Claim Stories

Claims Story #27: Medical Claim Dispute (Medical Treatment Certification)

Received a claim for knee surgery known as “JOINTREP” for the implant treatment.

Total claims submitted was RM31K++

Initially claim approved was RM22K++ but JOINTREP treatment was excluded, reason being under “experimental stage”.

On appeal and submission of evidence that JOINTREP was approved by Medical Devices Authority (MDA) under MOH via the below website:

  https://mdar.mda.gov.my/frontend/web/index.php?r=carian (where it was stated that the JOINTREP was registered with MDA and it is safe to use).

 

Finally, the JOINTREP treatment was approved.

1.   Understand the exclusion clauses under the Policy. In this case the exclusion included: –

      i)   Treatment under experimental stage

      ii)  Investigational or research nature

      iii) Preventive or screening nature

 

2.   To verify refer to MDA’s website for any new treatment whether the treatment is registered and approved.

 

3.   Knowledgeable and Professional Insurance Agent to act on your behalf is important during claim processing.

Claims Story #26: Falling Tree Damage to Property

Received a claim for damage property due to falling tree caused by strong wind.

Total claims submitted was RM19K++ (Tree removal RM13K; and roof repairs costs RM6K)

Removal and replace of damage metal grill and metal roof was payable, as it is part of the insured property.

However, removal of the fallen tree trunk was not payable, reason “tree is NOT an insured property and hence is not cover under the removal of debris”.

Understand the coverage of the policy as per below: –

   1.  The Insured Items and Properties;

   2.  The Scope of Coverage; and

   3.  The Root Cause of any incident.

 

In this case: –

   1.  The building is the insured property and not the tree.

   2.  The cause of incident was “windstorm”.

 

It is advisable to include “falling tree peril” in the policy if property is surrounded by trees. This will extend the coverage include other reasons such as unstable rooting, aging, destroy by white ant and etc.

Claims Story #25: Wall Collapsed Due to Soil Erosion

Received a claim for wall collapsed due to heavy windstorm, adjuster visited the site incident on the next day.

Total repair costs submitted was for RM270K++.

Initially, it was reported that the wall collapsed due to strong wind and heavy rain.

 

However, based on the Meteorological Department’s weather report, there was no evidence of violent wind at the time of incident.

 

The wall collapsed due to soil erosion. The claim was not admissible, hence rejected.

  1. The root cause of an incident is the key factor to determine whether the claim is payable.
  2. Soil erosion is an exclusion clause under the policy.
  3. If the damage was due to heavy windstorm as the originally reported, then the claim will be payable.
  4. Seek help from qualify insurance agent for interpretation and better understanding of the policy clauses.

Claims Story #24: Amount Claimed vs Amount Approved

Received a claim from a Management Residence for damage to a 3rd party vehicle parked at the lobby due to impact from scaffolding.

Quotation received for the repair was: –

1.   Replace body lift amounting to RM3K++

2.  Knocking, install and spray painting amounting to RM900++

After studying the actual damage and the photos submitted the insurer approved the claim for RM900++ only, for knocking, installing and spray painting works to restore it back to normal.

 

To replace the entire body lift of the damage item was found to be unreasonable and rejected.

1.  Any claim approved must be seen to be fair and reasonable.

2.  The main principle on insurance is on reimbursement basis: –

  • To compensate on the actual damages or losses.
  • Only the repair costs to restore the damage items back to its original are allow; and
  • Not to make any gain from the situation for all claims.

3.  Don’t panic to admit the mistake and promise to 3rd party for compensation in advance.

4.  Let the professional adjuster or insurer’s representative to investigate and come out with the outcome.

Claims Story #23: Risk Improvement

Received a claim from a Condo for water meter pipe burst. The claim happened 2 months before policy renewal date. Total repair cost was about RM32k++.

Claim resolved within one (1) month. This was the 3rd water damage claim within the year, and has been classified as an “unprofitable portfolio”.

 

On coming renewal, Insurance company intends to impose “Special Excess Clause” on Water Damage: 10% or RM25k per loss.

After several discussions, agent suggested for the following risk improvement: –

1.   To have a 4-inch-high cement barrier and;

2.   With an add-on discharge hole.

This will deter the similar incident from happening again.

As the result, Insurance company agreed to renew the policy without imposing the “Special Excess Clause”.

1.   Water Damage tends to be high frequency and repeatable incident.

2.   All Insurance companies will impose unfavorable conditions for those repeatable claims, if there is NO any risk improvement action being carry out.

3.   In order to continue to enjoy a good premium rate and favorable term & conditions, risk improvement is a MUST.

4.   This will not only be a “Premium Saving” in the long run, and also to ease the day-to-day maintenance operations.

5.   If we do not take care of our own property, then who care? Sooner or later no insurance companies would like to cover the condo.

Claims Story #22: Bursting Water Pipes – Damage to Lifts

A Condo Management reported of bursting water pipes at the pump room causing damage to four lifts.

The Condo Management file claim for the four (4) lifts damages with repair quotation amounting to RM990K++.

 

Due to the huge amount, forensic expert from AGI (Approved Group International) was appointed for further investigation.

The policy was liable for the damages but more time was needed to finalize the case, due to the substantial claims amount submitted earlier.

The Claim was approved with the final amount of RM257++, reason for this claim was as follows:-

  1. Only essential replacement of damaged parts caused by the water was necessary.
  2. in most instances quite a number of parts does not need replacement but only servicing.
  3. not all parts were damaged by the water, only replacement parts for the actual damaged were approved.
  4. some items quoted were over prized.

1.  Some lift vendors/contractors may offer unnecessary repair works and replacements.

 

2.  The bigger value of claims will trigger more details of investigation.

 

3.  The insurer needs longer time to finalize the claims, and it may cause delay.

 

4.  Claim payment made must be fair and reasonable, as claim were payable to make good those item damaged and not meant to gain or profit from the claim submitted.

Claims Story #21: Damaged of Circuit Breaker – Speedy claim approval

Received a call from a condominium about a flashover that caused damage to the vacuum circuit breaker on Saturday morning.

Informed the Insurer immediately and Adjuster visited the incident site on the same day.

The incident resulted in the power supply being interrupted.

The total claims submitted amounting to RM80K++. All documents together with all relevant supporting was fully complied by the Condo Management.

Fast approval with full sum claimed of RM80K++ from insurer within two (2) weeks.

The full commitment shown by the serving agent in putting the insured interest first is utmost important.

 

In this case immediate action and reporting a claim upon receiving a call from the insured on a Saturday morning, even though it was an off day.

 

Good working relationship with insurer and managed to arrange the Adjuster to visit the incident site immediately, on the same day.

 

Finally, fast approval with full sum claimed by the insured, all within 2 weeks.

Claims Story #20 : Lightning Claim – Can repair bill be added on after the claim offer is out???

A claim was reported from a condominium about a damage to the card access system for the barrier gate caused by lightning.

At first a quotation for RM4K++ was received to repair the damage, subsequently a revised quotation for RM5K++ was received.

The claim was approved for RM5K++ by the insurer within FOUR (4) working days, one day before the Chinese New Year celebration and without any adjuster being appointed.

 

It is a normal standard practice by the insurer that adjuster would be appointed if the value of claim is exceeding RM5K.

1. The damaged to the access card system for the barrier gate to function properly must be addressed immediately, if not it would cause a lot of inconveniences to the resident especially when the Chinese New Year festival is around the corner.

 

2. Yes, claimant allow to submit add on repair bill so long as the damage is under the covered area and it’s genuine. 

 

3. A Responsible Agent will always act and put the insured right and interest as their top priority.

Claims Story #19 : Student Sport Injury: Volleyball vs Skiing

Received a claim from an International School student who injured his right knee while paying volleyball.

The total submitted medical bills from various hospitals amounting to RM10K++.

The claim was rejected at first by the insurer. Reason being the injury sustained during the fall while playing volleyball aggravated the injury at the same location, where the student had met with an injury during a skiing incident in year 2019.

 

The Policy clearly stated that injury caused by skiing incident falls under the exclusion clause.

An appeal was sent to the insurer to have a further examine of the injury. Adjuster was appointed, an appointment arranged to have the student examine by an Orthopedic Consultant.

 

The appeal was successful and the claim was approved for RM6K++.

  1.  Any reason(s) of rejecting a claim must be further scrutinize on its validity & the fairness of rejection.
  2. Not just simply and easily of accepting the reason(s) of rejection.
  3. It is the insured right to have a fair compensation and treatment.
  4. A responsible Agent will always be looking after the insured right and interest.
  5. Selection of a qualify agent is very crucial, they play an important role as when claim arises.
  6. The School has extended their appreciation to Dindings Corporate Insurance Agency (DCIA) as below: –

Claims Story #18 : Golfer – Hole In One

Insured reported of a golfer who fire a Hole in One in a game at a country golf club and the case was immediately registered with the insurer.

The required claim documents were collated and submitted to the insurer the next day: –

a) Claim Form;

b) GIRO Form;

e) Certificate of Achievement – Hole in One;

f) Receipt of Booking – Golf Game; and

g) Golf Score Card

The claim was approved on the same day – in ONE Working Day.

The reasons for the fast claim approval: –

  1. Immediately report of the claim by the insured;
  2. Fast action by the agent to liaise with the insured for the required claim documents;
  3. Proper advice and guidance given by the agent on the claim processing;
  4. Good working relationship between the agent and the insurance company;

 

It is important to appoint a professional and knowledgeable agent who is well versed with insurance matters and has strong partnership with the insurance company.

Claims Story #17 : Fire Damage to Condo Top Floor & Roof

Fire incident happened to a condominium penthouse and on the building roof top. The insurer was immediately be informed and adjuster visited site of incident on the same day.

Due to the material damages & huge loses, a professional consultant was appointed for: –

  1. Checking on the building structure.
  2. Identify the actual damages and tabulation of BQ.
  3. Calling tender among various contractors.
  4. Submission of Summary Proposal.
  5. Tabulation of repair Works schedule
  6. Monitoring of the works progress
  7. Conducting meeting with various relevant parties from time to time.
  1. The claim was approved for RM648K++
  2. Losses for individual house owners were rejected, reason “Personal properties and renovation done by house owners are not covered under the policy”.

Amongst other things, insured should take note of the important of the attending agent: –

  1. Quick respond to notify insurer;
  2. Immediate action to arrange Adjuster visit on the same day of the incident without delay;
  3. Coordination of the claims submission to ensure the full completion of required documentation.
  4. Appropriate advice and proper guidance during the entire claims process;
  5. Follow-up action on the claims progress at all time;
  6. Review the final Claims Offer to ensure it is a fair compensation.

A professional and knowledgeable agent will not only to ease your burden during the claims process, and the most challenging is to speed up the claim approval within the shorter timeline.

Claims Story #16 : Stolen Cables at Construction Site

A M&E contractor submitted a claim for stolen cable at the site of a project.

Total quantity of missing cables was more than 100 tones, amounting to RM1.0 million losses in value. Due to the huge quantity of cables that were stolen the insurer appointed an adjusted.

The claim was rejected due to below reasons: –

  1. Breached of policy general condition as insured did not notified the insurer on the material change in the risk whereby the Main Contractor was terminated and a new contractor was appointed.
  2. The loss was not notified to the insurer within 14 days which again had breached the Policy Condition as it had jeopardized the insurer right to mitigate the risk/avoid the recurrence of the lost.
  3. The claim had fell within the Exclusion Clause that states “The insurer will not indemnify the insured in respect of loss, damage of liability directly caused by or arising out of aggravated by cessation of work whether total or partial”

Insured should ensure that a proper project management is in placed which should include the followings: –

  1. Proper personnel to be employed to manage a project.
  2. Roles, duty and responsibility of each personnel in the project team is clearly assigned.
  3. Proper channel of reporting with full documentation is a crucial.
  4. Timely and frequent updating on the progress of the project, so that any incident could be highlighted and immediate action to be taken.

In addition, insured to appoint a reputable and professional insurance agent to provide proper advice & guidance on their insurance protection.

Claims Story #15 : Water Damage to Outlet in Shopping Mall

A shopping mall was flooded due to the bursting water pipe and caused damages to all goods & fittings in few shops lots

The mall management submitted the claims for the piping repair costs and the restoration of the ceiling.  And the affected tenants/shop owners also submitted their claims for stocks damages, furniture & fittings respectively.

The water leakage was caused by the bursting water pipes due to aging, wear & tear of the said pipes. The claims for the repair were fully approved. However, the claims by the shop owners or tenants were rejected.

 

It was clearly stated in the Tenancy Agreement that it is the duty and responsibility of all tenants to have their own insurance coverages for their stocks, renovations, equipment and all assets & contents in their shop respectively.

 

The buildings fire policy only covered the building structure and fittings and not inclusive of the contents in the individual shop.

 

The Mall Management Public Liability would not be responsible to third party claim as the tenant had “pre-agreed” in the Tenancy Agreement to be fully responsible for their own property and would not proceed with subrogation claim against the mall management. Therefore, the third party claim is not apparent in this case.

As the tenant or shop owner, it is a MUST to have their own insurance policy protection.

 

This will provide a clear area of responsibility and duty between both the landlord and tenants.

 

By doing so, it will also avoid any unnecessary argument or dispute that may arises when incident happened.

 

At the same time the Tenant shall arrange the protection to protect their own interest. As the loss or damage could come from their owner negligent (property damage claim) and the negligent may cause damage to other tenants as well (3rd Party claim).

Claims Story #14 : Stolen Cable in Project Site

A M&E Contractor reported a cable theft claim in a project site where the installed cable had been cut and stolen in all 15 floors inside the building.

The estimated losses amounting to RM600k++.

Adjuster findings: –

1)     With the substantial size per floor and 10 feet ceiling height, it needs 2 or more manpower to cut the cable.

2)     It is also impossible to cut the all cables within one night for all floors (i.e. total of fifteen (15)).

3)     Therefore, in the conclusion that the incident could be happened more than one night.

4)     Poor in project management, only came to know after it happened to so many floors. Lacking of monitoring and checking on the side progress daily.

5)     The efficiency of the security guards on duty also questionable.

The claim was approved based on the assumption that the incident happened over 15 days period i.e. one night per floor, which they applied 15 times excess deduction. The final claim amount was RM425k++

 

  1. A professional Agent that always prepared to help the insured/ claimant especially when there is a claim arises
  2. It is the duty of the Agent to negotiate for a timely and fair claim settlement.
  3. Lacking in project management skill, may cause the unnecessary damages such as project costs overrun or losses, and delay in completion.

The Adjuster also proposed the “Risk Improvement”: –

 “There is a MUST for the Project Manage or Site Supervisor to conduct daily checking to all floors, and make sure the site conditions are in order before going off.”

Claims Story #13: Vacant Unit & Water Damage Claim

On 4th June 2020 neighbors complained of water leakage affecting few units, on 9th June adjuster visited the site of incident and discovered six units were affected and the cause was an overflow of sewerage pipe from unit 2A.

The reported total losses amounting to RM100,000++.
But the net claimable losses are around RM80,000++, exclude the wear and tear.

Claim was approved for RM20,000++.
Adjuster findings, only 4 units of the 6 units were payable, claim for two units were rejected as both units (2A & 2B) were vacant and fall under the PIAM Revised Fire Tariff general exclusion clause under Section 5, item 7b(a).

i.e. Bursting or overflowing of water tanks apparatus or pipes is under exclusion, as when the building is vacant and unattended for more than 90 days period.

Insured shall always update and inform your agent or insurer for your premise if there are any changes of
1) The business activities/occupations; and
2) Any major extension/renovation.

In order that the needed protection is in place and/or waiver of exclusion has been granted, if necessary.

Tower House Unit 1 (1A – Occupied & 1B – Vacant); consider occupied.

Tower House Unit 2 (2A & 2B – Vacant); consider overall Vacant.

Claims Story #12: Insurance for Condominium

The Subsidence Landslip that occurred at a newly Condo due to heavy downfall, caused the damage to the water outlet and drainage system.

The JMB submitted the losses for: –

  1. The repair costs for the entire water outlet system.
  2. The replacement costs of the drainage.
  3. The enhancement of the soil condition surrounding the drainage.

The claim amount submitted was RM200,000++.

The Adjuster took a little longer time to finalize the claim offer due to: –

  1. There was an argument whether there was an “extended coverage” of the subsidence landslip in the policy.
  2. The substantial amount of the claim. For higher amount of claim, they need more details investigation.

Adjuster findings: –

For normal subsidence landslip, they only cover the damages to building structure and any build-in infrastructures in the building.

With an “Extended” coverage, it will cover the damages for those infrastructures outside the building but within the boundary (i.e. within/inside the fencing).

The claim was only approved for the repair costs of the water outlet system amounting to RM75,000++.

The replacement of the drainage and the soil enhancement on the surrounding area were NOT payable.

The reasons: –

  1. Any enhancement or protection upgrade is not cover under the policy.
  2. The ownership of the drainage was under the Authority not part of the condo or insured building.
  1. The Subsidence Landslip perils must be extended with Deletion (A) clause, in order to include the coverage for the infrastructures outside the building but within the fencing.
  2. In this case if without the extended coverage the claim will be fully rejected. The repair costs for the water outlet would not be payable, as it was located outside the building.
  3. Getting a proper advice is crucial for a comprehensive insurance coverage.
Claims Story #11: Contractor All Risks – Theft Case

OMG! Total stolen item worth RM150,000++

The Theft happened at a newly completed Sewerage Treatment Plant. Stolen equipment included blowers, elm motors, gear motor, control panels, lightning arrestor, copper wiring etc.

Claim approved within 45 days with final offer of RM117,000++.

Adjuster findings, the installed equipment was heavy and large, and the theft incident may not be happening in one (1) day.  It could be 2 incidents or more.

How to have a speedy claim approval even with substantial claim amount?

1. The Insured’s Role:-

  • Fast action of notification;
  • Full corporation with Adjuster;
  • Submission of Claim Form & required documentation without delay

2. The Agent’s Duty:-

  • Professional advice;
  • Closely monitoring & following-up the claim process;
  • A Star Club Qualifier by having the “Fast Track Claim” privilege treatment from insurance company.
  • Strong relationship with insurance company
Claims Story #10: “Own Damage” or “3rd Party Vehicle Insurance”

Wah! How this happen?
A car suddenly knocked into the barrier gate while leaving a shopping mall. Luckily the driver escaped injury.

It is an obvious case that the mall management shall claim the damages from the 3rd Party Vehicle Insurance.

However, in order to have a faster claim approval, we have advised and assisted the mall management to claim under their own property damage Insurance. The reasons: –

  1. Own property damage insurance is straight forward and no adjuster appointment is required.
  2. The claim processing will be simple and faster approval.
  3. And let the Insurance company to do their own subrogation with the 3rd party vehicle insurer thereafter.

The claim was approved and paid within 2 weeks period.

  1. Fast and accurate advice from an insurance agent is important especially during claim.
  2. The 3rd Party Vehicle claim might be drag to 3-6 months for the settlement.
  3. And for a straight forward own damage claim can be settled within 14 working days.
  4. When comes to selection of Insurance Agent, make sure they are reputable and professional.
Claim Story #9: Public Liability

The Dog Vs. Joint Management Body (JMB)
A German Shepherd, lived at a condominium with his owner. Everything was peaceful, until one fine day the dog owner lost control, and the dog bite a visitor, a tuition teacher who suffered a torn pants

The tuition teacher file a claim against JMB for the damaged to her pants.

There was not negligence or wrong doing of the JMB that caused of the damages. In fact, it was the dog owner who was negligence in not able to manage and control the dog that resulted in the tuition teacher been bitten.

The Claims was rejected.
Any claims toward the liability policy, it must be a proof of wrongful act or negligence by the JMB.
The visitor (tuition teacher) may seek for the dog owner for Personal Liability.

Claim Story #8: Error and Omission

A “PUPPY” Vs. Joint Management Body (JMB)
A puppy was kept by a tenant who stay in a condominium. JMB decided to take action, to advise her to move the dogs away from the Condo as this was against the Condo house rules. Excuses were given on why she insisted to keep the dogs, as it was a companion and part of her life and must be with her.
She engaged a lawyer to fight her rights and the case ended in the Tribunal Court. To defend the case, the JMB also engaged a lawyer for legal advices.
Verdict of the Tribunal Court, fined the dog owner of RM200.00 in favor of JMB.

The JMB file a claim for recovery of the legal fees incurred during the course of action.

Refer to the Error & Omission coverage terms: –
Firstly, there should be a proof of any “Wrongful Act” by the JMB. However, in this case there was none.

In addition, under the definition of loss it does not covers for legal costs in defend, as when the JMB is not liable.
The extract from the policy jacket: –

The Claims was rejected.

Majority of the Liability policy does not cover for legal fees. There are two versions of coverage terms provided by the insurers in the market, one with the inclusive of legal costs for defend, and the other is not. Of course, with the inclusion, the premium charged will be higher.

Claim Story #7: All Risks

Bursting Water Pipes – Damage to Lifts

On 6 Aug 2019 informed by a Condo Management Office of bursting water pipes at the pump room causing damage to four of their lifts.

We immediate notified the insurer to register the claim. The appointed adjuster visited the site of incident on the same day.

On 13 Aug 2019 the duly completed Claim Form and Incident Report were sent to the adjuster for processing together with a quotation of RM900k++. The condo management admitted that they didn’t review and negotiate, because they are not the “Lift Expert” and just leave it to the vendor and accept their proposal.

In view of the substantial claims amount, Approved Group International (AGI) was appointed as the forensic, to further assess on the damages.

The Condo Management file claim for the four (4) lifts damages due to bursting water pipe.

It was a clear-cut case that the policy is liable for the damages and the claims is payable. And more time taken to finalize due to the substantial claims submitted early.

The Claims was approved with the final amount of RM271K++.

1. It is not advisable to have only “One” quotation from a single supplier. To get few quotations for comparison and seek advices from different suppliers.
2. It is the insured responsibility to review and negotiate before submitting the claims to insurance company.
3. The bigger value of claims or damages will trigger more details of investigation.
4. Additional expert’s view is needed to arrive on a fair compensation and also for statutory compliance purposes.
5. Time needed to let those relevant experts to come out with their findings and report.
6. The insurer needs longer time to finalize the claims and it may cause delay.
7. The condo residents are the victim for more longer inconvenience period, without a proper working lift for their daily activity.

Claim Story #6: Public Liability

A Resident’s Car Hit by Parking Barrier Gate
Received an accident report from a condominium management office, the car park barrier gate was malfunction and hit on a resident car. It caused the car front bonnet dented and paintwork was scratched. The car owner is claiming the damages from the JMB.

The car owner file a claim to Condo Management for the damages, and this case was related to the Public Liability policy of the condo.

As per stated in the current condo policy, all residents together with the JMB was named as the insured or the owner of the policy. Therefore, as the owner of the policy, the resident is not entitled to make any claim under their own public liability policy.

The claim was rejected with the reason that it is no logical sense for the owner of a policy to claim for their own Public Liability. The Public Liability policy is to protect the insured for damages or bodily injury claim from a third party.
We are not convinced and happy with the outcome and decided to further appeal on this case.

After looked into the details, we found out that it was an “error” in the policy issued. There are two parts of coverages under the normal condo policy packages: –
– Part 1 is for the building fire and;
– Part 2 is the miscellaneous classes which more relevant to the daily operations of the JMB, such as burglary/theft, equipment all risk, petty cash, error and omission, others and public liability is included under this section.

Because of the insurer “condo promotion package”, the policy has been named as one.
Under the normal circumstances if without the promotion, there will be two separate named section i.e. Part 1 is named under all residents and JMB; Part 2 is named under the JMB only.

In view of the above, we submitted an appeal on the JMB behalf based on the above findings. Finally, the insurer accepted and agreed with our argument, and the claims was approved.

Please do check and make sure your condo policy is named under two separate sessions: –

Part 1 (Building Fire) – named under all residents together with JMB;
Part 2 (Misc. classes) – the JMB alone is the insured or named owner.

Claim Story #5: Public Liability

A Flying Object Hit on Student Forehead
It was raining heavily and the wind was strong. A student was walking back to the condo, as he passed the guardhouse, suddenly an unknown flying object hit his forehead and caused serious injury that needed at least 10 stiches. An incident report was raised by the condominium management office.

The student submitted his medical claims and the case fell under the condo Public Liability policy.

Since the origin of object could not be verified it was confirmed as not a part of the condo property and does not belongs to the condo. Hence no evidence of wrongful act by the Management and the insurance policy was not liable for the compensation.

The claim was rejected. It was obvious that there was no negligence by the Condo Management.

However, we managed to appeal successfully on behalf of the Management. Basing on our strong relationship with the insurer and on the ground of humanity, the insurer agreed with our proposal to pay. This was a genuine case as the student was really suffering due to the injury. Moreover, it was an honest claim, the student only submitted for his medical bills together with the spectacle replacement cost. It was a fair claim and the amount was reasonable.

The incident was classified as ”Act of God” as it was beyond the control of the Management. Hence the claim under Public Liability was not payable but due to the strong relationship between the serving agent and the insurer the claim was finally paid.

Claim Story #4: Burglary

Stolen Generator Set
This was a theft case happened in two blocks of Condo simultaneously. These two buildings were situated side by side. It was reported that the generator room was broken in and the key component of the generator set was dismantled.

Both Condo Management submitted their claim for the replacement costs of the stolen parts. This coverage was under the “Condo Package – Burglary” policy.

The lost was confirmed cover under the policy. The claims were payable.

First Building;
Total claims = RM150K++
Claim approved = RM50K, as per the sum insured on first loss basis.

Second Building:
Total Claims = RM80K++
Claim approved and paid full. Sum insured @RM100K on first loss basis.

  • It is important to review and to make sure the sum insured is adequate.
  • Don’t ever just pick and follow the sum insured as per the standard packages offered by the insurer.
  • The service quality of the security company must possess a reasonable level of standard.
  • If possible, the security company must have their “Error and Omission or Public Liability” policy in place.
  • To take serious measure such as make sure the generator room is locked at all the time.
  • And also, there will be compulsory routine check by the security guard too.
  • Additional risk measurement: –
  1. To install a CCTV at the entrance of the generator room; and
  2. To install an alarm system to the door.
Claim Story #3: Public Liability

A Shopper Fell Inside Toilet
While in the toilet of a shopping mall a shopper suddenly fell and suffered a broken bone. A complaint was lodged against the Mall Management for negligence as the floor was wet when she fell and claimed for compensation.

The injured shopper sought compensation from the Mall Management for her medical bills.

There were no evidence to show that Mall Management was negligence or did any wrongful act. No toilet cleaning activity was held during the time of accident, if there was then the management would be blamed for not displaying the caution signage “wet floor” at the toilet entrance.

Moreover, everyone has a responsibility for their own safety when using the public toilet, knowing that the toilet floor could not be dry all the times.

Based on the adjuster finding and the policy’s wording, the claim was not payable.

However, the serving agent took into consideration of the following: –

1. Mall business reputation and to avoid unnecessary retaliation that could affect the businesses;
2. On humanity ground that she did suffered pain due to the injury;
3. Her honesty to claim only for her medical bills;
4. The strong relationship between the servicing agent and the insurer.

The insurer approved the claim for her medical bills.

It is important to choose a right candidate as your Insurance Agent who would assist you when needed especially during claim. The agent relationship with the insurer is also a critical path in deciding the claim outcome.

Claims Story #2: Combined Risks

Broken Glass Windows (Claim Settlement within 3 Hours)
Received a report from Condo Management for a broken glass window.

Case was submitted to the insurer to register the claim.

Upon submission of the full set of claim documents to the insurer on 7 April 2020, time 2.10pm, the claim was approved and Settlement Letter received from the insurer same day, time 5.10pm (3 hours later).

How to speed up the claim processing: –
1. A claim must be genuine, the key insurance principle is for recovery of the losses only; and not to make any profit.
2. A full set claim documentation is important, such as the claim from; incident report; police report; quotation; photos and etc.
3. All documentation must be in order and the claim form must be fully completed and duly signed.
4. The cooperation and fast action taken by the insured is also very important.

Claims Story #1: Goods in Transit

Cables Damaged During Transit
This is a cable manufacturer company. The company engaged a third-party transporter to deliver their finished products to their customer at Terengganu.
The cables were damaged during transit. The main cause was due to poor stacking and no proper tightening of the stocks on the lorry

11 drums of cables were damaged and the case was submitted to insurer to register the claim.

Full set of claim documents were submitted on 8th April 2020 to the insurer and claim offer was issued on 17th April 2020 and claim for RM36k plus was paid on 27th April 2020.

Prevention is always better than cure: –

  • Better to engage a reliable and trusted transporter when transporting important and expensive materials.
  • There must be a contract drawn up whereby the responsibility of the transporter is clearly and fully stated.
  • The insurance claim only allowed for the actual replacement costs or the cost value of the goods; and NOT the selling price which inclusive of the profit margin. The principle of insurance “compensation or reimbursement of the losses”.
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