Claims Management

Most people are aware that the law requires that parties to normal commercial contracts exercise good faith.  Most people, however, would be surprised to know that the law requires parties to an insurance contract to exercise Utmost Good Faith.  The difference has arisen because, with normal commercial contracts, the parties entering into the contract are able to see what is being purchased and have an opportunity of inspecting it.  With a life insurance contract, the insurer is only giving a promise that in the event of certain things occurring (ie the life insured becoming disabled); the loss of income will be reimbursed. The laws that govern commercial insurance products are to a large extent part of the wave of consumer protection legislation enacted in recent years.

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Today, one would imagine that with all the consumer protection schemes in place, making a claim on your personal insurances (most particularly income protection) would be a very straightforward and simple process.  Unfortunately, this is not always the case.  The table below lists some examples.

In the last 12 months we have managed claims for; Repair of Shoulder Rotator Cuff, Stress/Depression, Lateral Tibial Plateau Fracture, Fractured Clavicle, Multiple Rib Fractures, Interstitial Lung Disease, Peridiverticular Abscess and a disc prolapse and discectomy.  All claims were honoured and direct credits were made to our client’s bank accounts at the first ...

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