Accidents happen when you least expect them. That is why they are called “accidents” and there will always be a criminal element in society who believe the easiest way to obtain the goods they want is merely to take them. While you always hope the worst won’t happen, making a claim is the whole purpose of having insurance. It is to protect you and your business against financial losses when unforseen events occur such as theft, motor accident or fire.
Of course, your decision to lodge a claim does rest on the circumstances of the incident and how much damage was done. You may decide it is more beneficial in the long term to pay for the loss yourself rather than risk paying higher insurance premiums as a result of a claim.
Generally speaking, claims are usually settled quickly with little fuss. However, on some occasions claims can be refused, disputes between the various parties can occur and the process will become drawn out. Understanding the processes involved in making a claim, your rights and responsibilities and those of the insurer, should help keep the situation in check.
Depending on the nature of the incident or accident, there are different procedures you should follow to limit your risk and any further loss.
For instance, if your premises have been broken into, it is important to not only contact the police immediately and make a report, but also make sure action has been taken to reduce any further theft or damage by securing the premises, if possible.
You will have to contact the relevant professionals, such as a locksmith or glazier, to help you achieve this. The level of loss reduction achieved will depend on the amount of damage done to your business.
Your contingency plan will play an important part in how you react in an insurance-related event. The plan should contain guidelines which will enable you to know how to respond and what procedures need to be put in place.
You should then contact your insurer or agent as soon as possible. Be prepared to provide details of the loss, policy details and personal information. Expert staff will assist you with any questions you may have.
Have the following information on hand when calling about a possible claim:
Claimant information: Date of accident/incident, personal details, street information and date-of-birth
Coverage information: Policy number and name, business details, location details
Information on the incident: time, description, any witness details
General liability (if necessary): Owner of premises, type of product, address and manufacturers details.
In the past the usual process was for the insurer to then send you a claim form. You were then required to complete this as accurately, and in as much detail as possible, and return to the insurer. Some insurers have streamlined the process to cut out the need for the claimant to fill in a claims form, thereby speeding up the claims process for the customer.
You will need to divulge information regarding the loss and personal information whether in a claims form or over the phone. The more detail that you provide the faster your claim can be processed.
Theft and property damage procedures
If your premises are damaged, whether by arson or burglary, etc., you will need a plan of action. A good, basic action plan is highlighted in the following guidelines:
If you have business insurance, report the loss immediately and be prepared to provide an accurate description of the events/damages – such as time, date, circumstances, items stolen, evidence of forced entry etc. – storing all relevant information in a convenient place
Close out all current books as of the date of the loss and maintain a separate business log of extra expenses incurred because of the accident/loss.
Implement your contingency plan
Receive authorisation from your insurance company to remove damaged goods or debris, as a claims officer may need to assess the damage to arrive at a more equitable payment
Organise claims officers and/or other professionals, such as architects, builders and engineers to help assess the extent of any damage
If non-food stock has been damaged, separate damaged goods from the unharmed goods
Order a dumpster/industrial waste bin for debris or damaged stock
Secure the business from potential looters and weather damage
Use temporary signs to redirect parking and traffic
Restore utilities promptly. However, you will need to receive certification from a licensed electrician before reinstating electricity.
Be pro-active in the repair and replacement of resources
Consider making either a public or limited announcement advising any changes/alterations that will occur during the recovery process to lessen customer concerns and manage expectations.
Motor vehicle accident procedures
If you are involved in a car accident, there are some points which you should follow immediately after the accident to limit your liability as much as possible.
Depending on the circumstances, you should report the accident or incident to the police, particularly if your vehicle was maliciously damaged or stolen. Obviously, if the damage was caused by you reversing into an immoveable object, such as a concrete post, you will not need to contact the police.
If you had an accident that involved another vehicle, you should make note of the following details. (This will help in the processing of your claim and, if necessary, further investigation.)
Name and address of the vehicle owner (if not the driver)
Name, address and licence number of the driver
Insurance company of the other vehicle and the policy details
Registration number of the other vehicle
Description of the other vehicle and the damage it sustained
Name and address of any witnesses.
If the other driver has been injured, you will also need to ensure he/she receives medical attention. Make sure you keep a record of any first aid given at the scene, if possible. Witnesses will also need to be questioned and reports made whenever it is possible.
Employee injuries
Regardless of how many risk management practices you adopt to ensure the safety of your staff and customers, it is likely that, at some stage, someone will be injured on your premises.
This can be something as simple as an employee picking up a heavy box incorrectly and injuring his/her back.
Depending on the nature of the incident, ensure that proper medical attention has been given to the injured person. As this could affect your workers compensation insurance, make sure you keep accurate records of any first aid given and the condition of the employee at that time.
You will also need to interview any witnesses to the incident and make a report. If the employee is under medical supervision as a result of the incident, your insurer will also need copies of medical certificates.
Insurance investigations
Whenever an incident has occurred and the insured has indicated to the insurance company the intention to make a claim, the insurance company will usually assign certain individuals to investigate, such as an investigator or loss adjustor/assessor.
Under the General Insurance Code of Practice, insurers require investigators, assessors, collection agency and loss adjusters to:
Operate in a professional manner
Inform consumers of their status and the identity of the insurer for whom they are acting
Comply with the law and the Code of Practice.
Insurers must also ensure, as part of the Code, that each investigator acting on behalf of the insurer (not being an employee) has:
Been approved by the insurer
A current licence as required under relevant state legislation
Sufficient expertise to act in relation to the matter that they are investigating.
If an insurance assessor/investigator is called in they will usually visit and take control of the location and establish or confirm facts concerning the accident/loss.
Any investigation by an investigator or loss assessor should set out to establish facts and not have the establishment of blame as a primary objective.
Depending on the nature of the incident, they will look at a variety of different factors, such as:
Exact location of the incident
The general environment, such as whether it is light or dark, slippery, etc.
Details of any injured person
Details of the damage
Taking photographs of any damage
The names of possible witnesses.
Where applicable, especially in the event of an employee injury, they may also investigate the work systems in place at your business, including:
The personnel involved, their training, age, experience and position
Level of supervision
The nature of the work – routine, sporadic or incidental
Situation with regard to personal protective equipment, established rules, issue and use, correct type.
Establish the timing and sequence of events
Consider the need for any immediate steps necessary to prevent recurrence.
However, in some circumstances, particularly when it involves a “near-miss” or workplace injury, it can help your claim if you conduct your own investigation, particularly if you were on the scene when the incident occurred and can talk to witnesses while it is still fresh in their minds.
