Insurance Law is a complex area which requires a good understanding of tort and contract before addressing the precise legislative environment which governs this industry. The Insurance Agents and Brokers Act, the Insurance Contracts Act and the Financial Services Reform Act impact heavily in this area.
Lawyers are often instructed to assist with a wide range of matters including policy drafting, policy revision, advice on policy wordings, acting on a wide range of claims, negotiating settlements or litigating matters. Where claims have not been properly assessed and quantified we rely upon LAC Loss Adjusters to do this.
We are available to assist with the following:
Agency and Broker Agreements
All Property claims
Aviation
Building Warranty
Business Interruption
Claims Management
Claims Resolution
Class/Representative Actions
Contractors All Risks
Directors’and Officers’Liability
Engineering
FSRA Compliance
Financial Claims (Burglary, Theft, Loss of Rent, Advance Profits)
Marine/P&I claims
Negligence Cases
Personal Accident and Sickness/Disability
Policy Drafting and Interpretation
Product Guarantee
Product Recall
Professional Indemnity
Public and Products’ Liability
Recoveries
Risk Management Strategies
Insurance - Disputed/Denied Claims
One of the most problematical areas in Insurance Law is the area of Disputed/Denied Insurance claims. Although there are a number of mechanisms to deal with contentious insurance claims many of them still end up either in a tribunal or court. We have appeared in the CTTT in New South Wales; VCAT in Victoria and the Local, District Court and Supreme Courts in NSW and the Magistrates, County and Supreme Courts in Victoria. We have acted in contentious matters where claims have been disputes, denied or are allegedly fraudulent. We have provided advice and acted for clients on contract works, engineering, legal liability, marine and all material damage or property classes of insurance. Whether claims are property or liability considerable expertise must be brought to bear to successfully resolve them. Property claims are the most frequent and may be categorised as follows:
Building and Building Warranty
Commercial
Corporate
Business Interruption
Domestic
Motor
Travel
The majority of our work in this field is advising clients on the operation of insurance policies and how the best outcome can be achieved. Whether a matter involves aviation claims, broker agreements, business interruption, property claims, financial claims, insurance fraud, insurance litigation, negligence cases, policy drafting, professional negligence, recoveries, risk management or statutory interpretation of various acts which operate in the insurance field, do not hesitate to contact LAC Lawyers for proper advice.
Insurance Claims
Although we get involved in a wide range of insurance matters one of the most frequent areas in which we are retained involves insurance claims. Interestingly we are approached by clients to represent them on both life and general insurance matters. All too often insurers refuse to pay claims based on the misapplication of the facts and material presented to them. Unfortunately they are often missing vital information because they are relying upon either investigators or loss adjusters who lack the requisite skill and experience to obtain all relevant facts allowing them to be put before the insurer. Alternatively the quality of claims staff is so poor or they have been given little opportunity to acquire the necessary skills to undertake their work properly. Irrespective the outcome is the same, the claim slows down and finally it is refused.
This problem is far more prevalent with general rather than with life insurance due to the frequency of claims made. Although many insurers have made substantial attempts to overcome this problem there are still some who frequently deny claims on an extremely tenuous basis. Unfortunately most solicitors have little knowledge of property damage claims and the methods adopted to secure information provided to insurers. Without this knowledge it makes it extremely difficult to properly advise clients whether insurer or insured. All insurance claims rely upon the validity of facts applied so that the policy can be properly applied to ascertain whether the claim fits within the terms and conditions of the policy. It does not matter whether you are dealing with domestic or commercial claims, irrespective of their size the same principles apply. The only real difference between the two categories is that the numbers are larger with commercial claims with consequential losses sometimes being covered by business interruption insurance.
For fire and general claims, irrespective whether domestic or commercial, problems are often encountered with the quantification of the loss. That is, in principle the insurer accepts that a genuine claim has been lodged but it is the assessment of quantum and the adjustment of it which causes the problems. They can start with simple problems of valuation through to large commercial losses irrespective of the type of entity involved where there has been substantial damage to a wide range of property and it has not been effectively dealt with. One of the major areas of concern for insurers and therefore insured's is the treatment of smoke-damaged plant and equipment. The question becomes – can it be effectively cleaned and or repaired such that the performance characteristics of it are not impaired. Of course the insurer will argue that it has been whereas the insured may not. A problematic area is encountered when dealing with repairers such as lift companies who always seem to take the view that nothing can be cleaned or repaired and therefore replacement is the only option available. Sometimes claims will be encountered where plant and equipment has been written off in the books of account of the relevant entity and it has been assessed as having no value including residual value. Irrespective how the problem arises it will always get back to what is the appropriate indemnity value which will cost you real money if you do not satisfy yourself as to what your legal entitlements are.
Most practitioners are unaware that there is a difference between personal sickness and accident policies and disability ones. The former is a general insurance product, the latter a life insurance one. Recently there has been an increase in the number of these claims which have been referred to our office. Normally they relate to the time at which the insurer was notified and whether or not the disability amounted to a pre-existing condition. These cases normally involve some complicated medical condition such as cancer, epilepsy or even Alzheimer's disease. Many of these claims are made under some form of group, life or disability scheme, which often causes problems for the insurer. Of particular importance here is the onset of the condition and just because an insurer refers an insured for medical assessment that does not always mean the matter is final because we have seen cases in which the medical assessment has failed to detect the condition at an early stage although there were symptoms present.
Our personnel have a long association with the insurance industry and we always strive for fairness and equity on our clients’ behalf. We give clear, concise advice on success prospects. We focus on achieving early resolution of disputes and where this is not possible litigation may be the only means left open to our clients.
In some cases alternative claims management strategies need to be considered which may assist to reduce cost whilst producing the proper outcome. All client instructions are welcome.
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