Two member cases below show how applying simple rules of evidence, and the requirement at Law to remain in honour, had insurance claims against them dismissed.
Case #1 Vehicle insurance claim just went away
The member received presentment demanding payment of around $5,000 for damages sustained to the claimant’s vehicle. The member acknowledged the part he had played in the incident but had disputed the extent of damage to the claimant’s vehicle given its age and substantial marks, scratches and indents from general wear and tear.
The first attempt to claim the amount was made by the claimant directly over the phone. This was declined on the grounds it was excessive and unjustifiable with evidence of photos and phone video taken of both vehicles immediately after the incident. The member remained in honour stating willingness to make payment for damages, but only to the extent of damage caused by the incident.
The claim was escalated to claimant’s insurer who again made the same demand for $5,000 payment, this time in writing. The member again remained in honour by responding to presentment with a conditional acceptance notice (also related to show cause notice). The member acknowledged the claim and agreed to his part in the incident, however requested evidence showing the extent of damage caused with an itemised list of damaged parts, costs of repairs, replacements, etc.
The claimant’s insurer responded with another demand for full payment and made no mention of the request for evidence showing extent of damage attributable to the incident and the claimant’s liability. Once again also, the member remained in honour, replying to the new presentment with reiteration of requests of the first conditional acceptance notice.
The matter was further escalated to a law firm, likely engaged by the claimant as the escalation did not emanate from the insurer’s legal department. The lawyer made similar demand for full payment as the claimant and insurer, to which the remember responded with a reiteration of the notice of conditional acceptance claims for evidence of liability directly attributable to the member and his vehicle during the incident. The lawyer responded with repeat demand and, just like the insurance company presentments, failed to address the requests for evidence.
The response to the lawyer’s second demand letter was the final in the matter as the member had no longer heard back from the lawyer, the insurer or the claimaint, and the matter had simply ‘gone away’.
The key takeaways to this case were the position of remaining in honour by the member, responding in timely matter and in a cooperative tone, indicating willingness to make the payment should the provision of sound evidence by provided in accordance with the offer of conditional acceptance. This demonstrates that all matters being commercial, or by contract and agreement, the terms and conditions of engagement can be negotiated.
Case #2 Claim for property damage dismissed for lack of evidence
The second case shares elements of the first. The incident for which damages were claimed involved the member flooding his bathroom after a late-night party whereupon damage was sustained to the apartment below, including costly floating timber flooring that was recently installed. At the time building management had contacted the member and entered the apartment, the member claimed he started the bath but simply passed out on his bed due to heavy intoxication.
Several weeks later, a letter of demand for around $9,000 was sent to the member by mail. The deman notice indicated he was the party at fault, citing claims made by the building manager. The member responded in honour within time required also with a conditional acceptance. The member indicated an intention and willingness to make payment and settle the claim pending providing evidence proving that he was the one to have caused the flooding to occur, noting the building manager’s account constituted ‘hearsay’.
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The insurance company escalated the matter to their legal department with a further statement of claim, ignoring the member’s request for sound, admissible evidence supporting the building manager’s claims, noting in particular there was no recording of the interaction or the presence of a third person witness to the facts.
A third notice was issued again from the insurer’s legal department merely reiterating demands of the first two notices. The member remained in honour, dealing with the latest presentment in a cooperative tone, indicating willingness to pay the amount claimed should the insurer produce evidence sufficiently robust to meet the member’s requirement in the notice of conditional acceptance.
The member did not hear back from the insurer again. The matter simple went away.
The key takeaways with this case are the requirement to remain in honour with responding to each presently in a timely manner and with a cooperative tone, and to apply rules of evidence to which the insurer was bound to act if the matter was to be resolved in their favour. The opinion of the insurer’s legal department was clearly to not pursue the matter further for lack of concrete evidence.