Disputed Claims – A Good Practice Guide for Claims Professionals

Disputed Claims – A Good Practice Guide for Claims Professionals

Written by Roger Flaxman and James Moorhouse for The Society of Claims Professionals

Why an effective customer complaint procedure could improve public trust with insurers.

When a claim is disputed, or a complaint is made, the most likely reasons are because a customer was unhappy with the levels of service received, the claim paid was less than expected or they suffered a financial loss during the process of making the claim. Customer expectation of their insurance policy is at the same time both everything and nothing.

Sometimes there is an assumption of ‘comprehensive cover’ without understanding exactly what ‘comprehensive’ means. Yet there is also a belief that payment of a claim will be declined. Most complaints are about the insurer’s treatment of the customer or a perceived unfairness of decision. For example, the consequences of underinsurance and the application of average will cause a financial shortfall that can severely harm a customer. Not understanding how or why it is fair will usually cause a complaint.

Insurance is a complex contract and it cannot be expected that most customers will understand it equally with insurance practitioners. This Good Practice Guide, written with the guidance of Flaxmans (Insurance Dispute Resolution), examines the way insurers should put themselves in the position of the customer, examining the situation from their point of view. This guide looks at:

  • Why customers make complaints
  • The FCA’s rules for handling a complaint
  • Escalating complaints
  • Why false or exaggerated claims are made
  • Sharing feedback

You can read the full Good Practice Guide HERE.