How Does an Insurance Company Decide Who Was at Fault?

Many people find that dealing with the insurance company after any accident offers the biggest challenge in the personal injury claim process.

One critical step that often bogs down the compensation process or makes it difficult for accident victims to get the compensation they deserve: determining who bears liability for the accident.

Often, the insurance company will do its best to establish that the individual or entity it covers did not cause the accident. You may know that the other party caused your accident, including the serious side effects you have had to contend with.

If the insurance company decides otherwise, it can prove much more challenging to get the compensation you really deserve for your accident and your injuries.

An Insurance Company’s Internal Process

The insurance company receives a claim: a notification that someone intends to pursue compensation on a specific policy. Ideally, the accident victim would, at this point, already have a lawyer working for them. A lawyer can prove vital to establishing that the party covered by the insurance policy did cause the accident.

Your lawyer may already have collected considerable evidence. Your lawyer may present part of that evidence as part of the initial claim. However, that does not automatically mean that the insurance company will send the claim straight through.

1. A statement from the Insured Individual

Many insurance companies will wait to start processing an insurance claim until they hear from the party covered by the policy. After a car accident, for example, the insurance company might wait to hear from the liable driver before moving forward with the claim process.

Sometimes, the liable party will contact his insurance company shortly after the accident. He may know that he caused the accident and even admit fault, which can streamline the claim and make it easier for you to pursue the full compensation you deserve.

Other times, the liable party may drag his heels when reporting the accident and giving any statements. He might refuse to accept fault for the accident, which can make life much harder for you as you try to pursue compensation.

Once the insurance company has received information about the accident, the investigation process can begin.

2. An Evaluation of the Evidence

Once the insurance company has received a report about the accident, the investigation can begin. A statement of fault from the insured party can make that process easier, but in high-value claims, the insurance company will want to investigate more thoroughly. That investigation will ultimately serve to help the insurance company evaluate who it feels caused the accident and, therefore, what compensation you might deserve.

3. An Internal Review

In some cases, especially high-value claims, the insurance company may want to determine who it thinks caused the accident based on the evidence.

Sometimes, an adjuster may make the call about the claim. Other times, the accident and the claim may need to go through a more complicated internal review before the insurance company decides whether to accept financial liability for the accident.

What Evidence Does the Insurance Company Look At?

The insurance company may look at several key factors when determining liability following a serious accident.

#1. The Police Report

When a police officer arrives at the accident scene, he will perform two key tasks. First, he will determine whether anyone needs emergency medical attention. The officer may summon medical help or, in many cases, provide basic medical services while you wait for help to arrive. Next, he will evaluate the scene of the accident

The responding officer will take statements from both drivers, look at the vehicles, and even take statements from witnesses to help get a better idea of who caused the accident. If one driver clearly admits fault, or the accident clearly shows which driver caused the accident, the police officer will have an easier time immediately determining fault for the accident.

The officer will then put together a police report. Typically, you can request access to that report online several days after the incident. The police report helps establish who caused the accident.

That police report does not, however, represent an infallible document. Sometimes, it may contain inaccurate information. Regardless of who caused the accident, you should review that document as soon after your accident as possible and make sure it does not contain any inconsistencies. If it does contain inaccurate information, you should correct it quickly so you can use it as an accurate source of information regarding the accident.

Police reports do not just apply to traffic accidents. You may also want to file a police report if you sustain severe injuries due to inadequate security at a venue, or if you have a major accident that involves a great deal of property damage.

#2. Witness Testimony

Witness statements about the accident can serve as a vital tool that can help you establish who caused your accident. Not only can witnesses help provide eyewitness accounts of exactly what happened, but they may also have noticed details that you did not take into account immediately after your accident.

For example, a witness might have noticed a clear spill on the floor that you failed to note as you moved through the area, or that sagging stairs indicated that you might not have the ability to navigate them safely.

If you do need to use witness testimony to help establish fault in a serious accident, make sure you contact an attorney and have your attorney take the witnesses’ statements as soon after the incident as possible.

The details of memories become increasingly less vibrant over time. Witnesses may also find their memories less accurate as days, weeks, and months pass after the accident. Getting witness statements quickly can make it easier to accurately represent exactly what led to the accident, including any contributing factors.

#3. Video Evidence

Video evidence can provide a clear view of exactly what happened during the accident. For example, many drivers now use dash cameras to help display exactly what may have led to an accident. If either driver in a traffic accident had a dashcam, that footage may help the insurance company decide which driver caused the accident and, therefore, who bears liability.

Other entities may also have cameras that can offer vital assistance with personal injury claims. Many stores, for example, have security cameras that record activity throughout much of the premises.

Some organizations may also have external security cameras that can capture what happens outside the building. Not only can those security cameras prove useful after an accident on those store grounds, but they may also capture things that happen in the parking lot or even on the streets around the store.

Video evidence, however, often gets deleted quickly. Many stores do not have long-term storage solutions for their video footage, so if the store does not realize that an incident has occurred, it may not have the opportunity to store or set aside that footage. Even if you report an incident in a store, like a slip and fall, the workers may not automatically store that footage for future use. To help ensure that you have access to that vital footage as you put together your claim and deal with the insurance company, you want to make sure you have a lawyer on your side.

#4. Photos

If you can take photos of the accident scene, whether after a slip and fall, an auto accident, or a serious premises liability accident, those photos can prove extremely beneficial later. Insurance adjusters  and lawyers cannot fully recreate the accident scene, and they typically did not see the accident in the first place. Photos can give them a better idea of exactly what the accident looked like.

Following an auto accident, for example, that might mean taking photos of the positions of the two vehicles or damage to them. If a set of stairs collapses, you might want to take photos of the stairs and the surrounding area. Did you slip and fall on a spill that no one had cleaned up in a store? You may want to take photos of the spill, the flooring, and the surrounding area.

Of course, you do not want to move around the accident scene if you cannot get up and move around safely due to your injuries. You may also want to avoid any actions that could cause further damage, including entering an unsafe area. You may want to have a companion with you at the time of the accident take those photos so that you can provide that essential evidence later.

Sometimes, you may need to submit photo evidence of the scene from well after the accident. Your lawyer, for example, may visit a store to get a better look at the damage that caused a premises liability accident, or to check on the presence of warning signs. You might want to submit photos of a damaged vehicle from days or weeks after the accident, even if you did not take them immediately, because you want to show how much damage the vehicle sustained.

Many times, insurance companies will use that photo evidence to help evaluate the extent of serious damage or injuries an accident caused.

#5. Expert Witnesses

Many types of personal injury claims rely on the testimony of expert witnesses to help put together what may have led to or contributed to an accident. Insurance adjusters often have some key knowledge about various aspects of the claims they handle regularly, but they may not have the kind of expert knowledge you need to clearly establish exactly what led to an accident.

In a medical malpractice claim, for example, you might need an expert witness to come in and establish the level of treatment you should have received compared to the treatment you actually received. A medical expert or doctor might provide vital testimony regarding exactly what caused your injuries and what side effects you have suffered as a direct result of the other medical care provider’s negligence.

Following a car accident, you might need an expert witness to provide testimony about which driver likely caused the accident, based on the position of the two vehicles or other information about the scene of the accident.

After a premises liability accident, you might need a contractor to come in and testify about the damage to the building and what might have caused it, including whether the liable business should have had knowledge of that damage ahead of time and should have done anything to prevent it.

#6. Medical Records

While your medical records might not indicate who caused your accident, they can serve to show when your injuries occurred. To claim compensation through a personal injury claim, you will need to establish that you suffered an injury due to another party’s negligence. Your medical records will show your injuries and the bills you faced because of the negligent party’s actions. Seeking medical attention as soon as possible after your accident can prove critical to presenting that vital evidence to the liable party’s insurance company.

Working With a Lawyer Can Prove Critical

If you need to deal with an insurance company following your accident, having an attorney on your side can prove critical. An attorney can look at the evidence from the accident and put together a claim that shows liability for the accident and what compensation you may deserve. Contact a lawyer as soon as possible to maximize your ability to collect that vital evidence.