Docs Category: General Insurance Claims
General Insurance Claims
Distinction between a loss and a claim
Last Updated: December 26, 2022A claim is a request by the insured to be indemnified by the insurer following a financial loss. A loss is the occurrence of the insured event such as fire which results in a financial disadvantage of the insured. A loss event might arise but this may not necessarily translate to a claim because the...
Claim conditions
Last Updated: December 26, 2022The handling of any claim is governed by policy conditions and terms. Compliance with conditions applicable to the policy is very important as it determines the acceptance of liability. Some of these conditions affect the amount payable. The claims conditions exist in two forms; Expressed claim conditions These are conditions introduced by the insurer and...
Types of Claims
Last Updated: December 26, 2022There are two types of claims, Property (Material Damage) claims Property or material damage claims are more fairly straightforward than liability claims because they involve the insured and the insurer only. An important aspect which loss adjusters consider is the policy liability. In event the proximate cause of the loss must be ascertained – an...
Claim Procedures
Last Updated: December 26, 2022The actual procedure of handling claims varies according to the class of business, the type of cover and the amount of loss. the points discussed below are the the main steps in the claim procedures. Claim Notification This is the reporting of the claim by the insured to the insurer. It is a policy condition...
Reinstatement of the Sum Insured /Limits of Liability
Last Updated: December 26, 2022Every successful partial loss has the effects of reducing the sum insured by the claim amount. The insured has to restore the sum insured or limits of liability to its original amount for the unexpired period of insurance. A pro –rata premium will be charged after remaining period of insurance. If the amount of additional...
Methods of dispute resolution
Last Updated: December 26, 2022Disputes between the insured and insurance can be costly if they are not solved amicably. This can result in destruction of the relationship between the insurer and insured and also bad publicity as a whole regardless of the merits of any one case. The main methods of resolving risks disputes include, Litigation This is the...
Recoveries
Last Updated: December 26, 2022After payment of a claim, its often the case that the insurer will be able recover part of the claim amount from other sources. For example, a third party considered liable for the insured event may be pursued under subrogation rights. Recoveries can also be made from reinsurers who reinsured the same risk or other...
Market agreements
Last Updated: December 26, 2022There are inter- company agreements adopted for good practices, signatories to these agreements undertake to observe certain procedures when dealing with claims affecting their companies. However, the agreements are not legally binding. The common agreement in the country is the Knock for Knock Agreements. this is applicable to motor insurers. In each agreement, each insurer...
Claim leakages
Last Updated: December 26, 2022This refers to over payment of claims. Over payment can be classified as either soft or hard leakage. Soft Leakage This refers to the subjective aspects of the claimed failure to adjust the claim for wear and tear Hard Leakage This refer to the interpretation and application of the policy, egg failure to apply excess.