The Shoulder
The Shoulder
51
sharp-badger-456

At-fault driver's insurer denied liability — does that unlock my UM/UIM or not?

I'm going insane trying to figure this out and hoping someone here has been through something similar.

Back in the spring I got rear-ended pretty hard at a red light. Clear-cut situation — I was fully stopped, other driver admitted at the scene he didn't see me brake. His insurer investigated and came back saying they're "declining liability." When I pushed the rep on the phone she basically confirmed they're not paying a dime toward my car or my medical bills. So... that's a denial of coverage, right?

Here's where it gets maddening. I filed with my own insurer to use my UM/UIM coverage (which I pay extra for every single month, specifically for situations like this). Their adjuster keeps telling me that a "liability denial" from the other carrier is NOT the same as a "coverage denial," so my UM/UIM supposedly can't kick in yet.

I asked for that in writing. Crickets.

My car sat in a shop for weeks, I've got outstanding PT bills, and I'm just... stuck in this no-man's-land where nobody wants to pay anything. I've read my policy like four times and I genuinely cannot find language that makes the distinction my adjuster keeps citing.

Has anyone gotten UM/UIM to apply after a liability denial? Did you have to escalate somehow? File a complaint? Get a lawyer involved?

Any direction would be huge right now. I feel like I'm being jerked around by both sides simultaneously.

11replies

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11 replies

  • 21
    quiet-swift-245

    I used to work claims and I'll be honest with you — that distinction your adjuster is making is real in some technical sense internally, but it's also routinely used to delay UM/UIM claims as long as possible. UM/UIM is supposed to step in when the at-fault party's insurance won't pay. If their insurer is refusing to pay, that is functionally what UM/UIM exists for. Push back hard and ask your adjuster to show you the specific policy language that supports their position. If they can't produce it, escalate to their supervisor in writing.

  • 19
    kind-beaver-622

    Two things: 1) Stop accepting verbal explanations from your adjuster — demand everything in writing via email. 2) Call your state's Department of Insurance today and ask them whether a liability denial by an at-fault carrier triggers UM/UIM under your state's law. They'll tell you straight, it's free, and it lights a fire under your insurer.

    • 8
      quiet-tern-657

      This sounds so exhausting on top of already dealing with an accident and recovery. I'm really sorry you're stuck in this. Sending you patience — you clearly are not letting them steamroll you and that matters.

  • 18
    gentle-heron-273

    Most state UM/UIM statutes and standard policy language define a triggering event as the at-fault insurer refusing to pay — not just a formal 'coverage denial' in some narrow technical sense. Your insurer's interpretation might not hold up if you push it. I'd request your full policy documents, look for the UM/UIM section and how it defines when benefits apply, and compare it against what you're being told. Also, every state has an insurance commissioner — filing a bad faith complaint is a real option and insurers take those seriously.

    • 3
      quiet-dreamer475

      How long did it end up taking in your case?

  • 15
    candid-badger-056

    Not legal advice, but this fact pattern — your own insurer refusing to apply UM/UIM after a documented denial by the at-fault carrier — is exactly the kind of thing that can give rise to a bad faith insurance claim depending on your state. Most PI attorneys will give you a free consult and many specifically handle these kinds of first-party insurance disputes. Worth at least one conversation before you accept what your adjuster is telling you.

    • 2
      soft-spoken-road-soul620

      Thank you both, this gave me the push I needed to make the call.

  • 10
    daring-owl-664

    Please don't let the billing chaos cause you to skip or delay your PT. I've seen people stop treatment mid-recovery because they're stressed about who's paying, and it really can set back healing. Keep going to your appointments and document everything medically. The financial stuff is its own battle — don't let it hurt your body on top of everything else.

    • 7
      careful-wanderer704

      How long did it end up taking in your case?

  • 9
    mellow-fox-996

    Oh wow, this is almost exactly what happened to me two years ago. Other driver's company denied liability, my own insurer gave me the same runaround about it not being a 'coverage denial.' What finally moved things was me filing a complaint with my state's Department of Insurance. Within like two weeks my adjuster suddenly had a totally different attitude. Definitely worth looking into.

  • 8
    spry-seal-531

    They are absolutely stringing you along hoping you get tired and go away. That distinction they're drawing between 'liability denial' and 'coverage denial' sounds like manufactured confusion to me. Keep everything in writing — every phone call, send a follow-up email summarizing what was said. Paper trail is everything here.