14 answers

Fighting Insurance Regarding a Car Accident

So my sister was in a wreck the Monday before Christmas. Thankfully, battered bruised, but no one was hurt seriously. She was stopped at an intersection and then the light turned green. She went and then out of no where a woman hit her on the front right side of her car. My sister couldn't tell if the woman ran a red light or just slid in the rain. Her car was totalled, in fact I think both cars were totalled. The woman's SUV flipped. Police were called and everyone was sent to the hospital. My sister gave a report before leaving the scene and then again over the phone with a police officer. The woman that hit her has no recollection of the incident. She said she had no memory of the accident. She couldn't remember things the following day either. There were several people mulling around saying they saw what happened, but no one stuck around to give the information to police (my sister was sent off almost immediately in an ambulance and couldn't ask people to stay and tell police, she didn't know anyone, etc.). There were no red light cameras or any other cameras at the intersection. Last week she got a call from someone at the woman's insurance telling her she would be reimbursed for her car and that she needed to send medical bills to the adjuster. So we gathered the paperwork and mailed it out to him. Today, he calls and said he made a mistake and her claim was denied. She won't be getting the check. My sister is flipping out, she is concerned about the medical bills. An ambulance ride and checking everything inside and out isn't cheap and she has no insurance. She doesn't make very much money. She's basically coming unglued. I told her to talk to the adjust calmly a bit later and find out the reason it was declined. My theory is that they are calling it a no fault accident, since my sister is the only one who reported what happened, but I don't know for sure. Besides getting a lawyer...she can't afford that. SHe doesn't really care about the car even. She just wants to have the medical bills paid (She hasn't told the adjuster this at all). How can she fight this? Is there an appeals process? Does she even have a case?

What can I do next?

So What Happened?™

Just to fill in some blanks...

The other carrier is a reputable company. My sister's in questionable. My sister has been talking to the lady's insurance directly.

The police report basically says my sister said X and the other lady doesn't remember what happened. No witnesses no cameras. And there was a diagram showing the point of impact and where the cars wound up...not sure how they got the point of impact unless it was based on what my sister told them.

My sister had liability coverage. Her company is being of no assistance at all. When she called to report the accident (in case a claim was filed) she was told they couldn't help her since she only had liability. ANd that she needed to deal with the other person's insurance.

I don't think anyone was ticketed, I know my sister wasn't.

And she was thoroughly checked out in the ER...even hooked her up to an EKG. She was sore for a week and missed some work, but feeling fine now.

More Answers

Of course the other insurance will deny payment. That's what insurance does. Does your sister have car insurance? If she does then she needs to give all the information to her carrier and let them duke it out with the other carrier. If she doesn't carry car insurance then she should contact the woman's insurance carrier asking for a denial in writing giving the reason for denying the claim. She should also indicate that she will be filing a complaint with the Texas state department of insurance who will investigate this on her behalf. https://wwwapps.tdi.state.tx.us/inter/perlroot/consumer/c...

My daughter's car was hit in walmart's parking lot by a woman who was backing out of her spot without looking. The other carrier denied the claim. My carrier went into arbitration with them and they were held 75% liable. Insurance companies spend as much time denying hoping that you'll just drop it. Tell your sister not to freak out, not to accept liability on any part of the accident and not to settle for just having medical stuff covered.

5 moms found this helpful

You got some excellent advice here...definitely follow up with the state Dept of Insurance if your sister's company doesn't do their job.

Ditto what everyone said about the other company automatically denying...tell your sister not to give up. She is not at fault.

Lastly, have your sister ask for a copy of the woman's cell phone records. My mom got hit at an intersection by a guy running a red light, and when I threatened a subpeona of cell phone records, his insurance company immediately rolled over. Incidentally, they tried to deny my mom's claim at first also.

5 moms found this helpful

She needs to do what you suggested. There is an appeals process through the insurance company.

She definitely needs to find out why the claim was denied. Even in a no-fault situation unless she only has liability coverage her car and medical should still be covered.

If she's still unhappy with the result of the appeals process, then she needs to get in contact with the state's insurance commission. They're here to help in just these types of situations. They can give you the objective legality of everything and will let you know what your rights are.

In fact, I might send this question (e-mail or call them) to them now just to make sure you take the right steps.

My husband was in an accident recently and we were getting what sounded like some wonky information from the other party's insurance company. While he was on the phone with our insurance I call the insurance commission and got some answers straight from them. Helped us both feel more comfortable with our next steps and what our rights were.

http://www.tdi.texas.gov/consumer/ or 800-252-3439

4 moms found this helpful

your sister needs to call her own insurance company. If the police were called and your sister gave a report then the police report should show what happened. If the other person hit your sister then she will have to pay. When someone has one of those fly by night insurance companies they will try and get out of paying. your sisters insurance company should be fighting for her. she does have car insurance right? there is no way that the other insurance company can decline a claim.

4 moms found this helpful

Personal Injury attorneys work on a contingency basis. They don't get paid unless your sister wins. Get an attorney right away. Your lawyer can access information more easily. They maybe able to get information from the transit authority as to who had the red or green light at the time of the accident, even without a camera.

4 moms found this helpful

She can file it on her own insurance if she has collission coverage and the insurance company will fight for her.
SHe should get her own copy of the police report and see how the officer wrote it up. Does it not clearly define who is responsible? If they got it wrong, she has the option of calling the station and talking to him or his seargent for clarification. FIling on her own insurance is her best bet. SHe should file onhers anyway if she has PIP or Medical Payments coverage.

3 moms found this helpful

My first question is did both drivers had automobile insurance? If so what kind? My next question is, who received a ticket? My last question is which insurance adjust is your sister dealing with...someone from her insurance company or someone from the other driver's?

The answers to those questions make a big differece. I'll explain what I know and it may help you help her with this. Keep in mind, I am in DE not TX.

1. Going on the assumption that both had liability insurance - Who ever was at fault (or received the ticket/deemed at fault by the police)...their insurance would pay for the other driver's (the not at fault driver) vehicle and medical bills. Their own vehicle would not be covered but medical bills should be (I think).
2. Going on the assumption that both had compensative insurance (typically required if they are still paying off a car loan for that vehicle) - Their own insurance would cover their car only.
3. Going on the assumption that they had both liability and compensative...both cars would be covered regardless of who was at fault. If there is question as to who is at fault, they would each deal w/ their own insurance companies to get their cars and/or medical bills paid. Then the insurance companies would have to battle it out.

Since the other driver doesn't remember, they have to go with what the scene, the police, the witnesses, and your sister can tell them. Based on the scene and witnesses, the police make a determination as to what happened (write a report and usually a ticket) so unless that contradicts what your sister is saying the other driver should have gotten a ticket/been at fault. Most insurance companies try to put at least some of the blame on the other driver too because it lessens their liability (most of the time, the "not at fault" driver could have done something different to have avoided the accident...stayed stopped longer, slowed down, swerved, something so the insurance companies do try to minimize their liability). Going on the assumption that your sister was not at fault, I would have her file the claim w/ the other insurance company (assuming there is one) and simply notify her insurance company (if I were her I would make that call first). What happens next depends on who was deemed at fault and what type of insurance each had. If there isn't another insurance company then your sister needs to file the claim w/ her insurance company.

Since she has already talked to an adjuster (again, which adjuster was it), she first needs to find out on what grounds it was denied. Even if she is filing w/ the other insurance, her agent should be able to help guide her through this.

**Just read your SWH. She definately has to file with the other driver's insurance. At this point, she needs to find out more details about the denial of the claim and go from there. Sounds like she may also need to get a copy of the police report and maybe talk to the officer.

3 moms found this helpful

She should be working through her own insurance company. They are her advocate and will fight for her benefits. If needed, they will hire a lawyer to make sure that her expenses are covered.

(trust me on this... my husband is an attorney called in by insurance companies to defend their insured people)

All that said, though, a lot of times, it simply doesn't matter who's at fault. It just matters who has better insurance coverage. My husband sees cases all the time where the insurance company of the person who wasn't at fault ends up paying everything because it's better coverage.

3 moms found this helpful

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