How is fault determined when an insurance company refuses to accept liability?

A Liability Denial Is the Insurer’s Position, Not a Final Decision

When an insurer refuses to accept liability, it is usually stating that its investigation does not support payment of the claim. The insurer may contend that its driver followed the rules of the road, that another driver caused the crash, or that the available evidence is inconclusive.

That position can be challenged. An adjuster does not have the final authority to decide legal fault. A denial may change after additional evidence is submitted, during negotiations, or after a lawsuit is filed. If the dispute reaches trial, the judge or jury evaluates the evidence under North Carolina law.

It is important to determine whether the insurer is denying liability or denying insurance coverage. A liability denial means the company disputes fault. A coverage denial means the company contends that the policy does not cover the driver, vehicle, or event. Those are different issues and may lead to different claim options.

What Must Be Shown to Establish Fault?

In a North Carolina vehicle accident claim, an injured person generally must show that a driver failed to use reasonable care, that the failure caused the collision, and that the collision caused compensable injuries or losses. Examples of conduct that may matter include failing to yield, following too closely, making an unsafe turn, disregarding a traffic signal, or failing to maintain proper control.

Fault is determined from the full set of facts rather than from one document. A crash report can provide useful information, but an officer’s recorded assessment does not automatically resolve a civil injury claim. Insurers and, when necessary, a court may consider:

• Statements from the drivers, passengers, and independent witnesses.
• Photographs or video showing vehicle positions, impact points, traffic signals, signs, or road conditions.
• Vehicle damage and repair documentation.
• The law enforcement crash report and any available investigative materials.
• 911 recordings, nearby surveillance footage, or dashboard-camera video.
• Electronic vehicle information when available and properly preserved.
• Medical records connecting the reported injuries to the accident.
• Messages, claim letters, and recorded statements given to insurers.

Evidence should be reviewed as a whole. For example, vehicle damage may help test whether a driver’s description of the impact matches the physical evidence. A neutral witness may help resolve conflicting accounts about a light, lane change, or right of way.

How North Carolina Contributory Negligence Can Affect the Dispute

North Carolina permits contributory negligence as a defense. If the defense proves that an injured person’s own negligence helped cause the injury, the claim can face serious problems. Under N.C. Gen. Stat. § 1-139, the party raising contributory negligence generally has the burden of proving it.

A passenger’s position is different from a driver’s because the passenger usually does not control either vehicle. The negligence of the driver transporting the passenger is not automatically treated as the passenger’s negligence. However, an insurer may still investigate whether the passenger independently acted unreasonably under the circumstances. The evidence should therefore address both what each driver did and whether the passenger acted with reasonable care.

Being a passenger also does not automatically establish which driver must pay the claim. One driver, the other driver, or potentially both drivers may have acted negligently. Each driver’s conduct should be evaluated separately.

Challenging the Insurer’s Fault Decision

A useful first step is to obtain the denial in writing and identify the precise reason given. A general statement that the insured was “not responsible” may not reveal which facts the insurer accepted, rejected, or overlooked.

A challenge can then focus on the disputed point. That may involve correcting an inaccurate accident description, providing witness contact information, supplying photographs, explaining the vehicle damage, or identifying a traffic rule relevant to the collision. A clear timeline and organized supporting materials are often more useful than repeatedly asking the adjuster to reconsider without new information.

Before giving another detailed or recorded statement, consider whether the questions could affect disputed fault or an alternative insurance claim. Any statement should be accurate and limited to facts the person actually remembers. Guessing about speed, distance, or another driver’s intentions can create unnecessary disputes.

Could the Passenger Make a Claim Through the Vehicle’s Insurer?

Possibly, but the basis of the alternative claim matters. If the driver of the vehicle carrying the passenger may also have contributed to the crash, that driver’s liability insurer should generally receive notice so it can investigate. Submitting notice does not mean that the passenger is accusing the driver of causing the entire accident; it preserves the opportunity to evaluate all potentially responsible parties.

Uninsured or underinsured motorist coverage may also need review, depending on the policies, the passenger’s status under them, and the reason for the other insurer’s denial. Under N.C. Gen. Stat. § 20-279.21, North Carolina automobile policies are subject to statutory uninsured and underinsured motorist requirements. However, a denial that a driver was at fault is not necessarily the same as a denial that the driver had coverage.

Potential insurers should receive timely notice, and the relevant policies, declarations pages, claim correspondence, and denial letters should be preserved. Coverage depends on the policy language, the facts, and North Carolina law. An injured passenger should also be cautious about signing a release for one driver without understanding whether it could affect claims involving another driver or insurer.

How This Applies to an Injured Passenger

Here, the other driver’s insurer has denied liability by claiming its insured did not cause the accident. That denial does not end the passenger’s claim. The next task is to identify the factual basis for the denial and compare it with witness accounts, the crash report, photographs, vehicle damage, video, and other available evidence.

At the same time, the insurer covering the vehicle in which the passenger was riding may need notice. That carrier may investigate whether its driver had any responsibility and whether another type of coverage could apply. The passenger should not assume that submitting an alternative claim determines fault or guarantees coverage.

Documents and Information to Preserve

• The written liability or coverage denial.
• Claim numbers and adjuster contact information for each insurer.
• The crash report and any correction or supplemental report.
• Scene, vehicle, and injury photographs.
• Witness names, contact information, and statements.
• Available video or electronic data.
• Insurance cards, policies, and declarations pages.
• Medical records, bills, and visit summaries.
• Proof of missed work and accident-related expenses.
• Copies of emails, letters, texts, and notes from insurer conversations.

Do Not Let Negotiations Cause a Missed Deadline

Many North Carolina personal injury actions are subject to a three-year filing period under N.C. Gen. Stat. § 1-52, although the correct deadline depends on the claim and circumstances. Negotiating with an adjuster, submitting more evidence, or waiting for an alternative insurer to investigate does not automatically extend the deadline for filing a lawsuit.

Insurance policies may also contain notice requirements or procedures that must be followed. Prompt review can help preserve evidence and identify which insurers should receive notice before a legal or policy deadline becomes an issue.