Making a Claim Through an Insurance Broker
In this article, we explore three common questions we often get asked about making an insurance claim through us. Please note, an Insurance Broker can only submit a claim for you if they are already your Broker. If you are insured direct with an Insurance company, the process will vary slightly.
What are the steps involved in making a claim through an Insurance Broker?
1. If required call Emergency Services. If your house is burning down please call the Fire Brigade before you call us… Scott Morrison vibes? We don’t hold the hoses!
2. If required and safe to do so: make the situation safe and minimise the risk of future damage (following the instructions of emergency services of course). E.g if someone has a workplace accident slipping on a spill, clean the spill so no one else slips.
3. Contact your Insurance Broker. They will require information, often revolving around ‘Who? What? When? Where? How?’. Notify your Broker as soon as possible following Steps 1 & 2. Some claims such as Workers Compensation have a legislated timeframe for the Insurer to be notified.
4. The Broker will notify the Insurer to initiate the claim process, and provide you with a claim number – you will need this if you need to contact the Insurance company.
5. The Insurer may require additional information to finalise the lodgement of the claim. This may include further details, reports, or photos. They may also organise for someone to secure the site, vehicles to be towed, an assessor to come out etc.
6. The Insurer may require that you obtain quotes for repairs/replacement or may organise this for you. E.g. you may be required to take your vehicle to their authorised repairer for a quote.
7. Claim Outcome: When a claim is approved, the Insurer provides instructions for finalising the claim. This may involve a cash settlement, repairs, or replacement
Generally, for Steps 5 and 6, the Insurance Company will liaise with you directly. This enables the process to move faster. The Broker may get involved if there are issues with communication or if you need something explained to you that the Insurer hasn’t been able to explain clearly etc.
The Insurance Broker can advocate for you to ensure you get what you are entitled to, under your cover. This may include things like car hire, temporary accommodation, professional cleaning etc. You should always read your PDS carefully when taking out the cover so you know what you are and aren’t covered for (Your Broker can help explain any sections you’re not sure of).
What happens if my claim is declined or I’m not happy with how the Insurer is handling the claim?
If you are unhappy with your claim, please let us know as soon as possible. Because the Insurer should liaise directly with you, often we will not be aware of issues unless you tell us. We can then escalate as needed.
There may be occasions when a claim is declined, for example: if the incident is not covered under the policy, or if the policy has certain exclusions. However, the Insurers that we use are committed to paying out claims when they are covered under the policy. While the process may seem cumbersome, they are ensuring that all the t’s are crossed, and i’s are dotted. This also helps protect both you and them, if there are any issues down the track relating to the claim e.g. repairs not completed properly.
If your claim is declined, we will explain the Insurer’s reason to you. We may indicate whether we think it is reasonable or whether we should take action on your behalf such as requesting the decision be reviewed. You also always have the option to lodge a complaint. Insurers are heavily regulated by ASIC and APRA. Complaints submitted to AFCA are often quickly resolved.
Whilst you may need to complete parts of these processes yourself, such as submitting a complaint to AFCA, as your Broker we will heavily support and guide you through any appeals/complaints processes. Where we think it is appropriate, we can also escalate issues through Oracle, our Broking Group, which can gain more traction with Insurers.
Who pays for approved claims? Does the money come from Strive?
If you’ve received an invoice from us, you may have noticed references to three companies: Strive Insurance, Oracle Group and the Insurance Company your policy is being take out with. It is understandable that it can be confusing about who pays out a claim. To answer this question, it can help to understand who these players are and where your premium goes.
Strive Insurance Services is an independent Brokerage. We pay for membership within the Oracle Broking Group. Oracle hold the Australian Financial Services License (AFSL) that Brokers need to operate, and they manage the license’s regulatory requirements. You will see on our documents that Strive is an ‘Authorised Representative No 1238961 of Oracle Group (Australia) Pty Ltd AFSL 363610’. Whenever you are dealing with a business that provides financial services, make sure you can see their AFSL number.
We generate your invoices through the Oracle systems and Oracle receive the amount paid. Oracle then pay the premium to the Insurer noted on your invoice, and a small percentage as commission and/or a small Broker Fee to us at Strive. Any Broker Fee will be detailed in the breakdown on the invoice. Oracle don’t keep any money from you.
The fees we receive are usually a very small amount compared to the premium as a whole. These fees are how Brokers generate income. This covers the time spent researching policies for you, liaising with insurers, completing the paperwork required to put your cover in place, liaising with you and any work required for a claim. Depending on the type of policy and the number or complexity of claims, it can work out as a very low hourly rate – definitely not enough to cover claims!
The liability – the responsibility for paying out claims – sits with the Insurer, not with your Broker. Insurers are carrying the risk that over time their customers will pay enough in premiums to justify what they need to pay out in claims. This is why Insurers assess relevant statistics: area crime rates, security features of a property, accident rates in professions, flood and fire zones, your individual claim history etc. and adjust premiums accordingly, they are balancing the risk that they carry.
When you lodge a claim, the funds for repairs, replacements or cash settlements, will come directly from the Insurer, not from Strive Insurance Services.
If you have any questions about anything we’ve covered in this article, get in touch at admin@striveinsurance.com.au