Insurance broker: An agent acting on behalf of the insured (not the insurance company) who negotiates the terms and cover provided by the insurer in the insurance policy.
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Indemnity insurance may sound like complex legalese, but at its core, it's a straightforward and crucial protection for businesses of all types and sizes. Simply put, it's a form of insurance that shields a business from bearing the full brunt of financial losses due to lawsuits or claims made against it. - read more
Professional indemnity insurance is an essential safeguard for practitioners and businesses that provide expert advice or services. This type of insurance helps to protect professionals against legal costs and claims for damages from an act, omission, or breach of professional duty in the course of their work. For Australian professionals, where litigation is increasingly common, it's a pivotal component of risk management. - read more
Insurer Held Accountable for Overseeing Claim Delays
Insurer Held Accountable for Overseeing Claim Delays
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Following a detailed review by the Australian Financial Complaints Authority (AFCA), it has been determined that the insurance giant QBE must compensate a policyholder to the tune of an additional $65,000.
This ruling emerged on account of identified delays, by the insurer's assigned loss adjuster, that stalled crucial repairs to a fire-damaged bed and breakfast in Tasmania.
In agreeing to honor the insurance claim post a fire incident on September 23, 2022, QBE acknowledged its obligation to both demolish the compromised structure and oversee the property's reinstatement. Initially, the insurer had distributed $130,000 to the insured, forecasting a year's duration for business interruption.
Nonetheless, progress hit a snag soon after QBE commissioned a third-party loss adjusting firm, named CG for confidentiality. CG had hired an agent, BH, who diligently issued progress reports until his unexpected departure from the company. This personnel change triggered a lapse in communication, yielding only sporadic updates and substantial reconstruction delays.
Documents from AFCA suggest that despite receiving the go-ahead from Tasmanian Heritage, CG was still seen mulling over quotations for the demolition demanded by the situation. As the troubling latency persisted, QBE intervened by employing an alternate loss adjuster, which also saw BH once more at the forefront, nonetheless under new employment.
Both QBE and the claimant concede that reconstruction endeavors are now underway; nevertheless, they anticipate the project's culmination only by the latter stages of the present year. According to the claimant, prior to June of the previous year, no substantial restoration had been set in motion.
Beyond just the heritage stipulations, the AFCA acknowledged the project's intrinsic complexities, which extend to concerns around asbestos.
It cited "considerable, inexplicable delays" predominantly ascribed to CG as well as its delegates, particularly following BH's exit.
The AFCA, while absolving QBE from being directly at fault for the setbacks, does hold the insurer accountable for the oversight of their appointed loss adjusting entities. Where control lapsed and significant delays ensued, the insurer should have, according to the authority, demonstrated greater vigilance and requested explicit elucidation of said delays.
The authority elucidated that although QBE is not to blame for the turnover of personnel or ill health among its agents, it bears the responsibility for ensuring continuity of the repair process. It explicated that disregarding or faulting its agents for inadequate monitoring is unacceptable.
Topping off their directive, the authority also mandated QBE to pay the claimant an additional $3000, acknowledging the non-financial havoc wrought, such as the distress and frustration due to the renovation hold-ups.
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An individual's anticipation of a serene vacation in Hawaii was met with a grievous twist when wildfires ravaged Maui, leading to an urgent evacuation and unplanned expenses. A customer of Mitsui Sumitomo ventured to the Pacific paradise only to have plans upended by nature's wrath. The ensuing insurance claim denial sparked a dispute which has now been resolved by the authoritative voice of the industry’s dispute resolver, leaving a glaring reminder of the importance of scrutinizing insurance options. - read more
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