End-to-end claims process from first notice of loss through to resolution and file closure. Version 2.0.
Questions or feedback: Roshan Khozouei (roshan@tenzi.ai)
The client reports a potential loss. The broker gathers basic details, does a quick policy check, advises on excess and immediate actions, and the client decides whether to proceed. The broker documents the conversation regardless of outcome.
Client becomes aware of a potential insurable event.
Client reaches out to report the loss.
Who, what, where, when. Gather enough to assess the situation.
Excess, basic coverage, obvious exclusions. Quick assessment — not a full review.
Let the client know what the excess is and any potential premium impact of claiming.
Assess whether immediate steps are required before proceeding.
Secure site, file police report, preserve evidence — whatever the situation requires.
Document the conversation regardless of whether the client proceeds.
Client makes the call on whether to lodge a formal claim.
Formal go-ahead. Triggers intake process.
The broker explains the claims process, creates a claim file, and sends the client an intake form to complete. Once received, the broker acknowledges it and organises the correspondence trail. This phase often involves chasing the client for the completed form.
Walk the client through what happens next, what they need to do, and what to expect.
Open a new claim in the broker's system.
Record the education conversation and any client questions.
Detailed coverage check now that the claim is proceeding.
Send the appropriate form for the client to complete.
Client fills out and returns the intake form.
Check whether the completed form has come back.
Follow up on the outstanding claim form. May require multiple nudges.
Confirm to the client that the form has been received.
File all correspondence into the claim record. Maintain the audit trail.
The broker reviews the claim for red flags, validates coverage in detail, requests and collects supporting evidence, and organises everything for submission. Often involves multiple rounds of chasing the client for incomplete evidence.
Check for inconsistencies, gaps, or prior losses that need clarification.
Ask the client to explain inconsistencies or gaps before proceeding.
Client responds with additional information or explanation.
Record all clarification exchanges in the claim file.
Update the claim record with any new or corrected information.
Detailed review: schedule, endorsements, sum insured, excess, sub-limits, exclusions.
Ask the client for photos, receipts, quotes, reports — whatever supports the claim.
Often piecemeal — multiple rounds of documents arriving over days or weeks.
Assess whether all required supporting documents have been received.
Follow up on missing documents. May require multiple rounds.
Name files, build folder structures, ensure everything is ready for submission.
The broker compiles and submits the claim pack to the TPA or insurer. Once acknowledged, an assessor may be appointed for larger claims, which the broker coordinates. The insurer typically requests additional information or quotes, triggering another round of client follow-ups. This continues until the claim is formally lodged and under assessment.
Assemble evidence, forms, and policy details into a complete submission package.
Send the complete claim package for lodgement.
Confirm the TPA/insurer has received and acknowledged the submission.
Follow up to confirm they received the claim pack.
Formal confirmation that the claim has been received.
For larger claims, an assessor is appointed to inspect.
Arrange for the assessor to visit the loss site.
Three-way coordination to arrange the inspection.
Client confirms availability and access arrangements.
On-site assessment of the loss.
Quotes, clarification, or further documentation required.
Pass the insurer's request to the client.
Client sends the requested documents or clarification.
Check whether the client has provided what was requested.
Follow up on outstanding items.
Package the client's response and send to the insurer.
Update the internal claim file with latest status and correspondence.
File all emails and notes into the claim record. This record-keeping happens after every significant interaction throughout the claim lifecycle, not just at this point.
Ongoing throughout the claim: provide regular status updates to the client (recommended every 3-7 days). Proactive communication builds trust, reduces inbound status requests, and is what distinguishes the best claims brokers. This isn't a single step — it runs in parallel with all submission and lodgement activity.
Client wants to know where things stand. Best practice: broker proactively provides regular status updates (e.g. every 3-7 days) rather than waiting for the client to chase.
Chase the insurer for a progress update.
Insurer responds with current claim status.
Check whether the insurer has responded.
Follow up on outstanding status request.
Pass the insurer's update to the client.
The insurer proposes an outcome — approval, partial payment, or decline. The broker reviews the decision, explains it to the client, and if unacceptable, prepares an advocacy challenge on coverage or quantum. Once resolved, the insurer processes payment, the broker confirms receipt, closes the file, and advises the client on any potential premium impact at renewal.
Approve, partial payment, or decline.
Does the decision align with what the policy covers and what was submitted?
Walk the client through what was decided and why.
Client responds — accept, question, or dispute.
Does the client accept the insurer's decision?
Build the case — coverage argument or quantum dispute.
Formal submission of the advocacy position.
Insurer reviews and responds to the broker's advocacy.
Record the resolution and confirm acceptance to the insurer.
Formal confirmation of the resolved claim outcome.
Payment is processed and sent to the client.
Client confirms the payment has landed.
Verify payment has been received by the client.
Chase the outstanding payment.
Verify and document that the settlement reached the client.
Mark the claim as resolved and close the record.
Let the client know this claim may affect their next renewal premium.
Final filing of all resolution and closure correspondence.
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