Expert: Claims Guy - 9/1/2011

Question
My wife was stopped at a red light was rear ended damaging the back of our vehicle. His vehicle suffered sever front end damage.

At the scene, he said he had been tapped from behind by another vehicle, panicked and slammed into our vehicle by either lifting his foot from the brake or hitting the gas pedal. He also said that the vehicle that hit him left the scene.

My wife never saw the 'alleged' other vehicle but there are small impressions of what look like the heads license plate bolts on his bumper. They could have already been there for all we know.

The driver was very apologetic and offered to have the damage fixed through a friend of his to avoid going through insurance. We refused his offer and decided to go through proper channels.

We reported the incident to our insurance company, they took his statement where he admitted to the facts as I have stated previously. Based on his statements, our insurance deemed him 100% responsible.

Concurrently, we notified his insurance company and was instructed to take the vehicle to their authorized shop where their adjuster could review the damage and prepare an estimate. We did as asked and got an estimate for the repair.

Over a week passed and we hadn't heard anything back. We called and were told they still hadn't inspected their insured's vehicle yet. Another week and two rescheduled appointments later, the vehicle was inspected.

We call and finally get to speak to an adjuster. We were told that in their determination, based on the damage seen at the rear of his vehicle, there was a third party involved and because the collision at the rear of his vehicle was the inciting incident, their insured is not at fault and they are denying our claim.

Obviously, we disagree with this decision. The further explanation received was that how could he be responsible when he was the victim of a hit and run and that's what caused the accident as a whole.

My question (finally) is how factual and accurate is their determination? We feel it is double-talk from an insurance company who is dealing with a private individual and is trying to avoid paying a claim.

We live in California and would like to know what recourse we may have in this matter? We are reluctant to have our insurance company pay the claim and go after them for fear of increased rates.

Any insight and advice will be greatly appreciated. Thank you in advance!

Best regards,
Ed

Answer
Your best bet is to let your insurer handle this.  They will cover your damages and file arbitration against the other insurer.  If the statement they took is clear, they will be likely to win.  They'll collect your deductible back for you.

Another option is to sue the other driver in small claims court.  I normally would only recommend this as a last resort, and you have a better option here.  The other insurer will defend their customer with an attorney, and it's not easy to go up against an attorney in court.

Finally, you could also file a complaint with the state insurance dept. But I don't think you would prevail.  The burden is normally eggregious behavior, and it doesn't sound like that occurred.