"Delivering the right outcomes"
Below is a list of case studies and the outcomes achieved on each claim. We'll now take a look at each example and how CEC turned these claims into success stories for the policyholders.
The insurers Loss Adjuster suspected fraud and requested documentation about the client and his financial affairs. These requests became more and more obscure and it was clear that this was simply ‘fishing’ for evidence and hoping to find a reason for the claim to be rejected or hoped this would cause the client to become frustrated and give up the claim.
Claim Outcome: The CEC Loss Adjuster was able to escalate a complaint to insurers to demonstrate there was no evidence that justified repudiating the claim and it was successfully paid by the insurers.
The claim was reported to insurers who quickly deemed that the activity was hazardous work and was outside the business description. The CEC Loss Adjuster reviewed the papers and identified that the Risk Assessment was incorrect in its portrayal of ongoing works. Statements were taken from personnel to determine that the incident arose during manual manoeuvring of materials at ground level and centred largely upon human error.
Claim Outcome: Representations were made to insurers to emphasise the ‘material’ circumstances and the CEC Loss Adjuster successfully challenged their earlier position.
Cover was declined on the basis of a failure to protect flammable material. Investigations by the CEC Loss Adjuster revealed that the Insured could not have known about the materials without fully dismantling the building structure.
Claim Outcome: Insurers subsequently accepted that the client had acted reasonably and consequently they agreed that their stance was too harsh.
The client told his Insurance Broker that he did not want to rebuild a fire damaged property and wanted the cash value instead. Insurers wanted to pay the pre-fire market value only less the value of the site. Insurers did not want to pay the rebuilding cost.
Claim Outcome: The CEC Loss Adjuster checked the entitlement under the policy and successfully negotiated a 50% improvement in the offer.
Underinsurance was alleged by the insurers. The CEC Loss Adjuster examined the lease and the correct allocation of rebuilding cost responsibilities. The CEC Loss Adjuster made the correct allocation of responsibilities between the landlord and tenant.
Claim Outcome: The insurers re-considered the claim and the average penalty was rescinded.
There was suspicion by the Insurer that a commercial property was unoccupied and cover was excluded. The CEC Loss Adjuster took detailed statements from witnesses and gathered other evidence to prove it was not unoccupied.
Claim Outcome: The CEC Loss Adjuster successfully persuaded the insurers that the claim should be met in full.