What You Should Know About...

1. The other driver does not carry enough insurance to pay for my damages in full. Can I submit my whole claim to my company for payment under underinsured motorist?

2. Do I need to get my insurer's ok before I settle with the insurance company for the other driver?

3. When do I notify my insurance company that I am filing an uninsured/underinsured motorist claim, and what do I have to provide them?

4. Can I file an uninsured motorist claim if the insurance company who insured the vehicle which caused the accident denies my claim because the vehicle had been stolen at the time of the accident?

5. My car was struck by a vehicle that was cut-off by a phantom (unknown) vehicle which fled the scene of the accident. Can I file an uninsured motorist claim?

6. My car and three other parked vehicles were struck by a vehicle which was only insured for property damage liability up to $10,000. If $10,000 is not going to be enough money to pay for the damages of all four vehicles, who gets paid?

7. The other driver was clearly at-fault for the accident but their insurance company is refusing to pay my claim because they say their policyholder won't cooperate with them. What can I do?

8. My car was struck while parked by another vehicle which ran off the road for no apparent reason. When I tried to collect from their insurance company I was told my claim was going to be denied because their policyholder had suffered a heart attack which caused the accident and he was, therefore, not at fault. Can I collect under my uninsured motorist coverage?

9. Where can I get more information about filing a first or third party claim?

10. What can I do if my insurance company and I can’t agree on the amount of my damages or if they deny my uninsured/underinsured motorist claim?

11. Must I conclude my claim within a certain time frame?

12. Other than filing a lawsuit, what else can I do if my insurance company refuses my demand for arbitration, or if they continually delay arbitration?

No. You must first submit the claim to the other driver's insurance company who will pay you for your damages up to the liability limit of their insured’s policy, once they have determined that their insured is at fault. If there are damages which still remain unpaid, you can then submit these to your company for reimbursement under Underinsured Motorist Coverage.

Example:

After being involved in an accident with another driver you learn from his insurance company that they only have $5,000 worth of coverage while your damages total $10,000. After the other insurance company offers to pay you their policy limit of $5,000, you then submit your remaining damages of $5,000 to your company for reimbursement under Underinsured Motorist. Your company investigates the claim and determines the underinsured driver is 80% at fault for the accident, while you were 20% at fault. Under these circumstances you would be entitled to be reimbursed a total of $8,000 for your $10,000 loss. As the other driver’s insurance company has already offered to pay their policyholders limit of $5,000, your company would than pay your Underinsured Motorist Claim in the amount of $2,500 after applying the $500 policy deductible.

Yes. Your insurance company has certain rights and most will require you to notify them and obtain their permission before settling with the other carrier.

While some insurance companies will only open a claim for Uninsured/Underinsured Motorist coverage once you receive written notification from the other insurance company that there is no coverage, or not enough coverage, to pay for your loss, it is in your best interest to contact your company immediately when there is any indication that the other driver may not have had adequate insurance to cover your loss. Your insurance company will be able to advise you on what specific information or documentation you need to supply them in order to substantiate your Uninsured/Underinsured Motorist claim.

Yes. If the individual who was driving the vehicle at the time of the accident did not have permission from the owner to use the vehicle, the insurance company does not have to provide insurance coverage for such a loss. Under these circumstances the vehicle is considered to be uninsured for this accident.

No. In order to file an Uninsured Motorist claim for property damage you must identify the vehicle and be able to demonstrate that the vehicle was either not insured under a policy of insurance or that there was no coverage provided under a policy of insurance at the time of the loss. Under these circumstances you may want to consider filing a first party claim if you have collision coverage or pursuing a third party claim against the driver of the vehicle which actually struck you to try to recover at least some of your damages based on that driver's degree of negligence.

In situations where the total amount of property damage from multiple claimants is going to exceed the liability limits of the responsible party, that party's insurance company will offer a pro-rated settlement amount to each of the claimants for their damages. If this amount does not pay for your damages in full, you can then submit the remaining damages to your own company for reimbursement under Underinsured Motorist if you have high enough limits.

If the insurance company does not intend to provide coverage for a loss based on their policyholder’s unwillingness to cooperate, which is a violation of the conditions of the policy, the vehicle and driver are considered to be uninsured for this accident. Under these circumstances you would be able to file an Uninsured Motorist claim with your own company once the other driver’s insurance company denies (disclaims) coverage in writing.

No. There is a difference between a denial of payment because of lack of coverage and a denial based upon lack of liability. While the individual is considered to be fully insured for the accident, his insurance company is denying your claim based on their belief that their policyholder was not liable, or at-fault, for the accident.

Under these circumstances you would either have to file a first party claim if you have collision coverage, or pursue a third party claim against the other driver and attempt to prove that he was, in fact, legally responsible for his actions.

• First party claims (your own insurer)
• Third party claims (another insurance company)

10. What can I do if my insurance company and I can’t agree on the amount of my damages or if they deny my uninsured/underinsured motorist claim?

If you and your insurance company can’t reach an agreement as to whether you are legally entitled to recover damages, or the amount of your damages, the terms of the policy require that such disputes be resolved through Arbitration. Either you or your insurance company can make a written demand for Arbitration as explained in your policy.

Here is how the process usually works:

• you choose and pay for an arbitrator to represent you
• the company will choose and pay for an arbitrator to represent them
• the two arbitrators will select a third arbitrator (for whom you and your company will split the cost)
• if the two arbitrators can’t agree on a third arbitrator within 30 days, either may request that selection be made by a judge of a court having jurisdiction
• a decision agreed to by two of the arbitrators will be binding unless the arbitration award exceeds the minimum limit for liability specified by the Financial Responsibility Law of New Jersey (Please see your policy for further details)
  
• arbitration should take place in the county in which you reside with local rules of law applying

Some policies allow for other processes as long as the company and the insured agree.

Yes. You must either accept a final settlement or file a lawsuit in the appropriate court of law within the time period specified by the statute of limitations.

If you fail to accept a final settlement offer or file suit before the statutory period runs out, you may jeopardize your right to receive any settlement at all.

You can file an appeal with the insurance company’s internal appeal panel. If you are still unsatisfied after the company’s internal appeal panel renders its decision, you can request a review of that decision by the Insurance Claims Ombudsman.

You can file a written complaint with:

Department of Banking and Insurance Office of Insurance Claims Ombudsman 20 West State Street PO Box 472 Trenton NJ 08625-0472 1-800-446-7467 E-mail: ombudsman@dobi.nj.gov