Put simply, “Insurance” is the payment of a small predictable amount of money (“premium”) to protect against a larger unpredictable expense (“loss/claim”). This transfers the risk from you to the insurance company for a fee.
Why Do We Need Insurance?
Only one answer – Peace of mind. Many of us have never had to make an insurance claim. Therefore, when we continue to write the check month after month, we feel as if we are pouring money right down the drain. Even though you have never had to make a claim on your insurance, there is a good reason that it is there. Naturally, insurance is there to protect you and your investments.
What is an insurance broker?
An insurance broker is someone who acts as an intermediary between businesses and insurance companies. Once you contact a business insurance broker and let them know what you need, they will search and find the best policies for your consideration.
Brokers typically have access to dozens of carriers, and can quickly find several policies for you to consider. Remember, you do not have to pay for the services of a business insurance broker; the insurance company you end up doing business with, pays the broker a commission.
A good insurance broker knows the industry, and can begin searching for additional insurance plans for you to consider. They know the procedures and processes of the various companies that offer coverage, and can cut through the red tape and interpret the jargon found in most contracts.
Does using an Insurance Broker increase my cost?
All insurers build a commission factor into their premium rates. These rates are the same whether you use a broker, an agent or go directly to the company.
What is a proposal form?
It is a legally binding agreement between the insured and insurer. It is also what is used to access the insured’s risk.
What is insurable risk?
For a risk to be insurable, the following conditions must be present:
- Any losses incurred must be accidental
- The insurer must be able to charge a premium high enough to cover not only claims expenses, but also to cover the insurer’s expenses. In other words, the risk cannot be catastrophic, or so large that an insurer is unable to pay for the loss.
- The nature of the loss must be definite and financially measurable, that is, there should not be room for argument as to whether or not payment is due, nor as to what amount the payment should be.
What is liability insurance?
Liability insurance is a part of the general insurance system of risk financing to protect the purchaser (the “insured”) from the risks of liabilities imposed by lawsuits and similar claims. It protects the insured in the event he/she is sued for claims that come within the coverage of the insurance policy. Originally, individuals or companies that faced a common peril, formed a group and created a self-help fund out of which to pay compensation should any member incur loss (in other words, a mutual insurance arrangement). The modern system relies on dedicated carriers, usually for profit; to offer protection against specified perils in consideration of a premium. Liability insurance is designed to offer specific protection against third party claims, that is, payment is not typically made to the insured, but rather to someone suffering loss who is not a party to the insurance contract. In general, damage caused intentionally as well as contractual liability is not covered under liability insurance policies. When a claim is made, the insurance carrier has the duty (and right) to defend the insured.
What is Indemnity?
An indemnity is a sum paid by A to B by way of compensation for a particular loss suffered by B. The indemnitor (A) may or may not be responsible for the loss suffered by the indemnitee (B). Forms of indemnity include cash payments, repairs, replacement, and reinstatement.
What is a peril?
A peril is a condition that can cause a loss. Three examples are fire, windstorm, and theft.
What is property insurance?
Property insurance provides protection against most risks to property, such as fire, theft and some weather damage. This includes specialized forms of insurance such as fire insurance, flood insurance, earthquake insurance, home insurance or boiler insurance. Property is insured in two main ways – open perils and named perils. Open perils cover all the causes of loss not specifically excluded in the policy. Common exclusions on open peril policies include damage resulting from earthquakes, floods, nuclear incidents, acts of terrorism and war. Named perils require the actual cause of loss to be listed in the policy for insurance to be provided. The more common named perils include such damage-causing events as fire, lightning, explosion and theft.
What documents do I need to produce when effecting homeowners insurance?
A valuation report is advisable but not mandatory.
What is Motor Vehicle Insurance?
Vehicle insurance (also known as auto insurance, car insurance, or motor insurance) is insurance purchased for cars, trucks, and other vehicles. Its primary use is to provide protection against losses incurred as a result of traffic accidents and against liability that could be incurred in an accident.
These provide protection for loss by accident, theft, or fire and can be arranged on the following basis:
- Third Party Only (Compulsory by law)
- Third Party, Fire and theft (Own damage not covered)
- Comprehensive Private ( Full Coverage)
What is the difference between Third Party cover and Comprehensive?
Third party car insurance is mandatory. However, there is substantial scope for reduction of costs or the premium payable in case this type of insurance policy is chosen. It must be remembered that, should your car be comprehensively insured, there is no need for a separate third party insurance policy. Comprehensive car insurance includes third party liability also. Third party insurance only would be the preferred option for older models of cars.
What are the necessary documents to effect new motor insurance?
- Certified copy of the vehicle
- Pro-forma/Invoice (all features of the vehicle. g. colour, engine & chassis number etc.)
- Valuation report (for roll-on, roll-off vehicles)
- Copy and original drivers permit
- NO Claim Discount letter (mandatory if insurer is changed)
On arrival a proposal form will be provided for your completion. These documents will also apply for any additional vehicles to be added to the existing policy.
What is depreciation? When is it applied?
It is a bookkeeping entry representing the decline in value of an asset that is wearing out. As property ages and becomes worn, it often loses value. That loss of value must be taken into account in any adjustment of property insurance that covers loss of actual cash value. Depreciation does not represent a cash outlay.
What is an Excess? How and when is it applied?
Excess is a term used in insurance, meaning the initial portion of any insurance claim which the policy does not cover.
Many policies allow you to set your own excess figure – the higher you set it, the lower your premiums will be. The excess figure is especially important in car insurance – if the claim amount is less than the excess or only slightly more, many people do not bother to make a claim in order to protect their no claims discount.
What is Marine Insurance?
Marine Insurance covers the loss or damage of ships, cargo, terminals, and any transport or cargo by which property is transferred, acquired, or held between the points of origin and final destination.
Cargo insurance—discussed here—is a sub-branch of marine insurance, though Marine also includes Onshore and Offshore exposed property (container terminals, ports, oil platforms, pipelines); Hull; Marine Casualty and Marine Liability.
What is personal liability insurance coverage?
Personal liability coverage protects you and all family members who live with you against a claim or lawsuit resulting from (non-auto and non-business) bodily injury or property damage to others and for which you become legally obligated to pay. Defense costs are included, but the insurance company has no duty to defend you after the limit of liability on the policy has been exhausted.
What is an Act of God?
Acts of God are natural disasters which are not covered by your insurance policy, such as earthquakes, unusual tropical storms, lightning strike etc. The key feature of an Act of God is that it cannot be reasonably foreseen, so flood damage to a property on a flood plain should be covered, while it probably would not be if the area has no history of flooding and no history of heavy rainfall.
If you make a claim and your insurer decides that the damage was caused by an Act of God, you have the option of going to court to settle the dispute.
Why is it mandatory to have insurance?
It can take years and a great deal of hard work and money to acquire your family’s personal possessions. Where would the money come from to replace your car if it were destroyed? What would you do if a court ordered you to pay thousands of dollars because of damage to someone else’s car or injury caused by you. Insurance protects you against financial loss when these kinds of personal disasters happen. And they happen to people just like you every day.
Why buy home insurance?
- Owners: To protect both your house and personal property.
- Tenants: To protect your personal property.
Everyone: Protection against liability for accidents that injure other people or damage their property
What is the difference between 'Named Peril Insurance' and 'All-Risk Insurance'?
Property insurance policies can be divided into two categories: “Named-Peril Insurance” and “All-Risk Insurance.” Named-peril policies pay only for the causes of loss specified in the policy. All-risk insurance covers losses except those specifically excluded in the policy.
What kind of damage does a basic property policy cover and what is not covered?
Most basic policies protect against damage from:
- Fire and lightning
- Vandalism and malicious mischief
- Damage by glass or glazing material that is part of the building
- Volcanic eruption
What are the different type’s methods of settlements?
There are three types of settlement possible, each of which is explained below. The choice of which method is used may be specifically written in the Policy, or may be up to the Insurer to decide.
- Replacement – To pay the cost of replacing items (excluding any betterment) covered under the policy
- Reinstatement – To pay all costs incurred in rebuilding the damaged property to a new condition without deductions for depreciation
- Indemnity – To put you back in a similar position as you were in immediately prior to the loss.
- Limit of Liability – To the limits of liability stated in the policy document.
What are the roles of all parties involved?
- Obligation of the Insurer
To INDEMNIFY you for losses which have occurred and that are specifically covered under the terms and conditions of the respective policies of insurance. Such payments must be made within a reasonable time frame.
- Obligation of the InsuredThe following are to be adopted for all situations, which may give rise to a possible claim:
- Take all steps to minimize loss – Reasonable steps and measures to reduce the
effects of a loss must be taken.
- Report the occurrence immediately to Agostini Insurance Brokers Limited. It is not necessary for you to await details of the incident before notifying us.
- Co-operate with your Insurer or their appointed representative. Answer all questions regarding the facts and circumstances of loss. It is important to have a positive work relationship, as it is in your best interest to help us provide the best possible service, which you deserve.
- Document precisely the cause and extent of loss. Causes of loss are not always readily identifiable. In some circumstances, it is necessary for you to prove that the cause of loss falls within the scope of your policy coverage. It is therefore important to document details that may not be apparent when investigations are carried out.
- Take all steps to minimize loss – Reasonable steps and measures to reduce the
- Obligation of the Broker
- To co-ordinate the smooth and efficient processing of all claims, thereby minimizing the traumatic effects of a fortuitous loss to you, the Insured.
- To ensure that all claims are settled within a reasonable time frame and that settlement is fair and just to all concerned.
- In the unlikely event of a dispute with regard to the claim settlement amount, to assist with the appointment of an agreed Arbitrator.
- To analyze loss data with a view to future loss reduction or elimination. This will be of great short and long term benefit for you as it further increases our ability to design an Insurance and Risk Management programme that best suits your financial situation.
- To ensure that your programme is placed and maintained with sound security thus eliminating unnecessary delays for settlement.
- Obligation of the Loss Adjuster
The Loss Adjuster, although appointed by the Insurer, is an independent party. In his professional capacity, he is expected to make expert recommendations to Insurers based upon the facts of the particular matter. The utilization of the Loss Adjuster also serves to remove the impression of any bias on the part of the Insurers. It should be noted that Insurers have no obligation whatsoever to accept the recommendations of the Loss Adjuster.
What to do after an Accident?
Most people are badly shaken up right after being involved in an accident. Taking the time now to review the steps you should follow after an auto accident will help reduce the anxiety surrounding the incident and avoid costly and time-consuming mistakes.
At the Scene of the Accident
- Stop your vehicle and survey the scene and determine whether there are any serious injuries.
- Call the police/ambulance depending on the circumstances.
- Give whatever help you can to the injured but avoid moving anyone so you do not aggravate the injury.
- Covering an injured person with a blanket and making that person comfortable usually is as much as you can do.
- If you are hurt and require an ambulance, call our 24 hour AIB Assistance 800-4AIB (4242) and give them your name, vehicle number and location.
- Do NOT ADMIT liability to anyone at the scene of an accident.
Obtain the following information from the other party:
- Vehicle license number
- Driver’s name
- Owner’s name (if different)
- Driver’s phone numbers at work and at home
- Owner’s phone numbers at work and at home
- Insurer and policy number
- Names, addresses and telephone numbers of witnesses
- Note areas of damage to both vehicles
You should also:
- Make a sketch of the scene of the accident noting street names, traffic lights stop signs etc….
- Do not move the vehicle if anyone has been injured until after the police have been to the scene. If the vehicles are moved, mark their positions.
- Report the accident to the nearest Police Station as soon as possible (preferably accompanied by the third party) and produce your driver’s license and insurance certificate.
Try to protect the accident scene. Take reasonable steps to protect your car from further damage, such as getting the car off the road and calling Motor Assist to move the vehicle to a place of safety.
Make notes. Keep a pad and pencil in your glove compartment. Write down the names and addresses of all drivers and passengers involved in the accident. Record the names and badge numbers of police officers or other emergency personnel.
Is individual health insurance available through AIB?
Yes. Upon submission of your Date of Birth, we can provide quotes from two leading insurers.
My company has a Group Health Plan brokered by AIB, how do I or my dependants enroll?
An Employee enrolls in the Plan by completing an Enrollment Form for him/her and for his/her eligible dependants at the time of enrollment. This Employee and his/her dependants are guaranteed automatic enrollment unto the health plan on the basis that this form is submitted to Agostini Insurance Brokers within 31 days of his/her employment confirmation date.
For Employees who acquire new dependants while covered on the Plan, he/she will apply by completing the necessary Enrollment Form in respect of such new dependant and submit same to Agostini Insurance Brokers within 31 days of acquiring these dependants.
Please note that all late enrollments will have to be accompanied by a Declaration of Insurability Form and will be subject to the Insurer’s underwriting practices in place at such time.
Who are eligible dependants?
The eligible dependants of an Employee are-
- the Employee’s legal wife or husband, (but not including spouses who are legally separated from the Employee) or
- the person living with the Employee in a recognised husband and wife relationship, who is registered as such in the records of the Company, and
- the Employee’s unmarried children, step-children and children legally adopted who are under nineteen (19) years of age and living in the Employee’s household and have the same permanent residence as the Employee or absent therefrom only to attend school. Such children must be registered as dependants in the records of the Company.
The Employee’s children who are over nineteen (19) years of age but under the age of twenty-three (23) years shall only be eligible if they have the same permanent residence as the Employee and if they are full-time students at an accredited college or university and coverage under the Plan was effected prior to such children attaining nineteen (19) years of age. Proof of attendance must be submitted to the Company annually.
I am covered under my spouse’s health plan; can I still enroll on my company’s health plan?
You are still eligible to join the plan even if your spouse is covered under another plan. The benefits to be derived from your plan shall be co-ordinated with the other plan’s benefits in accordance with the following:
- On submission of each claim form, Co-ordination of Benefits section must be completed for persons who have duplicate coverage
- Claims for you are to be submitted first through your plan
- Claims for children are to be submitted first through the plan covering the male spouse
- Claims for your spouse are to be submitted first through his/her plan
The initial payment would be made by the plan covering the member as an employee and the other plan pays the difference up to the plan’s limit.
Is there a time period an employee can claim on a health plan?
All Employees/dependants being transferred from the former health plan can claim immediately for Medical, Dental and Vision benefits.
Any other Employee/dependant can claim for Medical benefits from the first day they are effectively enrolled in the Plan. However, Dental and Vision coverage becomes effective only three months after enrolling in the Plan.
What is the reimbursement percentage?
The Plan will reimburse the percentage stipulated in the Schedule of Benefits for Medical, Dental Care and Vision Care expenses incurred by enrolled Employees. The insured Employee is responsible for the difference of the expenses.
What is a Pre-Existing Condition?
Upon joining a Group Health Plan, if an Employee within the three months prior to the effective date of participation was under a medical practitioner’s care or received any type of medical treatment or advice because of a medical disability or ailment, that condition is considered a pre-existing condition and expenses incurred by an Employee are not covered by the Plan.
What are Eligible Expenses?
‘Eligible Expenses’ shall mean the actual expenses and charges incurred by an insured Employee enrolled in the Plan, which are reasonable and customary for necessary Medical, Dental or Vision Care and services administered by or ordered by a physician licensed to practice medicine.
What are Reasonable and Customary Charges?
‘Reasonable and Customary Charges’ shall refer to charges for Medical, Dental or Vision Care and services administered. Charges are considered reasonable and customary to the extent that it does not exceed the general level of charges being made in the area where the charge is incurred.
How to Claim?
At the end of each visit to the relevant medical practitioner, that practitioner should be requested to make an appropriate entry in the ‘Doctor’s Visits Section’ of the ‘Attending Physician’s Statement’ on the Claim Form and, if necessary, retain the form in his files. (Employee should avoid awaiting the completion of a course of treatment before requesting the doctor to complete the Claim Form).
v STEP 2
On completion of a course of treatment, you should:
- Fill in the Employee’s Statement portion of the Claim Form.
- ATTACH ALL SUPPORTING ORIGINAL ITEMIZED BILLS AND RECEIPTS:
- Hospital bills should state the number of days spent and the charge for each day, as well as itemized charges for other hospital services. Receipts for Surgeon’s and Anesthetist’s Fees are to be included and specifically stated.
- Drug bills should show the date of purchase, name of patient, name of prescribing doctor, prescription number, the name and quantity of the drugs itemised if there is more than one with corresponding charges.
- Bills for X-rays/Lab tests and other diagnostic tests should show the date, name of patient, the name and cost of each test done.
Insufficient information on your bills may cause a delay in settlement of your claim.
Deposit your form and supporting documents to your company’s Plan Administrator and the documents will be forwarded to AIB.
Are referrals required for Specialists’ visits?
Yes, with the exception of Gynecologist and Pediatric
Why aren’t all drugs prescribed by doctor’s covered?
Insurance plans only pay for controlled drugs (antibiotics, narcotics, injections)
Are visits by chiropractors, chiropodists, podiatrists etc… covered?
No. Only doctors that are registered with the Medical Board of Trinidad and Tobago will be considered for reimbursement.
What services are not covered by most health plans?
- Cosmetic services, supplies or treatment
- Experimental Services
- Charges in excess of benefit maximums
- Services determined not to be medically appropriate and/or necessary
- Infertility nor Birth Control
In addition to the annual benefit, what are some of the most common limitations on Vision Care Benefits?
12 consecutive months for lenses and exams and 24 consecutive months for frames.
Does my Dental Care Benefit extend to cosmetic services like teeth whitening and implants?
Most plans do not cover these procedures.