So my girlfriend was involved in a accident where a pedestrian walked out in front of her car in a parking lot and she bumped the lady at according to the police report between 1-3 mph, but really it was closer to 1 mph. Anyways, we just got a message from her car insurance company that the lady she hit has gotten a lawyer. So my question is, will our car insurance company (AAA) get a lawyer to represent my girlfriend? Or do we have to hire a lawyer?

Also for privacy can we refrain from mentioning my girlfriends or my name in this thread so if someone searches online this doesn't come up.

Thanks for any help.

BTW- We are pretty sure this is a case of insurance fraud.

------------------

quote Originally posted by DeLorean00: So my question is, will our car insurance company (AAA) get a lawyer to represent my girlfriend? Or do we have to hire a lawyer?

Answer: Read your policy; that is all that matters. Most policies have provisions that if you and your insurance company are sued the insurance company has either the option or the responsibility to defend you. In most cases your insurance company will elect to settle and pay on a liability claim, up to the policy limits, rather than litigate. If the injured party still isn't satisfied after settling with your insurance company they can still come after you, and your insurance company will have no continuing obligation to defend you.

My advice: Ask your insurance company. If you're still not comfortable with the situation, consult an attorney.


Edit: to correct erroneous information.

[This message has been edited by Marvin McInnis (edited 03-10-2011).]

quote Originally posted by Marvin McInnis: Answer: Read your policy; that is all that matters. Most policies have a "subrogation clause," which means that if you and your insurance company are sued that the insurance company has the option to defend you. Note that I said "option," not "responsibility." In most cases your insurance company will elect to settle and pay on a liability claim, up to the policy limits, rather than litigate. If the injured party still isn't satisfied, they can come after you and your insurance company has no obligation to defend you. My advice: Ask your insurance company.

Thank you.

Your policy will have a responsibility to defend clause and they will be required to provide a lawyer for your wife. The subrogation clause is something entirely different. The only time your insurance company will not provide you with a lawyer is for criminal traffic violations or if there is no coverage, like if she intentionally hit the pedestrian cause she was road raging or something. It make sense because if the insurance company is going to have to pay for any damages they are going to want to provide the best possible defense to make sure the damages are as small as possible. They will initially have a bodily injury adjuster attempt to settle the matter before a lawsuit is even filed. If the adjuster cannot get the case settled and a lawsuit is filed, they insurer will then provide defense counsel who has significnat experience in defending personal injury claims. In most cases, a lawsuitis never filed, and the claim settles and you don't know anything about it until you see the rate increase.

Subrogation, just to clear that up, is when you are in an accident that is not your fault, your insurance company retains the right to recover any payments made to you or anyone else for damages to your car or for your medical bills, from the person who was responsible for the accident or their insurer.

Subrogation isn't in play here. Her Insurance Co. has an obligation to defend her, afterall, if the woman gets a judgement, it will be paid with their money. Look at her policy and have her call her insurance company ASAP to confirm this.

Good Luck,

Tom

State laws vary. Like M.M. stated, ask your carrier and make sure you let them know that you think it may be fraud, if you really think it is. They will probably open a special investigation case and look at the claimant to see prior losses, injuries etc.

In Florida, I have seen cases where the insurance company had to represent their insured who was being sued even after paying policy limits. There are so many catches to the system you have to be a lawyer to figure it out.

Thanks for all the replies, its really cleared things up.

However now the completely different topic. This is almost clearly a case of insurance fraud. She wasn't even injured on the scene, yet she made an ambulance come. The car was barely moving, she was still walking around, no broken bones, not even any bruises. Yet she made the ambulance take her to the hospital. She refused to talk to my girlfriend at the scene, not even one word. And she walked out in front of a car in a area where any person with 1 once of common sense would never walk out.

The whole deal seemed like fraud right from the start. And not that it matters, but she was a very ghetto girl with a criminal record. And now she has hired an attorney. Sounds fishy to me.

Insurance companies see this a lot and are prepared to deal with it. Even so, they just may cut her a check to go away rather than pay to defend in Court.

Tom

quote Originally posted by Tytehead: Your policy will have a responsibility to defend clause and they will be required to provide a lawyer for your wife. The subrogation clause is something entirely different. ... Subrogation, just to clear that up, is when you are in an accident that is not your fault, your insurance company retains the right to recover any payments made to you or anyone else for damages to your car or for your medical bills, from the person who was responsible for the accident or their insurer.

Thank you for that correction. I have edited my original post.

[This message has been edited by Marvin McInnis (edited 03-10-2011).]

So if she sues, can she actually get any of the money? Or will she only get paid out for her medical bills? She didn't even stay in the hospital for more then a hour. And they just gave her some pain killers with out any refills.

Most insurance fraud cases involve "soft tissue injuries" with treatments including massages, water beds, roller treatments and chiropractor treatments. Depending on where she is treated, the attorney she uses and the nature of her claim will all factor into how the claim is handled.

quote Originally posted by Terrible Tom: Insurance companies see this a lot and are prepared to deal with it. Even so, they just may cut her a check to go away rather than pay to defend in Court. Tom

True on both counts. Accident reconstructions are very expensive and typically reserved for large single injury cases, multiple claimant smaller cases or special investigation (fraud) cases. That said, if your carrier believes it was fraud (after their investigation), they will deny the claim and force her attorney to come up with several thousand dollars of his own money to reconstruct it and "prove" it. Not many of them are willing to do that. They will simply move on to the next questionable claim and hope the company pays that one.

Telling an insurance adjuster than an attorney is involved on either side is just business as usual, not a threat or intimidation. It just means the persons share of the claim just dropped by the attorney's fee. The carrier could care less in the cases I have seen, other than taking exponentially longer for the same result. This applies to dealing with fraud cases, not legitimate injury cases.

quote will our car insurance company (AAA) get a lawyer to represent my girlfriend?

Yes.
That's why you pay for insurance.

Terrible Tom (and some others) are correct.

[This message has been edited by NEPTUNE (edited 03-10-2011).]

quote Originally posted by DeLorean00: The whole deal seemed like fraud right from the start. And not that it matters, but she was a very ghetto girl with a criminal record. And now she has hired an attorney. Sounds fishy to me.

Actually, it does matter. Claimant credibility is important when an insurance carrier makes the decision to risk denying a claim. Drug addicts with criminal records do not make good courtroom appearances to a jury. They usually incriminate themselves way before they ever see a court room.

Insurance companies I have dealt with know what lawyers are credible and what ones use the same clinics and doctors over and over as their "experts". All red flags for a fraud claim.

Your insurance should handle the whole thing with you just being possible witnesses. Were a 'suing' society now where everyone tries to make a free buck for anything. Of course shes going to try and sue. They may or may not pay her anything to go away, so to her its a win - win, whether she gets a million dollars or $100. I hate lazy azz people like this and would have been tempted to just flat run her right over and said ' whoops, I thought I ran over a speed bump '. As long as you called your insurance company, you shouldnt have to do anything. I would recommend you check with them from time to time to see where it stands. I have seen them drop the ball a few times. She wont be able to come after you if the insurance company wont settle. She might even use her shistey lawyer to sue the property owner saying its not properly marked or whatever.

I just checked my own auto insurance policy, and here's what it has to say under "EXTRA BENEFITS." Your policy may or may not include a similar provision:

"... No deductible applies to these benefits, and these benefits are additional coverages over and above your coverage limits.

A. Legal Services

We'll defend against cliams and suits for bodily injury and property damage covered by this policy at our own expense. But our obligation ends when our limit of liability for this coverage has been exhausted by payment of judgments or settlements. We also reserve the right to investigate and settle a claim whenever we wish."

Please read your own policy to see if it includes similar provisions.

My wife had an accident, she was found at fault, other driver went to hospital with broken leg....... Both cars totaled.
Our insurance was taking care of everything, new cars for both. They paid any medical bills my wife had....A few days short of one year later we received a letter from Spitball,Slimball and Weasel....Unfortunately you only have $100,000 coverage and that will not be enough to satisfy our clients expenses. Please submit any other insurance you have or a list of your assets......our something like that.
It scarred the u-know-what out of me. I could see everything I've worked for GONE.
I panicked and went my estate lawyer for his opinion. He told me to just let the insurance company handle it and to ignore the letter.

They can't reach an settlement so they tell me they have obtained a lawyer to represent us. Buy this time the other driver got different lawyer and they started over.
All of this time I'm under the impression that if we go to court and he wins $500,000 that the insurance company would pay $100,000 and we would still owe $4000,000.

They finally settled for the $100,000 and we didn't have to go to court... After it was settled I was having a conversation with the adjuster telling I'm glad I didn't lose everything in court he said..................If we would have gone to court and lost $500,000 that it would have been paid by their trail insurance. All policies and companies differ
Let them handle it for now............I wouldn't contact to other party. Good luck.......don't Worry

First thing I did when I got the letter was up my insurance to $250,000..........

[This message has been edited by DL10 (edited 03-10-2011).]

quote Originally posted by DL10: First thing I did when I got the letter was up my insurance to $250,000..........

That brings up an interesting and important point. NEVER disclose the amount of insurance coverage you have to another party to an accident or claim. All you are required to disclose is evidence that you have valid insurance in force that meets the minimum requirements in your state. Let your insurance company and/or your attorney do the rest. Do not discuss the accident with the other party or anyone else involved in the accident. If in doubt, ask you insurance company first; you have a responsibility to help them represent you.

Being one of those "slimy personal injury" lawyers, I deal with these questions all the time. Insurance is always controlled by the contract. The contract will always tell you what your rights ans responsibilities are and what you can expect from the insurer. You should always read the contract to make sure you are getting the coverage you think you are and to determine what exclusions apply. As I stated above, every insurance policy comes with a duty to defend if you are sued. That sounds pretty cool, and like the insurance company s looking out for you, but in reality, the insurance company wants to protect its assets (money) and the best way to do that is to provide your defense lawyer, assuring your co-operation and gratitude. You will also have a duty to co-operate outlined in your contract. A failure to co-operate will almost always result in a denial of coverage for breaching the contract. The duty to defend may be limited by the contract, also. They will have a duty to defend in most cases where the accident is caused by carelessness, but not if the accident was intentional. There is no duty to defend if they deny coverage, like if you are driving another car you own but is not covered by the policy or you are driving the car without the owners permission or if you are driving your personal car for certain types of work or are engaged in a crime. In those cases there is no duty to defend because there is no coverage. If there is a question if coverage applies, they normally will err on the side of caution and provide you an attorney until that question is answered. Finally, many insurance policies contain what is known as a "pay and walk" provision, which means that if the insurer pays out the policy limits and the plaintiff (injured party) decides to sue you, they have no duty to defend. Many policies do not have the pay and walk provisions and most adjusters will try and get a release from the plaintiff releasing the insured before settling the case.

When purchasing insurance you should always buy the most you can reasonably afford. However, a good rule of thumb to follow is to have as much insurance as you do assets. If you don't own a house and have no significant savings or assets, maintaining the statutorily required minimums is usually fine. The more assets you acquire, the more insurance you should have. when you have more significant assets, (more than $200,000.00) you should really consider purchasing umbrella insurance. Umbrella insurance is extremely affordable and usually gives a high dollar coverage for a few hundred dollars a year. typically there will be underlying insurance requirements, like a minimum of $100,000.00 liability coverage for an automobile and homeowners or renters. But it is usually cheaper to get those policies and $1,000,000.00 umbrella that it is to get $500,000.00 of homeowners and auto liability. If you are purchasing umbrella coverage, find out if the Umbrella coverage contains uninsured and underinsured motorist coverage because those coverages protect you and your family if you are hurt, and again is usually very cheap. As a practical matter, if your insurance coverage propery covers your net worth, most attorneys (not all) will settle for the policy limits, even if you have some other assets, even if their client has substantially more damages, because they know that most people, if hit with a huge judgment ($25,000.00 or more) probably cannot afford it and will file for bankruptcy protection (even with the tough bankruptcy laws). If there is substantial damages and you have substantial assets, even if you are properly insured, you may be subject to a judgment, but, for most people, as long as there insurance is reasonably related to their worth, they will not have to worry about a plaintiff going after your personal assets.
DL10 - what happened to you was the lawyer trying to determine if you had umbrella or other insurance that he could go after for his client's injuries. Since you did not, he probably did an asset check and determined that you could protect most or all of your assets if you filed bankruptcy and decided to settle for the $100,000.00 rather than expend the money it would cost to go to trial just to try and pursue you individually. Also, there may have been first party insurance (uninsured or underinsured motorist) that he could go after. Like I said above, most plaintiff's attorneys will not pursue a course of action where the likelihood is there will be no substantial recovery above the policy limits. But you were correct, if he would have pursued it to trial and a judgment was rendered against you, it would have been your responsibility. I am not sure what trial insurance is that you were told about, but I assume it is coverage that attaches if they represent you through trial and you lose.

DeLorean regarding your concerns about insurance fraud, remember, any scam that can be thought of has been tried against an insurance company. There are many people out there that will fake an injury to make a quick buck. I try to avoid those clients but I am certain I have had a few. An insurer is going to thoroughly investigate any claim brought and it is going to require medical proof of injury before it pays anything. It is quite possible the girl was not hurt, but it just because she was hit at a slow speed does not mean she wasn't hurt. I am not taking her side, but I have seen some really serious injuries occur from things I doubted would cause harm, and I have seen others who were not hurt in accidents I would think would kill someone. So she may actually be hurt or she may be trying to make a quick buck, either way it is your insurer's job to figure that out and act accordingly. As many have stated above, trials are expensive and credibility counts, so if she was sketchy to begin with, unless there is some objective evidence of injury, she won't get very far. For some personal injury attorneys out there it is solely a numbers game and they won't take questionable claims to trial. In my practice, if I think a claim is questionable I walk away from it. I have spent to much time money and effort giving my sketchier clients the benefit of the doubt, I will not do it anymore. While she may recover on this, it will not be substantial (unless she had an x-ray or mri or something that show structural damage that a doctor states on the record is related to the accident). Insurance compnies don't stay in busines paying specious claims, it will be investigated and denied if they feel it is fraud.

Man Tytehead thanks for that huge post!! Lots of great info!!

Here the details. This is my girlfriend/fiance that was involved in the accident. She only had the state minimum insurance, and that is $25,000 per person, $50,000 be accident. She also has zero assets, her car has an auto loan, she lives in rent, she has nothing in the bank, and credit card debit and student loans. However she has a great job and great credit.I upped my personal insurance to what I could afford and that is $300,000/$500,000. That would more the cover my assets.

Now I agree, she might has some legitimate injury's, I cannot say she didn't, I am not a doctor. All I can say is the whole deal seem staged.

We obtained a copy of the police report today. It found my girlfriend not at fault for the accident. The report placed the pedestrian at fault, stating a code she broke to not yield to a vehicle that had the right away, also another code she broke for not crossing in a proper crosswalk, something to that effect. What is clear, the report clearly states it was the pedestrian at fault.

So with this now in our favor. Can the pedestrian come after my girlfriends insurance for anything?

[This message has been edited by DeLorean00 (edited 04-05-2011).]

Keep the police report. Did your gf have any damage to her car ? If she did, sue the pedestrian for the damage. Whats good for the goose is good for the gander,lol. Might even try for some stress benefits......

My own story...I had a little wreck in the Fiero about 4 years ago...nothing serios, took off the front fascia on my car, and dented the fender on the mazda or toyota or whatever it was..

In the courtroom, this girl was whining how it required an alignment--and she is pregnant--and how it need the whole car painted because of one fender--and she is pregnant--and how she couldnt get to work for a week because the car was in the shop---and she is pregnant..

Judge just rolled her eyes, gave me a 150 fine for fail to yield, and i kinda guess the pregnant girl had her baby...my insurance agent tells me the total cost was about 2500....non issue....

She can still come after you insurance for damages, but it is unlikely that the insurer will voluntarily pay the claim. Because a violation of the law is negligence per se, which means she is at fault, at least somewhat, for not crossing in the cross walk. Police reports, however, are considered hear-say evidence and are generally not admissible at trial because in most cases, the police did not witness the accident and base their report on word of mouth from the people involved in the accident or eye-witnesses. When they make their determinations, they are judging the credibility of the people they spoke with before preparing the report. It is the jury's job to determine credibility, so the witnesses and parties testify at trial and the jury makes their determination based upon who they find credible. How aggressively the attorney pursues the claim will depend on how your court's rule on negligence. There are different standards, and each state decideds which standard they will use. The fact that she was negligent per se may act as a complete bar to her claims in one state or may be use to reduce your girlfriend's responsibility in another. It would take more time than I have here to explain how that works, plus I don't know which fault assessment your state uses. And you can bet if there are significant injuries, it will be apursued by the attorney. If you want to discuss it further, PM me your phone number and I will givce you a call. Let me know what state you live in and I will look up how your state treats comparative fault issues and wiill be able to answer any questions you have more appropriately. Good luck to your girlfriend and if you have questions, let me know.

MEM, I am thinking this is becoming a non-issue as well. We have a lot in our favor if this goes to court.

Tytehead, Thank you so much for another long detailed post. I can not explain how much it means to us to hear the insight of a seasoned lawyer. At this point I don't think I will bother you further with having you call, unless things get worse. And to answer your question this took place in California. BTW, I owe you dinner!