Following a claim until the insurer decides
How Achekam's Insurance pack collects a client's claim documents, records the insurer's claim number, chases until a decision and reports it in writing.
By Achekam · · 4 min read · For Insurance businesses in South Africa, Nigeria, Kenya
Launching soon. The Industry CRM add-on described in this article is launching soon. This article describes it as it will work at launch.
The phone rings on a Monday morning. A client's geyser burst over the weekend, the ceiling has come down and the carpets are ruined. They want to know what happens next, and they want to know it will be sorted.
A broker cannot promise the outcome. The insurer decides every claim. What a broker can do is make sure the claim is complete when it reaches the insurer, keep it moving until a decision is made, and tell the client clearly what was decided. Clients judge their broker on exactly those three things.
Achekam's Industry CRM, with the Insurance pack, turns that job into a claim workflow. This article walks through it for brokers in South Africa, Nigeria and Kenya.
What the claim workflow does
The Insurance pack's claim workflow:
- requests the claim documents from the client;
- records the insurer's claim number;
- follows up until the insurer decides;
- tells the client the outcome in writing.
Each claim is its own record in the pack, separate from the policy it is made under, so a client with an open claim and a renewal due does not end up with the two mixed together.
Getting the documents from the client
Most claim delays start here. The insurer asks for something, the broker asks the client, the client sends half of it, and a week goes by.
In the Industry CRM, a workflow step can send the customer a request for documents, and the customer's answer moves the task on. The request lists what you need, the client sends it back through the request, and the workflow knows when it has arrived.
Be specific about what you ask for. For a burst geyser, that might be photographs of the damage, the plumber's report, quotes for repairs and an inventory of damaged contents. For a vehicle theft, the police case number, the client's licence, the registration papers and any finance agreement. A vague request gets a vague reply.
The insurer's claim number
Once the claim is lodged, the workflow records the insurer's claim number. From then on, every call, e-mail and document about the claim should quote it. It is the one reference that both you and the insurer can search for, and it saves the client from being asked to explain everything again whenever they call.
When you send the claim pack to the insurer, Achekam's Document Centre can share each document by e-mailing a personal link with an expiry, an optional one-time code and a choice about downloading. Sending claim documents to an insurer by secure link explains how.
Chasing until there is a decision
The workflow follows up until the insurer decides. Claims rarely move in a straight line: an assessor is appointed, the assessor asks for another quote, the insurer queries a date, the client goes on holiday.
The Industry CRM's tasks help keep this under control. A workflow creates its tasks stage by stage, and tasks can have subtasks up to three levels deep. A task such as "obtain insurer decision" can hold subtasks for the assessor's visit, the assessor's report and the insurer's response, each with someone responsible.
A simple rule of thumb: every open claim should have a next action and a date. If a claim has neither, nobody is chasing it.
Log each follow-up as it happens: who you spoke to at the insurer, what they said, and what they are waiting for. Then tell the client, briefly, even when there is no news. A client who hears "the assessor's report is still outstanding, we chased it today" is far calmer than one who hears nothing for a fortnight.
Telling the client in writing
When the insurer decides, the workflow ends by telling the client the outcome in writing. This applies whether the claim is paid in full, paid in part or turned down.
A good outcome letter covers:
- what the insurer decided, in plain words;
- the amount, if any, and how and when it will be paid;
- any excess deducted;
- if the claim was declined or reduced, the insurer's reasons as the insurer gave them;
- what the client can do if they disagree, which for South African clients can include the National Financial Ombud Scheme, free and impartial dispute resolution for complaints against financial institutions, including insurers.
A phone call is kind; the letter is the record. If the client later says they were never told, the letter answers that. The trail of documents from the start of the policy matters too, which is why new business: disclosure, mandate and record of advice is worth getting right.
The insurer decides, not the broker
The Insurance pack is clear about roles. Claims are decided by the insurer. The pack does not assess claims, approve them or pay them. It also collects no premiums; it invoices only the broker's own commission and fees.
Any settlement figures you record come from the insurer's own documents, as explained in where premiums and sums insured come from. Keeping the roles straight in your client communication matters too: "the insurer has declined the claim" is accurate, "we have declined your claim" is not.
A claim file checklist
- The loss reported, with date, place and what happened in the client's words.
- Every document requested, and every document received.
- The insurer's claim number recorded.
- Each follow-up logged, with the next action and its date.
- The insurer's decision filed as received.
- The outcome letter sent and filed.
Claims are where clients find out what their broker is worth. When the next call comes, the aim is a complete claim lodged quickly, a chase that never goes quiet, and a clear letter at the end, whatever the outcome.
General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.
