Consumer Protection, Good Advice

What is insurance?

Insurance, what exactly is it?

An insurance policy is a contract between you and an insurance company. It protects you against financial loss due to specific events, eg property damage, redundancy, illness.

It’s designed to put you back in the financial position you were before your loss. This is called indemnity.


Insurance types

There are many types of insurance cover, but the main are:

  • house
  • contents
  • motor vehicle
  • life
  • healt
  • travel
  • business.

Decide what kind of policy is relevant to your situation.

Different insurance companies call their products different things. They may have varying levels of protection and cover different events, so it pays to shop around.


Insurance brokers

Using a broker may be helpful to:

  • help identify risks
  • compare policies and prices.

This may be useful if you’re in business or need expert advice. You can also arrange insurance directly with insurer.

Avoid problems when you make a claim in the future by understanding what your policy covers.


What you need to tell insurers — disclosure

You need to be honest, and give complete, up-to-date and relevant information when:

  • you apply for insurance
  • you renew your policy
  • you make a claim
  • your circumstances change.

Make sure you:

  • answer all of the questions on the insurance application, even if you don’t think they are relevant
  • contact your insurer if you forgot to include something on the application
  • read through your application carefully before signing it if someone else fills it in
  • tell the insurer about any events, eg convictions, speeding tickets, accidents, losses that have happened since you the last renewal, each time you renew your policy
  • ask your doctor for a copy of your medical notes if you can’t remember your full medical history.

Before you make a claim, check the information you have already provided. If it is incorrect or you left out information, the insurer may refuse your claim, or even cancel your insurance from the starting date of the policy. They can only do this if the information is important (material) and would have affected their decision to insure or the level of premium charged.

If things go wrong

  1. Complain to your insurer: Many people are able to sort out their problem directly. Your insurance company will have a complaints process, eg if you’re unhappy with the outcome of a claim, a different assessor will look at your case.
  2. Go to your insurer’s disputes resolution scheme: If you and your insurer can’t agree, take your complaint to their dispute resolution service. Ask your insurer for the contact details — it’s free and all insurers must belong to one. You can contact the dispute scheme for advice while you’re still going through your insurance company’s complaints process.

Read more on each below.

1. Complain to your insurer

Before you do, read our information on:

  • your rights
  • common complaints
  • how to complain.

Your rights

Insurance covers sudden and accidental events. It is designed to leave you no better or worse than before the event happened.

What insurers must do

Insurers must comply with standard consumer law eg Consumer Guarantees Act and Fair Trading Act.

Consumer Guarantees Act

Fair Trading Act

Most insurers also belong to a professional association, who have their own set of rules — called a code of conduct.

Codes of conduct are based on:

  • standard consumer law
  • other expectations of what it means to be a responsible insurer.

They include agreeing to:

  • provide a professional service
  • give accurate information
  • not pressure you
  • explain terms and conditions, and exclusions — if you need them to
  • tell you if anything changes
  • settle claims fairly and in a reasonable amount of time
  • protect your privacy
  • have a fair complaints process
  • act on feedback and complaints.

General insurance industry code — Insurance Council of New Zealand

Life insurance industry code [PDF] — Financial Services Council

Health insurance industry code [PDF] — Health Funds Association NZ

What you must do

Customers must:

  • pay premiums on time
  • tell the truth
  • give insurers the information they ask for — called disclosure
  • report stolen items
  • take reasonable care, eg lock car doors, not put valuable jewellery in checked-in luggage.

Disclosure

When you take out a policy, insurers ask you a set of questions, eg about medical conditions, criminal record, if you’ve ever had a claim refused. You are expected to answer these accurately, and to update your answers when:

  • your policy renews
  • if anything changes.

You are also expected to give an honest account of what happened when you make a claim.

Little lies have big consequences — Insurance and Financial Services Ombudsman

Telling even a white lie could mean you claim is denied and make it harder to get insurance in the future.

Example: More evidence = accepted claim

Nessa’s vinyl collection is stolen in a burglary. The records were collected over the last 15-20 years. She doesn’t have receipts for most of them. She estimates their value in her contents insurance claim. Her insurer says they need evidence the collection was as big, and as valuable, as Nessa says. She provides photos of the collection, including pictures of her holding the most rare — and valuable — discs. Based on these photos, the insurer is accepts her claim.

Insurance - what exactly is it?

Before you complain

  • Talk to your insurer’s free disputes resolution scheme: They can offer guidance on settling your complaint
  • Check your policy: Look at what it covers. Make sure you’re looking at the most recent renewal document. You can ask your insurer for it, if it’s hard to find.
  • Decide your ideal outcome: What would it take to make it right, eg an apology, your claim being accepted.
  • Gather evidence: Have on hand anything helpful to making your case, eg emails or letters between you and the insurer, receipts, photos, repair logs, valuation

Tips when complaining

  • Be clear it’s a complaint: So your issue is dealt with following your insurer’s internal complaints process.
  • Stick to the facts: Explain the problem in detail and provide any evidence you have.
  • Tell them what you want: Be clear what you expect to fix your concern.
  • Take time out, if needed: If the conversation is getting heated or you need time to consider their response, call or email back another time.
  • Take notes: Write down the date you formally complained. Insurers must acknowledge your complaint in 5 business days and respond to it in 10 business days. For your own records, it may be best to put your complaint in writing, especially if it is complicated.

Disputes resolution schemes

All insurers must belong to a disputes scheme. Contact them:

  • for guidance before talking to your insurer
  • if you and your insurer are finding it hard to agree.

Their services are free.

Disputes resolution schemes are neutral — meaning they look at facts from both sides. They might help you and your insurer settle your complaint by talking it through, eg with mediation. If this isn’t possible, they will make a recommendation — sometimes calling on another expert, eg a loss adjustor, for extra advice.

Your insurer must act on whatever the scheme recommends. But you don’t have to accept their recommendation if you don’t agree. Speaking to a lawyer would be your next step, if this were the case.

There are two disputes resolution schemes who look at insurance-related complaints:

Ask your insurer which one they belong to. Or find a list of members on each site.

Commerce Commission

Report your insurer to the Commerce Commission if you think:

  • you have been misled
  • they have said something untrue, eg told you the policy covered something it doesn’t
  • they have pressured you into taking out a policy you did not want.

The Commerce Commission enforces certain consumer laws, including the Fair Trading Act.
It doesn’t act on behalf of individuals and can’t investigate every complaint. But their investigations do help make sure businesses are complying with the law. Your information helps them assess which consumer issues are causing the greatest harm.

Going to the Commerce Commission may stop the same thing from happening to someone else.

Make a complaint — Commerce Commission

Fair Trading Act

Do you need to get some advice with Insurance?

We can help with claims and dealing with an insurer on your behalf, but we can also recommend a number of advisers who can assist you and give quality advice on insurance, both Risk Insurance and Fire & General.

For more information please use our Contact Form.

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