What to do if Your Auto Insurance Company Disputes the Damages in Your Accident Claim

Insurance companies can dispute whether all of the claimed damages actually were a result of the loss event. Here are some tips on understanding why this might occur and what to do if it does.

There may be some element of the damages being claimed that the insurance company claims is not related to the accident; either occurring in another event, caused by wear and tear, or perhaps an unrelated mechanical issue. These issues are frequently described as causation disputes.

There are a variety of different types of causation disputes. One example is when there are collision damages on another part of the vehicle, separated from the main area of impact. Another example is when there are damages from a vandalism claim that appears related to a prior collision. A third example could be when the vehicle a vehicle develops mechanical issues immediately following an impact, even when there is not direct impact to the engine or transmission. If there was nothing wrong with the car prior to the accident, a person may feel that somehow the impact caused something to go wrong.

Should you be involved in a causation dispute, the first thing to do is make sure that your insurer has the full facts. If you fully understand how the damages happened and are related to the claimed incident, make sure that the insurer understands as well.

For example, if you were rear ended in an accident and then pushed into a guardrail, the front-end damages might not be clearly understood. Perhaps the insurer missed this key element of the facts of loss.

Another point to understand is that frequently damages occur that seem to be unlikely or implausible. But that does not mean they did not occur. Inexperienced adjusters can misunderstand this important point and resist paying for owed damages because of it. Unlikely and implausible events do occur and are often why accidents happen in the first place, as they are not anticipated. An insurer cannot deny an element of a claim just because it is implausible. They have to demonstrate with facts that the claimed damages could not have happened. If you find your adjuster questioning the likelihood or plausibility of damages claimed, be sure to make this point.

Sometimes, finding out what actually is the cause of the loss, could cost additional money. This commonly occurs when mechanical issues arise after a collision impact. For example, sometimes vehicles suffer transmission issues after being involved in a rear end accident. In order to diagnose what happened, it may need to be disassembled by a mechanic at potentially considerable cost. In this case, you will need to authorize the additional cost and be prepared to pay out of pocket for this cost, if the evidence proves that the problem is a result of some other non-related issue.

Here are some steps to consider taking should the insurer dispute the cause of some of the damages:

• Make sure that they fully understand the facts and how the damages occurred, if you know them.

• If you are not sure yourself, discuss the matter with independent people you know, who might help. Many times, a trusted and experienced mechanic or friend involved in the vehicle repair, insurance claim, or a related industry might be able to help clarify what happened to your car. Look for people with experience who can explain how what might not seem plausible, actually could have occurred.

• Make sure your insurer gives you a clear explanation in writing as to why the damages are not related. If they cannot offer facts and evidence to support their conclusions, this will be a signal to you that they are not clear themselves, and should not be denying payment for the additional repair costs.

• If the adjuster making the causation determination is not considering all of the facts, or is drawing the wrong conclusions, ask her manager to look into the matter. Insurers frequently have higher level adjusters used for complex investigations. Ask for this type of “expert” to get involved. You might also request that the insurer hire an independent adjuster to evaluate the situation. They are under no obligation to do so, but may consider it if the issue is very contentious or of high dollar value.

• Make a complaint to your state’s department of insurance. They may be able to help you by intervening on your behalf to resolve the dispute. Most of these state regulatory agencies have simple dispute resolution processes that cost nothing and often times can be very effective.

Ultimately, a causation dispute needs to be determined by the facts. Your objective should be to gather these facts, firmly and rationally present your facts to the insurer and make it clear you expect the matter resolved fairly. Your insurer must also understand that just because something was unlikely to occur, does not mean it did not. If the damages were related to the loss, this understanding will help you get the fair payment made.