QuestionQUESTION: About a year and a half ago I made a claim for my injuries as I was rear ended before a red light by another party. The insurance company paid for my car and rental as my car was a write off. After 5 months from the accident i gave an examination under oath and decided to close the case and did not pursue my injuries claim. About a year and a half from the accident I got a call from the insurance company telling me that the driver of the other car has gave a notice of claim against me for their injuries. They requested me to give them a date for a recorded statement as they are doing a background investigation on who the at fault is, even though i had already given them a statement. I later came to realize that the person asking for a statement is in the SIU, which was shocking since they only deal with fraud cases. Now im wondering if the SIU is lying about the claim against me only to get more information out of me and to why they still have not distinguished on who the at fault is. I am wondering If i should give them a statement at all and what the consequences would be from not giving it.
ANSWER: Hello Peter,
Let's take this one step at a time. First,liability. You were rear ended, and apparently that was established. In virtually all cases liability, or responsibility, for a rear end accident goes to the person who did the rear-ending. Now there can be some twists to this. For example, the person who rear-ended you might claim that you stopped suddenly (too bad for them,) or they may go so far as to accuse you of stopping precisely because you wanted them to hit you. Weird? It happens! That's one example of a staged accident.
But the point is, at least from the initial investigation you were deemed not at fault for the accident. You haven't specified which insurance company paid you. If the liability (or at fault) carrier paid you, they accepted liability admitting that their driver was at fault. If you filed with your own carrier, fault would not be an issue if you have collision coverage. But the point is, at the time there were no apparent red flags with your accident.
Second ... a year and a half later the other party is going after you for injuries? OK. I'm going to assume they have an attorney who is demanding a settlement.
So why would SIU logically become involved? It could well be that they suspect some type of ill deeds on the part of the other driver. Your insurance company has a contractual obligation to protect you. If they suspect that someone is going after your policy in perhaps a fraudulent manner, they are required to protect you. On the other hand, they are also required to protect you from getting sued personally. What that means, is that even if they disagree with a settlement, they might decide to pay it regardless. That is also protecting you.
I think it's a stretch that they suspect you behaved fraudulently. What would be your motive? You never claimed for injuries. Even if the other party is alleging that, your insurance company would have to prove it. How could they possibly do that? If they go down that road, their behavior is highly highly suspect in my opinion, unless they have strong supporting evidence ... the other driver not likely being strong supporting evidence.
You need to cooperate. Your policy requires it. What are the consequences for not cooperating after the fact? Ordinarily they can deny your claim for non cooperation. But you don't appear to have a claim! And again, I'm unsure who actually paid for your damages in the beginning. What you do have here is a liability claim being presented from another party. They can't deny that claim because you refuse to cooperate!
As a general rule, I would suggest cooperation after the fact, especially if your insurance company is acting in your best interests. Here's what I suggest. Talk to the SIU investigator. I have had similar situations and I always made it a point to inform my insured that I was investigating on his or her behalf! If that is the case, they clearly need to tell you that!
If the SIU will not be up front with you, you might need a legal opinion.
Hope this helps. Good luck!
Jane Pytel
http://SolutionsForYourInsuranceClaim.com
http://FloridaAutoInsuranceCentral.com
---------- FOLLOW-UP ----------
QUESTION: thank you Jane Pytel for the reply,
Im not sure which side paid for my car but im pretty sure it was the liabilities insurance since I only had one way coverage to begin with. I believe both of our insurance companies are the same so thats why Im uncertain regarding which side it came from. I actually made an injury claims to begin with but I ended up closing it and therefore not getting paid.
When I spoke to the SIU investigator, he had mentioned that the driver of the other vehicle made a claim against me and that they are doing a background investigation on who the at fault is, yet he did not mention if he was investigating on my behalf. I also received a letter from the claims department stating that if any reasons in sections 118 and 233 are to become known, they will deny my coverage entirely, which is why im skeptical regarding the situation.
My lawyer told me that I was supposed to receive a letter of notice stating that the other party is suing me but the Investigator stated that the lawyer is wrong and thats not how the process works when someone makes a claim. Im also curious on what they want to ask me during the statement if they are trying to figure out who the at fault is. Again, this accident happend about a year and a half ago so I dont remember too much details so im not sure what I can do to help me case. Im also unsure of what the at fault is claiming against me since he rear ended me.
Thank you for your time!
Answer Hello Peter ...
OK. So this is getting more weird as time goes on.
First of all, a professional SIU investigator does not tell an insured that his lawyer "is wrong".
Second, it is NOT the proper job of SIU to investigate liability. SIU investigates "suspicious claims" that could be fraudulent, not liability. Liability is the responsibility of an adjuster. It is the responsibility of the adjuster to make liability decisions at the time anyone files a claim. Period. Liability should be a closed issue.
Assuming the SIU is being truthful, the other party is filing a claim against you, not a lawsuit. But that is not the issue. What apparently is the issue is sections 118 and 223 of your policy. Have you read your policy?? What does that mean? Are you being investigated for fraud?
And I'm also not certain how they can deny your coverage. Coverage for what? Your liability coverage to cover the other driver? If the other driver is at fault, what coverage is there? The answer is none.
If they are alleging fraud, they must be able to prove it. They are going to start, apparently with your recorded statement. You mention a lawyer. RETAIN HIS SERVICES. You are going to need his advice. Your recorded statement or EUO can be legitimately delayed until you retain his services.
Also, you can go on my website, http://SolutionsForYourInsuranceClaim.com and read my articles concerning insurance investigations, etc.
Jane Pytel
http://SolutionsForYourInsuranceClaim.com
http://FloridaAutoInsuranceCentral.com
