Underinsurance. Surveys reveal alarming statistics.

Probably due to the harsh reality of the current economic climate, it is estimated that 1 in 6 small businesses have no insurance of any kind. Of businesses that are insured, half of these are insured for only 60 to 85% of Replacement Value. And it gets worse with the revelation that between 17 to 25% of ALL small businesses are under insured and risk business failure following a serious insurable event.

The most alarming part to Underinsurance is that it’s predominately discovered at the time of a claim or loss, which by then is too late to rectify. This has been demonstrated on many occasions over recent years following major events such as floods, storms, bushfires and cyclones.

Underinsurance may impact a wide number of General Insurance Products, including but not limited to:

  1. Home & Contents Insurance
  2. Commercial Motor Vehicle Insurance
  3. Strata Insurance – both Commercial & Domestic
  4. Business Insurance
  5. Industrial Special Risks (ISR) Insurance
  6. Marine Insurance – both Leisure & Commercial Hull
  7. Transit Insurance
  8. Liability Insurance

Under these named Policies there are also Policy ‘Sub Limit(s)’ in areas such as: 1) Removal of Debris; 2) Reinstatement; 3) Extra Costs of Reinstatement; 4) Business Interruption; 5) Care Custody and Control… and all need to be considered when tailoring specific insurance contracts. These Policy areas will be discussed in more detail in future editions of Brokerwise.

There are Insurer Guidelines that provide both Underwriting and Claims considerations once Underinsurance has been discovered. Different insurers have varying degrees of Underinsurance impacts to Insurance Policies and these are always displayed as part of the Policy Coverage Terms and Conditions provided.

That is why it’s imperative and prudent to constantly review your Policy Limits and sub limits as part of an on-going risk management strategy. This shouldn’t just occur at Policy Renewal as asset value increases, renovations or upgrades etc., may have occurred during the Policy ‘Insurance Period’. These reviews should be done in consultation with your insurance professional to ensure your Limits of Coverage are adequate. Don’t wait until you make a claim to find out they are not.

There are many considerations when selecting Policy Limits and there are professionals such as builders who are aware of building costs and any standard changes to the Building Codes that may assist.

Property and Business Valuers are also a real asset when setting figures. Specialist insurance areas such as Business Interruption may require the assistance of accountants or financial advisors, or both, to ensure accuracy.

It’s a sensible approach to discuss Policy Limits following any purchases or disposal of assets and a sound practice to ensure that your level of coverage represents a minimum of Replacement Value.

Remember, it’s too late once a claim occurs to say, “I should have phoned my Broker to discuss….”

The cost of Terrorism. How is it funded?

As a result of the Lindt café hostage siege in Sydney that ended in tragic circumstances, the Federal Government has now determined the actions of the gunman was a terrorist act.

This declaration was a key point for the insurance industry as the Terrorism Insurance Scheme that was created following the Terrorism Act 2003 can now fund claim settlements. The scheme is administered by the Australian Reinsurance Pool Corporation and provides a pool of money to minimise the impacts that flowed from the withdrawal of terrorism insurance. This standard exclusion introduced to policies was necessitated by the anticipated huge costs, estimated at $20 billion, in the wake of the terrorist attacks on New York’s Twin Towers on September 11, 2001.

The Terrorism Insurance Scheme provides cover for commercial property and associated business interruption and public liability claims. It does not cover residential property or residential property contents; also excluded are myriad other types of insurance too extensive to list here.

The scheme is funded by a percentage of premium contributions paid into the reinsurance pool to ensure there are adequate funds to pay for large-scale loss that may affect property and subsequent loss of income. The scheme was established as an interim measure and is formally reviewed every three years in order to decide if there is a need to continue. The latest review in 2012 decided that in the context of levels of Australian and International terrorism at the time, the scheme would continue.

The risk assessment and relevant premium payable by commercial enterprises is determined by postcode with inner city properties attracting a different rate to regional properties. The applicable rate is calculated from the property section of the policy and is a percentage of the existing premium – rather than a loading.

The Sydney café siege, from an insurance perspective, resulted in loss of income to many businesses that had to be evacuated due to the safety risk.

The Insurers facilitate the claims and pay as if the Terrorism exclusion did not apply; they then send the applicable amount for reimbursement via the Terrorism funding pool.

It is important to point out that claims are settled by insurers in accordance with the risks listed in your policy. The declaration of a Terrorism Act merely allows insurers to seek reimbursement from the pool.

Thankfully in the Lindt case, most surrounding business affected did not suffer any loss or damage to property but may have incurred loss of income and/or increased costs due to lost working time as a result of prevention of access to their place of business.

To be able to claim the business interruption financial loss, it is necessary for those businesses to have a policy that covers such financial losses. If you don’t have a policy then you are not able to receive any compensation.

Talk to your broker and make sure you have adequate coverage should you be faced with a similar claim.

Our way or the Highway!

When an Insurer says, “we won’t pay” …is that the end of it?

Trucking company, Highway Hauliers Pty Ltd, had the misfortune to have two of their prime movers and trailers damaged in separate accidents. Although the trucking company held a policy to protect it against damage such as this, the insurer denied the claim.

The refusal of the insurance company was based on the fact that the respective drivers of the prime movers, at the time of the accidents, had not achieved a minimum score in a prescribed driver test, known as PAQS, which was a requirement of the policy.

The Insurer did however concede that the failure of the drivers to be PAQS certified, did not cause or contribute to the accidents and did not cause any prejudice to them. Notwithstanding that, the insurer maintained that it was entitled to rely on the requirement to deny the claim.

Section 54 of the Insurance Contracts Act 1984, came to the rescue!

The intention of Section 54 is to strike a fair balance between the interests of the insurer and the insured party. The effect is to prevent insurers from refusing to pay a claim, even though there is non-compliance of contractual requirements, provided that the non-compliance did not cause or contribute to the loss. If the non-compliance did contribute, Section 54 allows the Insurer to reduce the claim, to the extent that their interests were adversely affected.

As the insurer accepted that the failure of the drivers to obtain the required PAQS score did not cause or contribute to the accident and resulting damage, there was no prejudice to the insurer. In fact, the Court not only ruled on an award to Highway Hauliers for damage to the vehicles, they added a further $145,000 in compensation for their lost business opportunities which was a result of the insurers refusal to pay the claim.

The insurer appealed, which was dismissed. Ultimately, the insurer appealed to the High Court, raising issues used in a similar case in a different court. That appeal was upheld… but in this case, the High Court dismissed the insurers appeal.

One court says no, another says yes. Which proves there are never any guarantees when going to court, as each case will be reviewed on its own merits and situation. Consequently, you cannot rely on the outcome of this case if faced with similar circumstances.

Highways

Dangerous Places!

At 8.55pm on 5 September 2014, a prime mover and two trailers in a B-Double combination hauling over 50 tonnes of ammonium nitrate, rolled at Angellala Creek near Bakers Bend, Mitchell Highway, approximately 30 kilometres south of Charleville and 700 kilometres west of Brisbane. The load of ammonium nitrate was being transported from Gladstone, where it was manufactured, to a mine site in South Australia. The truck failed to negotiate the bridge at Angellala Creek and came to rest in the dry creek bed adjacent to the road bridge.

The driver was injured and the vehicle caught fire. Two passers-by dragged the truck driver out of the vehicle. Approximately 1 hour and 20 minutes after the accident, it appears the chemical being carried has mixed with the diesel split following the rollover, and the ensuing explosion decimated the site, destroying the prime mover and two fire fighting vehicles and causing ‘catastrophic’ structural damage to the Mitchell Highway. A crater, 12m x 6m x 6 metres deep was formed in the creek bed.

“The infrastructure damage to that road is significant,” said Assistant Fire Commissioner for the south-west region, Tom Dawson. The fact that no one was killed in the blast went ‘beyond luck’, he said.

The driver of the truck received burns to about 30 per cent of his body. Four firefighters were also injured, along with a police officer and another member of the public.

Workplace accidents

How to Respond

There is common agreement amongst many Industry Regulators, Insurers, Lawyers, Employers, Trade Unions and Emergency Services, which maintains that the first few hours following a work accident are the most critical.

Once a workplace accident occurs, the overwhelming priority is to ensure that all fellow workers remain safe. The second task is to make the site safe, which may involve shutting down all or part of the total workplace if necessary.

Following a serious incident it is prudent to advise Workplace Health & Safety Queensland (WHSQ) as soon as possible so that they can conduct an investigation into the matter. The business principal or the person who is conducting the business should then cordon off or otherwise prevent people from entering the site, where practical, until the full consent of WHSQ has been obtained. It’s also worthwhile noting that the ‘workplace site’ may include any plant, substance, structure or any other property associated with the incident. Criminal penalties may result if any unauthorised persons interfere with the site.

It’s also wise to contact the company lawyers as soon as possible to discuss the establishment of legal privilege. Legal privilege means that any documents created for the purpose of obtaining legal advice or for the purpose of court proceedings can’t be used in court proceedings unless they are voluntarily provided.

Should the accident result in a fatality, the deceased’s next of kin should be contacted – a matter best handled by the police. Arranging counseling for employees, especially for those who may have witnessed or were involved in the incident is appropriate. A skilled person, either an HR Manager or equivalent, should be the contact person. There should also be a person appointed to establish a document and record management process to control the documents that will follow from the event for future use in insurance or legal discussions.

Your insurance broker and insurer should also be notified as soon as practical to allow these insurance partners to assist, if and when, the matter is brought before a Court or insurance related tribunal or enquiry.

Consideration should also be given to the method and operations of the workplace following the incident. This will allow the business owner to review their existing procedures and risk management strategies to ensure that they remain relevant and appropriate.

As you can see by this article there are many issues that need to be addressed following a workplace accident. Partnership collaboration between your insurance broker, lawyer, risk managers and other professionals will assist when these events occur.

Phone gone mobile?

Smartphones sell like hotcakes these days and you may have been one of the expectant iFans that awaited the new iPhone model like a nervous father in a maternity ward. But after the hype has calmed down and you’ve finally got your bundle of joy back home, what happens if (or most likely, when) you lose or break it?

Insurance brokers have seen many scenarios of mobile phones falling victim to theft and also heard more colourful claims that have become common; dropped into the toilet, fell into the pool, left on the roof of the car, back of the taxi, and even one case of ‘lost while invading the pitch’ at an AFL game.

So where do you stand in the event of a lost or damaged phone? If the handset is on a monthly plan, the standard reply from the Telco’s is that you would have the option to upgrade at your own cost, unless you had insurance cover as part of your contract with them. Telco’s are keen to push mobile phone insurance cover for around $10 a month but like any policy there are exclusions, namely, no cover if left unattended and most ask for their own repairer to inspect.

Many of us would have also had the misfortune of a cracked screen. In this case it’s an issue of cost of repair vs. the policy excess under a home or business policy.

Some insurers take a different stance, but a common requirement is that the phone must be inspected and considered beyond repair to be replaced. A specialist insurer for laptops, phones and mobile equipment advised that settlement is based on like for like replacement. In instances where the phone has been superseded they base settlement on the next available model. They insure the handset only, so they make no judgment between a phone owned outright and a phone on a plan.

The Telco’s offer cover with limitations, however, one point in their favour is insurance against misuse of a phone so the cost of unauthorised calls may be included in the claim up to a few hundred dollars.

With Australians being some of the most prolific mobile phone users, and our teenagers and even younger children being major users, the ‘number of users’ trend in Australia is spiraling upwards. It might be a good idea for those responsible for the bill to consider what phone insurance is right for them.

Direct insurers PDS reviewed

The Council of Queensland Insurance Brokers (CQIB) recently conducted a review of direct insurers Home and Contents PDS documents. With over 150 insurers issuing PDS documents it was not possible to review them all, nor forensically analyze the ones that were reviewed in great detail. However, what was found was a number of statements in policy wordings that should be of concern to the buying public.

Before providing a few examples, it needs to be said that the direct insurers operate with the price-point being their key to achieving sales success. But do they consider that the quality of the cover may be compromised to keep the price down? We all want to save money and pay as little as possible, however the real cost emerges when the cheap premium cover fails to make good your loss. That’s the principle of ‘you get what you pay for’ in action.

Of course there is always better quality cover available but direct insurers call-centre staff, all company employees with sales targets, are well versed in presenting the premium savings to be made with their product and rarely, if ever, offer cover options or any advice relevant to your needs. An explanation of any shortcomings of their cover product, at claim time, is something else you’re unlikely to hear. Here are a few examples that rang the warning bells:

Accidental damage cover offered by direct insurer: Accidental damage accounts for approximately 8% of all home losses and 47% of all contents losses. It is an important cover, yet many direct insurers do not automatically offer this cover. You must request to extend the policy and then an additional premium is charged.

When you request the extension don’t be fooled as some insurers place insufficient low limits on the amount they will pay in the event of an accidental loss.

Fusion cover offered by direct insurer: Fusion losses account for about 11% of Home and Contents losses and yet, again, some direct insurers do not automatically include it in the policy. You have to request and pay extra for the cover. We found polices with sublimits (the maximum the insurer will pay) as low as $1,000, a sum that is not adequate to cover the cost of today’s household appliances.

Away from home cover offered by direct insurer: With the holiday season approaching, it is important to have your contents covered while you have items away from your home in a holiday residence. Several polices reviewed have no cover at all for this situation whilst others, once again, require you to request and pay extra premium for an extension of cover.

Business equipment and tools of trade cover offered by direct insurer: Many quality policies automatically include cover sublimits of $5,000 to $10,000 however the lower priced polices have little or no cover unless (you guessed it) an extension is requested and a higher premium paid.

Building compliance cover offered by direct insurer: Building Compliance – Home cover excludes any additional costs resulting from the building/s not being compliant with the most recent building codes, laws or regulations. This is a big issue for older homes, as all would all be affected. These extra costs of reinstatement are automatically covered under most comprehensive, quality cover policies.

Let the buyer beware and remember, your CQIB Broker has the knowledge and experience to advise, select and provide quality comprehensive policies, taking into account your needs, the policy wording, the insurer’s performance including claims settlement history, and price. Be vigilant out there when buying insurance.

Employers’ Rights

WorkCover claims questioned

Employers are sometimes faced with a situation where they disagree with a decision of WorkCover to accept a claim for statutory benefits made by one of their employees who allege that they have been injured during the course of their employment. The employer may disagree with the acceptance of the claim for a variety of reasons, including a belief that the claim is fraudulent or that the injury did not actually occur at work.

Many employers do not appreciate that they have a right to challenge such a decision. If an employer is unhappy with a decision made by WorkCover on a claim they can seek to have the decision reviewed by the Workers’ Compensation Regulator. Conversely, an employee whose claim is rejected can also seek a review of the decision.

The Workers’ Compensation Regulator is a body independent from WorkCover Queensland and is required to impartially review decisions made by WorkCover.

There is no cost involved in having a decision reviewed by the regulator, other than, of course, if the employer chooses to engage legal representatives to assist them with the review application.

Once WorkCover has made a decision on the claim the employer is entitled to ask for written reasons for the decision within 20 days of being notified of the decision.

WorkCover has five business days to supply the employer with the written reasons for the decision. The employer then has 3 months from the date of that letter to apply for a review with the regulator. The employer is entitled to provide the regulator with additional evidence it wishes to rely on in support of the review application.

The regulator has 25 business days to hand down a review decision unless an extension has been agreed upon. The employer has a “right of appearance” on the regulator during the review process, which can either be done in person or over the phone. It is not necessary to have legal representation during the review process.

If either party is unhappy with the ultimate decision of the regulator they can appeal the decision to the Queensland Industrial Relations Commission. The regulator will normally appoint legal representation to defend their decision in the Industrial Relations Commission. Should the worker appeal the review decision the employer needs to apply to the Commission for the right to be heard on the appeal.