Navigating the Claims Process: A Practical Guide for Insurance Professionals

At Berkley Insurance Australia (BIA) we are proud of our claims philosophy – ‘Play Fair, Pay Early”.

We understand that brokers and their clients expect to be treated as individuals by an insurer who acts decisively in the moments that matter. This is why we treat the claims process as more than just a procedure, it is another opportunity to deliver value and support clients.

Drawing on the insights of claims specialists at BIA, this article outlines some of the key touch points when managing claims across Management Liability (ML), Professional Indemnity (PI), and Public Liability (PL) policies. By having a shared understanding, we can streamline the claims process and ensure clients feel confident that we are working as efficiently as possible to resolve their claim.

Early Notification: A Priority

Timely notification is the cornerstone of effective claims management. Whether you are dealing with occurrence based policies or claims made and notified policies, it is imperative that you notify as soon as possible and with as much detail as is possible.

Best practice: When in doubt, notify. Early engagement assists in preserving policy rights and enables proactive claims handling.

Establishing Policy Applicability

Determining whether a policy responds to a claim involves a structured assessment:

– Is the insured named on the policy schedule?

– Does the definition of “insured” extend to the party involved?

– Is the business activity or service covered under the policy wording?

– Are there any exclusions or endorsements that limit coverage?

This evaluation requires a detailed review of the policy as a whole, including the schedule, endorsements, and any other relevant material.

Managing Coverage Limitations

Cover may be limited by:
– Exclusions that remove or limit specific risks from coverage

– Sub-limits that cap the insurer’s liability for certain exposures

– Conditions that must be met for coverage to apply

Understanding these limitations is particularly important in ML policies, where extensions such as statutory liability or employment practices liability are often subject to sub-limits.

Claim Decisions

BIA is committed to having a rigorous, multi-tiered review process for all claims.

This starts with our handpicked claims specialists who bring to life our philosophy “Play Fair, Pay Early”. By living our philosophy, your clients can depend on us to pay valid claims.

BIA recognises your clients want their claims paid. The reality is that this may not always be the outcome. Rest assured that where we decline a claim we take extra care. Before issuing a claim decline, the decision is reviewed by a Claims Team Leader and/or the National Head of Claims to ensure it meets standards of assessment and reasoning.

When you or your client consider we didn’t get our decision right, then matters of concern can be further reviewed on request based on the information we already have and any further information provided to us in support of the review. In some circumstances, we may refer a review request to a panel solicitor or barrister for independent assessment.

Post-Claim Risk Management

A claim should trigger more than a lodgment with the insurer—it should initiate a post incident review (PIR). Through a PIR, brokers and their clients are encouraged to:
– investigate the root cause of the claim

– implement procedural changes to prevent recurrence

– communicate improvements to underwriters at renewal

These PIRs demonstrate a commitment to continuous improvement, can mitigate the risk of future incidents and can be taken into consideration at renewal.

Final Thoughts

Navigating the claims process requires more than technical knowledge, it demands application of a rigorous process, legal awareness, and a collaborative mindset. By understanding the intricacies of policy interpretation, the importance of early notification, and the value of post-claim risk management, insurance professionals can better serve their clients.

Learn More

To explore these topics in greater depth, including real-world examples and expert commentary, watch our full “Navigating the Claims Process” webinar—available now on the Berkley Insurance Australia website.

Important Notice

Berkley Insurance Company (limited company incorporated in Delaware, USA) ABN 53 126 559 706 t/as Berkley Insurance Australia is an APRA authorised general insurer. Information provided is general only, intended for brokers and has been prepared without taking into account any person’s particular objectives, financial situation or needs. It is not intended to be comprehensive or constitute legal advice. You should always obtain legal or other professional advice appropriate to your own circumstances before acting or relying on any of the information. Insurance cover is subject to terms, conditions, limits, and exclusions. When making a decision to buy or continue to hold a product, you should review the relevant policy wording.