08/11/2024
A necessary evil â the top 10 reasons why claims arenât paid
By Andy Lees and Tony Gimple of Risk Group UK
According to figures from the FCA, a staggering 23% of claims are rejected by insurers, with some firms refusing to pay some 45%!
The majority of people regard insurance as a necessary evil, and thatâs just as true for landlords as it is anyone else. After all, we pay our premiums every year but the first time we need to make a claim it seems as though the insurer is looking for any reason not to flash the cash and/or delay paying up as long as possible.
Truth be told, insurance companies are there to pay claims â thatâs the reason they exist â to provide the capital you need when you can otherwise least afford it, i.e. insurance is the one investment that pays the most when you need it the most.
So, why does it sometimes go wrong and we find ourselves fighting a battle that we can least afford?
To help, weâve compiled a list of the main reasons why claims arenât paid which also happens to be the most compelling case for not going it alone and instead using the services of an insurance broker whose role is to work for you at time of proposal and in fighting your corner when things go wrong.
Here are the 10 most common reasons for insurers to refuse/reject (repudiate being the technical term) your claim?
1. The policy was not in force when what you are claiming for happened
In most cases policies run for 12 months at a time but its all too easy to miss your renewal date which could lead to a gap in cover. Should that happen, you simply wonât be covered. That might be OK for a minor loss, but if for example there were a fire or flood then you could be left tens if not hundreds of thousands of pounds out of pocket.
2. The policy is invalid because you provided incorrect information
All insurance policies are based on you providing the correct information, but if for example the property in question is an HMO and not a single let, or its owned by a company and not you as an individual, and you fail to disclose that, the insurer would be within their rights to invalidate the policy, these are called material facts and form the basis of any insurance contract.
3. You failed to disclose relevant information when you applied for, or renewed, the policy
Non-disclosure of a material fact is probably the biggest reason for claims being repudiated. Examples could be failing to disclose that youâve been bankrupt or have made an arrangement with your creditors, the property in question has or is subject to subsidence, youâre letting to asylum seekers, that its subject to a Rent-to-Rent agreement or similar, or that youâve been refused insurance in the past or had special terms applied.
4. The item is not covered by your policy
Its easy to think that everything is covered, but not everything. Risks such as damage from war, certain natural disasters, damages caused by gradual wear and tear, or the insured property is left unoccupied for extended periods without advising insurers. Terrorism cover is a policy that can be added onto an existing policy but does not come as standard.
5. An exclusion clause means that you cannot claim
Its common practice for insurers to exclude claims arising from the insured not taking reasonable care. Likewise, requiring a claim or notice of breach to be made within a specified time frame, as well as setting a monetary cap on damages or excluding certain types of losses, such as indirect losses or loss of profits are standard exclusions.
6. You failed to update your insurance details when your circumstances changed
No one said that being a landlord was easy, especially if thatâs not your fulltime occupation, but you have a legal duty of care to inform the insurer of any change in your circumstances or to the properties youâre insuring as this could influence and underwriters decision towards the risk in question.
7. You have missed some of the instalments of your premium
Any businessman will tell you that cashflow is king, which is why many landlords pay premiums on a monthly basis. Trouble is, if for any reason you fail to pay, the insurer is within their rights to not pay the claim. If you canât afford to pay on an annual basis, then always opt for a premium finance facility. That way at least, if you do miss a payment, itâs to the finance company and not the insurance company and they can be flexible to your circumstances.
8. You have not followed the claims process correctly
The devil is always in the detail, and insurance companies can be pedantic when it comes to correctly following process. Failing to report incidents promptly or lacking adequate evidence to support a claim can lead to rejection.
9. You have not complied with the policy terms and conditions
All insurance policies contain terms and conditions that you obliged to follow. These can be maintaining the property, including the outside, fixtures, fittings, plumbing, gas, ventilation, and electrical wiring. Another example is water damage, and you may need to take extra care with pipes outside the property or in the loft and ensure that water tanks etc are lagged. Landlords may also need to tell tenants to keep the property at a minimum temperature of 12°C during the winter.
10. You have exaggerated the claim and are trying to claim for more than you should.
Insurance companies and their loss adjusters are pretty switched on, so thereâs little point in trying to gild the lily when it comes to a claim. That said, it may be advisable to appoint a loss assessor who works for you and not the insurance company to get the right settlement but the final decision always lies with the insurers.
Summary
Thereâs a far greater chance that your claim will be disputed if youâve arranged the insurance yourself as opposed to doing it through an insurance broker, for the simple reason that any broker worth their salt will not only take the time to fully understand your real needs, but theyâll ensure that the cover and the carrier are a perfect match.
One word of warning though, the necessary evil that insurance may be, please donât be tempted to buy on price alone, as the contingent capital market is an exemplar of that old adage, being that you only get what you pay for; and cheap doesnât always equal good.
What most people forget, is that an insurance policy is a legally binding contract between you and the insurance company. Both you and they are governed by the Insurance Act 2015 which imposes a range of duties on both parties, not least of which is for all concerned to act in good faith aka uberrimae fidei for the classicsâ scholars amongst you.
What next?
To find out more about how Risk Group UK can help you to get your property business back on its feet when disaster strikes, contact Andy Lees Andy Lees [email protected] (07786 707827) or Tony Gimple [email protected] (07974 099221), or visit https://www.riskgroup.uk/.