What can I do if the insurer agrees to pay some, but not all of my claim?

There may be many reasons why the insurance company may pay some but not all of what you perceive to be the full value of your claim. In general, the most common reason is where our assessment of the extent of damage differs to your assessment. The type of problem will depend on the specifics of the claim, the nature of the insurance provided and also on the specific cover available under the relevant policy. In general, if we decide to pay some, but not all of your claim we will provide you with written reasons for our decision. This is important because you need to determine what specific terms of the policy and what specific evidence we are relying on to not pay the entire amount you believe we are liable for. Disputes between consumers and their insurers about the extent of damage will be resolved in favour of whichever party provides the most convincing evidence.

 

George’s Story: George's roof was damaged by a severe storm. George claimed on his home building insurance for the damage with us. Andy a former builder, who was hired by George, believed that the roof needed to be replaced and that the amount we were offering him was not sufficient to replace the roof. George requested that we provide him with written reasons for our decision. When George read the written reasons he saw that we were relying on an expert report that stated the roof could be repaired and did not need to be replaced.  George requested that we provide him with copies of the expert reports and quotes we were relying on.  When he read our report and his report he found that the reports were contradictory. The report that he had taken from his builder included damages that did not exist and as a result the amount was higher.  George asked to have a report by an independent assessor who had confirmed that the quote of the insurance company was the correct one and that the roof could be repaired. This also reduced the time needed for full reinstatement.   

Tags: reduce, refuse

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