- March 30, 2022
by Kevin D. McCourt
THEME “CHANGING INSURANCE LANDSCAPE IN THE 21ST CENTURY”.
Good afternoon, it is a privilege for me to be asked to do a presentation to such a distinguished body of professionals.
I have repeatedly stated that my presentation ought to be brief and our interaction more participatory and interactive than a monologue.
Let me begin by briefly summarizing the role of yourselves professionally as understood by myself.
1. Loss Adjustors are an independent claim specialist appointed by the Insurer;
- To investigate complex claims.
- Verify the whole claim; check the conditions of the policy to confirm they cover the loss.
- Estimate the cost of repairs.
- Provide the full report to both the insured and the insurer.
2. Risk Surveyors.
Appointed by the insurer to determine the potential financial risk of offering cover for properties and sites. Reports are presented to insurance underwrites, to better enable them to assess the risk.
So it would appear one group commences the process and other finalizes it, if an incident occurs.
I pose a question; Are Loss Assessors part of this Institute and if not, why?
My instructions or brief today, is to address you on the reports presented by yourselves vis-à-vis their usage in Court.
Logically my instructions would appear to exclude the Risk Surveyors Report, as it commences the process of Insurance in specialized cover, and I am yet to experience a suit brought by a potential insured, protesting the rejection of cover by an insurer, on the basis of a risk surveyors report. Perhaps somebody here, may have experienced that scenario and can share the same with us all?
The other potential situation is where an incident has occurred and the risk assessment report was previously shared with the insured, and the same materially differs with the subsequent loss adjustors report most likely on the value of the loss claimed. To avoid such situations, the sharing of the two reports would be advisable.
Let me now discuss the Loss Adjustors Report. In theory the Loss Adjustor is an independent professional similar to the lawyer being an officer of the Court, seeking the truth through presentation of the case to enable justice!
In reality we know neither of those two propositions are true. The lawyer is perceived as if they are the Client, and in many instances act as though the case is their own. This may be an age issue, as the older one gets the easier it is to put into perspective the Client’s problems and distance oneself from them.
The Loss Adjuster is perceived both by the insured and by the Court, as a witness for the insurer who is normally the Defendant. If they are lucky the Court will treat them as an expert witness on the determination of loss and replacement value. However, on the issue of the policy terms conditions and cover, the Loss Adjustor can merely be one voice in assisting the Court in its final determination of the case.
As a result, such a voice ought to be considered substantive and supported by evidence.
Practically the Report ought to succinctly produce its findings in a clear and concise manner referring to evidence attached in a paginated manner.
This will assist the Loss Adjuster producing the Report to refer to evidence in support, in a concise way. This will also be similar to the way Advocates produce documents in Court and its familiarity assists the Judges.
When testifying in Court on issues of terms, conditions and cover of the policy, explain the industry practices and explain the reasoning behind your finding on the matter. Please remember that we have written witness statements these days, and it is advisable to prepare your own draft which correlates with your report to share with the Insurers Advocates prior to them being filed in Court. Your Witness Statements together with the contents of your report, forms the basis of your cross-examination. It is therefore imperative that you are comfortable and conversant with the same.
In cross-examination by the Insured Advocate, remember any question may be asked, though relevance ought to be the criteria. It is likely that you will have filed your evidence electronically as a result the documents are scanned copies of the originals. It would be wise to carry the originals to Court especially if they are current quotations by suppliers for replacement goods.
The Judiciary has also transformed due to the pandemic to applying virtual Justice. Although most Court’s insist on physical hearings, it is not unusual to attend a virtual one whether in the insurer’s Advocates offices, or from your own. Whatever the situation is, it is wise to ensure that you have good internet, sound and visuals when testifying. Kindly ensure that other than the Advocates, there are no other persons in the room when giving your testimony as this can lead to challenges to your evidence, by the other side.
There is also need to be conversant with the investigation report, as your report may overlap in some aspects with the same, and they should not be contradictory, unless you disagree with how the investigation has been conducted and with its conclusions. Any such difference will be highlighted by the Insureds Counsel with glee.
If they exist, be prepared to explain why and show that the difference does not affect either the non-liability or the value, you have reported.
I think we can further discuss these issues in the plenary session.
To conclude, I wish to raise the issue of AI and the effect it is already having and its future role in the industry?
I would like for us to discuss that in the plenary.
Thank you for your time and patience during my presentation.
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