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THE CHALLENGES WITH MOTOR CLAIMS ADJUSTMENT (PT.1)

Motor Insurance is about 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 claim 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 many people do not believe in insurance and 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.

Areas of challenge with adjusting Motor Insurance claims

  1. What constitutes a loss claimable under the Motor Insurance policy: Not every damage to a vehicle can be paid for by your motor insurance policy. As a matter of fact, if underwriters were to go by the strict wordings of motor insurance policies, over 50% of motor insurance claims would be treated as “not claimable”. 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 was damaged, such loss is 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 in “multi-shade of colours” – now, this is quantifiable. A claimant was involved in an accident that resulted in damage to the rear booth and bumper of his car. The point of argument was when the estimate of repairs submitted included the cost of painting the entire vehicle instead of the damaged area. While it is indeed arguable that painting the affected parts might make some parts of the car appear newer than the others, painting the entire car would also amount to the insured benefiting from his loss, and that is against the principle of indemnity. At best, the insured is made to contribute to the cost of painting.
  3. The challenge of unrealistic expectation by the insured: A claimant once requested a replacement vehicle having damaged his. Such offer of course doesn’t come with a standard motor insurance policy in Nigeria. Another claimant once insisted that is motor insurance policy be responsible for the cost of servicing his car following an accident which had nothing to do with any mechanical component of the car,
  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 inflated unjustly. At other times, the damage claimed for did not occur and at other times, the subject matter of insurance does not exist, yet the insured wants to be compensated for a loss that did not happen. I once had a case where investigation revealed that the insured instructed the repairer to further damage the vehicle so has to enable him get more benefits.
  5. Non-availability of adequate and verifiable database. This particular challenge is not peculiar to the Nigeria insurance industry alone, it cuts across virtually all other sectors of the economy. Recently, the insurance regulatory body in Nigeria, NICOM, has made giant stride in this regard by the introduction of the Nigeria Insurance Industry Database platform. However, there still exist cases where there are as much as 2 to 3 insurance covers on a particular vehicle by different insurance companies. There has been cases where an insured lodged a claim on the same vehicle and incident with four different insurance companies.

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

3 thoughts on “THE CHALLENGES WITH MOTOR CLAIMS ADJUSTMENT (PT.1)”

  1. Excellent insight on Motor Insurance Claims. Situation is same in India where there is nexus between Workshop + Insured + Loss Assessor+ Insurance Co’s own employees. The problem is more when there is Cash Less Settlement ( means direct payment to the Repairer).

    On one of the point I difffer with your observations. In my opinion ” loss to car by scraching by some on when it was parked”is payable since the loss is due to Malacious act of some one and in India our Motor Policy covers such losses. I am not aware whether motor policy is Nigeria covers such Malacious Losses or not..
    Thanks,
    Naveen Marwah

    1. Naveen Chander Marwah, thank you for your comment.
      Indeed Malicious Damage is covered under motor insurance.
      You would however agree with me in the example cited that Malicious Damage is difficult to prove. What if the scratches were done by a minor out of sheer childishness, how do one prove that it was malicious?
      Each case would have to be handled based on its own merits.

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