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My Claim was wrongfully denied!

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chelsey86

Junior Member
On September 1, 2004, my husband was in a car wreck. The police report says that the other driver received a citation for failing to yield the right-of-way, but his insurance company has denied our claim because (this is directly off my insurance website) "Claimant carrier states claimant had green arrow" - THE DRIVER THAT GOT THE TICKET CLAIMED TO HAVE A GREEN ARROW AND SO WE HAVE BEEN GIVEN NOTHING! We weren't offered a rental car or any type of compensation. I'm thinking of going to small claims court, but I'm not sure who to sue. This is in TX by the way, so any advice, please email me at [email protected]. I have all supporting documents (police report, pictures of the vehicle in original condition, etc.). I appreciate any and all advice as this was our first vehicle and first wreck... I really have no clue what I'm doing....
 


nanaII

Member
If the other driver was cited..

If the other driver was cited, he was at fault. I would turn this claim over to your insurance company. Let them "duke" it out with the insurance company of the person who hit your husband. I assume you had insurance?
 

chelsey86

Junior Member
Insurance could care less...

We only had liability insurance, as well as uninsured/underinsured motorist protection. The other driver was an area manager for SBC, so it's being handled by SBC themselves. We went to our insurance company and they basically told us that they cannot pay us (because we didn't have collision insurance on the car) and it was up to SBC to compensate us for the loss. When we contacted SBC, the claims manager we spoke with told us that she will pay us nothing unless we have the name, address, and phone number of a witness. I told my insurance company about this, and they told me they can still do nothing, take them to court. This all seems completely ridiculous, especially because the police report totally supports our case. We are on our own, and I would like an out-of-court settlement, but apparently small claims is my only choice. My biggest problem is that I don't know WHO to sue (the driver of the car, the claims manager, the company) or if I can sue for a wrongful judgement, etc. We can't afford a lawyer and Legal Aide won't take auto accident cases. :(
 

nanaII

Member
A reason to carry full coverage

If I am not mistaken (others on here, please correct me if I am wrong) you would sue the person who hit you. They are the person at fault.

I am offering a word of advice for everyone on here... You NEED to carry full coverage. I have a junky, old, rust-infested, 18-year-old car. I pay $60 a month for full coverage. My insurance is outrageous, but you see time and time again on this forum the consequences for not carrying it. I have been in some of your shoes, so I know what I am talking about. It can cost you a LOT more to not carry the coverage because you think you will never need it, than it is to buy it in case you DO need it.
 

chelsey86

Junior Member
never trust insurance co....

I learned that the hard way! When we first went to have our car insured, our agent advised us that full coverage would be "a waste" on a car with as little value as ours. Next vehicle will have full coverage (and an agent with better advice).

So in the process of taking the other driver to small claims court: I must send him a letter giving him notice that if a settlement isn't reached within a certain amount of time legal action would be pursued, right? Do I have to give him a certain amount of time to respond? Also, I know I can sue the other driver for our loss, lost wages, and pain & suffering, but if I took the company to court could I sue for wrongful judgement? Afterall, they denied my claim even though the police report clearly shows it was his fault.

Thank you for your help.
 

Lynx 36

Member
Quote: "If the other driver was cited, he was at fault."

Not necessarily.
1. Was he found guilty in court?
2. Did the police officer actually witness the accident?
Tickets from accident scenes are easy to beat in court unless the police officer actually saw a violation being committed. This is why some states don't even issue tickets f/ moving violations on accidents, mine included. If it's a DUI, DUS, no insurance etc. they can, as this can be proven when they arrive on scene. But how is a cop to know who ran the stop sign or red light if they didn't see it? The police are told they have to issue a citation to someone, so they just pick somebody if it is your word vs the other, and there are no witnesses.

When insurance adjustors make a liability decision they use the police report f/ driver info. mostly. If the police officer didn't see the accident the police report is not even admissable in court and adjustors put very little weight in it other than that.

Cops arrive at the scene and take statements from drivers, witnesses etc. put it on paper and are done. Claims adjustors do a more in depth investigation of the accident. I've proven police reports to be wrong many times. Even proved diagrams completely wrong based on the physical damage of the vehicles, and statements I got.

I'm not saying who is right or wrong here, but if it is your word vs his word and there are no witnesses, that could be why you are being denied. Now sometimes, if this is all I have to go on, then I can sometimes look at the damage to the cars, do a scene investigation, to determine liability. If I can still come to no conclusion, then I take my insureds word f/ it. This is standard procedure f/ insurance companies. The other insurance company will also do the same.

You can certainly try small claims court. It doesn't cost very much to file a case and it seems to be the only option at this point.

Did your insurance company deny their claim f/ property damage?

Good luck to you. :)
 

chelsey86

Junior Member
an unnamed witness...

Yes, our insurance company denied the other driver's claim. Also, the police report has a line that says "witness states Grandview had green arrow" in the description - that is how he determined fault. Unfortunately, we didn't get a witness name and address (I was not at the scene and my husband, stupidly, did not get the information) although I do have the officer name on the report. Would it be possible to have him as a witness since he spoke to an eye-witness directly? It is also very obvious by vehicle damage and position that the other driver was at fault. He was attempting to execute a left hand turn south onto the street my husband was traveling north on (my husband was going about 40mph when he struck the other vehicle).
 

nanaII

Member
Online information

You don't indicate what state you live in. Some states (like mine) have an online court system where you may be able to see whether or not the person plead guilty of the ticket he was issued. If he plead guilty, that is a lot of ammunition for your benefit on this claim.
 

chelsey86

Junior Member
Texas

Sorry it wasn't in the beginning of my post, but I am in Texas. Where would I look for something like that to see if he DID plead guilty?
 

Lynx 36

Member
Quote: "You don't indicate what state you live in. Some states (like mine) have an online court system where you may be able to see whether or not the person plead guilty of the ticket he was issued. If he plead guilty, that is a lot of ammunition for your benefit on this claim.'

Bingo!! That would seal it. If this were the case I don't see how the adjustor could ultimately deny the claim then. They would have to provide an atty f/ their insured in court and would lose anyway. So it would cost them more $$ than if they just settled.

Like nanall said check to see if he was found guilty or not. If they don't have info. on line then call the clerk of courts to see what the verdict was. You could also possibly go to his court date (if he hasn't gone yet) and testify. You were there and witnessed it, so I see no reason why your testimony couldn't be taken into consideration as well.

Quote: (from nanall) "I am offering a word of advice for everyone on here... You NEED to carry full coverage. I have a junky, old, rust-infested, 18-year-old car. I pay $60 a month for full coverage."

Good point nanall. After reading this post I'm going to reinstate the collision coverage on my 95 Honda. I dropped it when I bought my new truck recently. Even though I'm a claims adjustor and know how to navigate the system, I could easily be in this same situation, and also be helpless.
 

racer72

Senior Member
chelsey86 said:
I learned that the hard way! When we first went to have our car insured, our agent advised us that full coverage would be "a waste" on a car with as little value as ours. Next vehicle will have full coverage (and an agent with better advice).
What was the value of the car? And example to determine if full coverage is a waste would be to take the difference in monthly premiums from basic and full coverage, muliply that by 24 (average vehicle ownership is 2 years), add in the deductable that would apply to full coverage. If that figure is more than 50% of your vehicle value, full coverage is a waste of money. If the difference is $50 a month with a $500 deductable, that would mean a vehicle worth less than $3400 would be a waste to fully insure. This is based on the fact that the vehicle will probably be totalled even for minor damage. So do a little bit of math before you start throwing good money away on insuring an older car.
 

nanaII

Member
That may be true, but...

That may be true, BUT once you get in a wreck and don't have the money to replace your own vehicle (say it was your fault, you then have no coverage on your vehicle), it doesn't seem like too much to pay.. Right now I am unemployed. It is winter here (lots of snow and ice). If I were to go out and lose control of my vehicle and hit a telephone pole and I only have liability insurance, I am screwed! I can't afford to just go out and buy another vehicle. To me, the premium is worth it (believe me, I know exactly what you are saying, and yes, I am paying too much, but should the above happen, at least I can count on having my vehicle replace). Look at the people on this forum and tell them NOW that having full coverage for their new or old beater wouldn't have been worth the price..
 

LdiJ

Senior Member
nanaII said:
That may be true, BUT once you get in a wreck and don't have the money to replace your own vehicle (say it was your fault, you then have no coverage on your vehicle), it doesn't seem like too much to pay.. Right now I am unemployed. It is winter here (lots of snow and ice). If I were to go out and lose control of my vehicle and hit a telephone pole and I only have liability insurance, I am screwed! I can't afford to just go out and buy another vehicle. To me, the premium is worth it (believe me, I know exactly what you are saying, and yes, I am paying too much, but should the above happen, at least I can count on having my vehicle replace). Look at the people on this forum and tell them NOW that having full coverage for their new or old beater wouldn't have been worth the price..
Actually, you CAN'T count on your vehicle being replaced...that is the problem. What could very likely happen is that the insurance company would total your vehicle, and the amount you recieve may not be enough to purchase a new one...or at least not a reliable new one. It would be far better to put the additional amount you would be paying for full coverage, in a savings account each month. Check the blue book on your car...because that is the most that you would get back if the car was totalled.
 

JETX

Senior Member
nanaII said:
If the other driver was cited, he was at fault.
And of course, that is NOT correct. The fact that the officer cited the other driver, based solely on his opinion, does not establish LEGAL liability.... or even insurance liability.
The insurance company will review the facts and statements and determine liability..... which can be completely different than that of the officer.
 

JETX

Senior Member
chelsey86 said:
On September 1, 2004, my husband was in a car wreck. The police report says that the other driver received a citation for failing to yield the right-of-way, but his insurance company has denied our claim because (this is directly off my insurance website) "Claimant carrier states claimant had green arrow" - THE DRIVER THAT GOT THE TICKET CLAIMED TO HAVE A GREEN ARROW AND SO WE HAVE BEEN GIVEN NOTHING! We weren't offered a rental car or any type of compensation. I'm thinking of going to small claims court, but I'm not sure who to sue. This is in TX by the way, so any advice, please email me at [email protected]. I have all supporting documents (police report, pictures of the vehicle in original condition, etc.). I appreciate any and all advice as this was our first vehicle and first wreck... I really have no clue what I'm doing....
Somehow, this thread was diverted into a discussion of the merits of insurance coverage.... without any real answer to your question. So, lets get this back on subject.

Your options are very limited. They are:
1) To turn this issue over to your insurance company. However, based on your subsequent post, you don't have coverage, so this option is not available.
2) Litigate. This is your only real available option. You will have to file a lawsuit against the other driver. The drivers insurance will then provide an attorney to represent him. That means that you will be facing a licensed, experienced attorney in court, playing on HIS homecourt. If the damages were less than $5000, you can use the TX small claims courts. If higher, then you would need a higher court, usually the County Court-at-Law.

Also, the police report has a line that says "witness states Grandview had green arrow" in the description - that is how he determined fault. Unfortunately, we didn't get a witness name and address (I was not at the scene and my husband, stupidly, did not get the information) although I do have the officer name on the report.
Look at the FULL report. It is very likely that the officer wrote the witness information elsewhere (I have found them as 'scribbled' notes on the accident diagram!). If not found, contact the officer directly and ask him/her to review their notes and write a supplemental report with that information.

Would it be possible to have him as a witness since he spoke to an eye-witness directly?
No. Any statement he would make as to what someone else said or saw, would be hearsay.
 

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