Guidelines on Insurance Claims, Repair & Disputes

Consumers often complain about processing delays in their insurance claims.

More often than not, the stumbling blocks in the claim process are insufficient information given on the claim form, lack of supporting documentation or the lack of understanding on what the policies actually cover.

The most common general insurance policies purchased by consumers are to cover for property damage or loss through fire, houseowners and householders contents insurance and motor insurance policies. By knowing what to do in instances of damage to your property, burglary or a motor accident would help alleviate some of the anxiety that comes with the incident as well as ensure a speedy claims process.

HOW TO MAKE A CLAIM

If your home is damaged or your belongings are damaged or stolen, the first thing to do is to check that the type of damage you are claiming for is covered. Your policy will also tell you whether your claim will be settled without deduction for age or wear and tear or whether you should deduct an amount for these when you work out how much to claim. Next, tell your insurer by telephone or letter that you wish to claim and request a claim form be sent to you.

If you are involved in a motor accident, make notes of the accident including the names and addresses of all drivers and passengers involved in the accident. Also note the licence number, make and model of each car involved and record the driver’s licence number and insurance identification. Record the names and addresses of as many witnesses as possible.

When making your police report, provide the police with whatever information they require and obtain a copy of the report. Contact and inform your insurance agent or insurance company regarding the accident and seek advice on what forms or documents are required to support the claim.

Normally, the claim form is to be submitted with (a) the police report lodged by the driver, (b) photocopy of the Identity Card, (c) Driver’s Licence (d) Vehicle Registration Card and (e) Road Tax disc.

HOW SOON SHOULD YOU CALL YOUR INSURER?

Insurance companies expect you to do this as soon as possible. Any unreasonable delays may prejudice your case. The best advice would be that when in doubt, it is better to notify your insurer sooner rather than later.

If someone else is claiming against you for damage to their property or for personal injury, it is very important to contact your insurance company immediately. You will be told what to do and it is very important to follow the instructions given.

WHAT ABOUT REPAIRS?

If your home is damaged and temporary repairs have to be made to stop further damage (such as from rain coming in through a damaged roof or window), arrange for these to be carried out straight away. Keep the bills as the costs may form part of your claim. For permanent repairs to the building or contents, get estimates and send them to your insurance company. The company must have an opportunity to see the damage and approve the estimates before work begins. Depending on the work involved and the cost, you may be told you can go ahead and get the work done.

If there is serious damage, the company will send someone to see you. This may be one of their own officials (claims inspector) or an independent loss adjuster appointed by the company. The caller’s job is to advise you what to do immediately and to tell you what further information will be required. When all the necessary information is available, the claims inspector or loss adjuster will agree with you the amount payable under the policy.

In a motor accident where your car is considerably damaged, the first step is to ascertain whether your policy covers damage to your vehicle. If yes, take your car to a PIAM-authorised repairer and inform your insurer immediately that you have done so. If your insurer recommends or requires that repairs be done at a specified workshop, then take your car there as advised. Any estimates should be sent to your insurer for checking purposes.

Alternatively, the insurer will send an insurance loss adjuster to assess the damage to your vehicle, after which the insurer will authorise repairs. The insurer will authorise repairs subject to a satisfactory claim form being submitted together with the relevant documents.

If you have an ‘excess’ on your policy, you must pay the amount of the “excess” direct to the repairer. The “excess” is that part of the claim that you have agreed will be borne by you. Check your insurance policy for this “excess” amount. The excess is payable irrespective of who is to blame.

If your policy does not cover damage to your car and you make a claim against a third party, you would need to notify the other driver in writing of your intention to claim from him and ask him to notify his insurers.

If possible, write to his insurers if you have details – quoting his policy or certificate of insurance number and send an estimate of damage as soon as possible.

The other driver should tell his own insurers of the accident as his insurers will only be able to deal with your claim if they have been asked to do so by their policyholder. Lastly, you should inform your own insurers that you are claiming against the third party.

DISPUTES

If you become dissatisfied with the way your claim is being handled and the issue on hand is not resolved even after you have written to your insurance company branch manager and to its head office, you can refer your complaint to PIAM Information Centre or to Financial Mediation Bureau. (here)

All general insurance companies also subscribe to the Financial Mediation Bureau which is an independent dispute resolution body to mediate any disputes between yourself and your insurance company.

CHECKLIST OF ITEMS TO REMEMBER:

  • Read your policy, and pay particular attention to advice on claims and conditions that apply.
  • It is your responsibility to keep your property/vehicle in good order. An insurance policy does not cover the costs of maintaining your house or its contents/vehicle.
  • You have to take reasonable steps to prevent a loss occurring – and, if it happens, to do what you can to prevent further damage.
  • It is up to you to understand the extent of your coverage. Your insurance company will be able to assist you on this matter.
  • Get in touch with your insurance company promptly and take their advice on what you should do
  • Your insurance company will deal as quickly as possible with your claim but this will also depend on getting estimates and other information they need to assess the claim, which can take time.