Principles of insurance, claims mgmt

From B7

document only to get a “wake up call” when broker or insurer is reciting the contents and their implications.

dejectedly, this will be at the time when the loss would have happened.

Through experience we have had instances were insured persons fold their arms (not to mention stage managed accidents) and watch their property being destroyed by an insured event taking comfort in the fact that they are insured. The implied duty on the part of the insured requires him to act as if he were not insured and hence take all reasonable precautions to minimise loss.

almost all policies require that the insured should report immediately any event which could give rise to a claim under the policy and full particulars are to be provided within a stipulated period of time. The reason purely being that the insurer would want to conduct thorough investigations (if need be) whilst evidence is and witnesses are still available.

in any case, it is in the insured’s best interest if they seek insurer’s protection early or prior to litigation processes being instituted by the third party. tendency has been to see, especially motorists coming to lodge their claims upon receiving letters of demand from third party attorneys.

it is, therefore, a requirement for the insured to fill in a claim form even if one is not claiming to ensure that the event is recorded by the insurer and appropriate reserves put in place.

mere completion of the claim form does not necessarily mean that the insurer is automatically liable for the claim. The onus lies with the insured to prove that:

•He suffered a loss due to an event he is insured against

•

amount of the loss suffered if the insurers wish to rely on some exclusions/exceptions in the policy, the onus shifts to them to prove that specific exclusions/exception apply.

The insured is therefore entitled to full indemnity within the terms and conditions provided for by the policy if fully complied with. settlement less applicable excesses should be expeditiously processed and can not be delayed or held up pending recovery.

excess can only be reimbursed upon full recovery of the outlay or via market agreements.

expeditious processing of claims settlements does not prevent insurer from conducting its own investigations should this be necessary. depending on the complexity of the claim, at times losss adjusters/assessors are appointed. Though appointed by an insurer, the adjuster works independently of the insurance company.

problems and delays are encountered when information is not availed on time and in some instances loss adjuster will not issue conclusive reports until all relevant information has been availed.

it is therefore in the interest of both parties to ensure that they are in agreement from the on set and if there are any problems these be addressed within the shortest possible time.

Simplified claims procedure

assuming that premiums are fully paid up and appropriate cover in place:

•report accident to police and obtain police reference number

•

obtain three quotes preferably from repairers approved by your insurer

•

obtain claim form from your insurer / broker and complete same attaching copy of drivers licence and the quotations

• •

•

•promptly notify your insurer / broker / agent either by phone,fax, or email. remember you need to have your policy number with you. should you be unfortunate to suffer a fortuitous loss, depending on the nature of the claim try any of the above procedures and see how your insurer act in response.

am out of here.