How do insurers decide who is at fault?

Editorial team Published on

Insurance companies determine fault through an investigation by claims adjusters who review physical evidence, official reports, and statements.

Key Evidence Reviewed

  • Police Reports: Officers document the scene, note traffic violations, and often record their initial opinions on who caused the crash.
  • Photos and Videos: Images of vehicle damage, final resting positions, road conditions, and dashcam or surveillance footage provide objective proof.
  • Driver and Witness Statements: Adjusters interview everyone involved and any independent bystanders to build a timeline.
  • State Traffic Laws: Adjusters compare each driver's actions against local right-of-way, speed limits, and signaling rules.
  • Physical Evidence: Vehicle damage patterns, paint transfers, and skid marks help specialists reconstruct how the collision happened.

Shared Fault and State Laws

If both drivers acted negligently, adjusters assign a percentage of blame to each party using state comparative negligence rules. Your final payout or ability to recover damages depends directly on your assigned percentage of fault and your state's specific liability laws.

What happens if insurance can't decide who is at fault?

If insurance companies cannot determine fault due to conflicting stories or missing evidence, they typically assign shared fault (comparative negligence) or treat it as a standoff where each insurer pays for their own policyholder's damage (subject to deductibles).

📊 What Happens in a Standoff

  • Split Liability: Insurers may agree to a 50/50 or proportional split of the total repair costs.
  • Deductibles Apply: You must pay your collision deductible if your own insurance covers your car repairs.
  • Rate Increases: Both drivers may see a rate increase if fault is split or assigned partially to them.
  • Arbitration: The two competing insurance companies submit the case to an independent third-party arbitration panel to make a final binding decision.

🚗 Your Action Options

  • 💡 Use Your Own Collision Coverage
    • How it works: File a first-party claim through your own provider.
    • Pros: Gets your car fixed much faster while companies argue.
    • Cons: Requires paying your deductible upfront.
  • 🔎 Provide Extra Evidence
    • How it works: Submit dashcam footage, witness details, or surveillance video.
    • Pros: Can completely overturn a split-fault or unclear decision.
    • Cons: Dependent on what you or nearby properties recorded.
  • ⚠️ Hire an Attorney or Arbitrator
    • How it works: Retain a personal injury or traffic lawyer to fight the ruling.
    • Pros: Forces a deeper legal investigation or independent reconstruction.
    • Cons: Involves legal fees and potential court delays.

What not to tell your insurance company?

Never say I'm sorry or admit fault to an insurance adjuster, as these statements can be used to reduce your payout or deny your claim.

✅ What Not to Say or Do

  • ❌ Admitting Fault: Saying "I'm sorry" or "It was my fault"
  • ❌ Downplaying Pain: Saying "I'm fine" or "I'm not hurt"
  • ❌ Speculating: Guessing speeds, distances, or timing
  • ❌ Recorded Statements: Agreeing to give a recorded interview
  • ❌ Early Settlements: Accepting the first check right away

💡 Safe Communication Strategy

  • 🗓 Report Promptly:
    • Contact your insurer within 24 to 48 hours
    • Provide only date, time, and location
  • 🗒 Stick to Facts:
    • State what you saw without opinions
    • Decline to guess causes or blame
  • 🔎 Protect Medical Info:
    • Do not sign blanket medical releases
    • Get checked by a doctor first

Will my insurance go up if it was someone else's fault?

Yes, your insurance can still go up even if the accident was not your fault, though it depends on your state and insurance company.

Why Rates Can Increase

  • Filing a claim on your policy: If your own insurance company pays for your repairs or medical bills upfront (such as through collision coverage, uninsured motorist coverage, or in a no-fault state), it counts as a claim on your record.
  • Assessed risk: Insurance companies view anyone involved in an accident as a higher statistical risk for future claims, regardless of who caused the crash.
  • State laws: Some states (like California) explicitly forbid rate increases for not-at-fault accidents, while many other states allow insurers to raise your rates.

How to Prevent or Lower the Impact

  • File a third-party claim: File the claim directly with the Official State Insurance Department or the at-fault driver's insurance company instead of your own, which reduces the chance of a rate hike on your policy.
  • Check for accident forgiveness: Review your policy to see if you have coverage that protects your rates after an accident.
  • Shop around: Compare quotes from different providers if your rates do go up.

Does insurance or police determine who is at fault?

Insurance companies determine fault for financial payouts, while police officers investigate the scene and write a factual report, but do not have the legal authority to determine final civil liability.

The Role of Police

  • Document the scene: Officers record physical evidence, vehicle damage, and driver or witness statements.
  • Enforce laws: They may issue traffic citations for rule violations, which can point toward negligence.
  • Offer an opinion: An officer may write their perspective in the report, but this is an initial observation, not a legally binding verdict on fault.

The Role of Insurance

  • Conduct investigations: Insurance adjusters review the police report, talk to drivers, examine photos, and look at video footage or witness accounts.
  • Assign financial responsibility: They use their findings and state traffic laws to decide who pays for damages, and they can assign shared percentages of fault.
  • Make independent decisions: Insurance companies are not legally bound by a police officer's opinion or notes and can reach a different conclusion if other evidence supports it.

The Role of the Courts

  • Final legal authority: If insurance companies disagree or a driver files a lawsuit, a judge or jury makes the ultimate, binding decision on fault.

How Do Insurers Assign Car Accident Fault?

9 related questions found

Do I call the other person's insurance if they hit me?

Yes, you can call the other driver's insurance company to file a claim, but you can also go through your own insurance if you have collision coverage.

Ways to Handle the Claim

  • Call the other driver's insurance (Third-Party Claim):
    • Do this if the other driver is clearly at fault and you want them to pay for your repairs and medical bills.
    • You will not have to pay a deductible.
    • They might take longer to investigate and accept liability before paying out.
  • Call your own insurance (First-Party Claim):
    • Do this if you want your car fixed faster.
    • Your insurance fixes your car right away, but you must pay your deductible first.
    • Your insurance will try to get your deductible back from the other company later (called subrogation).

What You Need Ready

  • The other driver's name, phone number, and insurance policy number.
  • The police report number (if the police came).
  • Photos of the damage and the crash scene.
  • The date, time, and location of the crash.

Which insurance denies the most claims?

Oscar Health denied 25.3% of in-network claims in 2024, representing the highest denial rate among major national ACA marketplace health insurers.

Health Insurance Denial Rates

  • Oscar Health: Denied 25.3% of marketplace claims.
  • Molina Healthcare: Denied 22% of claims.
  • Ambetter (Celtic): Denied 21% of claims.
  • UnitedHealthcare: Denied 20% of claims (down from 33% the previous year).
  • Kaiser Permanente: Recorded the lowest national rate at approximately 6%.

Homeowners and Auto Insurance Denial Rates

  • Allstate and USAA: Frequently flagged by public reports and consumer data for closing roughly 40% to 50% of property and homeowners claims without payment in high-risk regions.
  • State Farm: Reported home insurance denial rates exceeding 41% to 59% in catastrophe-heavy markets like Florida.

What's the biggest mistake people often make when dealing with an insurance claim?

The biggest mistake people often make when dealing with an insurance claim is giving too much information too soon—such as providing a recorded statement or casually saying "I'm fine" to an adjuster. Insurance adjusters often call quickly to get statements that they can use to lower or deny your payout.

Other Common Mistakes to Avoid

  • Admitting Fault Prematurely: Saying "I'm sorry" or guessing about what happened at the scene can be twisted into an admission of liability before all facts are known.
  • Accepting the First Offer: The initial settlement check is usually a low-ball offer meant to close the case cheaply before you realize the true cost of repairs or medical bills.
  • Delaying Medical Care or Filing: Waiting too days to see a doctor or report the incident gives insurers an opening to argue your injuries or damages didn't happen during the event.
  • Poor Documentation: Failing to take photos, keep receipts, or track medical visits makes it hard to prove the real value of your claim.
  • Posting on Social Media: Sharing photos or details online gives the insurance company evidence to claim you are less injured or damaged than you state.

What scares insurance adjusters?

Insurance adjusters are most afraid of claimants who are organized, informed, and represented by legal counsel. Rather than emotional outbursts or intimidation, adjusters fear concrete evidence and professional accountability.

What Disconcerts Adjusters

  • Detailed Documentation: Keeping complete medical records, repair bills, photos, and a daily pain journal makes it impossible for an adjuster to downplay your losses.
  • Legal Representation: Hiring a personal injury attorney signals that you will not fall for lowball settlement offers or delay tactics.
  • Strict Fact-Based Communication: Sticking strictly to basic facts and refusing to guess or provide speculative recorded statements strips away their ability to trap you in contradictions.
  • Bad Faith Accountability: Knowing your policy details and threatening regulatory complaints or bad faith lawsuits when they delay or deny valid claims without cause.

Is it better to have a $500 deductible or $1000?

A $1,000 deductible is better if you want lower monthly payments and have enough savings to pay the higher amount during a claim, while a $500 deductible is better if you prefer lower out-of-pocket costs when an accident happens.

Comparison of Deductibles

  • $500 Deductible
    • Monthly premium: Higher.
    • Out-of-pocket cost during a claim: Lower ($500).
    • Best for: Drivers with limited emergency savings, those who feel uneasy paying a large cash sum unexpectedly, or people with higher driving risk.
  • $1,000 Deductible
    • Monthly premium: Lower.
    • Out-of-pocket cost during a claim: Higher ($1,000).
    • Best for: Drivers with a strong emergency fund, safe drivers who rarely file claims, and those who want to save money on yearly insurance costs.

How to Decide

Read guidance from Tapley Agency or review InsuraMatch to weigh your personal budget. Ask yourself these questions:

  • Can you afford $1,000 right now? Never pick a $1,000 deductible if paying it on short notice would cause financial hardship.
  • What is your car worth? If your car is older and only worth a few thousand dollars, a high deductible might not make financial sense.
  • How often do you drive? If you have a clean record and rarely drive, a $1,000 deductible helps you keep more cash in your pocket.