Residential and Domestic Insurance Recovery Information
Introduction
Many residential and domestic claims against insurers, depend on the nature of the loss and whether the contract of insurance or policy of insurance entered into with the insurer responds. In many cases, a simple interpretation of the policy will assist the client in determining whether a claim exists.
By their nature, many claims are small in size and thus the economics of the dispute are best served by the client addressing their issues with the insurer direct.
To assist residential and domestic clients, Shine Lawyers has developed a self-help pack to assist them in resolving their insurance dispute.
The Residential and Domestic Insurance Self Help Guide
Introduction
This self-help guide is designed by Shine Lawyers to assist you in your dispute with your residential or domestic insurer. The purpose of the guide is to ensure that you cover all aspects of your claim to ensure that your rights and entitlements are best represented. The guide is structured in a number of easy steps for you to follow.
Step 1 - Securing Information in the Aftermath of a Disaster or Loss
Being the victim in any natural disaster, or suffering the loss or damage to an asset is a traumatic experience. Such events are often highly publicised and do not only involve you, but others around you such as your neighbours or community. The experience is one that can have a negative impact on your emotions, health, well being and your financial security. Despite these significant influences, it is important to remain calm and set yourself upon a journey to collect as much information as you can regarding your rights to recover against your insurer. The information you should obtain includes, but is not limited to:-
- Inventories of your possessions.
- Photographs, or videos of your worldly goods.
- Copies of your financial documents. If they are destroyed, many of them can be obtained from insurers, banks, financial institutions that will have copies, some of which are easily accessible on the Internet.
- Details of any emergency services personnel, including registered volunteers, Police Officers, Army personnel, or representatives of State Emergency Services. These people will often prepare reports, or are individuals who are witness to your loss.
- Copies of bank statements or receipts in evidence of the payment of insurance premiums, including cheque butts and Mastercard/Visa statements.
- Any information that you think will be of relevance to the insurer’s decision to pay should be accumulated and kept in an ordered document folder.
Step 2 - Read your Policy of Insurance
In many cases, the cause of your loss will be easily identifiable such as in the case of cyclones or earthquakes. For your policy of insurance to respond, it is necessary that the cause of your loss is covered by your policy such that the insurer will pay for the loss that you have sustained. Your should ensure that:-
- Your insurance is current and paid for.
- Your policy of insurance responds. This can only be ascertained after reading it carefully.
- You follow the insurance company’s request in regards to claims made under the policy and the information that is required.
Step 3 - Commence the Claim Process
The policy of insurance will prescribe the manner in which claims should be made. In residential and domestic contracts of insurance, it is usually as simple as telephoning the insurer and lodging the claim with them over the telephone. Insurers now have call centres where call operators take particulars and provide a claims reference number. Once the information is provided to the insurance company, then they will commence the process of investigating the loss, including its cause, whether it is covered under the policy, and the amount of the loss.
Step 4 - Be Conscious of the Insurance Code of Conduct
Australian insurers participate in a code of conduct called the “Insurance Code of Conduct” (the Code).
The Code sets out and prescribes the timing and manner in which insurers deal with claims. This is effectively a set of performance measures that the insurer should adhere to as part of its service obligations to you. It includes the manner in which claims are investigated and the timeliness of their response. You should make sure that your insurer complies with the insurance code in its delivery and determination of your loss. By doing this, it will keep the insurer moving on your claim.
Step 5 - Co-operate with Loss Adjustors
Insurers will have loss assessors or adjustors who are specialists in assessing losses. They will attend your property and commence assessing the loss. That may necessitate obtaining quotes from trades people to securing information from you regarding the inventories of your property and your loss of goods and chattels. The more accurate and specific you can be, and evidence you can provide, will assist the loss adjustor in speeding up your claim and making sure that you are fully compensated under the policy.
Step 6 - Payment or Denial of the Claim
The insurer will ultimately make a decision as to whether the circumstances surrounding your loss is recoverable under the policy of insurance. If your loss was caused by a flood and your policy of insurance does not cover flood, then the insurer is entitled to deny indemnity to you and not pay your claim. The harsh reality in many cases is that people are not insured for losses and therefore cannot claim under policies. However, for those that are covered, it is necessary to ensure that you receive the full extent of that cover. You should liaise with your insurer to resolve that matter.
Step 7 - Issues of Dispute
If there is any dispute between you and your insurer, then insurers have internal dispute resolution processes to review that dispute.
If your claim has still been denied after an internal review, the next step is to complain to the Insurance Ombudsman Service (IOS) within three months of the date of refusal.
Please read this article for more information about submitting a complaint to the insurance ombudsman.
If these measures have been taken and the insurer does not consider that there is merit to your claim, then you are entitled to seek alternative opinion, and we invite you in doing so to contact us by phone on 13 11 99 or email.