The Shoulder
The Shoulder
55
gentle-dove-267

My insurer flip-flopped on fault TWICE and now the other side wants their money back — what do I do?

I'm honestly losing my mind trying to figure out what's happening with my claim and I could really use some outside perspective.

About two months ago I was in a collision in a parking structure. Another driver came flying around a blind corner and clipped my rear quarter panel pretty hard. There was no signage assigning right-of-way, police came out but said they couldn't pin fault on either of us, so we just exchanged info and went our separate ways.

Both of us filed with our respective insurers. My adjuster called me fairly quickly and said they were treating it as a shared-fault situation — something like an even split. Fine, I wasn't thrilled but I understood. I thought we were moving forward.

Then out of nowhere, the other driver's insurance reached out directly and said they'd reviewed everything and were going to cover my repairs at 100%. I was surprised but not complaining — the payment hit my account and I got my car fixed.

Fast forward to last week. I get a formal letter from that same insurance company saying the payment was "issued in error" and demanding I send the money back because they've now decided I'm fully at fault.

So I called MY insurer to find out what's going on. The rep I spoke with said their own internal review still supported a shared-fault outcome and they seemed confused too. But then I got an email two days later from my insurer basically saying they've accepted 100% liability on my behalf. No phone call. No explanation. No nothing.

I have the original repair already done. I don't have that money just sitting around anymore.

A few things I'm trying to figure out:

  • Can my insurer just quietly accept full fault without ever consulting me?
  • What are my actual obligations with the money I already spent on repairs?
  • Is there any way to force a real review here — like escalate past the front-line adjusters?

Any help or shared experience is really appreciated. This whole thing feels like a complete mess that I didn't cause.

11replies

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11 replies

  • 12
    humble-marmot-845

    Oh man, this is almost exactly what happened to me after a parking lot dispute last year. My insurer caved to the other side without telling me a single thing, and I only found out when I got a subrogation notice in the mail. The short answer from my experience: yes, they absolutely can accept fault on your behalf — it's buried in your policy language — but that doesn't mean you have to just lie down and take it. I filed a formal written dispute with my insurer and demanded a supervisor-level review. It took a few weeks but they actually reversed course. Document EVERYTHING in writing from this point forward.

  • 18
    spry-seal-708

    This reeks of two insurance companies quietly negotiating behind the scenes and using YOU as the settlement chip. Happens constantly. The other side pressured your insurer, your insurer folded to avoid a fight, and now you're left holding the bag. Stop taking this sitting down. Send a certified letter to your insurer demanding a written explanation for the fault determination change and asking specifically what new evidence caused the reversal. Make them put it in writing. Verbal conversations disappear. Letters don't.

    • 16
      swift-hare-853

      Not legal advice, but: the combination of (1) an insurer changing a fault determination without notice, (2) a payment issued and then clawed back, and (3) possible bad-faith handling — that's a fact pattern a lot of PI attorneys would want to hear about on a free consult. Some states have pretty strong bad-faith insurance statutes with real teeth. At minimum, stop communicating about the money dispute verbally. Write everything down and keep copies.

    • 1
      weary-wanderer297

      Appreciate the detailed write-up. Saving this for later.

  • 16
    curious-beaver-725

    I worked in auto claims for several years so let me give you a peek behind the curtain. What likely happened is your insurer got a demand from the other carrier, someone at a higher level decided settling was cheaper than fighting, and they just... accepted liability without looping you in. It's not ethical but it happens.

    Here's the thing — you have the right to dispute a fault determination with your own insurer. Look up your state's Department of Insurance website. Most states have a formal complaint process and insurers tend to move faster when a DOI complaint is on the table. Also check whether your policy has an arbitration clause between carriers — that should have been used BEFORE they just flipped the decision on you.

  • 15
    hearty-swan-713

    A couple of things worth knowing without this being any kind of legal advice: First, the money question. You received that payment in good faith based on what the insurer told you. Spending it on the exact thing it was meant for (repairs) is very different legally from, say, blowing it on something unrelated. Courts look at "unjust enrichment" claims differently when the recipient acted reasonably. Second, your insurer has a duty to defend you and to keep you reasonably informed of decisions that affect you. Quietly accepting 100% fault without notice could be a bad-faith issue depending on your state. Might be worth a free consult with a PI attorney just to understand your options.

  • 9
    clear-bison-278

    Here's what I'd do right now, today: Write a single email to your insurer with the subject line 'Formal Dispute — Fault Determination Change — [your claim number].' In it, state that you were never notified of the fault change, that you dispute the 100% determination, and that you're requesting a written explanation and a supervisor review within 10 business days. CC your state's insurance commissioner if you can find the address. That email creates a paper trail and signals you're not going away quietly.

  • 20
    quiet-kestrel-377

    This sounds incredibly stressful and honestly so unfair. You did everything right — filed promptly, got your car fixed with money you were legitimately sent — and now you're being squeezed from both sides. Please don't try to navigate this alone. Even just talking to an attorney for a free consultation doesn't commit you to anything but at least you'd know where you actually stand.

    • 8
      careful-rider480

      Really glad you posted an update — gives the rest of us some hope.

  • 19
    silent-dove-128

    Few things I'd want to know before forming a strong opinion: Was there any security camera footage from the parking structure, and if so, has either insurer actually reviewed it? Also, did the police report say anything even informally about the circumstances, or was it truly a blank exchange? And do you have the original communications from your insurer in writing — emails or letters — acknowledging the shared-fault position? That stuff matters a lot if this escalates.

    • 0
      gentle-survivor815

      This is exactly what I needed to read today. Thank you.