Accessing your insurance claim

CHUKWUMA ONONIWU

FCILRM (NG), FICRMP (U.K.), alumnus of Abia State University Lagos Business School, Pan Atlantic University, is a consummate insurance broker, insurance management consultant and digital insurance advocate. He is an i.g.i. goldcrest award winner. He can be reached on:: riskswisepro@gmail.com and +234-903-596-8732 (whatsapponly).

A claim is a risk against which has crystallised. Every class of insurance has a claim. If not, insurance will be a cesspool of fraudulent collection of premiums. This is the great reason why in every insurance policy document, the terms, the conditions and the clauses are explicitly stated. Going further, the implied conditions, the express conditions, the perils insured against and the perils exempted [are stated]. 

Filling an insurance claim, is akin to a litigant filing a lawsuit. Thus, in addition to the client’s knowledge of his rights and privileges, the client has a need for the professional guidance of an insurance broker. 

Please Note: Having engaged the professional services of an insurance broker from inception, the client is not to pay the insurance broker for processing the claim, as the insurance broker’s professional fee is part of the premium paid. The critical steps to be taken in the pursuit of an insurance claim payment include, but not limited to the following:

A thorough reading of the insurance policy document, to enable the insured to avail the rights and privileges. For instance, many motor comprehensive insurance policy holders are not even aware of their rights and their privileges in the AUTHORISED REPAIR LIMIT PROVISO of the insurance policy document.

The essence is to fast-track the settlement of minor claims, to give comfort and to give convenience, by giving the insured the window to first fix the motor with his own finance and thereafter, forward the evidence to the insurance firm for expedient reimbursement. Please note that the insurance firm has to be notified first and the exercise of the rights and privileges has to be done in the spirit and in the letters of ‘Utmost Good Faith’. 

Going further, not exceeding the financial limit. In the pursuit of an insurance claim, it is critical for the insured to truthfully fill the claim form. Equally critical, is the attachment of the claim substantiating documents, at least to a reasonable extent. 

In a motor comprehensive insurance policy – This includes but is not limited to: Quotations for panel beater repair, spray painter work, electrical work, mechanical work, air-conditioning work, replacement of light, replacement of windscreen, etc. Police reports and medical reports are only needed in the event of death or injury to a third party. 

In the case of a fire incident in a warehouse – The copy of the stock, fire service report and other claim substantiating document. 

In the case of marine insurance cargo claim – The copy of the invoices of the goods on voyage, the claim investigator’s report and other associated claim substantiating documents. 

In the case of theft of goods stocked in a warehouse: The copy of the stock report, the invoices and other claim substantiating documents. 

The essence of the above requisitions, include but not limited to the following: Establishing the proximate cause of the claim; the cost to be paid; to equally ascertain if the claimant has an insurable interest and if there is a breach of the duty of utmost good faith. 

In the event of life assurance death claim: The autopsy report/medical certificate of cause of death/the death registration certificate. The Essence is to ensure that claims are paid in tandem with the provisions of the insurance policy document. For instance, in life assurance, SUICIDE is an EXEMPTION. Same for specified terminal illness. Same for specified professions. 

Generally, an insurance claim must be FORTUITOUS and not premeditated/intentional/deliberate; for example, ARSON.

Internally, the insurance firm will collate the claims reported within a  period of time. For instance, one week for deliberation and adjudication in the claims management committee meeting, which usually consist of insurance professionals, lawyers who are staff of the insurance firm and staff of the audit unit. 

Please note that there are levels of authorisation for claims payment: Branch managers, regional controllers, divisional directors, etc. Thus, claimants are advised to be PATIENT, as a GENUINE CLAIMS, must be paid within the time frame, in order not to incur the wrath of the regulatory authority. Please equally note that some claims might entail the appointment of an insurance claim investigator and an insurance claim loss adjuster, by the insurance firm. 

In all of these, PATIENCE is of the ESSENCE, as the appointed external insurance professionals are BOUND to file in their report within a timeline. An innovative approach, which has been adopted by insurance firms, is to pay the claim cheque directly into the account of the insured. The objective is to fast track the time that the claim cheque will hit the account of the insured. 

SUMMARY: The zenith of an insurable risk placement is the expedient payment of a genuine insurance claim.

Thus, insurance is not the ADVERTISEMENT of the INSURANCE FIRM. The payment of an insurance claim is not shrouded in myth and mystery. Rather, for the long term robust sustainability, insurance firms take claims payment with THE SERIOUSNESS IT DESERVES, as a satisfied claimant, will end up advertising the insurance firm through word of mouth REFERRALS, etc.  

However, a lot lies in the hands of the insured: Did the insured engage the services of a professional insurance broker? Did the insured, diligently read through the insurance policy document? Did the insured pay the insurance premium, as and when due, with a receipt issued? Did the insured renew the insurance policy, as and when due, with premium paid and receipt issued? Did the insured notify the broker of changes in the risk insured, for instance, the addition of a new life/new life’s in a group life assurance policy? Did the insured notify the insurance broker of the change of voyage route on a marine insurance policy? Did the insured notify the insurance broker of the addition of vehicles in a motor comprehensive fleet each leet insurance? Did the insured notify the insurance broker of the addition of state stock in a warehouse fire and burglary insurance policy? 

Notifications as and when due is critical in all classes of insurance. Insurance practice, being close to legal practice, entails due diligence and utmost good faith. Please note, that insurance firms have a PROVISO FOR EX-GRATIA CLAIM PAYMENT; based on the premium payment track record of the insured; based on the claim ratio of the insured; based on the prevailing and on the  extenuating  circumstances of the incident, which led to the claim and based on the pedigree of the insurance broker.