When insurance companies handle claims where fault is disputed, they follow a structured process to investigate and determine liability. Here is a neutral, step-by-step overview of how this typically works:

Investigation Process

• Gathering Evidence:
  Insurers collect statements from drivers, passengers, and witnesses, review police reports, and examine physical evidence such as photos, videos, and vehicle damage.
• Scene and Vehicle Inspection:
  Adjusters may visit the accident scene and inspect the vehicles involved to better understand how the accident occurred.
• Review of Documentation:
  Insurance companies analyze all available documentation, including medical records, repair estimates, and any other relevant evidence.

Determining Fault

• Internal Assessment:
  The insurer’s claims adjuster evaluates all collected information to determine who is at fault. This decision is based on factors such as driver behavior, traffic laws, and the circumstances of the accident.
• Written Explanation:
  If a claimant disputes the insurer’s determination, they can request a detailed written explanation of how fault was assigned.
• Formal Dispute:
  Claimants may submit a formal dispute, providing additional evidence or pointing out inaccuracies in the insurer’s assessment.

Dispute Resolution

• Internal Appeal:
  If a claimant disagrees with the insurer’s decision, they can request an internal review or appeal. This involves submitting a detailed explanation and supporting documentation to the insurance company.
• External Review:
  If the internal appeal does not resolve the dispute, claimants may have the right to request an external review by an independent third party, whose decision the insurer is generally required to follow.
• Legal Action:
  If the dispute remains unresolved, claimants may pursue legal action, such as filing a lawsuit, to challenge the insurer’s determination of fault.

Key Considerations

• Evidence is Crucial:
  The outcome of a disputed claim often hinges on the quality and quantity of evidence provided by both parties.
• Communication:
  Keeping detailed records of all communications with the insurer is important for supporting a dispute.
• Legal Rights:
  Claimants have the right to challenge the insurer’s decision through both internal and external review processes.

This process is designed to ensure that fault is determined as fairly as possible, based on available evidence and applicable laws.