QUESTION
We have been experiencing a rapidly growing number of claims where assessors and loss adjustors are displaying a strong bias against the client in favour of the insurers. We all know they are supposed to provide an impartial opinion, but this just simply isn't the case for a lot of our claims.
We have assessors interpreting contracts (not insurance), deciding what agreements actually were between tenants and landlords, in complete contrast to what the tenants and landlords have advised their contracts were meant to achieve.
Others are manipulating repairers' comments to suit a 'this isn't a claim' narrative, and when we question the repairers, find the assessor has skewed what they actually said, to suit a 'not a claim' scenario in perfectly valid claim situations.
We are seeing assessors using "Is it possible that this damage could have happened in a different way?" and using that as a means to decline a claim or require clients to lodge a second claim/second excess for what is clearly a single valid claim.
We have other cases where assessors have totally ignored a repairer's report regarding the cause of damage eg. repairer says a 'massive power surge', the assessor says "Damage is not consistent with a power surge so no cover." Go back to the repairer who says 'one of worst power surges they have ever seen', yet the assessor still recommends a claim decline. Insurer and assessor both saying things like 'You know what repairers are like" and "repairers can say anything' not meeting any kind of burden of proof to decline. We even have photos of scorch marks around burnt out speakers etc.
We also have assessors blindly sticking to their original opinion and recommendation to insurers, even after we have shown them the errors they have made.
Who are they answerable to? What body can we register complaints to when an assessor manipulates statements and outright ignores repairers to minimise or decline a valid claim?
EXPERT ANSWER: Jeff Crawford, Portfolio & Reinsurance at Ando Insurance Group
Where there is dispute around a loss adjuster's recommendation or interpretation of a claim, please refer it back to the claim's handler at the insurance company.
Most (if not all) companies will engage and discuss/address concerns you, as a broker or a client, have. Any supporting documentation or facts to support a discussion will assist.
