How to Resolve a Dispute with Your Insurance Company

Even if you’re a careful driver, there’s always the possibility of a car accident happening to you. In the event of such instances, you may think that you have nothing to worry about because you believe that your insurance will cover most if not all of your expenses. However, you may soon find that you and your insurance do not see eye to eye regarding the benefits you’re entitled to.

From time to time, you may face a disagreement with your insurance company regarding a claim. These disagreements can stem from the circumstances surrounding the claim’s approval, the amount due on a bill, or even the complete nonpayment of a claim. Resolving claim and coverage disputes require you and your insurer to come into an agreement that benefits you both, but before that can happen, you need to know your rights and understand the process of coming to a mutually beneficial settlement. Here are some tips about how to dispute a car insurance claim and resolve it.

## When your claim is minimized or rejected

Your insurance provider may reject your claim because it believes your accident is not covered by your policy, or because the information and documents that accompany your claim are incomplete. If you are underinsured, your insurer may decide to pay only a small percentage of the claim, as your policy will likely have set limits for a list of particular accident situations.

Some of the more common reasons that an insurer will reject a claim include:

- Non-disclosure – failing to inform your insurer about previous driving accidents and claims is not allowed.
- Poor eyesight – your insurer can ask for an eye test after a claim is made. If your eyesight is not as good as you claim, then your application can get rejected.
- Modification – any changes you make to your vehicle that affects its performance that have not been divulged to your insurer can be a reason for rejection.
- Negligence – leaving the doors unlocked, the car windows open, or the keys in the ignition when the vehicle is unattended constitutes negligence.

If you are not satisfied with your insurance company’s decision about your claim, you can request for a review. All insurance companies have an in-house dispute resolution system that can handle such matters. Likewise, they are also required to be active members of a third-party dispute resolution scheme to prevent disputes from escalating. If you are still unhappy with your insurer’s decision after being reviewed both in-house and externally, there are two legal methods that you can use to resolve your car insurance claim dispute:

1- Mediation

Mediation is a pre-legal process where you or your insurance claim lawyer has to sit down with your insurance provider to discuss your case in the presence of a neutral mediator. Mediations can be conducted in person, over the phone, or via videoconferencing. The mediation process is normally completed in 60 days from the approval of the application, but may be extended as long as both parties agree in writing. You or your car insurance lawyer must be present in all mediation meetings. When the mediation process is finished, the mediator will file a report that identifies which issues have and have not been resolved, along with the necessary steps to be taken next.

2- Arbitration

If your dispute with your insurance company is not settled by mediation, the next likely step is arbitration. To be eligible for arbitration, the application must come from you, not your insurance company. In addition, your application also needs to come within two years of the beginning of the dispute, or 90 days after the mediator has filed his report, whichever comes later.

At the beginning of the arbitration process, you or your representative will have to meet with the arbitrator to discuss your case. This meeting is called a pre-hearing conference. During the conference, the arbitrator will attempt to settle your case, but if an agreement proves elusive, the arbitrator will schedule a hearing date. Whatever the arbitrator’s decision may be, it will be binding on both parties involved in the dispute.

## Know your rights

Your best weapon against dispute claims with your insurance provider is to know your rights. The insurance industry is highly regulated for the protection of consumers like you, and many laws dictate what an insurance company can and cannot do when it comes to settling claims and other matters concerning your policy. Most insurance providers are required to strictly adhere to the following statutes that govern their industry:

- Your insurance provider is not allowed to misrepresent your policy. In simpler terms, this means they are not allowed to give another meaning to the provisions of your policy beyond what’s stated.
- They cannot withhold payment on one portion of your policy in order to compel you to settle in another portion of it. For example, they cannot withhold payment on a collision claim to force you to settle on the liability portion.
- They must process claims promptly, and are not allowed to demand from you any unnecessary document in an attempt to delay payment of a claim.
- They must have a good compelling reason to deny or delay a claim, and must thoroughly explain this reason to you, the policyholder.

## Reporting violations

If you believe that your insurance company, agent, or adjuster is violating any law, contact your local Department of Trade and Industry (DTI) to file a formal complaint. The DTI practices Alternative Dispute Resolution techniques similar to the ones described above, so if the DTI determines that your case is under its jurisdiction, you may need to go through a mediation and arbitration process, this time, to be handled by the DTI. DTI’s decision regarding your dispute will be legally binding and enforceable to both parties.

In case your car insurance dispute is beyond DTI’s jurisdiction, the government agency will promptly endorse it to the appropriate agency and monitor its progress to ensure that your case is resolved in the soonest possible time.

For more information on your right to file a complaint against your insurance provider, you can either call DTI Direct at 751-3330, drop by a local office during office hours from Monday to Friday from 8 AM to 5 PM, or visit the DTI website at www.dti.gov.ph. They welcome all inquiries, comments, suggestions, and complaints from consumers.