ClaimsCo Technical Spotlight: December Edition

Welcome to this month’s Technical Spotlight, where we shine a light on the skill and persistence of our claims consultants as they tackle challenging insurance cases and secure positive results for our clients.

For December, we’re excited to highlight the work of Deb, one of our exceptional Senior Claims Consultants. Through her unwavering determination, Deb transformed a completely denied claim into a full approval, achieving a settlement value of $62,355.46.

Case Summary

This case began with a complete denial, leaving the client feeling defeated. Deb stepped in, leveraging her experience and expertise, to fight for a fair review of the claim. Over an extensive 343-day period, she navigated delays from the insurer, ensured every detail was thoroughly examined, and guided the case to success. Her efforts led to a settlement for a full roof replacement, a significant victory for the client.

While this claim’s timeline was unusually long due to insurer delays, Deb’s resilience, empathy, and consistent communication set a remarkable example of ClaimsCo’s dedication to its clients.

Here’s a closer look at Deb’s process and strategies for achieving this outcome:

Q. When you first received the claim, what was your initial step, and how did you tackle the denial?

Deb: My starting point was to thoroughly analyse the inspection photos and cross-reference the date of loss with other claims successfully resolved in the area for the same period. Collaborating with Brett, one of our Sales Managers, we identified earlier hail events that contradicted the insurer’s denial, which claimed the damage was caused at a prior time.

Q. What steps did you take to gather the evidence needed to support the case?

Deb: Since I wasn’t initially authorised on the claim, I advised the client to obtain their policy documents for the relevant date of loss, 11 December 2019. After reviewing the details, I requested the client’s pre-purchase property report, which confirmed the absence of hail damage before their policy began. This document played a critical role in reopening the claim with the correct date of loss.

Q. How did you manage communication with the insurer to keep the process moving?

Deb: Building a professional rapport with the claims handler at the insurance company was crucial. I emphasised our shared responsibility to serve the client and highlighted their vulnerabilities to encourage timely processing of the claim.

Q. What tools or systems helped you stay organised and persistent throughout this lengthy process?

Deb: Our structured claims management system ensured that all tasks were actioned promptly. Additionally, I relied on the support of our experienced team, who collaborated closely to strategise and deliver consistent progress on the claim.

Q. How did you identify and address the flaws in the insurer’s initial decision?

Deb: By meticulously reviewing the evidence and thoroughly understanding the claim, I was able to confidently challenge the insurer’s reasoning. This preparation allowed me to present a compelling argument that overturned the denial.

Q. How did you maintain transparency and trust with the client over such a prolonged period?

Deb: Throughout the process, I ensured the client was informed of every action taken and the rationale behind each step. Clear communication, paired with a positive and supportive approach, helped maintain their confidence and trust.

Q. What do you believe was the most critical factor in achieving this outcome?

Deb: Persistence was the key. By continuously re-evaluating the claim, consulting with colleagues, and providing the necessary documentation, we kept the case moving forward. This relentless effort ultimately led to the desired result.

Deb’s success is a powerful example of the dedication and compassion our team brings to each claim. Her hard work and commitment have set a high standard for client advocacy and care.

Stay tuned for next month’s spotlight, where we’ll share another inspiring story of expertise and perseverance from our talented team at ClaimsCo.