All Things Lodgement
What 1 (or 2) notes must be left on a claim at the completion of a lodgement over the phone?
Lodgment template note
and
Liability note (if applicable)
Where must all vulnerabilities be recorded regardless?
Connect (Under Alerts). If the caller did not provide consent we still need to place an alert in Connect to state that support services have been offered
ClaimCenter can record vulnerabilities after INS has consented to having vulnerability recorded but Connect is regardless
What is the definition of a complaint?
An Expression of dissatisfaction made to us, related to our products or services, our staff, or the handling of a complaint where a response or resolution is explicitly or implicitly expected or legally required.
What date do policy renewals fall under the new PDS
09/12/2024 onwards
Besides the landing page. What else needs to be advised to a member at the lodgement of a claim?
Confirmation of Transaction Statement
"You will receive a document outlining a summary of your finalised claim. This is just for your records and no action is required, however if you have any questions or concerns, please contact us "
Scenario:
Inbound call from a member returning a missed call regarding a cash settlement. Member is asking the CMO to slow down and repeat statements but can be understood. Member advises English is not their first language. What action should be taken?
An offer should be provided to INS for assistance with translation (from INS family or friends) or for RACQ to arrange the Translating and Interpreting service (TIS). Given the involvement of a settlement, we should confirm the member is confident in understanding the circumstances, sometimes even when we can understand callers it is still ok to offer TIS.
How long does a complaint have before it is auto escalated to our Internal Dispute Resolution (IDR) team?
25 calendar days.
Scenario:
INS is driving his car in remote QLD and has impacted a kangaroo. Due to this INS is stuck and has had to book a nearby motel. INS is looking for reimbursement for temporary accommodation. Can we cover this?
Normally No.
The Temporary accommodation benefit is only listed under the caravan PDS, not the motor vehicle PDS.
(bonus points if you noted to review for ex-gratia)
If a new claim is lodged relating to a collision with vehicle involving merging lanes. What Primary actions are required before a liability decision should be made?
Accident Description and Diagrams sent to both parties. (both parties VOE at a minimum).
And Request any supporting evidence (dashcam, cctv, witnesses, Police Reports, etc)
Can you refer to Hypercare with their referral form without consent?
Yes.
Hypercare referrals can be completed without consent in certain circumstances. Hypercare then review and possibly contact the member for a check in.
STILL TRY TO OBTAIN CONSENT PRIOR TO A REFERRAL
You receive an inbound call where the customer is wanting to speak specifically about a complaint that is with EMT. What do you do?
If in scope, attempt to provide assistance or resolve dissatisfaction. Otherwise, reach out to the assigned EMT consultant on teams or (if no response) your CA who will reach out to EMT to determine who is available to take a call. If no response or no one is available, obtain best contact information and general time preference for a call back (specific time is not a guarantee).
Scenario:
Collision with Vehicle. TP at fault. INS has Fire, Theft, Third Party insurance. TP has confirmed they are uninsured.
INS has requested a hire vehicle. Can this be provided?
No. UTP claims only provide coverage for repairs, recovery, towing and storage
How many Claims are required in relation to a boat that has had an impacted hull, trailer and outboard?
partial trick question.
1 claim
3 ARNIES (separate ARNIES for Hull, engine and trailer)
If a member discloses a vulnerability whilst in discussion about a hire vehicle extension request when their policy limit is reached. how is this to be managed?
The HV portion would need to be considered either under a complaint or Ex-Gratia.
Vulnerabilities are to be recorded and Hypercare can be offered for discussions or assistance specific to the vulnerability however, Hypercare cannot provide assistance with hire vehicle extensions
When do we need to provide a Final Decision Letter?
Any complaint outcome that is either:
Longer than 5 days to resolve,
A resolution that impacts or changes the value of a claim,
Is in regard to a claim decision or decline orIf an incident occurs on 12/01/2025 but the policy is set to renew on 20/01/2025, what PDS is to be used
09/21
policies renewed after 05 December 2024 are subject to the new PDS. However, if the incident occurs prior to the policy renewal, the claim will be subject to the policy that was in place at the time of the incident.
RIGHT TO CLAIM:
If a member phones to discuss circumstances of a loss prior to lodging a claim. Can we advise of their policy coverages and limits prior to lodging a claim?
Yes.
Information can be provided however we cannot discourage a member from lodging a claim.
It is our responsibility not to discourage or deter a member from their right to claim and to educate the member on the claims process and the potential outcomes of lodging a claim, so they can make an informed decision.
Scenario:
Inbound Call from a TP. Claim is assigned to recoveries. Tp has received the recovery demand letter and advises he cannot afford this. Tp states he recently lost his job and cannot afford his power bill let alone this. What is the appropriate action?
Obtain Consent to record vulnerability.
Attempt to warm transfer to the recoveries officer (if available). Advise the Recoveries officer of the circumstances and allow the recoveries officer to discuss financial hardship process.
Hypercare is possibly available to talk to the CMO (not the TP) if assistance is required however when in relation to a recovery, the primary action is to reach out to recoveries as they have processes regarding this.
Scenario:
First call with a TP. TP VOE is conflicting and TP disputes liability. TP states they have dashcam.
Is this a complaint?
Generally No.
This should be advised to the TP that a liability review will be conducted and the liability decision will be provided after a review.
but if TP does not mutually agree to work with us such as sending dashcam/filling out MREC01 or is continuing to escalate or express dissatisfaction then it could be a complaint.
Match the scenario to the Hire car entitlement on the new PDS:
a) Damage Whilst Parked. TP at fault and TP details on file. INS has optional HV benefit on policy
b) Damage Whilst Parked. TP at fault. No TP details on file. INS does not have the optional HV benefit on policy
c) Theft unrecovered. INS has optional HV benefit on policy
a) unlimited
b) no coverage.
c) 42 days total. 21 for theft and an additional 21 for optional HV benefit. (bonus points if you check the claim prior to providing this as most theft unrecovered claims should be settled before this)