Car accidents can be traumatic experiences, and dealing with insurance companies afterward can add to the stress. The insurance company’s main goal is to minimize its financial liability, which may not always align with your best interests as the policyholder. “Car accident victims require empathy besides compensation. In most cases, victims are left with devastating injuries and loss that may alter their lives permanently. A little kindness to such a person might make so much a big difference besides the compensation, which in most cases are not commensurate to the injury/loss suffered,” says Mr. Sospeter Opondo Aming’a, the Managing Partner at SOKLAW Advocates. As such, it’s essential to understand your rights and responsibilities as a policyholder and know how to tell if the insurance company is treating you fairly. Here’s what you need to know about determining whether your insurance company is acting fairly toward you and your claim.
Africa Automotive July-August digital issue 2023
Understanding your insurance coverage after an accident
Automobile insurance is mandatory in most countries and is designed to provide coverage for damages and injuries resulting from car accidents. “In a world filled with unpredictable twists and turns, the necessity of insurance cannot be overstated,” remarks Ms. Lauretta Oyile, a Lawyer at Simba & Simba Advocates.
“In the context of a car accident, it may only qualify for settlement under an insurance policy if three prerequisites are satisfied. One, the insurance policy should be valid and active. Two, the accident must have been an event contemplated under the policy. Three, the accident must not fall within an exception or have arisen due to the negligence, carelessness or recklessness of the insured,” she clarifies.
She further explicates the prerequisites, notwithstanding, the insured is also required to give notice of the accident to the insured, furnish particulars in sufficient detail using the prescribed format and within reasonable timelines, and substantiate the claim. The law imposes a duty upon a party who seeks reliance of their statements as true to give evidence of their truth. Different insurance companies have formulated claim forms to enable them reconcile and settle claims. The insured, is expected to give full particulars of their claim using those forms. The claim should equally be made within set timelines provided under the policy or customarily within twenty-four (24) hours.
“Once the insurer has been supplied with the requisite information, they may opt to settle the claim out of court. In the event they do not, the claim may be subjected to legal proceeding before a court or tribunal for the determination of their liability. Once liability is proven, the insurer has an obligation to pay the insured, the assignees of the insured or Third Party. It is only upon such payment that the insurer is deemed to have discharged their obligation and the claim settled,” she compliments.
Your insurance policy will outline the types of coverage you have, including liability, collision, and comprehensive coverage. Your insurance policy will also specify your financial responsibility in the event of an accident, including your deductible and policy limits. Your deductible is the amount you pay out-of-pocket before your insurance kicks in. Policy limits are the maximum amount that your insurance company will pay out for a claim. It’s also important to note that insurance companies are businesses and their primary goal is to make a profit. This means that they may try to minimize payouts or deny claims altogether if they believe it will benefit their bottom line. If you feel like your insurance company is not treating you fairly after an accident, there are steps you can take to protect yourself. “Insurance policies create certain rights and obligations for the parties involved. Key among the obligations include the duty of the insured to disclose all material facts within their actual and perceived knowledge to the insurer. Material information is any circumstance that would influence the judgment of a prudent insurer in fixing the premium or determining whether they would take up the risk,” elaborates Ms. Oyile.
Insurance companies are working for their interests
During the investigation process, it is important to remember that insurance company partners such as adjusters and investigators are working for their interests rather than yours. While they may seem friendly and helpful on the surface, their ultimate goal is to minimize payouts on claims. “A fair insurer will guide an accident victim on the documentation they require and the process they have to undergo in order to have their claim settled. A shorter claim settlement turn- around time will also account for fairness. Many insurers take accident victims in circles with the excuse of investigations, even where the facts are straight. Last but not least, the amount of settlement should also be reasonable and commensurate with the injuries suffered. An insurer should not take advantage of the victim’s desperation to meagerly compensate them,” highlights Mr. Aming’a. This means that they may use tactics such as downplaying injuries or damages sustained in an accident in order to reduce payouts. “The perception is that insurance companies do not usually want to pay out their claims. They are believed to utilize loopholes to latch onto evade liability,” adds Ms. Oyile. They may also try to pressure you into accepting a settlement offer that does not fully compensate you for your losses. Accusations of bad faith can arise when an insurance company fails to act fairly and honestly toward its policyholders. Some examples of bad faith accusations include:
– Failing to investigate a claim properly.
– Refusing to pay a valid claim without justification.
– Delaying payment on a valid claim without justification.
– Offering an unreasonably low settlement amount.
– Misrepresenting policy provisions or coverage limits.
Recognizing when an insurance settlement offer is too low
When you’re involved in a car accident, one of the most important things to consider is whether or not the insurance company is offering you a fair settlement. But how do you know what a fair settlement offer looks like? According to Gillian Ombogo, a legal practitioner at Ombogo and Company Advocates, the relationship between an insurance company (insurer) and the policy holder (insured) is in form of a legally binding contractual agreement, which is the insurance policy document. Before signing, you ought to read and understand the fine print of the document and seek clarification from the insurer on any terms, conditions, restrictions or limitations that may seem unclear. “This may sound simple, but is a very important step that could prevent anguish and loss, in the unfortunate event of an accident. Having said this, the best way to detect unprofessionalism from either party to the contract is when they fail to act in utmost good faith and contrary to the terms of the policy document,” affirmed Ms. Ombogo.
Every case is different and there are many factors that can impact the amount of money you receive. However, there are some general guidelines that can help you determine if an offer is too low. Firstly, consider the extent of your injuries, lost wages, and other damages. If your needs aren’t met by the settlement offered, you may need to seek a better offer. It’s important not to rush into accepting a settlement offer without first reviewing all the details and ensuring it covers all your losses. Insurance companies may try to pressure you into accepting an offer quickly before you have had time to fully assess your damages and expenses. Insurance companies are businesses, which means they’re always looking for ways to save money. One way they do this is by offering low settlements in hopes that policyholders will accept them without question.
Seek out a car accident attorney for your case
In conclusion, being involved in a car accident can be a traumatic experience that can leave you feeling vulnerable and helpless. It is important to understand your rights as a policyholder and to know how to determine if the insurance company is treating you fairly after an accident. Even with precautions taken, there may still be instances where an insurance settlement offer is too low or unfair. This is where hiring an experienced car accident attorney becomes crucial. In this case, you will have the options to seek out compensation even if the insurance company is unwilling to settle with you fairly.
