Program Overview

Subject Information

Description

This subject provides the student with the knowledge and skills to manage and resolve claims in Commercial Lines (Property, ISR, Contract Works).

Grading System

HD/FL

Duration

One session

School

School of Accounting and Finance

Enrolment Restrictions

• Bachelor of Business (Insurance) students only

Assumed Knowledge

• INS201

Learning Outcomes

Upon successful completion of this subject, students should:

• be able to apply legal terms and concepts to Personal Lines claims management
• be able to evaluate non-routine claims
• be able to resolve claims disputes
• be able to participate in negotiations to settle personal lines claims
• be able to finalise settlement
• be able to process facultative and treaty claims
• be able to review claims settlement policy and procedures

Syllabus

This subject will cover the following topics:

• Definition of Personal Lines and the distinguishing features of Personal Lines policies
• Application of legal terms and concepts to Personal Lines claims
• Evaluation of non-routine claims and implementation of the assessment / investigation required to determine acceptance or declinature of liability
• Interpretation of policy coverage and analysis of the legitimacy of the claim
• Determination of settlement terms in relation to policy terms and type, company policy, Codes of Practice and legislative requirements
• Implementation of the negotiation process, document preparation and reporting arrangements with client and relevant parties concerning the settlement of the claim or denial of liability in accordance with legislative and regulatory requirements
• Investigation process to support internal dispute resolution and preparation of documentation for external dispute resolution
• Communication process with relevant stakeholders in the dispute resolution process to support dispute resolution in a timely, considerate and, where possible, non-litigious manner without resorting to formal conciliation services
• Settlement documentation, file preparation and recovery procedures
• Claims reserving and reporting processes
• Reinsurance - facultative and treaty claims and reporting processes for settlement with reinsurers
• Portfolio data collection, review and reporting including audits of field operations, settlement campaigns and special loss studies
  • The risks covered by commercial lines may include:
    • Contract Works
    • Business Interruption
    • Material Damage
  • Principles of insurance and legislation may include:
    • Duty of utmost good faith
    • Duty of disclosure
    • Misrepresentation