Insurance policies exist to safeguard policyholders against unexpected loss in value of an asset or other possible risks. Despite this, claiming for injuries or damages on your motor insurance policy can be a daunting experience, and with Jamaica witnessing insurmountable road crashes, claiming insurance remains a key issue for the protection of policyholders and should be a priority for insurance regulators.

Insurers require basic information in the claims-handling process before settling a claim: policy

information and copies of official documents — police report, photos, estimate of repairs, assessor’s report, etc — relevant to the damage and details of the accident.

During this process, however, policyholders should be aware of various techniques insurers undertake to prevent paying out claims.

DENY, DELAY, CONFUSE, AND REFUSE

In an attempt to prevent paying out settlements, some insurers engage in habitual activities, which are considered to be ruthless, lacking integrity, and unfair to policyholders, such as:

• Denying insurance claims at the onset of report

• Delaying mechanisms — going out of their way to make the claims process difficult, confusing, and time-consuming

• Unreasonable and incoherent use of loss evaluation methods

• Low-ball offers

• Refusing to settle claims

Insurers with uncensored liability may use diverse, manipulative tactics to their advantage, hoping that the daunting task of hiring a lawyer and pursuing legal action — whether due to financial weakness and/or time constraint — will force policyholders to accept the initial low-ball settlement offers.

POLICYHOLDERS

In order to navigate the common complaints of insurers not paying out claims, lack of transparency, or increasing premiums after a reported accident policyholders should equip themselves with information on the laws and regulations that govern the operations of the insurance industry.

Policyholders should also take into consideration that they:

1) have the right to receive adequate assistance and disclosure of all required information pertaining to his/her insurance claim

2) have a clear understanding of the terms and conditions of his/her insurance policy, the different types of provisions set out for such coverage, and pay special attention to the exclusions

3) be notified by insurer of his/her right of subrogation and be informed of the main principles governing the subrogation process

4) note that the claim settlement procedures are clearly identified and outlined on the insurance policy

5) have easy access to the insurer’s claims/complaint policy and procedures documents

6) secure legal defence to help determine the extent of the obligation of insurer, if any, and how damages should be applied ultimately

FINANCIAL SERVICES

While the FSC aims to promote stability and public confidence in the operations of financial institutions that it regulates, and ensures that the principles and practices of sound market conduct are observed by all its registrants in order to protect the interests of policyholders, it must also ensure that insurance companies are, in fact, compliant with the principles governing the claims/complaint processes and the minimum standard of the FSC’s Market Conduct Guidelines on Best Practice for Motor Insurance Claims (IR-GUID-09/08-0014) by asking the following questions:

• What are the stipulated penalties to insurers for any such non-compliance?

• Are insurers demonstrating high standards of integrity and fair dealing in their

business conduct?

• Are insurers demonstrating due care, skill, and diligence towards their policyholders?

• Are insurers handling complaints in a timely, fair, and effective manner?

• Are established protocols of insurers’ motor insurance claims in line with the Third Party Insurance Act?

THE INSURANCE ACT

Under the Insurance Act and Insurance Regulations 2001, the FSC is responsible for the supervision of life and general insurance companies and intermediaries. Protection of the interests of policyholders is the primary consideration for the FSC in its role as supervisor and regulator for the insurance industry, and yet countless policyholders who invest millions of dollars in yearly premiums to safeguard their properties through insurance find themselves being disenfranchised, unprotected, and victimised of insurers.

It would be interesting to note the insurers’ established protocols and timelines as they relate to:

• claims handling process

• monitoring of a complaints management system and delivery of quality service

• policyholders’ access to claims and complaints policy/procedures documents

• undermining legitimate claims

Is it safe to say that Jamaica’s insurance industry players are ruthless exploiters of their own policyholders’ vulnerabilities in order to generate maximum revenue?

Should policyholders continue to expect insurers to behave in a less-than-favourable manner, charcterised by a lack of integrity? If so, there needs to be a paradigm shift that challenges this status quo.

LEGISLATIVE FRAMEWORK

It is incumbent on the State and regulatory agencies to take a proactive approach and put controls in place that ensure compliance with applicable laws and regulatory requirements.

Established laws discourage fraudulent practices by policyholders and make it known that failure to meet regulatory rules can result in penalties and appropriate legal action taken to address false insurance claims.

A reformed legislative framework should, therefore, be established on equal merit that enforces transparency and accountability while highlighting sanctions for non-compliance of insurers that do not meet the appropriate law, statute, or regulations of claims/complaints handling procedures. These measures will assist in protecting aggrieved policyholders and ensuring insurance companies are managing claims in a consistent, flexible, and fair manner.

The infamous English conspiracy theorist and author David Icke once said, “The power of the few is in the acquiescence of the many. If we stop acquiescing with our own enslavement we cannot be enslaved. If we take our power back and stop fighting among ourselves, then the majority of our population cannot be controlled by just a handful of others.”

In the event there are no changes to current regulations that accommodate the growing advantage of centralised organisations and State power and the continued disadvantage of ‘regular’ citizens, Jamaicans will find themselves living in an Orwellian State, sooner, rather than later.

impact360ja@outlook.com