3. Claims consideration and administration

Understand claims considerations and administration:-


  1. Describe the role of the claims department.
  2. Explain the importance of service standards and managing customer expectations.
  3. Understand the different parties to an insurance claim.
  4. Explain the importance of claims estimating and how reserving operates.
  5. Understand how fraud affects insurance claims.
  6. Describe the main regulatory and legislative environment for claims handling.
  7. Describe how disputes and complaints could be resolved.
  8. Describe the concepts of good faith and the duty of fair presentation.

Describe the role of the claims department:-

  1. The Claims department plays a key role in the success of an insurance company by shaping the opinion of

    the customers as the “proof of the pudding is in the eating. Competent and professional staff are required.

  1. They are considered the SHOW window of the insurance company.
  2. They manage the POOL of funds belonging to ALL insureds.
  3. They are bound by legal requirements and can be sued 


The role of the Claims Handler:

  1. To deal with all submitted claims quickly and fairly
  2. To settle claims with the minimum of wastage or avoided overpayment called leakage

      iii. To estimate accurately the final costs of outstanding claims

  1. To distinguish between genuine and fraudulent claims