Auto Insurance Claims: How does the insurer determine to pay or deny the third party claim?, witness statements, percentage basis

Question
QUESTION: Hi, the insurer needs to determine who was at fault BEFORE paying compensation on behalf of its client, right? If so, how does the insurer determine whether it needs to pay for the other driver’s loss or deny the third party claim? Thank you for your answer.



ANSWER: Hi Ryan,
Making the decision of fault can be simple or extremely complicated and sometimes never 100% determined.
A simple decision is when both drivers are in agreement with how the accident happened.
Following that, the investigation goes to a police report, any and all witness statements, inspection and comparison of damage to both vehicles all the way to hiring an expert to reconsrtuct the accident.
Many times 100% fault can't be placed on any one party, then the insurance companies have to work together to agree on a degree of fault for each driver.
I hope this has been of help.
Your feedback by rating my answer will be appreciated.
Sincerely,
Bennie
San Francisco Bay Area

---------- FOLLOW-UP ----------

QUESTION: You said, “Making the decision of fault can be simple or extremely complicated and sometimes never 100% determined.” If the insurance decides to pay for someone loss, what does it mean, no one was at fault but settled only or the insurance has taken the responsibility of the accident, meaning their insured was at fault? Can you explain it? Thank you.

ANSWER: Hi Ryan,
When an insurance company decides to pay 100% of the bills presented to them, it means that their investigation has found their client to be 100% at fault and they are accepting 100% responsibility.
Many times an investigation determines there is a degree of fault against each party and the accident is setteled on a percentage basis, ranging from 50/50 to 95/05.
I hope this better answers your question.
Sincerely,
Bennie

---------- FOLLOW-UP ----------

QUESTION: I have a follow up question. Can you explain it? If the insurance determined the fault such as 95/05, will the insurance try to recover 5% from the other insurance or just deducts 5% from the loss and pays the third party claim 95%?

Answer
Hi Ryan,
If an insurance company reaches a decision that the fault was 95/05 against their client, they will pay the other party 95% of his damages and injury.  
Their own client has the legal right to recover 5% of his damage and injury from the adverse insurance company.
I hope this is helpful.
Sincerely,
Bennie