The role of Insurance Claims Agents 

Insurance business involves the making of a promise by the insurer that, in consideration of the premium paid by the insured, the insurer will settle a valid claim that may be submitted by the insured.  Where an insured engages the services of an insurance broker, the process of settling claims is facilitated because a broker has the necessary expertise to accurately compute and submit the claim to the insurer. 

Difficulties are likely to be faced by individuals and firms who take out direct insurance and do not employ insurance experts.  The possibility of differences arising in this situation may be escalated as both parties may have very different interpretations of policy terms.  In any event, there are very few non-insurers who will have an understanding of the procedures for dealing with claims.  Insurance companies are always willing to help claimants with the necessary steps that must be taken in the submission of a claim.  However, this arrangement may, at times, create a challenge in the event that an insurer repudiates the claim or makes an offer that does not satisfy the insured.  In such situations, insured persons tend to regard insurers with suspicion and tend to view them as being protective of their financial resources.  It is not uncommon for such disputes to result in litigation. 

The law recognizes the significant role that insurance claims agents can play in assisting insured persons process their claims.  These agents basically receive instructions from insured clients and depending on the nature of the claim, may need to investigate the claim before computing and submitting it to the insurer.  In the process of assessing the claim, the agent acts as an adviser to the client.  A prudent agent will objectively examine all potential claims and where the claim does not appear to have any merit or where it is highly exaggerated,  the client should be advised accordingly. 

After a claim is submitted to an insurance company, it is carefully studied and where no issues of concern are raised, arrangements are made for payment.  However, complex claims may call for further investigations and negotiations.  The claims agent is well positioned to carry out this role.  An appreciation of the legal principles dealing with the quantum of damages often aids the agent in the negotiation process. 

In most claims agency contracts, a provision exists for payment of the claim through claims agent.  However, some arrangement requires the insurer to pay the claim directly to the insured less the commission which is passed on to the agent.  All insured persons intending to use an agent must ensure that they fully understand the contractual terms of the agreement that they are about to enter.  Clients must also satisfy themselves that the agent is duly licensed by the Pensions and Insurance Authority.  Claims agents are issued with licenses for each calendar year.

In recent times, agents have been engaged mainly by third party motor accident claimants.  A number of such persons have successfully derived their benefits as stipulated under the Road Traffic Act.  However, the scope of work that may be handled by agents exceeds that of motor accidents victims.  Any insurance claimant can utilise these services.  A case in point is that of individuals who may be too busy to personally pursue a claim or those who may be out of the country when they suffer a loss in Zambia. 

So, next time you suffer an insurance related loss and you have difficulties in pursuing your claim, consider using the services of an insurance claims agent.  The earlier you appoint one, the better.

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