Consumers Guide To Automobile Claims Settlement

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Most policies are subject to an excess clause. An excess is the first amount of a claim for which you will have to pay. Your insurance pays for the amount beyond the excess. Some insurers will overlook application of the excess if repairs are undertaken at their panel of repairers. A standard motor insurance will not cover certain losses, such as your own death or bodily injury due to a motor accident, your liability against claims from passengers in your vehicle except for passengers of hired vehicles such as taxis and buses and loss or damage arising from an act of nature, such as flood, storm and landslide.

However, you may pay additional premiums to extend your policy to cover flood, landslide and landslip as well as cover your passengers. It is important to check your policy for the exclusions.


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The Motor policy allows for policyholders to extend cover to include extra benefits and additional cover apart from the standard coverage. Do communicate with your insurers to request for these additional covers. The basic premise of a motor insurance policy is to put the owner in the same condition as he would have been in before an accident occurs. Betterment will apply, when in the course of repairing an accident-damaged vehicle, a new part is used to replace an old part. Betterment is a portion of the cost that consumers will have to bear when the damaged part of the vehicle is replaced with a brand new original part.

As the car will be in a better condition prior to the accident the insurance company will require the car owner to bear the difference in costs. This will be based on a scale of betterment adopted by the insurance industry as shown below:. The premium payable may be reduced if you have no-claim-discount NCD entitlement. Different NCD rates are applicable for different classes of vehicles. When you are involved in an accident, you may either make an own damage claim or a third party claim if your Policy is under Comprehensive cover This refers to making a claim on your own insurance policy, i.

However, you will lose your NCD entitlement. In notifying your insurance company of the accident, enquire about the names of approved workshops to send your vehicle for repair. Submit the fully completed Motor Accident Report Form together with all supporting documents as soon as possible to your insurance company.

NJDOBI - Division of Insurance

The workshop will commence repairs on your vehicle upon the approval of your insurance company. Upon completion of repairs, you will be informed by the workshop to collect your vehicle. There are times when your third party is clearly at fault and has been charged by the police for being the cause of your accident. You may make a third party claim if you are not the party at fault in the accident and you can retain your NCD entitlement. There are two ways of making a third party claim, i. You are encouraged to submit your claim to your own insurance company for speedier claims processing.

As the third party claimant, you are required to mitigate your loss i.

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Appoint a licensed adjuster to assess the loss. The workshop or the third party insurance company may advise you on this. Insurance companies, at their own discretion, may allow an additional seven working days for any unforeseen or unavoidable delay. RM15 Alternatively, you may also claim the cost of hiring a replacement vehicle of equivalent type and capacity for the recommended number of days of actual repair time as evidenced by a receipt from a licensed car rental company.

After submission of the claim form, you must cooperate fully with your insurance company or its representative during the course of investigation of the theft claim. In view that the police and your insurance company will require time to investigate your claim, you should receive the offer of settlement from your insurance company normally within six months from your theft notification or upon completion of the police investigations into your theft, whichever is earlier.


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  • The claims process will be easier to understand if you know the details of your coverage and your responsibilities. Once your claim is reported, you will be contacted by the claims adjuster assigned to your file.

    What's In The Booklet

    In some cases the adjuster will want to meet with you in person; in other cases the entire claim will be handled over the telephone. To support your claim, you may also be required to complete a claim form, also known as a Proof of Loss form a sworn statement in support of your claim. Your claims adjuster will determine the extent to which the claim is covered by your insurance policy, explain the coverages provided by your policy, and help guide you through the entire claims process.

    Insurance companies must determine the degree of fault to be assigned to each driver for purposes of determining which property damage coverages apply to the accident, and to ensure that the premiums of the driver who was more than 25 per cent at-fault are adjusted appropriately. The Fault Determination Rules are regulations put in place to help insurance companies provide consumers with prompt claims handling and consistent treatment.

    After you report an accident to your insurer, the company will investigate the circumstances of the accident and then make a fault decision based on the Fault Determination Rules. Fault is allocated to each driver based on which accident scenario most closely resembles the accident. If the accident is not described by any of the scenarios, then fault is allocated according to the ordinary rules of negligence law. If you are charged with an offence, you will not necessarily be found at fault for insurance purposes.

    For example, if a vehicle was unable to stop on an icy road and rear-ended another, a police officer may say that neither of the drivers was at-fault. Such a comment relates to the laying of charges and should not be taken as an opinion about how the Fault Determination Rules apply to an auto insurance claim. In a case like this, the insurer would apply the rule stating that a vehicle which rear-ends another is at-fault. On the other hand, with certain types of charges, the Fault Determination Rules will not apply, and fault will instead be determined according to the ordinary rules of negligence law.

    The circumstances of an accident may show that more than one driver was partially at fault for insurance purposes. A driver can be anywhere between per cent and zero per cent at fault. Any driver who is more than zero per cent at fault will have an at-fault accident on his or her insurance record. If you are found more than 25 per cent at-fault for the accident, it is more than likely that your premium will go up on renewal. To confirm how your rates will be affected, check with your insurance agent, broker, or company representative.

    Note: When you lend your vehicle to someone, you are also lending him or her your insurance.

    Motor Insurance

    If the individual you lent your vehicle to has an accident and is found to be more than 25 per cent at-fault while using your vehicle, the accident will go on your insurance record, and your auto insurance premium will go up. Ask him or her what rule in the Fault Determination Rules has been applied in your case. Bring any new information to the attention of your insurance company. Generally, an insurance company will revise or reconsider its decision on fault only if additional, relevant information is provided. For example, if an accident occurred in which each driver stated that the other driver had gone through a red light, an insurance company would have little choice but to assign fifty-fifty fault.

    However, if an eyewitness confirmed which driver went through the red light, an insurance company could review its decision. If your insurance company refuses to revise its decision and you still disagree, contact your company's complaint officer. Refer to the section in this brochure entitled "If You Have a Complaint" for more information on how to file a complaint with your insurance company. The amount you receive for your damage claim will depend on the extent to which you are at fault for the damage, as well as the type of coverages you purchased.

    Can't Find What You're Looking For?

    Speak to your claims adjuster regarding your specific situation. He or she will be able to outline the precise coverages that are available to you, as well as any deductibles that may apply. Under a DC-PD claim, you can to the extent you're not at fault recover for damage to the vehicle and the cost of a temporary rental vehicle Transportation Replacement Coverage. You can also recover costs for damaged personal contents that are carried in the vehicle, less the deductible you arranged with your insurance company.

    For example, if you were 75 per cent at-fault for the accident — and therefore 25 per cent not at fault — your company will pay 25 per cent of your loss, less any deductible. If your accident is with a vehicle from outside Ontario, DC-PD Coverage does not apply unless the insurer of the out-of-province vehicle has signed an agreement with Ontario to settle claims under the DC-PD rules. If an agreement does not exist, you will have to sue the out-of-province vehicle owner and the driver to recover your loss.

    Your insurance company will know if the out-of-province insurance company has signed an agreement. If the other vehicle involved in the accident does not have insurance, you may claim under the mandatory Uninsured Motorist Coverage of your policy. Specified Perils Coverage : If you purchased Specified Perils Coverage, your insurance company will pay for damage to your vehicle caused by one of the following perils: fire; theft or attempted theft; lightning; windstorm, hail, or rising water; earthquake; explosion; riot or civil disturbance; falling or forced landing of an aircraft or parts of an aircraft; or the stranding, sinking, burning, derailment, or collision of any kind of transport in, or on which, an insured vehicle is being carried on land or water, regardless of fault, less the deductible you chose at the time you purchased the coverage.

    How to Negotiate an Insurance Claim Settlement (2018)

    Comprehensive Coverage : If you purchased Comprehensive Coverage, your insurance company will pay for the repair or replacement of your vehicle due to a non-collision loss, including those perils listed under Specified Perils, falling or flying objects, missiles, and vandalism, regardless of fault, less the deductible you chose at the time you purchased the coverage. Collision or Upset Coverage : If you purchased Collision or Upset Coverage, your insurance company will pay to fix or replace your vehicle if it is damaged in an accident, regardless of fault, less the deductible you chose at the time you purchased the coverage.

    For example, if your vehicle is hit while parked and the responsible driver does not remain at the accident scene and cannot be identified, you will be reimbursed for your vehicle repair costs only if your policy includes Collision or Upset Coverage. Collision or Upset Coverage also pays to fix or replace your vehicle if a driver who was not insured, or cannot be identified, damaged your vehicle. All Perils Coverage : If you purchased All Perils Coverage, your insurance company will pay for all losses noted above under Collision or Upset and Comprehensive Coverages, regardless of fault, less the deductible you chose at the time you purchased the coverage.

    If you had personal items that were stolen or damaged while in your vehicle, your policy may not pay for them, or may pay only a limited amount. This includes any clothing, luggage, and sporting equipment, as well as any electronic accessories and equipment, other than factory-installed equipment. However, if you have a homeowners, condominium, or renters insurance policy, your personal property may be covered under that policy.

    Call your broker, agent, or insurance company representative for more information.


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    • It depends. It's best to ask your claims adjuster if you're covered before renting a replacement vehicle. If the other driver's insurance company accepts complete fault for the accident, you will be entitled to a replacement vehicle for a reasonable length of time while your vehicle is being repaired. However, if you are found to be partially or completely at-fault for the accident, and did not purchase optional Loss of Use Transportation Replacement Coverage, the cost of a rental vehicle may not be fully covered.