The whole insurance claims process is fraught for the consumer. You should hear the horror stories of home owners making claims from TC's Yasi & Larry up our way. I'm sure its even worse for "flood" victims with the definitions of "flood", "rising waters" etc. After TC Yasi, I have friends who have had seven - yes seven - visits from loss adjusters assessing their claim, all with ludicrous ambit initial offers. The dumb thing was the then non-income producing (retired) ex-farm assets "no worries" but the house - what a nightmare.
Originally Posted by Cgcc
For us having a MV policy application wrongfully declined "due to fraud" was a nightmare, distressing for my wife, very time consuming, and difficult to rectify, and incurred significant unrecoverable costs to us! Plus it also had the potential of significant implications for my employment. Not to mention destroying a wonderful gift to our daughter whilst we placed the new vehicle delivery on hold until we could secure a policy. Fortunately RACQ accepted our policy application then Suncorp without any explanation "reviewed and have accepted your application" some two weeks afterwards.
Correct no loss until the claim is rejected, however they have been taking premiums - therein is the loss. The consumer has paid a premium for cover that most likely was never going to be accepted! The are making out that the policy holder has been fraudulent by not disclosing key information for them to fully assess the risk. BS!
How many small businesses have assets, plant, tools, materials stored at their home, or vehicles, plant, machinery registered to their home address! Food trucks etc? Many employees (Telstra staff Tech's & Liney's plus many more) and "contractors" are coerced into storing materials and vehicles at their residence.
My contention is that they are a specialist insurer with very substantial actuarial resources who calculate risk. We are "naive" insurance consumers. They are accepting the premium, they know the extent of the home based business situation, they make no attempt to assess the additional risk (if any) & they have the policy of rejecting claims on very dubious grounds ..... plus they place the onus upon the consumer to inform them of "matters they should know in the ordinary course of their business." They are fully aware of the extent of home based businesses and exploit a loop hole to their advantage.
If an entity accepts an insurance premium knowing full well that a high percentage of claims "may" be rejected due to the "high proportion" of home based businesses then the onus should be upon them to make reasonable efforts to identify the full extent of the "risk." They must clearly inform the consumer of such a critical material policy exclusion, not rely upon wording in an 84 page PDS that a typical or even a well educated consumer struggles to interpret.
Consumers should really read their Product Disclosure Statements to understand what they are paying for - you may be very surprised by what and how your interpretation of "new for old" or "like for like" differs from the insurers definition in the PDS. Good luck with getting a "fair" cash payout for "antique tools" unless they are listed specifically.
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