Tue | Apr 25, 2017

Advisory Column: A sequence of unfortunate events vs claims sceptics

Published:Sunday | March 1, 2015 | 3:00 AM

QUESTION: While on my way to Kingston on January 8 to service my vehicle, I was attacked. An object was thrown into the windscreen of my car. The windscreen shattered. I panicked and crashed the vehicle into a small wall. Unable to move, I came out of vehicle only to be shot at by someone in the dark. I had to run and leave vehicle and hide in the cane piece until police came for me about a mile away. After they arrived, we returned to the scene. The vehicle was on fire and was being extinguished by firemen.

Two days later, three insurance investigators visited the scene. They took photos and interviewed me afterwards at home. The next day, a forensic investigator called me to say that he wanted to meet me by the burnt-out vehicle. When we arrived, the vehicle was missing. Drag marks leading into the cane field were all that we saw.

The insurers have since denied my claim. They say that they could not verify that the burnt-out vehicle was indeed the insured vehicle. Without that verification, they are unable to pay my claim. I have comprehensive insurance. I do not understand why if three investigators were sent to the scene, not one of them bothered to check vehicle to see if this was the vehicle they were sent to investigate. What can I do to get the insurers to pay my claim?

- B.D.

HELPLINE: The events you have described remind me of another case a few years ago. It involved a young woman with an expensive, high-performance European vehicle. She lived on the north coast.

Early one morning, on a trip to Kingston, the vehicle caught fire. It was totally destroyed by the time the fire services arrived.

The vehicle was insured comprehensively. Six months later, the claim remained unpaid. The young lady, who had reportedly just ended a relationship with a 'sugar daddy', had sought to convert her motor vehicle into cash, according to investigators. Her insurers refused to pay the claim.

Dishonest persons are thieving billions of dollars from insurance companies each year. This practice is not limited to Jamaica. It is a global industry.

Much in the same way that local lotto scammers and their overseas cronies prey upon naive Americans to part with millions of US dollars, there are other persons here who make a living from bogus insurance claims.

This was the subject of my June 29, 2014 article, Insurance fraud is a billion-dollar industry. One of the many by-products of the economic adjustments that are now taking place, insurance experts say, is a big increase in the number of dishonest claims.

Selling bogus insurance documents is also another racket affecting insurers.

Am I calling you a fraudster? Absolutely not. However, over the course of many years, I have developed a keen sense - call it a nose - based on how an insurer treats a particular claim, whenever fraud is suspected. This is precisely the reason for the opening paragraphs and why three - not one - persons visited you at your home to carry out investigations and a fourth person was also appointed to inspect the remains of the vehicle. Identifying claims that look suspicious is part of insurers' standard operating procedures.

Your email is short on details. It did not say anything about: (a) the name of the town from which you were travelling; (b) the name of the road on which the incidents took place; (c) the time of day; (d) the make, model, year of manufacture and estimate of value of your vehicle; (e) how many gunshots were fired and if the car was hit; (f) whether you saw any of the persons that were involved; (g) when the police arrived and the name of the station to which they were attached; (h) if any spent shells were found by the police; (i) what was the renewal date of the insurance; (j) when the claim was reported to your insurers; and (k) when the vehicle was last valued.

Without that and other information, I have to guess why your insurer refused to honour your claim.

My suspicion is that the investigators have unearthed information about you which, given the current economic climate and the events surrounding your claim, have raised a number of red flags.

Bear in mind also that the real job of the four investigators was to gather information to help the insurer decide if the claim was fraudulent. It was not to help you to prove your claim.

You will definitely be needing the services of a good attorney if your insurer reached the wrong conclusion about your claim.

n Cedric E. Stephens provides independent information and advice about the management of risks and insurance. For free information or counsel, write to: aegis@flowja.com