Disputing Auto Insurance Claims: Your Rights And Recourse

Disputing an auto insurance claim can be a complex and time-consuming process, but it is important to know your rights and understand the steps you can take if you feel you have been treated unfairly. The first step is usually to review your claim denial letter and gather relevant evidence, such as medical bills, police reports, and photographs, to support your case. It is also crucial to be aware of the statute of limitations for disputing insurance claims, which varies by state and can range from two to five years. Communicating your concerns clearly and in writing to your insurance company is essential, and you may need to seek external assistance or legal advice if the dispute remains unresolved.

File a complaint with your insurance company

If your auto insurance claim has been rejected, you should receive a notice explaining why. Before considering litigation, it is worth going through your insurer's internal dispute resolution process.

Firstly, ask your car insurance company to reconsider their decision. Many provinces, such as Ontario, have established a standard complaint-handling protocol that all licensed insurance companies must follow. The intricacies of the process vary from company to company. In many cases, you will speak to an insurance adjuster—the individual who determines whether your insurance policy covers the repairs in question. Before disputing your claim, ask your insurance adjuster for a detailed explanation of your policy and the insurance company’s decision.

If speaking with the adjuster doesn’t work, consider contacting your insurance company’s Consumer Complaint Officer, who runs the complaint process. If you and the Consumer Complaint Officer can’t reach an agreement, they must provide you with a letter stating the insurance company’s final position on your complaint.

If you have exhausted your options with your insurer, you can contact an independent third party to help mediate a resolution. For example, in Canada, you can contact the General Insurance OmbudService (GIO), an independent consumer dispute-resolution system. While the GIO can help you and your insurance company reach an agreement, their determination is non-binding. If you are still unable to resolve your complaint, you may want to consider filing a lawsuit.

Understand your rights

Understanding your rights is an important part of disputing a car insurance claim. Here's what you need to know:

Your Rights During the Claims Process

When it comes to disputing a car insurance claim, it's crucial to understand your rights. If you believe you're being unfairly blamed for a car accident, you have the right to dispute the insurance company's finding of fault. This starts by letting the insurance company know that you plan to fight their decision and presenting your case with supporting evidence.

Your Rights to Information and Recourse

You have the right to request a detailed explanation of your insurance policy and the company's decision regarding your claim. You can ask your insurance adjuster for this information. Additionally, you can reach out to organizations like the Insurance Bureau of Canada for answers to technical questions and to better understand the factors influencing the insurance company's decision.

Your Rights to Appeal

If speaking with the insurance adjuster doesn't lead to a resolution, you can escalate the matter. Contact the insurance company's Consumer Complaint Officer, who is responsible for handling the complaint process. If you and the Consumer Complaint Officer cannot reach an agreement, they are obligated to provide a letter outlining the company's final position on your complaint.

Your Rights to External Support

If working directly with the insurance company doesn't yield a satisfactory outcome, you have the right to seek external support. You can appeal their decision to an independent public insurance adjuster, who will have a good understanding of the adjustment process and the insurance company's motivations. Additionally, you can reach out to dispute-resolution systems like Canada's General Insurance OmbudService (GIO) to help facilitate an agreement between you and the insurance company. However, it's important to note that the GIO's determination is non-binding, and the insurance company can choose to refuse their recommendation.

Your Rights to Legal Action

If all other options have been exhausted without a favourable outcome, you have the right to pursue legal action. You may consider filing a lawsuit, claiming that the insurance company breached your insurance contract by refusing to pay your claim. This could potentially lead to recovering damages in court. Alternatively, if your legal claim is strong, the insurance company may opt to settle out of court to avoid a lengthy and complicated lawsuit.

Gather evidence

Gathering evidence is a crucial step in disputing an auto insurance claim. The evidence you collect can help prove your case and strengthen your position during the dispute process. Here are some detailed instructions on gathering evidence:

• Collect Documents: Gather all relevant documents related to the accident, including police reports, accident reports, photographs, witness statements, medical records, and repair estimates. These documents can provide valuable details about the accident and support your claim.
• Obtain Witness Information: Get the names and contact information of any witnesses who saw the accident or have relevant information. Witness statements can be powerful evidence, especially if they are neutral parties with no personal connection to those involved in the accident.
• Take Photos and Videos: Document the accident scene by taking photos and videos of the vehicles involved, vehicle damage, skid marks, traffic signs, license plates, and weather conditions. These visual aids can help reconstruct the accident and provide valuable context.
• Gather Medical Records and Bills: If you or anyone else involved in the accident sustained injuries, collect all medical records and bills related to the treatment. This includes hospital bills, doctor's reports, therapy expenses, and any other relevant documentation.
• Obtain Vehicle Repair Estimates: If your vehicle was damaged, gather repair estimates from multiple sources. This will help you argue for the necessary repairs and associated costs.
• Maintain a Journal: Consider keeping a car accident journal to document your experiences and how the accident has impacted your life. Note any headaches, missed workdays, lost opportunities, sleepless nights, or anxiety resulting from the accident. This journal can help you explain your damages and provide a comprehensive picture of the accident's impact.
• Dashcam Footage: If available, dashcam footage can be highly valuable as evidence. It can provide a clear record of how the accident occurred and who was at fault.
• Collect Invoices and Receipts: Gather invoices and receipts related to medical treatments, vehicle repairs, car rentals, and any other expenses incurred due to the accident.
• Preserve Digital Copies: Ensure that you have both physical and digital copies of all relevant documents. This includes electronic versions of police reports, medical records, invoices, and any other pertinent information.

Remember, the more evidence you can provide, the stronger your case will be during the dispute process. It is important to act quickly and start gathering evidence as soon as possible after the accident, as some information may only be available immediately following the incident.

Contact your insurance company

Contacting your insurance company is the first step in disputing a claim report by your auto insurance. Here's a detailed and instructive guide on what to do:

Step 1: Notify Your Insurance Company of Your Disagreement

It is important to act promptly and notify your insurance company of your intention to dispute their claim report. You can do this by contacting them via phone and also sending a follow-up letter or email. This initial step is crucial as it expresses your disagreement and can prompt further investigation by the insurance company.

Step 2: Understand Your Insurance Policy

Before escalating the matter, it is essential to thoroughly understand your insurance policy. Review the terms, conditions, and coverage limits of your policy. Knowing your rights and obligations under the policy will help you build a stronger case during the dispute process.

Step 3: Gather Evidence and Relevant Documentation

Collect and organise all relevant evidence and documentation to support your dispute. This includes accident reports, photographs of the accident scene and vehicle damage, witness statements, medical records, invoices from repair shops and medical providers, and any other information that can help your case. The more evidence you have, the smoother the claims process will go.

Step 4: Communicate with Your Insurance Company in Writing

Provide a detailed and written explanation of your dispute to your insurance company. Clearly communicate your concerns and present the evidence you have gathered. Keep a record of all correspondence, including emails, letters, and any responses from the insurance company. This paper trail will be important if the dispute progresses further.

Step 5: Engage with the Insurance Adjuster

In many cases, you will be communicating with an insurance adjuster, who is responsible for determining whether your insurance policy covers the repairs or claims in question. Ask the adjuster for a detailed explanation of your policy and the company's decision. You may also request information about any external reports or assessments that influenced their decision.

Step 6: Contact the Consumer Complaint Officer

If you are unable to reach an agreement with the insurance adjuster, the next step is to contact the insurance company's Consumer Complaint Officer (CCO). The CCO is responsible for overseeing the complaint process. Engage with the CCO and present your case, including any new or additional evidence. If you still cannot reach an agreement, the CCO is obligated to provide you with a letter outlining the company's final position on your complaint.

Consider mediation or arbitration

If you are unhappy with your auto insurance company's decision regarding your claim, you may need to consider mediation or arbitration as alternative dispute resolution methods. These methods are typically less costly and time-consuming than litigation and can help you resolve your dispute without going to court.

Mediation

Mediation is a voluntary and non-binding process where a neutral third party, the mediator, guides negotiations between the two parties involved in the dispute. The mediator does not impose an agreement but uses specific techniques to facilitate a joint discussion and help both parties reach a mutually satisfactory agreement. The mediation process is confidential, and any statements made during the mediation cannot be used against either party in future legal proceedings.

Mediation is generally less formal than arbitration or litigation, and you can choose to walk away from the proceedings at any time. While it is not mandatory to hire an attorney for mediation, it is often advisable, especially if the insurance company will be bringing their own legal representation.

Arbitration

Arbitration is a quasi-judicial process where both sides present their arguments and evidence before a neutral third party, the arbitrator, who then renders a decision. Arbitration can be either binding or non-binding, and voluntary or involuntary. With binding arbitration, the arbitrator's decision is legally enforceable, and both parties must abide by it. Non-binding arbitration is similar to mediation in that either party can choose to walk away if they are dissatisfied with the outcome.

It is generally advisable to hire an attorney experienced in insurance law to help prepare and present your case during arbitration. While arbitration may be cheaper than a lawsuit, it is not free, and the arbitrator will charge for their services.

Choosing Between Mediation and Arbitration

Mediation and arbitration can be seen as two stages of the same overall process, with every arbitration case beginning with mediation. If mediation fails to resolve the dispute, the case then moves to arbitration.

Mediation and arbitration offer advantages over filing a lawsuit, including lower costs and faster resolution times. However, it is important to note that arbitration clauses in insurance contracts may disadvantage policyholders by mandating proceedings in a forum that favors the insurance carrier. Additionally, policyholders who are unhappy with the outcome of arbitration have very limited appeal options and cannot pursue further litigation.

Frequently asked questions