Welcome to our December Edition of our Claims Technical Spotlight!
In this series, we showcase the expertise and dedication of our claims consultants as they navigate complex insurance claims to secure the best outcomes for our clients.
This month, we’re proud to showcase Deb, one of our incredible Senior Claims Consultants, whose dedication and perseverance helped overturn a denied claim into a fully approved one with a final value of $62,355.46.
Case Overview
This claim began with an outright denial, leaving our client feeling disheartened. Our experienced claims consultant, Deb, stepped in with unwavering dedication, navigating significant delays from the insurer over 343 days to make sure our client's case was thoroughly reviewed and fairly assessed. Through her persistence and strategic advocacy, the claim progressed from denial to partial approval, and ultimately to full approval for a complete roof replacement, resulting in a settlement of $62,355.46.
While this was an extreme case where the insurer's delays far exceeded typical timelines, Deb’s resilience, empathy, and consistent communication kept the client reassured and confident throughout the process, exemplifying our commitment to achieving the best outcomes for our clients.
Here’s an inside look at Deb’s approach to securing this result:
Q. What was your first step when you received the claim, and how did you prioritise your approach to address the denial?
Deb: When I first received the claim denial, I decided to first carefully review the photos from the clients inspection, then cross check the date of loss and other claims that had been successfully resolved in the same area, for that same date. With the help of the Sales Manager, Brett, from Rebuild Relief, I was also able to identify earlier events that strengthened my argument, as the denial reports stated that the damage occurred earlier.
Q. How did you make sure all necessary evidence and documentation were gathered to support the claim?
Deb: I requested that the insured contact their insurance company, as I was not authorised on the claim at that stage to review their policy for the current date of loss, which was December 11, 2019. After reviewing the policy, I requested the clients pre-purchase property report which showed no hail damage to the property at that time.
Once the insurance company received the pre-purchase report, the claim was reopened with a date of loss that reflected the hail damage to the client’s property.
Q. What strategies did you use to communicate effectively with the insurer and keep the process moving forward?
Deb: Building rapport with the insurance company's claims handler and addressing our mutual client’s vulnerabilities were key to ensuring their claim was processed within appropriate timeframes.
Q. What tools, techniques, or systems helped you stay persistent over such a long period?
Deb: A well-structured system makes sure claims are regularly actioned, supported by a dedicated team with years of experience, always ready to help and work closely together to deliver exceptional results.
Q. How did you identify and address the weaknesses in the insurer's initial denial?
Deb: By thoroughly reviewing and gathering all the evidence, I gained a deeper understanding of the situation and became more confident in advocating for my client. This allowed me to present a strong case to have the insurer's initial denial overturned.
Q. How did you deliver transparency and trust in your communication with the client throughout the 343 day process?
Deb: At every stage of the process, the actions being taken on the claim and the intended outcomes were clearly explained to the client. Efforts were made to ensure consistent enthusiasm and positivity during all interactions, providing reassurance and support throughout the process.
Q. What would you say was the key factor in turning this claim from a denial into a fully approved outcome?
Deb: The key factor in turning this claim from a denial into a fully approved outcome was persistence. By continuously reviewing the details and consulting with colleagues, the claim was kept moving forward, ensuring that all necessary information and support were provided to achieve the desired result.
Deb’s story is a testament to the dedication and empathy our claims consultants bring to every case. Her tireless effort and commitment have set a new standard for client care.
Stay tuned for next month’s spotlight, where we’ll share another story of expertise and determination from our team.
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