When we have an appointment on site for a claim, I have to visit all the rooms of the house and enter into the intimate life of the insured. The insured rightly questions this approach even more when I take photographs or measurements of the surfaces of each room before even discussing the circumstances of the event. Imagine the tension that is felt when the garage or mezzanine have been converted into living quarters and not declared to the insurer, voluntarily or not. The same is true of a shopkeeper who closes his front door with a padlock.
What are the consequences of non-compliance of the risk visit on the compensation of a claim?
On our expertise reports, the Insurance Company asks the Expert first and foremost for the report of his "risk verification", in other words the control of the surfaces and the real number of rooms in relation to those declared by the insured at the time of subscription of the multi-risk home insurance contract. Concerning the means of protection on the front door and windows, the insured must comply with the requirements laid down, even more so for traders.
The most important compensations paid to policyholders concern fire claims, €1.4 billion in 2016 according to the French Insurance Federation's dashboard. It is also important for him to check that the means of prevention in this area are well in place (fire extinguishers).
Frequently, we are therefore led to declare non-compliance on the number of parts visited (more or less) and/or in the means of protection put in place before the claim and/or other points declared at the time of subscription. Simple omission of update or false declaration?
The key points of the risk visit for the individual
- The declaration of the number of habitable rooms :
- The very definition of a habitable room varies according to the insurers or even contracts within the same company; this is the reason why I systematically invite you to refer to your general and particular conditions of your insurance contract in all my articles.
- Generally: it is a question of taking into account floor area alone (0 m2 to 9m2)
- if the surface area exceeds 40 m2, the room counts as 2 main rooms or even 3 if it exceeds 80 m2.
- Ceiling height is not always a determining factor;
- sometimes the surface area alone on the ground is sufficient to qualify the part counting towards the premium calculation,
- sometimes it is necessary to calculate and retain only the living area under ceiling height at 2 meters from the floor.
- as well as the destination of the room :
- certain rooms such as the dressing room or linen room or veranda may or may not be excluded.
- For example:
- a 7 m2 dressing room can count as a room at one insurer or not at another.
- The kitchen is not counted as a main room unless in certain cases the surface is larger than the one defined in the contract!
- Particular puzzle: the entrance, living room and kitchen located in the same space: the kitchen, the living room and the ...
- Means of closure required on the front door are sometimes detailed in the contract.
- The most commonly used button safety lock does not fit directly into the door frame. The door can be easily opened by simply pushing it; it is not an anchor point in the strict sense but a closing point.
- The means of protection required for windows and window doors such as shutters or bars are sometimes mentioned in your contract (a maximum distance may be required, if so!).
- The value of the contents is a key factor in determining the limits of cover according to the category of goods: valuables or jewellery. The HISCOX Company offers a new "Fine Art" service with free valuation of 10 precious objects of the insured person's choice.
- Other points are to be specified according to the companies: which are the persons having the quality of insured and residing on the premises as main or secondary residence, presence or not of chimney, insert, photovoltaic panels, swimming pool, the building and the floor of the apartment, the environment (inhabited area or not...) and other points.
In summary, it is preferable to inform your insurer of any changes that have occurred since you took out the policy, even if you change floors in the same building or blocks in the same condominium, as this may affect the calculation of the premium you pay annually.
- A rented apartment located on the ground floor is not the one you occupy on the top floor, you must also specify which one is your main residence! (case of a claim in a rented apartment and declared as your principal residence while the insured lives on the same floor)
Key points of the risk visit for merchants
- In addition to the declared surface area, all the elements related to the premium calculation included in the subscription must be taken into account, such as
- the precise definition of the activity, opening and closing hours
- the annual turnover,
- the number of full-time equivalent employees
- KBIS, Rental lease in good and due form etc...
- Presence of fire extinguishers in working order, emergency exits and fire prevention instructions (storage place...) Standards have been established by the NCPC.
- The means of protection may be more restrictive:
- The installation of burglar-retardant glazing on the facade (laminated or not, quality of glass products specified)
- Number of anchor points on main doors and secondary accesses,
- Grids or other mechanical defence systems placed on the front and other openings,
- An alarm system connected to a central monitoring station or not,
- An annual maintenance contract for the alarm system or not etc...
I have to repeat myself but it is necessary to reread all the documents that make up the contract (the general, special and sometimes special conditions subscribed to in professional multi-risk), to find out about the updating of the contracts regularly.
Then you can check whether your benefit limits and requirements mentioned, correspond to your needs before the claim.
If you have any doubts, do not hesitate to contact your insurer. It is a shame not to have revised your coverage limits between the subscription and the date of the loss. Then it will be too late!
Application of the proportional premium rule
Article L 121-5 of the French Insurance Code states that
In other words, in the event of non-compliance, there could be the application of the proportional premium rule, i.e. your indemnity will be reduced in proportion to what you would have had to pay if you had declared the reality (in good faith or not).
At my level, I can say that in practice these rules have become more flexible for some insurers in the market place who wish to change their approach to claims settlement and accompany their clients in these difficult times rather than apply a sanction.
With diplomacy, the Expert must therefore gather all this information in order to transmit it to his principal who will decide what action to take.
Our regular practice of claims management with many companies and insurance companies, allows us to target all the key points of the risk visit before the claim, as part of prevention, and help you to evaluate your different types of Fine Art and other content.