Claims explained

This article was originally published in June 2019 and has been updated.

When life doesn’t go to plan, for example after an unexpected extreme weather event or accident, making a claim against your insurance policy can be the moment you truly experience the benefit of insurance.

An insurance policy symbolises an agreement that assistance will be given when things go wrong, so long as the incident in question falls within the policy’s terms and conditions.

“We can’t stress enough how important it is for you to familiarise yourself with your policy,” says QBE General Manager of Short Tail Claims, Arron Mann.

When a claim is accepted, an insurer fulfils their agreement as outlined in your insurance policy, as set out in the Product Disclosure Statement (PDS) or policy wording.

“While financial assistance is a key service provided by insurance companies, there’s other types of ways we help our customers when they make a claim,” says QBE’s Arron Mann, General Manager of Short Tail Claims.

“The ways we assist are not just to pay the claim, but to actually repair damaged property or replace lost items. We don’t want to just send a cheque, we want to actually support our customers. We have strong established relationships with repairers, builders and suppliers that can provide priority service and great quality work that we can guarantee for you.”

How to make a claim

Making a claim to an insurance company means you’re requesting action and assistance after you’ve experienced loss or damage from an event that’s covered by your policy. 

Claims are best made via telephone, for example, after you’ve been involved in a car accident or experienced a damage to your home.

“Once you’ve contacted your insurer and the claim is lodged, we review all the details you’ve provided and check that your policy covers you for the circumstances of your claim,” Mann says.

“Depending on the type and extent of damage, we’ll send the appropriate Preferred Supplier to inspect the damage so we understand what’s required to get your claims resolved. In the case of a vehicle, we’ll ask you to go to one of our Preferred Supplier who might be one of our Accredited Smash Repairers or a Specialist Hail Repairer”

From there we know whether the damages can be repaired, or whether we need to pay you the value of damaged item if the repair costs exceed the value of the item.

Lodgement

It’s important to make contact as soon as possible after the event and have as much information as you can.

“Our preference is for you to ring us so we can begin to help immediately. The sooner we know about your situation, the sooner we can start to help and hopefully get your life back to normal,” Mann stresses.

“We provide emergency assistance by sending our Preferred builders out immediately, we can arrange a tow truck driver for example, so it’s really important we get you on the phone as soon as possible,” he adds.

“We keep an electronic copy of all policies, so don’t panic if you can’t find your policy documents. If you bought insurance through a broker, they should have your details handy too.”

Working with an insurance assessor and external experts

Some claims are complicated and we may need the help of an insurance assessor (also known as a loss adjuster).

“The role of an insurance assessor or a loss adjuster is to review the circumstances of your claim and assess the loss and its total value. They have a key role in more complex claims, and that is about having a face-to-face interaction with our customers,” Mann explains.

They may need to come to your home as part of the process, so they can advise us on your situation and help us settle your claim.

When we assess your claim, we may need to get an external expert to provide specialist advice and perform professional services for us. For example, reviewing your loss, damage, or the circumstances of your claim.

They help us to decide on your claim outcome or, provide advice on the best way to manage or resolve your claim. For example, some of the common types of external experts we use include:

• Specialist loss adjusters and assessors
• Building consultants
• Engineers
• Hydrologists
• Forensic investigators
• Accident re-constructionists
• Forensic accountants.

We only use an external expert if we believe they have the appropriate expertise to provide the opinion we ask them for. They must also comply with the regulations relevant to their area of expertise.

Quotes for the scope of works

Mann says an essential part of the claims process is working with your insurer to agree on the scope of work required and quotes for the repairs or replacements of property or belongings after the damage has been done.

“This step is critical because once we understand what’s required – including costs – we can start the work to return our customers to the situation they were in prior to the incident they experienced,” he adds.

Preferred suppliers

We have an established panel of licenced builders, repairers and assessors to respond to our customers when they need us most.

“Insurance companies deal with different tradespeople on a daily basis and so we have the experience and the knowledge about who should do the work for you, whether it be builders, plumbers, smash repairers or other professionals,” Mann says.

“We have contractual obligations with our suppliers to ensure we see the right outcomes for customer service, the quality of repairs and the cost so we can control premiums,” he adds.

Repairs, total loss and cash settlements

Different insurers will have their own process, however, mostly once quotes and the full scope of work has been agreed, the required tradespeople can begin work on an agreed start date for repairs.

“In some situations, the cost of the repairs will exceed the value of the item, whether it be your car or your property.

In this case, we would pay the total loss value which will be either the agreed value on your policy or the market value that’s determined by the loss adjustor,” Mann explains. 

This is the stage of the process when cash settlements can be discussed with your claims handler.

“However, the preference is for us to handle all aspects of your repairs to avoid our customers needing to worry about the financial side of the incident because this can be stressful.”

The importance of your sum insured

Your sum insured is a value that should be consistent with replacing your entire home, in case of total loss.

Underinsurance can you leave with a short fall of costs to rebuild your home.

“Too often we find that people underestimate the importance of their sum insured and take shortcuts to achieve a lower premium, but this can leave people exposed to being underinsured in a crisis. An accurate sum insured comes down to valuing your home and your belongings correctly,” says Mann.

“When calculating your sum insured make sure you take into account the replacement costs of items and fixtures, preparing land and foundations and understanding that costs must be new for old at today’s prices,” Mann says.

To help our customers work out their sum insured we’ve built calculators as a guide.

These take into account extra costs that may not be obvious, for example, removing debris could add 10-15 per cent to your sum insured.

“Some policies automatically account for inflation for your sum insured but it’s best not to rely on this as your sole safeguard,” Mann says.

Another tip is to speak to a reputable builder and get a current quote for the cost of a complete rebuild of your home.

We’re here to help

“We understand you’re often only contacting an insurance company when something bad has happened and this can be stressful but remember we’re here to help and it’s our job to make the claims process as smooth as possible,” says Mann.

“There’s no shame if there’s something you don’t understand, we will explain it to you. We do this every day and hopefully you don’t have to go through this process too often.”

“Once we hear from you, we come up with and coordinate a tailored course of action using these resources to deliver the best outcome possible,” he adds.