| What happens when you and the insurance adjuster do not agree on a settlement amount? What are your options? Most insurance policies contain a provision that calls for arbitration should the policyholder and insurance company disagree on a settlement figure. Arbitration is when a neutral, third party is brought in to settle a dispute, rather than having the dispute settled in court through litigation. Arbitration can save both time and money. Binding arbitration simply means that a final decision in arbitration is binding (or final) on both parties, and may not then be taken to court if one party does not agree with the outcome. If your policy requires binding arbitration in the event of a dispute between you and your insurer, then both you and your insurer must seek out arbitration and comply with the decision of the arbitrator. Arbitration is typically only used in situations where damages are the only issue.
How Arbitration Works and Its Costs
Arbitration provisions in insurance policies are often called “appraisal clauses.” Each party (the policyholder and the insurance company) hires an appraiser to look at the claim and recommend a settlement figure. If the appraisers can’t agree on a settlement figure, a third, neutral appraiser is brought in to look at the claim. A decision by any two of the three appraisers is typically binding on the parties. Either party may invoke the appraisal clause when a settlement can’t be reached. The process itself can take anywhere from a couple of weeks to a couple of months.
While the arbitration process is considerably less costly than litigation, it is still not free. Each party must pay for its own appraiser and share the cost of the third appraiser. If these costs are more than what you’re hoping to get in a settlement, then rethink your strategy. If should not cost you more to go through arbitration than you would otherwise gain after settlement has been reached in your favor.
An insurance company is acting in bad faith if it does not honor a binding arbitration decision and can be sued in a court of law. If you are in this situation, consult an attorney right away.
Other Roads to Take if All Else Fails
If negotiations hit the proverbial “brick wall,” you might consider one of the following:
(1) Small Claims Court: This option may make sense if your damages involve a relatively small amount. Small Claims Courts are a faster, inexpensive and less stressful way to resolve disputes. And generally you can sue without using the services of a lawyer (though using a lawyer to coach you as to strategies makes sense). All Small Claims Courts, however, have a maximum amount for which you can sue, and this amount differs from state to state. So if you are looking for $8000 and your state’s dollar limit is $5000, it may not make sense to proceed. You will be giving up your right to seek the extra $2000 in another court.
(2) Department of Insurance: You can make a complaint to your state’s department of insurance, although the agency is unlikely to intercede favorably on your behalf. However, the mere suggestion that you are filing a complaint may spur a recalcitrant insurance adjuster to increase the settlement figure. Your state agency may investigate your claim if the insurer wrongfully denied coverage, acted improperly or refused to negotiate a settlement.
(3) File a lawsuit: You can sue the person responsible for the accident if: 1) you’re not getting anywhere with the insurance adjuster, 2) the claim is more than the maximum limit in your state’s small claims court, 3) there are insurance coverage issues, or 4) your statute of limitations is set to expire within 2 or 3 months. Where the stakes are high (i.e., serious or permanent injury), you are better off with legal representation. See How a Personal Injury Attorney Can Help You for more information.
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