How to Guide - Insurance Claims

INTRODUCTION

If an insured event occurs, the events in the immediate aftermath of a loss and the steps you take to protect your position, can be significant in the outcome and handling of the claim.

It is important that the first step you take is to call your broker/account executive and advise them of the facts so we can advise you on the best steps to take.

Your insurance company will want to investigate the circumstances giving rise to a claim and, if thought appropriate by the insurer, to repudiate the claim or avoid the policy.

As your broker, we are here to help you though this process and to ensure that we advise your insurer of all the relevant information.

We therefore want to take you through some of the key stages in making a claim. It is our role as your broker to work with you through the process and assist where possible to ensure valid claims are paid, or acted on, quickly and efficiently.

STEP BY STEP GUIDE

Notifying and proving the claim

As soon as any incident that may give rise to a claim occurs, you should notify your account executive without delay. It is important that we present the relevant information to the insurer to demonstrate the extent of the loss and that it has arisen from an insured risk.

We should emphasize that any undue delay in advising your insurers of a potential claim can greatly affect whether an insurer will accept or refuse to deal with a claim. There are strct terms in your insurance policy that you are to advise your insurer, without delay, of any incident that may give rise to a claim.

It is also vital that you preserve all the evidence required, for these purposes, such as for example, damaged plant and machinery forensic evidence and relevant documents.

Presenting the claim

With smaller claims, presenting the claim does not usually pose a problem. However with larger, substantial claims, you will usually need professional help and support. Primarily, this help will come from your broker. We may also decide to use the services of a loss assessor, who will carefully research and formulate the material damage, business interruption, and any other claims.

Care should always be taken not to overstate a claim. To do so may lead to a great deal of difficulty in establishing that your claim is genuine, and in some cases may even result in the claim being turned down or refused by your insurer.

Duty to co-operate with insurer’ Loss Adjuster

For larger claims, insurers will appoint a loss adjuster to investigate the claim on their behalf. Under the terms of your policy, you are obliged to co-operate fully with any loss adjuster whilst they are dealing with the claim on behalf of the insurer.

Your broker will be there to help you through this process and, where possible, should also attend any meeting you have with the insurer’s loss adjuster. This does not prevent you from taking reasonable and proper advice in connection with any problems arising during the course of that investigation form your own legal representatives.

Protecting your position

When a claim occurs, it is your broker’s duty to work with you to protect your position at all times.

If any information is required in support of your claim, you should always seek the advice of your broker before sending.

THE PARTIES INVOLVED

The Insurance Broker

BJP (Your Insurance Broker) are officially regarded as agent of the insured (You). This may seem strange, as we receive payment from the insurers and are often closer to the insurers in practical terms, acting as selling agents for particular insurance companies under express authorities enabling them to do so.

We, your broker, are officially recognised as a professional insurance intermediary and as such, owe you, the insured, various duties.

These include ensuring that you are fully and properly insured, that you are aware of your duties to insurers and let you know and understand all terms and conditions of the policy non-compliance with which may jeopardise your insurance cover.

A broker’s primary role, however, is to represent and support their client in all matters relating to their insurances. Your broker also has a duty to help you through the whole claim process and ensure your receive the full protection of the your insurance policies.

The Loss Adjuster

The insurer will generally instruct a loss adjuster for larger claims. The job of the loss adjuster, initially, is to investigate your claim and to advise the insurer whether to pay a claim or not, and if so, in what sum.

The Loss Adjuster acts for and is paid by the insurer. Many loss adjusters are anxious to stress that they endeavour to act fairly between the insurer and the insured. No doubt, many do their best to do so, but it is a fact that the Loss Adjuster will be looking to the insurer, not the insured, for his future instructions.

Loss Assessor

For complex, or potentially disputed problem claims, you can choose to appoint a loss assessor, who will act on your behalf and liaise with the loss adjuster on your behalf.

Most importantly, the loss assessor will advise you on what steps to take and what experts to instruct to protect your position. Many are excellent and have extensive experience of handling large and complex claims.

Once appointed, the loss assessor is your agent and you are responsible for his actions. BJP can give you access to one of our recommended loss assessors and help you through this side of the claim process.

Forensic evidence

Increasingly, and particularly in case of major fires or burglaries, insurers sometimes will instruct forensic scientists and other experts such as the forensic accountants and private investigators.

They will conduct detailed investigations into the circumstances of the loss, the state of your business and even your own personal background. Be ready to instruct your own forensic experts or solicitors or advice from your broker, loss assessor, or other professional adviser.

Claim Checklist

  • Notify your broker of any incident that may give rise a claim as soon as possible
  • Take all reasonable steps to minimise the loss
  • Make sure that all material and forensic evidence is preserved
  • With your broker, collate all evidence necessary to substantiate your claim
  • Do not overstate your claim, if in doubt, please speak to your broker If necessary, we can seek professional advice from a loss assessor
  • Be aware of the possibility of claiming for uninsured losses from any third party liable for causing the loss or damage

Not a BJP Client? We can still help!

Even if you are not an existing BJP client, we can offer comprehensive claims support, negotiating the best possible settlement from your insurance company on disputed claims for a negotiated fee.

We provide the expertise and resources that may not otherwise be available to prepare claims to get the right settlement for you.

     
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