Claims

A claim is the mechanism by which the insured obtains the financial protection promised under the policy. The process follows a broadly standard sequence: notification of the loss, submission of a claim form, provision of proof of loss, investigation by the insurer, and finally settlement (or repudiation).

Notification must be prompt. Most policies contain a condition precedent requiring the insured to notify the insurer within a stated period (e.g. as soon as reasonably practicable, or within 30 days). Late notification can prejudice the insurer's ability to investigate and may entitle it to reject the claim.

The claim form is the insured's formal statement of what happened. The burden of proof rests on the insured to show that a loss has occurred and that it falls within the cover — the insured must prove the loss was caused by an insured peril. If the insurer wishes to rely on an exclusion, the burden shifts to the insurer to prove the exclusion applies.

Proof of loss may include receipts, invoices, valuations, police or fire brigade reports, medical certificates and photographs. The insurer then investigates to verify the facts, quantify the loss and confirm cover before settling.

Loss adjusters are independent professionals appointed and paid by the insurer to investigate larger or more complex claims. They establish the cause and extent of loss, check that the policy responds, negotiate the amount and recommend a settlement figure. Despite being paid by the insurer, they act impartially.

Loss assessors act for and are paid by the insured (the policyholder). They prepare and present the claim to secure the best settlement for the insured. A simple memory aid: assessor = insured's side; adjuster = independent, insurer-appointed.

Surveyors may be engaged to inspect and value property either before cover is granted (risk survey / underwriting survey) or after a loss to assess damage. In marine insurance, surveyors commonly inspect damaged cargo and vessels.

For small, straightforward claims the insurer's own claims staff handle the matter in-house without appointing external experts.