Legal Requirements of a Claim – Part 1

When an insured puts in a claim the onus of proof falls on him. For this reason, the insured will have to prove two things:

• Firstly, that an insured peril arose: That he/she suffered a loss directly caused by a peril covered by the policy.
• The amount of the loss: the insured must show proof of a financial loss and size. The proof would include receipt, repair account or a valuation

Duties and responsibilities of insurer

The insurer will need to ensure that:

1. Cover was in force at the time of the claim
2. The insured is the same as the one named in the Policy or the one entitled to indemnity
3. The insured has taken reasonable steps to minimise the loss
4. The principle of utmost good faith was originally complied with
5. No exceptions apply
6. The value of the loss is reasonable

It ought to be noted that the insurer has a duty to its other policyholders as well as shareholders to ensure that all claims payments are fare.