Insurance claims: How, what and why

By Herman Liebenberg – General Manager, Insure City Insurance Brokers

It’s inevitable that at some point we all have to navigate the claims process on our insurance policies regarding assets covered. For those not familiar with the process, this can be very intimidating. This article will explain the process and provide guidelines to make it as smooth as possible.

This process varies from insurer to insurer and broker to broker, and we’ll cover the different options:

This mainly applies to either specific claims, which with InsureCity, would be geyser related claims or any claims happening outside of business hours. Insurance companies prefer to have certain claims (as with the geyser example) reported directly to them, reason being they have contractors who are approved and can be sent out immediately to reduce any consequential damage. Most insurers offer a benefit should the incident be reported to them directly as opposed to the client appointing their own plumber. Ideally, clients don’t have a limit on their geyser replacement nor have to pay any excess. This obviously varies from insurer to insurer but in most cases, there are incentives for specific type of claims. Please speak to your broker or your insurer to obtain clarity.

We at Insure City have an “Incident report” form. This is used to get as much information as possible from the claimant regarding the claim being submitted. This form clearly defines what the claim is about, what section of your policy it affects and what is required from you in order to get the claim reviewed and processed without any delays.

Example of what is required from you regarding the information on the form:
. Personal information
. Cause of incident
. Date of incident
. Checklist as to what is required: Invoices, Damage report/s, Certificates of Compliance if required, case number, etc.
. Third-party details if applicable

This is to ensure that we as brokers have all the relevant details beforehand when approaching the insurers with as much information as possible. This removes any delays, enabling the insurer to open the claim and process it.

There will always be scenarios where it’s either quicker or more convenient to just pay a contractor or replacing an item before opening an insurance claim. Please note that this could have risks involved.

Take the burst geyser: As client, you realise the geyser has burst and know a local contractor. You appointment him since it happened over a weekend and pay him for his services. Monday you open a claim to reimburse you for the costs.

The onus of the geyser replacement being according to regulations now shifts to you as the client, meaning in future, if the geyser wasn’t installed correctly, it could negatively affect future claims. Secondly, each insurer has limitations on the geyser replacement based on the policy wording and the size of the geyser. Say you replaced a 100 L geyser and it ends up costing you R12 000. When you submit the claim, you could be made aware that the limit as per your schedule is R8 500 for a 100 L geyser excluding excess. Meaning if the excess is R1 500 you will only be reimbursed R7 000 of the total R12 000 you spent. Please keep this in mind.

Your broker will have a record of your claim and keep track of the process. All questions from the insurer will be raised to the broker and answered on your behalf. Should they not have all the required information, they will ask you to provide it, and forward it to the insurer.

If it’s an easy and straightforward claim, the insurer will approve and either send out a contractor to do the work or reimburse you, should you have already have the damage repaired. In some instances the insurer would like to have a look for themselves to make sure the claim is valid and to assess the magnitude of the damage. In these cases, an appointed assessor will contact you and make an appointment to visit the site.

Once the assessor’s report has been completed and the necessary done, this will be handed to the insurer and they will make a call on what should be repaired, what the total costs are and if it’s a valid claim or not. This normally causes a slight delay in the processing of claims so we encourage our clients to be as comprehensive on the “Incident Form” as possible to mitigate the need to appoint an assessor.