How Does an Insurance Company Determine Fault?

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How Does an Insurance Company Determine Fault?
Insurance? (Billy Alexander)

Claims adjusters working for insurance companies typically determine the percentage of fault for each party involved in an accident. Adjusters use their companies' actuary tables, which list the amount of payment or denial on each claim. Actuary tables vary from company to company and are subject to interpretation from adjusters. While some companies base their fault for car accidents on the person who received the ticket, other insurance companies consider anyone involved in an accident at fault. The ticket may affect the level of fault they contribute to the insured, which then affects the amount of payment the company is willing to provide. Insurance companies typically expect to negotiate most determinations. A personal injury lawyer can be brought in to facilitate negotiations on levels of fault as well.

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Adjusters

Claims adjusters working for insurance companies typically determine the percentage of fault for each party involved in an accident. Adjusters use their companies' actuary tables, which list the amount of payment or denial on each claim. Actuary tables vary from company to company and are subject to interpretation from adjusters. While some companies base their fault for car accidents on the person who received the ticket, other insurance companies consider anyone involved in an accident at fault. The ticket may affect the level of fault they contribute to the insured, which then affects the amount of payment the company is willing to provide. Insurance companies typically expect to negotiate most determinations. A personal injury lawyer can be brought in to facilitate negotiations on levels of fault as well.

Vehicle Insurance

Some factors that insurance companies use to determine fault in automobile accidents are weather conditions, the time of day, the location of the point of impact and the mechanical condition of the vehicle. If your car slipped out of gear and hit another car, for example, you would be considered at fault. If you backed up and another car broadsided you in a car park, you would still retain a level of fault for not seeing the errant driver. If both cars in an accident are in motion, both insurers usually will level fault at both drivers. Once the level of fault is determined, the insurance adjuster applies the percentage to the claim. For example, if you were found to be 50 per cent at fault by the insurance company's calculations, the company would pay 50 per cent of your claim.

Personal Injury

Insurance companies must follow tort law to determine fault for personal injury claims. Torts are wrongs committed by a person or company that are negligent and contribute to an injury or accident. Negligence is primarily left to the injured party to prove. Through witnesses, evidence at the scene and medical records, a plaintiff presents a case to an insurance claims representative. If the claim is solid beyond a reasonable doubt, the insurance company typically settles. Many personal injury cases end up in court when the insurer and the plaintiff cannot come to an agreement.

Determinations

The level of tort responsibility is defined by state regulations. When the injured party is partly responsible for the accident or injury, it constitutes contributory negligence in some states. When an injured party plays any role in the accident in contributory negligent states such as North Carolina, the injured party can receive no compensation. Other states, such as California and New York, have enacted laws to cover injured parties through comparative negligence laws. Complicated formulas are used to consider the level of negligence. Most states are moving to a compromise system that says if the plaintiff is more than 50 per cent responsible for the injury, no compensation may be claimed; but partial recovery is due when the plaintiff is found to be less than 49 per cent at fault.

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