Altus Insurance whitepaper spreads - Flipbook - Page 9
The key elements of a strong claims service
Communication
Fairness
As well an understanding
of policy coverage and
the strict contractual
position, claims handlers
will need to understand
the approach the FOS may
take on their decision
which may well go beyond
the strict contractual
position. The FOS will
apply a standard of what
is ‘fair and reasonable’,
and its decisions are
essentially binding.
From how easy it is to
notify a loss, through to
the explanation of cover
and how each stage
of the claims process
will play out, it is vital
insurers are clear in their
communication with
customers, and proactive
throughout.
Prompt settlement
Not all claims will be dealt
with instantly. However,
whether or not a claim
has been settled promptly
needs to be considered
in the context of the
circumstances of the
loss, the complexity of
the claim and the method
of indemnifying the
customer.
Claims
Management
Management of
expectations
As part of the overall
communication, it is vital
that customers have a real
understanding of what
they are being asked to do
and why, what the insurer
is doing, what this means
for their claim, and where
they currently sit in the
claim process. Customers
must be brought on this
journey too if they are to
trust the process and the
outcomes.
Empathy
Understanding
of liability
Whether it’s the
contractual liability to
the customer under the
insurance policy, or a
third party’s claim in
tort, the claims function
needs to have a robust
understanding of how the
law should be applied in
whatever scenario it is
presented with.
In all of its dealings with
a customer going through
a claim, the insurer
should demonstrate an
understanding of the
impact that the loss and
the claims process is
having on them from a
human perspective. This
applies equally to the
design of processes and
systems as it does to the
direct conversations with
the customer.
Figure 2: Outcomes-based view of good claims management
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