Presenting/Filing an Auto Insurance Claim
Claims for damage to tour car that are submitted to your own insurance company:
These claims would include claims under your own collision, comprehensive, uninsured motorist or underinsured motorist coverage. These claims also include most no fault claims (if you live in a state with a no fault law). In order to determine the amount of the loss, obtain detailed repair bids from at least two different repair shops. These should be shops of your own choosing. Make sure that the shops use factory replacement parts, not after-market parts. The latter, though cheaper, have been known to pose quality and even safety problems.
The amount of this loss that your company is responsible for paying is the reasonable repair amount minus any deductible or other applicable policy limitation.
Claims for bodily injury to you or other insureds that are submitted to your own insurance company:
These claims would include med pay, uninsured motorist or underinsured motorist claims. They also include most No-Fault claims (if you live in a No-Fault state).
For med pay, in order to determine the amount of the loss, you must ascertain the amount of your present and future medical/hospital expenses. Obtain this information from your treating doctors. Do not sign any settlement agreements involving a med pay claim until the injured person’s condition has stabilized and a true diagnosis and prognosis can be rendered.
For uninsured and underinsured motorist claims, in most states you are entitled to damages beyond your medical and future medical bills, such as damages for loss of earnings, future loss of earnings and pain and suffering. This is so because your insurance company steps into the shoes of the uninsured or underinsured driver. They are responsible for paying you for all of the damages you are caused- not just your medical bills. Calculate these items carefully. If necessary, obtain the assistance of a lawyer in helping you put a dollar amount on those aspects of your loss.
The same thing is true for estimating losses for bodily injury in No-Fault states. As mentioned earlier, the specifics of No-Fault provisions differ from state to state. To find out your recovery rights for your own bodily injuries or those of other insureds, check your policy provisions carefully.
Liability claims that are submitted to your insurer:
These would include requests (tenders) for a defense and indemnity in situations where a claim or suit has been filed against you.
If the claim is covered by your policy, your company is responsible for paying the costs of your legal defense and for indemnifying (paying on your behalf) any settlement or judgment obtained against you and within your policy limits.
Your company probably has the right and duty to settle a liability claim on your behalf – either with or without your consent.
If they should refuse to settle such a claim where a demand has been made that is for an amount of money within your policy limits, the carrier may be obligated to pay any ultimate judgment- even if it is beyond your limits. This is dependent on the particular facts of the case and the law of the state in which you live.
If the damage to your car is substantial, you should have an independent scope of loss and repair estimate prepared by a reputable repair shop. This is so regardless of whether the damage is going to be paid under the collision coverage of your own policy, or under the liability coverage of the person who caused the accident.
For Fault insurance liability claims where you were at fault, your insurance company must determine whether a suit against you is covered by the policy. If your insurer agrees to represent you, but only with a “Reservation of Rights,” that means your insurance company may be contending that the suit against is not covered under your policy. An example of this would be if you knowingly allowed an un-licensed driver to operate your car. In such a situation, you may wind up personally responsible for paying any judgment against you and in addition, may be asked to reimburse your insurer for all legal fees and costs incurred in your defense.
If your insurer is defending the case against you with one of these “reservations of rights” the attorney representing you in the case may have a “conflict of interest.” This means that the attorney, who is being paid by the insurance company, has a conflict between representing your interests (in wanting there to be insurance coverage applicable to the claim) and those of the insurance company (in contending that there is no coverage).
In such a situation, you should ask the insurer to appoint, and pay for, an independent attorney who represents only YOUR interests in the case.
YOUR DUTIES After Submitting an Automobile Insurance Claim
As with other lines of insurance, after you submit an auto claim of any type, you must:
- COOPERATE with the insurance company’s investigation of the claim.
- Preserve evidence of the loss. Do not have anything repaired without the written permission of the insurance company.
- File a Sworn Proof of Loss (under penalty of perjury) with the I insurance company if asked to do so.
Again, everything you submit to the insurance company should be precise and correct. Never overestimate, misstate or exaggerate any aspect of the claim. If you do so, you will lose all credibility and may give the insurance company a basis for denying your claim entirely. If you do make a mistake, correct it in writing as soon as possible and keep a copy of the letter in your file.
Next: The Claim Process