What Is An Insurance Claim?
An insurance claim is a formal request by a policyholder (you) to your insurer for coverage or compensation for a covered loss or insured event. Simply put, this means that a claim is what you will submit when something goes wrong.
When you experience a sudden and unforeseen event that costs you money, it is called a loss. Following a loss, you can ask your insurer or broker to pay you for what you have lost. This request or process is called a claim.
At the time of this claim, be prepared to submit information, whilst this can be challenging at times, you need to be aware that when information is not provided the insurance company may decline to even look at your claim due to the facts not being presented. Whilst this is at times a tedious experience and at the worst time, we would recommend for your own good that you push through and provide the necessary.
The insurer will either validate (approve) or deny (reject) the claim. If it is approved, the insurer will issue payment through the channels specified and the claim will be closed. Your policy will detail how your payout will happen in the event of a claim being submitted.
The whole reason you have insurance is to bring you back to the financial state you were in before your loss. This process is known as indemnification. If the loss is caused by something covered in your insurance policy, your insurer will indemnify you as the insured and they will pay you the value specified in your policy (less any excess/first amounts payable) or at times approve a service provider to complete the repair/replacement work where it may be required.
So how does it work? When you suffer a loss, you want your insurance company to pay for it. However, coverage is always detailed in your insurance policy, so if you are not covered for the event you encounter, they will, unfortunately, be unable to help. To combat this, always make sure your information and insured goods are up to date.
These are some examples of claims that you might make, depending on the type of insurance you have.
Vusi’s New Wheels
Vusi has just been able to buy his first car and he is so excited to show it off to those close to him! After lunch one afternoon, Vusi waves goodbye to his friends and takes a quick walk to where he left his car, only to find that it has been stolen.
In this moment, Vusi is SO glad he decided to get car insurance, so he knows that he is covered. The first thing he needs to do is call the police and report the theft of his vehicle by providing his registration number, VIN number, and a description of the vehicle.
After a few moments, Vusi remembers that he got a tracker installed. He calls his tracker company, gives them the car’s last known location, and asks that they activate the tracker and start tracking the car.
Last, but most definitely not least, Vusi calls his insurance broker and advises them that he needs to submit a claim. Vusi knows that the sooner he tells his insurer or broker, the sooner they can start processing his claim and the sooner he will be able to get a new set of wheels.
Vusi will need to submit a few documents during the claims process, including a picture of the police report, the case number, a copy of the vehicle registration, a certified copy of his ID, and a form that gives the insurer consent to access police records and border movements of his car. He might also be asked for the mileage, tracking device details, photos of the car keys, and a description of any marks or dents on the car.
The insurance provider will prepare an agreement of loss document detailing how much money is due to Vusi and how much will be paid directly to the bank. Once Vusi signs this document he will need to return it to his insurance company along with the car keys and the original registration documents. From there, Vusi will receive a payout and be able to get himself a new car in no time.
Alternatively, Vusi’s car could be located and recovered before the claim is settled. His car will have to be assessed for any damage. If there is no damage, Vusi will get his car back. However, if there is damage found on Vusi’s car, and repairs need to be made, the claim will need to be changed from a stolen car to a damaged car. Then the repairs can take place and Vusi will be riding in style!
If you ever find yourself in the same circumstance as Vusi, having insurance can change the outcome from a crippling financial state to either getting your car back or being able to afford to get a new one as soon as possible.
A hailstorm has damaged Bob’s house last night. It is going to cost thousands of Rands to repair his roof, windows, and stuff on his patio like furniture and his braai stand. Luckily, Bob has home insurance that covers hail damage. The morning after the storm, he calls his broker to make a claim. Bob expects that they will pay to repair all the damage, so he will be in the same financial state as he was before the storm.
What Bob does not realise, is that his cover is referred to as broadform insurance that provides comprehensive cover to his house, but his possessions are only covered by specified causes of loss (also known as perils). Unfortunately, hail is not a specified cause of loss for Bob’s possessions and therefore they cannot be covered in his claim.
Bob is expecting full coverage, but the policy he chose does not have the sufficient cover he needs for his possessions. This is when an adjuster would assist to adjust Bob’s claim to include only what is covered and pay out the claim, leaving Bob to cover the costs to replace/repair the outside furniture that was damaged in the storm.
The takeaway from this story is that it is best to make sure what you are covered for and increase or add additional cover if necessary. Having a broker would help with this as they can achieve the best cover for you with your insurer and make sure you are not left in a difficult spot in a terrible time.
It was always Fatima’s dream to own her own apartment in a complex. Having the best of both worlds, privacy and security, something a stand-alone house cannot offer today. Complex living can be called many things; Body Corporate, Homeowner’s Association, Share Block, etc. and it comes with many pros, but it has some cons too, something Fatima is about to find out.
On Sunday afternoon, while having lunch with her family, there is a loud noise and water starts pouring out of the wall. Unfortunately, water leaks are quite common in buildings that have apartments, especially when you have an upstairs neighbor that uses washing machines, showers, etc.
The first step would be for Fatima to establish where the leak is coming from and how to stop it. This is not as easy as it sounds because buildings are likely to have many pipes and appliances. Water can also travel through the walls before you notice any dripping in your apartment.
Fatima lives in a Body Corporate complex that has an insurance policy in place. It would be best for Fatima to check if tracing the source of the leak is covered. Once the leak has been traced, Fatima can move on to see who is responsible for the costs involved in repairs. Any pipes in the wall will fall on the Body Corporate to repair, along with any resultant damage made to the structure.
The tricky part about this is that if any of Fatima’s personal belongings got damaged, that would be for her to claim from her own insurance for the contents of her home. This may seem unfair, but the Body Corporate policy cannot do special favours for a few owners and only covers the fixtures of the owners on this policy.
If the leak is from something like someone leaving a bath running, this is considered as accidental damage and is covered by the Body Corporate policy. Fatima would have to contact her broker to advise what documentation is required to complete a claim to get resolution as quickly as possible.
Claims can seem scary at times, and we need to follow this process in one of the most stressful moments of our lives, whether it be for a stolen cellphone or a roof caving in, submitting an insurance claim should be looked at as helpful paperwork for the best outcome. Chat to your broker about the claims process they follow so that you are prepared if the worst does come to pass.