INSURANCE CLAIMS

This query is : Resolved

Querist : Anonymous

Querist : Anonymous (Querist)

01 January 2010 There was a theft in one of the branches of my clients gold busienss. However, the insurance company has rejectd the theft claim stating that the door no. of the said branch in which the theft was done,, was not mentioned in the insurance application.

Any ideas of what can be done

Pawan Periwal

Pawan Periwal (Expert)
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02 January 2010 Plz name the insurance company and teh entire story...this muck of info will not lead s to any conclusions

Querist : Anonymous

Querist : Anonymous (Querist)

11 January 2010 The assessee has two shops. Stock of gold is kept in both shops. Shop 2 was subject to a burglary. In the insurance papers, by over-sight, the assessee had mentioned only address of shop 1, which is the head-office, but value of stock in both premsies was insured. Insurance Company is national insurance company ltd.What can be done

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Querist : Anonymous

Querist : Anonymous (Querist)

13 January 2010 PLEASE REPLY TO MY NEW POST

Asha Kanta Sharma

Asha Kanta Sharma

(Expert)
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01 August 2024 In this situation, where the insurance claim for theft has been rejected due to discrepancies in the insurance application, you have a few options to address the issue:

### **1. Review Insurance Policy and Terms**

- **Check Policy Details:** Review the insurance policy document thoroughly to understand the specific requirements and clauses related to coverage, including details about the premises and conditions for making a claim.
- **Examine the Application:** Confirm the details provided in the insurance application, including whether the address of both shops should have been included.

### **2. Communicate with the Insurance Company**

- **Request a Reconsideration:** Contact the insurance company to request a reconsideration of the claim. Provide any additional documentation or evidence that supports the inclusion of both shops in the coverage.
- **Clarify the Oversight:** Explain the oversight and provide evidence of the actual loss and the value of stock insured. This may include security logs, inventory records, and other supporting documents.

### **3. Document Evidence**

- **Gather Evidence:** Collect all relevant evidence related to the theft, including police reports, photographs of the damage, and witness statements. This documentation can support your case.
- **Proof of Coverage:** Provide proof that the value of stock at both locations was covered under the policy, even if the specific address was not mentioned in the application.

### **4. Seek Legal Advice**

- **Consult a Lawyer:** If the insurance company remains uncooperative, consider consulting a lawyer who specializes in insurance claims. They can provide legal advice and help you understand your rights and options.
- **Explore Legal Action:** If necessary, you might consider legal action against the insurance company for breach of contract, especially if you can demonstrate that the oversight did not affect the coverage or the validity of the claim.

### **5. Negotiate a Settlement**

- **Settlement Discussion:** Engage in discussions with the insurance company to negotiate a settlement. Sometimes, insurance companies may offer a partial settlement or ex gratia payment to resolve the issue without formal legal proceedings.

### **6. Review Internal Procedures**

- **Improve Documentation:** Review and improve internal procedures for documenting insurance details to avoid similar issues in the future. Ensure all relevant information is accurately provided and updated in the insurance application.

### **Summary of Actions**

1. **Review** the insurance policy and application for details and discrepancies.
2. **Communicate** with the insurance company to request a reconsideration or clarification.
3. **Document** evidence of the theft and proof of insurance coverage.
4. **Seek legal advice** if necessary and explore legal action if the claim is unjustly denied.
5. **Negotiate** a settlement if possible.
6. **Review** internal procedures to prevent future issues.

By taking these steps, you can work towards resolving the issue with the insurance claim and ensure that your client’s interests are protected.