Tips on dealing with insurance

1. Obtain a certified copy of your insurance policy from the company. Without an accurate and complete copy of the policy in force, you have very little chance of protecting yourself from unscrupulous insurers.

There may have been changes in the current policy, or it may comprise renewal of a previous policy that still contains provisions relating to the old or original policy.

2. If your insurance firm appoints a loss adjuster or investigator, request details of their terms of appointment, instructions and whom they represent.

The company may appoint a loss adjuster without advising the policyholder of the true purpose of the appointment.

If your policy provides for appointment of a loss adjuster to act as an independent assessor, find out if the adjuster has actually been appointed under that provision or whether he has been appointed to act for and assist the insurance company to minimize payout, investigate and/or delay the claim.

3. Identify who within your insurance firm is authorized to handle your claim, keep them involved and forward them a copy of all correspondence.

The company may use the loss adjuster to divert the policyholder from direct access to their claims-handling staff.

If you are required to deal with their loss adjuster, make sure your insurance firm is fully informed and cannot later deny any of the steps which have taken place by the loss adjuster purportedly on their behalf.

4. Keep a daily journal of the activities underway and progress of the claim and note any delays such as unusual request for further supporting documentation.

By doing this, you are in a better position to later take action against unethical insurance firms if they have engineered intentional delays.

5. Make sure you keep a copy and written record of all correspondence, documents and information provided, discussions and meetings.

If you do not keep a complete written record you might find that what is said to you and what actually happens may be two completely different stories.

Insurance companies make their money by minimizing the amount that they pay out on insurance claims such as yours.

6. Avoid or refuse "off the record" or private meetings or negotiations.

The insurance company may request an "off the record" meeting or private discussion purportedly to advance the claim.

At such a meeting, a company may put forward an inappropriate basis of settlement once it considers the delays and hardship the policyholder has endured which may cause the policyholder to give up his full claim entitlement and settle.

7. Arrange for minutes of meetings for the insurance company and for adjusters to provide or sign and return as evidence of events as a true and correct record.

In addition to obtaining copies of witnesses' statements, record and keep detailed notes of all interviews and discussions with insurers so that the insurance firm or loss adjuster cannot later misrepresent this information.

Remember it is in the policyholders best interest to manage and push along the claim handling process, not the insurance company.

8. Insist that the insurance firm follow the provisions of the policy.

The insurers or their loss adjuster may simply calculate and seek your agreement upon some hypothetical basis of settlement outside of the terms of the policy, but encourage you to accept in the interest of a quick settlement.

9. Do not rely upon a loss adjuster to correctly interpret provisions of the policy.

Loss adjusters are appointed by insurance firms to minimize the amount it has to pay the policyholder -- not to be fair or impartial in dealing with the policyholder.

They may misrepresent policy provisions or omit allowable items from your claim to intentionally put forward a lower settlement figure favorable for the insurance firms.

10. If you are uncertain of the meaning of any provisions of your policy, get independent professional advice immediately. Insurance contracts can be complicated and obscure documents.

Before you start with your claim, obtain a clear and thorough understanding of your specific policy provisions.

Note that many policies have notification clauses and other timetable requirements that can jeopardize your claim if not complied with.

Source: CGA Complaint Group Association 1999