How Do Adjusters Determine Who Is at Fault in a Car Accident?
After a crash, insurance adjusters play a critical role in deciding who should be held responsible. But for injured drivers and passengers in Philadelphia, this process can feel confusing, slow, and sometimes unfair. You might be wondering: How do adjusters determine who is at fault? And what does that decision mean for your ability to recover compensation?
In this guide, we explain what evidence adjusters look at, how they evaluate fault, and how Pennsylvania’s legal rules affect the outcome of your claim. If you’re struggling with an unfair determination of liability, the Philadelphia car accident lawyers at Rosen Justice Injury Lawyers are here to help you challenge it.
Why Fault Matters in a Pennsylvania Car Accident
Pennsylvania is a choice no-fault state, meaning drivers can elect either limited tort or full tort insurance. Limited tort coverage restricts your ability to recover pain and suffering damages unless you meet certain injury thresholds, while full tort allows you to pursue full compensation even for noneconomic damages.
That said, fault still plays a key role in both types of coverage. If the other driver was at fault, you may be entitled to compensation for property damage, medical bills, lost wages, and more, even with limited tort coverage. If you have full tort, proving the other party’s negligence is essential to recovering the full value of your losses.
How Do Adjusters Determine Who Is at Fault?
Insurance companies rely on multiple sources of evidence when assigning fault. While this process may seem formulaic, it often involves interpretation and discretion, which means you may need legal support to make your voice heard.
Police Reports
Police reports often carry significant weight in fault determinations. These documents typically include the officer’s narrative, observations, citations, and sometimes a diagram of the accident. Although not legally binding, insurers give strong consideration to the officer’s account.
Statements from the Parties
Both drivers usually provide a statement to their insurance companies. Adjusters compare the two versions to identify inconsistencies, admissions, or explanations that clarify who made the error. Keep in mind that what you say in these statements can heavily influence the final outcome.
Witness Testimony
Eyewitnesses can provide objective details about how the crash occurred. Adjusters may contact bystanders, pedestrians, or passengers who saw the collision. A credible third-party account can tip the scales when the drivers’ stories conflict.
Photographs and Video
Photos of vehicle damage, skid marks, road conditions, or surveillance video can help reconstruct the accident. Adjusters use this visual evidence to support or challenge the statements made by the parties involved.
Traffic Laws and Violations
Adjusters apply relevant traffic laws to the facts of the case. If one party ran a red light, failed to yield, or violated another rule of the road, that violation may serve as the basis for assigning fault.
Expert Opinions or Accident Reconstruction
In serious collisions or cases with conflicting evidence, adjusters may consult accident reconstruction experts. These specialists analyze speed, angles, and impact points to provide an opinion on how the crash occurred. Their findings can help adjusters allocate fault percentages or challenge an initial determination.
These steps combine to form the backbone of the adjuster’s analysis. While some decisions seem straightforward, others involve gray areas that may require legal advocacy to promote fairness.
How Do Adjusters Determine Damage?
Once fault is established, adjusters must assess the extent of the damage. This includes both physical injuries and vehicle-related losses. To calculate damages, insurance companies typically review the following:
- Medical records—documentation of diagnosis, treatment, and injury severity;
- Mechanic estimates—repair quotes or total loss calculations based on car condition;
- Lost income—proof of missed work, reduced hours, or job changes due to injuries; and
- Pain and suffering—subjective damages based on the severity of physical and emotional harm.
Adjusters may also evaluate long-term prognosis, especially in cases involving permanent disability or chronic pain. Their valuation often falls short of what an injured person truly deserves, which is why legal guidance can make a meaningful difference.
How Is Fault Determined in a Car Accident?
Because Pennsylvania uses a modified comparative negligence system, fault affects both your eligibility and your compensation. If you are found to be more than 50% at fault, you are barred from recovering damages. If you are 50% or less at fault, your award is reduced in proportion to your responsibility.
For example, if you are deemed 20% at fault for the crash and your total damages are $100,000, you would be eligible to recover $80,000.
Insurance companies often use this system to their advantage. Even a small shift in the percentage of fault can significantly impact your payout. An attorney can help protect your rights and challenge unfair assessments.
Can You Dispute an Insurance Adjuster’s Fault Determination?
Yes, and in many cases, you should. If the insurance company wrongly places the blame on you or assigns an unfair fault percentage, it can reduce or eliminate your compensation.
You can dispute a fault finding by:
- Providing new evidence such as photos, expert opinions, or witness statements;
- Requesting a reconsideration or escalation within the insurance company;
- Filing a formal complaint with the Pennsylvania Insurance Department, if the evaluation process was unfair; and
- Filing a lawsuit to let a judge or jury decide the outcome if settlement negotiations fail.
An experienced personal injury lawyer can guide you through each of these steps. At Rosen Justice Injury Lawyers, we regularly help injured Philadelphians push back against unjust fault determinations.
How Do Insurance Companies Determine Fault in Multi-Vehicle Accidents?
In chain-reaction crashes or pileups, determining fault can be more complicated. Adjusters must consider:
- The actions of each driver involved;
- The timing of each collision;
- Any traffic violations by individual parties;
- Road and weather conditions; and
- Whether any driver was distracted, impaired, or speeding.
Insurers might assign different fault percentages to multiple drivers, and those numbers directly affect how much compensation each person can recover. Legal assistance is often crucial in these cases to untangle complex liability webs.
What If the At-Fault Driver Is Uninsured?
If you were hit by an uninsured driver, you might still be able to recover compensation through your uninsured/underinsured motorist coverage (UM/UIM) if you selected this option in your policy. This claim would go through your own insurer, but it is still subject to fault analysis and policy limits.
Pennsylvania law does not require UM/UIM coverage, but insurance providers must offer it. If you have this coverage and your insurer fails to handle your claim fairly, you may have grounds for a bad faith insurance claim.
Speak with a Philadelphia Car Accident Lawyer Today
If you’re asking, “How do insurance adjusters determine fault?” chances are you are facing an uphill battle with the insurance company. Whether the adjuster has already made a decision or you’re still waiting, Rosen Justice Injury Lawyers can step in to protect your rights and demand fair treatment.
We have extensive experience helping clients in Philadelphia and throughout Pennsylvania fight back against unjust fault determinations and recover the full compensation they deserve. Our firm offers free consultations, and you never pay unless we win your case.
Contact us today to speak with a skilled Philadelphia car accident attorney about your case.
