Sun | Dec 4, 2016

A case of justice delayed and denied?

Published:Sunday | January 4, 2015 | 12:00 AM

Cedric Stephens, Insurance HELPLINE

Question: I was involved in an accident on February 15, 2013. It occurred at about 12:10 p.m. along Maxfield Avenue. A blue Honda motor car hit the back of my 1999 Honda Civic. The other driver and my passenger got into a row. I intervened and said that we should go to the police station. The third party drove away, but I got the registration number of his vehicle before he left the scene. I went to the station and made a report. I also filed a report with my insurer. I submitted assessors and police reports plus a repair estimate for about $60,000.

After pressing the insurance company for months, they finally sent an investigator in November. I kept asking what was happening and why I was not hearing anything. They gave me many different stories. In August 2014, they wrote saying that the other vehicle was not involved in any accident. I found out that both vehicles are insured by the same company. Also, that the driver was not the registered owner. The owner is arguing that the vehicle was not in a collision. Can I do anything to get redress?

Answer: Your accident is a fender-bender: a minor collision. That, plus the fact that the two vehicles are insured with the same company a point your insurer has not denied suggest that this matter should have been resolved within weeks. Now, nearly two years later, the company is repeating the same storyline to me that they gave you four months ago.

Your insurers claims manager to give her the benefit of the doubt has either been too busy to conduct a proper review of the files or knows something that she is keeping very close to her chest.

I asked her: Can you please investigate and advise me why this seemingly uncomplicated accident is taking such a long time to resolve, especially given the provisions of the claims condition(s) of your policy? She replied: The alleged accident was investigated and the investigator was not able to confirm that the incident occurred. Our insured and the driver is (sic) adamant that the vehicle was never involved in any accident ... (with) any other person on the date and time in question. In light of this, we are not in a position to accept any liability ... These statements do not answer the question that I asked.

Are you not a customer, too? Or, because you had the nerve to report an incident that the investigator was not able to confirm? Whatever those five words mean is that cause for treating you as a liar? Isnt justice always blind? Oddly, the guy who drove off and failed to file a report with the police, as is required by law, and the owner are being treated as saints.

The actions of insurers can best be explained in the context of contracts of insurance. What senior officials do is also very important. These persons often influence, write, interpret and execute contracts. The actions of your insurer in relation to this dispute can be interpreted mainly within the framework of the claims condition in your policy and the third partys. That condition would read something like: You, or any other person who claims under this policy, must not negotiate, admit fault, or make any payment, offer or promise of payment, unless you have our written permission. In dealing with any claim under the terms of this policy, we may: (a) carry out the defence or settlement of any claim ... (c) take any legal action in your name or in the name of any other person ... we can do any of these in your name, or in the name of any other person covered by this policy. The meaning is clear. Your insurers have the total and exclusive right how the claim is handled. The decision to settle, compromise or refuse payment lies squarely with them and nobody else.

Your insurers actions, as communicated by the claims official, have caused me to question their motive for not paying the claim. Has all of the evidence being properly evaluated and weighed and the question asked (and answered): on the balance of probabilities, which version of the incident yours or the third partys? Is more likely and why? On the other hand, if the two sets of evidence were carefully considered, why wasnt the full detail of the investigators report shared with you (or me)? Why the secrecy? What were the reasons for your statement about the event and the independent evidence that you furnished from the police, repairer and the loss adjuster being completely ignored?

Is the claims official aware that her failure to disclose all of the supposedly independent investigators report with you (and me), when coupled with the long delay in dealing with the claim, will lead you (and me) to question the validity of the decision not to compensate you? Does the company have a written policy for dealing with single-insurer collisions that are designed to ensure that customers are treated fairly and their interests take priority over those of the company? Can the companys decision withstand the scrutiny of an independent body or, is it arbitrary and self-serving?

I do not have answers to the preceding questions. I am, therefore, unable to advise what action you should take to get compensation. On a hunch, I decided to speak with my editor and the claims official of your insurer. The official admitted that she withheld information from the investigators report from you and me. Why? Your guess is good as mine. She has undertaken to invite you and the third parties to meet at her office this month and then reconsider her decision about liability. I hope that things will turn out more favourably for you during 2015.

Cedric E. Stephens provides independent information and advice about the management of risks and insurance. aegis@flowja.com