Have you heard the one about the insurance claim that was turned down? Sadly, it happens - although not as often as conventional wisdom suggests.

The Canterbury earthquakes and now Kaikōura showed up what a fine line insurance companies walk, and sometimes cross when it comes to claims. Where a single claim might have slipped through, faced with thousands, the insurance companies took a fine-tooth comb to their wordings.

There is an art to getting borderline claims paid. The first steps take place when you buy the policy, not at claim time.

For example, if you're unclear as to whether your policy covers something that might occur, ask via email so that you have the answer in writing, says Chris Boys, insurance lawyer at Assure Legal.


Then, whatever you do, read the policy. Doing this could help avoid a lot of the most common complaints, says Karen Stevens, Insurance & Financial Services Ombudsman.

When you take the policy out you should also declare anything that might be relevant, says Suzanne de Geus, chief marketing officer for Cigna New Zealand.

A classic case of this is that for house and contents insurance you must declare the criminal convictions of anyone covered under the policy - such as adult offspring. Or in the case of motor vehicle insurance, any serious traffic convictions such as careless driving or excess breath alcohol.

Insurance policies state this in plain English, but it just doesn't get through to many people who seem to freeze like a possum in the headlights at the idea of reading their policy.

For this and other reasons, buying through an insurance broker can make sense. Brokers know their way around complex policies.

For example, says Steve Morris, insurance adviser at SW Morris & Associates, ordinary Kiwis might not understand the "buyback" tick box in income/mortgage protection or life insurance.

Yet if they add on a buyback and later have time off work ill, their premiums will be paid for them, which means they still have cover for future claims. Many people fail to keep up payments when off work and can't get the same level of cover through a new policy in the future.

Sadly, I think Kiwis should record all their calls with insurance companies, both when buying from a call centre or making a claim. Sometimes the most apparently innocuous of details can make or break a claim.


Insurance companies record calls but sometimes miraculously lose them come claim time. I experienced this with a UK insurer that argued the call was lost. Only starting the process of taking the claim to the relevant Ombudsman resulted in the claim being paid.

Many people seem to freeze like a possum in the headlights at the idea of reading their insurance policy.

When I was investigating Youi Insurance last year the company was telling customers it would charge them to listen to their own calls. It can do this legally, but readers can make their own conclusions around the ethics of that. The moral of the tale is to record your own calls in the first place.

Another thing you can do at the outset, says Michael Naylor, senior lecturer at Massey University, is video record the contents of your house (and the condition of your car).

Upload that recording to the cloud along with copies of relevant receipts. Having such photos or videos can prove that you own the items even if you can't find the receipts, says Stevens.

Once you do have a claim, take videos immediately after any event, says Naylor, and keep a complete paper trail.

In Christchurch some homeowners waited four years for an assessor, by which time it wasn't conclusive whether the earthquakes were responsible for the damage.

It's times like these that a broker can go into bat for you. Morris has seen more than one case of a life insurance client who is going through chemotherapy and doesn't have the energy to fight when their claim is declined.

Boys saw a broker use her commercial clout with an insurer to have an unhelpful claims manager changed.

Some people struggle to get any case manager at all. With major claims, says Naylor, try to get the insurance company to appoint one and only talk to that person.

If you really think you're in the right, says Gary Young, chief executive of the Insurance Brokers Association of New Zealand, don't take no for an answer.

"It is increasingly common for claims people to not understand their policy wording nor the intricacies of the law," says Young.

"A broker can also present the claim in a way that it is easy for the claims handler to see where it is covered under the policy."

Each type of claim is different, says Sharron-Moana Botica, Sovereign's chief customer officer.

Nonetheless some things are relevant to many types of claims. For example, lodging the claim early is really important as is providing the insurance company with all the paperwork it needs up front.