Difficulty With Insurance Company Claims

[Cohan85]

Thank you all very much for your replies. It is great to hear from a few who have come through a similar battle with some success. The broker i purchased the coverage through claims to be doing all they can to get a result but by this stage it sounds like it might be time to shell out the coin for a lawyer to send a nicely worded letter. I have already sent local weather report and our record of distress call from sea rescue along with a brief history of my trade background and years of working in the marine industry and commercial sea time, however they still knocked it back. I will keep at it though.
Again, thanks for the encouragement.
Cheers,
Cohan

[TomLewis]

Originally Posted by foufou

I agree with Anne T Cate. Persistence pays off. A few years back I had a claim that was denied. I spoke to a lawyer and an accountant who supported my position. In the States we have insurance commissioners who advocate for the insured. Just mention of my conversations and possibility of bringing in the insurance commissioner turned the tide. After a half hour I received a call back to tell me they were mailing a check. Keep after them

Concur with foufou, if you have the equivalent of an insurance commissioner (voted in, not appointed), that is a free way to start. Insurance companies do not want to lose their ability to do business in the state.

[buzzstar]

My suggestion would be to carefully review the insurance policy itself. If the legal language causes concern, read it with the assistance of someone, perhaps a friend who is a disinterested insurance broker (assuming a broker can be that) or has a legal document background. Unless you find something that absolutely (in your opinion, not your fiend's) lets the insurer off the hook, remain persistent and insistent. At some point you may want to consult with a local solicitor familiar with small vessel marine insurance, but I can offer no advice as to costs or possible outcome. Just as an example of the information that could affect an outcome, what if you lightly hit a submerged object and this provided enough increased stress to cause the resulting damage without creating visible damage of its own?

[hellosailor]

I could see a structural failure being caused by "improper" maintenance, if that meant structural wood had rotted due to leaks being ignored, or termite infestation. Or simple rot from wood with iron fasteners being in salt water for too long.


But without knowing how your boat was constructed, or exactly what your insurer has determined are structural failures...it is all meaningless.


You might ask them, simply and innocently, to specify exactly what manner of failure, in what materials and what parts of the structure, they allege to have occurred because of what specific lack of maintenance.


I suspect even in Oz, they can't just say "it broke", surely they are required to be specific as to what broke, how it broke, and why it broke? And, to specify what maintenance they expected to have been done in the past. Which the previous owner might have a record of, or be able to attest to.


AFTER you've got that reply--or their refusal to give it--then you retain counsel.

[JPA Cate]

Cohan 85:

A few years back, a CF member who was in Perth located a maritime attorney for Boatman 61. If you send "Wotname" a PM, he will be able to give you the contact details for this atty. (Sorry, I no longer have his name and address.) He took Boatie's case on a contingency basis, and won.

Ann

[Colin A]

Having worked in claims for a yacht insurer, I would say my experiences were pretty good most of the companies operating in the US market are at least OK. That's not to say that there aren't some claims workers (and in particular some claim supervisors executives etc) that do make the experience painful.
Quick questions
Did they Deny the claim in whole or in part? Some times you will see a partial pay where the will cover to repair what they believe was caused by the loss but not damage they believe to be old (if this is the case you may want to get a surveyor with claims (court) experience).
Did they send a letter saying why it was denied?
How old was the previous survey?

I think for now your best bet would be persistence. You can also try to work up the chain of command that usually will let you know if it was kicked up higher before being denied. You seem to have your ducks in a row regarding your information so they really need to provide you details as to why they aren't paying.

I didn't deal much with lawyers in my time but they do often get the attention of those in charge. As mentioned industry regulators can be helpful as well. Getting a call from an insurance regulator usually results in some tense meetings and moves you up the priority list. Also certain lawyers have reputations for winning. There were a couple that were boat specific that usually caught the bosses attention right away doesn't really matter young or old more their reputation for winning against the insurers that helps you.

[David B]

Originally Posted by Cohan85

Hi guys,
bit of a frustrating one. After a few years of searching we finally found a suitable vessel to suit our needs and budget. Its a oldish 1985 simpson firebird 40ft catamaran and thing were looking great until we copped a larger than average wave at an awkward angle during rough conditions and split the bulkheads of the port side hull and a few cracks through the saloon area bulkhead on the delivery run home from east to western Australia. We were able to lower sails to reduce stress and motor into the nearest marina. The vessel was insured when I purchased it only 10 days prior to the incident. It was insured through the same broker as the previous owner and there was no survey requested as they had one on file from the previous year. The claim was filed and we found a suitable Shipwright in the area who quoted repairs and things seemed to be progressing ok. Now the insurance company is flat out denying the claim and saying that the weather was not extreme enough to cause the damage and that it was caused by improper maintenance. I find this ridiculous as it was clearly in good enough condition for them to insure it only 10 days prior and take my money for it! This has been going on for over 4 months now.

Has anyone had a similar experience and had a successful outcome and how did you go about it?

Appreciate your advice greatly as we are very frustrated and stuck with a busted dream.
Cheers

You need to get in touch with the Financial Ombudsman Service (free service)
1300 78 08 08 or email info@fos.org.au.

They will assign a case manager, request documentation from you and the insurers, and assess the case on your behalf, then make a decision.

From what I see, the insurers insured you without condition.
Assuming the yard has not advised them that there is rot or some structural integrity issue due to lack of maintenance, then it seems you have a good case.

Good luck, and let us know how you go. Very disappointing for this to happen at all, let alone during the excitement of a long searched for purchase and the delivery trip home.

David

[ian murch]

hi I know of another yacht who had the same experience at my club.
in the policy there should be a clause detailing your rights to refer your claim to Lloyds for mediation after giving notice to the insurer. You can also take it up with the Australian Financial Ombudsmans Service. If the insured is who I think it is this is there standard modus operandi but it is worth taking it further. Try to find photos and/or a stat dec from the previous owner that states the damage was not present at the time of hand over

[SeeLevel]

I don't suppose it would be worth asking the questions . . .

If it was a new boat would it have suffered the same damage, and to the same degree?
And, did the previous owner submit any damage claims for that boat? If so, what is the record of completed repairs?

Either way, polish up your long gun and take your best shot.

[Fore and Aft]

So you purchased a 40 foot cat without a survey is what you are really saying and now expect the insurance company to pick up the tab for the damage that was caused while sailing in rough weather? Must have been one hell of a wave or just bad luck?
I have surveyed plenty of Simpson cats and wonder what could have gone wrong? Generally they are bloody good boats.
How did you determine the condition of the boat? Surely before you spent all that money you paid a professional to survey the boat?
I have been involved with a number of these cases and in at least one instance the insurer never had to pay out. There is some sort of clause that says the vessel has to be in seaworthy condition.
It's a bit like having a car crash and your car does not have a current road worthy? You can hardly expect the insurer to pay out if you have bald tyres and bad brakes?
Cheers

[ozsailer]

I am going through the process of wanting to change insurance comapnies at the moment as from what I have researched the old addage "The devil is in the detail" is as true today as when first quoted. Regardless of whether you had a survey done or not the insurance company agreed to insure you. In most policies that I am aware of most boats are insured for storm damage "unless" it relates to named storms IE Cyclone and hurricanes then it all depends on what is in the small print regarding your coverage.
Being in Oz I agree with the comments regarging your first option of getting in touch with the relevant obusdman immediately. I would also be seeking legal advise (as much as I am not a fan) but in this case a letter from a solicitor holds a lot of weight in these cases (from similar experiences) plus a solicotor will quickly point our your rights.
I struggle with the concept of them saying the conditions were not sufficiently severe to have caused the issue. Unforecast micro storms occur and its is easy to sustain damage. Crumbs, hitting a dock at low speed can cause severe damage and you are covered.
Are you able to nominate who you are insured with.


Greg H
Sunshine
Lagoon 410

[Cohan85]

Thank you David.
This is certainly a option I am looking at and I will be happy to keep the forum updated as I get some progress. Can't wait to get back out there.
Cheers

[Cohan85]

Originally Posted by Ann T. Cate

Cohan 85:

A few years back, a CF member who was in Perth located a maritime attorney for Boatman 61. If you send "Wotname" a PM, he will be able to give you the contact details for this atty. (Sorry, I no longer have his name and address.) He took Boatie's case on a contingency basis, and won.

Ann

Thank you Ann. I am going to chase that up.
Cheers

[JPA Cate]

Good luck with it, Cohan.

Ann