QuestionYour earlier answer to me was REALLY HELPFUL!!! Thank you. Here's more, if you'll bear with me.
This is a one-car accident near a small town. Car took out part of a barrier, rolled down a hill and stopped against a tree. It's a Tesla (or a hybrid of some kind) Local police didn't do much investigating (how would/do adjusters contact/deal with police regarding an accident? The adjuster would interview the EMT and the police, too?) He does this to protect the wealthy family involved.
How quickly would the adjuster appear? Would the insurance company immediately call for a tow truck and haul it to a wrecking yard? I understand some police departments actually contract with wrecking companies.
The car smelled of alcohol. Would the adjuster request/be able to get lab results to determine if the driver was drunk? The cop thinks he's protecting the driver by not reporting suspected alcohol--driver is killed, passenger in a coma. Most policies would cover the car, correct, even if alcohol was involved, though the driver (if drunk) would be dropped as a policy holder afterward?
The heroine of my book believes (later on) that someone sabotaged the car (it's related to a part of the battery/drive control)
The police took few photos, didn't notice swerve marks far from the accident site. How much "accident physics" do adjusters study/employ in analyzing the cause of the wreck. Would this only be done once suspicions are aroused and the adjuster turns the case over to an investigator?
Would the adjuster provide information to the daughter/sister of the victims to help her investigate further or would that be proprietary? If the adjuster thought she was second-guessing his work, could he resist?
Would it be reasonable to take as long as a week for the adjuster to arrive to investigate. I want the initial judgment to be "lost control of car on a curve and crashed--no malfunction, possibly due to drunkenness." The swerve was way, way back from the crash site, leading the heroine to believe something was wrong with the car.
The adjuster doesn't notice a paint scrape on a fender--possible?--that later the heroine realizes came from her mother's car--she accidentally "nudged" the car that crashed, then the tampered-with device kicked in, causing the crash.
Would the original adjuster examine the engine? Interior of the car? I'm guessing that won't happen until my heroine convinces the adjuster that something is amiss, right? And an investigator takes over.
How readily would the adjuster be willing to do more examination? The idea is not to pay the claim if (what?) turns out to be the case? Would the adjuster notify police of a possible crime?
Hope you're interested in this kind of spit-balling! Thanks in advance. I was seriously stalled until you jumped in.
AnswerGlad to help! Please let me know if you are published as I'd love to see the book.
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Local police didn't do much investigating (how would/do adjusters contact/deal with police regarding an accident? The adjuster would interview the EMT and the police, too?) He does this to protect the wealthy family involved. THIS WOULD DEPEND ON THE SCENARIO. IF THERE WAS A FATALITY OR SERIOUS INJURY, THE CLAIM RE WOULD INTERVIEW POLICE, FIRE, EMT, ETC. IF THERE WERE "SUSPICIOUS LOSS INDICATORS" (SLI's) THE CLAIM WOULD BE REFERRED TO AN SIU (SPECIAL INVESTIGATIVE UNIT) INVESTIGATOR WHO WOULD DO THE SAME. BUT IF THIS APPEARED TO BE A RUN OF THE MILL SINGLE CAR LOSS, THEN THERE WOULD BE VERY LITTLE INVESTIGATION. THE CLAIM REP WOULD JUST TAKE THE STORY OF THE DRIVER/INSURED AND LIKELY MOVE ON TO THE NEXT CLAIM.
How quickly would the adjuster appear? THE INITIAL INTERVIEW WOULD BE OVER THE PHONE AND PROBABLY WITHIN A FEW HOURS OF THE LOSS REPORT. THE ADJUSTER WOULD LIKELY INSPECT THE VEHICLE AND/OR SCENE WITHIN 1-2 DAYS. IF THERE WERE SERIOUS INJURIES OR SLI'S THIS MIGHT HAPPEN SOONER. Would the insurance company immediately call for a tow truck and haul it to a wrecking yard? YES. I understand some police departments actually contract with wrecking companies. CORRECT - THE POLICE WOULD PROBABLY TOW IT TO A LOCAL STORAGE LOT, AND THEN THE INSURER WOULD PROBABLY MOVE IT TO A SALVAGE YARD THAT DOES NOT CHARGE THEM STORAGE FEES. MOST INSURERS HAVE SUCH ARRANGEMENTS WITH SALVAGE YARDS THAT HELP THEM EVENTUALLY SELL THE SALVAGE.
The car smelled of alcohol. Would the adjuster request/be able to get lab results to determine if the driver was drunk? ONLY IF THE POLICE ORDERED TEST RESULTS (IF OFFICER SUSPECTS DWI) OR THE DOCTOR AT THE HOSPITAL ORDERED THEM (TO AVOID DRUG INTERACTIONS). ER DOCS USUALLY DO THIS TO BE SAFE. THE CLAIM REP WOULD THEN BE ABLE TO GET COPIES OF THE MEDICAL RECORDS/TEST RESULTS IF THE INJURED PARTY SIGNS A MEDICAL AUTHORIZATION. THE INSURED WOULD NEED TO SIGN, BECAUSE FAILURE TO DO SO WOULD BE CONSIDERED "FAILURE TO COOPERATE WITH INVESTIGATION" WHICH IS GROUNDS FOR DENIAL OF ANY/ALL CLAIMS.
The cop thinks he's protecting the driver by not reporting suspected alcohol--driver is killed, passenger in a coma. Most policies would cover the car, correct, even if alcohol was involved, though the driver (if drunk) would be dropped as a policy holder afterward? CORRECT. THE CAR DAMAGE WOULD BE COVERED UNDER COLLISION COVERAGE AND ALCOHOL USE WOULD NOT IMPACT THIS COVERAGE. BUT CANCELLATION AFTER THE FACT WOULD BE LIKELY. WE SHOULD DISCUSS WHICH OTHER COVERAGES WOULD APPLY:
*MEDPAY (MPC): SIMILAR TO HEALTH INSURANCE, COVERS MEDICAL BILLS AND LOST WAGES FOR PARTIES INSIDE THE COVERED CAR.
*COLLISION: DAMAGE TO THE COVERED CAR. IF A TOTAL LOSS, PAYS ACTUAL CASH VALUE PRIOR TO LOSS.
*BODILY INJURY (BI): THIS IS A LIABILITY COVERAGE THAT PROTECTS THE DRIVER FROM LAWSUITS IF THEY WERE NEGLIGENT. THIS MIGHT APPLY FOR THE INJURED PASSENGER WHO COULD SUE THE DRIVER.
*UNINSURED MOTORIST (UM): IF THE ACCIDENT WAS CAUSED BY AN UNINSURED MOTORIST OR A "PHANTOM" HIT AND RUN DRIVER WHO FLED THE SCENE, THEN THIS WOULD PROVIDE BODILY INJURY COVERAGE FOR BOTH OCCUPANTS OF THE COVERED CAR. THE INSURER WOULD ESSENTIALLY ACT AS THE INSURER OF THE OTHER DRIVER.
*CALCULATING THE VALUE OF A BI OR UMBI CLAIM: THE INSURER TRIES TO ESTIMATE WHAT A JURY WOULD AWARD IF THE CASE WENT TO TRIAL. THEY THEN NEGOTIATE A SETTLEMENT WITH THE INJURED PARTY OR THEIR ATTORNEY. IN SERIOUS INJURY CLAIMS, THERE IS USUALLY AN ATTORNEY BECAUSE IT CAN BECOME COMPLEX. THE VALUE WILL INCLUDE SPECIAL DAMAGES (MEDICAL BILLS, LOST WAGES, FUTURE MEDICAL BILLS, ETC) PLUS GENERAL DAMAGES (PAIN, SUFFERING, INCONVENIENCE, SORROW, GRIEF, ETC). IF THERE WAS A FATALITY, THE CLAIM INCLUDES LOSS OF FUTURE EARNINGS AND GENERAL DAMAGES FOR THE FAMILY.
The heroine of my book believes (later on) that someone sabotaged the car (it's related to a part of the battery/drive control) UNINSURED MOTORIST BODILY INJURY (UMBI) MIGHT APPLY IN THIS CASE. THE INSURER WOULD BE INTERESTED BECAUSE THEY COULD SEEK RECOVERY FOR AMOUNTS THEY PAY FROM THE GUILTY PARTY. THIS IS KNOWN AS SUBROGATION.
The police took few photos, didn't notice swerve marks far from the accident site. How much "accident physics" do adjusters study/employ in analyzing the cause of the wreck. Would this only be done once suspicions are aroused and the adjuster turns the case over to an investigator? IN A CASE LIKE THIS, A LARGE POLICE DEPT WOULD NORMALLY HAVE AN ACCIDENT RECONSTRUCTIONIST ON STAFF TO INVESTIGATE THIS TYPE OF THING. A SMALL DEPT WOULD NOT HAVE SUCH STAFF UNLESS THEY CALLED IN STATE POLICE TO HELP. BUT THE OFFICER IN A SMALL DEPT COULD PROBABLY SKIP THIS STEP IF HE WANTED TO COVER IT UP. IF SUSPICIOUS, THE CLAIM REP OR SIU REP WOULD HIRE AN INDEPENDENT RECONSTRUCTIONIST TO DO THIS. WE HAVE MANY VENDORS WE USE REGULARLY FOR HIGH DOLLAR CASES. WE DO NOT DO THIS UNLESS THE EXPOSURE IS LARGE THOUGH. THIS CASE WOULD PROBABLY APPLY, ESPECIALLY IF SLI'S EXIST. WE DO NOT HAVE THEM ON STAFF BECAUSE WE WANT AN INDEPENDENT EXPERT TO TESTIFY IN COURT. AN EMPLOYEE WOULD NOT BE INDEPENDENT. THESE INDIVIDUALS ARE HIGHLY TRAINED AND OFTEN HAVE ENGINEERING DEGREES. THEY CAN TELL A LOT FROM AN ACCIDENT SCENE - YOU'D BE AMAZED. THE ONES WE HIRE ARE USUALLY BETTER TRAINED THEN THE POLICE INVESTIGATORS, WHO ARE NORMALLY FORMER OFFICERS TRAINED IN A SPECIALTY, BUT WHO DO NOT HAVE ENGINEERING BACKGROUNDS.
Would the adjuster provide information to the daughter/sister of the victims to help her investigate further or would that be proprietary? If the adjuster thought she was second-guessing his work, could he resist? ANYTHING THE CLAIM REP GATHERS IS CONSIDERED WORK PRODUCT AND NEED NOT BE RELEASED ABSENT A SUBPOENA FROM LAW ENFORCEMENT OR ISSUED BY THE COURT AS A RESULT OF A LAWSUIT. HOWEVER, THE INSURER HAS THE OPTION TO RELEASE IT IF THEY WANT TO OR THINK IT WOULD DO NO HARM. THE SISTER COULD GET IT BY FILING A LAWSUIT AND THEN A SUBPOENA.
Would it be reasonable to take as long as a week for the adjuster to arrive to investigate. I want the initial judgment to be "lost control of car on a curve and crashed--no malfunction, possibly due to drunkenness." The swerve was way, way back from the crash site, leading the heroine to believe something was wrong with the car. THIS COULD HAPPEN IF THE CLAIM REP THOUGHT THIS WAS A RUN OF THE MILL ACCIDENT AND INVESTIGATION WAS NOT NEEDED. ALSO, LIKE ANY PROFESSION, SOME CLAIM REPS ARE VERY PROMPT AND TROUGH, WHILE OTHERS ARE SLOWER AND LESS EFFECTIVE. IF THE CLAIM REP'S WORKLOAD WAS UNUSUALLY HIGH, HE/SHE MIGHT CUT SOME CORNERS OR BE SLOW TO REACT. SO YOU COULD SET IT UP THAT THE CLAIM REP INITIALLY THOUGHT THERE WAS NOTHING UNUSUAL, THEN LATER REALIZED THERE WAS MORE TO THE STORY.
The adjuster doesn't notice a paint scrape on a fender--possible?--that later the heroine realizes came from her mother's car--she accidentally "nudged" the car that crashed, then the tampered-with device kicked in, causing the crash. POSSIBLE IF THE CLAIM REP AND POLICE WERE NOT LOOKING VERY HARD. ESPECIALLY IF THE VEHICLE HAD LOTS OF OTHER DAMAGE.
Would the original adjuster examine the engine? Interior of the car? I'm guessing that won't happen until my heroine convinces the adjuster that something is amiss, right? And an investigator takes over. IN ORDER TO SETTLE THE CLAIM, THE CLAIM REP WOULD NEED TO INSPECT THE VEHICLE AND DAMAGE. HE WOULD LOOK AT THE ENGINE AND INTERIOR TO GET A CONDITION RATING, BUT MIGHT NOT CLOSELY EXAMINE OR CATCH SMALL THINGS.
How readily would the adjuster be willing to do more examination? The idea is not to pay the claim if (what?) turns out to be the case? Would the adjuster notify police of a possible crime? THE CLAIM WOULD BE DENIED IF THE POLICYHOLDER, VEHICLE OWNER, DRIVER, OR PASSENGER COMMITTED AN "INTENTIONAL ACT," MEANING FRAUD. IF SOMEONE NOT INSURED UNDER THE POLICY CAUSED THE ACCIDENT INTENTIONALLY, THIS WOULD NOT BE INSURANCE FRAUD SO THE POLICY WOULD PAY. HOWEVER, THE INSURER WOULD HAVE INCENTIVE TO UNCOVER THIS SO THEY COULD SUBROGATE AGAINST THIS PERSON.
