Insurance Lawyers Melbourne

Insurance Law is a complex area which requires a good understanding of tort and contract before addressing the precise legislative environment which governs this industry. The Insurance Agents and Brokers Act, the Insurance Contracts Act and the Financial Services Reform Act impact heavily in this area.

Lawyers are often instructed to assist with a wide range of matters including policy drafting, policy revision, advice on policy wordings, acting on a wide range of claims, negotiating settlements or litigating matters. Where claims have not been properly assessed and quantified we rely upon LAC Loss Adjusters to do this.

We are available to assist with the following:

• Agency and Broker Agreements
• All Property claims
• Aviation
• Building Warranty
• Business Interruption
• Claims Management
• Claims Resolution
• Class/Representative Actions
• Contractors All Risks
• Directors’and Officers’Liability
• Engineering
• FSRA Compliance
• Financial Claims (Burglary, Theft, Loss of Rent, Advance Profits)
• Marine/P&I claims
• Negligence Cases
• Personal Accident and Sickness/Disability
• Policy Drafting and Interpretation
• Product Guarantee
• Product Recall
• Professional Indemnity
• Public and Products’ Liability
• Recoveries
• Risk Management Strategies

Insurance Claims

Although we get involved in a wide range of insurance matters one of the most frequent areas in which we are retained involves insurance claims.  Interestingly we are approached by clients to represent them on both life and general insurance matters.  All too often insurers refuse to pay claims based on the misapplication of the facts and material presented to them.  Unfortunately they are often missing vital information because they are relying upon either investigators or loss adjusters who lack the requisite skill and experience to obtain all relevant facts allowing them to be put before the insurer.  Alternatively the quality of claims staff is so poor or they have been given little opportunity to acquire the necessary skills to undertake their work properly.  Irrespective the outcome is the same, the claim slows down and finally it is refused.

This problem is far more prevalent with general rather than with life insurance due to the frequency of claims made.  Although many insurers have made substantial attempts to overcome this problem there are still some who frequently deny claims on an extremely tenuous basis.  Unfortunately most solicitors have little knowledge of property damage claims and the methods adopted to secure information provided to insurers.  Without this knowledge it makes it extremely difficult to properly advise clients whether insurer or insured.  All insurance claims rely upon the validity of facts applied so that the policy can be properly applied to ascertain whether the claim fits within the terms and conditions of the policy.  It does not matter whether you are dealing with domestic or commercial claims, irrespective of their size the same principles apply.  The only real difference between the two categories is that the numbers are larger with commercial claims with  consequential losses sometimes being covered by business interruption insurance. 

For fire and general claims, irrespective whether domestic or commercial, problems are often encountered with the quantification of the loss.  That is, in principle the insurer accepts that a genuine claim has been lodged but it is the assessment of quantum and the adjustment of it which causes the problems.  They can start with simple problems of valuation through to large commercial losses irrespective of the type of entity involved where there has been substantial damage to a wide range of property and it has not been effectively dealt with.  One of the major areas of concern for insurers and therefore insured's is the treatment of smoke-damaged plant and equipment.  The question becomes – can it be effectively cleaned and or repaired such that the performance characteristics of it are not impaired.  Of course the insurer will argue that it has been  whereas the insured may not.  A problematic area is encountered when dealing with repairers such as lift companies who always seem to take the view that nothing can be cleaned or repaired and therefore replacement is the only option available.  Sometimes claims will be encountered where plant and equipment has been written off in the books of account of the relevant entity and it has been assessed as having no value including residual value.  Irrespective how the problem arises it will always get back to what is the appropriate indemnity value which will cost you real money if you do not satisfy yourself as to what your legal entitlements are.

Most practitioners are unaware that there is a difference between personal sickness and accident policies and disability ones.  The former is a general insurance product, the latter a life insurance one.  Recently there has been an increase in the number of these claims which have been referred to our office.  Normally they relate to the time at which the insurer was notified and whether or not the disability amounted to a pre-existing condition.  These cases normally involve some complicated medical condition such as cancer, epilepsy or even Alzheimer's disease.  Many of these claims are made under some form of group, life or disability scheme, which often causes problems for the insurer.  Of particular importance here is the onset of the condition and just because an insurer refers an insured for medical assessment that does not always mean the matter is final because we have seen cases in which the medical assessment has failed to detect the condition at an early stage although there were symptoms present.

Our personnel have a long association with the insurance industry and we always strive for fairness and equity on our clients’ behalf. We give clear, concise advice on success prospects. We focus on achieving early resolution of disputes and where this is not possible litigation may be the only means left open to our clients.

In some cases alternative claims management strategies need to be considered which may assist to reduce cost whilst producing the proper outcome. All client instructions are welcome.

Contact us now for Fast, Accurate and Timely legal advice

Phone LAC Insurance Lawyers Melbourne on 1300 734 638 or send us an email.