Every car accident insurance claim starts with a car accident. If you are the owner of the car and want to claim for damages, you should report the accident to your insurance company at the first opportunity. This will officially set in motion the claim process.
Usually, an insurance company settles the claim based only on the adjuster/surveyor's report on the extent of the damage to your car. And if you are satisfied with the claim your insurance company has offered to you then the issue is settled. But what do you do if you think the claim amount offered by your insurance company is not right?
In most cases apart from the trauma of an accident the next biggest ordeal could be the long negotiating process a non-agreement on the claims amount could spark off with the insurance company!
So how do you negotiate a claim to get it fully or at least the maximum amount? What do the insurance companies usually do during a negotiation process? What are your rights and when and how do you exercise them?
The following is a comprehensive guide to give you an insight into the various possibilities involved in negotiating accident claims for cars.
Understanding the basics is important
Perhaps the first thing that you should do in case your car is damaged in an accident is report it to your insurance company within the time frame as mentioned in your car insurance agreement.
You could also do your best to get as many details of the accident as possible like taking pictures of your damaged vehicles and any injuries sustained. You could also get in touch with the witnesses to the accident who could be a big plus later on to help prove your insurance claim.
Fill up the claim form with all facts mentioning the claim amount you believe your claim is worth.
Support your claim with all related documents including your medical bills if any, the first information report (FIR), if any, in case of accident involving third party injury or damage and the original estimate of repairs obtained from the workshop. This will put you in an advantageous position in case there is an impasse on the claims amount settlement.
The estimation process: Know your rights
After you have submitted your claim and before a claims adjuster or a surveyor from the insurance company who deals exclusively with claims contacts you regarding your claim, the insurance company will look into your policy details to know the extent of its coverage, the deductibles if any and also the coverage limits that may affect your claim.
That is whether your car accident policy is the Motor Policy A - Act Only Risk which is also known as third party risk or the more sensible Motor Policy B which is otherwise known as comprehensive insurance policy. It is always a sensible option to go for a comprehensive insurance policy for your car.
Physical assessment
After this initial check on your car policy coverage and depending on the claim amount, the adjuster/surveyor will physically visit the site or visit the accident site, talk to witnesses or refer to the police complaint if any to decide on the claim amount.
Usually many insurance companies have their own in-house adjusters/surveyors to assess the damage and decide on the claim amount, usually for claims below Rs.20, 000. But in some cases the in-house adjuster/surveyor assesses damages worth more than Rs. 20, 000 which is illegal.
There are provisions in the Insurance Act regarding that has specific rules about who qualifies for carrying out an assessment or survey of the damaged car in case the claim amount is more than Rs 20, 000. According to the Insurance Act it is mandatory that only an independent surveyor can do the assessment for all claims above Rs 20, 000.
This way a fair assessment of the extent of the damage is ensured paving way for an amicable settlement between the insurer and the insured. The law also states that the adjuster/surveyor should submit the damage assessment report within 30 days of the surveying the damage.
When you should negotiate
If your claim is simple that is there is no ambiguity on whose at fault issue, or the damage was negligible, and required only a little or no medical treatment for the passengers, then the adjuster/surveyor may require you give an estimate for repairs, study it and if satisfactory then probably settle the claims fully.
But if your claim is complicated that is if the liability is uncertain, or if your car insurance does not have adequate coverage or simply you do not agree with your adjuster's/surveyor's settlement offer, then this is when you should begin negotiations.
Remember, it is always better to keep a written account of the conversations/discussions on the claims dealings with your insurance agent and with adjuster/surveyor and any other people involved in the claims process.
When to preempt the adjuster's/surveyor's settlement
Usually it is the insurance company that makes the first move to offer you a settlement on your claim which could be all, or part, or in worst cases even nothing none, will typically be on the low side.
After all, it is the job of the adjuster/surveyor to save the employer's money. At the same time, the adjuster/surveyor would like to close a case and has the rights to typically allow a settlement range during negotiation.
In case you are definite on the value of your claim, which is advisable to be done only after consulting a lawyer experienced in handling car accident claims cases, you could preempt your insurance company by writing a demand letter mentioning the claim amount you believe your claim is worth.
Usually, the adjuster/surveyor will return to you with a counter offer which will be predictably lower sparking off a series of negotiations. Luckily if you reach an agreement then it is ok but when he gets to the top of his range that he usually has there will be no further offers and there is an impasse.
Before moving on to find out the other options available to you as the insured, you should first find out if your claim that has been denied either in whole or in part, has any legitimate and reasonable reasons to it.
Try to find out if the denial has to do anything with the limits in your coverage. Usually, the adjuster/surveyor will send you a denial letter against your policy. Check this to see if the denial seems legitimate or not. If you still feel that your claim has been unfairly denied, read on to find out the other options before you.
However, there is a word of caution. Whatever the course of action you decide to take on reaching an impasse remember that it should be based only on facts and made at the right time. If you sit on your claim for too long, there is every possibility that you might lose the right to sue in court to get your recovery.
Other options before you even if you reach an impasse
The obvious and wise choice for you will be to seek the advice from a lawyer specialized in handling car accident claims. This will help you determine if the settlement amount you seek is reasonable or not based on the facts and the supporting documents that you intend to furnish.
On the other hand if you prefer to continue negotiations on your own without a lawyer, you could write to the insurance company explaining the situation and strengthening your claim amount with more additional documentation and/or information not previously provided.
You could also talk to the adjuster/surveyor directly or if required seek an appointment with his superior. Else, you have the option to request for an alternative dispute resolution like mediation or arbitration.
If none of this works out you may file a complaint with the concerned state or central authorities/ministries or move the court of law to sue your insurance company for Bad Faith. Of course this depends on the clause provided in your car insurance agreement.
Most insurance policies mentions about an "appraisal clause" on the preferred way to settle disputes between insurers and policyholders. Usually, the clause says that disputes must be arbitrated, where a neutral party could hear the case and decide. There is very little room for a provision that disputes can be settled through litigation or in a court of law.
