How does an insurer decide who is at fault in a bodily injury claim?

What the Insurer Is Trying to Determine

A bodily injury claim usually involves several separate questions. The insurer first considers whether the policy may cover the incident. It then investigates liability, evaluates whether the incident caused the claimed injuries, reviews the claimed damages, and decides whether to negotiate, deny the claim, or continue investigating.

When deciding liability, the adjuster generally asks:

• What duty applied? For example, a driver may have been required to obey a traffic signal, keep a proper lookout, or yield the right of way.
• Was that duty violated? The insurer looks for evidence of careless conduct or a violation of an applicable rule.
• Did the conduct cause the incident? A mistake does not establish liability unless it contributed to the event that caused the injury.
• Did the injured person also contribute? In North Carolina, the insurer may investigate the claimant’s conduct as well as the conduct of its insured.

An adjuster may reach an initial decision and later revise it when new information becomes available. A liability decision can therefore remain pending while the insurer interviews a witness, obtains a law-enforcement report, requests photographs, or asks its insured for more information.

Evidence That Commonly Influences a Fault Decision

An insurer does not have to rely on one document. It may compare several sources and look for agreements or conflicts among them. Common evidence includes:

• Statements from the people involved;
• Independent witness names, contact information, and recorded statements;
• Law-enforcement reports and any supplemental reports;
• Photographs or video showing the scene, vehicles, property, hazards, or visibility;
• Dash-camera, surveillance, or body-camera recordings, if available;
• Vehicle damage, debris locations, measurements, and other physical evidence;
• Traffic citations, incident reports, or relevant safety rules;
• Phone records or electronic data when lawfully obtained and relevant;
• Contemporaneous messages, notes, or admissions; and
• Medical records that help connect the reported event to the claimed injuries, although those records do not usually establish who caused the incident.

Evidence can disappear quickly. Video may be overwritten, vehicles may be repaired, scene conditions may change, and witnesses’ memories may fade. Preserving original photographs, messages, witness information, and damaged property can matter even when an insurer is already investigating.

How Much Weight Does a Police Report Carry?

If the claim arose from a motor vehicle collision, a crash report is often an important starting point, but it is not automatically the final word on civil liability. Under N.C. Gen. Stat. § 20-166.1, law enforcement investigates reportable crashes and prepares a written report.

An officer may not have witnessed the collision. The report may depend on statements gathered at the scene, and one person may have been unable to provide a complete account. Supplemental reports or later witness interviews can add information. For those reasons, an insurer may consider the report alongside photographs, video, physical evidence, and witness accounts rather than treating the report as conclusive.

Why the Injured Person’s Conduct Matters in North Carolina

North Carolina permits contributory negligence as a defense. In general, if the defense proves that the injured person failed to use reasonable care and that failure helped cause the injury, the claim may face a significant obstacle. Under N.C. Gen. Stat. § 1-139, the party asserting contributory negligence generally bears the burden of proving it.

This is different from a simple percentage-based system. An insurer may still assign percentages in its internal evaluation, but North Carolina’s legal rule can make even an allegation of contributing negligence important. Evidence should therefore address both what the insured did wrong and why the injured person’s own conduct was reasonable under the circumstances.

Adjusters may examine speed, attention, visibility, warnings, right of way, evasive actions, footwear or property conditions in a premises claim, and whether the claimant recognized an apparent danger. An insurer’s allegation is not automatically correct. It should be compared carefully with the complete evidence and the applicable law.

What a Pending Liability Investigation Usually Means

A pending decision does not necessarily mean that the insurer has denied the claim. It often means the adjuster believes more information is needed. The insurer may be trying to resolve inconsistent accounts, locate a witness, obtain the complete report, confirm coverage, or speak with its insured.

It is reasonable for legal counsel to seek clear written information about:

• The claim number and assigned adjuster;
• Whether the representation letter was received and added to the file;
• Whether future communications will be directed to counsel;
• What liability information remains outstanding;
• Whether a witness interview or report request is pending; and
• Whether the insurer has made an initial or final liability decision.

Because the injured person already has representation, direct insurer contacts should be shared promptly with counsel. Counsel can decide whether and how to respond. An injured person should not assume that silence means acceptance, denial, or loss of the claim.

How This Applies to the Current Situation

Here, the insurer has not confirmed receipt of the representation letter and has not announced a liability decision while gathering information from a witness and law enforcement. Those facts suggest that the liability investigation may still be open, but they do not establish what the insurer will ultimately decide.

The attorney handling the bodily injury claim can verify delivery of the letter, confirm the correct claim and adjuster information, resend the notice if appropriate, and request a written status update. Counsel may also obtain the available report independently, contact relevant witnesses, compare their accounts, and preserve other evidence instead of relying only on the insurer’s investigation.

Useful items to provide or preserve include:

• A copy of the representation letter and proof of delivery;
• The claim number and all adjuster contact information;
• Every letter, email, text message, or voicemail from the insurer;
• Witness names and contact information;
• Reports, photographs, recordings, and scene information;
• A personal timeline of the incident prepared while memories are fresh; and
• Medical records, bills, and visit summaries relevant to the bodily injury claim.

An Insurer’s Decision Does Not Control the Final Legal Outcome

An insurance company’s liability determination is a negotiating position based on its investigation. It does not prevent the claimant’s attorney from submitting additional evidence, challenging factual assumptions, or disputing the insurer’s interpretation of North Carolina law. If the parties cannot agree, a court may ultimately decide disputed liability based on admissible evidence.

Timing still matters while the investigation continues. N.C. Gen. Stat. § 1-52 provides a three-year period for many personal injury actions, although different rules can apply depending on the claim and parties. Insurance discussions, an open investigation, or a pending liability decision do not automatically extend the deadline for filing a lawsuit.