Accident Investigations for Automobile Physical Damage Claims

Investigations conducted by loss adjusters into physical damage claims for automobile accidents must yield enough information to assess the claim.

The scope of an investigation depends on the seriousness of the claim and whether a direct compensation scheme operates in the province, whether a fault chart will be used to determine fault or whether the ordinary rules of law apply to fault determination. Adjusters must establish who was at fault for the accident (or who shared in the fault), the extent of the damage, and whether anyone was injured in the accident and to what extent.

When investigating an automobile claim, there are a few points to keep in mind. The investigation and damage appraisal must be adapted to respect the law of the accident location, and some of the elements mentioned here might be unnecessary or not permitted in some American states or Canadian provinces. Diverse automobile insurance legislation in each province results in as many variations in interpreting the law.

Adjusters are often required to explain the rights and entitlements available under a policy to an insured, and informing him or her of what steps must be taken to qualify for coverage. Therefore, knowledge of the applicable auto legislation and policy conditions is important.

An interview in person with the insured or the claimant and a visit to the accident site as soon after the loss as possible may be required. Adjusters who promptly visit the scene are more likely to identify and preserve any available evidence. For example, physical evidence of foliage obscuring visibility at an intersection or the absence of a stop sign at a corner may not be apparent at a later date. But some knowledge of what took place is necessary in order to evaluate relevant evidence with subrogation possibilities in mind.

Photographs can be taken of important visual elements such as road signs, vegetation, and other factors affecting the rules of the road and visibility. The insured’s view of the accident as well as the third party’s can be recorded. Through both viewpoints, some analysis of the direction followed by each automobile before the impact can be developed.

Any other parties who may have contributed to the loss or witnessed the incident should be identified.

To document the file and make a plan for subsequent investigation, the policy contract must be assessed, not only to confirm coverage, but also to confirm the accident occurred during the policy period.

The policy covers anyone who has the owner’s permission to drive the insured automobile. When the operator of the automobile is someone other than the named insured or a listed driver, the circumstances under which the automobile was being used must be established to determine whether consent was granted.

When an accident occurs, primary coverage follows the policy on the automobile. For example, if A was driving B’s car because A’s car was being repaired, B’s policy would provide coverage first. If A carried collision coverage for any portion of the claim for automobile damage not covered under B’s policy, such as a deductible, a claim could be advanced under A’s policy.

Has the insured taken all reasonable action to protect the automobile and any other involved property from further loss or deterioration? Subsequent damage resulting from a failure to mitigate the loss would not be recoverable. Reasonable expenses for towing and storage fees incurred in the interests of mitigating damages would usually be recoverable.

Under which coverage does the loss apply? The policy must be examined to categorize the damage under its appropriate coverage. Has damage resulted from an insured peril? From the description of the accident, an adjuster can confirm the physical damage claimed resulted from the reported accident. Perhaps the insured did not buy coverage for the type of loss suffered.

Hugo collided with a guardrail driving to work and his car was damaged. He had not purchased collision coverage or all perils coverage and he did not live in a province where coverage on his own automobile was compulsory. The loss adjuster checked the policy coverage and determined the loss for Hugo’s automobile was not covered.

Depending on the jurisdiction where the accident occurred and the seriousness of it, police may or may not attend the scene. If police are on-hand, the insured should provide the name of the investigating officer, badge number, occurrence number and the details of any charges laid. The adjuster may have an opportunity to meet with police officers. Police reports, especially for a serious accident, may include diagrams of the accident scene, information relating to the individuals and automobiles involved, and perhaps names of witnesses to the accident.

Written statements from police could provide important factual details to assess liability. Details such as the position of the automobiles, tire tracks on the road, whether the surface was asphalt, nature and location of any debris on the road — which could indicate where the impact occurred — whether there was snow, ice, or any other surface elements affecting road conditions, layout of the scene, and existing weather conditions could be part of a police report.

Police testimony tends to be highly credible; however, it provides a picture of what the scene looked like after the accident, and not necessarily the automobile movement before the accident.

Violations of highway safety legislation, such as speeding or driving under the influence of alcohol, are documented in police reports. Reports would confirm whether a Breathalyzer test was administered or refused.

The insured may have to provide authorization to the insurer to obtain a copy of a police report.

Automobile physical damage claims are often very straightforward, particularly those involving single car collisions. Regardless, it is important for adjusters to maintain basic investigation principles with all claims. Otherwise, there may be insufficient documentation and evidence to support an assessment of liability when complications arise, for example, when third parties claim for damages.

This article is based on excerpts from the study material in the Claims Professional Series of applied courses — a core of the CIP Program that helps adjusters learn the functional knowledge and skills required of their profession.