Claims Investigations.

Loss Adjusters and Claims Investigators should always have a system in place when investigating Red Flag Claims. It is not sufficient to simply call by appointment and ask questions and call this an investigation.

It is important to have gained as much knowledge regarding all aspects of the claim as possible before any face to face discussion takes place. This is not to say that there should be any delay in dealing with the claim as speed in visiting the scene and collecting data and information is crucial in any investigation.

Local knowledge plays a big part in any investigation so research the area if it is unfamiliar ground. Don`t be afraid to talk to locals who often visit the scene of major events and are often in possession of important information that they are quite happy to share if asked. 

Always be aware of the Data Protection Act when gathering information. Your job is to gather information and not to supply it to unauthorized persons. 

The use of Conversation management and SE3R (Forensic solutions) is a tool that every claims investigator should have a solid understanding of.

Never attend a meeting or scene unprepared and always have your questions prepared before your visit. It is also vital to be able to see flaws with regard to explanations and be capable of responding with further relevant questions where necessary.

Always remember that the policy holder may be completely innocent of any wrong doing and just because a claim may initially look suspicious there may be a perfectly good reason for this. it is extremely important that policy holders are not made to feel they are being accused of anything.

The purpose of the exercise is simple to get explanations where certain aspects of the claim were initially classed as Red Flag issues.

 

How does the Claims Process work when I use a Loss Assessor in Ireland?

The Claims Process:

Starts with you or your representative ( A Loss Accessoror often your Insurance Broker) informing your Insurer that an incident has occurred and that a claim will be initiated under the terms of the policy.

You will have to show that the damage was caused by a peril that is covered under the terms of your policy. An example of this would be a plumbers report in the eventof a leaky water pipe.

Your Insurer will in most cases appoint a Loss Adjuster to represent them in the claims process. Small valued cases will usually be desk topped(handled by internal staff).

The Loss Adjuster will want to call and view the damage. He may be a direct employee of the Insurer, or often he will work for an outsource company who handle the claim for Insurers with delegated authority to settle the claim. He will, however, have to operate under a strict service level agreement between the Insurer and the outsource company.

Your Loss Accessor will represent you when the Loss Accessor visits the scene and will agree as much as possible regarding the scope of the damage with the Loss Adjuster. He will also prepare the claim to be submitted (for larger claims he may well use a Quantity Surveyors and or other professionals where necessary).

Having submitted the claim your Loss Accessor will negotiate the best possible settlement on your behalf.

Gerry Carter CDIP LA, CIP.
Carter Claims.

What types of Claims can a Loss Assessor help with?

Here at Carter Claims, we can help you with any of the following calims:

  • Fire, Explosion, Lightning, Earthquake Claims
  • Smoke Damage Claims
  • Storm or Flood Claims
  • Escape of Water Claims
  • Burst Pipe Claims
  • Impact Damage Claims
  • Theft / Malicious damage / Vandalism Claims
  • Third Party Claims
  • Subsidence or Heave Claims
  • Freezing Claims
  • Escape of Oil Claims
  • Accidental Damage Claims
  • Contractors All Risks Claims
  • Business Interruption or Loss of Profit Claims
  • Agricultural Claims
  • Forestry Claims
  • Travel Insurance Claims
  • Liability Claims

And if there is something not mentioned above, that you would like us to  look at, please get in touch. 

What is a Loss Assessor?

What is a Loss Assessor?

A Loss Assessor is a Professional registered with the Central Bank of Ireland, who is  Appointed by the Policy Holder to represent them in the claims process.

The settlement is always paid directly to the policy holder (via your broker where you used one to get your Insurance policy). There can be exceptions to this in certain circumstances i.e. where Banks or leading institutions are involved.

What does a Loss Assessor do?

Loss Assessors will handle all aspects of the claims process, including;

a) Meeting with insurance company representatives or their appointed Loss Adjusters
b) Preparing the claim
c) Negotiate the best possible settlement of the claim
d) Deal with cases where a claim has initially been declined by the insurance company or where problems or delays have occurred in agreeing settlement