Claims & Loss Adjusters
In the event of a loss and a claim needing to be made, most policies contain a ‘claims notification condition’ which requires the loss to be reported immediately to whoever the first point of contact is, whether it be the insurer, an appointed claims management company or the broker.
A breach of this condition could lead to the insurers restricting or possibly withdrawing their insurance coverage.
RMC’s are recommended to hire a consultant or surveyor for project management and to keep detailed accounts of costs because hiring professionals will a) cut the overall life-cycle of the claim, b) maximise the policy cover and the claim presentation and supporting documents, and when done correctly will make the job of the loss adjuster easier, negating the potential for credibility to be damaged and ensuring the settlement will not be smaller than expected.
Note: Most blocks of flats policies will include cover for ‘professional fees’ up to a pre-determined indemnity limit. However, a condition of the policy may be the earlier agreement of the insurer to the appointment of an expert.
The Loss Adjuster is an impartial claims specialist that deals with investigating claims for damages arising from many causes such as fire (including arson), storm, flooding, accidents, burglaries and fraud.
Sometimes they are employees of the insurer and often independent, qualified experts.
Note: It is important not to confuse loss adjusters with loss assessors who work for the claimant and take a percentage of the final settlement as a fee.
On receiving an insurance claim the loss adjuster interviews the claimant (or client) to take evidence on the cause, or suspected cause, of the loss.
At this stage, activities may involve:
- Visiting the scene of ‘loss’ – fire, accidental damage, burglary, etc;
- Surveying any physical damage;
- Examining the causes of loss or damage;
- Confirming that claimants that they are covered by the insurance policy;
- Asking for valuation certificates;
- Requesting copies of reports (from the police or fire brigade, and from relevant representatives of the claimant, such as security staff);
- Obtaining and viewing film from security cameras;
- Commissioning reports from experts, such as building surveyors or forensic investigators;
- Ensuring, when necessary, that the property is protected against theft or weather conditions by arranging for the site to be boarded up or for builders to carry out repairs.
The next stage of the process involves:
- Advising the insured on procedures;
- Liaising with clients insurers;
- Preparing evidence to support claims against third parties and verifying the claims;
- Negotiating with the insured parties and advising insurers of settlements;
- Writing claims reports and making recommendations on what should be paid.
IS FRAUD SUSPECTED?
If fraud is suspected, further investigations will need to be made, which may involve examining a company’s accounts or checking stock records to confirm the existence of goods for which the claim in being made.
Loss adjusters may also recommend the actions that the claimant should take, such as installing betters locks, security lights and cameras, stronger doors, etc, before the insurance policy is renewed.