Insurance claims experts in the United Kingdom: an overview

The cast of characters in a British claim

Three roles are central. The loss adjuster is appointed by the insurer to investigate and value claims, often working for an independent adjusting firm; the profession's main body is the Chartered Institute of Loss Adjusters. The loss assessor is appointed by the policyholder to prepare and negotiate the claim on their behalf, playing the role that a public adjuster would play in North America or an expert d'assuré in France. Brokers, who arrange the cover, can also support clients at claim time, especially on commercial accounts.

Around them sit technical specialists: building surveyors, structural engineers, forensic accountants, fire investigators and valuers. Any of them can be instructed by either party, and some may later become expert witnesses if the dispute reaches court.

Regulators and the legal framework

Insurers are authorised by the Prudential Regulation Authority and regulated for conduct by the Financial Conduct Authority. FCA rules require insurers to handle claims promptly and fairly and to treat customers fairly, and the Consumer Duty raises expectations for retail customers. Insurance contract law draws on the Insurance Act 2015 for business insurance and the Consumer Insurance (Disclosure and Representations) Act 2012 for consumers.

The UK has three legal systems, England and Wales, Scotland, and Northern Ireland, with differences in court procedure and limitation periods. The Financial Ombudsman Service covers the whole country.

What an expert witness is

An expert witness gives independent opinion evidence to a court or tribunal on matters requiring specialist knowledge, such as the cause of a fire, the cost of reinstatement or the calculation of lost profit. In civil cases in England and Wales, Part 35 of the Civil Procedure Rules and its practice direction govern expert evidence.

The key principle is that the expert's overriding duty is to the court, not to the party who instructs or pays them. Courts may limit expert evidence, require a single joint expert, or direct experts on both sides to meet and produce a joint statement of agreed and disputed issues.

From assessor to witness: different hats

A loss assessor is an advocate for the policyholder. An expert witness must be impartial. The same individual cannot comfortably fill both roles in the same dispute, so if a claim goes to litigation, a separate expert is usually instructed by the solicitors. Some professionals do both kinds of work, but on different files.

Risks that shape British claims

Each peril has its own pitfalls, such as gradual-damage exclusions for leaks or high excesses for subsidence, which explain much of the demand for independent advice.

• Escape of water from burst or leaking pipes, particularly after cold spells
• River, surface water and coastal flooding, with major events in recent winters
• Subsidence on shrinkable clay soils, linked to dry summers and trees
• Storm damage to roofs, chimneys and fences
• Fire in homes, commercial kitchens and industrial premises
• Business interruption following physical damage

When independent expertise is worth seeking

Independent expertise is most valuable when the loss is large, the cause is disputed, the policy wording is complex, or the insurer has made an offer that does not cover the real cost of reinstatement. Commercial policyholders facing a business interruption claim, and homeowners facing a total loss after fire, are typical examples.

For small, straightforward claims, dealing directly with the insurer is often sufficient. Whatever the size, keep records, photographs and correspondence from the first day.

Before appointing anyone, ask for a written engagement letter, check professional indemnity insurance and membership of a relevant professional body, and confirm whether the person is acting as an advocate or as an independent expert. Those two roles carry different duties, and choosing the wrong one at the wrong stage of a dispute can weaken a claim. A short first consultation is often enough to decide which kind of help suits the situation.

Resolving disputes

Complaints go first to the insurer, which generally has eight weeks to issue a final response. Consumers and eligible small businesses can then usually go to the Financial Ombudsman Service within six months, free of charge. Larger commercial disputes may proceed to mediation, arbitration where the policy provides for it, or the courts, where expert witnesses come into play.

Practical tips for international readers

Foreign businesses with UK premises should note that cover is usually arranged through Lloyd's or company market insurers via brokers, and claims handled by UK-based adjusters. Ask your broker early about the claims process, any claims preparation cover in your policy, and the appointment of your own loss assessor or forensic accountant.

• Business interruption claims in the UK and the role of an independent loss assessor
• Escape of water claims in the UK and the independent loss assessor
• Fire damage claims in the UK: working with an independent loss assessor
• Flood claims in the UK: how an independent loss assessor can help
• How much a loss assessor charges on a UK flood claim
• Loss assessor fees for escape of water claims in the UK
• Loss assessor fees on a UK fire claim
• Subsidence claims in the UK and the independent assessor
• The cost of independent help on a UK subsidence claim
• What a loss assessor costs on a UK business interruption claim

Knowing who works for whom is the first step in any British claim. expertdassure.com offers peril-by-peril guides for the UK, including the costs of independent help.