Accidents happen when we least expect them, and when they do, we rely on our insurance to step in and help us through the aftermath.
Whether it’s a car crash, a property damage incident, or a personal injury claim, insurance is there to provide financial protection and peace of mind. However, what do you do when you can’t settle with your insurance company after an accident claim?
It’s a scenario no one wants to face, but it’s important to understand that insurance disputes can and do occur.
While insurance companies are supposed to act in good faith and provide timely and reasonable settlements, sometimes there are roadblocks, disagreements, or disputes that can leave you feeling frustrated and uncertain about your rights.
From understanding your policy to navigating the dispute resolution process, we’ll provide guidance to help you make informed decisions and work toward a resolution that’s fair and just.
Possible Reasons for a Failed Settlement
Reaching a settlement with your insurance company after an accident is usually the desired outcome, but there are situations where a settlement may fail to materialize. Here are some possible reasons for a failed settlement with an insurance company:
- Liability Disputes: Insurance companies may contest the issue of liability, questioning who is at fault for the accident. This can lead to a lengthy negotiation process and difficulty in reaching a settlement.
- Contributory Negligence Laws: In some states, contributory negligence laws come into play. These laws state that if the injured party is found to be even partially at fault for the accident, they may be barred from recovering any compensation. This can make it challenging to secure a fair settlement.
- Cost of Care Disputes: Insurance companies might dispute the need for costly medical treatments or argue that the accident injuries suffered are not severe enough to warrant compensation. This can lead to disputes over the extent of injuries and the necessary medical care.
- Unfair Settlement Offers: Insurance companies may present settlement offers through claims adjusters that are far below the fair value of the claim. These offers may not adequately cover medical expenses, property damage, loss of enjoyment of life, financial losses, or pain and suffering, making it necessary to explore other options.
Steps to Take When You Can’t Reach a Settlement With The Insurance Company
If you find yourself unable to reach a settlement agreement with your insurance company after an accident, there are several important steps you can take:
Review Your Policy
Take the time to carefully read and understand the terms and insurance coverage your policy provides. Look for any relevant clauses that may affect your claim process.
Your policy will give you a clear understanding of what you’re entitled to. It will help you determine if the insurance company is acting in bad faith or if they are denying a legitimate claim that should be covered.
Remember, insurance policies are legal contracts. By familiarizing yourself with the terms and coverage, you can protect your rights and ensure a fair settlement.
Contact Your Insurance Company
If you can’t reach a settlement with your insurance company after an accident, it’s important to initiate contact with them to discuss the issue and try to understand their decision. Start by reaching out to your insurance company and ask for clarification on why they are not offering a settlement.
During this conversation, be sure to gather as much information as possible. Ask for a detailed explanation of their decision and try to understand their perspective. It’s possible that there may be a misunderstanding or miscommunication that can be resolved through discussion.
Request a Supervisor
When speaking with the initial representative, if you find that your concerns are not being addressed or if you feel unsatisfied with the outcome of your conversations, kindly ask to be transferred to a supervisor. Explain your situation and express your desire to escalate the matter in order to reach a fair resolution.
A supervisor or claims manager may have a better understanding of your case and the authority to make decisions that the initial representative did not. They can review the details of your claim, consider any additional evidence or documentation you provide, and potentially offer a more favorable settlement.
Document Everything
Document everything by keeping detailed records of all your interactions with the insurance company, whether it be through phone calls, emails, or letters.
Note the names of the representatives you speak with and the dates of communication. This information will be important in case you need to refer back to any specific conversation or correspondence.
By documenting everything, you can provide a clear and accurate account of your efforts to reach an insurance settlement. This will be important if you need to involve a personal injury lawyer or take legal action. Having a record of all your interactions with the insurance company will help support your case and ensure that you have all the necessary information to present your claim effectively.
Dispute Resolution Process
Many insurers have internal procedures in place for handling disputes, which can provide a path for resolving issues. [1]
When facing a dispute, inquire about the specific process your insurance company follows. They may have a separate department or mediator dedicated to handling disputes. This department or mediator can review your case independently and help facilitate a fair resolution.
Typically, the dispute resolution process involves a thorough examination of your claim, including an assessment of any evidence or documentation you provide. This review allows the insurance company to reconsider its initial decision and potentially offer a more favorable settlement.
Submit a Formal Complaint
Filing a formal complaint allows you to escalate your concerns and have them addressed by a higher authority within the company.
When submitting the complaint, provide all relevant information, such as the claim number, policy details, and names of the insurance adjusters you have been dealing with. Clearly explain the issues you are facing, such as unresolved medical bills or property damage, and the specific desired outcome you are seeking.
Once your complaint is submitted, the insurance company will review your case and conduct a thorough investigation. They will consider the information and evidence you provided, as well as their own internal policies and guidelines.
During this process, it is important to maintain clear and open communication with the insurance company. Continue to follow up on the progress of your complaint and provide any additional information or documentation that may be requested.
State Insurance Department
The state insurance department is a regulatory agency that oversees insurance companies and can provide guidance in resolving disputes.
By contacting your state insurance department, you can seek their help in facilitating communication between you and the insurance company. They can review your case and provide insight into whether the insurance company is acting in accordance with state laws and regulations.
To seek assistance from the state insurance department, provide them with all relevant details of your claim, including the claim number, policy information, and any correspondence you have had with the insurance company. Clearly explain the issues you are facing, such as unpaid medical bills or unresolved property damage.
The state insurance department will then review your case and work to mediate between you and the insurance company. They will evaluate the facts of the case, including any evidence or documents you provide, and provide guidance on how to resolve the dispute.
Consider Mediation
Mediation is a non-binding process that involves a neutral third party who helps facilitate a settlement between you and the insurance company. [2]
To begin the mediation process, both parties agree on a mediator who is experienced in insurance claims. This mediator acts as a neutral facilitator, guiding the discussions and helping the parties find common ground. They do not make any decisions or judgments but instead, work to facilitate open communication and negotiation.
During mediation, you and the insurance company will have the opportunity to present your arguments and discuss the issues at hand. The mediator will help identify areas of agreement and encourage both parties to consider possible solutions.
One of the main advantages of mediation is that it allows for a more flexible and creative resolution to the dispute. Unlike a court trial, where a judge’s decision is binding, mediation empowers both parties to come to a mutually beneficial agreement.
If mediation is successful and an agreement is reached, it can be turned into a legally binding document. However, if mediation fails to resolve the dispute, you still have the option to pursue other legal avenues such as arbitration or filing a lawsuit.
Consult an Attorney
If you find yourself unable to settle with your insurance company after an accident, it may be time to consult with an experienced lawyer who specializes in insurance disputes. These professionals have the expertise and knowledge to navigate the complexities of insurance claims and can provide you with valuable guidance on your legal options.
Consulting an attorney can help you understand your rights and ensure that you are receiving fair compensation for your losses. They can negotiate with the insurance company on your behalf, advocating for your interests and working towards a favorable resolution.
File a Lawsuit
When filing a lawsuit, it is important to gather all necessary evidence to support your claim. This can include medical records, police reports, witness testimonies, and any other relevant documentation. Consulting with an accident attorney can help you navigate the legal process and ensure that you have a strong case.
Ultimately, filing a lawsuit against your insurance company should be considered as a last option due to the complex and costly nature. It is recommended to consult with a personal injury attorney who can guide you through the process and help you explore other alternative methods for resolving your accident claim.
Prepare for Court
Preparing for court can be an overwhelming task, but with the right approach, you can present your case effectively. If you are unable to reach a settlement with your insurance company after an accident, going to court may be your next step to pursue the compensation you deserve.
To prepare for court, hire a reliable and experienced attorney who specializes in personal injury cases. They will guide you through the entire process, from court filings to the presentation of evidence. Your attorney will help gather all necessary documentation, including medical records, bills, and any other evidence related to the accident.
Do your best to be organized and have all information readily available. Make sure you have a copy of your insurance policy, a record of all communication with the insurance company, and any witness statements or other evidence that supports your case. Your attorney will help you compile and present this information effectively.
During court proceedings, be attentive, dress appropriately, and remain composed. Your attorney will represent your interests and present your case to the best of their ability. Be prepared to answer questions and provide any additional information requested by the court.
In Life, Accidents Can Happen, and When They Do, Insurance Is There To Provide a Safety Net and Help Us Recover.
However, the process isn’t always as straightforward as we’d like, and sometimes reaching a settlement with your insurance company can become a challenging endeavor.
If you need assistance with getting the appropriate compensation for your injury, book a free consultation with Goldberg & Loren today.
Sources:
[1] Liberto, D. (2023, May 15). Alternative Dispute Resolution (ADR): Definition and Meaning. Investopedia. https://www.investopedia.com/terms/a/alternative-dispute-resolution.asp
[2] alternative dispute resolution. (n.d.). LII / Legal Information Institute. https://www.law.cornell.edu/wex/alternative_dispute_resolution
