Empathy Claims Resolves Deductible Dispute Through Detailed Investigation & Perseverance

Overview Of Claim
An insured driver who was covered under a commercial inland marine policy was involved in a traffic accident, which caused the company vehicle to overturn. The standard deductible for this policy was ten thousand dollars, however a provision in the contract stated that should an overturn of a vehicle occur as a direct result of a covered claim, the deductible would be increased to twenty five thousand dollars. The insured disputed the fact that their vehicle had overturned in the accident and felt that the standard policy deductible of ten thousand dollars should be applied to their claim.

Independent Inland Marine Claims Adjusters
On behalf of our insurance carrier client, Empathy Claims began a comprehensive investigation regarding the details of the accident, in order to document cause in relation to coverage. To determine whether the vehicle had overturned, our adjuster took statements from the drivers involved in the collision, as well as from those who witnessed it. We also completed an inspection of the insured’s vehicle and took detailed photographs. Lastly, through a FOIA request, our adjusting team learned of the presence of police dashcam video from the responding officer’s squad car. We spoke with the investigating officer about the dashcam footage who confirmed that the vehicle did in-fact overturn.

Claim Investigation Results
Because of the comprehensive claim investigation conducted by the highly knowledgeable independent adjusting team at Empathy Claims, it was determined that the insured’s vehicle had overturned. Through witness interviews, police dashcam video and an inspection of the vehicle’s damage, there was conclusive proof that an overturn had occurred. An added complexity to the case surfaced when the insured became unresponsive when being presented with a Proof of Loss document that included the overturn deductible of twenty five thousand dollars.

Acting under the authority of our insurance company client, Empathy Claims sent a letter to the insured citing policy language that they had a duty to return the signed Proof of Loss document within 60 days of issuance or there would be no payment under the insurance contract. Due to the insured’s initial lack of timely response, we obtained permission from our client to grant a thirty day extension for the return of the signed Proof of Loss document, which detailed the claim settlement figures and the twenty five thousand-dollar deductible. The insured did sign the Proof of Loss and we were able to finalize the claim on behalf of our client.

Independent Product Defect Claims Adjusters
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Since 1994, Empathy Claims has been committed to helping our insurance company and self funded entity clients with all of their claims adjusting and investigation needs. This case study illustrates that as a result of our investigative abilities and perseverance, we were able to uphold the policy provisions of our client’s insurance contract. Contact us today to learn more about how Empathy Claims can be a strong advocate out in the field for your company’s claim operations.