Claims

We at Balens pride ourselves in the sympathetic support we provide to our clients.  Over the years we have received very many unsolicited testimonials from grateful clients.  Things that happen to people in life can be very varied, but the basic rules of dealing with the claim are very straightforward. In this section of our site, we give instructions as to what to do in event of different types of claim and offer a compilation of extracts from various articles we have produced in the past in various journals about protecting yourself as a health professional and some basic risk management.

Malpractice & Liability Claims

As we all know, the climate of complaint and blame has evolved over the last decade, assisted by no win no fee solicitors, and legislation.  When we first started to roll out our specialist and in many ways, pioneering multitherapy covers for Complementary Health Practitioners over 16 years ago, the number of claims we saw were few and far between.  Now we are daily advised of new incidents across the disciplines. 

Read more about Malpractice & Liability Claims.

Household Claims

For most types of claim, such as Water, Storm, Flood or Fire Damage, Insurers normally need a claim form which we will send once we have heard from you.  You will need to get estimates for replacement or repair, which the Insurers need to approve.  If a claim is large, they may instruct a Loss Adjuster who will meet with and go over the claim.  If glass damage is involved, then some insurers have a recommended supplier who will offer round the clock service, to minimise the security hazard and danger that broken glass may present. 

Remember that Insurers these days will not replace a whole suite if only one item is damaged.  They do not pay for wear and tear claims, Storm damage to fences will also be excluded.  Damage to underground pipes is another type of problem that does not always result in an Insurer paying out - there has to be an accidental damage incident - again wear and tear or even faulty workmanship would not be covered. They will also expect you to keep your losses to a minimum- this is your common law duty.

Commercial Property Claims

Many of the above points apply to Commercial Property Claims also.  In addition there may be claims involving loss of money, Loss of Profits, and Public or Employers Liability Claims.  With the latter it is important not to admit liability and to send on correspondence unanswered.  Balens and your Insurance Company will guide you from there.  Loss of Profits claims are more complicated to calculate and you will probably need the services of your accountant to help you.

All Commercial Policies are governed by what is known as the average clause, which basically means that if you are underinsured, your claims will be reduced by the same proportion of underinsurance.  For this reason, it is vital to regularly review your cover and let us know when things change.  Non Disclosure is another area where insurers will not hesitate to decline a claim - if in doubt - notify! Circumstances which the insurer may want to know in assessing the risk - this may be personal information such as a bankruptcy or Voluntary Arrangement with Creditors, conviction or previous claims history.

Theft or Loss Claims

For Commercial Policies these normally require a forcible entry to or exit from the premises concerned for a claim to be acceptable.  Occasionally an entry has been made and yet no signs are apparent.  These types of claim are much harder to get through.  Always make sure you comply with Insurers security requirements stated on your policy- these normally require you to ensure that all window and door locks are engaged when closed for business or when unoccupied.  If your premises whether home or commercial is unoccupied for more than 30 days or 60 days with some insurers, then cover reduces significantly, sometimes reducing to Fire, Aircraft and explosion only - always notify us in such situations so we can alert Insurers- other ways of maintaining cover are sometimes possible upon request.

Always inform the police when losing items away from the premises.  Restricted cover may apply for goods left in unattended vehicles, particularly overnight- always check your policy and ask for an extension of cover, this may be available under certain circumstances.

Public, Employers or Product Liability Claims

These may not require a claim form, but all correspondence particularly if a summons or from a solicitor should be sent immediately with your side of the story and any evidence you may have.  There is a limit to the amount of time you or your insurers have to reply, so time is of the essence.

Travel Claims

If you lose something abroad always get a police notification receipt - most policies insist on this and it is difficult to get these once you return home.  Bills for medical treatment or medicines should be obtained and kept - you usually have to pay and claim back afterwards.  If you should have a serious issue involving great expense and / or hospitalisation, then there are emergency helplines where 24 hour assistance is at hand to smooth the path with the local medical facility to ensure them that the bills will be paid and assist you or the members of your party travelling with you.

Income Protection Claims

You will need Doctors Notes and other Medical Proof as requested by the insurer.  Proving the actual correct amount to be claimed causes the commonest problems.  If you are self employed your accounts may not be up to date.  They may be reduced by you claiming many expenses which reduces your tax bill but may mean that your taxable income is a lot lower than the amount you want to claim especially in the early years of a business, where this is quite common.  It is important to insure only 60% or so of your TAXABLE Income- i.e., the amount after expenses but before tax.  A few of our clients have had dissappointment by not observing this rule, and also paid unnecessarily for cover they didn't need. In start up businesses, they sometimes make a loss - if that is the case no weekly benefit would be paid because technically there is no loss.  Lump Sum Disablement amounts for loss of eyes, limbs etc in an accident would not be affected by this rule.

Serious Injury Claims

Here an injury has to result in a permanent disabling condition, whereupon a tax free lump sum is paid.

Clients sometimes get confused between weekly benefits for either partial or total temporary disability causing a loss of income and lump sum disablement cover caused by an accident.  Although some policies cover both types of claim, many are just covering Permanent Disablement for example loss of sight, limbs, hands etc.

Legal Expenses Claims

These can be varied, arising  from criminal proceedings, where you would be represented by a solicitor, to Inland Revenue Investigations, Jury Service, Employee Disputes, or simply Telephone advice Helplines for Legal or Tax advice.  In all situations you would contact the adviceline who will log the issue and send if necessary a claim form.  Pre existing situations before you took the cover out, would not be covered.  Employee Tribunal Hearings may be covered under certain policies, but only if you follow Insurers and ACAS guidelines included in your handbook.  Sometimes you will get telephone advice, but not the full service a solicitor would give for example writing letters, in others, you will get full legal expenses paid for up to £100,000.  These policies normally cover defence and will not pay for you to sue someone else.

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Or phone the Claims Department on 01684 580798