Claims Management and Loss Assessment
Claims Management and Loss Assessment
This domain covers the claim lifecycle from notification to settlement or repudiation, including the role of surveyors, quantification of loss and recovery rights. Questions test procedural compliance, indemnity calculation and the evidence needed to reject a claim defensibly.
The claim lifecycle
A well-run claim follows a documented sequence:
- Notification and registration: record date, time, location and immediate cause; confirm policy validity and premium payment.
- Surveyor appointment: above the statutory threshold, a licensed surveyor must be appointed; the report is evidence, not a final determination.
- Documentation: claim form, proof of loss, invoices, police/Fire Brigade reports, medical records and title documents as applicable.
- Assessment: measure the loss, apply the sum insured, deductible/excess, depreciation or betterment, and salvage.
- Decision: settle or reject in writing with reasons, within the prescribed timeline.
- Recovery: take subrogation rights and salvage where the insurer has paid.
Worked example
An insured reports a collision. The insurer registers the claim, appoints a licensed surveyor, and obtains repair estimates. The surveyor finds pre-existing damage and betterment on tyres. Settlement = assessed repair cost − policy excess − betterment − salvage value, capped at the IDV. If the vehicle is a total loss, the insurer pays the IDV less salvage and takes subrogation rights against the negligent third party.
Traps that cost marks
Settling a general insurance claim above the statutory threshold without a surveyor; paying new-for-old without deducting betterment; overlooking subrogation or salvage; rejecting a claim without written reasons; and ignoring the limitation period for filing a claim or suit.