Bowen Buchbinder Vilensky

Posts Tagged ‘Insurance’

How Best to Submit an Insurance Claim?
Tuesday, August 26th, 2014

By Les Buchbinder, Director at Bowen Buchbinder Vilensky Lawyers

26 August 2014

What’s the best way to submit an insurance claim.  In three words: through a lawyer.  Of course, if it’s a straightforward and relatively minor claim – for example, when you discover someone has reversed into your car, denting the passenger door and causing a couple of hundred of dollars worth of damage – there is probably no need or point involving a lawyer.

But for larger and more complex matters, legal advice can make all the difference because the wording of an insurance claim is extremely important.  I want to make it abundantly clear than under no circumstances should an insurer be lied to or deceived.  But getting advice on what information must be included in any claim form submitted to an insurer, and how to word this information, is critically important.

I have been involved in cases where significant disability claims have been paid out, while others, that seemed identical, were not.  The difference in outcomes was likely caused or contributed to by the way the claim form was completed.

If an insurer rejects your claim, that’s not the end of the road.  You can seek legal help to have a letter written to the insurer demanding a full explanation of the basis of rejection of the claim.  The grounds on which the claim has been rejected may be able to be contested and other arguments raised in support of your case.

If the insurer still refuses to accept the claim in part or in whole then, you may then have the option to commence legal action against the insurer for breach of the insurance contract and/or on other grounds, which the insurer will be required to defend.

Whilst current statistics suggest that around 70% of these kinds of disputes are settled during the course of the litigation and mediation process that occurs before going to trial, given the protracted nature of the process and the potentially high legal costs associated with it, you would be well advised to use the services of a fixed price fee lawyer. Doing so provides more peace of mind about costs, and also helps ensure that the momentum of the action is maintained.

In summary, for the quickest and cleanest result, when submitting an important insurance claim, get help from a fixed fee lawyer.

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How Routine Form Filling can Become a Legal Issue
Saturday, January 25th, 2014

By Leslie Buchbinder, Director at Bowen Buchbinder Vilensky Lawyers

25 January 2014

Many companies delegate the filling in of ‘routine’ paperwork to junior staff.  This includes firms such as accounting practices, financial planners and others who may have comprehensive quality control policies, targeting complex and financially significant matters. Ironically, the more mundane matters can sometimes cause the greatest heartache.

One matter which came to the attention of an Australian court concerned a situation where accountants miscalculated the amount of depreciation allowable as a deduction and the mistake was then carried through in succeeding years.  The error resulted in an overstatement of the tax payable and no refund could be obtained for taxes that were paid more than 3 years ago because they were statute barred.   The client successfully sued the accountants, who were  found not only to have been negligent but also to be in breach of their contract. A significant amount of damages were awarded against them.

In a different case, a client provided a partially completed handwritten insurance proposal form which needed to be submitted to the insurance company.   It was later entered by his financial planner via an online platform.  In undertaking this task and providing answers in all the required fields, the employee of the financial planner who filled in the form inadvertently failed to notice  that the client had in the previous 2 years been declined by a number of other insurers.   A subsequent investigation revealed that the insurance policy that was issued to the client by the insurer was in fact based on material non-disclosure.  Instead of being paid out by the insurer, the client found himself being pursued by it for money they had already paid to the client on the grounds of material non-disclosure and fraud.   His response, in turn, was to take steps to recover the losses suffered from his advisers for negligence, breach of contract and potentially misleading and deceptive conduct,  because of the way they dealt with his proposal form.

While most professional service companies are aware of their duty of care obligations to avoid claims of Professional Negligence, it’s also helpful to bear in mind potential exposure to breach of contract. In particular, remember that your exposure to legal or disciplinary action does not always arise from the most complex or financially sophisticated aspects of your work.  Proper quality control processes are critical to ensure that routine form filling does not expose one to legal liabilities.

Click here for the full article in the BBV Media page.

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