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The Value of a Loss Assessor.

I started in the insurance industry post university and gained an invaluable basic training in insurance claims at Eagle Star (yes a name from the past!). Part of the training was how the policy can be interpreted to provide cover. Nothing is ever simple, especially when policies are written generically for sale by brokers or online, without underwriting consideration being given to the householder or business who bought the policy. For claims handlers in an office based environment, everything seems black and white, but where there was ambiguity we often appointed a loss adjuster to look at the detail. A loss adjuster acts on behalf of the insurers as their eyes and ears. This role appealed to me, and I moved to work at Cunningham Lindsey Loss Adjusters in 1999.

When I finally made the decision to become a loss assessor in 2004 – and act on behalf of the policyholder not the insurer – this breadth of training was invaluable. It enabled me to interpret the policy to the policyholders benefit. Not for more than they are entitled, but to ensure that cover was not missed and they received the maximum that insurers were liable to pay.

Point of view is often critical. Insurers can sometimes view the policy through narrow eyes. More often than not this is a failure by the agents they instruct to view the claim. Video surveys by inexperienced validation firms, who are merely pointing an iPad but not providing technical expertise, invariably mean that the settlement offered is well below what will repair the damage. Critical issues are often missed that will have repercussions for the policyholder in years to come.

As an example, I was referred a client in Sussex who had water damaged oak floor in their kitchen from a washing machine. The insurer had offered to pay for the floor which was visible, but little more and asked the policyholder to sign and acceptance form. Unhappy with this and sensing this was not the full extent, they wrote to their insurer who was not very receptive. Once I visited, it was obvious to me that the floor ran under all parts of the kitchen units, so the kitchen would need to be removed. It was also evident that the kitchen units were glued to each other and to the granite worktop. This meant that the kitchen would likely need to be replaced.

After our report and opinion was submitted, insurers appointed a more suitable loss adjuster. When works proceeded, the sub floor was rotten (concealed by the oak) and floor joists also needed replacing. As expected the kitchen was replaced. The claim had suddenly gone from the £3,000 offered to around £35,000. Now this may seem excessive, but had the policyholder accepted the original settlement, the insurer would have settled the claim at a significantly reduced liability.

It is not that insurers were necessarily attempting to pay less, but by appointing poor agents they had not given the insured true indemnity. This is not typical of all insurers however increasingly if you pay a low premium, you tend to get a low claims experience! With the onset of virtual visits by insurers now that COVID is limiting site visits, I fear the worst.

Policyholders do not understand their rights and remedies. This is why the insurance claims process will always be weighted against the policyholder and where possible and where appropriate, you should always seek professional help from a loss assessor.

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