How Do Insurance Companies Investigate Auto Claims?

Posted on April 2, 2020 in Car Accidents

Filing an auto insurance claim is only the beginning of the recovery process after an accident. Once you notify the insurance provider of the accident, it will assign someone to review your claim and decide if you are eligible for coverage. Understanding the investigative process could give you an advantage during the handling of your insurance claim in Arizona.

Assigning the Claims Adjuster

First, the insurance company will give your case a claims adjuster. An insurance claims adjuster is a person whose job is to review the cases the insurance company receives, decide whether the insurer should accept them and determine how much is appropriate to award the client. The adjuster might work directly for the insurance company or as a third-party contractor. Claims adjusters typically deal with multiple cases per month. Most insurance claims adjusters receive training on how to minimize the insurance company’s liability by reducing payouts for claimants. The claims adjuster may try several tactics to get you to settle for less.

Making Initial Contact

You might receive a phone call from an insurance claims adjuster as soon as the day of your car accident, or in the days following. An adjuster will generally work for the other driver’s insurance company, not yours. Prepare yourself for a conversation with a claims adjuster. Have the facts of your case ready and understand what you should and should not say.

  •         Be polite.
  •         Stick to the facts.
  •         Tell the truth.
  •         Do not offer unprompted information.
  •         Keep your answers short.
  •         Do not admit fault.
  •         Decline to give a recorded statement.

These are general tips when talking to an insurance claims adjuster about your auto accident. Remember, the adjuster will want to convince you to accept a lowball settlement offer to save the insurance company money. If you do not feel confident talking to an adjuster after a vehicle collision on your own, hire a lawyer to do so for you.

Collect Information

After speaking with you about the accident, the insurance claims adjuster will proceed with his or her own investigation. The adjuster might contact the other driver and eyewitnesses to find out if their stories align with yours. Then, he or she will learn more about how the crash occurred, who might be liable and the extent of your damages by analyzing sources of evidence. These could include police reports, images of the scene, investigative reports and medical records. The adjuster may also appraise your damaged vehicle in person.

The insurance adjuster will need you to sign a release before accessing your medical records. Bring the release form to a Phoenix accident attorney before signing. The insurance company might try to gain access to all of your medical records instead of only those pertaining to the car accident to allege that your injuries were preexisting. Use a lawyer to help you discuss your case with a claims adjuster.

Determination of Fault and Payment

 Once the claims adjuster believes he or she has all the facts, the adjuster will make a preliminary determination of fault for the auto accident. The adjuster will draft a report to send to the insurance company, giving his or her opinion on how the insurer should handle the claim. If the adjuster thinks the company should accept the claim, the adjuster will provide an amount he or she believes is appropriate.

Settlement or Appeals Process

If the insurance company denies your claim after an investigation, you will have the option of appealing the decision – first through the insurance company and then through Arizona’s Court of Appeals. If the company accepts your claim and offers a settlement, you and your Phoenix personal injury lawyer can accept or negotiate for a higher amount you believe is fair. Agreeing on a settlement amount will conclude and resolve your claim. The insurance company will write a check and you can pay for your damages. Failing to come to an agreement could lead to a personal injury lawsuit in the civil courts in the pursuit of full compensation.