Tips No. 3 on General Insurance Claims Handling

Tips No.3: Loss Notification

It is a condition precedent to liability that any claim for loss or damage should be notified by the Insured to the Insurer, in writing, immediately.

However, there are many cases of such claims being rejected outright by the Insurer as the loss or damage does not come within the scope of the cover or there are breaches of Policy Conditions. The Insurer will want to double check the followings are in order before registering the claim.

THAT:
1)  the loss or damage is an insured peril under the policy
2) the subject matter damaged is the one specified under the Policy
3) the claimant is the one insured and named in the policy
4) the policy is still in force
5) the loss or damaged happened within the territorial limit
6) the Premium has been paid
7) All other Policy Conditions are fully complied with

Upon satisfying themselves with these conditions, the Insurer will sent out the claim form to the Insured for completion. Insured is required to return the Claim form to the Insurer  together with all claims supporting documents, within 30 days from the loss notification date.

Whether or not a Loss Adjuster is appointed to investigte the loss or damage depends on the quantum of loss, fraud or complexicity of the claim etc. If the Loss Adjuster is involved, the Insured is required under the policy condition aka Rights of Insurers to fully co-operate with the Loss Adjuster to expedite the claim.

However, in many known situations, the Insured could not produce the supporting documents or proof of purchases to justify the loss or damage within the 30 days period. In the event a delay is anticipated,  the Insured can write to the Insurer officially, with valid reasons, to seek an extension of time to procure the required documents.

Notwithstanding the condition, it is the normal market practice for the Insurer to write to and to remind the Insured of the outstanding documents in the 12 months that followed. But if the Insured still failed to respond to the Insurer inspite of repeated reminders to do so, then the Insurer can exercise their rights under the "Time Limitation Condition" to close the file without further notice to the Insured. This time limitation condition is not applicable to claims involving litigation procedures.

TIPS NO 4 WHY THE NEED FOR CLAIMS SUPPORTING DOCUMENTS