Cedric Stephens | Insurance service delivery for traumatised accident victims

The ideas for this article were planted a few weeks ago by a consumer who sought my help.

She had insured her bank-financed car two years ago. The contract of insurance, or policy, has still not been sent to her even though she has paid the premium. Her insurer is one of the three that is listed on the Jamaica Stock Exchange.

The vehicle was wrecked when it overturned three months ago. She took evasive action to avoid a head-on collision. Her action caused the car to hit a roadside obstruction and it capsized as a result. The seatbelt restrained her in an upside-down position for several minutes until a Good Samaritan helped to remove her.

By then, the other driver had left the scene. The way she described her recollection of the incident suggested that three months after the event she was still suffering from post-traumatic stress disorder or PTSD. This was evident because of her inability to drive and sleep difficulties. She confirmed that her doctor was aware of her condition and had prescribed medication.

The front-line claim staff of insurers and intermediaries who serve policyholders and claimants, from my experience, are often not trained to recognise the symptoms of PTSD.

Studies conducted in the United States have found that the disorder is quite common after motor vehicle accidents.

Auto accidents are said to be one of the leading causes of PTSD in the general population. The studies suggest that “a significant percentage of accident survivors develop PTSD symptoms, with some estimates indicating that around 39.2 per cent of motor vehicle accident survivors experience PTSD”.

Persons with a history of trauma or psychological distress and the absence of social or emotional support after auto accidents can often worsen the symptoms of PTSD. It is estimated that about 10,000 people in Jamaica are injured in traffic accidents annually.

The second phase of the claimant’s PTSD began when she visited her insurer’s office to begin the process to file a claim under her comprehensive policy. The first official ‘brushed her off’ in an uncaring manner. Her lunch break was being interrupted.

The second person was also unhelpful. She did not know her job and was unaware that her employer owed a statutory duty to the claimant. Specifically, the company, by the actions of its agent, the employee, failed to comply with Regulation 142E(1) of sub-section (e), and 142 (2), (1), (a) of the rules enacted under the Insurance (Amendment) Regulations 2022 of the Insurance Act 2001. It did not provide the claimant with information to help her navigate the claims process.

The opinions expressed in the preceding paragraph were formed after I spoke with the claimant by telephone and drafted a

one-page, 480-word, eight-step claims process guide that was prepared to comply with one of the regulations. The claimant said that before she read the guide, she was ignorant about the claims process and that her insurer had provided wrong information which delayed settlement.

The insurer’s other sins include its failure to:

* Recognise that the claimant was displaying signs of PTSD, was vulnerable and in need of empathetic and caring treatment.

* Explain that the contract of insurance was subject to a compulsory excess (or deductible) amounting to five per cent of the vehicle’s pre-accident value or $100,000 in the event of damage. This amount would have to be borne by the claimant.

* Explain the process for recovering the costs and other expenses that were incurred because of the accident from the insurers of the other vehicle and how to avoid some of the probable obstacles.

* Provide the policyholder with guidance about recovering uninsured expenses like the excess, medical, and other expenses from the other driver’s insurance company and preserve her entitlement to a no claims discount.

I benefited from my interactions with the claimant and gained new insights into a problem that is seldom discussed. It is my hope that she also benefited from speaking with me and will fully recover from her frightful experience.

Cedric E. Stephens provides independent information and advice about the management of risks and insurance. For free information or counsel, write to: aegis@flowja.com or business@gleanerjm.com