Denied Claims. The Auto Insurance Adjuster Denied my Claim

Reasons Adjusters Deny Claims: 
What has happened with your automobile injury claim against the other guy's insurance? Why do they deny every claim, and fight everything now?

The Law Office of Doug Goyen, top expertise, aggressive, personal injury lawyer in Dallas, Texas. If you are looking for an attorney for a personal injury automobile accident lawyer who will handle your automobile injury claim, premises liability, workplace injury, slip and fall, dog bite, wrongful death, or any other case where you need a personal injury lawyer, you can contact the law office at (972) 599 4100. They are located in Dallas, Plano, and Addison, Texas.

A little background about me. I’m a personal injury lawyer in Dallas, Texas. I have been one since 1998. Prior to becoming a personal injury lawyer, I worked as a claims adjuster working automobile injury claims from 1989 to 1997. When I worked as a claims adjuster, I worked a 13 state region (not all at once, but we’d move around from state to state within the region). I’ve lived through, and worked through, all the changes in personal injury over the last couple decades.

Often I get phone calls from people who are involved in an automobile injury claim resulting from an accident involving injury, or even more often, calls from people who have been involved in an auto accident with no injury. The insurance company is refusing to pay for their damage for some reason. More and more, I get reasons from insurance companies that NEVER used to pop up 10 years ago. Here are a few top reasons for insurance companies denying claims:

1) Non-Reporting: The person who caused the accident did not call in the claim to his or her auto insurance company.

Back in the day, when I was an adjuster, this would just delay payment, but would not end up in a denial of coverage. The reason for the delay back then - obviously, the insurance company wants to talk to their driver to see if there is another version of what happened. Maybe there is another version, maybe with witnesses even. Maybe there are circumstances that would show the vehicle should be covered by some other insurance policy if they can talk to the driver. So there is a legitimate reason to delay payment, even if the police report is in your favor, and you have a witness in your favor. The insurance company needs to make sure that they have the “whole” story, and that they are the ones who are supposed to pay.
When I was an adjuster, if my client never called in the claim, if there was a police report, or witnesses, or some other evidence that my insured indeed did cause this collision, we would end up paying the claim, even if no report was made, but only after we made reasonable attempts to get our client’s version, which could delay payment for a couple weeks if our client would never call us back.

NOW, in present times, insurance companies will flat out deny the claim if their insured does not call in the claim. If there is no report by the insured, then there is no coverage. Even if you have 10 police officers investigate who interview every person there and get videotaped admissions of fault from the Defendant, a bus of nuns who are your witnesses, and the other driver was a drunk illegal immigrant who speaks little to no English and curses out the person he ran into after causing the injury collision.

Lesson: If possible, get the other driver who caused the collision to report to his insurance company right there at the scene. If he won’t call, you call it in and hand the phone over to their driver right there.
i. We should also consider legislation that requires the person to call in the claim to his or her insurance company right there at the scene, if the person refuses to do so, the police can be called and the person is charged with a citation of some sort. What is the use of forcing people to purchase insurance if there is no coverage due to them not calling in the claim? What if they die after they leave (or in the accident itself)? Who is going to call in the claim then? What if they become disabled, or are mentally unable to call in a claim due to some condition, or illness? There needs to be a mechanism to protect auto insurance coverage that is required by law to protect the public (its not required by law to protect the individual wrongdoer, its required to protect his victims). There should not be “tricks” that auto insurance companies can use to get out of paying a legitimate claim.

2) Multi-Car Accidents: Example - a 4 car chain reaction. If you are the 3rd car up (#3), a common scenario is that the the two cars behind you are arguing about whether the very rear car (#1) pushed the next car (#2) into your rear, or if the #2 car hit you first, and then the #1 car hit the #2 car due to the sudden stop from the initial impact.

Here you are, the innocent victim to one of these guys. What happens is that BOTH insurance companies will deny your claim. Nobody will pay for your damage due to both pointing the finger at the other.

Joint & Several Liability Rule: Back when I was an adjuster, and the first few years I was an attorney, Texas’ Joint and Several Liability Rule was that if a Plaintiff was an innocent victim (in other words, did not contribute to the cause of the harm), then the Plaintiff could choose to go after any of the people who caused the harm as long as they were at least 20% at fault. So in the above case, you could choose the car you thought was most likely the one at fault, sue them, and get your full damages. That car could then join in the other vehicles to make their insurance companies contribute to whatever their percentage of responsibility was.

Tort Reform of the 1990’s changed this. The Texas Legislature made it where you now have to prove 1) the defendant in a multiple car situation like described above that you choose to make your claim against was at least 51% at fault to make him pay the full claim, and 2) that if the defendant was under 51% at fault, he would only owe the percentage he was found at fault.

Why did this change anything? Now, in multiple car accidents, insurance companies will always try to point the finger at one or more of the other vehicles in a multi car accident. They know that the likelihood of you being able to prove 51% responsibility on their particular client is small if their client starts making excuses for his behavior. Now all insurance companies just play the tactic of pointing the finger at each other, and nobody pays. Before, you had some leverage – you could pick the one you thought most at fault, and you only had to prove 20%, then it was that person’s insurance company’s responsibility to get the other insurance companies to contribute their responsibility amounts. Now, very few multicar collisions get paid in full, and often the innocent victim won’t be paid at all. There is almost always some finger pointing, and insurance companies victimize the innocent victim by blaming each other, in a scheme to avoid paying anything at all if possible.

3) Person Driving Car is Not on Policy: (Old way): Insurance policies traditionally have covered anyone who had "permissive use" to drive the automobile, as long as they weren't listed by name as an "excluded driver". An excluded driver is typically someone that lives in the household of the person taking out the auto accident insurance policy, and that person (son, husband, etc), has a history of DWI, or some other bad driving history that causes the insurance company to basically say "we can't insure you if you let that guy drive the car". So they draw up a policy with an "exclusion" saying that if that particular named excluded driver drives the car, then there is no insurance coverage.

(New way): Now, many auto accident insurance companies are writing general "exclusion" clauses that say that if ANYONE who is not listed on the policy drives the car, they are an excluded driver. Meaning that the automobile insurance policy only covers the named insured. They are not paying for collisions that have been caused by any other driver of the vehicle.

Police have no idea that this is happening. So when the person produces an insurance card on the vehicle, the driver is not ticketed or arrested for driving without insurance. People are not required to carry around the actual policy with the exclusion terms, so how would a police officer know? The Texas State Board of Insurance is to blame for this, as they have allowed insurance companies to write policies any way they want, without requiring that this particular type of problem be disclosed on the insurance card.

This is a selling point for these "fly by night" insurance companies that are doing this. They are able to sell policies cheap to one person, who can use that card on the car that maybe 5 or 6 people actually use. Only one of those 5 or 6 people are actually covered in reality, but those 5 to 6 people are able to use that insurance card as proof of coverage in applying for inspections, registration, when pulled over by a police officer for a traffic stop. Its a lie - those people are uninsured, but the lie is being allowed to be perpetrated on the people of Texas by the State Board of Insurance.

___________________

Do not give up if the above denials are happening to you. Call me at (972) 599 4100 to discuss your case. Often these denials are not legitimate. They are hoping you will just go away, and your bills and injury that you suffered will go away with you. They want you to carry the burden of their driver's wrongdoing, rather than them. That isn't fair, the wrongdoer and their auto insurance company who caused the automobile injury claim should have to bear the burden, not the innocent victim or the innocent victim's insurance. Someone is going to have to pay - him, and his insurance, or you and your insurance, or if you have no insurance - then soceity pays (bills just don't disappear - writeoffs, taxes, social programs that pay, etc.), somewhere down the line society picks up the bill if the insurance company doesn't. So don't buy the excuse that this will cause insurance rates to go up. Better that the wrongdoer's insurance rates go up than the innocent victims. Better the people insured by the wrongdoer's insurance pay for the insurance company choosing to cover bad drivers, than the insurance companies who cover innocent victims having to raise their rates due to the bad insurers deciding not to pay for illegitimate reasons. You need someone to fight for you. Call us.