Why and How Do Car Insurance Companies Investigate Accident Claims?

Jan 18, 2022

How Do Insurance Companies Investigate Claims?

Proving your case to your insurance company may be just as frustrating as an auto accident. There are several steps you must take to receive compensation. The process can take weeks, months, or sometimes even years. You may be asked many questions and be required to submit documents, like medical records, or even undergo an independent medical examination.

You may wonder why the insurance company is making your life so difficult. Why do you have to jump through all these hoops for accident injuries that weren’t your fault? The answer is that insurance companies investigate accidents to ensure your claim is valid and determine how much you should be compensated.

Why Does the Car Insurance Company Need to Investigate Your Claim?

There are a few reasons why the other driver’s insurance company investigates your claim: to avoid auto insurance fraud, to value your claim correctly, and to determine fault.

Fraudulent or exaggerated claims occur, and insurers are incentivized to discourage those types of claims aggressively. While most car accidents happen unintentionally, a small percentage of people use staged crashes to defraud an insurance carrier.

Insurance companies are required by law to honor their contracts, which means providing fair claim payments when it’s appropriate to do so. They need to gather as much information as possible to do this. They also don’t want to overpay claims, so they invest a lot of time and effort into accurately determining the value of your injuries.

All businesses, including insurance companies, want to save money. That desire serves as a built-in incentive for insurance companies to find ways to undervalue your claim. An extensive insurance investigation of your auto accident can help the insurance company determine who was at fault for the crash.

If you were not at fault, the other driver’s insurance company is legally obligated to compensate you for any injuries or property damage caused by the crash. The company will use its investigation to try and prove whether or not its policyholder was responsible.

When Does the Car Insurance Claim Investigation Process Begin?

The process begins when you submit your claim. You can do this by calling to report your claim or filling out a form on the insurance company’s website. Although your insurance shouldn’t be paying for damage or injuries the other driver caused, they may still be able to help you with the logistics of the process.

Once your information is submitted, it’s assigned to an adjuster. This person works on behalf of the insurance company and will be the initial decision-maker behind your claim.

What Will the Adjuster Need?

The insurance adjuster will contact you to ask questions about your car accident. They will want to know the details of what happened and may ask many clarifying questions to make sure they got their facts right.

They may also ask that you submit evidence and reports of the accident, such as a police report, pictures from the scene, and copies of your medical records and bills.

What Are Some Additional Steps the Adjuster May Take?

Each insurance claim is unique, and some cases are more straightforward. Certain cases will prompt the insurance adjuster to examine your vehicle or interview the other driver and witnesses. They will want to make sure your version of the accident matches theirs.

Will the Adjuster Ask for Medical Records?

Yes, they likely will. The adjuster will want to look at your medical records to evaluate your injuries and confirm the claim is accurate.

The adjuster may also ask you to undergo an independent medical examination. An independent examination allows the insurance company to evaluate your physical injuries and see if they align with the medical records you provided. Interestingly, the doctor performing your independent medical examination isn’t necessarily independent as the insurance company pays them.

Providing medical records and undergoing independent evaluations can be a tricky thing. If the insurance company requests you receive an examination from their doctor, consider seeking guidance from a car accident attorney who can help you avoid any potential pitfalls.

What Else Do I Need to Do?

At this point in the process, you’ve submitted all the necessary information, and it’s time for the adjuster to make a preliminary determination of fault and approve payment according to the other driver’s policy limits.

In many accident cases, compensation for injuries is capped by the responsible driver’s bodily injury liability limits.

Can I Appeal the Decision if I Disagree With It?

Yes. If you disagree with the adjuster’s decision, there are a few routes you can take. You can ask the adjuster to review your case and provide them with any additional information you think might help. If this doesn’t work, you can ask for your case to be escalated to a supervisor. At this point, many people choose to hire an auto accident attorney to represent them in negotiations and potential litigation.

What Should I Do If My Claim Is Denied?

You have a few options if the insurance company denies your claim. You can ask an auto accident attorney if they think it’s worth challenging the decision or negotiating with the insurance company for more money. In some cases, taking them to court may be necessary. Understanding all your options is essential before deciding which way to proceed.

If your claim is denied, you may be able to pursue a lawsuit against the insurance company for breach of contract. An experienced auto accident attorney can help you decide if this route makes sense for you or not.

Regardless of what happens, always keep plenty of documentation about the accident and make sure everything is in writing. This will be an essential part of the process if you need to take legal action against the other driver or their insurance company.

Do I Need an Auto Accident Attorney to Handle My Case?

You aren’t required to hire a lawyer to help with your personal injury claim. However, working with an experienced auto accident lawyer may help you maximize your compensation, especially if you think the insurance company will undervalue or underpay your claim.

At the Dressie Law Firm, our skillful injury lawyers can shed light on insurance policies and procedures. We’re also experienced in negotiating with insurance companies and advocating for our clients in court. If you need help with your personal injury claim, don’t hesitate to contact us. We’ll be happy to answer any questions you have.

Car accident cases can be complicated, and you must understand the claims process before negotiations. If you have any questions or concerns about your claim, don’t hesitate to call our Atlanta office at 770-756-6333 or message to schedule a free consultation.