Major Loss Case Closed

Transcription

1 Volume 2 Major Loss Case Closed Every day in Casualty Claims across EMEA we deal with a variety of cases, many of which are complicated and time-consuming. The circumstances are often unclear and the damages and losses sustained significant. Through a dedicated and highly skilled team of Casualty Claims adjusters we make sense of the confusion, identify the critical issues and get to work bringing those claims to optimal and fair outcomes for our insureds and for the claimants with minimum fuss and maximum expertise. Here we recall some of those claims our adjusters have dealt with... Louise Walton Major Loss Auto A very sensitive matter involving a dreadfully injured young man, and a claim made many years after the event. Louise s thorough and effective investigation of a trail gone cold ensured that a fair and correct decision on legal liability was made. In 2003, our insured s driver was proceeding on a main road when she collided with a pedestrian Mr M. The police attended and investigated the incident and as a result no charges were brought against our insured s driver. Nearly a decade later AIG were approached by lawyers acting for Mr M, with an allegation that the insured s vehicle had actually mounted the kerb and collided with the claimant. We quickly ascertained that the claimant had sustained massive brain injuries and for the last ten years had resided in a rehabilitation centre. Due to the passing of time, the original police investigation report was no longer available. Moreover, the driver had left our insured s employment many years earlier and there were no available records relating to her whereabouts. We therefore had a real challenge in terms of getting the evidence needed to fully understand legal liability and, if necessary, defend the claim. Louise utilised the services of her colleagues in our Global Investigation Services team, who were able to establish that the driver was living at the opposite end of the country. This enabled Louise to obtain a witness statement, confirming that the claimant had stepped into the road and into the path of her vehicle without warning, giving her no opportunity to avoid a collision. From further investigation Louise was also able to identify and track down one of the police officers who had attended the incident and who had since retired. This witness also provided a statement, confirming that the insured s vehicle did not mount the pavement. Both statements were disclosed to the claimant s solicitors with a denial of liability. Matters were formally discontinued and a case reserve of 1.14M removed. Whilst one cannot lose sight of the fact that this is a dreadful and tragic event, Louise s work has protected the customer s position and ensured that the right call was made. Page 1 of 5

2 Martin Dawson Miss L, a senior employee of a large multinational company, suffered catastrophic spinal injuries following a biking accident whilst competing in a company sponsored team event. Recognising the dreadful personal tragedy to our insured s employee, Martin worked fast to ensure that our 1.95M contribution towards a larger settlement pot was paid within months of the claim being made. Our multinational policyholder had taken a great interest in the case, and was keen to make sure that Miss L, a highly regarded member of the organisation, was well cared for, and were ultimately delighted with the outcome. Thank you very much for all of your assistance in working with us to get this done in such a timely manner. We, too, felt it was a good result and we re very happy not to be in litigation with our employee, who suffered such an extreme loss. We appreciate the partnership with AIG. Thank you again. Oliver Werner In 2006 a fire broke out in one of our insured s storage and distribution plants in Spain. As a result, two neighboring properties were severely damaged and claims against our German multinational insured followed in the Spanish courts. Elixabete Albela Martinez Oliver in Germany and Elixabete in Spain worked on the claim together, Oliver liaising closely with the insured and Elixabete providing expertise in relation to local law and damages. They firmly denied legal liability on behalf of the insured, on the grounds that there had been no negligence. Oliver and Elixabete sought to argue that fault lay with the manufacturers of some defective equipment which, they contended, had caused the fire. In 2014 a Spanish Judge held that AIG s assessment of legal liability was correct and that there was no culpability on the insured s part. A cross border partnership between our major loss adjusters in Spain and Germany ensured that the insured, quite properly, prevailed at trial. Page 2 of 5

3 Jim Lynch Our insured were the main contractors on an office and residential apartment block development project in Ireland. A 48 year old technician employed by one of the subcontractors suffered serious injuries following a fall of fourteen feet, whilst trying to install cables at ceiling level. The claimant had exited the cradle of the site lift and removed his harness to climb on top of a metal cabinet, which had been recently installed. The cabinet subsequently collapsed and the claimant suffered career ending trauma, including a badly fractured foot and severe back injuries. He never returned to work. Our insured, as the main contractor, were named as one of the defendants, alongside the claimant s employers and the engineering company who were responsible for the claimant s supervision on a day to day basis. Jim took the view that there was no culpability on the part of our insured, arguing that liability rested with the engineering company and the subcontractor, with substantial contributory negligence on the part of the claimant. The engineering company believed however that as the main contractor our insured had a liability of 50% and therefore the case was heard at the High Court. The claimant and his legal team sought 895,000 damages plus the same again in legal costs. The case had run for 3 days when Jim s robust position paid off the Judge accepted his argument that the main contractors were too removed from supervisory responsibilities. The injured claimant thus received fair and proper compensation from the two other defendants. Our insured, quite correctly, had nothing to pay. Jim s tenacious and justified denial of legal liability, on behalf of the insured, ultimately ensured no damages exposure to them, and protection of their claims experience. Nick Denham It actually goes some way to restoring our faith in the legal justice system, and the use of common sense. We would also like to thank AIG in having faith in ourselves, Thanks again. Insured s Company Director A claim was received on behalf of Mr A, an employee of our insured, alleging that he had received a blow to his head when a piece of debris fell from a defective crane. Three days after the alleged accident Mr A collapsed at home and was rushed to hospital, where he underwent emergency brain surgery. Significant damages were sought. Our major loss adjuster, Nick, immediately contacted the insured who were rather astonished that a compensation claim was being pursued. For whilst the employers were aware that Mr A had recently undergone major surgery, the alleged accident came as news to them. Nick therefore organised some background checks on the claimant which revealed that he was known to the police. Detailed statements were taken from the four colleagues whom Mr A claimed had witnessed the accident and would support his version of events. All four individuals confirmed that the accident had never occurred. Nick was also able to prove, through a detailed analysis of documentation, that there was nothing wrong with the crane at the time of the alleged incident. Nick denied legal liability on the grounds that no accident had occurred as alleged, and much to the delight of our insured, the matter was withdrawn. Page 3 of 5

4 Matthias Karaus The insured manufactured and delivered tubular packaging to the claimant, a leader in the production of beauty, and cosmetic products. The claimants would fill the packaging tubes, supplied by our insured, with various types of hair and shower gel, and then sell the end product on to distributors. An issue arose when the distributor s specialized staff discovered that tubes supplied by our insured had a faulty printing design. The lettering was not only blurred, but also easily removable. The claimant quickly filed for damages, seeking compensation for manufacturing costs, inspection and sorting expenses, loss of profits and loss of their license for the end product. Matthias scrutinized the statement of loss forensically and such was his attention to detail that we were able to successfully challenge numerous items. Following several rounds of negotiation on behalf of the insured, AIG were able to agree a settlement with the third party at approximately one third of the amount originally claimed. Our insured s legal department expressly thanked Matthias for his efforts in settling this case. On behalf of our insured Matthias scrutinized the statement of loss forensically and such was his attention to detail that we were able to successfully challenge numerous items. Sarah Scott Recent feedback from a broker to Sarah Scott following the settlement of a highly complex personal injury claim Hello Sarah, Such wonderful news, for all parties. The insured were (and are) so very relieved when I called a few minutes ago and very grateful of course! Thank you so much for your considerate handling it was an added burden placed on you all and you have served us admirably. On top of that, to keep having to ask you how the case sat regularly as the insured asked, you showed so much patience and supplied us with an incredible amount of information each time. I m not sure I could have been so patient! Thank you for such a good result all round and such empathy showed to us along the way. (You are very approachable as you show such empathy!) We will keep our fingers crossed the courts approve this in due course. Have a great weekend it is well deserved! Page 4 of 5

5 Martin Dawson A claim was made by a Mr S, who allegedly suffered an injury whilst employed as a delivery and maintenance driver. Court proceedings were served, with a demand for over 975K plus costs. being underpinned by the specific suggestion that the ladder was old and defective. With all the hallmarks of a potentially expensive pain case our major loss adjuster, Martin, identified numerous issues that didn t ring true; co-workers described as witnesses knew nothing of the incident; alleged prior complaints about the condition of the ladder had no corresponding defect sheet record as per company requirements; there were conflicting stories from the claimant with regards to the precise mechanics of the incident, and his physical reaction to what were effectively soft tissue injuries seemed disproportionate. Martin focused on obtaining forensic medical and surveillance evidence and eventually this work bore fruit. Whilst Martin could not quite prove that the incident did not occur, his ability to cast doubt over, if not fully repudiate, many aspects of the claim led to Mr S accepting a nominal amount in full and final settlement. The resultant 520K reduction in case reserve has gone a long way to protect the insured s claims experience. Mr S, the claimant, drove a light goods vehicle which had an integrated ladder that he was required to use in his role. The claimant alleged that he had slipped and fallen whilst descending the ladder, causing a wrenching injury to his lower leg. Mr S never went back to work and pursued his seven figure claim on the basis of breaches of the Work at Height Regulations and the Provision & Use of Work Equipment Regulations, his case Martin s ability to cast doubt over, if not fully repudiate, many aspects of the claim led to Mr S accepting a nominal amount in full and final settlement. American International Group, Inc. (AIG) is a leading international insurance organisation serving customers in more than 100 countries and jurisdictions. AIG is the marketing name for the worldwide property-casualty, life and retirement, and general insurance operations of American International Group, Inc. This material is for information purposes. Products and services are written or provided by subsidiaries or affiliates of American International Group, Inc. and may not be available in every jurisdiction. For additional information, please visit our website at Registered in England: company number Registered address: The AIG Building, 58 Fenchurch Street, London EC3M 4AB. AIG Europe Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. 0515