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09/21/2020
At Pantaenius | Stories & People
There’s fraud around every corner
Whilst insurance is designed to help those that suffer accidental losses, the sad reality is that some individuals try to take advantage of the benefits an insurance contract can offer. We see fraud all too often, it is however usually only small cases, but we do every now and then have special exceptions that make for hair pulling situations, but also great stories.
Let us tell you a little story about a claim we had back in 2018, where one of our clients, let’s call him Steve, alerted us that his catamaran had sunk on its mooring. Steve rang our office and we of course actioned the case quickly to get the vessel salvaged, as well as investigate what had caused the incident. Steve was told to leave the vessel as is so that we could get our experts to sort it out and mitigate further damage. What started off as a straight forward case- retrieve boat, investigate what caused the loss and review the insurance coverage- quickly turned ugly as we uncovered a minefield of lies. Firstly, the boat was in a horrendous condition, the only thing keeping the boat from sinking was the engine room bilge electric pumps. We could write a novel about all the issues the boat had but, cutting to the chase, what caused the boat to sink was a directly attributed to Steve’s actions. It turned out that Steve loosened the hose clamps as well as disconnected the battery. The exhaust pipe became disconnected and overnight the catamaran sank.
To thicken the plot, Steve had also over insured his boat significantly – knowing very well that Pantaenius works with an ‘Agreed Fixed Value.’ We tracked down his purchase receipt from the broker he purchase it from to find out the boat was actually purchased for 20% of what he had declared. This was all quite contrary to the information in the survey report that Steve had provided to our office when he took up insurance. In the end the claim was successfully declined but it had to go through a legal processes and also the Ombudsman who supported our findings.
Cases such as this shows why insurers have such meticulous claims processes in place. We have to ensure that a claim is covered for many reasons, an important one being: when insurer’s claims go up, so do the premiums for all their clients. Therefore our thorough processes helps us ensure that we can keep our premiums as low as possible for our many caring and honest clients!
