Disputing Auto Insurance Claims: Your Rights

If you're unhappy with an auto insurance claim, you can dispute it. The process can be expensive, time-consuming, and frustrating, but it's possible. The first step is to contact your insurance company and let them know you're unhappy. If that doesn't work, you can move up the chain of command, get an independent review, or take legal action. You may need to gather evidence and write an appeal letter, and in some cases, you might need to hire an attorney.

Communicating with the company

• Document every interaction: Keep a notebook or diary to track all communication with your insurance company, including phone calls, emails, and letters. This helps you stay organised and allows you to refer back to specific details if needed.
• Create a paper trail: Follow up on any promises or representations made by insurance company personnel in person or over the phone with a short email or letter. This ensures that you have a record of all important information and commitments.
• Use proper language: When communicating with your insurance company, it is important to use good grammar, punctuation, and capitalization. Respond promptly to letters and requests, and if you find them unreasonable, express your disagreement in writing.
• Be proactive: Provide your insurer with proof of your losses and be clear about the compensation you are entitled to. Don't wait for them to offer a settlement amount.
• Use improper conduct as leverage: If your adjuster or insurer has acted improperly, use this as an opportunity to negotiate a better settlement. Your diary or notebook can be useful here to document specific instances.
• Maintain a professional attitude: Remember that you are in a business negotiation, even if your claim adjuster is friendly. Keep the conversation professional and avoid sharing unnecessary details or venting your emotions.
• Avoid confidentiality agreements: Do not sign any confidentiality or non-disclosure agreements without consulting an attorney first. Signing such agreements prematurely can reduce your leverage and ability to obtain full policy benefits.
• Be polite, prompt, and persistent: A positive attitude can go a long way in resolving your claim. Respond promptly to all communications and be persistent in following up on your concerns.
• Start with the adjuster: When raising a concern or dispute, begin by communicating with the adjuster assigned to your claim. If necessary, contact their supervisors or superiors within the insurance company's claim department.
• Provide clear and concise information: When writing letters or emails, be clear, polite, and concise. Confirm your cooperation and provide only the information requested. Avoid making threats or writing lengthy responses, as this may hinder your claim.
• Seek professional help if needed: If you feel stuck or unable to resolve your concerns on your own, consider hiring a lawyer or public adjuster specialising in auto insurance claims. They can guide you through the process and protect your rights.

Getting an independent review

If you're unhappy with the outcome of your auto insurance claim, there are several steps you can take to get an independent review. Here's a detailed guide on how to get an independent review of your auto insurance claim:

Step 1: Contact Your Insurance Company

First, reach out to your insurance company and express your dissatisfaction with the claim outcome. It's important to communicate your concerns clearly and in writing. Provide them with any supporting documentation or evidence that strengthens your position. You can also request the name and contact information of the head of the insurer's claims department if your agent or representative is unable to resolve the issue.

Step 2: Review Your Auto Insurance Policy

Familiarize yourself with the terms, conditions, and coverage limits of your auto insurance policy. Most insurance companies offer arbitration or appraisal services to help settle disputes. Your policy documents will explain these options and guide you on how to initiate the process.

Step 3: Gather Evidence and Documentation

Collect all relevant documents and evidence to support your case. This includes accident reports, photographs, witness statements, medical records, invoices from repairs or treatments, and any other information that may be relevant to your claim. The more evidence you have, the stronger your case will be.

Step 4: Contact Your State Insurance Department

Get in touch with a consumer services representative at your state insurance department. Explain the reasons for your disagreement with the claim outcome. They will collect the information and may choose your case for an individual review. While they might not be able to resolve every complaint, they can provide guidance and support.

Step 5: Consider an Independent Arbitrator

If you want an independent review of your claim, you can contact an independent arbitrator with experience in insurance matters. They can assess whether the settlement offered by your insurance company is fair and reasonable. You can suggest your own arbitrator or use a service like the American Arbitration Association to find one.

Step 6: Consult an Attorney

As a last resort, consider consulting an attorney who specializes in auto insurance claims. Each state's bar association offers a free legal referral service that can provide you with qualified candidates. Attorneys typically work on an hourly rate or a contingency basis, so be sure to discuss their fee structure and get it in writing before proceeding. Remember that your attorney must have your agreement before committing to any settlement.

Remember, each state has different laws and time limits for disputing insurance claims, so it's important to act promptly and understand your rights as an insured individual.

Pursuing mediation

Mediation is a voluntary process in which you and your insurance company submit your dispute to a neutral third party (the mediator) who works with both of you to reach a settlement. The mediator has no power to impose an agreement; their role is to facilitate open discussion and help both parties understand each other's views and priorities. They can also help to reduce hostility and promote a candid discussion of the issues at hand.

In the context of an auto insurance claim, mediation can be used to resolve disputes related to property damage, bodily injury claims, and overall claim amounts. It is important to note that mediation is non-binding, which means that neither party is required to accept the outcome. If a settlement is reached and you are not satisfied, you have the option to rescind the agreement within a certain timeframe.

To pursue mediation, you will need to follow the normal complaint process with your insurance company first. If there is no satisfactory settlement, the relevant department or authority will notify your insurer, allowing them time to resolve the dispute before initiating mediation. If the dispute remains unresolved, you will be offered mediation.

During mediation, you will have the opportunity to present your case and explain your perspective to the mediator and your insurance company. It is important to come prepared with all the necessary documentation, such as your policy, photographs, estimates, bills, and reports. You may also be asked to provide a mediation conference statement, summarizing your claim, the reasons for it, and what you consider a fair resolution.

Mediation can be a cost-effective way to resolve disputes without the need for litigation. It allows both parties to openly discuss their issues and work together towards a mutually agreeable solution. However, it is important to remember that mediation is not always successful, and you may need to explore other options, such as arbitration or legal action, if a settlement cannot be reached.

Arbitration

Most car insurance policies offer arbitration or appraisal services to help settle disputes. The process of arbitration involves both parties agreeing on an impartial third-party arbitrator who will listen to both sides of the case and determine a fair settlement. The arbitrator acts as both judge and jury, and their decision is usually legally binding and not appealable.

Before the arbitration hearing, both parties will exchange information and prepare their arguments. During the hearing, each side will have the opportunity to present an opening statement, call and cross-examine witnesses, and present evidence. The arbitrator will then review the information provided and make a decision, typically within a few days.

It is important to note that arbitration is not always voluntary. In some cases, it may be mandatory, such as when a claim is for uninsured or underinsured motorist benefits. In other situations, both sides must agree to arbitration. Additionally, arbitration clauses in insurance agreements may require that disputes be resolved through arbitration.

While arbitration can be a beneficial way to resolve auto insurance claim disputes, it is important to seek legal advice to determine if it is the best option for your specific case. Consulting with a lawyer who specializes in auto insurance and arbitration can help individuals understand their rights and make informed decisions throughout the process.

Taking legal action

If you've filed an auto insurance claim but are not satisfied with the result, there are a number of actions you can take to try to resolve the issue.

Firstly, let your insurance professional know that you are unhappy with the outcome. If the agent or representative is unable to solve your problem, ask for the name and phone number of the head of the insurer's claims department. Your insurance company may also have a consumer complaint department that can help.

Be prepared to support your case with evidence. Send documents and a letter explaining why you are disputing the claim and make sure you have the figures to back up your argument. Be certain to include your claim number and contact information.

Review your auto insurance policy. Many companies offer either arbitration or appraisal services to help settle differences and disputes. Your insurance policy will explain these options. Contact an arbitrator to hear your case. An independent arbitrator with experience in insurance matters can decide if the settlement you were offered is fair. Your insurance company may suggest an arbitrator, or you can source your own from the American Arbitration Association.

If you've exhausted these options and are still not satisfied, you may want to consider taking legal action by consulting an attorney who specialises in auto insurance disputes. Each state's bar association offers a free legal referral service, which will give you the names of qualified candidates. Attorneys work either on an hourly rate or on a contingency basis, depending on the type of case, so be sure you're comfortable with the attorney's fee structure—and get it in writing. To stay current on the progress of your claim, ask your attorney to provide copies of all correspondence. Keep in mind that your attorney must have your agreement before committing to any settlement.

By claiming that your insurance company breached your insurance contract by refusing to pay your claim, you may be able to recover damages in court. If your legal claim is strong, your insurance company may wish to settle out of court, paying you a negotiated amount instead of dealing with a long and complicated lawsuit.

Frequently asked questions