Welcome to our Winter 2013 Edition and 45th Claim Solutions’ Newsletter.
“Physical, loss, destruction or damage”
How often do we hear these words? They appear in the initial clauses of many insurance policies.
To us claims are not about “physical, loss, destruction or damage” they are about rebuilding, reconstruction, and regeneration.
Claims are not about operative clauses, conditions and exclusions, they are about people.
They are about vision, growth and direction achieved through empathy, transparency and communication.
A claim is an opportunity to lay solid foundations for a brighter future.
With involvement in claims since the 1980’s we at Claim Solutions know that claims need to focus on the positives not negatives. They are about looking forward from past experience and most of all they are about finding Solutions.
After issuing our Newsletter for in excess of 10 years it is time to revisit the past and how our clients found success. It is time to consider the solutions which are relevant to the present and how they can be best applied to the future.
If you, or your clients, have suffered loss or damage we wish you a speedy recovery.
We are available to assist you and welcome any claim enquiries.
For a fully searchable history of our newsletters check out Insuropedia at
On 25 September 1998, following a fire at Longford, Victoria, the supply of natural gas to the Melbourne and metropolitan area either ceased or was severely restricted. The impact on businesses dependent on gas supplies was both significant and widespread. Our list of clients affected by this incident includes a multitude of businesses from manufacturers to restaurants. All survived the gas disruption and fifteen years later many of them continue to succeed.
This experience is repeated following many catastrophic events such as the severe storms in Queensland in January 2008, 2009 and 2011 and the ferocious bushfires in Victoria in February 2009. Our client list includes businesses in the manufacturing, wholesale, retail, logistics, hospitality, education, research and health industries. All our clients re-established their businesses and, after a period of reconstruction and refocusing, continued to prosper.
It is not only the events which cause widespread damage that are relevant. The experiences from isolated fires, storms, breakdowns, accidental damage, etc all provide a wealth of knowledge to determine how businesses not only recover but grow.
What makes a claim successful?
A claim involves a team including an Insured, Insurer(s), an Insurance Broker, a Loss adjuster and a Claim Preparer. Investigators, engineers, architects and other specialists may also be involved.
With so many stakeholders the scope for conflict is high. In our experience successful claims are those in which all parties understand a common goal regardless of interest.
The goal is to ensure the circumstances of the loss are investigated and conveyed in full and the cover offered by the insurance policy is clearly explained. Only then can the claim succeed.
The outcome may not always be that which is expected but it must be understood.
The Insurer(s), The Insurance Broker, the Loss Adjuster and the Claim Preparer deal with claims every day. While we are exposed to the results of fires, storms and floods regularly it is important to acknowledge that the Insured is not.
It is the Insured who has suffered, it is the insured who requires assistance and it is the insured who has paid the premium. Those exposed to claims regularly can never forget that claims have an emotional as well as a monetary impact.
Claims can never be allowed to become routine to the extent that empathy is lost.
In our experience claims which succeed are those where all parties are transparent.
It is naive in the extreme to assume all claims are straight forward. The extent of cover offered by an Insurance Policy is sometimes open to interpretation. Grey areas may exist.
All parties must work towards quantifying the grey areas to enable a successful claims outcome.
The claims which we have seen succeed are those where communication is paramount. If there is a problem it needs to be tabled; if there is a difference in opinion it needs to be explained; if there is a delay it needs to be justified.
Open communication is vital.
By recognising that claims are about people and by communicating regularly, accurately, empathetically and transparently a claim may be successfully and amicably resolved.
The history of our claims has proven that it is also important to recognise that loss may provide an opportunity for an insured to expand, to grow and to improve.
The insurance cover should respond to the reinstatement of the damage and no more. It should respond to the Business Interruption which flows from that damage and no more.
Few businesses reinstate exactly as they existed before the damage. From adversity comes opportunity. Perhaps there is an opportunity to reconfigure the layout to improve output. Perhaps there is an opportunity to replace a damaged machine with a larger one to increase production. Perhaps there is an opportunity to relocate the business to a more profitable area.
All these scenarios are likely to provide more than the indemnity contracted in the insurance policy. All are likely to attract costs or losses which may not be the subject of the claim but they should not be ignored.
Provided the insurable loss is accurately measured and the Insured is aware of the costs and losses they must fund beyond the indemnity offered by the insurance cover they should be encouraged not discouraged from making the decisions necessary for their business to thrive.
Claims provide an opportunity to lay foundations for a brighter future. An opportunity which should not be lost.
History has proven that people, empathy, transparency, communication and vision are the foundations to a successful claim.
Some of the developments available today support these foundations while others do not.
The face of claims today is certainly different than it was 30 years ago.
The Virtual Insurance World
Today there is a proliferation of on line applications and quotations to purchase insurance, calculators to determine sums insured or declared values and forms for making a claim.
The past has demonstrated that insurance cover and claims are about people. This has not changed.
The virtual insurance world is no substitute for human interaction.
“Plain English” Policies
For many years efforts have been made to simplify policy wordings. Product Disclosure Statements are written in “plain english” to make them more understandable to The Insured.
Sometimes this succeeds but occasionally the intention of the wording is lost in translation and key clauses vital to achieve indemnity are omitted or over abbreviated creating greater rather then less confusion.
Clear communication cannot be lost by over simplification.
As the cost of assessing claims increases the resources available to smaller claims decreases.
Every claim is not equal. Small claims may not be simple and large claims may not nececesarily be complex.
Large claims attract attention. This is understandable. The impact on both the Insured and the Insurer may be significant. Resources such as both Loss Adjuster and Claim Preparer skills are made available promptly and readily.
Smaller claims sometimes fall through the cracks. The reasonableness of claim assessment costs is often judged in comparison to the magnitude of the claim and accordingly the time which can be devoted to a smaller claim may be restricted. Claims which have a small monetary value can involve complex claim issues.
All claimants should have access to appropriately skilled claim specialists.
We no longer live in a world of mail, facsimile or heaven forbid, Telex. Today communication is instant. Not only is it instant but tranparency is easier to achieve.
Multiple people can be informed of the current status of a claim by e-mail, teleconferencing enables numerous stakeholders, interstate or overseas, to regularly participate in claim discussions. Computer data rooms, accessible by all relevant stakeholders, can be established to encourage sharing of documents and transparency.
Today there is a far greater opportunity to communicate in a manner which keeps all parties involved and on track.
Professional associations such as CPA Australia, the Australian & New Zealand Institute of Insurance and Finance and the Chartered Institute of Loss Adjusters all require ongoing education as part of their membership encouraging high standards and skills.
Today Insurers offer formal dispute resolution to handle claims where agreement has not been reached.
Although none of the claims we have prepared have required formal dispute resolution, we are informed that the process is usually prompt and efficient adding an important layer to the communciation process.
Advances in communication technology, education standards and claims processes need to be used to support successful claims outcomes.
Unfortunately fires, floods, storms and earthquakes will continue to occur. In some instances the losses associated with these risks will be minimised by better building techniques and contingency planning but in others they will not. Losses will continue to be sustained.
The tools available to the claims specialist will also continue to evolve providing even greater opportunity for complete, prompt, accurate and transparent communication to all parties involved in the claim process. The claims specialist needs to continue to harness these changes and strive to achieve a claim outcome satisfying to all parties.
While risks may be better managed and the tools available to assess losses may improve our experience has shown that the foundations to a successful claim outcome are likely to remain the same. A focus on people, empathy, transparency, communication and vision are essential for a successful claim solution.
We are pleased to announce the launch of our new website which focuses on people and positive claims outcomes.
Please do not hestitate to drop in, subscribe to our services and stay in touch.
Bookmark us at: -
We are social!
Within the insurance industry Claim Preparation Services are well known, however, outside the industry, many insureds are unaware that our service exists. They are often surprised to learn that assistance is available. When we discuss our services with a first time claimant a number of questions often recur: -
How can we help?
We are claim specialists who represent you. We gather information in relation to your business, your loss and the information necessary to present your claim in accordance with your insurance cover. We work with you, the loss adjuster and insurer to resolve your insurance claim.
Will the Insurer or Loss Adjuster object to your appointment?
In many instances loss adjusters have recommended our appointment as they know that the claim will be presented in accordance with the insurance cover.
Who do you represent?
We are independent consultants who represent the Insured.
What area do you cover?
We prepare claims for Insureds throughout Australia and overseas.
Who pays your fees?
The Insured pays our fee. In most claims we prepare cover is available for Claim Preparation Costs and The Insured receives reimbursement of our fee from The Insurer.
Do I Have Adequate Insurance Cover?
It is important to establish whether your cover is adequate and we will work with you and your insurance advisers to determine this at the earliest opportunity. Our quarterly newsletters contain many articles providing tips to ensure your cover is right.
About Claim Solutions…
Claim Solutions provides a specialist insurance claims service. Our firm is recognised as one of the leading practices in this field with both national and international companies featuring amongst our clients. Our aim is to provide an efficient, professional and complete claims service which responds to your needs in times of crisis. We are available to assist you and your clients.
The Articles which appear in this Newsletter are not intended to be a substitute for specific technical advice.