THE CHALLENGES WITH MOTOR INSURANCE CLAIMS ADJUSTMENT (PART 1)

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Motor Insurance ranks as one of the most popular of all the various classes of insurance in Nigeria and understandably so. It is an everyday risk and the very nature of an automobile easily brings to mind the risks attached. Besides, in Nigeria, it is a criminal offense to drive an automobile without having at least a Third-Party Motor Insurance cover (read more on Third-Party Motor Insurance cover “here“).

Motor Insurance also has the highest frequency of claims and like other classes of insurance, it comes with its own challenges.

As a loss adjuster, i witness on firsthand basis, the effects of people’s misconception about insurance and many times their deliberate attempt to swindle underwriters into paying a loss that never occurred or deceive them into paying more than is required. I however must also point out that it insurance penetration in Nigeria is very low and despite the level of awareness created by the key players in the industry, many people still do not believe it. It is at the point of claim that underwriters have the opportunity to prove that insurance is for real.

A claimant once insisted that he maintains his car with a particular standard auto garage and would not have his car repaired anywhere else. On my visit to the auto garage i requested for his service history from which it was observed that his claim was not true. Being a difficult client that he is we opted to pay the auto garage directly. It was at this point that he started to sing another song. Apparently, if he had been paid directly, he would have taken the vehicle to where it would be repaired cheaper thereby benefiting from his own loss.

Some areas of challenge with adjusting Motor Insurance claims.

  1. What constitutes a loss claimable under the Motor Insurance policy: Truth be told, if the policy wordings of a motor insurance policy are to be adhered to strictly, about 50% of motor insurance claims would be thrown out of the window.  The fact is, not every damage to your vehicle can be paid for by your motor insurance policy. A claimant once got back to where his car was parked only to discover that someone had drawn a long line on it using a sharp object. He reported a claim and requested that insurance should bear the cost of painting the said car. While it is true that the vehicle had been damaged, such losses are not covered by the motor insurance policy. Another that is like it is when an insured is effecting a complete body works on his vehicle and attempts to transfer the cost to his insurer.
  2. Challenges with determining the degree of indemnity: The purpose of insurance is to return you (as much as it is practicable) back to the position you were before the loss (not better than). Insurance can only repair that part of your vehicle that was damaged. Anything more is overcompensation. This implies that you cannot request your insurer to bear the cost of painting the whole vehicle because painting only the affected part could result to multi-shade of colours.
  3. The challenge of unrealistic expectation by the insured: A claimant once requested for a replacement vehicle having damaged his. Such offers of course doesn’t come with a standard motor insurance policy in Nigeria.
  4. Fraudulent intent on the part of either or both the insured and or the third party auto garage. Often times we have the cost of repairs being inflated unjustly either in value or in replacement parts or both. At other times, the damage claimed for did not occur and at other times, the subject matter of insurance never existed in the first place, yet the insured wants to be compensated for a loss that never occurred.

 

Thank you for reading. We would like to have your views and also know if this post has been of any benefit to you. Kindly leave a comment.

MY RIGHTS TO YOUR PROPERTIES…I PAID YOU OFF

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In an insurance contract, responsibilities flows between both the insurer and the insured. And with responsibilities comes duties and rights.  Indeed as an insured, you have the right to have your losses mitigated. The insurer also has the right to recover their outflow on your claim too.

Another of my responsibilities to my principal is to retrieve from an insured, properties which were subject of an insurance claim where the claim is being treated as a total loss (either actual or constructive) and the insured has been or is to be paid off. Continue reading MY RIGHTS TO YOUR PROPERTIES…I PAID YOU OFF

I WILL GO MILES FOR YOU…WILL YOU DO SAME?

 

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Insurance is like a romantic relationship. As in the latter, the parties involved in the former also have their expectations, duties, responsibilities and rights for the relationship to be mutually beneficial.

As an insured, having suffered a loss which is covered by the policy, you have the right to seek compensation from the insurer. So also, the insurer, having compensated you, has the right to recover their outflow where there is a negligent third-party responsible for the loss. Continue reading I WILL GO MILES FOR YOU…WILL YOU DO SAME?

EATING YOUR CAKE AND HAVING IT BACK

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Mr. XYZ took up a comprehensive motor insurance cover on his brand new car which he got for N7,500,000.00. Since the insurance premium payable would be based on the value of the vehicle, he decided to reduce the value to N3,000,000.00  so that he would not have to pay so much in premium.

Some months after, his car was involved in a ghastly accident and the cost of repairs was about N2,500,000.00. In settling his loss, his insurance company, having weighed the amount he was claiming to the sum insured, opted to treat the claim on a Constructive Total Loss(CTL) basis. By this option, it means that the insurer decided that based on their records, the vehicle was beyond economic repairs. Mr. XYZ was offered the sum of N2,800,000.00 (after all deductibles) in settlement of the claim.

Mr. XYZ found himself in a fix. The amount he was offered was not even up to half of the value of the car but he couldn’t afford to repair the car himself. However, accepting his insurer’s offer would require that he forfeits the damaged car to them in line with the conditions of the insurance policy.

You obviously cannot eat you cake and have it back. Continue reading EATING YOUR CAKE AND HAVING IT BACK

HOMEOWNERS INSURANCE POLICY – UNDERSTANDING WHICH LOSSES ARE COVERED

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We started a new series of discussion on Home Owners Insurance Policy last week and we examined the items covered under the policy. Having understood this, we now need to examine the degree of protection provided by the policy and those losses that the policy would provide compensation against.

Before we proceed, we summarize our last discussion below; Continue reading HOMEOWNERS INSURANCE POLICY – UNDERSTANDING WHICH LOSSES ARE COVERED

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