it will provide most of the pertinent information, Eager says. Fill in any gaps, though. Make sure to get phone numbers.
Step 3: Look for witnesses who will be willing to tell what they saw and get their contact information as well. If you are unable to gather information at the scene, the police report can be a back-up source of information on the other parties involved and witnesses.
“There are a lot of jurisdictions where the police officers may try to avoid taking an accident report, assuming that the damage is under $500,” a typical insurance deductible, warns retired insurance adjuster J.D. Howard, who co-founded the Insurance Consumer Advocate Network, based in Branson West, Mo. “Insist on a report. If [officers] won’t file a traffic accident report, insist on an incident report. You want an independent, disinterested record of what happened. You’d be amazed at how often the other driver’s story will change.”
If the accident happens in a parking lot, an officer may plead no jurisdiction. Insist on an incident report, Howard says. Failing that, in a mall or other facility that has a security force, you may ask security to file a report. In a lot without any security, you may want to ask a shop owner.
“You want to get something in writing,” Howard says, because “insurance companies are obliged to believe the story given to them by their own policyholder” unless there’s proof to the contrary.
Finding of fault is very important. Besides the rental car and diminished value issues, the negligent party’s carrier might owe you for any time off work, Howard says. In addition, your company cannot raise your rates if you are not at fault.
Also, the majority of states have adopted “comparative negligence,” Eager says. This is a concept based on the idea that no one party is necessarily completely at fault, but that fault is just a matter of degree. Your settlement can be reduced based on the degree of fault.
Step 4: Contact your insurance company as soon as possible. With a cell phone, you may call your company right from the scene. Many have 24-hour claim-filing service by phone. Your insurance ID card should provide the number. Whoever takes your claim will walk you through the process.
Although the other party may be at fault, both Eager and Howard agree that generally you should file the claim with your own insurance carrier. Each carrier is obliged to protect the interests of its own insured, making your claim a secondary concern for the other party’s carrier. Chances are you’ll get the service you need more readily from your own carrier.
“You have rights with your own carrier that you don’t have with the other party’s insurance,” Howard says. This includes the right to a process for resolving disputes over what expenses should be covered by the insurance.
With no-fault insurance, you have no choice initially but to file with your own carrier. No-fault insurance has thresholds below which your own carrier pays all expenses, except the deductible. Above those thresholds, you may seek restitution from the other party. These thresholds vary by state.
Assuming the other party is at fault and you do not have collision coverage on your vehicle, you will have no choice but to file a claim against the other party’s carrier. On the other hand, if the other party does not have insurance, you will have to negotiate with the other party directly or go to court.
Step 5 (if the other party is at fault): You should advise the other party’s insurance company that you’re pursuing a claim through your carrier and will seek reimbursement for costs your carrier will not pay, including your collision insurance deductible, time off work, auto rental differential and the amount of your diminished resale value, Howard says.
If you have the patience to take an unconventional route that will be challenged by your carrier, Howard believes that if the other party is at fault, you should file claims with both carriers.
“You cannot collect twice for the same thing,” he says. However under “multiple source recovery,” he adds, “you can collect from two sources and put the checks in a kitty and decide how much was paid for what.”
This means meticulously itemizing every expense involved, and which carrier’s check paid for which expense. At the end of the process, you would submit the itemized list to your carrier and, if there’s anything left in the kitty, you would write a check for the overage to your own carrier.
Step 6 (this may happen earlier or later in the process, depending on the other insurance carrier): You’ll get a phone call from the other company asking for your version of events that led to the accident. You need to prepare for this, Eager says.
“Especially with an injury claim, you’d want to check with your insurance carrier to see what statements you need to make to the other insurance carrier.”
It’s a good idea to write down exactly what you will tell the other carrier beforehand so that in the worst-case scenario — a lawsuit — your statement will remain consistent. Don’t trust your memory. The other carrier will be taping your statement and will have your exact words at their disposal.
Step 7: The adjuster comes out to take a look at the damage to your vehicle and comes up with an estimate of what it will take to restore it (or replace it, if it’s totaled). Then, the insurance company will cut a check in the amount of the repair, minus any collision deductible amount.
If an insurance company has a direct repair program, the adjuster might not even have to come out, Eager says. Under such a program, your insurance carrier will refer you to a shop with which they have an agreement. So, depending on the insurance company, the damage claim estimate may be done by the shop itself, the shop won’t have to wait to start repairs and the check can be transmitted right to the shop, Eager says. The shop may also make arrangements for a rental vehicle if you need one.
If the adjuster says the car is totaled (in other words, beyond repair), the adjuster will estimate your compensation on the actual cash value (or depreciated value) of the vehicle before the accident, essentially enabling you to buy a similar used car. However, if you’ve bought coverage for replacement cost value, the estimate will cover the cost of buying a similar new vehicle.
Step 8 (When disputes arise): If you think your carrier’s damage settlement offer is too low, you may ask your carrier for a form of arbitration to resolve the dispute. This process may take two to six weeks, but generally speaking, you will not have to wait for payment. In most cases, the insurance company will pay you the amount it offered immediately, and you’ll get the rest when and if the dispute is resolved in your favor.
On the other hand, if you disagree with an offer from the other party’s carrier, you may or may not be offered such dispute resolution. If not and the amount in dispute is significant, it may be worthwhile to take legal action.