How Does an Insurance Company Decide Who Was at Fault?

How Does an Insurance Company Decide Who Was at Fault?
insurance company decide who was at fault

Accidents are sudden events, and it can be difficult to pinpoint exactly how and what went wrong, leading to the accident and injuries. Often, the versions of all parties involved can conflict or contradict each other, making it more challenging to determine who is ultimately responsible for the accident.

Insurance companies’ approach to deciding who is at fault for an accident will consider various factors and considerations.

Does a Police Officer Determine Who Is at Fault?

Accident scenes are disorderly and confusing. If there are victims with injuries, much of the focus is on getting them the help they need. A police officer will first arrive on the scene to try and get help for those most vulnerable, who might face life-threatening injuries or risks.

Once authorities secure the scene and EMS arrives to assist those in need, a police officer will prioritize investigating the accident and its cause. As part of their accident inquiry, the officer will speak with those at the scene and analyze the evidence available to them to determine who they believe violated any traffic laws or signals which may have led to or contributed to the accident.

A police officer will prepare a police report that can include information about who they believe was primarily at fault for the accident. However, that is not always the case. There may be situations in which an officer cannot determine responsibility for the collision or indicate that multiple parties are to blame for the incident. An officer will also commonly issue a citation when they see evidence of a traffic law violation.

A Police Officer’s Determination is Not an Absolute

Many victims of accidents will assume that the determination an officer makes at the scene of an accident carries over to the insurance claims process. However, this is not the case. Police officer reports, traffic tickets, and the information within the reports can be evidence in a personal injury case. Still, the insurer and other parties are not obligated to defer to the determination by an officer.

When police officers analyze the scene of an accident, they are looking for violations of laws and are not making determinations about what constitutes negligence. A police officer may find that a party did not break any laws. Still, the application of negligence in the same scenario may show that a party was more responsible for the injuries and damages to another.

There is also a possibility that a police officer’s account is wrong or faulty. Officers must make determinations quickly and with the evidence available to them at the scene. If a party suffers serious injuries, they may get transported to a hospital; they can't speak with an officer; an officer may not have access to video recordings at the scene.

There are many situations in which an officer might determine fault based on the information available, only to be mistaken in their assessment when further evidence and information comes to light.

What Evidence Will an Insurer Consider When Determining Fault in an Accident?

Insurance companies will use a combination of factors to make fault determinations in accidents for purposes of an insurance claim. An insurer will look to the elements of negligence to determine who is at fault for the accident. To determine negligence, an insurer can evaluate any evidence available to them to determine who is at fault for the accident.

The critical point is the evidence available to them, not all of the evidence that may be available. While insurers will conduct their investigation into an accident, their primary concern is reducing or eliminating any liability they may have to a victim. If they can accomplish that with their information before them, they will not keep digging for more evidence.

This is where you and an attorney on your behalf will come into play to influence the determination of fault in an accident possibly. If you or your lawyer have evidence that contradicts or offers additional information that can change a fault determination, it may prove liability for an accident and your injuries.

Evidence that can prove fault in a personal injury accident includes:

  • Photographs or videos of the accident, the aftermath, and the destruction of property or injuries - Actual depictions of the accident scene can be crucial in determining fault for an accident injury. Seeing the accident location, the factors contributing to the crash, and the positioning of vehicles can determine how and why an accident occurred.
  • Police reports and citations - Many believe the purpose of the police report is to see the determination by an officer. While that information can be relevant and help bolster evidence of negligence, police reports also include information about the scene of an accident. Where the parties and vehicles end up after the initial impact, the location of the damage on the vehicles, visible injuries to victims, complaints of victims of pain, and the state of the parties when speaking to the officers at the scene are essential pieces of information.
  • Medical records of injuries sustained in an accident - Seeking medical attention after a crash serves the primary purpose of getting you the help you need. Still, it is also beneficial for you to show evidence of your injuries and your treatment and recovery. Medical records from providers following an accident are strong evidence of injuries and the lasting damage that may affect a victim in the future.
  • Testimony of witnesses to the accident or events leading to the accident - Other passengers, drivers, or bystanders can testify their recollection of the events leading to the accident. Those with a different perspective may offer clues as to what may have led to an accident that another driver or accident victim did not see.
  • Expert testimony relating to the accident - Accident experts study injuries, positioning of victims and vehicles, location of damage, and other accident factors that can recreate the scene and give insight as to how they believe the accident was likely to occur. These unbiased experts can help determine fault in accidents where testimony is unavailable or unreliable.

Can More Than One Party Cause Your Injuries?

Determinations of fault are not always black and white, and it is not always a choice between one party or another. Many accidents can have multiple parties that share in the responsibility of an accident and the injuries that arise from it. Insurance companies will often apportion fault in an accident with the party with the most percentage primarily liable for the accident.

Insurers often use this tactic to try and blame victims for the accident and apportion enough fault to them or to another party to reduce or eliminate any liability from the insurer towards a victim and their damages.

Fortunately, personal injury attorneys are well aware of this strategy and how insurers will try to protect their bottom line versus compensating a victim fairly for their losses in an accident.

When more than one party causes an accident, this can complicate a case. Still, it does not prevent victims from seeking the compensation they deserve from the parties responsible, whether an individual, organization, or combination of parties. There are many situations where a party can be at fault for an accident, even if they were not present at the scene. This is common when commercial vehicles are involved in an accident or third parties’ actions that led to the accident.

Parties that can be at fault in an accident include:

  • Vehicle owners
  • Drivers
  • Property owners
  • Employers
  • Manufacturers of a defective vehicle, part, or product

How Does Fault in an Accident Influence Your Case?

There must be a fault determination before moving forward with an insurance claim because it will, in turn, determine who is liable to the victims for their losses and, ultimately, who must pay for these damages.

Additional damages such as pain and suffering losses are available to victims of a crash that are not available to parties to blame for an accident, even in a no-fault insurance state. Beyond insurance coverage, the fault determination also lets a victim know who else is potentially liable to them personally if an insurer fails to offer a settlement that compensates them for a sufficient amount of their losses or if insurance coverage is not available.

Can You Fight an Insurer’s Fault Determination?

The fault determination by an insurance company can catch many accident victims off guard. You may believe that your case is the fault of the other party only to find that an insurer has apportioned blame to you or determined you were the party that acted negligently in the accident. While it may not be a worthwhile fight in every case, there are many cases where a party can fight the determination of fault entered by an insurance company.

When you do not have an attorney, you may inadvertently make a comment, assumption, or offer inaccurate information in your communications with an insurer that it uses against you. Insurers can misconstrue your statements or misinterpret the meaning of what you state to prove that they are not liable to you for your losses.

Always seek the help of a qualified attorney as soon as possible after an accident. A lawyer can help you evaluate your case, including the events leading to the accident and your injuries, to discover liability and who may be responsible for your damages.

If you disagree with a determination of fault by an insurance company, speak to a lawyer as soon as possible to discuss what, if any, options you may have available to you to fight that determination.

How Can a Lawyer Help You With Your Case?

An attorney can be a crucial asset to have at your side that will protect you from any arbitrary or unfair fault determinations that do not follow the evidence in your case. Your attorney will independently evaluate the accident and your injuries to make sure you find those responsible and that you can gather all evidence available to prove they are at fault to support your claim.

When you hire a lawyer, you will not need to talk to insurance representatives yourself, as you can direct all communications to the attorney’s office. This can prevent the possibility of making erroneous comments or statements to insurers that could harm your case and result in claim denial.

What Will an Insurance Company Do After They Determine Fault?

Once there is a determination of fault, an insurer will take one of two actions. They will either enter a denial of the claim if they determine they are not liable for any of the losses to you, or they will move forward in the claims process.

If your claim remains active, the insurer will then move on to calculate your damages and offer a settlement to you. Be wary when an insurance company gives you payment quickly.

You should always discuss all settlement offers with an attorney on your behalf if you have not yet hired one. Insurers will try to pay you as little as possible for your losses. Contact a personal injury attorney as soon as you are in an injury accident. This can help you understand your case and the damages you may recover when another party injured you.