Claims Procedure

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Experiencing a loss or damage can be stressful. At Agostini Insurance Brokers Limited, we aim to alleviate that stress with a straightforward and transparent claims process. Our goal is to ensure that you receive the support and compensation you deserve in a timely and efficient manner. Below, we outline the key steps in our insurance claims procedure, ensuring you know exactly what to expect at every stage.

Claims Handling

Claims Procedures

Learn more about claims procedures for various risks.

Covers all risks of physical loss or damage to scheduled property subject to the terms, conditions and exclusions of the policy.
In the event of a loss, you should do the following:
  1. Take all reasonable steps to secure and protect remaining property as well as to minimize loss or damage to machinery/ property and disruption to the business.
  2. Immediately identify and obtain details of all employees and/or witnesses who were on the spot at the time of the occurrence.
  3. Leave as much of the evidence as possible available for inspection by the Loss Adjuster providing that this does not cause further damage or danger.
  4. With regard to physical damage losses, unless an emergency, do not undertake repairs to property until first discussed with the Adjuster.
  5. In the event of urgent remedial steps being required, keep accurate records and sketches / photographs or video recording to prevent later disagreements as to the extent of the remedial measures that were necessary.
  6. It is essential to furnish accurate details of the incident as far as possible and submit such details without delay, in order to give the Loss Adjuster an opportunity to investigate the circumstances of the accident whilst the facts are still fresh in the minds of all concerned.
  7. Nominate a person(s) to lead the restoration task and assign specific roles and responsibilities to required personnel.
  8. If damaged is caused by a suspected defect, check similar equipment.
  9. Consult with Architects, Engineers and Quantity Surveyors to determine the extent of damage and obtain the relevant estimates.
  10. Obtain quotation for removal of debris, if applicable.
  11. Obtain information from local or foreign suppliers on both the availability and replacement cost of Stock, Plant, Machinery, and Equipment.
  12. Where possible, obtain agreement from the loss adjuster on all actions to be taken and the process for settlement request. Do not commit to a significant purchase or expenditure without the prior approval of the loss adjuster or insurer
  13. Consider measures to expedite the repair and or replacement process and any other possibilities to mitigate the loss and its impact
This policy affords cover for damage and losses as the result of forcible and violent entry into the premises.
In the event of a loss, you should do the following:
  • Report the matter to the nearest Police Station. Ensure you note the details of the Police Officer taking your report, and note also the time and date of your report.
  • Secure the premises if required, in order to reduce further losses.
  • Obtain and complete the necessary claim form from our Offices.
  • Take an inventory in order to establish exactly what has been stolen and the extent of any damage to the premises.
  • Prepare and present to us a detailed statement of claim, together with copies of invoices and estimates to substantiate amounts being claimed. The list of missing items can be submitted on a separate sheet of paper, if necessary.
  • Substantiate the total value at risk on
  • each item of insured property.
 
Keeping accurate records of the items at your facility will greatly aid in the substantiation of your claim. Serial and model number, copies of invoices and other such information not only assist in settling the claim, but may also help the Police in their recovery efforts!
Under the terms of the Policy, claims falling into this category arise as a direct result of destruction or damage to property, and are entertained only after liability under the material damage policy has been admitted or a claims settlement made.
The outcome of the Business Interruption claim in both financial magnitude and length of the period of interruption may be influenced substantially by the action taken immediately after the loss occurs, and as such, it is in everyone’s interest to take quick action to mitigate losses.
In the event of a Business Interruption loss, you should do the following:
  • Identify the areas of financial loss
  • Discuss with us the possibility of:
  • The use of alternative premises
  • Alternative source(s) of supply
  • Salvage sale
  • Any additional expense, which you feel if incurred will minimize the loss of your Gross Profit
  • Staff requirements in prevailing circumstances
  • Savings in standing charges, e.g. telephone, water, electricity, Internet.
  • Adjustments for trends and special circumstances affecting the business
  • Turnover achieved for the benefit of the business, other than on the premises
  • Set up separate books of accounts for recording extra expenses incurred to minimize loss
  • Establish with the Insurer/Adjuster the probable period of interruption
  • Record all trends or circumstances affecting the business during the interruption period
  • In attempting to continue trading, do not incur expenses over and above what the business will possibly have lost in Gross Profit
In establishing your statement of claim, it will be necessary to provide the following accounting information:
  • The turnover achieved in the interruption period
  • The turnover achieved in the similar period in the last financial year
  • Standing charges, as defined in the policy, taken from the last completed financial year
  • Total turnover for the last financial year
  • Wages
TIP: These requirements highlight the importance of careful pre-loss planning and information management, so that if and when a loss does occur, the required information can be easily obtained.
Covers all risks of physical loss or damage to money while being transported to and from a Bank and while on premises. Losses will include hold-up, robbery and/or theft.
In the event of a loss you should do the following:
  • Notify the Police immediately
  • Prepare notice in writing to us stating the circumstances of the loss
  • Take immediate steps to ascertain the full extent of claims and obtain all particulars and documents of evidence to substantiate your claim to insurers
TIP: There are several things you can do in order to greatly reduce the likelihood of suffering a cash loss.
  • Staggering timings and dates of bank visits so that they are unpredictable to the observer.
  • Try as much as possible to reduce the amount of cash carried by an unprotected person – if large quantities of cash must be moved, consider having an armored guard service instead of an employee.
  • Small, regular deposits are preferable to large weekly ones.
  • Having a system whereby cash is put in a locked safe (with a deposit slot) at specified intervals would reduce the amounts lost in a hold-up or burglary, provided that the key to the safe was kept off-site, of course.
Covers all risks of physical loss or damage to scheduled property subject to the terms, conditions and exclusions of the policy.
The following documentary evidence is required in order to process a claim:
  1. Complete the related claim form affixing company stamp
  2. Provide copy of invoice for the damaged / lost item(s).
  3. Obtain a pro forma invoice for the same or similar make and model of the computer equipment that is damage or stolen
  4. All incidents of larceny must be reported to the Police and the receipt provided. Please note the “Locked Vehicle Clause” (see policy for details) which is applicable to laptops.
  5. Technician reports are required for physical loss or damage to computer equipment
  6. Retain any damage computer equipment for further inspection by Insurer / Reinsurer/ Loss adjuster
  1. Immediately notify AIB as soon as you become aware of an incident or an allegation of a wrongful act.
  2. Immediately submit to AIB any letter or notice of claim from a third party or through their solicitors any writ, summons, proceedings, pending prosecution or inquest. Unless approved by Insurers (due to court imposed deadline), documents should be forwarded unanswered.
  3. Insurers will appoint legal counsel to take the appropriate action and to liaise with the Insured to gather evidence and defend the matter.
  4. Ensure that deadlines identified in legal correspondence is adhered to.
TIP: It is important that liability is not admitted. Do not make any offer, compromise, promise, payment or settlement without written consent of the Insurer.
Indemnifies you against loss by larceny, fraud, Guarantee embezzlement or misappropriation upon the part of any employee:
  • Immediately upon discovery of the loss, or reasonable cause for suspecting a loss, prepare notice in writing, of particulars of the acts or defiance of the employee which must be submitted by Insurers.
  • Notify the Police
  • Take immediate steps to ascertain the full extent of claims and obtain all particulars and documents of evidence for insurers, to substantiate claims
  • Obtain all information which will lead to the whereabouts, if unknown, of the employee
  • All monies due to the employee/suspect to be deducted from the amount being claimed.
Time is of the essence under this coverage. All claims must be reported within three (3) months of discovery. Discovery must take place within six (6) months, (or as specified in the policy document) of the expiration of this policy, or death, dismissal or retirement of the employee involved.
This Policy Affords cover for losses which arise from Fire & Explosion, together with added Perils such as Earthquake, Hurricane, Riot & Strike, Flood, etc..
In the event of a loss to fire or a special peril, you should do the following:
  • Take reasonable steps to secure and protect the remaining property
  • Implement contingency business plan and advise us on how you wish to proceed
  • Consult   with   Architects,   Engineers   and Quantity Surveyors to determine the extent of damage and obtain the relevant estimates
  • Obtain quotation for removal of debris
  • Obtain information from local or foreign suppliers   on   both   the   availability   and replacement cost of Stock, Plant, Machinery and Equipment
  • Prepare and itemized list of all real and personal property damaged as a result of the loss. Keep separate worksheets and files on all loss details.
  • Present a detailed Statement of Claim with supporting documentation.
  • Keep us informed of any developments as they arise
  • When   meeting   with   Insurers/Adjusters, establish agreement as to the nature and extent of salvage. Sell or dump as agreed.
TIP: Diligent contingency planning can result in significant benefits to your business should a loss occur- levels of damage, downtime and recovery time can all be positively affected by having a good plan.
Covers all risks of physical loss or damage to goods while being transported to and from your premises as well as to customers and from suppliers. This would include losses due to collision, hold-up, robbery and theft etc.
In the event of a loss you should do the following:
  • Notify the Police immediately
  • Prepare notice in writing to us stating the circumstances of the matter
  • Take immediate steps to ascertain the full extent of claims and obtain all particulars and documents of evidence to substantiate your claim to insurers
TIP: The following factors will influence both the frequency and severity of Goods in Transit loss:
  • Adequate packaging materials
  • Care in loading and unloading
  • Using the proper equipment for the job
  • Special care with fragile items
  • Caution in carrying high valued goods and in moving goods through areas of high crime
  • Use of security guards on trucks for those items to high value
  • Secure unattended vehicles
A Group Health policy will reimburse plan members for covered expenses incurred as a result of an accident or illness, according to the Schedule of Benefits limits noted in the policy. A Group Life policy provides a predetermined sum of money to a named beneficiary in the event of death of a plan member while an employee of the company.
Medical Claims – documents required
  • Completed Claim Form (duly stamped and signed by the attending Physician/Dentist)
  • Original receipts for incurred expenses, indicating prescription number, Patient’s name, date of purchase, name and quantity of drugs
  • Claim Forms should include the following information:
  • Policy number
  • Employee’s Certificate number
  • Company stamp
  • Plan Administrator’s signature
  • Claims should be submitted no later than ninety (90) days from the date expenses were first incurred.
Death Claim – documents required:
  • Completed Claim Form
  • Certified Death Certificate
  • Certified Birth Certificate
  • Life Insurance Certificate
In the event of death by accident, a Coroner’s report is required in addition to the above.
TIP: Documentary proof of attendance must be supplied with respect to a child or children under the age of 19 years and attending an Accredited College of University

Homeowners Comprehensive

This Policy Affords cover for losses which arise from Fire & Explosion, together with added Perils such as Earthquake, Hurricane, Riot & Strike, Flood, etc..
In the event of a loss, you should do the following:
  • Take reasonable steps to secure and protect the remaining property
  • Consult   with   Contractors, Architects,   Engineers   and/or Quantity Surveyors to determine the extent of damage and obtain the relevant estimates
  • Obtain quotation for removal of debris
  • Submit claim form with itemized list of all real and personal property damaged as a result of the loss and quotations for repair or replacement (as applicable).
  • Obtain a Technician’s Report for any damaged electronic items that you have insured. These items must be kept for inspection by the adjuster.
  • Keep us informed of any developments as they arise.
  • When   meeting   with   Insurers/Adjusters, establish agreement as to the nature and extent of salvage. Sell or dump as agreed.
Covers loss or damage to the hull of a ship and its tackle, passenger fittings, equipment, stores, boats, and ordinance.
The following documentary evidence is required in order to process a claim:
  1. Contact person and telephone number
  2. Date and time of loss
  3. Cause of loss
  4. Loss estimate
  5. Obtain/secure full and detailed statements from eye witnesses on the circumstances of the accident.
  6. In the event damage caused by another vessel, obtain the following:
a. Full information on the offending vessel i.e. name and port of registration, owners and addresses, details of any Marine Protection & Indemnity policies.
b. Statements of full liability in negligence by the captain of the vessel and undertaking by him and/or the local agents on behalf of the vessel to settle full cost of repairs.
c. In the event that the captain or local agents fail/refuse to give admission of liability and undertake payment for cost of repairs where such repairs appear not to be significant, advise Harbour Master and Immigration Office so that efforts can be made to prevent the vessel from sailing until favourable arrangements are made for settling cost of repairs.
d. Where the damage appears to be substantial, advise Legal Department or external legal counsel immediately so that legal action can be taken to obtain the arrest and detention of the vessel.
Coverage for watercraft. It protects the insured from liabilities, from bodily injury, or property damage arising out of the use, or ownership of declared vessels.
The following documentary evidence is required in order to process a claim:
When the Client’s property or facilities suffer damage by third party ocean-going vessels, the following information must be provided:
  1. Date and time of loss
  2. Cause of loss
  3. Property location
  4. Property involved
  5. Loss estimate
  6. Contact person and telephone number
  7. Obtain/secure full information on the offending vessel i.e. name and port of registration, owners and addresses.
  8. Obtain/secure full and detailed statements from eye witnesses on the circumstances of the accident.
  9. Obtain/secure statements of full liability in negligence by the captain of the vessel and undertaking by him and/or the local agents on behalf of the vessel to settle full cost of repairs.
  10. In the event that the captain or local agents fail/refuse to give admission of liability and undertake payment for cost of repairs where such repairs appear not to be significant, advise Harbour Master and Immigration Office so that efforts can be made to prevent the vessel from sailing until favourable arrangements are made for settling cost of repairs.
  11. Where the damage appears to be substantial, advise Legal Department or external legal counsel immediately so that legal action can be taken to obtain the arrest and detention of the vessel.
Covers marine shipments (including air and Insurance inland marine shipments) against loss or damage while in transit.
The following documents will be required:
  • Bill of Lading
  • Shipper’s Invoice
  • Certificate of Insurance
  • Rejected Steamship claim
  • Landing Certificate or Surveyor’s Report
  • The Landing Certificate will be either non-delivery of white slips issued by Port Contractors
Short landed Cargo
In each instance claims must be supported by evidence to this effect. This may take the form of the Port Contractor’s ‘white slip’ or as the Ship’s outturn report
Non-delivered Cargo
This is in fact cargo that has been outturned from the vessel, but is not delivered on application due to some reason. In such cases, a ‘white slip’ is issued by the Port Contractors. Reasonable follow-up attempts should be made to have the authorities state their position on the matter.
Cargo delivered – bad condition
Where fact cargo is delivered in apparent bad order it should not be accepted without obtaining a noted receipt as to its condition at the time of delivery at the Port. The consignee should also note this on the Bill of Lading when signing. Some attention must be given to this detail, as damage may occur to the goods during inland transit.
Surveys – damaged cargo
Requests for surveys should be made promptly. Goods delivered to warehouse in apparent good order should still be examined upon receipt to determine condition.
Normal policy coverage terminates on delivery at consignee’s warehouse!
Air Shipments
Notice of claim must be given within a reasonable time after taking delivery of the cargo. In some cases, that may be as short as seven (7) days. The airway bill will stipulate time periods allowed.
 
TIP:
  • No rejection of a valid claim upon the Ship-owners (through their local agents) should be accepted.
  • All claims on ship-owners must be properly stated
  • Claims on ship-owners, Port Authorities and insurers must be presented in writing within three (3) days of delivery.
Covers minimum third party liability limits required by law, and depending upon the level of additional cover purchased, may include cover for fire, theft, and damage to your own vehicle.
In the event of a loss you should do the following:
  • Report the accident to the nearest Police Station, presenting them with your driver’s permit, certificate of insurance, and a written statement of the circumstances of the accident. (Make a note of the Police Officer’s name and number who is taking your statement, as this information will be required on the claim form.)
  • Complete the Claim Form, answering all of the questions and attaching a copy of the driver’s statement, together with those of any witnesses
  • Obtain an estimate for repairs to your vehicle, and submit same to us.
TIP: Some important points:
  • Do not authorize repairs to the vehicle until it has been seen by the insurer and/or adjuster!
  • Prompt claims reporting are absolutely necessary.
  • Never admit liability to third parties
  • Vehicle should be maintained in a road worthy condition, with particular attention being paid to brakes, tyres and lights
  • Allow a reasonable time for the insurer/ adjuster to view you vehicle
Provides indemnity in the event of injuries, disability or death caused solely by violent, accidental, external and visible events. It is different from life insurance and medical & health insurance
The following documentary evidence is required in order to process a claim:
  1. Immediately identify and obtain details (proper name and contact information)/ statements of any witness who were on the spot at the time of occurrence, this report would form part of your claim submission
  2. Complete the related claim form affixing company stamp, along with Copy of ID, Medical and Fitness Certificates. Documents should not be accumulated, and ought to be forwarded as received to AIB
  3. If claim results in any Permanent Partial Disability, a medical report from the treating physician including full details will have to be submitted.
  4. In the event of accidental death, the following documents are to be submitted:
  • Death certificate
  • Birth certificate
  • Copy of identification
  • Copies of identification of beneficiaries
  • Birth certificates of beneficiaries, if there are any name changes of the beneficiaries – affidavit or necessary legal documents to support same
  • Coroner’s report
  • Police report
  • Completions of the relevant claim forms
Covers liability to third parties arising our of your products or operation
As soon as you become aware of an incident which may give rise to a claim, it is imperative that you:
1. Obtain full details as follows:
  • Date and time of accident or knowledge of damage arising from same
  • Location and description of accident
  • Details of the Injured person/damaged property
  • Witnesses (if applicable)
  • Complete the necessary Claim Form
2. Direct all claimants, correspondence, notices, writs, summons or written communication to your Insurers/Brokers who will deal directly with them.
3. If serious bodily injury arises, obtain emergency medical attention. However, under no condition should you admit liability or offer or promise to pay monies without the express consent of the insurer
Compensates employers for earnings paid to employees as a result of sick leave and for injuries sustained in the course of their employment.
The following documentary evidence is required in order to process a claim.
  • Complete the Accident Report Form
  • Substantiate wages paid to the employee during his/her period of illness, by way of payment vouchers or signed statement by the employee, indicating clearly the monies representing Compensation for injury leave
  • Submit a sick leave certificate for the entire period of absence if this in excess of three (3) days
  • Provide final fitness certificate pronouncing the employee fit to resume normal duties, and advising whether employee has suffered any permanent partial disability
  • Submit total wages to the employee including overtime and COLA as applicable for the twelve (12) months preceding, or the longest continuous period not exceeding fifty-two (52) weeks prior to the injury
  • The standard recoverable medical expense limit is $500.00
  • The sick leave wages formula is calculated as follows:
  • 2/3 Average Monthly Earnings * X No. of days sick leave
  • 30 days* based on wages for 52 weeks prior to the accident
TIP: Finalization of a claim can only be accomplished when the injured employee receives his final fitness certificate (or a medical report in the case of an employee who has suffered permanent partial disability)

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