Holistic Claim Review
When should we look at the diaries in a claim and why
When you enter into a policy (to see what needs to be actioned) and before you leave (to reallocate, move or complete the diary)
Which step of a Holistic Review covers the following?
The Assistance #
The Referral #
The Complaints #
Trace
Vulnerability
Step 1: THE POLICY HOLDERS CIRCUMSTANCES
Which step of a Holistic Review covers the following?
The date and time of incident
The incident type
The incident Description
MISC
Step 2 INCIDENT TYPE
Which step of a Holistic Review covers the following?
Check the Diary # to read the next steps
Check the Booking #,
Check the TTD #
Check the F5’s
View images/documents
AND
Check the Booking #
Check the AudaNet #
Check the F5’s for assessor/repair updates.
Check the reserves
If Non Drive, identify towing status.
Step 3 and 4 THE CLAIM IS UNFINALISED and THE CLAIM IS SETTLED
Which step of a Holistic Review covers the following?
Check for any outstanding reserves
Check for outstanding Diaries/Images
Check Claims TTDs have been completed
Check excess has been collected where applicable
Step 5 CS CLOSURE
The customer is wanting an update on their claim we can see the assessor is assigned and within the assessing timeframe. What can we do?
Advise the customer that the assessor has been allocated on (Date). Advise assessment can take between 1-5 business days depending on the severity of the damages. Once assessment is completed the repairer will let you know the next steps.
Is it important to be looking at the Brand that the customer has purchase, why or why not?
It is very important that we are brand aware. We now offer 6 Brands for Motor Insurance and some can have differing PDS wording benefits ect. For Example Qantas offering like for like Hire Car for a NAF Accidents or Oceania not offering NAF Hire Car
You see the customer has lodged two claims for the same incident, what do you do?
Review and close one of the claims as a duplicate. Ensure to follow the Close a Claim (Motor) Hiya Page
If the car is Non drive and we identify the tow has been delayed what can we do?
If location of vehicle is unknown set diary for ND PATHING to use their resources and contacts to try and obtain the location
What hiya page would we refer to when reviewing closing the CS?
Close CS (Claim Status) in DISC
You are reviewing a claim that has been lodged online. What Hiya page are you following?
What letter must be sent at the end of the claim?
What diary would you review completing?
Process Online Claims (Motor) is the hiya page to follow
Send relevant lodgement letter. Refer to Send Lodgement Letter (Motor) if needed.
Complete the NEW ONLINE (CLAIM TYPE) CLAIM diary
If a customer has called in and you see the Referral # has an active entry on it, what would you do?
If you receive a call while the claim is allocated to RAH, advise the customer the claim is still being reviewed and the team will be in contact when the review is complete
You are reviewing a claim and see the incident description is lacking detail and is not a clear description of the accident. What can you do and what Hiya page would you follow?
Update the incident description using the framework provided within Hiya Handle New Claim Lodgement Enquiry (Motor) or relevant lodge (claim type) flow
If you see F5 comments from Audanet would they be important to read when Holistic Reviewing a claim, why or why not?
The F5 comments that show within a screen from Audanet would be important to read as they show the communication between the repairer and the assessor. This can be utslised to share information with the customer to provide an accurate update of the claim.
What it a COTS Statement?
COTS is a written statement that outlines any transactional information that occurred during the life cycle of a claim
When attempting to book a Non Drive car in for repairs, 3 repairers show and when you call they advise they don't have capacity to take the car. What can you do?
Ask if the customer has another repairer they would like to use?
Search Surrounding suburbs for additional repairers
If no capacity - see a team leader for approval to override
Use the Assessing Feedback Form to advise the nil capacity
If the customer is experiencing vulnerabilities such as language barriers and also has physical health conditions. What would you need to do on this claim?
Ensure the assistance # is completed filling in all the necessary details, including support organisations
If you see that details from the claim lodgement have been entered incorrectly or have caused the customer delays and impacted their claims experience what can you do to educate another consultant?
Lodge Feedback within the Frontline Motor Claims Feedback Form
If the claim is unfinalised and the booking isnt completed for a non drive car, should we be booking in the customer for repairs. Why or why not?
Yes we should be booking a non drive unfinalised claim in for repairs. The reason why is because we dont want to cause any delays to the customer and as our HIYA process tells us to book the customer in
Why do we want to close the CS?
To show that all tasks have been actioned
and the claim is completed
It allows for COTS to be triggered
Financial and portfolio accuracy
If the pathing system doesn't prompt any out of network repairers in the customers suburb what should you do?
Google other repairers in the customers area
Call the repairer to ensure they are willing to repair the car
Customer attends the reparier, a quote get completed and sent through for assessing to review
If a customer is currently expressing dissatisfaction with a process and you see the customer has multiple complaints 2 within the complaints # and upon further holistic review another 2 listed within the F5 comments, what should you do?
Open up all of the complaints within Aptean to review the issue and resolutions provided. If the customers issue is already in a previous complaint and it is still within 30 days from the complaint lodged date we are able to reopen this complaint. If outside the 30 day timeframe, we must lodge a new complaint and link the previous complaint.
What are 5 things that you can see within the MISC # that might be relevant to be reviewing when holistic reviewing a customers claim?
Damage to the car
Use
Incident location
Location of vehicle
Driver
UW claim questions answers
TP Details
Witness/police details
Safe to drive
Injuries
Prior Repairs
You are able to authorise a claim and see an open reserve for Personal Effects? What should you do?
Check the F5 comments to see why the reserve was open and what we are awaiting. Check the diaires to see if an image has come through with the proof of PE to be able to review reimbursing the customer
Once the CS is closed - If the Excess is higher than the cost of repairs what would we do?
Follow Hiya page Refund Claim Excess (Motor)