Business insurance claim denied- without customer submitting claim

M

MarySmyth

Guest
A friend has a shop and recently had a break-in - small quantity of cash stolen. They enquired with broker if this was covered and received an email stating the low amount that would be paid out if claim submitted- as insurer could not cover any higher.

They subsequently requested a claim form some weeks later and were advised that claim had already been denied- and copy of formal letter from the insurance company was produced.

He is confused- as broker initially said that they consulted with insurer when the shopowner told details- but he wasn;t expecting a claim to be processed based on an email.
 
what exactly is the question? Money claims tend to be subject to a reporting condition, normally about 14 days otherwise its invalid. So he asked his broker. His broker notified it. Your friend didn't have to action it even if the claim was lodged. So what is the problem?
 
Friend advised broker after money stolen and queried if it was covered under policy. Broker said they checked with insurer and a 500 limit applied. He waited for Garda update and then requested a claim form, as non sent out- was told that insurer had already notified broker than claim was denied!
 
Hi Mary

Is he better off not claiming €500 and keeping his clean no-claims record?

Presumably if the claim was denied, a reason was given? What was the reason?

He pays a big fee to the broker for advice, so he probably should take the broker's advice on this one.

Brendan
 
Cash stolen

Thank you kindly for feedback.

Claim denied on basis that money not in safe- but he never got to the stage of submitting the claim/ full facts. Would have even expected that a rep from the insurance company would have visited premises, garda report, etc

He is aggrieved that the claim was denied- without ever getting to the stage of submitting one- and noting that he probably wouldn;t have based on the low 500 limit.#
 
If they made a decision based on the incorrect facts, he can submit a formal claim.

It's unlikely that the insurance company would visit his premises for a claim where the maximum liability was €500.
 
Insurance company error in 'assessing' claim

Appears my friend was correct to query how the 'claim' was denied when it hadn't been actually formally reported- both the broker and insurance company issued their 'Final Response Letters' with apologies...
 
Without my acting as a 'Smartie', this could be a case of the First Loss might be the best loss.

From what has been posted, sure the Insurance Company might allow for a claim to go through, but on renewal date they might simply be unwilling to quote. And with a claims record, a different Insurer might be the cost of the theft in additional premium.
 
'claim'

hence the reason I have suggested to friends to pursue via FSO and have all on record of broker and insurer
 
I'm not disagreeing with you Mary at all, and I do understand the position your friend is in, but in the first instance, to obtain a decision from them will take three or four months and if they do find in the Insured favour, it will still cost them.

This looks like a case of 'The operation was a total success, but the patient died' syndrome. Think about it.
 
There's something not right here. If the broker notified the insurer of the claim and the facts were incorrect, they could reasonably go back to the insurer and notify them of the correct circumstances and problem solved.

Also the policy wording would allow for arbitration before a Final Response letter came into play at any point.
 
Facts

Customer had theft and reported to Gardai etc

Then queried with broker what they were covered for. Broker reverted saying threshold max.

A month later when the customer had update from Gardai, they asked about making a claim- Broker replied saying claim had been considered and denied - turns out that this was unknown to BOTH the broker and customer- who understood initial query was just that - an enquiry.
 
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