I'm asking this on behalf of an acquaintance.
The main question is whether an insurer can refuse payment on a claim that's covered under its own theory of what happened, even though they're alleging the person's report was "inconsistent."
His car was hit in a mall parking lot, and he filed a claim. The damage is about 4 feet high, and is a yellow scratch along most of the car length on the driver's side. The insurance seemed to think was odd. The first appraiser who looked at the car said a school bus was a possibility. However, it seems the person's insurance agent gave the insurer the impression that the car hit a street sign. A second appraiser who looked at the car said it was possibly caused by items sticking out of a pickup truck bed, and he agreed that a school bus was a possibility. Furthermore, the "investigation" only consisted of two recorded statements, and two appraisers taking pictures. I don't think mere pictures can show whether a car was in motion.
The insurance company freely admits that a collision with a stationary object is covered, and that a car hit while parked is also covered. Thus, coverage exists even under its own theory of what happened. Despite this, the person received a denial letter accusing him of making a false statement and stated that the person had been referred to an insurance bureau.
However, one of the elements of fraud is that the statement be material. Under either scenario, the result is the same: same cost to repair, same deductible etc. Thus, it seems that any alleged discrepancy is immaterial - especially given that the insurance company admits that coverage exists for hitting a stationary object.
Can somebody please tell me if I'm missing something here?