Insurance Claims FAQs
Author(s):LAC Lawyers
Publish Date: April 18, 2008
Q. Is flood covered under my domestic insurance policy?
A. Normally the answer is no, although in some cases limited flood cover is given and it may be limited either by way of a sub-limit or by way of a percentage of the total sum insured.
Q. My property was insured for $300,000 and I have a claim for $250,000, yet the insurance company doesn’t want to pay the full cost of repairs saying that I am uninsured because the proper sum insured should be $500,000?
A. In all cases in which average or co-insurance may apply you should seek the services of an experienced insurance lawyer. Different formulas apply in both cases but fundamentally the principal is much the same as there will be a proportional reduction in the amount of loss relating back to both current sum insured and the value at risk. Sometimes the problem may be exacerbated by the builder who is being used to conduct the repairs.
Q. What happens if I don’t properly disclose to my insurer my previous claims history?
A. Where it is relevant and it should be disclosed the issue will become one of non-disclosure of material fact which may allow the insurer to void the policy from inception.
Q. What happens when your insurer instructs an investigator to investigate your business loss, home contents or motor vechile claim and you are asked to submit to a recorded interview with the investigator and/or your insurer requires you to produce your telephone records and bank statements?
A. Your insurer is suspicious of your claim as to compliance with your duty of disclosure or of attempted fraud on your part. Your insurer may or may not have reasonable grounds for their suspicion. You need to obtain our expert legal advice before agreeing to attend any such recorded interviews.
Q. What happens when your insurer denies your business, home contents or motor vechile claim?
A. You need our expert legal advice without delay. Claims are often denied for the wrong reason or because of a lack of proper information supplied to your insurer by their assessor, adjuster or investigator. The only way to overcome this is to seek our independant legal advice.
Q. I took my car for repairs and they left it unsecured outside the workshop from where it was stolen. What can I do?
A. If there be a lack or want of care by the workshop owners then you should retain a solicitor to make a demand against them including their insurer and if they do not respond positively to this then sue them for a breach of their duty of care to safeguard the vehicle.
Q. My company was carrying some drilling work in close proximity to some power lines following which there was a major blackout. A claim was made against me by the electricity authority and I put it into my insurers who have refused to pay stating that as I had not reported it at the time they were refusing my claim. What do I do?
A. Ask the insurer to refer the matter to internal disputes resolution and if that fails to obtain a positive response then retain a lawyer. The facts suggest that no other work was being carried out in that area by any other electricity provider and provided you can establish that you were drilling in the precise spot over and above the lines that were affected then you would appear to have a genuine claim which is actionable against your insurer even if it was reported late as they have suffered no prejudice.
Q. I am in business and recently made an insurance claim for damage to stock. Unfortunately a window was left open and a number of garments suffered accidental water damage. My claim has been denied. Is there anything you can do for me?
A. Yes. Under most contracts of insurance the building or contents are covered by storm, tempest and rainwater if they are defined events wording or will be covered under accidental loss or damage. Unfortunately there are a number of insurers who really do not understand their policy wording and therefore the claim may be denied.
Q. Recently I took a couple of my newly born pups to see a local vet where they contracted a virus and subsequently died. What should I do?
A. To put it simply, you should contact the vet and say that you are looking for an apology and compensation. If the animals were not particularly valuable then it would not appear to be a case in which it would justify you retaining a solicitor. Do the best you can in the circumstances.
Q. What happens if someone communicates a full transcript of what a member of parliament said in parliament through the media which has had the effect of seriously impacting my business?
A. This does not amount to defamation as it is the record of a conversation the subject of parliamentary privilege and where true there is no damage at law.
Q. Recently my son was overcome by a smoke machine at a school function which triggered a severe asthma attack, resulting in him being rushed to hospital and admitted to intensive care where he responded to treatment. Is there anything we can do in the circumstances?
A. No. Although you have the potential to pursue a personal injury claim on behalf of your son, the fact that he is in the process of making a full recovery precludes you taking action for damages at common law.
Q. I was involved in a car accident and made a claim against my insurer. I have my own business and no criminal record but they have denied my claim because allegedly they have received a report which contradicts the manner in which the accident occurred. What are my options and can you assist?
A. Yes. Unfortunately insurance companies sometimes get things very wrong. It may be they have reacted to a report which is unsubstantiated or they are relying on information provided by a witness who really did not see what they are suggesting. Irrespective provided the claim is a genuine one there is every reason to believe that we can it paid.
Q. I have recently bought an expensive motor vehicle from a dealership and they said they would include insurance as part of the deal. Subsequently I had an accident and asked the dealership to provide me full particulars of the insurance they had effected. Am I entitled to this information and do I have an action against them?
A. Yes. You are entitled to obtain this information as it formed part of the contract of sale of the new motor vehicle to you. Secondly, it appears they may have been involved in misleading and deceptive conduct and if this occurs it is actionable under the Trade Practises Act.
Q. I have recently had my motor vehicle claim knocked back because it was stolen when I had parked it outside my premises. Is my insurer with whom I have been for the last couple of years entitled to do so and can you help?
A. Yes. There is no basis whatsoever for an insurer to knock back your claim because it is geographically approximate to your home and although your vehicle was parked outside this does not prevent the incepted cover from operating.
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