Tag Archives: loss adjuster

Loss Assessors, Loss Adjusters and the Perils of Confusing Them

One of the problems we occasionally come up against is that people don’t understand the difference between a loss assessor and a loss adjuster. Now, this might seem like a trivial distinction for anyone who hasn’t gone through the process of making an insurance claim on their building or contents insurance. Those who have been through this, on the other hand, will realise that confusing them is a bit like confusing an accountant with a tax inspector.

A loss adjuster works for the insurance company you have your policy with, and it’s their job to make sure their employer doesn’t end up paying out money unnecessarily. A loss assessor like Allied Claims, on the other hand, works for claimants like you on a case-by-case basis. Our job, therefore, is to make sure you get every penny you’re entitled to.

That doesn’t mean, of course, that the loss adjuster is the bad guy, any more than the tax inspector is, or the opposing lawyer in a court case. They have an essential job to do and, in our experience, they normally do it professionally and ethically. At the same, however, it’s important to remember that the loss adjuster isn’t on your side. Your loss assessor is.

What Do Loss Assessors and Loss Adjusters Do?

If you have an insurance claim to make, both the loss assessor and the loss adjuster get involved early on. The difference is that the loss adjuster will be involved whether you like it or not, whereas you’ll have to engage the loss assessor yourself. And the time to do that is right away.

This is because a loss assessor can look at the claim you’re making and ensure that there are no errors in it that could give the loss adjuster a reason to reject or reduce the claim. The loss adjuster will look at what you’ve sent and ensure that it corresponds to what’s specified in your insurance policy. If it’s valid, they’ll accept it on principle — but that doesn’t mean your problems are over.

Because the loss adjuster is responsible to the insurance company, they’ll try to keep any pay-out as low as can be justified. This is where an expert loss assessor will really come into their own. Because they know as much about the insurance industry as the loss adjuster (if not more), they’ll be able to counter any invalid arguments the loss adjuster makes and ensure you get everything you’re entitled to.

That’s not all you get from a loss assessor, however. If they offer a full service, like Allied Claims, they’ll also arrange the quotes you need from contractors and project manage the work, saving you from having to constantly take time off work.

Most people wouldn’t face a court without their own lawyer, or tackle the taxman without an accountant — unless their affairs are very simple. Few insurance claims are simple, so why would you face the loss adjuster without the support of your very own expert fighting your corner?

Cover for Whizz-Kids — Electric Bikes and Insurance

One of the big success stories of the lockdown has been electric bikes, with sales tripling during last summer. If you’ve joined the trend of whizzing along on a powered bike, you might not have much information — including what you need to do about insurance.

The legal definition of an EAPC (electrically assisted pedal cycle) is that its electric motor can’t have an output more than 250 watts and must cap assistance at the speed of 15.5mph. If it meets this requirement, anyone aged fourteen or over can ride it in public without needing a licence.

There’s also no legal obligation to insure an EAPC, as there is for a car or motorbike — but that doesn’t mean you should ignore insurance. After all, electric bikes can cost anything up to £5,000, so it makes sense to give yourself the peace of mind that you can make an insurance claim if it’s stolen or damaged.

In fact, you may be able to cover an electric bike under your home insurance, if you declare it as a single item. This process is normal for ordinary bicycles, but there’s likely to be a limit for an item’s value under your general policy. If you’ve gone for that top-of-the-range £5,000 model, you’ll almost certainly have to take out a separate policy.

What’s Covered by Electric Bike Insurance?

Although different policies vary a little, most will cover your electric bike for theft, personal accident and accidental or malicious damage. In general, if you bought your EAPC new, replacement will be on the basis of an equivalent new bike, while a second-hand bike will be compensated according to market value.

The insurer may offer additional cover, such as for third-party liability (in case of a claim made against you for an accident), accessories or roadside breakdown assistance. On the other hand, there are various situations where the loss adjuster is likely to turn down your insurance claim, including:

  • Wear and tear or damage not caused maliciously or through accident.
  • Theft of a bike that’s inadequately secured.
  • Any incident occurring while you were under the influence of alcohol or drugs.
  • Any claim where you’re unable to prove your ownership of the bike.

As in the case of any insurance policy, Allied Claims would strongly advise you to go through a reputable insurance broker, who can explain exactly how to make sure you’re covered for what you’re likely to need.

Don’t Let Your Phone Be the Insider on the Job

Scammers have always used whatever means are available to part you from your money, but the latest trick is to use your phone as the insider on the job. The type of fraud known as “sim-swap” (also sometimes called sim splitting, simjacking and port-out scamming) has mushroomed from 144 cases in 2015 to 483 in just the first half of 2020.

Sim-swap works by criminals collecting data about you in more familiar ways, such as exploiting data breaches of companies that hold details or stalking you on social media. This is then used to convince your phone provider to change your account to a phone they hold, allowing them to intercept messages from your bank and other sources, in particular those sent for two-step authentication.

In one recent sim-swap fraud, the scammers managed to clear £5,000 out of a victim’s accounts. If you identify the theft and contact your bank, they may refund the stolen money. It’s important to remember, though, that just like an insurer’s loss adjuster when you’re making an insurance claim, the banks may refuse to pay if they conclude that your own negligence has contributed to the problem.

How to Avoid Being the Victim of Sim-Swap

As with most types of scam, the best cure for sim-swap fraud is prevention. It only works if the scammers manage to get hold of information about you that will convince the phone company, so don’t make it easy for them:

  • Avoid replying to emails, phone calls or texts unless you’re confident about who they’re from.
  • Don’t be too free on social media with the kind of personal information often used for identification (e.g. date of birth, your first pet or your first school).
  • Use long passwords that combine letters, numbers and symbols and are difficult to guess.
  • Use a one-step app like Google Authenticator or a password vault such as LastPass.

If your phone stops working or you can’t access your bank or credit card accounts, the first thing to do is to contact your phone provider and bank to alert them of possible problems. You may not be in time to stop the loss of money, but taking prompt action makes it more likely that it will be refunded.

While this issue doesn’t directly involve insurance, it’s vital for your security to do everything possible to avoid being caught by the sim-swap scam. We at Allied Claims hope this warning will help with that.

Just When You Thought It Was Safe to Travel — The Occupancy Clause

After months of lockdown, it looks like holidays might not be so impossible this year as they seemed. Travel restrictions and quarantine rules are being relaxed, and the chances of being able to jet off to the sun are steadily increasing

But there is still a danger you may not have you may not have thought of — and this is nothing to do with Covid-19. It’s about your insurance policy.

Chances are you haven’t read the small print on your policy, or if you have, it was a long time ago and you’ve forgotten it. If your policy is typical, though, it’s likely to include an Occupancy Clause.

This puts restrictions on how long you’re allowed to leave the property unoccupied. If you haven’t met the requirements and you need to make an insurance claim, whether for fire, flood, theft or accidental damage, it’s possible that the insurer’s loss adjuster may turn down your claim.

What Is the Occupancy Clause?

Policies vary, but for most domestic policies and many commercial ones, the Occupancy Clause allows you to leave the property empty for thirty days, though it could be less. If the period is likely to exceed the limit, the Insurer must be notified, preferably in writing or by email.

There are also specified actions you must take. The most common are that the heating must be kept on, someone must make fortnightly visits and you must install an alarm. It’s vital to check exactly what your policy says, though, and make sure you know exactly what needs to be done.

This can apply to any circumstances when the property will be unoccupied, not just to holidays, and it’s particularly relevant to anyone letting out a property. The landlord must notify the Insurer as soon as the tenant has moved out. Perhaps the landlord’s making repairs or decorating before the new tenant moves in. This can easily stretch out beyond thirty days, so watch out if you’re about to make an insurance claim.

Whether your insurance is for a domestic or a commercial property, make sure you know your obligations under the Occupancy Clause. If you don’t, there’s a good chance that the loss adjuster will turn you down and leave you without a penny if you have to make a claim — and not even Allied Claims will be able to help you then.

Don’t Get Caught with Blocked Pipes

We’ve already had a taste of the autumn weather to come. There’s no chance of getting through this autumn and winter without at least a few storms, which means that it’s vital to be ready for them.

No, I’m not talking about battening down the hatches and stocking up on supplies — though, if you really want to do that, don’t let me stop you. No, I mean getting your guttering and downpipes ready for the rough weather to come.

Falling autumn leaves get blown around in the wind, and other debris gets blown with them., and some of this debris can end up in your gutters and downpipes. If it’s left, the rainwater can’t run away and could end up flooding your home, perhaps causing structural damage.

But that’s OK — you can make an insurance claim for any damage caused. Can’t you?

Perhaps not. If the insurer’s loss adjuster finds out neglect of your guttering has contributed to the damage, you could well find yourself having to foot the entire repair bill yourself.

Give Your Guttering Some TLC

Before the winter storms set in seriously, it’s vital to get your guttering and downpipes looked at and cleared out. In the case of the guttering, this can be quite straightforward, but you’ll need to rod all your downpipes to make sure they’re not blocked. At the same time, you need to check that nothing’s damaged in the guttering system, since this too could cause flooding of your property.

Getting all this done will be good for your home, but if you end up needing to make an insurance claim anyway (because of a particularly destructive storm, for instance) you’ll also need evidence to give the loss adjuster to prove it’s been done. If you hire a contractor, make sure you get fully itemised receipts. If you’re going to do it yourself, get someone to take photos or video footage of you at work.


Don’t Let the Burglars in While You’re on Holiday

It’s quite likely that, over the next couple of months, you’ll be heading off for a well-earned break. Whether your idea of the perfect holiday is action packed, or whether the only action you want is walking to and from your lounger by the pool, you want to come back with glowing memories. Not to find your home burgled.

That would be bad enough, but it could be even worse. Suppose you make an insurance claim for your lost valuables, only to find the insurer’s loss adjuster turns your claim down? That could happen if they decide you’ve contributed to the situation through negligence.

That would be a nightmare end to your dream holiday.

What Can You Do?

Some of the steps you can take to safeguard your valuables, or at least keep the loss adjuster off your back, are quite straightforward. Burglars watch for homes where lights don’t go on and off, curtains are never opened or closed, and the mail piles up. If you can get a friend, relative or neighbour to go into your home daily while you’re away, that will create the illusion it’s occupied.

Make sure that all your doors and windows have robust locks. That might not keep out a really determined burglar, but it gives you a far better chance, as well as safeguarding your insurance claim if necessary. And make sure all your valuables are securely locked away, preferably in a safe with a combination lock — and a combination that isn’t easy to guess.

If you have valuables in your home, perhaps in any case you should be thinking about alarm systems and cameras. Many systems are surprisingly inexpensive these days, and if you have something that can be checked on your smartphone, you can reassure yourself everything’s fine while you get on with enjoying yourself.

Allied Claims would like to wish you a great holiday — and hope it’s not blighted by burglars.

Summer Holidays and Social Media — an Insurance Danger Zone

Do you post about everything you do on social media? If so, there could be consequences. Quite apart from notorious issues such as your boss not seeing the funny side of your antics, your social media posts could also damage any insurance claim you have to make on your home.

You home insurance will almost certainly contain a Reasonable Care clause, which allows your insurer’s Loss Adjuster to turn down your claim if your negligence has contributed to the situation. For instance, if you went out leaving your door wide open and came back to find your possessions gone, the likelihood is that you’d get nothing.

Lately, however, insurance companies have begun applying the clause to burglaries that happen while the owners are away on holiday. They’ll search through your social media, and if they find posts about what a great time you’re having in Florida or Thailand, they’ll refuse your claim.

Why is Social Media a Problem?

It isn’t just insurers and suspicious employers who check up on social media. Increasingly, police forces all over the country are warning that tech-savvy burglars are using Facebook, Twitter and the rest as part of their research. Your innocent post about what a great time you’re having on holiday is a big, flashing sign to the burglars — “This house is empty.”

Of course, if you have robust security at home, it might be enough to keep them out, but not necessarily. Burglars who are up to date enough to use social media are likely to also be pretty good on the latest anti-security measures.

If you are burgled after effectively advertising that your home is available, your insurance claim isn’t going to get a sympathetic hearing from the Loss Adjuster. So play it safe, and wait till you’re safely home before you share all those great holiday memories. Then, if despite everything you do get burgled while you’re away, Allied Claims will have a good chance of getting you the compensation you’re entitled to.

Have You Rodded Your Pipes Yet?

Autumn is a dangerous time for your guttering. Falling leaves get blown around in the wind, and other debris gets blown with them. And some of this debris can end up in your gutters and downpipes. If it’s left, the rainwater can’t run away and could end up flooding your home, perhaps causing structural damage.

It’s time to get rodding.

Preventing damage to your home should be enough reason, but failing to clear your gutters and downpipes could prevent you from making an insurance claim. This is because there’s usually a clause in your policy specifying that you have to get your guttering cleared and rodded at least once a year.

It’s not enough to do it, though. If you’re making a claim, the loss adjuster will require proof before allowing it to go through. If you feel confident enough to do the rodding yourself, you could get someone to take pictures of you. Or even take selfies — but remember that safety comes first.

If you’re hiring a contractor to rod your pipes, it’s vital you have a receipt. This isn’t always as straightforward as it might seem, as some contractors prefer to work cash in hand, with no documentation. That might be cheaper in the short term, but it could end up costing you a lot more, if you have nothing to show the loss adjuster.

Care for Your Roof

Your roof does a vital job protecting you and your home, and it’s essential to take care of it. It’s not just the guttering and downpipes that need regular attention. If you end up making an insurance claim for a leaking roof, you might be in trouble if you haven’t had it checked lately.

This requirement is often written into insurance policies, especially if you have a flat roof. Even if it’s not explicitly stated, though, failure to look after your roof could still mean you end up paying for the entire cost of repairing flood damage to your home. All for the lack of a bit of rodding.


Safeguard Your Business with Key Person Insurance

Any business, but especially a small one, can be vulnerable to losing a key person in its operations, whether permanently or for an extended period. This could be the owner or founder, but equally it could be someone in a crucial position who has knowledge and experience that would be difficult to replace.

Losing a person like this to serious illness or death can be terminal for the business. If this is the owner, for instance, it could prove impossible to afford the costs of bringing someone in to run the company. This would be devastating both for the lives of the owner’s family and for employees and customers.

This is why insurance companies offer Key Person Insurance (traditionally referred to as Key Man Insurance). This means that, if the crucial person dies or is incapacitated, the business can make an insurance claim to help it survive the crisis.

How Does Key Person Insurance Work?

Anyone involved in the business can be designated a Key Person, and you can have as many as you like — though, of course, a separate premium will have to be paid for each. If this person should unexpectedly die or develop an illness recognised by the insurer’s Loss Adjuster as a critical illness, the business can make an insurance claim.

The normal result will be a lump-sum pay out. This would, for instance, allow you to recruit a new person with the required expertise, or perhaps pay for training an existing employee to fill the role.

It’s important to be clear exactly what the policy does and doesn’t cover. For example, a policy may be just for critical illness, or it may offer life and critical illness cover. In the latter case, it’s also important to bear in mind that this isn’t the same thing as personal life cover. The Key Person may need a separate life policy, especially if they have a family. Your insurance broker should explain exactly what you’re insured for.

Do You Have Insurance Cover for Non-Forced Entry to your Home or Office?

There are many circumstances in which you may give your keys to someone providing a service. This could be a cleaner, a babysitter or a builder, plumber or electrician doing work in your home or office.

Most of the time, these people are completely reliable, but it only takes one exception to cause you trouble. Can you imagine coming back to find someone you trusted has made off with your property? Could it get worse?

It could. If you try to make an insurance claim for the loss, you’re likely to find it rejected. This is because the insurance company’s Loss Adjuster will point to it being a “non-forced entry”, which isn’t covered by most domestic or commercial property insurance.

Is There a Way of Getting Covered?

Any company that sends employees into customers’ homes should cover this risk in their insurance policy — but that doesn’t guarantee they’ll have done so. One of the checks you can do when choosing a service provider is to ask to see their policy.

Even so, it can still go wrong, since the policy is only any good if the company is paying the premiums at the time of the incident. The alternative is to discuss the matter with your insurance broker, who should be able to find you a policy that does cover this kind of insurance claim.

Even then, though, you aren’t home and dry. In order to ensure the Loss Adjuster won’t refuse your claim, it’s important to notify the insurer whenever you’re going to give a service provider access to your home. This is a requirement of all policies that cover non-forced entry.

This is a very real issue. In a recent case Allied Claims is aware of, a homeowner ended up out of pocket by £48,000 after being burgled during renovations, because the insurer hadn’t been informed. Be sure you don’t make such an expensive lapse.