Claims for loss to property : Genuine or Fraudulent

Case details
Dinesh Mishra was the owner of apparel showroom situated in

commercial area Navi, Mumbai.

The showroom stocked clothes for wealthy, trendy young people.

On weekdays the closing time of the shop is up to 1.00 am as

people in the city preferred to do late evening shopping. Every weekend Mishra spent time wit his family.

One evening on a weekend, he received a phone

from the security guard of the apparel showroom.

 Mishra was informed that there was a major fire in the

showroom & the showroom was completely destroyed in

the fire. After regaining his composure, he rushed to the spot &

tried to get the first hand information about the fire

accident & then he informed to UB insurance corporation about the accident.

UB insurance was the primary insurer for the property.

UB insurance sent a claim adjuster, Venu. Venu met Mishra and assessed the situation.

 Venu asked about the daily turnover of business & Mishra informed the business is moving quite smoothly. But the book of accounts showed that there was a reduction in sales & Mishra replied its because of low

demand during the off- season period.

When Venu enquired with other apparel showroom, & he was told that its because of competition. Venu felt that there should have been less chance of a fire accident occuring during the weekend.

 REASONS: 1. The showroom was closed at the time of accident. 2. All lights & other electricity related equipment had

been switched off.

3. The fire fighters informed Venu that the fire might have been caused by a short circuit. 4.The fire occurring on a Sunday & not a weekday, and that too, at such a late hour.

 Should Mishras claim for compensation be rejected by UB insurance corporation on grounds of breach of policy conditions? Explain

 There are a number of reasons why a claim could be rejected.

Incorrect information if you gave wrong information at any stage

(for example, about how something got damaged), it could affect your claim.

Lack of due care for example, leaving valuables on display in your

car or your mobile phone on the bus may mean youre not covered under the terms of the policy

You didn't take reasonable care to answer all the questions on

the application truthfully and accurately for example you might not have told the company about a pre-existing condition.

So, by the above statements, UB insurance shall reject the claim.

if & only if
If Mishra is not happy with the reasons the insurance company rejecting his claim (genuine), he have a right to complain. If, after going through the insurance companys complaints process, you are still unhappy with the outcome, you have a right to take your complaint to the Financial Ombudsman

Service.

 The Financial Ombudsman Service is an independent, free service that

investigates complaints from individuals about financial companies. If you take your complaint to them theyll consider both sides of the story, look at the documentation and attempt to find a fair outcome based on the facts and common sense. If they decide your claim was wrongly rejected, the Ombudsman Service has the power to make the insurance company: 1.explain their actions 2.apologise, and 3.pay compensation or take appropriate steps to change the outcome.

 How does a insurer resolves a claim for a loss which may have resulted due to the intentional act of the insured?

 Many insurers have Special Investigation Units, or SIUs. Employees who work in SIUs generally have backgrounds as detectives, police officers, medical personnel and the

like.
The following are the samples of what they do: 1. Conduct burn pattern analyses and computer simulations on cars and homes damaged by fire to determine if the fire was intentionally set or accidental.

2. Determine if a claimant's injuries match a reported accident.

3. Investigate damaged vehicles to see if the resulting dents

and scratches jibe with the accident report. Also, use rust

analysis and wear patterns to see if your car's damage is

actually from an old accident.