What Clients Have Said About the Process

Challenge

A commercial tenant received a partial settlement offer from the insurer following fire damage. The insurer's loss adjuster had applied a depreciation schedule that the client considered inconsistent with the policy's reinstatement clause.

Our Approach

We reviewed the loss adjusting report against the policy's reinstatement basis clause and the definition of "day one reinstatement value." We prepared a detailed written response identifying the specific clauses that limited the adjuster's discretion to apply depreciation.

Outcome

The insurer revised the settlement figure following the internal review. The revised settlement represented a 34% increase over the initial offer. The engagement was completed at the correspondence stage without FMOS referral.

Challenge

A family medical policy declined coverage for a hospitalisation event, citing a pre-existing condition exclusion. The policyholder disputed that the hospitalised condition was related to any pre-existing matter disclosed or undisclosed at the time of policy inception.

Our Approach

We reviewed the policy's definition of pre-existing condition and the medical documentation. We prepared a FMOS case memorandum supported by a medical practitioner's letter distinguishing the two conditions. The factual position was presented in clinical chronological order with specific policy clause cross-references.

Outcome

FMOS found in favour of the client. The insurer was directed to settle the hospitalisation claim in full. The client noted that having the documents organised clearly before the hearing made the remote process straightforward to follow.

Challenge

A professional services firm faced a third-party claim. The firm's professional indemnity insurer declined to extend coverage, citing a claims notification clause and arguing that the underlying circumstances had been known before the policy renewal date.

Our Approach

Originating summons for a coverage declaration was filed in the Kuching High Court. Pleadings addressed the knowledge test under the claims-made policy and the chronology of the firm's awareness of the potential claim. An expert report on industry practice for PI policy interpretation was coordinated.

Outcome

The court granted a declaration that coverage applied. The insurer was required to defend and indemnify the firm in the underlying third-party claim. The case was resolved at the interlocutory stage without a full trial after the expert report was served.