This is a term I have used a lot over the past few weeks when speaking with experienced Loss Adjuster’s. I strictly use this term in relation to the treatment of insurance claims and how either claims handlers or loss adjusters deal with claims.
While I welcome the benefits the central bank has placed within the market place via the consumer protection code and the minimum competency code the words of Fianna Fail spring to mind “A lot done, more to do”.
Within the current APA curriculum there is very little importance placed upon the understanding of property and the different elements and aspects which are vital components to understanding any loss incurred by a policyholder.
I use the APA as a reference guide since these are the exams required so that one doesn’t have to read from a pre-approved script and can essentially handle claims unsupervised.
A very good example of this was a recent case which was declined based on being “out in the open”.
The claim was for CTTV cameras which were stolen off the side of the building. The cameras in question were directly connected to the outer walls of the insured property and under the definition of the fixtures and fittings the policy schedule stipulated was, “Machinery, Plant and All Other Contents in or on the described premises and in the open adjoining the property of the insured or held by them in trust for which they are responsible excluding property described under (A) Buildings, (C) Stock and property more specifically insured*. The claims handler within this situation was incorrect within their decision as the CCTV was clearly covered as per the above definitions.
Similarly, we had a recent case whereby a client had a chimney fire, we opened the stove and it was self-evident that the chimney liners had been cracked, coupled with exterior cracks on the chimney and the insured smelling smoke however the loss adjuster stated that they required a report from a chimney expert to state the cause of damage to the liner and complete a CCTV survey. We noted that the preparation of claims is not covered within the policy and indeed the CCTV costs were not covered either. Had the loss adjuster any property experience they would have been able to determine this and avoid these unnecessary requests. They expected our client to pay €250 to validate a claim due to their lack of understanding of the subject however after much discussion and the loss adjuster referring to management regarding the situation, they declined such requests however it was noted that this placed our client in the unfortunate situation of not being able to repair the damage within a timely fashion.
Another example, is a water leak that occurred within a kitchen. The insurer in this case decided in their wisdom that this claim should be dealt with in-house as in their opinion fell under that criteria. The water leak originated in the centre of a tiled floor however there was visible damage to the skirting boards and walls, kitchen plinths and walls. They were allowing for new skirting, slabbing, redecoration and replacement plinths within the kitchen however would not pay for the tiles which were in closest proximity to the leak. When we were appointed, a field adjuster was appointed and after mush use of a moisture meter it was proven that the kitchen cabinets themselves held 40% moisture, the connecting tiles in the utility, bathroom and hallway also warranted replacement. The scope of works then included a new kitchen, new floor tiles within the kitchen, utility, bathroom and hallway coupled with new skirting and redecoration for all rooms.