Insurance Claims Handling Procedure

Purpose. This procedure sets how the firm lodges, manages and negotiates insurance claims on behalf of clients so that claims are handled promptly, documented fully and settled fairly.

1.Notification

When a client reports a loss the broker must record the claim in the Insurance Policy and Claims Register the same day, confirm the policy was in force and the loss is within the cover, and acknowledge the client within one business day. The client must be told what to do immediately to reduce further loss and what evidence to keep.

2.Policy check

The broker must read the policy wording for the relevant section, the excess, the sum insured, exclusions, conditions and any endorsements before advising the client. Where cover is doubtful the broker must tell the client honestly and lodge the claim anyway so that the insurer decides.

3.Lodgement

The claim must be lodged with the insurer through its broker portal with the completed claim form, the client's statement, photographs, quotes, invoices, police or incident reports where relevant and the policy schedule. The lodgement reference must be recorded in the register.

• Completed claim form signed by the client
• Statement of events with dates
• Photographs and evidence of the loss
• Quotes or invoices for repair or replacement
• Police, fire or incident report where relevant
• Proof of ownership and value

4.Management

The broker must follow up the insurer at least weekly, keep the client informed at every step and record every contact in the register. Where the insurer appoints a loss adjuster or assessor, the broker must attend the inspection where practicable and review the report. The broker must challenge any decision that is inconsistent with the policy wording.

5.Settlement

The broker must check the settlement offer against the policy, the evidence and the excess, explain it to the client in writing and obtain the client's instructions before accepting. Settlement funds must be paid directly to the client or repairer, never through the firm's own accounts. The register must be updated with the settlement amount and date.

6.Disputes and complaints

Where a claim is declined or the client disputes the settlement, the broker must explain the insurer's internal dispute process and the client's right to go to the Australian Financial Complaints Authority, and must assist the client with the dispute. A complaint about the firm's own handling must be recorded under the Complaints Handling Policy.