There are usually differences between the claim presented by the Insured and their expert and the loss adjustment proposed by the experts acting for the Insurers.
Based upon our own experience, at VANTEVO CLAIMS ADVISORS we know that these differences are due to the following five factors:
- Differences in measurements.
- Differences in unit prices.
- Betterment or concepts not attributable to the actual loss event are included
- Maintenance tasks are included.
- Salvage and recoveries are not taken into account.
Once the above differences have been clarified and corrected and an agreement reached regarding the appraisal of the loss, then you must refer to the Policy in order to agree the indemnity payable.
- Is the cover on an actual value or new replacement value basis?
If it is at actual value, then depreciation for wear and tear, age, obsolescence etc. will have to be applied to the replaced items.
- Is the Sum Insured adequate or inadequate?
In the case of the latter, unless the Average Clause is waived or the Policy is on a first loss basis, the Average Clause must be applied.
- Does the Policy have any Deductible?
If yes, then it must be applied.
To summarise, the differences between a claim and the agreed settlement must be clearly defined and analysed by the experts, since they have to stem from the five factors indicated above and from the conditions of the Policy.
Obviously if a timely and equitable agreement on the payable indemnity is to be reached, it will help a lot if the claim is correctly detailed, structured and documented. This is precisely the job that VANTEVO CLAIMS ADVISORS undertake in those loss events where we are contracted to act as the Insured’s expert advisors. This facilitates a swift, fair and professional agreement between the parties.