ISSUES OF INSURANCE CLAIM PROCESSES: What every policyholder must know

One major factor that is really damaging the reputation of insurance in Ghana has to do with claim settlement. An insurance claim is a formal request to an insurance company for compensation against loss or damage to an insured item or risk. A paid insurance claim serves to indemnify a policyholder against financial loss.

When an incident occurs, the first concern is the health and well-being of the persons involved. If there is injury, the priority is to ensure that the injured person(s) receives proper medical attention. If a vehicle is damaged in an accident, an insurance company recommends reliable workshops to make the necessary repairs. If a home gets damaged, the insurer should tell the policyholder how to contain the damage, and recommend professionals to fix it.

Insurance can be complex and confusing, especially when it comes to making a claim after suffering a loss or damage. Understanding the insurance claims process is where the value of insurance and the company you are dealing with becomes apparent. If you have never submitted an insurance claim before, then you might be wondering what to expect or the frustrations you might go through.

 

Claim Period

In Ghana the period limit to make a claim for injury is up to three years from the date of accident. Claim limit for death is also up to three years. For damages, the limit is up to six years from the date of accident.

The Claim Process
The first thing to do when a policyholder suffers loss or damage is to contact the police, especially if the loss or damage is due to theft, fire or a serious accident. A police report will be prepared which the insured has to include it in the insurance claim. Most often, if the policy is a motor comprehensive and no third party is involve in the accident, the police report will not be a mandatory requirement by the insurer.

The second important thing is to notify the insurer or broker of the loss and seek guidance. It is important to call your insurance company or broker from the scene of the incident if you can, while you wait for the police, or after you are safe. They will help walk you through the next steps and tell you what you need to send to them. In Ghana, insurance claims cannot be made over the phone without the insured filling a claim form.

The most common practice to file a claim is to write to the insurer or fill an accident report form provided by the insurer, which is the first step. If the policyholder is dealing directly with the insurer, then he or she has to go through all the stress before the claim is settled. If the insured has a broker, then the broker has to process the claim and make all the follow ups till the claim is settle. Failing to report the claim on time means the insurer may not pay for any additional loss or damage caused by the delay of the policyholder. If the policy document cannot be found, it does not cause for panic. Insurance companies have electronic copies of every policy. If policy was purchase through a broker, the broker should have the policy details on their files.

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When a claim occurs, there is some needed information and documents that the insured has to provide to the insurance company or through the broker in order to process the claim. First the information on the policy concern should be provided. If it is motor insurance, the name of the policyholder, his or her address and the vehicle registration number have to be provided. With this information, the insurer can verify and confirm if such vehicle is insured and it is still covered. If it is other policies such as fire, burglary, personal accident insurance, among others, similar verification will be done. If it is motor insurance, then the information needed is the particulars of the one who was driving the vehicle when the accident occurred. A photocopy of the driver’s licence is required to verify if the driver is qualified to drive the vehicle. If the driver is unqualified, the insurance company will repudiate the claim.

Also, the circumstances relating to the date, time, location, speed of vehicle, and the description of how the accident happened have to be provided. In the case where third parties are involve, information such as their names, contact numbers, items, extent of damage or injury have to be provided as well. If witnesses were available at the time the incident occurs, then their information will be required. If the incident was reported to the police, then the name of the police station and the officers who came to the scene should be provided. With all these information, the police report or in the case of fire, a fire report will be needed. Similar information will be needed if the claim is on other insurance policies other than motor insurance.

Once this information is provided and the insurance company has accepted the liability, the claim will be processed.

Do not admit Liability
When an accident occurs, the insured is not supposed to admit liability or make any payment, or offer payment without the consent of the insurer. If an incident occurs, it is the responsibility of the police to investigate and then identify the one responsible. Nevertheless, an insurance investigator examines matters pertaining to insurance claims that are suspicious or otherwise in doubt for some reason. Investigators in this field have differing specialties and backgrounds. Some insurance companies have their own in-house investigation teams while other companies sub-contract the work to loss adjusters. Although such investigations are usually conducted to combat fraud, very often investigators will be working simply to establish the circumstances of a particular claim.

Final Stage

Insurance companies have certain customised insurance policies that provide extra benefits with surcharge. Examples, there are some executive motor comprehensive insurance product in which the claim is settled the same day in which the claim was made. Some insurance companies provide temporal vehicles or apartments when policyholders of such customised policies suffer loss or damage till the claim is settled. Others provided free towing services for their clients when they purchase those customised policies. All these benefits come with extra premiums and it is restricted to comprehensive motor insurance alone.

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After all the needed information and documents are submitted to the insurance provider, the insured or policyholder will need to wait a few days until a decision is made. In the case of motor insurance, if the insured decide to repair the vehicle by himself or herself, it is a very good idea to have an adjuster look at the damage and provide an estimate before the repairs are done. In fact, the insurance provider will likely insist on it. This is important as it provides both the insured and the insurer with a solid idea what a reasonable settlement of the damages will be, thus avoiding any subsequent misunderstanding. Once the claim is settled, any additional or remedial repairs or charge will be paid by the policyholder.

In the area of theft or burglary, an investigation has to be done by the police and the insurance company’s in-house investigation team to establish the authenticity of the claim, and if possible arrest the culprit. For injury claims, doctor’s report would be required before the claim can be settled. If the claim is death and the policy is not Life Insurance policy but non-life insurance, there is no limit for the amount that has to be paid. The insurance company has to negotiate with the next of kins of the decease at a reasonable amount. There is no price on human life.

Repudiation

Policyholders of insurance most of the time get disappointed when their insurers decide not to honour certain parts of the insurance contract when claims arise. These are some reasons why a claim may be repudiated: when the person driving the insured vehicle has no valid driving licence, or is unqualified; where there was no insurance cover at the time of the accident; where there is no change of ownership of the insured vehicle or risk; when the claim is not submitted within the claim period; using the vehicle without the insured’s consent or for unauthorised purposes; and finally when the driver was drunk whiles driving.

It is important to write a letter of claim to your insurance company or broker when the unexpected happens. For theft and fire, it is advisable to notify your insurers within twenty-four hours so that evidence will not be tempered with.

Conclusion

People do not believe in insurance because they think it will be too tiresome to demand for claims whenever loss or damage occurs. Yes, claim processes and settlement may be frustrating. Nevertheless, if you think insurance is unworthy, try recovering from a disaster when you don’t have it.

Writer: Gideon Sarfo

Email Address: sarfo.gideon03@yahoo.com

Place of work: Tri-Star Insurance Services Gh. Ltd.

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