Harris Balcombe FAQ Section
Expert help when you need it most
1. What is the difference between a loss assessor and loss adjuster?
Loss assessors and loss adjusters are both professionals who play essential roles in insurance claims, but they have distinct responsibilities and represent different parties in the claims process.
A loss assessor, such as Harris Balcombe, is typically hired by the policyholder (the person or entity making the insurance claim) to prepare, present and negotiate their insurance claim. The primary responsibility of a loss assessor is to represent the interests of the policyholder. They work on behalf of the policyholder to ensure that the insurance claim is properly documented, valued, and settled at the right level.
Loss assessors assist policyholders in preparing and submitting their claims, negotiating with the insurance company, and documenting the extent of the loss. They help policyholders maximise the settlement they receive from the insurance company, making sure that the policyholder is treated fairly and compensated adequately.
A loss adjuster, on the other hand, is typically employed by the insurance company to investigate and adjust insurance claims. The primary responsibility of a loss adjuster is to represent the interests of the insurance company. They work to determine the extent of the loss, assess the validity of the claim, and ensure that the insurance companies exposure is mitigated.
Loss adjusters investigate the circumstances of the loss, gather evidence, interview witnesses, and assess the damage or loss to determine the coverage and liability of the insurance company. They aim to settle claims fairly based on the terms and conditions of the insurance policy and applicable laws and regulations.
In summary, the key difference between a loss assessor and a loss adjuster lies in their roles and allegiances. A loss assessor works on behalf of the policyholder and advocates for their interests, while a loss adjuster works for the insurance company and is responsible for investigating and managing claims on the insurer's behalf. Both professionals play important roles in the claims process to ensure a fair and equitable resolution for all parties involved.
2. Why do I need a loss assessor?
Hiring a loss assessor, such as Harris Balcombe, can be beneficial in various situations where you're dealing with an insurance claim. Loss assessors, such as Harris Balcombe, can provide valuable assistance and expertise to policyholders in the following ways:
- Expertise and Knowledge: Loss assessors are experienced professionals who understand the complexities of insurance policies, claim processes, and the valuation of losses. They can navigate the insurance industry on your behalf, ensuring you understand your rights and entitlements under your policy.
- Proper Documentation: A loss assessor can help you gather and document all the necessary information and evidence to support your claim. This includes assessing the extent of your loss, gathering invoices, receipts, and other relevant documents, which can strengthen your case and improve your chances of a successful claim.
- Negotiation with the Insurance Company: Loss assessors have experience in negotiating with insurance companies. They can handle communications, negotiations, and settlements with the insurance company's adjusters, ensuring that you receive fair compensation for your loss.
- Time and Stress Savings: Managing an insurance claim can be time-consuming and stressful, especially when you're dealing with the aftermath of a disaster or loss. A loss assessor can take on the administrative burden, allowing you to focus on recovery and other important matters.
- Maximising Your Settlement: Loss assessors work to maximise your insurance settlement. They have a deep understanding of insurance policies and can help you receive the full compensation you are entitled to, rather than accepting a lower offer from the insurance company.
- Avoiding Costly Mistakes: Filing an insurance claim can be complex, and errors or omissions in the process can lead to claim denials or reduced payouts. Loss assessors can help you avoid common mistakes and ensure that your claim is submitted correctly.
- Advocacy and Representation: A loss assessor serves as your advocate throughout the claims process. They are on your side and work to protect your interests, ensuring that the insurance company treats you fairly and fulfils its obligations.
- Peace of Mind: Knowing that you have a professional handling your insurance claim can provide peace of mind during a challenging time. You can trust that your claim is being managed effectively and that you are not being taken advantage of by the insurance company.
Ultimately, the decision to hire a loss assessor depends on the complexity of your claim, your comfort level with the claims process, and your desire to have professional assistance in navigating the insurance system.
3. Which type of claims do loss assessors manage?
Loss assessors can manage various types of insurance claims, including but not limited to:
- Property Damage Claims: Loss assessors often assist policyholders with claims related to property damage caused by events such as fires, floods, storms, earthquakes, vandalism, or theft. They help assess the extent of the damage and work to secure fair compensation for repairs or replacements.
- Business Interruption Claims: When a business is forced to temporarily close due to an insured event (e.g., fire, natural disaster), loss assessors can help calculate and negotiate claims for lost income, additional expenses incurred, and other financial losses resulting from the interruption.
- Public Liability Claims: Businesses and individuals may seek assistance from loss assessors when dealing with public liability claims. These claims arise when someone is injured or their property is damaged due to the negligence of the policyholder, and the insurance policy provides coverage for such incidents.
- Product Liability Claims: Companies facing product liability claims may hire loss assessors to manage these claims. These claims involve injuries or property damage caused by a defective product manufactured or distributed by the insured company.
- Construction and Engineering Claims: Construction companies and engineers may hire loss assessors to handle insurance claims related to construction defects, project delays, or other issues covered by their insurance policies.
It's important to note that the specific types of claims that loss assessors manage can vary based on their expertise and specialisation. When hiring a loss assessor, it's essential to ensure that their experience aligns with the type of claim you need assistance with to maximise the effectiveness of their services.
4. What stage is best to get in touch with Harris Balcombe?
The best time to get in touch with Harris Balcombe depends on your specific situation and the type of insurance claim you are dealing with. We suggest you get in touch with our specialised team as soon as you can:
- Immediately After the Loss or Damage Occurs: In many cases, it's a good idea to contact a loss assessor like Harris Balcombe as soon as possible after the loss or damage occurs. They can provide guidance on how to document the incident and initiate the claims process with your insurance company.
- Before Submitting a Claim: If you're unsure about how to proceed with your insurance claim or have concerns about the claim's complexity, it can be beneficial to contact Harris Balcombe before submitting the claim to your insurance company. They can review your policy, assess the situation, and provide advice on how to maximise your claim's chances of success.
- When Facing a Dispute: If you encounter difficulties or disputes with your insurance company during the claims process, it's a good time to contact Harris Balcombe. They can act as advocates on your behalf, negotiate with the insurance company, and help resolve any issues that may arise.
- When Dealing with a Complex Claim: Insurance claims can become complex, especially for large losses or when multiple parties are involved. If you have a complex claim, consider reaching out to Harris Balcombe early in the process to ensure that all aspects of the claim are properly managed and documented.
- When You Need Expert Guidance: Harris Balcombe specialises in insurance claims management and has experienced professionals who understand insurance policies and the claims process. If you're unfamiliar with the claims process or want expert guidance throughout, contacting them early can be beneficial.
- When You Want to Maximise Your Settlement: If your goal is to maximise the settlement you receive from your insurance company, working with Harris Balcombe from the beginning can help ensure that your claim is properly assessed and valued, potentially leading to a higher payout.
5. How much does a loss assessor cost?
At Harris Balcombe, we offer two fee structures for our clients to choose from.
Option 1: Zero % Model
If you decide to use all of our support services to handle your claim for your domestic or commercial property, our services can be delivered with no direct cost to you. In this instance, our approved Chartered Surveyors and Insurance approved contractors will pay us a management fee to oversee the claim. The insurance company pays the contractors and surveyors as part of your claim, which leaves nothing for you to worry about.
Option 2: Percentage of Claim Value
Some of our clients prefer to use their own contractors or receive a cash settlement to reinstate themselves. In this instance, our fees are based on a percentage of the value of the claim plus VAT and are payable on all amounts received by you or anybody on your behalf under the policy, third party or any other recovery process.
6. What happens if my claim is repudiated or rejected?
If your insurance claim is repudiated or rejected by the insurance company, it means that the insurer has declined to provide coverage or pay for the loss or damage you've claimed. This can be a frustrating and stressful situation, but there are steps you can take to address it:
- Review the Rejection Letter: The first step is to carefully review the rejection letter or communication from the insurance company. It should outline the reasons for the denial and reference specific policy provisions or exclusions. Understanding why your claim was rejected is crucial for your next steps.
- Consult Your Policy: Thoroughly review your insurance policy to understand the coverage, terms, and exclusions. Ensure that the insurance company's reasons for rejection align with the policy terms. Sometimes, claims are denied due to misunderstandings or misinterpretations of the policy.
- Contact the Insurance Company: Reach out to your insurance company to discuss the rejection and seek clarification. It's possible that there may have been a misunderstanding or a clerical error. If you believe the rejection is unjustified, provide additional evidence or documentation to support your claim.
- Appeal the Decision: Most insurance companies have an appeals process in place. If you believe your claim was wrongly denied, submit an appeal along with any additional information that strengthens your case. Follow the appeal procedures outlined by your insurer, which may involve submitting a formal written appeal.
- Seek Legal Advice: If you're unable to resolve the issue through communication and appeals, consider seeking legal advice from an attorney who specialises in insurance law. They can help you understand your rights and options and represent you in legal proceedings if necessary.
- Engage Loss Assessor: If you haven't already done so, you may want to engage a loss assessor to assess your claim, gather evidence, and negotiate with the insurance company on your behalf. These professionals can often improve your chances of a favourable outcome.
- File a Complaint: If you believe the insurance company has acted unfairly or in bad faith, you can file a complaint with your state's insurance regulatory authority. They can investigate the matter and ensure that the insurer is adhering to state insurance laws and regulations.
- Consider Mediation or Arbitration: Some insurance policies include provisions for mediation or arbitration to resolve disputes between policyholders and insurers. This can be an alternative to litigation and may lead to a resolution.
- Litigation: As a last resort, you may consider filing a lawsuit against the insurance company if you believe you have a valid claim that has been wrongfully denied. Consult with an lawyer to assess the viability of a lawsuit and navigate the legal process.
Insurance claim denials can be complex, and the outcome will depend on the specifics of your policy, the circumstances of your claim, and your ability to present a compelling case. Seeking professional assistance from Harris Balcombe and legal advice can be crucial in these situations.
7. Is it necessary to have a loss assessor for a small claim?
Whether or not you need a loss assessor for a small insurance claim depends on several factors, including the complexity of the claim, your familiarity with the claims process, and your comfort level with handling the claim yourself. Here are some considerations to help you decide:
- Claim Complexity: The complexity of the claim is a significant factor. Small claims that involve straightforward property damage or minor losses may not require the assistance of a loss assessor. However, if the claim is more complex, involves multiple parties, or has disputes over coverage, it might be beneficial to seek professional help.
- Insurance Knowledge: Your familiarity with insurance policies and claims procedures plays a role. If you are experienced with insurance claims and understand your policy well, you may feel confident in handling a small claim on your own. If you're uncertain about your policy's coverage or the claims process, a loss assessor can provide guidance.
- Documentation and Evidence: Small claims still require proper documentation and evidence. If you're comfortable gathering all the necessary information, receipts, invoices, and documentation to support your claim, you may not need a loss assessor's assistance.
- Time and Stress: Consider your own time constraints and stress levels. Even small claims can be time-consuming and involve communication with the insurance company. If you prefer to have someone else handle these tasks and reduce your administrative burden, a loss assessor can help.
- Disputes with the Insurance Company: If you encounter disputes with the insurance company over a small claim, a loss assessor can advocate on your behalf and negotiate with the insurer to help resolve the issues.
- Maximising Your Settlement: While small claims may not involve substantial payouts, a loss assessor's expertise can help ensure that you receive the full compensation you're entitled to, potentially maximising your settlement even for minor losses.
- Cost Considerations: Keep in mind that loss assessors typically charge fees for their services, which are often a percentage of the insurance settlement. For small claims, the cost of hiring a loss assessor may outweigh the benefits, so it's essential to weigh the potential benefits against the fees.
8. How long do claims usually take?
The duration of an insurance claim can vary significantly depending on various factors, including the type of claim, the insurance company's policies and processes, the complexity of the claim, and the promptness of the policyholder in providing necessary information and documentation.
Some insurance companies may have faster or slower claims processing procedures, and external factors like the volume of claims and the availability of adjusters can also impact processing times. To expedite the claims process, policyholders can take several steps:
- 1. Promptly report the claim to the insurance company.
- 2. Provide all requested information and documentation as quickly as possible.
- 3. Maintain clear and open communication with the insurance company.
- 4. Follow up with the insurance company as needed to check the status of the claim.
- 5. Cooperate with any investigations or inspections required by the insurer.
- 6. If a claim is taking longer than expected or if there are disputes or delays, policyholders can contact their insurance company's claims department for updates and clarification. In some cases, involving a loss assessor or seeking legal advice may be necessary to resolve disputes or expedite the process.
9. Can you still help me if I am under-insured?
A loss assessor can still assist you even if you are under-insured. While their primary role is to help policyholders navigate the insurance claims process and maximise their compensation within the terms of their insurance policies, they can offer valuable assistance and advice in situations where you have insufficient coverage.
Here's how a loss assessor can help when you are under-insured:
- Assessment of Loss: A loss assessor will assess the extent of your loss and damage, even if it exceeds your policy limits. They can help you understand the full scope of the damage and its potential cost, which is crucial information to have when negotiating with your insurance company.
- Policy Review: They will review your insurance policy to determine the coverage limits and any applicable exclusions. This can help you understand the limitations of your policy and identify areas where you may be under-insured.
- Negotiation with the Insurance Company: A loss assessor can negotiate on your behalf with the insurance company to try to secure the maximum compensation available under your policy. While they may not be able to exceed the policy limits, they can work to ensure that you receive the full amount of coverage provided by your policy.
- Exploring Additional Coverage: In some cases, loss assessors may also help you explore additional sources of coverage or compensation, such as umbrella policies, third-party liability claims, or other insurance policies that might provide assistance.
- Claims Documentation: They can assist you in documenting the loss and providing all necessary information to support your claim, which is essential even when you are under-insured.
While a loss assessor's ability to secure compensation may be limited by your policy's coverage limits, their expertise in the claims process and their ability to advocate on your behalf can still be highly valuable. They can help you make the most of your insurance coverage and explore all possible avenues for recovering your losses, even if you find yourself under-insured for a particular loss or event.
10. Do you take a percentage of my entitlement / settlement?
This depends on which package option you choose. We offer a Zero % Model which if you decide to use all of our support services to handle your claim for your domestic or commercial property, our services can be delivered with no direct cost to you. The insurance company pays the contractors and surveyors as part of your claim, which leaves nothing for you to worry about.
Alternatively, we offer a Percentage of Claim Value model where some of our clients prefer to use their own contractors or receive a cash settlement to reinstate themselves. In this instance, our fees are based on a percentage of the value of the claim plus VAT and are payable on all amounts received by you or anybody on your behalf under the policy, third party or any other recovery process.
11. Glossary
- Ab initio : Latin for ‘from its inception’; refers to a breach of a condition that may render a policy null and void.
- Adjustment : The portion of a claim that a loss adjuster reduces after considering factors like under-insurance, policy limits, or overstatement.
- All risks insurance : Insurance designed to cover the policyholder against loss or damage from various causes, with some limitations despite the comprehensive name.
- Average clause : A provision in an insurance policy stating that if the sum insured is less than the property's value at the time of loss, the settlement will be adjusted proportionately.
- Betterment : Occurs when a policyholder replaces a lost or damaged item with an item of higher value, with the policyholder responsible for the difference in cost.
- Breach : Failure to comply with a condition in the insurance policy, such as a security requirement.
- Excess : The portion of each claim paid by the policyholder, deducted from the final settlement.
- Ex gratia : A payment made by the insurer that isn’t strictly required under the policy terms.
- Inception : The start date of the insurance policy.
- Indemnity : Compensation provided to the policyholder for loss, damage, or legal liabilities covered by the insurance policy.
- Index linking : Automatic adjustment of the sum insured based on a specific index, such as the House Rebuilding Cost Index.
- Insured peril : An event covered by a specific insurance policy, such as fire or theft.
- Loss adjuster : An insurance company's representative who investigates and adjusts claims to reach a settlement.
- Loss assessor : A specialist employed by the policyholder to manage and negotiate insurance claims on their behalf.
- Misrepresentation : Providing false information, which may lead to the insurer voiding the policy or refusing a claim.
- Non-disclosure : Failing to disclose important information to the insurer, which may lead to policy voidance or claim refusal.
- Policy liability : The insurer's obligation to compensate the policyholder under the terms of the insurance contract.
- Proximate clause : The main cause of a loss, which may not be the first or last event in a chain of occurrences.
- Quantum : The actual amount paid by the insurer to settle a claim.
- Repudiated : When the insurer refuses to accept liability, resulting in claim rejection.
- Salvage : Items paid for by the insurer as part of a claim, becoming the insurer's property for potential sale.
- Subrogation : The insurer's right to pursue recovery from third parties for losses covered under the policy.
- Sum insured : The maximum amount payable to the policyholder under the policy terms.
- Third party : An individual involved in an incident leading to a claim but not party to the policy.
- Under-insurance : When the sum insured is less than the actual cost or value of the insured property.
- Underwriter : The individual who assesses risks for insurability and determines premiums.
- Value-at-risk : The total value of a property or item that could be subject to a claim under the policy. Void: When a policy is considered null and void, often due to non-disclosure or misrepresentation.
- Warranty : A condition of the policy that must be met for coverage to apply.
- Without prejudice : An offer, proposal, or settlement made without admission of liability.
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