Claims Handling and Customer Service
Claims handling is the point where the insurance promise is tested. Candidates must know the claims process: notification, registration, verification of cover, investigation, assessment, decision, settlement and recovery (subrogation/salvage). Understand the insured's duties: notify promptly, provide evidence, mitigate loss, cooperate and avoid admitting liability. The insurer's duties include fair and prompt handling, clear communication, and explaining decisions.
Know the difference between indemnity settlement, reinstatement, repair and cash settlement, and the role of excesses, deductibles and average in reducing payment. Fraud detection is a key competency: indicators include late notification, inconsistent statements, exaggerated values and unusual circumstances. Understand complaint handling and escalation, and the importance of treating customers fairly, including vulnerable customers.
Traps: assuming a claim is payable simply because the peril is insured (exclusions, conditions and non-disclosure may defeat it); confusing salvage (insurer takes ownership of damaged property) with subrogation (insurer recovers from a third party); and forgetting that the insured has a duty to mitigate loss.
Worked rule of thumb: Use the 'four questions' test on any claim: (1) Is there cover? (2) Was there a valid contract and full disclosure? (3) Are conditions satisfied (notice, mitigation, evidence)? (4) What is the correct settlement (indemnity, less excess and average)? This structure keeps answers accurate and complete.